Week 23
Your baby is about 27.8 cm (11 in) long from crown to heel and weighs about 430 g (15 oz), about the weight of a large mango. Every baby grows at their own pace, so treat these numbers as a rough guide. The lungs are building the branching airways they will need for breathing, and your baby now spends long stretches asleep, with clear spells of activity in between. For you, this is a week of practical medicine. Your glucose screening test is likely coming up soon, and it helps to know what it involves. This week also covers an important milestone, viability, and the signs of early labour that every pregnant person should know. It ends with a calm look at the baby gear you really need.
Day 155 · 22 weeks 0 days
Your baby has a rhythm of sleep and waking
Your baby spends most of the day asleep, perhaps as much as 90 percent of it at this stage. That sleep is not one long stretch. It comes in cycles, often 20 to 40 minutes long, sometimes longer, that alternate between quiet sleep and a more active sleep in which the eyes move under closed lids and the limbs twitch.
Between cycles come spells of wakefulness, when you are most likely to feel kicks, rolls and stretches. Over the coming weeks these patterns become more organized, and many parents notice a regular time of day when the baby is busiest.
That time is often the evening, or just after you lie down to rest. When you are up and moving, the motion tends to rock your baby to sleep. When you settle, the rocking stops and the baby stirs. A meal or a cold drink can also seem to rouse some babies, though the evidence for this is mixed. These rhythms are not linked to the day and night outside yet. A newborn's sleep is spread across 24 hours, and the body clock takes months to settle after birth.
Try this: For the next few days, jot down the times you notice your baby is most active, and see whether a pattern emerges.
Day 156 · 22 weeks 1 day
What to expect from the glucose test
Most care providers offer a test for gestational diabetes between 24 and 28 weeks. If you have risk factors, such as gestational diabetes in a past pregnancy, you may be tested earlier as well. The test measures how your body handles a measured dose of sugar.
There are two common approaches. In a one-step test, you fast overnight, have a blood sample taken, drink a very sweet glucose drink, and then have more blood taken after one and two hours. In a two-step approach, you first have a shorter screening test, usually without fasting: you drink a glucose drink and have one blood sample an hour later. If that result is high, you come back for a longer, fasting test to confirm.
Your care provider will tell you which version you are having and how to prepare. Follow any fasting instructions exactly, and ask whether you can take your usual medications that morning.
The drink tastes like very sweet, flat soda. Some people feel a little queasy or light-headed afterward. You will usually need to sit quietly in the clinic between blood draws, because walking around can change the result. Try this: Book your test if you have not already, and plan to bring water, a book and a snack for afterward.
Day 157 · 22 weeks 2 days
If you are diagnosed with gestational diabetes
Gestational diabetes affects somewhere between about 1 in 20 and 1 in 7 pregnancies, depending on where you live and how it is tested. It is more likely if you have a family history of type 2 diabetes, a higher body weight before pregnancy, gestational diabetes in a past pregnancy, or South Asian, East Asian, African, Middle Eastern, Hispanic or Indigenous ancestry. Many people with no risk factors also develop it.
A diagnosis is not your fault, and it is very manageable. Most people control it with changes to what and when they eat, along with regular activity such as a walk after meals. You will likely be shown how to check your blood sugar at home with a finger-prick meter. If diet and activity are not enough, insulin or another medication may be added; the options used are considered safe in pregnancy.
Keeping blood sugar in range lowers the chance of your baby growing very large, of a difficult birth and of low blood sugar in your newborn. You may have extra scans to check growth. Gestational diabetes usually goes away after birth, but it raises your risk of type 2 diabetes later, so a follow-up test after the baby arrives is important. Try this: If you are waiting on results, write down two or three questions you would want to ask, so you are ready either way.
Day 158 · 22 weeks 3 days
Understanding viability
Around this time, you may hear the word viability. It describes the point at which a baby born early has a chance of surviving outside the uterus with intensive medical care. In well-equipped hospitals, that point is now around 22 to 24 weeks.
At the edge of viability, the chances are hard to hear. Babies born at 22 or 23 weeks need intensive care for months, and many do not survive. Those who do are at higher risk of lasting health problems. The outlook improves sharply with each week. By 24 weeks, more than half of babies born in specialized centres survive, and by 28 weeks the large majority do. Most pregnancies continue well past this point. About 1 in 10 babies worldwide is born before 37 weeks, and only a small fraction of those arrive this early. Knowing about viability is not a reason to worry. It is useful background, because it explains why your care team takes signs of early labour seriously from here on.
If you have had an early loss before, this week can stir up strong feelings. That is understandable, and worth sharing with your care provider. Try this: Save the phone number of your hospital's labour and birth unit, or your care provider's after-hours line, in your phone today.
Day 159 · 22 weeks 4 days
Know the signs of early labour
Preterm labour means labour that starts before 37 weeks. Recognizing it early matters, because there are treatments that can delay birth or help prepare the baby's lungs if birth is likely. Early labour can be subtle and does not always hurt, so it is worth knowing the signs.
They include:
tightenings or contractions that come regularly, roughly four or more in an hour, even if painless
period-like cramps, low and dull, that come and go or do not ease a constant low backache that is new for you
pressure in your pelvis, as if the baby is pushing down a change in vaginal discharge, especially watery, mucus-like or blood-tinged a trickle or gush of fluid from the vagina
Braxton Hicks tightenings, which you read about last week, are irregular and settle with rest and fluids. Tightenings that keep coming, or any of the other signs, are different.
Get help right away if you notice any of these signs before 37 weeks. Call your care provider or labour unit, or your local emergency number if you cannot reach them. Do not wait to see whether it passes, and do not worry about wasting anyone's time. Being checked and sent home is a good outcome.
Try this: Read through this list with your partner or support person, so they know the signs too.
Day 160 · 22 weeks 5 days
Your bump is public now, but your body is still yours
Once a pregnancy shows, many people find that strangers, colleagues and relatives feel free to comment. Remarks about size, guesses about the sex, birth stories and advice can arrive unasked. Some people also reach out to touch the bump without asking.
You may enjoy some of this attention and find other parts intrusive. Both reactions are normal. Comments about whether you look big or small can sting, and they say nothing useful about your baby's health. Only your care provider's measurements do that.
It helps to have a few phrases ready. "I'd rather you didn't touch, thanks" is enough, said with a step back. "My care provider is happy with how things are going" can close a conversation about your size. You do not owe anyone an explanation of your choices.
Your own feelings about your changing body may also be mixed. Pride, wonder, discomfort and grief for your old shape can sit side by side. Talking about it with someone who listens without fixing can help. For your partner: If someone reaches for the bump or makes a comment that lands badly, step in kindly and change the subject. Afterward, ask how it felt, rather than assuming.
Day 161 · 22 weeks 6 days
You need less baby gear than the shops suggest
Baby stores and online lists can make it seem as if you need dozens of products. In the first weeks, a newborn needs very little: a safe place to sleep, clothes and a way to keep warm, diapers, a way to feed, and a safe car seat if you travel by car. Most of the rest is optional.
A short starter list might include a crib, bassinet or play yard with a firm, flat mattress; five to eight sleepers or bodysuits in newborn and three-month sizes; a few hats and a warm outer layer for the season; diapers and wipes or cloths; and a way to carry or wheel your baby. Feeding supplies depend on how you plan to feed, which you will think about in the coming weeks.
Second-hand clothes and many items are a great way to save money. Some items, though, need extra care. Cribs must meet current safety standards, with no drop sides and no missing parts. Car seats have their own rules and expiry dates, covered later in the book.
Waiting until after birth to buy extras lets you find out what your baby, and your home, actually need.
Try this: Start a shared list with three columns: need before birth, can wait, and could borrow.