Pregnancy - Week 20 (Weight gain, Anatomy Scan, and more)

Yikes! I can't believe another month has passed. A lot of big milestones since my last update at week 16. Keep in mind that there are a lot of factors in my favor when it comes to feeling baby move this early as a first time mom. So don't fret if you're reading this and wondering why you haven't felt baby move yet - check out my week 16 post and be patient!

• Week 17 - first legitimate kicks. I had been feeling the beginning of baby's movements very early, but during week 17 I felt my first concentrated kick that took me by surprise. Once or twice a day, and not every day, I would get a nice solid kick in the uterus.

• Week 18 - By week 18, movements have been every day for several minutes at a time. She takes after her daddy, and becomes most active after 11:00 pm (oh boy...). I think Daddy could have felt her at any point during this week, but he was a little impatient and would put his hand on my belly for all of 5 seconds before declaring it a loss and removing his hand. At 18w4d, however, his timing was just right and she gave him a big one and then continued on for another couple in immediate succession.

• Week 19 - I lost weight...weird right? Apparently not too uncommon though. Like everything when it comes to conceiving and pregnancy, every one is different. Some mom's haven't gained any weight by this point, thought that is generally not recommended unless your BMI was over 25 pre-pregnancy. More on this below.

• Week 20 - Anatomy scan! This is one of the highlights of pregnancy and a scan that nearly all moms look forward to, but it can also be nerve racking. Ultrasound technology has gotten so good, and they look at all the vital organs and body parts, that a lot of moms walk away from this scan feeling like something must be wrong. Therefore, I've dedicated a discussion below to just the anatomy scan.

Now, let's talk weight gain. I'm a member of a few different pregnancy groups and forums, and I'm constantly surprised how often I see the question "How much did you gain by [insert number] week?" This question often comes with no further qualifier and they seem to be the most commented on posts in the forums. If you browse the responses, you'll see that it's an entirely useless question if you're trying to compare yourself and no matter what week you insert there will be women who have lost weight and women who have gained double or more the recommended amount.

There are a few important things to remember when it comes to weight gain:

• Gaining too little has been shown to have a higher association with low birth weight complications than gaining too much

• How much you should gain depends on where you started. Underweight pre-pregnancy? Your recommended weight gain throughout the total pregnancy is 28-40lbs. Overweight? Current guidelines say 11-20lbs, but you'll want to check with your doctor on your specific recommendation so as not to complicate any pre-existing conditions. Women of "normal" BMI should gain between 25-35lbs.

Here's where it can get a little touchy - normal BMI is considered 18.5-24.9. The average American woman has a BMI of over 29, meaning the average American woman is overweight. Keep in mind though that this report does not distinguish between age or pre/post menopause. BMI is also a controversial indicator of health, because it does not account for fat versus muscle. Therefore, my best advice is to 1) check with your doctor if you're not sure about your weight gain and 2) not judge yourself based off a forum of random women from the internet!

For those women simply looking for resources to educate themselves, this paper on gestational weight gain is an excellent source of information and doesn't require too much medical prerequisite to digest. It also has several helpful charts and tables, with recommended guidelines by week of pregnancy. If you're up for a challenge, you can access this entire book through the National Institute of Health - Weight Gain During Pregnancy, Reexamining the Guidelines.

Now - the much awaited anatomy scan! Guidelines vary by country, but in the US the anatomy scan is typically recommended between 18-22 weeks gestational age. During this scan, the doctor will check all the vital organs for soft markers of genetic defects and general abnormalities. They also measure amniotic fluid, arms, legs, head, chest, and overall length to estimate baby's weight and general progression against milestones. Some doctors will also conduct a transvaginal ultrasound at this appointment to check cervix length, as shortening or thinning can be a concern for pre-term labor. My doctor did this check via the abdominal ultrasound, so it just depends on your clinic and their preferences.

Many women walk away from this scan with misconceptions about what is healthy. I have seen countless women think something is wrong with their baby just because they measured below the 50th percentile. Just like adults, babies come in all sizes. 50th percentile is not a marker for health, it just means your baby is exactly average size. However, it's also perfectly normal for a small mom who is shorter than average herself to have a perfectly healthy baby that is measuring 40th, 30th, or even 20th percentile. Being in the 40th percentile is no worse or better than being in the 60th. Sizes are just a distribution that cluster around the mean!

This scan can also lead to anxiety because your baby is still forming. For example, a somewhat common finding is a small cyst on the brain. This sounds terrifying, but it is normally a fairly innocent finding. At our scan, our ultrasound tech showed us a very small white spot on the ultrasounc that showed in our baby's left heart ventricle. The doctor told us this was called a echogenic intracardiac focus and then stressed, without a shadow of a doubt, that it was no cause for concern and causes absolutely no complications. Sometimes they go away by the third trimester, but she said that if she scanned me or Daddy she would probably find the same thing in one of our hearts. It's simply a small spot of calcification, but her valves are functioning normally and her blood is flowing perfectly.

If you're prepping for your anatomy scan, drink a lot of water in the week leading up to it as ultrasound pictures are better when you are well hydrated. If you're used to providing a urine sample during your check-ups, they'll usually have you do the scan first with a full bladder and the urine sample after. This is because a full bladder lifts the uterus up a little, making it easier to get good images. The length of the scan will depend on how much your baby is cooperating, but expect somewhere between 30 minutes to an hour. Because they have so many measurements to take, baby has to be in a good position to capture all the parts they need to check. Our little girl was blocking her heart with her hand when they were trying to check her arteries, so I had to rock my body and forth to encourage her to move it out of the way.

Overall, this past month has been one of the most exciting of the pregnancy so far. I feel relaxed and excited by baby's movements, my belly is becoming un-mistakingly pregnant and not just fat, and Daddy is getting to experience her as a real little person that he can interact with now. The downside - oh man has my back started aching!