Pregnancy lasts roughly 40 weeks, and each stage brings something new for your body, your baby, and your mind.
This pregnancy care guide walks you through what to expect at every stage, which tests are usually done, and when something needs urgent attention.
It is not a replacement for your obstetrician. It is a way to walk into each appointment knowing what is normal, what is worth asking about, and what comes next.
This guide is especially useful if you are planning pregnancy care in Sofia or Bulgaria and want to understand how the process usually works.
Before you are pregnant: preconception planning
The healthiest pregnancies often start months before conception. If you are planning to try, three things matter most.
Folic acid, 400 to 800 mcg daily, ideally started 2 to 3 months before conception. This significantly reduces the risk of neural tube defects in the baby.
A general health check, including blood pressure, blood sugar, thyroid function, and any chronic conditions that should be optimised before pregnancy.
A conversation about family history, including miscarriage, genetic conditions, or fertility issues on either side. This helps decide which tests may be useful.
If you have been trying for over 12 months without success, or 6 months if you are over 35, schedule a fertility evaluation. Earlier action shortens the road.
The first trimester: weeks 1 to 12
The first three months are when the baby’s organs form. They are also when most pregnancy symptoms appear, and when miscarriage risk is highest. Both are normal, but the combination can feel hard.
Common symptoms: nausea, often called morning sickness but rarely limited to mornings, fatigue, breast tenderness, food aversions, and more frequent urination.
What your doctor will do
- Confirm the pregnancy and date it accurately by ultrasound, usually around weeks 6 to 8.
- Run baseline blood work, including blood group, haemoglobin, infections that can affect pregnancy, vitamin D, and thyroid function.
- Around weeks 11 to 13, offer the first-trimester combined screening, an ultrasound, NT scan, plus blood test that estimates the risk of Down syndrome and a few other chromosomal conditions.
What to do yourself
- Continue folic acid and start a prenatal vitamin if you have not already.
- Avoid alcohol, smoking, raw or undercooked meat and fish, soft cheeses, and unpasteurised dairy.
- If you take any medication regularly, ask your doctor whether it is safe to continue.
Call your doctor if you have heavy bleeding, severe one-sided pain, fever above 38 °C, or vomiting that prevents you from keeping fluids down.
The second trimester: weeks 13 to 26
For most women, this is the easier stretch. Nausea usually settles, energy returns, and the bump becomes visible. Many women start feeling movements between weeks 18 and 22. In a first pregnancy, this can sometimes happen later.
What your doctor will do
- The anomaly scan between weeks 18 and 22, a detailed ultrasound checking the baby’s anatomy, organ development, and growth.
- A glucose tolerance test for gestational diabetes, typically between weeks 24 and 28.
- Continued monitoring of blood pressure, weight, and the baby’s growth.
What to think about
- Birth preparation classes, most hospitals in Bulgaria offer them, and private classes are also available. They are worth doing, especially for a first pregnancy.
- Where you will give birth, public hospital, private clinic, and with which obstetrician. These decisions are easier in the second trimester than rushed in the third.
- Maternity leave paperwork, in Bulgaria, maternity leave usually starts 45 days before the expected due date. Your doctor issues the relevant medical document, which your employer uses for the official leave process.
The third trimester: weeks 27 to 40
The baby gains roughly half its birth weight in the final 10 weeks. You may feel slower, sleep worse, and notice more practice contractions, known as Braxton Hicks. This is common.
What your doctor will do
- More frequent appointments, usually every two weeks until week 36, then weekly.
- Group B Streptococcus screening around week 36, using a vaginal-rectal swab. If positive, antibiotics are usually given during labour.
- Ultrasounds to confirm the baby’s position and estimated weight.
What to prepare
- Hospital bag, packed by week 36. Include documents, passport or ID, insurance card, pregnancy chart, comfortable clothes, basics for the baby, and anything that helps you feel calm.
- A birth plan, including your preferences for pain relief, who will be with you, and feeding choice. Hospitals do not always follow it exactly, but it is a useful conversation to have with your team in advance.
- A car seat, installed and tested before the due date. Hospitals in Bulgaria do not lend them.
Call your doctor or go to the hospital if your waters break, you have regular contractions every 5 minutes for an hour, you have heavy bleeding, you notice reduced baby movements, or you have a severe headache, vision changes, or sudden swelling in your hands and face.
Labour and delivery
Labour has three stages: dilation, pushing, and delivery of the placenta. A first labour averages 12 to 18 hours. Later labours are usually shorter.
Pain relief options in Bulgaria
- Epidural, widely available in private clinics, but less consistently available in public hospitals. Confirm this with your chosen hospital in advance.
- Nitrous oxide, also called gas and air, offered in some clinics.
- Non-medical options, including breathing techniques, position changes, and water immersion in some private hospitals.
A caesarean section may be planned in advance for medical reasons or decided during labour. Both vaginal birth and caesarean birth can be safe when the situation calls for them. The goal is a healthy mother and a healthy baby.
A New Beginning: Postpartum Care
The first six weeks after birth: postpartum
The fourth trimester is real and often underestimated. Your body is recovering from a major physical event while you are also caring for a newborn.
What is normal
- Vaginal bleeding, called lochia, for 4 to 6 weeks, gradually reducing.
- Soreness, especially after a tear, episiotomy, or caesarean.
- Strong emotions, sleep deprivation, and mood swings. Many women experience baby blues in the first two weeks.
What is not normal
Call your doctor if you experience:
- Fever above 38 °C.
- Heavy bleeding, such as soaking a pad in an hour or passing large clots.
- Calf pain or breathlessness, which can be possible signs of a blood clot.
- Persistent low mood, hopelessness, or intrusive thoughts about yourself or the baby. These can be symptoms of postpartum depression. It is common, treatable, and not a reflection of your love for your baby.
Your six-week check, usually with your obstetrician, covers physical recovery, contraception, and how you are really feeling. Bring up anything, even if it seems small.
When to seek immediate care during pregnancy
Go to the hospital or call emergency services if you experience:
- Heavy vaginal bleeding.
- Severe abdominal pain.
- Severe or persistent headache, blurred vision, or sudden swelling of the face or hands, which can be possible signs of preeclampsia.
- Reduced or absent baby movements after week 24.
- Signs of labour before week 37.
- Fever above 38 °C with no obvious cause.
- Severe breathlessness or chest pain.
When in doubt, call. Obstetricians would rather be called for a false alarm than miss something serious.
Looking for pregnancy care in Sofia?
Dr. Shefketova provides personal pregnancy care for Bulgarian and international patients, from preconception consultation to postpartum follow-up.
Dr Anne Laure
October 16, 2023 at 10:29I found this pregnancy care guide incredibly informative and comprehensive. It\’s a valuable resource for expectant mothers, offering guidance on everything from prenatal health to postpartum care. The journey to motherhood can be daunting, and this guide provides much-needed support and knowledge for a healthier pregnancy. Thanks for sharing this invaluable resource!