Second Trimester 1
Second Trimester Teaching Sheets
INFORMATION ABOUT PREGNANCY:
SECOND TRIMESTER WEEKS 14 – 26
References for listed page numbers are at the end of these sheets.
ABOUT MAKING LIFESTYLE CHANGES AND ADAPTING TO PREGNANCY
1. I have information about handling common physical and emotional changes of early pregnancy:
a. Backache
 Common in pregnant women because of postural changes. During pregnancy the uterus tilts the pelvis
forward, shifting the center of gravity forward with it. This affects the pelvic joints and increases the
lumbar sacral curve (the curve in the lower back) causing a sway back (lordosis). Increased breast size can
also contribute to back pain by weighing down the front of the body, causing the shoulders to become
stooped.
 Prevention or relief of back pain
o Use good body mechanics
o Wear low-heeled shoes
o Watch diet and weight gain
o Continue exercising (with permission from provider), stretching exercising work well for
alleviating back pain.
o Pelvic tilt exercises
o Get adequate rest; avoid fatigue
o Sleep on side, on firm mattress
o Avoid excessive exercise, walking, bending, lifting or standing
o Apply heat or cold to sore area
o Some analgesics may be acceptable to take with approval from provider
o Consider Pregnancy & Back Pain Class sponsored by U/M Spine program~See handout
o *If pain becomes severe or constant contact provider. Back pain is also a symptom of
pyelonephritis (kidney infection), kidney stones or possibly pre-term labor.
L&P, p. 425, 433
b. Varicose Veins
 Varicose veins can range from just a blemish to being painful and bulging.
 The amount of blood circulating throughout your body during pregnancy continues to increase, hormones
cause vasodilitation and relaxation
 Increased pressure from the uterus on the iliac veins and inferior vena cava cause increased pressure on the
perineum and leg veins
 Varicose veins are strongly inherited, and unfortunately there is little you can do to prevent them. However,
things you can do to keep them from getting worse and from aching are:
o Lie on your side or with legs elevated when ever possible
o Do not cross your legs (this cuts off circulation and can aggravate the problem)
o Exercise regularly
o Move around after sitting or standing for a period of time
o Wear support hose every day (consult your provider first)
o Wear clothing that doesn’t restrict circulation
o Avoid excess weight gain
L&P, p. 433
c. Hemorrhoids
 Hemorrhoids are varicose veins of the rectum. They may protrude out the rectum with strenuous bowel
movements.
Second Trimester 2


Hemorrhoids can continue to worsen throughout pregnancy, labor, and birth.
For now, take care of your hemorrhoids by:
o Avoiding constipation (drink plenty of liquids; increase your fiber through fruits, vegetables, and
bran)Don’t strain when having a bowel movement
o Do Kegel exercises (they will tighten the muscles around your vagina and rectum and increase
circulation)
o Sleep on your side
o Avoid standing for prolonged periods
o Use sitz baths
o Local application of astringent compresses (witch hazel pads)
o Keep perineal area clean
o Wash with warm water after bowel movement, wipe from front to back and avoid harsh wiping
o Do not use over the counter preparations unless they are advised by your provider
L&P, p. 357, 433, 630
d. Mood swings
 Common to be emotionally labile
 Mood swings may decrease during the second trimester
 Some moodiness and irritability may persist due to hormones
 Some women may experience anxiety over the anticipation of becoming a parent
 Communicate your concerns, feelings (good and bad), and fears with your partner, family, or others.
 Participate in pregnancy support group
 Request referral for supportive services (financial assistance) if needed
L&P, p. 431
e. Interest in/safety of sexual activity
 There is a wide range of sexual responses, interest and frequency of intercourse
 It is safe to continue to have and enjoy consensual sex during pregnancy
 Sexual desire may change, or it may remain unchanged
 Many women find an increase in their sex drive during the second trimester.
 Women in the 2nd trimester have increased feelings of well-being (discomforts such as nausea, vomiting,
fatigue and sore breasts have passed)
 There is a slight engorgement of the genital area with blood that will last throughout the pregnancy. There
is also an increase in vaginal secretions during the 2nd trimester.
 It is also perfectly normal to have a decreased interest in sex; everyone is different.
 Common fears about sex during pregnancy
o Fear of hurting the baby
o Causing miscarriage
o Feeling like the baby is watching you
o Fear of infection
***Rest assured, that in a normal pregnancy these fears are exactly that, fears. The baby is well protected
above the cervix in the fluid sac and won’t get hurt and isn’t watching you! Unless the partner has a STD or
the water has broken, there is no increased risk of infection.
 Intercourse should be restricted and physician notified if:
o Bleeding occurs
o Rupture of membranes
o Partner has a sexually transmitted infection
o Hx of miscarriages or shows signs of miscarriage
o Hx of premature labor or experience signs of premature labor
L&P, p. 435-437
f. Round ligament pain
 Round ligaments are attached to each side of the upper uterus and to the pelvic sidewall.
 As the uterus grows they are stretched and become longer and thicker.
Second Trimester 3

Movements can stretch or pull them causing pain. The pain may be on one or both sides of the abdomen
and may be relieved by lying down.
L&P, p. 289, 433
g. Sciatic pain
 An occasional, sharp pain through the buttocks and down either the back or side of the legs

Caused by the growing uterus putting pressure on the sciatic nerve, which runs behind the uterus into the
pelvis and legs.
 Tx: Lying on the opposite side of where the pain exists relieves some of the pressure on the nerve. Heat
can also be applied.
h. Heartburn
 Hormones have slowed down the GI tract and also relaxed the sphincter between the stomach and
esophagus.
 This relaxed sphincter (which acts like a valve) allows stomach acids to flow back up into the
esophagus, causing a burning sensation in the middle of the chest.
 As the uterus grows, it crowds the intestines, and heartburn may get much worse.
 Heartburn may be prevented or relieved by doing the following:
o Identify the foods that make it worse and avoid them.
o Eat 6 small meals a day instead of 3 big meals
o Avoid greasy or spicy foods.
o Avoid lying down right after eating; or, lie on your right side to improve your stomach
emptying. Sleep propped up to keep the stomach fluids from flowing back into the esophagus.
o Consult with your care provider about the use of antacids.
o Avoid excess weight gain (excess weight puts added pressure on the stomach)
o Eat slowly and chew thoroughly
L&P, p. 432
2. I have information about the following class offerings (give her a handout, refer to local paper or Women’s
Resource Center. Classes fill up quickly. It is wise to sign up early!)
a. Childbirth preparation (Natural Childbirth, Prepared Childbirth, Lamaze, Bradley, other)
 Childbirth education classes offer the opportunity to learn about pregnancy and childbirth. They often will
help you prepare for labor and delivery as well as inform you about things you can do to have a healthy and
happy pregnancy.
 There are many different options in childbirth preparation classes for you to choose from (i.e. Lamaze,
Bradley, Birthworks etc.) depending on what you would like to gain from these classes.
 Your provider may be able to provide you with a list of local classes. You may wish to check with your
insurance company to see if they cover the cost of this class. If they do, they may have a specific provider
you need to take the class through
o Lamaze Childbirth Preparation Association of Ann Arbor (734-973-1014)
o Bradley Method of Husband-Coached Birth (734-475-0022)
o Brighton Community Education – Lamaze, Childbirth Preparation Refresher (810-229-1419 or
810-231-2820)
o Plymouth Childbirth Education Association (Lamaze) (734-459-7477)
o North Campus Nursing Center at the University of Michigan – Childbirth preparation (734-7471636)
L&P, p. 451-454
b. Breastfeeding
 A breastfeeding class is designed to teach women techniques that will help promote breastfeeding of their
newborn.
 Breastfeeding requires effort and patience and a class may give women more confidence.
 These classes typically cover material such as latch on, positions, pumping, pacifier and supplemental
bottle use, advantages of breastfeeding, hunger cues, nutrition, potential problems and common mistakes
and misunderstandings.
Second Trimester 4

Your provider may be able to provide you with a list of local classes. You may wish to check with your
insurance company to see if they cover the cost of this class. If they do, they may have a specific provider
that you need to use for the class.
o La Leche League (734-994-0113)
o Breastfeeding Class, North Campus (734-747-1636)
o Breastfeeding Class, Plymouth Childbirth Education (734-459-7477)
o Breastfeeding Class, Livingston County Department of Public Health (517-546-9850)
L&P, p. 764-774
c. Infant Care
 Infant care classes teach parents how to care for their newborns
 Topics often covered: umbilical cord care, bulb syringe use, feeding cues, breast & bottle feeding basics,
newborn adaptation to extrauterine life, bathing, car seat use, newborn complications, etc
o Infant Massage Classes (734-741-9706
o Baby Care Class, North Campus (734-747-1636)
o Newborn Class, Plymouth Childbirth Ed. Assoc. (734-459-7477)
L&P, p. 789-809
d. Lifestyle changes
 Parenting classes
 Father classes
e. Hospital Tour (sign up at Taubman OB clinic check out desk)
 These tours can be beneficial to both you and your partner because you will feel more comfortable with
your surrounding. It will be helpful during labor for your partner to know where to find refreshments, the
waiting room, a pay phone etc. You will also likely appreciate seeing the facility before delivery and
knowing what amenities they have available (whirlpool, shower, squatting bar etc.)
 Suggest to register and attend during your seventh or eighth month of pregnancy
 Tours are offered weekly. They take place in the early evening and last 60 – 90 minutes.
 A walking tour of Women’s Hospital Birth Center, followed by a question & answer session
 The tour is also included on videotape
 Register at Taubman Center’s OB-Gyn Clinic (at check out) or call 734-763-6295
YYB&U, p. 21
f. What is available in my community
 Body & Soul (Prenatal exercise program) (734-668-0304)
 Massage Therapist for Pre- and Postnatal Women (734-482-1841)
 Ann Arbor YMCA (734-663-0536)
o Prenatal Yoga
o Prenatal “Aqua-size”
3. I know what to expect of 2nd trimester care:
a. Appointments with a physician, midwife, or nurse practioner every 4 weeks plus extra visits if my
health or my baby’s health requires them
L&P, p. 413
b. A “triple screen” test available between 15 and 20 weeks
Triple screen (may also be referred to as Quad Screen or Multiple Marker Screen)
Triple screen is a blood test recommended by the American College of Obstetricians and Gynecologists (ACOG) for
all women between 15 and 20 weeks gestation. The test measures three substances: Maternal Serum Alpha-Feto
Protein (MSAFP), Unconjugated Estriol (UE3), and Human Chorionic Gonadotropin (hCG). AFP levels rise in the
maternal blood as pregnancy progresses; accurate dating of the pregnancy is essential for a valid triple screen.
Second Trimester 5
The triple screen is a screening test, not a diagnostic test. It cannot screen for all birth defects and cannot guarantee
a normal baby. It will detect 85% of all open neural tube defects (ONTD), about 75% of abdominal wall defects and
approximately 60% of babies affected with Down syndrome. Ultrasound and genetic amniocentesis would be
diagnostic and give conclusive results.
An abnormal result is not diagnostic but indicates the need for follow-up procedures. These include genetic
counseling for families with a history of NTD, repeated AFP, ultrasound examination, and possibly amniocentesis.
An ultrasound would identify:
 Women whose pregnancy dating is inaccurate, either further along or not as far along in pregnancy as
thought.
 Women whose fetus may have certain types of birth defects, particularly open neural tube defects, ventral
wall defects.
 Women carrying more than one fetus.
 Women who may be at increased risk of having a premature birth or low birth weight (LBW) infant.
Other important information for reliable analysis of the Triple Screen test results includes the maternal age, weight,
race, and presence of insulin dependent diabetes (IDDM). If a woman becomes 35 years of age during her
pregnancy or has other risk factors, diagnostic testing is recommended rather than the triple screen.
AFP is produced by the fetal liver. Increasing levels are detectable in the serum of pregnant women from 14 to 34
weeks. High levels may indicate neural tube or ventral wall defects. Low levels may indicate the presence of Down
Syndrome.
UE3: is produced by the placenta and fetus. Low levels can be associated with Down syndrome.
hCG: is produced by the placenta. High hCG may be associated with Down syndrome. Low levels may be
associated with Trisomy 18.
L&P, p. 828-829; V. p. 628-629
c. An Antibody Screen test if I have an Rh negative blood type
 An Antibody screen (ABS) is done at the initial visit and at 26 - 28 weeks
 Most significant if the mother is Rh negative
 If the ABS is negative, then the mother has not made antibodies to Rh antigens, which are present on the
RBCs of an Rh positive fetus. If the ABS is positive, the mother’s immune reaction will hemolyze fetal
RBCs and may cause intrauterine fetal death (IUFD); successive antibody titers are drawn to determine if
the antibody levels are rising
L&P, p. 1085-1086
d. If I have Rh negative blood type, I should receive an injection of RhoGam at about 26 - 28 weeks of
pregnancy, and also if I have any episodes of bleeding
 Maternal Rh negative blood and a negative ABS titer is an indication for prophylactic Rhogam at 26 - 28
weeks gestation
L&P, p. 1085
e. Complete blood count and screening test for diabetes about 26-28 weeks of pregnancy.
Complete Blood Count
Hgb (normal) 2nd & 3rd trimester >11 g/dl
Hct (normal) 2nd & 3rd trimester >33%
WBC (normal) < 15,000/cc
L&P, p. 358, 918
Blood Group and Rh Factor
Grouped to be A, B, O, and AB
Rh factor is either negative or positive [The Rh factor is positive if the Rh D antigen is present on the
surface of the woman’s RBCs—LMH]
Second Trimester 6
L&P, p. 1083, 1084
Oral Glucose Tolerance Test (OGTT)
 1-hour post-Glucola test is done at 24 - 28 weeks gestation to screen for gestational diabetes.
[Glucola is the Trade name for the glucose drink that is made by one particular company; there are
glucose drinks made by other companies that have different names—LMH]
 1 hour oral glucose test: Drink 50 grams of glucose within 5 minutes. Blood is drawn 1 hour later
o A glucose level > 140mg/dL is a positive screen (elevated)

3-hour glucose tolerance test is done if 1-hour glucose is elevated, to determine if the patient does
indeed have gestational diabetes (diagnostic)
 3-hour OGTT: Fast for 8 hours. FBS done. Drink 100g glucose. Blood drawn at 1, 2, and 3-hour
intervals.
L&P, p. 895-897
Diagnostic Criteria for GDM
100g
Threshold glucose levels
glucose
Fasting
 95 mg/dL
1 hour
 180 mg/dL
2 hours
 155 mg/dL
3 hours
 140 mg/dL
(American Diabetes Association, 2003, as in L&P, 2004)
f. Other tests as necessary to evaluate my health or my baby’s health
Urine Dip Stick
Urine is tested for glucose, albumin (protein), nitrites and leukocytes at each prenatal visit. The presence of
these may indicate possible complications (e.g., renal disease, pre-eclampsia, infection, diabetes, weight loss,
inadequate nutrition, infection, etc.) and should be reported to the physician. Should patient complain of nausea
and vomiting, urine is checked for ketones.
Glucose--many women have glucose in their urine and it is considered normal unless the glucose reading is >
1+.
Protein--many women will have a trace of protein in their urine. However, protein is considered a very
sensitive indicator of pregnancy induced hypertension which is seen after 20 weeks gestation. It is important to
know what the protein was on the very first visit, which is a baseline. If the protein is a trace, it probably
represents contamination of the urine by cervical or vaginal secretions, especially if it is present in the first and
second trimester. If the patient develops protein in the urine beyond the baseline, then pregnancy-induced
hypertension must be considered. (Bleeding is ruled out)
Nitrates--are a break down of gram negative rods. Positive nitrites mean the presence of bacteria and urine
cultures need be to be sent to the lab to determine which bacteria are present.
Leukocytes--WBC's, positive mean leukocytes are present, in 3rd trimester is normal but if positive when
nitrites are positive, a urinary tract infection is suggested. UTI’s aren’t always related to gram (-) rods. Large
number of leukocytes with or without symptoms may indicate a UTI. Send culture.
L&P, p. 361-362, 564, 840
Ultrasound done to detect structural abnormalities of the developing fetus. Size of the fetus, dating, amount of
amniotic fluid, lung and cardiac activity, and fetal movement can be assessed.
L&P, p. 818-825
Amniocentesis done to determine genetic abnormalities usually at 15-week gestation. Also, done to determine
lung maturity late in pregnancy. Amniocentesis is recommended when the mother is over the age of 35; when
results of a screening test (usually triple screen or ultrasound ) are abnormal; the couple have a child with a
genetic abnormality or metabolic disorder; family history of neural tube defect; parent is carrier of trait for
genetic disorder. A sample of the amniotic fluid from the amniotic sac is obtained through ultrasound guided
Second Trimester 7
needle aspiration. There is an increased risk of infection and miscarriage. Risks and benefits should be
discussed.
L&P, p. 649, 824-827
4. I understand that the following could be signs of labor:
a. Contractions
b. Loss of mucus plug/bloody show
c. water breaking
L&P, p. 480-481

Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of
pregnancy. Preterm birth is any birth that occurs before completion of 37 weeks of pregnancy.
 Some risk factors for preterm labor: African American; <17 years; > 35 years; hx of preterm labor or births;
smoking; alcohol use; poor nutrition; low weight gain; multifetal pregnancy; infections; incompetent cervix
 A common screening tool for preterm labor is cervical length assessment
o Cervical length is assessed via vaginal ultrasound
o Cervical length of < 30mm may predict preterm labor in a singleton pregnancy
 Fetal fibronectin is being used to predict the likelihood of preterm labor in women who are at increased risk
for this complication; the negative predictive value is high (up to 95%)
o Fetal fibronectin is a protein found in plasma and cervicovaginal secretions of pregnant women
before the onset of labor
o When a woman has a short cervix combined with a positive fetal fibronectin result, her risk for
spontaneous preterm birth is substantially higher than that for women positive for only one marker
or none at all
o The value of detection of fetal fibronectin in management of women with preterm labor has yet to
be determined
 Assessment is critical! Call provider immediately if any of the following s/sx of preterm labor are present:
o Uterine cramping (menstrual-like cramps which are intermittent or constant)
o Uterine contractions (10-15 min apart, or more often)
o Low abdominal pressure or pelvic pressure
o Dull low backache (constant or intermittent)
o Increase or change in vaginal discharge
o Feeling that baby is pushing down
o Abdominal cramping
o Diarrhea
 If s/sx of preterm labor occur, have woman stop what she is doing, lie down on left side, drink 2 – 3 glasses
of water or juice, wait 1 hour. If sx persist, call health care provider immediately. If in doubt, call health
care provider!
L&P, p. 435-436, 481, 984-985
5. I have information about what to expect of my baby’s movement and activity
 The first fetal movement (quickening) is usually felt between 16-20 weeks. Women with previous
pregnancies usually feel the fetus moving sooner than first-time pregnant women.
 Common descriptions of what fetal movement feels like are:
o Fluttering in the abdomen
o Butterflies in the stomach
o Bumping or nudging
o Twitching
o Stomach growls
o Gas
o Bubble bursting
 During the second trimester the feeling of fetal movement is erratic. You may feel it for a few days in the
beginning and then not feel it for several days. By the end of the second trimester movement should be
more regular.
 Kick Counts (also called Daily Fetal Movement Counts, DFMC) are usually started between 28-34 weeks:
Second Trimester 8
o
o
Do kick counts every day, 2 or 3 times per day, for 60 minutes each time
Do kick counts after eating or drinking water, juice, or milk; walking for 5 minutes; or during
your baby’s active time of the day (movements peak between 9 pm and 1 am)
o Write down the time you start. Make a check each time your baby kicks, twists or turns
o After baby has moved 10 times, write down the time again
o Fewer than 3 movements in one hour warrants further evaluation
o Call Provider immediately if fetal movements cease entirely for 12 hours (“fetal alarm
signal”)
L&P, p. 340, 354, 398, 418, 817-818
6. I have information about preparing the baby’s birth certificate
o Worksheet after page 26 of “You, Your Baby & Us”
o Begin the worksheet now; you can fill out a lot of the information while you are still pregnant
o You will have to complete the birth certificate worksheet after you deliver
o If you want to claim paternity (for single parents), both parents will need to complete and sign an
“affidavit of parentage form.”
YYB&U, p. 25, insert after 26
7. I have begun looking for a physician to take care of my baby
o This is an important decision that should be made before the baby is born
o Pediatrician, family physician, pediatric nurse practitioners all provide care for babies
o Ask friends and family for recommendations
o Think about what is important to you in a physician (breastfeeding support, circumcision, call-in
hours, emergencies, antibiotic use, beliefs on immunizations, hospital affiliations, if the office has
a sick and well area waiting room, how long to wait for an appointment, etc.)
o Call office ahead of time and request a consultation; bring a list of questions
YYB&U, p. 21
ABOUT BUILDING EMOTIONAL ATTACHMENTS
8. I have the information and help I need to deal with my emotions and feelings about pregnancy
 Hormonal shifts continue to influence psychological state.
 Emotional changes continue this trimester
 Instability comparable to PMS, which may include irritability, mood swings, irrationality, weepiness, fear,
joy, and elation
 Identify sources of personal and work related stressors
 Take a break when you can and rest
 Talk to trusted friend or relative, partner
 Talk to health care provider if you need additional assistance; referral to social services or a mental health
facility may be appropriate
L&P, p. 398-402, 431-434
9. My partner and I have the information and help we need to deal with our adjustment to pregnancy
 Partner adjustment to pregnancy
o Feeling left out
o Attend monthly visit with spouse
o Participate in exercise with wife, give up junk food, stop smoking, and give up alcohol with wife
o Attend childbirth classes with wife also father to be class.
o Couvade behaviors: partner experiences health symptoms similar to what the mother is experience
 Spouse mood swings
o Patience, not a permanent condition
L&P, p. 402-405
10. I have information about my baby’s growth, development and behavior during pregnancy
End of 4th month:
Second Trimester 9
o 4 inch fetus, nourished by placenta
o sucking/swallowing reflexes
o tooth buds, has fingers & toes, human looking
o cannot survive out of utero
L&P, p. 343
End of 5th month:
o 8 – 10 inches
o mother can feel baby
o has lanugo & protective vernix
o hair begins to grow, brows & eyelashes formed
L&P, p. 343
End of 6th month:
o 13 inches long, weighs! 1 3/4 lbs.
o skin growth is rapid; skin is thin & shiny, no fat
o finger & toe prints
o eyes open
o may survive out of utero; but would require NICU
L&P, p. 343
End of 7th month:
o ~ 3 lbs.,
o fat begins to deposit
o may suck thumb, hiccup, cry
o can taste sweet/sour; responds to stimuli, pain, light, sound
o fetus born between 28 – 31 wks has immature lungs; but has a good chance of survival out of utero (with NICU
support)
L&P, p. 344
11. I have information about preparing my other children for a new baby.
 Multiple ways to prepare siblings for a baby: sibling classes, visitation on the postpartum unit, reading
books about babies, attend prenatal visits, involvement in the preparation for baby, feeling the baby kick,
talking about what the baby will be like
 Other suggestions:
o Talk about the baby as “our baby”
o Let older child help pick name, make birth announcements, choose baby’s homecoming outfit
o Talk about what a baby does: won’t smile, can’t talk, no teeth, different “belly button”
o Make major room changes far in advance of the birth, especially if you plan to use the older
child’s crib, room
o Make arrangements for who will care for the older child while you are in the hospital
o Prepare child that you will be away from them a few days
o Consider a gift exchange between the older sibling and the baby
o Purchase some inexpensive gifts for the older child so s/he won’t feel left out when visitors bring
gifts to the baby
L&P, p. 405, 461-462, 580, 674-675
ABOUT PROVIDING A SAFE ENVIRONMENT FOR ME AND MY BABY
12. I know how to use a seatbelt during pregnancy.
 Always wear seatbelt
 Lap belt should be worn low across the pelvic bones and as snug as is comfortable (under growing belly)
 Shoulder harness should be worn above the gravid uterus (strap positioned between breasts)
L&P, p. 428, 429
Second Trimester 10
13. I have reviewed with my caregivers the drugs/medication I take to determine what is safe to take during
pregnancy (Ask patient what medications they are taking and have physician aware of the medications so s/he can
describe side effects, teratogens with use during pregnancy.)
14. I know that tobacco, street drugs and alcohol are harmful during pregnancy and should be avoided.
o Avoid alcohol during pregnancy (Fetal Alcohol Syndrome)
o Quit smoking; or at the least, cut down since tobacco use effects are dose related (SGA, apnea, SIDS,);
second hand smoke dangers
o Avoid street drugs ~ harmful effects to growing fetus, miscarriage, early birth
L&P, p. 430, 964-967
15. I know that I should avoid using hot tubs and saunas during pregnancy.
o Refrain from long stays in hot tub
o Anything that raises body temp over 102 degrees is potentially dangerous to baby
o It usually takes about 10 minutes for body to raise to high temps
o Recommend keeping belly out of water; soak feet & legs
o Most U.S. experts recommend avoiding the sauna
16. I have information about finding and choosing infant day care
o Consider who & where you want your baby to be cared for (your home, friend or relative home,
licensed day care provider, day care facility)
o Ask for recommendations from friends
o Question the staff-child ratio
o Consider nurturing qualities of caregivers, consistency of staff
o Safety and cleanliness of the facility
o Schedule of activities: nap, eating, outdoor activity, structured play, etc.
o Ask for references
o Visit your prospective care provider during the hours you would need to leave your baby there
17. I can identify the following problems and report them to my care provider:
a. Persistent, severe vomiting lasting more than 24 hours (hyperemesis, dehydration)
b. Vaginal bleeding, with or without pain (miscarriage)
c. Burning, pain and/or bleeding when I urinate (UTI)
d. Temperature about 100.6 degrees F (infection)
e. Abdominal pain, or painful and persistent abdominal cramping
f. Severe, continuous headache (pre-eclampsia, migraine)
g. Changes in eyesight, such as blurred vision or seeing spots (pre-eclampsia, migraine)
h. Consistent, persistent heartburn-like pain (pre-eclampsia)
i. Sudden swelling of my face & hands; weight gain > 5 lbs/wk ( pre-eclampsia)
j. Trauma
L&P, p. 438-439, 817-818, 870-872, 874-876
18. I can identify resources/help for protecting my physical and emotional safety.
 Questions to screen for abuse (If she answers “yes” even once, her partner is abusive!):
o Does your partner put you down and make you feel ashamed?
o Does your partner tell you what to do and who you can see?
o Has your partner ever threatened to hurt you or your family?
o Has your partner ever pushed or hit your, or forced you to have sex?
 Should screen with each visit. Pregnancy puts women at risk for domestic violence
 Places to call for help:
o The Domestic Violence Project/SAFE House (Washtenaw County) ~ 24 hour crisis line number is
734-995-5444
o The UM Sexual Assault Prevention and Awareness Center ~ 24 hour crisis line number is 734936-3333
o LACASA (Livingston County) ~ 517-548-1350
o National Domestic Violence Hotline ~ 1-800-799-7233 or 1800-787-3224 (TTY)
Second Trimester 11
o Women’s shelter ~ 734-665-6955
L&P, p. 110-111, 112-113, 114, 131-152
Prepared by Trudy Esch, MS, RN
Spring 2003
Revised by Linda Hawkins, RNC, BSN [LMH]
Fall 2004
References
Lowdermilk, D. L., & Perry, S. E. (2004). Maternity & women’s health care (8th ed.). St. Louis, MO: Mosby. (L&P,
abbreviation for citing in above text)
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