20 Weeks Pregnant: Baby Development, Symptoms and Tips
Short Answer: At 20 week pregnancy, you are halfway. Your baby measures about 25 cm from head to heel, roughly the size of a banana, and weighs around 300 grams. Your baby is swallowing, sleeping in cycles, hearing your voice and moving a lot, and you are likely feeling flutters or kicks. The top of your womb has reached your navel, and your bump is visible. This is the week for the anomaly scan if you have not had it, the start of calcium supplements for many people and the time to learn the warning signs of pre-eclampsia and early labour. Call a doctor for heavy bleeding, severe pain, fever, fluid leaking, a severe headache with blurred vision or a clear drop in your baby’s movement.
Pregnancy weeks are counted from the first day of your last period, not from conception. Twenty weeks pregnant means about eighteen weeks since conception. You are in your fifth month with about 20 weeks to go. For the week before, read our guide to 19 weeks pregnant, for the next, 21 weeks pregnant, and to follow the whole journey see our pregnancy guidelines week by week.
Week 20 at a glance
| Detail | At 20 weeks |
|---|---|
| Trimester | Second, the halfway point |
| Months | About 5 |
| Baby’s length | About 25 cm (10 inches), head to heel |
| Baby’s weight | About 300 grams |
| Heart rate | About 120 to 160 beats per minute |
| Weeks to go | About 20 |
| Size comparison | A banana |
From this week, doctors usually measure your baby from head to heel instead of head to bottom, which is why the length jumps from about 15 cm at week 19. Your baby has not grown that much in a week.
Your baby at 20 weeks
Growth. Your baby is growing steadily, and from now the weight rises faster than the length. Over the next 20 weeks your baby will grow more than ten times heavier.
Swallowing and digestion. Your baby swallows amniotic fluid, and the gut is working. A dark, sticky material called meconium is building up in the bowel. It is usually passed after birth, as your newborn’s first stool.
Senses. The nerve cells for taste, smell, hearing, vision and touch are linking up in the brain. Your baby can hear your voice, heartbeat and loud outside noises, though they are muffled. The eyelids are closed, but your baby can sense bright light, and may turn away from a torch pressed against your belly. These responses are faint, so do not test them often.
Movement and sleep. Your baby is very active, with kicks, rolls, hiccups, yawns, stretches and thumb-sucking. Sleep cycles are developing, so your baby is often busy when you rest, especially in the evening. Movements get stronger over the coming weeks.
Skin. The skin is thin and see-through, but fat is building up underneath. Vernix, a white creamy coating, protects it, and fine lanugo hair covers the body. Fingernails reach the tips of the fingers. Hair on the head is growing.
Genitals and organs. In girls, the womb is formed and the ovaries hold millions of egg cells. In boys, the testicles are starting to move down. The lungs have branching airways but are not ready to breathe air. The kidneys make urine, which adds to the amniotic fluid. The heart is strong, and a sonographer can see all four chambers.
Bones and teeth. The bones are hardening, and tooth buds for baby teeth and permanent teeth are forming. Your calcium and vitamin D help.
Your body at 20 weeks
Womb. The top of your womb, called the fundus, has reached your navel. A tape measure from the pubic bone to the top of the womb usually reads about 20 cm at 20 weeks. Your doctor may measure this at each visit as a quick check of growth. A difference of up to 2 cm either way is normal.
Bump. Most people have a visible bump now. If it is your first baby, the bump may still be small, and your height, build and muscle tone affect how you show. Your navel may flatten or pop out. Both are normal and return to normal after the birth.
Weight. A person of normal weight usually gains about 0.4 to 0.5 kg a week. By now most people have gained about 4 to 6 kg in total, though it varies. Your doctor tracks yours at each visit.
Energy and appetite. Most people feel well, with good energy and appetite. You need about 300 extra calories a day. You do not need to eat for two.
Blood pressure and heart. Your blood volume has risen by up to 40 percent, and your heart works harder. Blood pressure often dips in the second trimester and can start to rise after about 20 weeks, so every visit includes a blood pressure check.
Breathing. The womb pushes up and hormones make you breathe deeper, so mild breathlessness is common.
Braxton Hicks. You may start to feel practice tightenings, when the belly goes hard for 30 to 60 seconds and then relaxes. They are usually painless and irregular, and they are more common later. Drinking water, resting and changing position help.
Mind. Vivid dreams, forgetfulness and mood swings are common. Many people feel closer to the baby now.
Feeling the baby move
The first movement is called quickening. It often feels like bubbles, flutters, a gentle tap or a swimming fish. It is easy to mistake for gas at first.
- People who have been pregnant before often feel it between 14 and 18 weeks.
- First-time mothers usually feel it between 18 and 22 weeks.
- An anterior placenta, which sits at the front of the womb, or a larger body size can delay it.
- At this stage movement is irregular, so do not worry if you feel it one day and not the next.
If you have not felt movement by about 24 weeks, tell your doctor at your next visit. You do not need to count kicks yet. Doctors usually advise paying attention to your baby’s pattern from about 28 weeks. If you notice a clear drop in movement later in pregnancy, call your doctor the same day, and do not wait until the next day or rely on a home Doppler.
The anomaly scan
The anomaly scan, also called the mid-pregnancy or 20-week scan, is the most detailed scan of your pregnancy. The usual window is 18 to 22 weeks, so if you have not had it, book it this week.
What it checks:
- The head and brain
- The face, including the lips
- The spine
- The four chambers of the heart and the major vessels
- The stomach, kidneys, bladder and bowel
- The abdominal wall
- The arms, legs, hands and feet
- The umbilical cord, which should have three vessels
- The position of the placenta, to rule out a low-lying placenta
- The amount of amniotic fluid
- The size of the baby
How it works. You lie on a couch, a sonographer puts gel on your belly and moves a probe over it. The scan takes 20 to 40 minutes. A full bladder is not usually needed, but check with your clinic. Wear a two-piece outfit so your belly is easy to reach.
The sex of the baby. The sonographer can often see it, but not always. If the baby is curled up or facing the wrong way, it can be hard. If you do not want to know, tell the sonographer before the scan starts. Some clinics have their own policy about telling parents the sex, so ask in advance.
What the results mean. Most scans are normal. No scan finds every problem, and some things show up only later in pregnancy or after birth. If the sonographer sees something unclear, you may be asked to come back in a week or two. That is common and not always a sign of a serious problem. If a problem is found, your doctor will explain what it means, what tests are available and what the options are. Ask questions, and ask for a written report. A low-lying placenta is common at this stage and often moves up as the womb grows, though you will usually need another scan later to check.
Common symptoms and what helps
| Symptom | Why it happens | What helps |
|---|---|---|
| Backache | Growing womb, loosening joints, posture | Flat supportive shoes, good posture, side-sleeping with a pillow, gentle stretches |
| Round ligament pain, a sharp pull in the lower belly or groin | Ligaments stretch as the womb grows | Move slowly, rest, warm bath |
| Leg cramps, mostly at night | Circulation and mineral changes | Calf stretches before bed, drink water, ask about calcium |
| Heartburn | Relaxed valve at the top of the stomach | Smaller meals, avoid spicy and oily food, stay upright after eating |
| Constipation | Slow gut, iron tablets | Fibre, water, daily movement |
| Stuffy nose, nosebleeds | More blood flow to the nose lining | Saline spray, a humidifier, lean forward and pinch the nose for a bleed |
| Bleeding gums | More blood flow to the gums | Soft brush, gentle flossing, dental check |
| Headaches | Hormones, tiredness, dehydration | Rest, fluids, ask your doctor before taking medicine |
| Dizziness | Blood pressure changes, low blood sugar | Eat regularly, stand up slowly |
| Swollen feet and ankles | Fluid retention | Raise your feet, avoid long standing |
| Itchy, stretching belly skin | Skin stretching | Moisturiser, loose cotton clothes |
| Increased vaginal discharge | Hormones | Cotton underwear, no douching |
| Hip and pelvic pain | Loosening joints, sleeping position | Pillow between knees, change position often |
| Mild breathlessness | Growing womb, hormones | Rest, good posture |
| Braxton Hicks tightenings | Practice contractions | Drink water, rest, change position |
Do not take any medicine, including painkillers and herbal products, without asking a doctor or pharmacist. Paracetamol at the recommended dose is generally considered safe. Avoid ibuprofen, aspirin and diclofenac unless your doctor prescribes them.
Warning signs to know
| Usually normal | Call a doctor soon |
|---|---|
| Short, sharp pulls in the lower belly | Severe or constant abdominal pain |
| Mild, irregular tightenings that stop with rest | Regular tightenings that come more often and do not stop |
| Milky white discharge | Watery fluid leaking, or foul, itchy or coloured discharge |
| Occasional headache | Severe headache with blurred vision, flashing lights or upper belly pain |
| Tiredness, mood swings | Fainting, chest pain or sudden breathlessness |
| Mild swelling of feet late in the day | Sudden swelling of the face and hands |
| Light spotting after sex | Bleeding that soaks a pad in an hour, or with clots |
| Occasional nosebleed | Any fever, burning urination or pain in one calf |
Pre-eclampsia. After 20 weeks, a serious blood pressure condition called pre-eclampsia can develop. Signs include a severe headache that does not go away, blurred vision or flashing lights, sudden swelling of the face and hands, pain under the ribs on the right side, vomiting and rapid weight gain. It needs urgent care. Your blood pressure and urine are checked at every visit for this reason.
Preterm labour. Call straight away if you have regular tightenings, a steady low backache, pelvic pressure, a change in vaginal discharge or fluid leaking before 37 weeks.
Fever. In Bangladesh, a fever can also mean dengue, so do not treat it at home. See a doctor straight away.
If you feel sad, anxious or hopeless for more than two weeks, tell your doctor. If you ever have thoughts of harming yourself, seek help right away.
Prenatal visits and tests from here
The World Health Organization recommends at least eight contacts with a health professional during pregnancy. Many doctors see you every four weeks until about 28 weeks, then every two weeks, and weekly near the end. Each visit usually checks your blood pressure, weight, belly size, urine and your baby’s heartbeat.
| Test or step | When | What it does |
|---|---|---|
| Anomaly scan | 18 to 22 weeks | Detailed check of your baby’s organs and growth |
| Hemoglobin check | Every trimester, or as advised | Looks for anaemia |
| Glucose test | 24 to 28 weeks | Screens for gestational diabetes |
| Anti-D injection | About 28 weeks, if you are Rh negative | Protects future pregnancies |
| Whooping cough vaccine | About 27 to 36 weeks | Protects your newborn |
| Tetanus-diphtheria vaccine | During pregnancy, as your doctor advises | Protects you and your baby |
| Flu vaccine | Any trimester, in flu season | Protects you |
| Growth scan | Later, if advised | Checks your baby’s size and fluid |
The glucose test. Gestational diabetes is common and usually has no symptoms. It is checked with a sugar drink and a blood test, usually at 24 to 28 weeks, or earlier if you have risk factors such as a family history, a past large baby, obesity or polycystic ovaries. Ask your doctor how to prepare, such as whether to fast. If you have gestational diabetes, a change in food and exercise controls it for most people.
Calcium, iron and food
Calcium. The World Health Organization advises calcium supplementation from about 20 weeks in places where people’s diets are low in calcium. Calcium helps your baby’s bones and teeth and lowers the risk of high blood pressure in pregnancy. Ask your doctor about a supplement and the right dose. Take it at a different time from iron, because they compete for absorption.
Iron. Keep taking iron-folic acid tablets as prescribed. Take iron away from tea, coffee and milk, and with something sour such as lemon, to help absorption.
Eat more of:
- Protein: eggs, well-cooked fish, chicken, lentils (dal), beans and milk
- Iron-rich foods: leafy greens (shak), lean meat and lentils, with lemon or guava for vitamin C
- Calcium-rich foods: milk, yogurt, and small fish such as mola eaten with the bones
- Fruit and vegetables: a variety of colours every day
- Whole grains and fibre: brown rice, whole wheat roti and oats
- Healthy fats: well-cooked oily fish, nuts and seeds
- Water: about 8 to 10 glasses across the day
Limit: caffeine to about 200 mg a day, which is one or two cups of tea or a single small coffee. Limit sugary and fried snacks, sweets, juice and soft drinks, which raise the risk of gestational diabetes.
Avoid: alcohol, all tobacco (including zarda and jorda), raw or undercooked meat, fish and eggs, unpasteurized milk and cheese, unwashed produce, large predatory fish such as shark and swordfish, high-dose vitamin A supplements, unripe papaya and herbal tonics your doctor has not approved.
Weight gain. Total gain over the whole pregnancy depends on your weight before pregnancy, and Asian-specific BMI ranges may apply, so ask your doctor.
| Weight before pregnancy | Recommended total gain |
|---|---|
| Underweight | 12.5 to 18 kg |
| Normal weight | 11.5 to 16 kg |
| Overweight | 7 to 11.5 kg |
| Obese | 5 to 9 kg |
Sleep, exercise and posture
Sleep. Many doctors advise side-sleeping from about 20 weeks, because the womb can press on the large blood vessels when you lie flat on your back, and guidelines agree on it by 28 weeks. Sleep on your side, ideally the left, with a pillow between your knees and another under your belly. A long body pillow helps. If you wake on your back, simply turn over. Keep a regular bedtime and avoid screens at night.
Exercise. The standard advice for healthy pregnancies is about 150 minutes of moderate activity a week, such as 30 minutes of brisk walking on most days. Swimming, prenatal yoga, stationary cycling and pelvic floor exercises are good choices. You should be able to talk while you exercise. Avoid lying flat on your back during exercise, contact sports, heavy lifting and anything with a risk of falls. Stop and call your doctor if you have pain, bleeding, dizziness or trouble breathing.
Pelvic floor. Squeeze and lift the muscles you use to stop urine flow, hold for a few seconds and release. Do a few sets a day. Strong pelvic floor muscles help with bladder control during and after pregnancy.
Posture. As your belly grows, your centre of gravity shifts forward. Stand tall, keep your shoulders back and avoid high heels. Use a chair that supports your lower back, and lift by bending your knees.
Staying healthy in Bangladesh
Dengue. Dengue spreads by mosquito bites and is a real risk, especially during and after the monsoon. It can be serious in pregnancy. Remove standing water around your home, use a mosquito net and a pregnancy-safe repellent, wear long sleeves and see a doctor straight away for any fever. Do not take ibuprofen or aspirin for fever unless your doctor says so.
Heat. Hot and humid weather can dehydrate you and cause dizziness. Drink water through the day, wear loose cotton clothes, rest in the shade and avoid long hours in direct sun.
Food and water. Drink boiled or filtered water, wash produce, cook food all the way through and avoid street food from places where hygiene is uncertain.
Anaemia. Anaemia is common among pregnant women in South Asia. Take iron as prescribed, eat iron-rich foods and ask for a hemoglobin test each trimester.
Care options. Government community clinics and upazila health complexes offer prenatal checks, iron-folic acid tablets and tetanus vaccination at no cost or low cost, and district and medical college hospitals provide scans, delivery and emergency care. If you use a private hospital, ask for a written estimate that includes tests, delivery and complications.
Safety at home. If you feel unsafe at home, tell your doctor or a trusted person. In Bangladesh you can call the national helpline 109 for support with violence against women and children.
Planning the second half
Halfway is a good time to look ahead.
- Maternity leave. Under Bangladesh’s labour law, working mothers in the private sector are entitled to 16 weeks of paid maternity leave, eight before and eight after the birth. Government employees receive six months. Check your own contract and plan when to tell your employer.
- Place of birth. Choose a hospital or clinic with a qualified doctor or midwife, a way to handle emergencies and a blood supply. Ask what the delivery package covers and what an emergency would cost.
- Mode of delivery. Many births in Bangladesh are by C-section, and some are not medically needed. Ask your doctor when a C-section is recommended and what a vaginal birth involves.
- Transport. Plan how you will reach the hospital at any hour, and keep emergency numbers handy.
- Money. Start a simple budget for prenatal care, delivery and baby costs.
- Classes. Ask about classes on labour, breathing, newborn care and breastfeeding.
- Support. Decide who will be with you in labour and who will look after children or the home.
- Baby shopping. You do not need to buy anything yet. Make a list, and wait for sales, hand-me-downs and advice from other parents.
- Partners. Come to appointments if you can, share chores and listen. Talk about names, birth plans and parenting.
Checklist for this week
- Book your anomaly scan if you have not had it, and decide whether you want to know the sex
- Ask about calcium and when to start it
- Ask for a hemoglobin test and blood pressure check, and take iron-folic acid as prescribed
- Ask about the glucose test, anti-D, the tetanus-diphtheria vaccine and the flu vaccine
- Learn the signs of pre-eclampsia and preterm labour, and know who to call
- Check your home for standing water and use mosquito protection
- Switch to side-sleeping and buy a long body pillow
- Start or keep up a daily walk and pelvic floor exercises
- Book a dental check
- Save your doctor’s number and the nearest hospital’s emergency number
FAQ
How big is the baby at 20 weeks?
About 25 cm from head to heel and 300 grams, roughly the size of a banana. Sizes vary a little between babies.
Is 20 weeks halfway through pregnancy?
Yes. A full-term pregnancy is about 40 weeks counted from your last period, so week 20 is the halfway point.
Can I feel the baby move at 20 weeks?
Many people do. First-time mothers usually feel the first movement between 18 and 22 weeks. Tell your doctor if you have not felt anything by about 24 weeks.
Why is the baby’s length bigger this week?
From week 20, babies are measured from head to heel, not head to bottom, so the number jumps. Your baby has not grown suddenly.
What is the 20-week scan?
The anomaly scan, a detailed ultrasound at 18 to 22 weeks that checks your baby’s organs, spine, limbs, face, heart, placenta and amniotic fluid. It cannot find every problem, but it finds many.
Can I find out the baby’s sex at 20 weeks?
Often yes, if the baby is in a good position. It is not always possible. Tell the sonographer if you do not want to know.
Is it normal to have a small bump at 20 weeks?
Yes. First-time mothers often have a smaller bump. Your doctor measures the height of your womb to check growth.
What is pre-eclampsia?
A serious condition that can develop after 20 weeks, with high blood pressure and protein in the urine. Warning signs include a severe headache, blurred vision, sudden swelling and pain under the ribs. It needs urgent care.
Is it safe to exercise at 20 weeks?
Yes for most healthy pregnancies. Walking, swimming, gentle yoga and pelvic floor exercises are good. Avoid contact sports, heavy lifting and lying flat on your back during exercise.
Note: This article gives general information and does not replace advice from your doctor or midwife. Every pregnancy is different. Call your doctor or go to a hospital if you have bleeding, severe pain, fever, fainting or any symptom that worries you.
