Fertility and Pregnancy
Pregnancy

Your Pregnancy Roadmap

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Your Pregnancy Roadmap

20 MINUTE READ

Published September 2024

AUTHOR

Elisabeth Mulligan
Registered Nurse, MSN

Congratulations - you are pregnant! You’ve probably spent a good deal of time thinking about getting pregnant, but now that you are, the next set of questions come flooding in. Why am I so tired? Why do I have to pee all the time even though my baby is only the size of a jellybean? Should I REALLY be “eating for two”?

What to expect in the next 9 months

In this guide, we will dig into your pregnancy, week by week. The prenatal period can be associated with an increase in anxiety - after all, nothing can prepare you for the physical, emotional, and mental changes that are happening to you! However, we can prepare you with knowledge of how your baby is developing, what you can expect at each of your many prenatal appointments, and suggestions of what you can be doing to ensure you are taking care of yourself and your baby, during this exciting time.

Breaking it down further

Your prenatal appointment schedule

  • See your OB/GYN or Midwife (provider) every 4 weeks.

  • See your provider every 2 weeks.

  • See your provider every week.

Weeks 1-8 of pregnancy

    • The brain and spine begin to form¹.

    • Cardiac tissue starts to develop.

    • Muscles of the eyes, nose, and mouth form.

    • Webbed fingers and toes poke out from developing hands and feet. 

    • The lungs start to form the tubes that will carry air in and out after birth.

    • The inner ear begins to develop.

    • 6 weeks: You may have an appointment to check your hCG levels via a blood draw.

    • 7-9 weeks: You will see your provider for an initial prenatal appointment. You will have a transvaginal ultrasound and blood work completed².

    • You may experience some early positive signs of pregnancy, such as fatigue, sore breasts, nausea, increased urination, and an onset of anxiety³. 

    • Rest, stay hydrated, and start taking a prenatal vitamin if you are not already.

    • Avoid eating raw or undercooked food, unpasteurized foods, alcohol, and fish high in mercury⁴.

Weeks 9-12 of pregnancy

    • Cartilage for the limbs, hands, and feet start to form but won’t harden into bones for a few weeks¹.

    • Eyelids form but remain closed.

    • Genitals begin to form.

    • Liver begins development.

    • Kidneys begin making urine.

    • Pancreas starts making insulin.

    • Fingernails form.

    • 10-13 weeks: You will complete a first-trimester screening blood test and have another ultrasound⁵. 

    • You may also have the option to do comprehensive screenings such as cell-free DNA⁶, which screens for common chromosomal abnormalities and the baby’s sex.

    • You may continue to experience those early signs of pregnancy throughout your first trimester. Continue to rest and take care of yourself.

    • Ensure you have your prenatal appointments and ultrasounds scheduled.

Weeks 13-16 of pregnancy

    • Bones harden, especially the long bones¹.

    • Skin is thin and see-through but will start to thicken soon.

    • Toenails form.

    • Neck is defined and lower limbs are developed.

    • Hearing starts to develop.

    • Lungs begin to form tissue that will allow them to exchange oxygen and carbon dioxide when breathing starts after birth.

    • If indicated, you may have further diagnostic testing done such as chorionic villus sampling (CVS) or amniocentesis⁷. These tests are typically only indicated if you receive a positive screening test.

    • Around 16 weeks you will have second--trimester screening⁸, or a “quad marker screening”. This is another blood test that looks for abnormal levels of substances in mom’s blood that could indicate a risk for baby having a genetic disorder.

    • Swollen, painful and bleeding gums are common during pregnancy⁹, a byproduct of the hormonal changes you are experiencing. Use a soft toothbrush, practice good dental hygiene, and make sure you have a dental visit scheduled on your regular cadence.

    • Begin to consider when a good time is to share the news with your employer, if applicable. 

    • It is common to experience round ligament pain - quick sharp pains in the sides of your belly or groin. These are caused by the stretching of the ligaments that hold your uterus to the bones in your pelvis. It is not dangerous, but it can be painful. 

    • You may start to feel more energized - consider the types of exercise that you will enjoy during pregnancy and make a plan to stay active¹⁰.

Weeks 17-20 of pregnancy

    • The part of the brain that controls motor movements is fully formed¹.

    • Digestive system is working. 

    • Ears, nose, and lips are recognizable on an ultrasound exam.

    • In girls, the uterus and vagina are starting to form.

    • Soft, downy hair called lanugo starts to form and cover the body.

    • At 20 weeks you will have a standard ultrasound to screen for physical defects. This ultrasound will be your longest appointment, performed by an ultrasound tech where they will take measurements and photos of every angle of your baby. 

    • After your ultrasound you will meet with your provider to go over the findings.

    • You may start to feel your baby move as early as 16 or 17 weeks! 

    • You may be experiencing round ligament pains caused by your expanding belly. Find some exercise classes that focus on prenatal movements that you enjoy doing, including pelvic floor exercises. Walking and stretching are good alternatives if you are still feeling fatigued! 

    • If you haven’t told your employer about your pregnancy yet, consider having that conversation.

Weeks 21-24 of pregnancy

    • Kicks and turns are stronger¹.

    • Sucking reflex is developing.

    • Fat is forming under the skin.

    • Ridges form in the hands and feet that later will be fingerprints and footprints.

    • Skin is wrinkled and reddish from visible blood vessels.

    • Now that you’ve gotten your anatomy scan and all the screening and diagnostic testing out of the way, your prenatal appointments from now on will be fairly simple!

    • Your provider will listen to the baby’s heartbeat, take your blood pressure and weight, and check in on any questions you have.

    • You will be given a glucose drink to drink before your 28-week appointment to check for gestational diabetes¹¹.

    .

    • You may begin feeling uncomfortable while you are trying to sleep. Consider using a pregnancy pillow to support your bump and any aching muscles

    • Begin to consider how you would like to feed your baby. If you plan to breastfeed, research breastfeeding courses offered by your birthing hospital, and make a plan to attend one in your third trimester.

    • Research and sign up for any other prenatal classes at your birthing hospital, including a hospital tour and infant CPR.

Weeks 25-28 of pregnancy

    • Lungs are fully formed but not yet ready to function outside the uterus¹.

    • Loud sounds can make your fetus respond with a startled movement and pull in the arms and legs.

    • Eyelids can open and close. 

    • Lungs begin to make surfactant, a substance needed for breathing after birth.

    • Nervous system is developing.

    • Skin begins to look smoother as more fat is added.

    • At your 28-week appointment, you will drink your glucose drink 1 hour before your scheduled appointment time, then have your blood drawn to test for gestational diabetes. The blood test will also include a routine STI screening.

      • If you fail your 1 hour glucose test, you will be notified and will take another glucose test on a different day.

    • Your provider will listen to the baby’s heartbeat, take your blood pressure and weight, and check in on any questions you have.

    • If you have Rh- negative blood type (i.e., A-, B-, AB-, O-), you will be given a medication called Rhogam¹².

    • You will be offered the Tdap booster vaccine to protect your baby from whooping cough¹³.

    • As your baby grows and takes up more space, you may start to experience heartburn and indigestion. Try eating smaller meals more often, avoid spicy or acidic foods, and finish eating 3 hours before laying down.

    • Begin to consider thinking about birth control after your baby is born. We know that women who wait at least 1.5 - 2 years between pregnancies have healthier pregnancies for themselves and their subsequent babies¹⁴.

Weeks 29-32 of pregnancy

    • The fetus can stretch, kick, and make grasping motions¹.

    • Eyes can sense changes in light.

    • Bone marrow is forming red blood cells.

    • Head may have some hair.

    • In boys, the testicles have begun to descend from the scrotum.

    • Lanugo begins to disappear.

    • Your provider will listen to the baby’s heartbeat, take your blood pressure and weight, and check in on any questions you have.

    • If you don’t already have all of your remaining prenatal appointments scheduled, you will schedule them now! You will see your provider every other week until 36 weeks, and then once per week after that until your due date!

    • Check with your insurance and order your breast pump

    • Think about your labor and delivery plan - who will be with you during labor, how you want to cope with labor pains, and your hopes for delivery and immediate postpartum with baby. Discuss these expectations with your support person. If you have strong opinions, consider making a birthing “wish list” to share with your care providers in the hospital.

Weeks 33-36 of pregnancy

    • Bones harden but the skull remains soft and flexible¹.

    • Fingernails have grown to the end of the fingers.

    • Limbs begin to look chubby.

    • The fetus may turn into a head-down position for birth.

    • Your provider will listen to the baby’s heartbeat, take your blood pressure and weight, and check in on any questions you have.

    • Your provider may want you to have another ultrasound done if your belly is measuring larger or smaller than expected.

    • At your 36 week appointment, your provider may offer to check to see if your cervix has started to dilate.

      • You will also be tested for Group B strep, a normal bacteria that lives in the body, but can cause complications after delivery for baby if you are not treated with antibiotics for it¹⁵. Your provider will take a sample via a swab of your vagina and rectum. If you are positive for Group B strep, you will receive an antibiotic when you go into the hospital before delivery.

    • Pack your hospital bag! 

    • Ensure you have a safe space for baby to sleep at home¹⁶.

    • Install your baby’s car seat¹⁷.

    • Have a plan for if you go into labor early, including care for your pets and your home.

    • Revisit your birth “wish list” with your support person in case your preferences have changed.

Weeks 37-40 of pregnancy

    • Circulatory system is done developing¹.

    • Musculoskeletal system is done developing.

    • Lungs, brain, and nervous system are finishing their development.

    • Fat continues to be added all over to keep the baby warm after birth.

    • Your provider will listen to the baby’s heartbeat, take your blood pressure and weight, and check in on any questions you have.

    • Your provider will offer to check your cervix.

    • You may talk to your provider about options for being induced. A recent study found that induction of labor at 39 weeks in low-risk first time mothers resulted in a lower frequency of c-section delivery¹⁸. However, a planned induction may not be right for everyone.

    • Do any final preparations around your home - stock up on freezer meals, stock your pantry with your favorite snacks, stay on top of your laundry! 

    • Review the stages of labor so that you have a general foundation for the labor process¹⁹. 

    • Most importantly, enjoy your last few weeks before baby arrives! Go out to dinner, enjoy some one-on-one time with your partner and friends.

What the research says

  • Maintaining an active lifestyle during pregnancy is associated with preventing common pregnancy complications such as gestational diabetes, excessive weight gain, hypertensive disorders, urinary incontinence, and anxiety and perinatal depression²⁰.

  • Unless pre-pregnancy nutrition is suboptimal, the number of calories in your diet does not need to change in pregnancy. Instead, focus on eating a healthy diet, rich in nutrients such as folic acid and choline, instead of more food²¹.

  • Choline is a micronutrient that plays a vital role in brain development, and a recent study showed that over 90% of pregnant women are not getting the recommended daily intake of choline (450mg)²². Most prenatal vitamins do not include choline, so make an effort to bulk up your intake with choline-rich foods such as eggs (especially the yolk), kidney & soy beans, dairy, salmon, and cruciferous vegetables.

Putting it into practice

To prepare for your labor and delivery, focus on the following three items:

  • Use the following questions to guide your birth “Wish List” conversation with your support person (see our guide “Birth 101” for a template for you to fill out)

    • I am ok/not ok with people in training (med students or residents) to be part of my care team

    • I would like to try the following options during labor if available:

      • Birthing ball

      • Birthing stool

      • Squat bar

      • Warm shower or bath

    • I do/do not want anesthesia during labor 

    • I would/would not like to use a mirror during pushing

    • I would/would not like my support person to cut the umbilical cord

    • I would like my support person to take videos/pictures of the birth (note most hospitals have policies around this)

    • I would like for my baby to be placed directly on my chest immediately after delivery

    • In the event of a c-section, I would like the following person to be present with me

  • If you don’t know if you are in true labor, drink some water, lay down and rest. “False” labor contractions do not have a pattern to them and will subside on their own. “True” labor signs include:

    • Rupture of membranes (your “water breaks”)

    • Patterned contractions at regular intervals lasting 60-90 seconds each. Early contractions will be about 15-20 minutes apart, and will grow closer together as labor progresses.

  • See exercises recommended by the American College of Obstetricians and Gynecologists²³. If you cannot make time for all of them focus on the following:

    • Seated leg raises - Strengthens abdominal muscles and helps with stability

    • Ball wall squat - Stretches the muscles of the leg and glutes

    • Seated side stretch - Stretches sides of your body and hip muscles

About the author

Elisabeth Mulligan

Registered Nurse, MSN


Elisabeth started her nursing career in labor and delivery at one of the busiest birthing hospitals in the U.S., assisting with hundreds of deliveries from routine to complex. Now specializing in women's reproductive health across the lifespan . . .

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  • Mama Natural YouTube Channel ↗

  • Expecting Better Why the Conventional Pregnancy Wisdom Is Wrong--and What You Really Need to Know ↗

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When to get
expert support

It is common to have worries about your pregnancy or your baby’s health. Worry becomes anxiety when the thoughts are frequent, time-consuming, intrusive, and irrational. Research shows that untreated anxiety can make it difficult to feel connected to your baby both during pregnancy and after delivery²⁴. If you feel that you may be experiencing signs of anxiety, talk to your provider.

Contact your provider for any of the following warning signs throughout your pregnancy:

  • Light spotting early in pregnancy can be normal, but contact your provider for any bleeding that resembles a period

  • Contractions & leaking of fluid

  • After 28 weeks, you feel your baby is not moving like normal (at least 10 times in 2 hours)

  • A fever higher than 100.4

  • A headache that does not improve after taking Tylenol, vision changes, or pain under your right ribs

🤸 Nicely done…you’re making this look easy! 🤸