Head-to-Toe: Second Trimester Changes

The second trimester, roughly weeks 13 through 27, is often called the “honeymoon” stage of pregnancy, and for good reason. Morning sickness may ease, your energy may pick up, and your belly may finally start to look pregnant.

But as your baby grows, your body is changing too. Some changes are easy to connect to pregnancy, like a growing belly. Others, like bleeding gums, a stuffy nose, or feeling dizzy when you stand up, can catch you off guard.

Knowing what’s normal, and what isn’t, helps you take an active part in your care and speak up when something feels off. Here’s what may be happening from head to toe, what can help you feel more comfortable, and which symptoms deserve a call.

Want a quick reference? Download our head-to-toe printable to keep on your fridge or bring to your next appointment.

What may change, from head to toe

Headaches

Headaches are common in the second trimester. Changing hormones, extra blood volume, congestion, skipped meals, dehydration, and stress can all play a part.

What can help: Rest in a dark, quiet room, drink water, eat regular meals and snacks, and try a cool compress on your forehead or neck.

Ask your provider: Which pain relievers are safe for me?

When to call: Right away if you have a severe headache that won’t go away, or a headache with blurry vision, spots, or flashing lights, pain under your ribs on the right side, or sudden swelling of your face or hands. After 20 weeks, these can be signs of preeclampsia, a serious high blood pressure condition.

Mood and emotions

It’s normal to feel excited one day and worried or weepy the next. Hormones, physical changes, sleep, and big life adjustments all affect how you feel.

What can help: Rest when you can, keep moving, and talk with your partner, friends, or other parents-to-be about how you’re feeling.

When to call: If you feel sad, anxious, hopeless, or numb most days for more than two weeks, or lose interest in things you usually enjoy. Depression and anxiety can start during pregnancy, not just after birth, and they’re treatable. The National Maternal Mental Health Hotline is free, confidential, and open 24/7: call or text 1-833-TLC-MAMA (1-833-852-6262). If you have thoughts of harming yourself, call or text 988, or call 911.

Dizziness

Feeling lightheaded is common in the second trimester. Pregnancy hormones relax your blood vessels, and your blood pressure may run lower than usual.

What can help: Get up slowly, eat regular meals and snacks, stay hydrated, and lie on your side instead of flat on your back. If you feel lightheaded, sit or lie down on your side right away.

When to call: If you faint, or if dizziness comes with a racing heart, chest pain, shortness of breath, a severe headache, or vision changes.

Stuffy nose and nosebleeds

Congested even though you aren’t sick? Pregnancy hormones and extra blood volume can swell the tissues inside your nose. You may notice congestion, snoring, or occasional nosebleeds.

What can help: Saline nasal spray, a humidifier, or sleeping with your head slightly raised.

Ask your provider: Which decongestants or medicated nasal sprays are safe for me?

When to call: If a nosebleed is heavy, lasts longer than 20 minutes even with steady pressure, or happens often.

Tender, bleeding gums

Your gums may become more sensitive, swollen, or quick to bleed. This is sometimes called pregnancy gingivitis.

What can help: Brush twice a day, floss daily, and keep your dental visits. Routine dental care is safe during pregnancy.

Skin changes

Pregnancy can change your skin in many ways. You may notice a dark line down your belly called the linea nigra, darker patches on your face called melasma (sometimes called “the mask of pregnancy”), stretch marks, or itchier skin.

What can help: Sunscreen, moisturizer, and loose, breathable clothing.

When to call: If itching becomes intense, especially on the palms of your hands or soles of your feet.

Growing breasts

Your breasts may keep growing and feel tender. Your areolas may darken, veins may become more noticeable, and you may notice a little colostrum leaking.

What can help: A supportive, well-fitting bra can make a big difference.

Heartburn and indigestion

Pregnancy hormones relax the valve at the top of your stomach, and your growing uterus presses up on your stomach. Together, these make heartburn more common.

What can help: Eat smaller meals, and avoid lying down for 2–3 hours after eating. Spicy, fatty, or acidic foods may make it worse. Propping yourself up on a few extra pillows at night may also help.

Ask your provider: Which antacids are safe for me?

Growing belly

Around 20 weeks, your uterus reaches about the level of your belly button. You may also start to notice those first little flutters of movement. Many people feel them around 18–20 weeks, but if this is your first pregnancy, you may not notice them until closer to 25 weeks. If you’ve been pregnant before, you may feel them as early as 16 weeks. Where your placenta sits can also make early movements harder to feel.

What can help: As your belly grows, sleeping on your side with a pillow supporting your bump may feel more comfortable.

Braxton Hicks contractions

You may notice your belly tighten and harden for 30 seconds to a couple of minutes, then relax. These “practice contractions” are your uterus warming up. They’re usually irregular and mildly uncomfortable rather than painful.

What can help: Change positions, walk or rest, and drink water. Braxton Hicks often ease when you do something different.

When to call: Right away if contractions come at regular intervals, get stronger or closer together, are painful, or happen four or more times in an hour. Also call if they come with low back pain, pelvic pressure, bleeding, or leaking fluid. These can be signs of preterm labor.

Round ligament pain

A sudden sharp or pulling pain in your lower belly or groin can be startling. As your uterus grows, the ligaments that support it stretch. You may notice it most when you stand up quickly, roll over, cough, or sneeze.

What can help: Move a little more slowly, bend at your hips before you cough or sneeze, and rest when you need to. Gentle stretching or prenatal yoga may also help.

When to call: If the pain is severe or constant, or comes with bleeding or fever.

Back pain

As your belly grows, your center of gravity shifts forward. Pregnancy hormones also loosen the joints in your pelvis. Together, these can strain your lower back.

What can help: Stand and sit up straight, wear low-heeled shoes with good support, and bend your knees when you lift. Sleep on your side with a pillow between your knees. A warm (not hot) compress, gentle stretching, prenatal yoga, or swimming may also help. Some people also find relief with a belly band, which helps support the weight of your bump.

Ask your provider: Would physical therapy help me?

When to call: If back pain is severe, comes and goes in a rhythm, or comes with fever, burning when you pee, or bleeding.

Constipation and hemorrhoids

Pregnancy hormones slow digestion, and the iron in prenatal vitamins can make constipation worse. Straining and pressure from your uterus can also cause hemorrhoids, swollen veins around your rectum that may itch, hurt, or bleed a little.

What can help: Drink plenty of water, eat fiber-rich foods, and keep your body moving. Try not to strain. For hemorrhoids, a warm sitz bath or cool compress can ease discomfort.

Ask your provider: Which laxatives, stool softeners, or hemorrhoid creams are safe for me?

When to call: If you have more than a small amount of rectal bleeding, or severe pain.

Peeing more and UTIs

If you feel like you’re always looking for a bathroom, you’re not imagining it. Your growing uterus presses on your bladder, and pregnancy also makes urinary tract infections (UTIs) more likely.

What can help: Drink plenty of water, don’t hold your urine for long, and pee after sex.

When to call: Within a day if it burns when you pee or your urine looks cloudy or bloody. Call right away if you also have a fever or back pain.

Vaginal discharge

More discharge is normal during pregnancy. Healthy discharge is usually thin, white or clear, and mild-smelling.

What can help: Wear breathable cotton underwear and use panty liners if you like. Skip tampons and douching.

When to call: If discharge smells strong or fishy, looks green, yellow, or gray, turns thick and clumpy, or comes with itching or burning. Call right away if you have bleeding or watery fluid leaking or gushing.

Swelling

Some swelling in your feet and ankles is common, especially at the end of the day or in hot weather. Extra fluid and pressure from your uterus slow blood flow from your legs.

What can help: Put your feet up, avoid standing for long stretches, keep moving, and stay hydrated. Lying on your side and wearing compression socks may also help.

When to call: Right away if you have sudden swelling of your face, hands, or around your eyes, or swelling with a headache or vision changes. These can be signs of preeclampsia.

Leg cramps

Sudden nighttime calf cramps can be an unwelcome surprise.

What can help: When one strikes, flex your foot toward you and gently stretch your calf. Stretching before bed and staying hydrated may also help.

When to call: Not every painful leg is a cramp. Call right away if one leg becomes swollen, red, warm, or painful. This can be a sign of a blood clot.

Questions to bring to your next prenatal visit

Your appointments are a chance to talk through what you’re feeling, not just to get checked. You might ask:

• Which over-the-counter remedies are safe for me, like pain relievers, antacids, stool softeners, or nasal sprays?
• Is what I’m feeling normal for this stage of my pregnancy?
• When should I start paying attention to my baby’s movements, and what should I look for?
• How can I tell Braxton Hicks from real contractions?
• What are the warning signs of preeclampsia?
• Who do I call after hours or on weekends?
• Which symptoms should send me straight to labor and delivery?

When to call your provider

Most of these changes are a normal part of pregnancy. But you know your body best. If something feels different, worrying, or just not right, it’s always okay to call your provider.

Call within a day if it burns when you pee or your urine looks cloudy or bloody.

Get support if you feel sad, anxious, or hopeless most days for more than two weeks. Call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262), any time.

For more, see urgent warning signs during and after pregnancy.

The BirthX takeaway

Your body is doing a lot of work in the second trimester. You don’t have to just put up with every uncomfortable symptom. Small changes can help, and knowing what’s expected makes it easier to spot what isn’t.

You never need a better reason to call than “this doesn’t feel right.” Asking questions and speaking up are part of taking care of yourself and your baby. Download the head-to-toe printable to keep on hand or bring to your next appointment.

Sources: ACOG, Changes During Pregnancy; ACOG, Preeclampsia and High Blood Pressure During Pregnancy; ACOG, Preterm Labor and Birth; ACOG, Depression During Pregnancy; Mayo Clinic, Fetal development: The 2nd trimester. This article is for education only and is not a substitute for medical advice. Always contact your provider with concerns.