Pregnancy Physiology & When Pregnancy Goes Wrong
The Night 1 lecture deck. Use the inline viewer below or download to your device for offline review.
Join the Night 1 Teams Meeting
Opens Microsoft Teams in a new tab · 5:30 – 8:00 PM CST
Night 1 curriculum overview
Read through tonight’s structure, learning objectives, timing, and reference material below. Lecture slides are at the bottom of the page.
Online Night 1 · 5:30 PM to 8:00 PM CST · Microsoft Teams
Pregnancy Physiology
& When Pregnancy Goes Wrong
To support a pregnant person well, you need to understand what their body is actually doing. Tonight you build that foundation, and then you learn when something goes wrong and what to do about it.
By the End of Tonight, You Will Be Able To
- Explain the physical and emotional changes that occur during each trimester of pregnancy
- Offer evidence-based comfort strategies for the most common pregnancy discomforts
- Describe major prenatal tests and your role in supporting clients through them
- Describe the doula's role during the prenatal period, including scope of practice
- Recognize the warning signs of preeclampsia and other complications requiring immediate attention
- Practice advocacy language for when a client's concerns are minimized or dismissed
- Describe the impact of racial health disparities on maternal outcomes in Louisiana
Tonight at a Glance
| 5:30 PM | Welcome, Introductions & Housekeeping | 15 min |
| 5:45 PM | Normal Pregnancy: Physiology & the Doula's Role | 45 min |
| 6:30 PM | Common Pregnancy Discomforts & Prenatal Care | 45 min |
| 6:30 PM | Break | 30 min |
| 7:00 PM | When Pregnancy Goes Wrong: Danger Signs & Complications | 50 min |
| 7:50 PM | Key Takeaways & Closing | 10 min |
Part 1 · 5:45 PM
Normal Pregnancy: Physiology & the Doula's Role
How Pregnancy Begins
| Step 1: Fertilization | Sperm meets egg in the fallopian tube, forming a zygote that immediately begins dividing as it travels toward the uterus. The genetic blueprint is fixed at this moment. Pregnancy is dated from the first day of the last menstrual period, not from conception, which means most people are already two weeks "pregnant" before conception even occurs. |
| Step 2: Implantation | Around days 6 to 10 after fertilization, the blastocyst burrows into the uterine lining. This triggers the release of hCG, the hormone pregnancy tests detect. Some people notice light spotting at implantation and mistake it for a period. If implantation fails, the lining sheds as a normal period and the person will never know they were briefly pregnant. |
The Placenta
The only organ the human body grows and then discards.
| Delivers Oxygen & Nutrients | Maternal and fetal blood never directly mix. The placenta acts as a selective barrier, passing oxygen, glucose, and vitamins to the fetus while blocking most pathogens and toxins. |
| Removes Fetal Waste | Carbon dioxide and metabolic waste from the fetus cross back through the placenta into the mother's circulation for disposal. |
| Produces Key Hormones | Takes over hormone production around week 10, producing hCG, progesterone, and estrogen to sustain the pregnancy and drive physical changes. |
| Development & Delivery | Fully functional by weeks 12 to 16. Continues growing until birth, ultimately weighing about 1 to 1.5 lbs. Delivered as the third stage of labor. |
The Six Hormones of Pregnancy
Every symptom your client feels traces back to one of these six hormones. Understanding them lets you explain, with confidence and specificity, exactly why she feels the way she does.
| Hormone | Primary Role & What It Causes |
|---|---|
| hCG | Tells the body pregnancy is happening. Detected by pregnancy tests. Surges in T1 and peaks at week 10, then drops. Triggers the nausea center in the brainstem. |
| Progesterone | Maintains the uterine lining and suppresses contractions. Relaxes smooth muscle throughout the body, causing heartburn, constipation, and bloating. Has a sedating effect responsible for first-trimester fatigue. A sudden drop after birth contributes to baby blues. |
| Estrogen | Drives uterine and breast tissue growth. Increases blood flow to the skin, responsible for the pregnancy glow and also nasal congestion, nosebleeds, and bleeding gums. Causes stretch marks, linea nigra, and melasma. |
| Relaxin | Loosens pelvic ligaments for birth, but also every other ligament in the body. Causes back pain, round ligament pain, symphysis pubis dysfunction (SPD), and the "pregnancy clumsiness" clients describe. Peaks in T1 and stays elevated throughout. |
| Oxytocin | Builds throughout pregnancy and peaks at the onset of labor. Triggers and sustains contractions (Pitocin is synthetic oxytocin). Released by touch, eye contact, warm skin contact, and emotional safety. Drives bonding after birth and the milk let-down reflex. |
| Cortisol | Rises throughout pregnancy, which is normal and necessary. Adapts the immune system to tolerate the fetus and supports fetal organ development in T3. Chronically elevated cortisol from unmanaged stress is linked to preterm labor risk and lower birth weight. Doula presence reduces cortisol, which is one mechanism behind the Cochrane Review outcome data. |
Your calm, warm, reassuring presence is not just emotional support. It is hormonal support. Understanding these hormones lets you explain exactly why your client feels what she feels, and why what you do makes a measurable physiological difference.
How the Body Reorganizes
The uterus starts as a 3-ounce pear-sized organ. By full term it is the size of a watermelon and weighs about 2 pounds. Everything else in the abdominal cavity moves to make room. This single structural change causes the majority of third-trimester symptoms.
| Stomach & Intestines | Pushed upward and compressed from T2 onward, worst in T3. Progesterone slows gut motility. Result: heartburn, constipation, bloating, and slower digestion, all worsening after meals and when lying flat. |
| Diaphragm | Pushed upward about 4 cm in T3, reducing lung capacity. Causes shortness of breath, especially lying flat or climbing stairs. Most clients feel relief when the baby drops (lightening) in late T3. |
| Bladder | Compressed by hCG in T1 and by the baby's head in T3. Frequent urination is entirely structural. Clients who reduce fluids to cope risk dehydration and UTIs. |
| Kidneys | Filtration rate increases 60 to 80% to handle expanded blood volume. Mild glucose in urine (glycosuria) is normal, the kidneys are simply filtering more than usual. |
| Heart & Circulation | Blood volume increases 40 to 50%. Heart rate rises 10 to 20 bpm. Cardiac output increases 30 to 50%. This explains fatigue, dizziness on standing, and the swelling that comes from fluid redistribution. |
The Three Trimesters
First Trimester (Weeks 1 to 13): The Foundation
| Fetal Development | Week 4: neural tube forms, heart tube begins beating. Weeks 5 to 8: all major organ systems established. Week 8: now called a fetus, about 1 inch long. Week 10: placenta takes over hormones. Week 13: facial features recognizable, 3 inches and 1 ounce. |
| For the Pregnant Person | Nausea and vomiting (70 to 80%), extreme fatigue, breast tenderness, frequent urination, food aversions, heightened smell. No visible bump yet. Miscarriage risk is highest in T1. Emotional ambivalence, fear, and excitement can all coexist. Your most anxiety-containing work happens here. |
Second Trimester (Weeks 14 to 27): The Growth Surge
| Fetal Development | Weeks 14 to 16: facial expressions, sucking movements, fingerprints forming. Week 18 to 22: quickening, the pregnant person begins feeling fetal movement. Week 20: baby can hear sounds from outside the womb. Week 24: threshold of viability with intensive NICU care. Week 27: about 14 inches and 2 pounds. |
| For the Pregnant Person | Nausea often subsides and energy returns. Baby bump becomes visible, which can feel real and affirming for the first time. Round ligament pain begins. Nasal congestion, nosebleeds, bleeding gums. Skin changes: the glow, stretch marks, linea nigra, melasma. This is prime prenatal relationship-building time. |
Third Trimester (Weeks 28 to 40+): The Final Preparations
| Fetal Development | Weeks 28 to 32: rapid weight gain, body fat accumulating. Weeks 32 to 36: lungs produce surfactant. Week 37: "early term," lungs functional but brain still developing rapidly through week 39. Weeks 39 to 40: developmentally optimal. Full term: 19 to 21 inches, 6 to 9 lbs, all systems ready. |
| For the Pregnant Person | Increasing discomfort, difficulty sleeping, shortness of breath. Heartburn and indigestion intensify. Pelvic pressure, lightning crotch, frequent urination return. Gradual swelling normal; sudden severe swelling is a red flag. Nesting instinct. Emotional intensity: anticipation, fear, excitement, and impatience all at once. |
Part 1 Continued
Common Pregnancy Discomforts
Each discomfort section follows the same three-part structure: what you can offer, when to refer, and a doula script. Memorize the scripts. You will use them constantly.
Part 1 Continued
Prenatal Care: Navigation & Informed Decision-Making
Prenatal Tests: What Your Clients Go Through
Your role in prenatal testing is not to interpret results. It is to normalize, prepare, and help your client formulate questions so she walks in as an informed participant rather than a passive recipient.
| Test | Timing | What It Screens | Your Role |
|---|---|---|---|
| First Trimester Screening | 10 to 13 wks | Chromosomal risk assessment. Blood plus nuchal translucency ultrasound. A risk estimate, not a diagnosis. | Help clients understand a high-risk result is not a diagnosis. Many lead to healthy babies. |
| Anatomy Scan | 18 to 22 wks | Detailed fetal anatomy, placenta, fluid. Often reveals biological sex if parents want to know. | Normalize both the excitement and the anxiety. Help them write down questions beforehand. |
| Glucose Screening | 24 to 28 wks | Screens for gestational diabetes. A high 1-hour result does not automatically mean GDM. | Encourage bringing a snack for after. Normalize the test. |
| Group B Strep | 36 to 37 wks | Normal bacteria in 25 to 30% of pregnant people. GBS positive means IV antibiotics during labor. | Normalize the positive result. It is not an infection and not from anything they did wrong. |
Prenatal Vitamins
Folic acid prevents neural tube defects, which occur in the first 28 days, often before the person knows they are pregnant. Supplementation reduces the risk by 50 to 70%. Iron is equally critical: blood volume expands 40 to 50% and iron deficiency affects up to 52% of pregnant people globally.
| "They make me nauseous." | Try taking them at night, with food, or switch to gummies. Note: gummies often lack iron. |
| "I can't afford them." | WIC provides free prenatal vitamins. Community health centers and OB offices often have samples. |
| "I keep forgetting." | Set a daily phone alarm. Keep them next to something used every day. |
"Pregnancy Brain" Is Real and Adaptive
A 2016 study in Nature Neuroscience found that pregnancy causes measurable remodeling of the brain, specifically in areas governing social cognition, empathy, and understanding others. These changes persist for at least two years postpartum and correlate with stronger maternal-infant bonding. Short-term memory and executive function take a hit. This is adaptive, not pathological.
"Your brain is literally rewiring itself right now to help you bond with and care for your baby. You might forget where you put your phone, but your brain is getting really good at reading your baby's cues. It's a trade-off, and it's temporary."
The Doula's Role in the Prenatal Period: Scope of Practice
| Within Your Scope | Outside Your Scope |
|---|---|
| Provide accurate information about normal pregnancy | Diagnosing any condition or symptom |
| Help clients formulate good questions for their providers | Recommending specific medications or treatments |
| Recognize when symptoms need medical evaluation | Interpreting lab results or test findings |
| Support clients through normal discomforts | Advising clients to delay seeking medical care |
| Normalize prenatal testing and monitoring | Telling clients whether to accept or decline interventions |
| Support birth partners in their evolving role | Overriding or contradicting medical advice |
Breakout Discussion (10 min)
Imagine a client at 36 weeks who has been Googling everything. Based on what you just learned, what kinds of questions do you think she might bring to a prenatal visit? Pick 2 to 3 your group comes up with and work through how you would respond, and where scope of practice starts to matter.
Each group shares: What is the question? What would you say? What would you NOT say, and why?
6:30 PM · 30 min
Break
Step away, stretch, hydrate, reset. Back at 7:00 PM for the second half, which covers the harder material.
Part 2 · 7:00 PM
When Pregnancy Goes Wrong: Danger Signs & Complications
Scope of Practice Still Applies Here
You are not a medical provider. You do not diagnose. You do not prescribe. You do not override medical advice. But you ARE an educated support person who knows when something is not right. Sometimes that means calmly and clearly saying:
"We need to call your provider right now."
That is not overstepping. That is exactly what doulas do.
Preeclampsia
Preeclampsia affects 5 to 8% of all pregnancies. It is high blood pressure (at or above 140/90) developing after 20 weeks, with signs of organ stress: protein in urine, liver dysfunction, kidney problems, or low platelets. Severe features begin at BP at or above 160/110, where stroke risk rises dramatically. The ONLY cure is delivery. All other treatment buys time. HELLP syndrome is a severe variant affecting 10 to 20% of severe preeclampsia cases. Critically: preeclampsia can develop up to 6 weeks after birth.
Warning Signs: Memorize These Cold
| 1 | Severe Persistent Headache | Not responding to Tylenol |
| 2 | Vision Changes | Blurred, spots, flashing lights |
| 3 | Upper Abdominal Pain | Especially on the right side |
| 4 | Sudden Severe Swelling | Face, hands, around the eyes |
| 5 | New Nausea or Vomiting | Onset in the third trimester |
| 6 | Decreased Fetal Movement | Always take seriously |
Treatment & Postpartum Risk
| Treatment | Delivery is the only cure. Magnesium sulfate prevents seizures and causes intense heat, weakness, and a foggy feeling. Antihypertensive medications prevent stroke. Close monitoring includes BP checks, blood work, non-stress tests, and biophysical profiles. |
| Postpartum Risk | About 1 in 4 eclamptic seizures occur postpartum, most in the first 48 hours. Postpartum preeclampsia can occur up to 6 weeks after delivery and in women who had NO preeclampsia during pregnancy. This is why your postpartum check-in visits are not optional. You may catch something no one else does. |
Advocacy Scripts: What to Say When Concerns Are Dismissed
| When a provider minimizes symptoms: | "I understand that might be a normal variation, but she's really concerned and these are classic warning signs. Could we check her blood pressure and urine just to give everyone peace of mind?" |
| When the headache has lasted all day: | "She's saying this is the worst headache of her life and it's not responding to Tylenol. Given her history, could we have her evaluated today?" |
| When your client hesitates to call: | "I know you don't want to bother them, but this is exactly what they're there for. It's better to check and have it be nothing. Call them and if I haven't heard back from you in 20 minutes I'll check in with you." |
Health Equity & Maternal Mortality in Louisiana
The disparity is not a coincidence. It is a system.
| 2 to 3x | 60% | 2x |
| Black women face 2 to 3 times higher pregnancy-related mortality than white women nationally | More likely to develop preeclampsia, with higher rates and worse outcomes | Louisiana's maternal mortality rate is nearly double the national average, gap most severe for Black mothers |
Clinical Note
This disparity holds across income and education levels. Structural racism, not individual risk, is the primary driver. Symptoms are more often minimized in Black patients. Your informed, persistent advocacy is not optional. It is a clinical intervention.
Full Group Discussion (10 min)
Where have you seen, read about, or heard stories of racism in healthcare? In the news, in your own family, in your community, in your own experience as a patient. How does knowing this change what you think a doula's role should look like?
- What surprised you most about the statistics?
- What would it look like for a doula to address this in practice?
- What feels uncertain or hard about this conversation for you?
Other Common Complications: An Orientation
| Gestational Diabetes | Affects 6 to 9% of pregnancies. Managed with diet, exercise, sometimes insulin. Increases risk of macrosomia, induction, and cesarean. Doula role: normalize the diagnosis and support diet changes without judgment. |
| Preterm Labor | Contractions plus cervical change before 37 weeks. Signs: regular contractions, pelvic pressure, low backache, watery discharge. Doula role: encourage immediate evaluation. Do not wait and see. |
| Placenta Previa & Abruption | Previa: placenta covers the cervix, vaginal birth not possible. Abruption: placenta separates, life-threatening emergency. Doula role: painless vaginal bleeding in T3 requires emergency evaluation immediately. |
| Hyperemesis Gravidarum | Severe, persistent nausea and vomiting requiring medical treatment. Not "just" morning sickness. May require IV fluids and hospitalization. Doula role: validate the severity. It is often dismissed. Your presence matters. |
Case Study: Breakout Discussion (10 min)
Your client is 34 weeks pregnant. She texts you at 9:00 PM: "I have a terrible headache and my face looks puffy. It came on fast. Should I be worried?" Her sister had preeclampsia last year.
- What do you text back, word for word?
- What would change if she said the headache started yesterday?
- She already called her provider and was told to "just rest and drink water." What now?
If she also mentions seeing spots: 911 or immediate drive to L&D. Do not wait.
7:50 PM · Closing
Key Takeaways from Night 1
| 1 | Pregnancy is a 40-week transformation. Understand it deeply enough to support it well. |
| 2 | The prenatal period is where your client relationship is built. Trust before labor makes everything easier during it. |
| 3 | Common discomforts are real and sometimes severe. Normalizing and offering evidence-based strategies is a clinical skill. |
| 4 | Memorize the warning signs: severe headache, vision changes, upper abdominal pain, sudden severe swelling. Preeclampsia can develop after birth, up to 6 weeks postpartum. |
| 5 | Racial health disparities in maternal care are real, documented, and rooted in systemic racism. Your advocacy is part of the solution. |
| 6 | Your scope is observation, education, advocacy, and support. Never diagnosis, never medical advice. |