Overview: Pregnancy

Introduction

Giving birth to a child is often one of life’s most intense experiences. And the nine months of pregnancy are an exciting time for many women and their partners. They may find their feelings ranging from joy and hope to worries and fears: How will everything go? Am I doing things right? How will life change once the baby has arrived?

From conception to birth, a woman’s body goes through a number of astonishing changes as it prepares to carry and grow a new life. Yet these changes may be associated with problems typical of pregnancy, such as nausea and back pain, and can sometimes include diseases, like gestational diabetes. Regular screening tests are offered free of charge to detect any more serious issues. Most pregnancies don’t involve any complications, though, and a healthy child is born.

At a glance

• Your entire body changes during pregnancy, and adjustments need to be made in your everyday life as well.
• In Germany, all pregnant women are entitled to regular screening tests free of charge.
• These tests are used to check the child’s development and the mother’s wellbeing.
• Most pregnancies come to term without complications.
• But there may be difficult situations and decisions to make – like dealing with abnormal findings arising during prenatal testing.
• You can find support from pregnancy advice centers.

Signs of pregnancy

A pregnant woman will stop getting her monthly period. Many women also feel that their body is changing shortly after conception. Signs of being pregnant may include:

• Tension in the breasts
• Abdominal discomfort
• Nausea and vomiting in the morning (“morning sickness”)
• Food cravings
• Increased urge to pee
• Bloating and constipation
• Tiredness
• Dizziness

These kinds of changes could have other causes, so they aren’t to be taken as definitive proof. A pregnancy can be confirmed starting on the day after you don’t get your period by testing your urine using a home pregnancy test. These tests are available over the counter in pharmacies and drug stores. You can also have a pregnancy test done by a doctor or a midwife. You will typically have to pay for the test yourself. The embryo is visible in ultrasound starting in about the sixth week of pregnancy.

Outlook

The average length of a pregnancy is 40 weeks, so just over nine months. The weeks of a pregnancy are counted starting on the first day of your last period.

In early pregnancy, the physical changes are hardly noticeable. Skin may appear rosy because of increased circulation of blood. But most pregnant women notice that their body is changing: Many of them feel tired faster, their appetite changes, their breasts feel tender, and they may feel nauseous, especially in the morning (“morning sickness”).

Hormonal changes often influence a woman’s emotions, particularly in the first three months of pregnancy. Women might react more sensitively than they otherwise would, and and their mood can change more frequently. It is not always easy to adjust to the new challenges that lie ahead – especially if the pregnancy wasn't planned.

The second third (typically called a “trimester”) of pregnancy is often the most pleasant for women. Their body has now completely adjusted to the pregnancy, but the size of their belly and their body weight are still not too much of a problem in everyday life. Most women start feeling emotionally balanced again, and some develop a special energy and feel good in their body. At this point the child’s movements are usually quite noticeable.

During the final trimester, the child matures quickly, and gets bigger and heavier. About four weeks before birth it usually turns so that its head is pointing down into a birthing position. Towards the end of the pregnancy, most women have problems associated with their growing belly, and everyday tasks gradually become more difficult. In the last few weeks, the focus of pregnancy shifts to the upcoming birth – women may start feeling more excited about, but also more daunted by, what is about to happen. Contractions are a sign that the birth is drawing closer.

Screening

Pregnant women can have regular screening tests free of charge from their gynecologist or midwife. These are initially available on a monthly basis, and then every 14 days in the final two months of pregnancy. These tests are done to check that the mother-to-be is staying healthy and whether the baby is developing normally. The standard tests include feeling the tummy and regularly taking blood. The blood can be tested to find out things like the baby’s blood group and rhesus factor, and whether it is protected from rubella. A test for gestational diabetes can also be carried out.

Gynecologists offer an ultrasound scan as a check-up around the 10th, 20th and 30th weeks of pregnancy. They then look at things like how the unborn baby is growing and how its organs are developing. The ultrasound also shows the position of the baby and the placenta. Further ultrasound examinations may be done if any abnormalities are found. The results of the standard examinations are noted in your maternity records.

Prenatal diagnostics

Prenatal (before birth) diagnostic testing is carried out to detect certain abnormalities or malformations in the unborn baby. The standard ultrasound images can also show signs of problems, but they are not used to specifically look for them. The prenatal diagnostic testing is not part of the standard screening tests and is only covered by statutory health insurers in certain cases.

Doctors are required to inform you about the purpose, the accuracy and the possible consequences of these tests. It is important to consider: Prenatal testing can have far-reaching consequences. It can be helpful, but it can also be unsettling.

Prenatal diagnostic examinations can sometimes provide clarity if other examinations have found abnormalities. In Germany, statutory health insurers cover the costs of some of these examinations. They include certain non-invasive prenatal tests (NIPTs), further ultrasound scans, amniocentesis (amniotic fluid tests), and chorionic villus sampling (CVS). The statutory insurers usually don’t cover other tests, such as the commonly offered first trimester screening (FTS).

Women and couples can get information and advice about these tests at a doctor's office or centers for gynecology, prenatal diagnostics or human genetics. Psychosocial counseling for pregnant women can also be helpful.

Everyday life

Everyday life also changes over the course of a pregnancy: Preparing for the arrival of the new baby takes up quite a bit of time. Most pregnant women notice that it takes them longer to do everyday tasks, and working women go on maternity leave towards the end of the pregnancy. It is a good idea to plan ahead of time where the child will be born and who will be present at the birth.

It is common for women to pay more attention to their health than they used to. This includes thinking about questions related to nutrition and exercise: What should I eat, and do I need to take dietary supplements? How much weight gain is still considered normal? Can I continue to do sports and, if so, what do I need to consider? The regular screening appointments are a good opportunity to discuss these issues – as well as to ask about preparing to breastfeed.

Because alcohol and nicotine can cause serious harm to the unborn child, the vast majority of women don't drink alcohol or smoke during pregnancy. Many women use a planned pregnancy as an occasion to give up smoking. Smoking during pregnancy increases the risk of things like miscarriage, preterm birth and low birth weight. But it's not always easy for women who smoke to quit, and a lot of them will need help doing so.

Pregnancy-related problems

Some women feel fully healthy in pregnancy, and some feel even healthier than ever before. But many have typical problems associated with pregnancy. These tend to change over the months: Nausea is a common problem at the start. Later on, as more weight is gained, problems may include back pain, heartburn, water retention, varicose veins, having to go to the toilet a lot, or sleep problems.

Because these problems are often seen as being associated with a larger positive change, and they usually go away without treatment, most pregnant women cope well with them. Pregnancy-related problems can often be relieved by taking more breaks to rest, reducing stress and using home remedies. Your midwife or doctor can offer you advice on this.

Illnesses

Some medical conditions, such as pre-eclampsia or gestational diabetes, only develop during pregnancy. And other illnesses are more common during pregnancy, such as anemia or bladder infections (cystitis).

Some contagious diseases like rubella, genital herpes or a streptococcal infection are usually harmless for the mother, but can be dangerous for the child.

It is important to talk with your doctor about whether any medical conditions that you already have need to be treated differently during the pregnancy. That will depend on the specific illness. Medication, such as asthma medication, can typically still be used. But some medications increase the risk of complications during the pregnancy or they aren’t tolerated well. You can find out from your doctor whether there are alternatives available or whether you can go without the treatment while you are pregnant.

Unplanned pregnancy

If the pregnancy is unplanned, the following questions may arise: Do you (still) want to have a baby? Do you have a supportive relationship, family and workplace? Do you have the strength and financial resources for bringing up a child?

Depending on your answers to these questions, an abortion may be an option. Some women arrive at a decision rather quickly. For others, the choice poses a serious dilemma. Getting professional advice on this topic can help you make a decision that is right for you. In Germany, you can do this free of charge and, if you prefer, anonymously. The German Federal Centre for Health Education (BZgA) offers detailed information and locations for getting advice.

Further information

A lot of information (in German) about pregnancy, childbirth, and the time afterwards can be found at Familienplanung.de (BZgA). The section on pregnancy provides answers to many questions about the course of pregnancy, early childhood development, screening tests, childbirth and the time after birth.

Sources

• Bundeszentrale für gesundheitliche Aufklärung (BZgA). Familienplanung​.de. 2022.
• Gemeinsamer Bundesausschuss (G-BA). Mutterschaftsrichtlinien (Richtlinien über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung). 2022.
• Rath W, Gembruch U, Schmidt S. Geburtshilfe und Perinatologie: Pränataldiagnostik - Erkrankungen - Entbindung. Stuttgart: Thieme; 2010.
• Weyerstahl T, Stauber M. Duale Reihe Gynäkologie und Geburtshilfe. Stuttgart: Thieme; 2013.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.