Month four of pregnancy diary

How your body is changing

This may be the month when you finally begin to feel that it is real!

Here are some of the many changes your body is going through:

By now it should be possible to feel your growing uterus, or womb, as it has risen above the level of your pelvis.

As well as the increase in the size of your uterus, the volume of blood circulating round your body is expanding in order to support the pregnancy.

From early pregnancy the overall shape of the chest alters as a result of flaring of the lower ribs.

If you have been feeling sick for the last few weeks, hopefully this will be beginning to subside; in fact, during this month you may well have more energy than before and begin to feel fit and healthy. You might start to develop cravings for all sorts of different foods, some that you don’t normally eat.

For some women these cravings might be for non-food substances such as chalk, earth, or ice. If this is the case, it is worth a discussion with your healthcare professional (midwife or GP); it may be a sign of being anaemic i.e. not having sufficient iron.

Pregnancy is beset with minor irritations that usually cause no problem to you or your baby; you might begin to get heartburn or constipation. Making changes to your diet or to your eating habits may help in these situations.

You may feel that your breasts are changing as you begin to produce colostrum, the first nutrients that breastfeeding mums will give to their babies.

If apparent, the darkening, or pigmentation, affecting your nipples and face, and marking a line from the pubic area to the navel.

The placenta, the baby’s support system, has become the vital link between you and your baby; it has many functions. It will enable nutrients and oxygen to pass from you to your baby, and waste products from your baby back into your system. All this is achieved in normal circumstances without yours and your baby’s blood mixing.

Meanwhile …during this month your baby’s rapid growth continues. She is beginning to look more ‘human’ in form. Her eyes will now be facing forward instead of to the side, whilst her tiny ears are more or less in the correct position.

Her lower limbs have lengthened, and even though it is unlikely that you will feel anything definite, her movements are becoming co-ordinated and she is beginning to move around inside you. An ultrasound of your baby would be able to pick up eye movements.

The sex of your baby will be distinguishable externally this month.

If you are having a girl, her developing ovaries will already have the beginnings of egg cells.

Feeling the bump? As well as your uterus growing, you baby is now about the size of an avocado. Your baby will be surrounded by amniotic fluid that cushions and protects her. By now she will be breathing the fluid into her lungs and swallowing it. In fact at this stage it will consist mostly of her urine, made by her functioning kidneys.

From about 16 weeks, your midwife or GP will start listening to your baby’s heartbeat, most probably using a trumpet like instrument, called a Pinnard stethoscope, or a small hand held electronic devise that gives an audible recording so that you will be able to hear too.

Why your body is changing

A complex mix of different hormones, for example the oestrogen and progesterone now made by the placenta, act to enable your body to adapt to your pregnancy and keep it going.

That overwhelming urge to pass urine frequently comes from a combination of your baby pressing on your bladder, and your kidneys working hard to cope with the extra fluid mixed in with the increased amount of blood pregnant women make. You may find yourself leaking urine when you cough or sneeze. Time to do those pelvic floor exercises.

You may experience headaches, another consequence of the increase in hormones – make sure you have plenty of fluids and rest. If necessary

you can take paracetamol.

Constipation, heartburn, and haemorrhoids (piles) may bother you. As hormones relax and affect your muscles and muscle tone, these conditions may continue (or appear for the first time).

Your thoughts and feelings

Into the second part of the pregnancy now, so you can rest assured that for most women the risk of miscarriage has reduced. You may feel happier now, especially if the awful nausea has passed. You may also feel closer to your partner as the realisation of you pregnancy really begins to sink in.

Use this opportunity to involve your partner in the decisions you make for your pregnancy; one of the keys to a good outcome is having the support of people around you.

Remember that now you are beginning to look and feel pregnant it may cause conflicting emotions about body image, impending motherhood/parenthood and the impact your baby will have on your lives.

Relational and Social

Your pregnancy could have brought on other anxieties about your job, if you work, and money. Can you and you partner or a friend take time out to have a short break? If not, try to think about situations and strategies for you to relax. Deep breathing exercises are useful, and good practice for birth.

Whatever you are feeling, it may be better to share it with whoever you feel comfortable; this may be your partner, a friend or relative. It could also be your midwife.

By this time, if you have organised maternity antenatal care, you will have had the first ‘booking’ visit where you would have discussed your pregnancy with a midwife or GP, and discussed the care you will receive whilst you are pregnant. You may be considering such things as where to have your baby: at home, hospital, or birthing centre. You will have been given a lot of advice about diet and exercise.

You may have already had an ultrasound scan of your baby, if you have opted for this. This scan will have given information about ho many babies you are carrying, and an estimate of when your baby is due. This may differ from the ‘due date’ calculated using the first day of your last menstrual period (LMP). If so, it is often the scan date that is used.

Take time to talk about all the information you have received with your partner, as there may be important decisions to make. In this month, for example, you will probably be offered the screening test to assess the your chances of having a baby with certain conditions such as Down’s Syndrome. In general screening tests give information about the probability of there being a problem, whereas diagnostic tests give more information about whether your baby really is affected by a particular condition.

A pregnancy diary will help you to record all of your experiences, as well as to keep a note of any questions you have.

Help yourself

• If nausea and vomiting are no longer problems make sure that you have a well balanced diet, with plenty of fresh fruit and vegetables and try to limit your intake of fats and sugars.
• Have small frequent meals to help with heartburn.
• Make sure you contact your midwife or GP if you have any worries; you don’t have to wait until your next appointment, there is always someone a phone call away.
• Before consenting to antenatal screening make sure you understand the difference between screening tests and diagnostic tests. If not, you can clarify this with your midwife or GP.
• If you experience leg cramps, avoid adopting one position for too long, try walking and calf muscle exercises, and make sure you drink plenty of water. A warm bath at night may also bring relief. You may be lacking in certain minerals such as magnesium. This can be found in green leafy vegetables, whole grains, nuts and milk.

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