Second trimester overview: what to expect physically, mentally, and medically

What is the second trimester?

The second trimester runs roughly from week 13 to week 27 (months four through six), the middle third of pregnancy. For many people, this is the most settled phase. The nausea and bone-deep tiredness of the first trimester often ease, the pregnancy becomes visible and, somewhere around 16 to 25 weeks, you may start to notice the first flutters of movement (sometimes called "quickening"). This is also the point at which many people choose to share the news more widely.

During this stage, your baby's organs continue to mature, and many major structures become visible on ultrasound. Bones harden, hearing develops, and movements become stronger and more coordinated. By the end of the second trimester, your baby can respond to sounds and changes in light, although there is still significant growth and development ahead.

The "golden trimester" myth

The second trimester gets sold as the glowing, energetic honeymoon phase. For some people, this is true. For many others, difficult pregnancy symptoms linger. You may still feel tired, the changes to your body may still feel difficult, and low mood or anxiety doesn't politely take a trimester off. Some continue to experience nausea and sickness, and may even experience a more severe form of nausea and sickness called hyperemesis gravidarum (HG), which can persist throughout the entire pregnancy. Unlike typical morning sickness, HG causes significant dehydration and weight loss, and may require medical intervention or hospitalization. Talk to your medical care provider if you’re concerned about your symptoms.

The gap between being told you should be at your best and not actually being there can be its own kind of pressure, sometimes adding guilt or a sense of doing pregnancy “wrong,” or missing out on what everyone else gets to enjoy.

Your body in the second trimester

Most second-trimester body changes are driven by the ongoing hormonal shifts of pregnancy, an increase in blood volume and the simple fact that your baby is growing. Common changes include:

• Weight gain and/or a visible bump as the pregnancy develops
• Skin changes, which could include a darker line down the abdomen (linea nigra), darker patches on the face (melasma) and stretch marks
• Round ligament pain: sharp or pulling sensations low in the abdomen as supporting tissue stretches
• Digestive changes: heartburn, acid reflux and constipation may become more common as the pregnancy grows and presses on nearby organs
• Fluid retention and swelling, especially later in the trimester
• The easing of early nausea and fatigue for many people, although new aches and discomforts often arrive to take their place

It's also common to notice symptoms that aren't talked about as often, such as bleeding gums, nasal congestion, leg cramps, headaches or dizziness. While these can be a normal part of pregnancy, persistent or severe symptoms are worth discussing with your care provider.

You may find that it gets harder to recognize yourself in the second trimester. Your body is changing shape, and your usual routines (how you eat, how you move, whether you can exercise the way you used to) often change with it. For some people, that shift feeds negative self-talk or a sense of losing control. Physical and emotional change aren't separate tracks — one tends to pull on the other.

Some pregnant people may struggle with keeping a positive body image during pregnancy. This is especially true for heavier-set individuals, those recovering from eating disorders and queer, non-binary, genderqueer or transmasculine individuals. The round, neatly defined "baby bump" so often portrayed on social media and television is, in many ways, another beauty standard. Like other appearance ideals, many people find they do not match what they see represented, leading to feelings of shame or even body/gender dysmorphia. In reality, pregnant bodies vary enormously, and there is no right way to look pregnant.

Mental health in the second trimester

Mood and anxiety challenges during pregnancy are common. They can begin or worsen before birth, not only after it. And they aren’t limited to depression: it's a range that also includes anxiety, OCD (obsessive-compulsive disorder, which can involve unwanted, intrusive thoughts) and related conditions. Across pregnancy and the year after birth, about 23% of birthing parents in Canada report a mood concern. Risk isn't spread evenly, and factors such as income, age and ethnicity can affect vulnerability.

Mental health concerns can show up in different ways: feeling persistently overwhelmed, withdrawing from people you normally enjoy, struggling to sleep even when exhausted, or finding that worry is taking over much of your day. These experiences are common reasons to bring up mental health with a care provider.

You don't have to be in a crisis to ask for help. A low mood that doesn't lift, anxiety that stays with you or intrusive thoughts that keep returning are all worth raising with a care provider during pregnancy, rather than waiting until after birth.

If you're the non-birthing parent: Mental health challenges in pregnancy don't only affect the person who is pregnant. Non-birthing parents also experience mood concerns across the perinatal period and should be aware of their own mental health, and should reach out for support when needed. Getting support for yourself can not only help you, but help you to support your partner during this time. Additionally, you may be the one noticing changes in your partner before they do. One concrete thing you can do for them this week is to ask one question: "What's this phase actually been like for you?", and let the answer sit without moving straight to fixing it.

Read more about Second trimester: Medical care and screening

When to contact a provider

While many aches, pains and new symptoms are part of normal pregnancy, some changes should be checked promptly. Contact your provider if you experience vaginal bleeding, leaking fluid, severe abdominal pain, severe headaches, sudden swelling of the face or hands, changes in vision or if something simply doesn't feel right. Your care team would generally prefer to hear from you early rather than have you worry at home.

If you experience concerning symptoms, reach out for medical advice and treatment. Here in Newfoundland and Labrador, you can call 8-1-1 for medical advice, attend your local emergency department or schedule an urgent appointment with your primary care provider, doctor, OB or midwife.

If something here was new or useful, save the link to this article, or note one question to ask at your next appointment.

This article was developed using sourced educational content from Canadian Perinatal Mental Health Trainings (CPMHT), and informed by the collective knowledge and expertise of CPMHT professionals and Karen Clarke, BA, MSW, RSW, Doula (Open Book Doula, Counselling and Consulting Services), as well as the following cited research and clinical practice guidelines: