My second trimester was hard at the beginning and the end, but I had a few sweet days somewhere in the middle. There weren’t nearly as many good days compared to the honeymoon phase of my first pregnancy. Like many other moms, I’ve found my second pregnancy to be harder overall.
Related: The First Trimester With My Second Baby.
It’s been tougher because of more severe and frequent pregnancy symptoms on top of taking care of a toddler while pregnant. It’s also been a challenge to work in all my doctors’ appointments during a pandemic where I can’t bring anyone with me to the OB visits. In this post, I’m going to cover my medical care, my symptoms, and how I’m managing my lupus and chronic pain in the second trimester.
Second trimester medical care.
During my second trimester, I was seeing my OB every four weeks so I had three appointments. That wasn’t too bad and they were all pretty simple – check vitals for me and baby and then answer my questions.
I saw my maternal-fetal doctor twice during the second trimester and at the 18 week visit had the full anatomy scan and found out more about baby.
My two-year-old was sporting his blue dress shirt to celebrate his BROTHER!
At my 26 week ultrasound baby was super uncooperative and I only really got to see his feet. But that’s okay. I had the same amount of pregnancy-related appointments in the second trimester as in the first, but I had a lot of appointments for other medical reasons which made it more difficult to fit everything into my schedule.
Managing my lupus and chronic pain.
I had to temporarily stop my immunosuppressant right before my second trimester started, and then pick it back up again at a quarter-dose and then half-dose (there are more details on that in the first trimester post). Unfortunately, this decrease in medication immediately caused the inflammation in my eyes to flare up. My existing inflammatory eye lesions became more out of control and I started to experience something called a corneal melt. It’s pretty much as bad as it sounds.
My eye doctor was very concerned about my eyes and even had me come in to see him right after Christmas to check them. This was at 16 weeks of pregnancy. I never responded to steroid eye drops but thankfully we had already started immunosuppressant eye drops a month earlier to treat the ongoing eye lesions. Those drops take eight weeks to start working and the fact that I had already started them before the corneal melt started may very well be the only thing that kept me from having permanent damage done to my cornea.
As you can imagine, this entire situation left me quite unnerved. While we had no proof that my lupus was actively attacking my eyes, my eye doctor felt certain that a systemic autoimmune disease was behind the corneal melt. So, when I traveled to Duke to see the specialty rheumatologist at 20 weeks of pregnancy, I brought up my concerns about what happened to my eyes after lowering my lupus medication.
The doctor’s response was to send me to an eye doctor at Duke to have my eyes checked out. I thought this was a good plan of action, but unfortunately, it turned out to not be helpful at all.
It’s no easy task to travel to Duke – it’s a little over two hours away and my husband has to take most of the day off of work to drive me. We also have to arrange childcare or bring our two-year-old along. We were only able to get an early morning appointment with the eye doctor, so we chose to stay at a hotel nearby the night before instead of leaving our home at 5:30 am.
One good thing that came from the visit? These pancakes.
Not eating out because of COVID was really getting to me by this point and it was nice to have an opportunity to order room service. This was our first hotel stay since COVID started and it felt safe and clean.
I spent a long time getting my eyes checked out by the staff at the Duke Eye Clinic, but I had largely recovered from the corneal melt at this point. It had been two months since it appeared and I’d been on the immunosuppressant eye drops for three months.
When it came time to see the doctor, she barely glanced at my eyes and my history before saying everything looked fine and to keep doing what we’d been doing. Which is fine, but why did I need to travel to Duke to be told that? She could have at least given me a little more feedback about what had been going on with my eyes over the previous six months.
Furthermore, the rheumatologist had told me that the eye doctor partnered with rheumatology and would be able to advise them on the best medication to keep my issues under control long-term. Well, this turned out to be completely untrue. She did recommend medication, but it was the same one I had been advised to start last year before I became pregnant, and there was no insight into the autoimmune cause behind the eye symptoms. So this visit was a waste of our money and time. I felt misled and exasperated.
Things got more frustrating when I returned to the specialty rheumatologist early in my third trimester. I thought that we would choosing my next medication after I visited the eye clinic, but I was flat out refused another treatment for my eye inflammation and joint pain. The doctor told me I could take steroids (I really can’t take them at an effective level, but that’s another topic) and that she would provide me with an antidepressant to start pretty much right after giving birth.
I did not react well to this because I’m not currently suffering from depression, I have never done well on antidepressants, and I don’t think they are the right treatment for inflammation and autoimmune pain. It’s very important to keep autoimmune conditions under control during pregnancy, especially during the third trimester when they are most likely to cause issues. I was beyond frustrated that my disease activity wasn’t being addressed and furious that we had wasted so much time traveling to Duke to end up with nothing. I also felt completely panicked about my lack of treatment options as I neared the end of pregnancy – how will I care for my newborn during postpartum?
My ongoing search for better disease management.
My flare up of joint pain began in February when I was 22 weeks along. It manifested the way it always does – as increasing joint pain and tenderness in my hands, fingers, and elbows. Sometimes my knees and ankles chime in. When the pain began, I had been off my regular dose of immunosuppressant (azathioprine) for 10 weeks, so it seemed rather obvious to me that lupus was being given free rein over my body again.
This specific kind of joint pain, particularly in my fingers, has haunted me throughout my lupus journey – it was the first and most severe symptom I had and it’s continued to flare up over the years whenever my symptoms aren’t controlled. The last time it happened was June 2020 and I was put on Benlysta to treat it (which I failed) but even the brief two months on Benlysta seemed to have kept it at bay for quite some time.
I had emailed the rheumatologist from Duke right away when the joint pain appeared and was told to take Tylenol and use heat or ice as needed. Fellow chronic illness people, let’s all take a moment to roll our eyes and take a deep, calming breath.
So I brought it up again in person at my third trimester visit, paired with my concerns over my eye inflammation, and was pretty much told to go home and suffer because she felt it was only a fibromyalgia flare. There’s more to the story, but, while I certainly think there is a clearer autoimmune link to my symptoms, her lack of compassion is what really got to me.
I explained to her that I was unable to use my hands for important tasks – like opening a pill bottle or putting my son in his car seat. It had been eight weeks since the pain began and it was only getting worse. But the doctor referenced my “good” labs as a reason to not prescribe disease modifying drugs and didn’t seem interested in my serious quality of life issues, which made me feel abandoned.
At this point, I started kicking myself for going off the immunosuppressant without insisting that we put something else in place right away. I know better. I remember what my life was like before I started taking that medication.
Things just kept getting worse since the first week in February when my hands started hurting. It’s now late April and I can barely type on my computer or use my hands to push my pregnant self out of bed. I keep thinking they can’t get worse and yet they do – every week. They are even starting to get stiff, which isn’t typical for me, and no one will ever convince me that the severity of my joint pain is from fibromyalgia alone. (Unless, maybe, some discovers an autoimmune link within fibro.)
Thank goodness I have another doctor to turn to. I took my concerns to my regular rheumatologist and was met with kindness and a willingness to act. One thing I love about her is that she will always look for a way to treat horrible symptoms, even if there isn’t a clear link to active autoimmune disease (which can be tricky, especially since many are seronegative).
I honestly don’t know what I would do without that doctor – her compassion is saving my sanity right now. Since this is an ongoing issue as I’ve gone from the second trimester into the third, I’ll save more of the details for my blog post about the third trimester.
Second trimester pregnancy symptoms.
Pelvic joint dysfunction: What I thought was sciatica pain turned out to be symphysis pubis dysfunction (SPD). The pain was similar to what I experienced in my first pregnancy, but there are some nuanced differences. For one, SPD happens when the ligaments in your pelvis loosen – in preparation for birth – too much and too early. The pain is lower in the pelvic region and primarily on my left side compared to the lower back pain of sciatica in my first pregnancy.
The SPD appeared around 21 weeks and by 24 weeks it was so intense I was unable to walk, stand, bend, or roll over in bed at times. After trying sciatica stretches on my own for a while (they didn’t help – this is why it’s best not to self-diagnose!) I finally saw a physical therapist at 27 weeks who sent me straight to women’s health because he said it wasn’t sciatica. Well, he was right.
Thankfully, I’ve been able to strengthen the muscles around the ligaments, which compensates a bit for their looseness. This lessened the pain overall, but it still flares up if I’m not careful. I have to avoid sitting as much as I reasonably can, especially sitting upright or leaning forward on hard surfaces. The pain can flare up quickly in those circumstances and become unbearable. It’s been difficult to work, drive, and sit on the floor to change my son. This pain doesn’t necessarily resolve after pregnancy, at least not right away, but there are many treatments available after the baby is born.
Pressure: I’m not sure if this baby is lower or if it’s just because he’s bigger, but I feel a lot of pressure in my pelvic area. According to the OB, this is part of the reason why the SPD pain can be so bad – because baby is pushing into the area. He was head down and very low at my 26 week ultrasound, too low to get a photo of his face and certainly low enough to pummel my bladder relentlessly.
I felt so much pressure while walking and standing that I was concerned about premature labor. The doctor said it’s fine and common in second pregnancies, but it was new and a little unnerving for me.
Nausea: Unfortunately my nausea stuck around for my second trimester and stayed pretty bad through the 18 week mark. It would come and go after that and was usually mild or more of a food aversion than nausea. I seemed to be on a rotating schedule where I’d be a little nauseous, then that would improve but I’d feel like my stomach was too squished to even drink water, and then randomly I’d experience outrageous, endless hunger and eat a whole pizza without feeling full. Pregnancy is weird.
Restless legs: My lower legs and feet hurt so much I can barely stand it. About halfway through the second trimester, the pain became an all-day and all-night sensation. I continued taking magnesium supplements, attempting walks (which is difficult due to the pressure issue), taking lots of baths, and using compression boots. I also purchased magnesium cream to rub on my legs at night, although I hate the stuff because it’s oily/waxy/buttery/whatever and ruined some of my sheets. I can’t stand the texture and the way it gets on everything (honestly I might have to replace all of my bedding after this is over) but yet I’m grateful for it because it’s better than the pain from restless legs.
Additionally, I upped my iron supplementation at my doctor’s recommendation. I’m always anemic, even more so during pregnancy, and low iron levels can make restless legs worse. It did help significantly, but then I had to suffer some unpleasant side effects from my iron tablets. Again, it was better than the alternative.
I got a referral to neurology because the pain was so constant, but they weren’t able to fit me in until two months after I have the baby. I didn’t take the appointment because my restless legs went away after my last pregnancy. But I surely do wish there was more understanding and treatment for restless legs in pregnancy!
Cramping: As I neared the end of the second trimester everything was ready to cramp at the drop of the hat. When I woke up and stretched at night my calves would immediately start to cramp, but if I stopped stretching they would stop (I don’t expect this to last – the middle of the night Charlie horses are coming). My feet cramp easily and I can feel muscle aches building throughout my body. My hips and muscles along the sides of my torso are prone to cramping as well. I don’t know why this happens even when I stay hydrated and get plenty of minerals (like potassium, calcium, and magnesium) but it is mega annoying. I suppose it’s just the stage of pregnancy and increased demands on my muscles.
Swelling: everywhere! Some days I feel like a balloon and it’s painful. My feet are starting to swell up, which didn’t happen in my first pregnancy. They hurt and some days I can only stand for a few minutes at a time. This symptom comes and goes in my feet, but my hands stay swollen. Although, my untreated lupus is likely contributing to the swelling in my fingers.
Shortness of breath: I said goodbye to this symptom for a very brief period early in the second trimester but it came right back around 20 weeks. That’s the same time frame where I had to stop sleeping on my back (the weight of the baby compresses a major blood vessel), so if I accidently rolled onto my back in my sleep I’d wake up gasping for air. The shortness of breath with exercise (even slower walking) is no surprise but what really gets me is when I’m lying down on my side and suddenly can’t breathe anymore, and I have to sit up to get a good breath. It’s strange and I don’t remember it happening in my first pregnancy.
Movement: This baby is totally different from my first one. He doesn’t kick me to the point of tears, in fact, he doesn’t kick very hard at all. He mostly bounces, or at least I think that is what he is doing. I’m not sure if my first son was just unusually strong or if I’m not able to feel this baby’s movements as clearly (I’m certainly more distracted), but it’s a much calmer sensation overall.
Other: I still have some abdominal pain, likely round ligament pains, but they aren’t nearly as bad as the first time around. Though sometimes they hit me hard when I’m rolling over or getting up.
For the first half of the second trimester, I had some intense irritability. It was bad. I even started to wonder if I was suffering from prenatal rage. I just could not reign in my anger and I felt bad for my poor husband. Thankfully it has chilled down to just regular pregnant woman irritability, which is much easier to handle and less explosive.
At 24 weeks my son brought home a cold from preschool and it was brutal. All of us struggled with it but I think it knocked me down even more due to immunosuppression from pregnancy and lupus. It took almost three weeks to recover and I lost a lot of momentum. I also had an asymptomatic UTI, which we discovered after routine lupus blood work. I’m glad we found it because UTI’s can be problematic during pregnancy and now I’m a little paranoid that I may be having recurrent ones – the whole lack of symptoms thing makes it hard to tell, of course.
At 20 weeks was about the size I was at 30-35 weeks last time. I had nearly outgrown all my old maternity clothes from my first pregnancy by the end of the second trimester. I don’t want to invest in much clothing at this point though, so I may be dressed a little strange for this last stretch.
My fatigue has been pretty light overall, at least compared to how bad I know it can and probably will get. While a lot of women tend to suffer from these pregnancy related symptoms in the second trimester, it’s so much harder because I’m also dealing with lupus and chronic pain. I can’t manage my health issues the way I can outside of pregnancy, plus I have to deal with all sorts of new issues at the same time.
I have struggled a lot with being unable to find adequate solutions for my lupus and issues from my pregnancy. It’s just too much sometimes. Plus, I keep getting punched in the bladder which is just unfair.
Like in my last pregnancy, I’m ready to stop sharing my body with another person all the time. All the time. There is never a single moment where I’m not pregnant – there’s no break from it oncesoever. I’m ready for a break. Newborns aren’t easy, but at least you can step away from them once in a while.
Looking forward to meeting baby soon.
Overall the second trimester proved to be a more trying time for me than I expected. It’s usually thought to be the easiest trimester and that was true for my first pregnancy but the second pregnancy has brought new and more difficult issues.
Plus, the resurgence of my joint pain around 22 weeks has caused significant problems. If I had been able to keep that pain under control then my second trimester wouldn’t have been nearly as difficult. The pain kind of bleeds into every aspect of my life and multiplies other pain issues.
Plus, I have had to deal with the fear of not being treated promptly for the joint pain, because I know it takes weeks to get a lot of medications approved by insurance and months for them to become fully effective. We simply don’t have that much time before we will be meeting baby.
But meeting baby is something we’re very much looking forward to, he’s taken us on quite a journey so far!
Up next: Read about my third trimester.
My Second Trimester: I’m Not Having a Good Time! All about the complexities of managing #lupus during my second pregnancy. Click To Tweet
