23 Weeks Pregnant: Baby Development, Symptoms & What to Expect

What Does My Baby Look Like at 23 Weeks?

At 23 weeks pregnant, your baby weighs approximately 550 grams (1.2 pounds) and measures about 28 centimeters (11 inches) from head to heel. Your baby's skin is becoming less translucent as fat deposits develop, facial features are fully formed, and the baby can now hear sounds from outside the womb, including your voice and heartbeat.

Week 23 marks an exciting stage in your baby's development. Your little one is now about the size of a large mango or a papaya, and significant changes are happening both internally and externally. The baby's appearance is becoming more like a newborn, though the skin is still thin and somewhat wrinkled due to the lack of fat beneath it. Over the coming weeks, your baby will continue to accumulate subcutaneous fat that will fill out the skin and help regulate body temperature after birth.

The development of your baby's sensory systems is progressing rapidly during this period. Your baby's ears are now fully developed enough to hear sounds from the outside world. Research shows that babies in the womb respond to familiar voices, particularly the mother's voice, which they hear most clearly through the amniotic fluid. Playing music or reading to your baby at this stage can help establish early bonding, as your baby is beginning to recognize and respond to these auditory stimuli.

Your baby's lungs are continuing to mature, though they are not yet ready to function independently. The baby is practicing breathing movements by inhaling and exhaling small amounts of amniotic fluid, which helps the lungs develop. This practice of respiratory movements is essential preparation for breathing air after birth. The surfactant-producing cells in the lungs are developing, which will eventually help the air sacs stay open after delivery.

Brain Development at 23 Weeks

Your baby's brain is undergoing remarkable growth and development during week 23. The brain is rapidly forming neural connections, with billions of neurons being created and organized into complex networks. This neural development will continue throughout pregnancy and into early childhood, but the foundations being laid now are crucial for your baby's future cognitive abilities, motor skills, and sensory processing.

The cerebral cortex, which is responsible for higher-level thinking, memory, and consciousness, is developing its characteristic folds and grooves. These convolutions increase the surface area of the brain, allowing for more neural connections and greater cognitive capacity. Sleep cycles are also becoming more established, with your baby alternating between periods of activity and rest, similar to the sleep patterns they will have after birth.

Physical Features Development

Your baby's physical features are becoming increasingly defined at 23 weeks. The fingernails and toenails are now fully formed and continue to grow, sometimes requiring trimming shortly after birth. The hair on your baby's head is growing, though the amount and color may change after birth. Fine hair called lanugo covers your baby's body, helping to regulate temperature and hold the protective vernix caseosa (a waxy coating) in place on the skin.

The bones are continuing to harden through a process called ossification, though they remain somewhat flexible to allow for growth and to facilitate passage through the birth canal. Your baby's grip is now stronger, and the baby may grasp the umbilical cord or their own hands and feet. The taste buds are functional, and your baby can taste the amniotic fluid, which carries flavors from the foods you eat. Studies suggest that babies may develop preferences for certain flavors based on their exposure in the womb.

Can a Baby Survive If Born at 23 Weeks?

Yes, babies born at 23 weeks can survive with intensive neonatal care, though they face significant challenges. Survival rates at 23 weeks typically range from 30-50% depending on the medical facility and resources available. Week 23 is considered the threshold of viability, making this a critical milestone in pregnancy.

The concept of viability refers to the point at which a fetus could potentially survive outside the womb with medical support. While definitions vary, week 23 is generally considered to be at or near this threshold. Advances in neonatal medicine over the past decades have dramatically improved outcomes for extremely premature babies, but survival at this gestational age remains challenging and varies significantly based on multiple factors.

Babies born at 23 weeks are classified as extremely premature or micro-preemies. Their organs, particularly the lungs and brain, are still immature, making them vulnerable to numerous complications. These babies require specialized care in a Neonatal Intensive Care Unit (NICU) with experienced medical teams, advanced technology, and round-the-clock monitoring. The quality and level of available neonatal care can significantly impact survival rates and long-term outcomes.

It's important to understand that while survival is possible, many babies born at this gestational age will face short-term and long-term health challenges. These may include respiratory problems, feeding difficulties, infections, brain bleeding (intraventricular hemorrhage), vision problems (retinopathy of prematurity), and potential developmental delays. Each baby's situation is unique, and families facing potential preterm birth at this stage should have detailed discussions with their healthcare team about expectations and care options.

Factors Affecting Viability

Several factors influence a baby's chances of survival if born at 23 weeks. These include the baby's birth weight, sex (female babies statistically have slightly better outcomes at extremely premature gestations), whether the mother received corticosteroid injections before delivery to help mature the baby's lungs, and whether the birth occurred at a hospital with a Level III or IV NICU equipped to handle extremely premature infants.

The decision-making process around resuscitation and intensive care for babies born at the threshold of viability is complex and highly individualized. Healthcare providers work closely with families to discuss the potential outcomes, risks, and benefits of various approaches. These conversations take into account medical factors, family values, and quality of life considerations. Guidelines from organizations such as the American Academy of Pediatrics and the World Health Organization provide frameworks for these discussions.

What Changes Are Happening to My Body at 23 Weeks?

At 23 weeks pregnant, your uterus has risen above your navel and can be felt as a firm, round shape. Common changes include visible fetal movements, Braxton Hicks contractions, increased vaginal discharge, skin changes like the linea nigra and stretch marks, and swelling in the feet and ankles. Many people experience their best energy levels during this part of the second trimester.

Your body continues to adapt remarkably to support your growing baby during week 23. The fundal height—the distance from your pubic bone to the top of your uterus—is now typically around 21-25 centimeters, approximately matching the number of weeks of pregnancy. Your healthcare provider will measure this at prenatal appointments to monitor your baby's growth and ensure it's progressing appropriately.

The expansion of your uterus affects many body systems. As your uterus grows, it puts pressure on surrounding organs, which can lead to various symptoms. The compression of your bladder may result in more frequent urination, while pressure on your digestive system can contribute to heartburn, constipation, and bloating. Your lungs also have less room to expand fully, which may cause mild shortness of breath, particularly during physical activity.

Your cardiovascular system has adapted significantly to support the pregnancy. Your blood volume has increased by 30-50% compared to pre-pregnancy levels, and your heart is working harder to circulate this increased volume. This cardiovascular adaptation is necessary to provide adequate oxygen and nutrients to your baby and the placenta. However, it can also contribute to symptoms such as faster heart rate, occasional dizziness when standing up quickly, and visible veins on your skin.

Common Physical Symptoms

Many pregnant people at 23 weeks experience a range of physical symptoms, most of which are normal aspects of pregnancy. Braxton Hicks contractions may become more noticeable around this time. These "practice contractions" involve tightening of the uterus that typically lasts for 30 seconds to two minutes. They are irregular, usually painless (though they may be uncomfortable), and help your uterus prepare for labor. Unlike true labor contractions, Braxton Hicks contractions don't become progressively stronger, longer, or more frequent.

Back pain is increasingly common as your center of gravity shifts forward with your growing belly. The hormone relaxin, which loosens your joints and ligaments in preparation for childbirth, can also contribute to back discomfort. Good posture, supportive footwear, gentle exercise, and sleeping with a pregnancy pillow can help alleviate this symptom. If back pain is severe or accompanied by other symptoms, consult your healthcare provider to rule out other causes.

Leg cramps often occur at night and may be related to changes in circulation, mineral imbalances, or pressure on nerves. Staying hydrated, stretching your calf muscles before bed, and ensuring adequate calcium and magnesium intake may help reduce their frequency. Swelling in the feet and ankles (edema) is also common due to increased blood volume and fluid retention. Elevating your feet when possible and avoiding standing for long periods can provide relief.

Skin Changes

Your skin undergoes several visible changes during pregnancy due to hormonal influences. The linea nigra, a dark vertical line running from your pubic bone to your navel (and sometimes beyond), may become more prominent. This line has always been present on your body but becomes visible due to increased melanin production during pregnancy. It typically fades after delivery, though it may not disappear completely.

Stretch marks may appear on your abdomen, breasts, hips, or thighs as your skin stretches to accommodate your growing body. These reddish or purple streaks are caused by the breakdown of elastic fibers in the skin and are largely influenced by genetics. While they cannot be completely prevented, keeping your skin well-moisturized may help maintain skin elasticity. Stretch marks typically fade to a silvery color over time after pregnancy.

How Much Should My Baby Move at 23 Weeks?

At 23 weeks, you should feel regular fetal movements, though patterns vary between babies. Many pregnant people notice increased movement in the evening when resting. Your baby may kick, punch, roll, and even hiccup. While formal kick counting typically begins around 28 weeks, being aware of your baby's normal movement patterns is important at this stage.

Fetal movement is an important indicator of your baby's well-being. By 23 weeks, most pregnant people have been feeling their baby move for several weeks, and the movements are becoming stronger and more defined. You may now be able to distinguish between kicks, punches, and rolling movements. Some people can even see their belly move when the baby is particularly active.

Your baby is most active when you are resting, particularly in the evening or when you lie down to sleep. This is because your movements during the day have a rocking effect that lulls the baby to sleep, while the stillness when you rest allows the baby to become more active. Additionally, after eating, especially sweet or cold foods, you may notice an increase in fetal activity due to the rise in your blood sugar levels.

The amount and pattern of movement varies significantly between babies. Some babies are naturally more active than others, and activity levels can vary from day to day. What's most important is getting to know your individual baby's normal pattern of movement. If you notice a significant decrease in movement or a change from your baby's usual pattern, contact your healthcare provider. It's always better to seek reassurance than to ignore concerns about fetal movement.

Understanding Fetal Hiccups

Fetal hiccups are a common occurrence that many pregnant people begin to notice around this time. They feel like rhythmic, repetitive movements or gentle tapping that occurs at regular intervals and typically lasts for a few minutes, though they can continue for up to 30 minutes. Unlike kicks and punches, hiccups have a distinctive pattern of consistent, evenly-spaced movements.

Hiccups occur when your baby's developing diaphragm contracts involuntarily. This happens as your baby practices breathing movements by inhaling and exhaling amniotic fluid. These practice sessions help develop the respiratory muscles and prepare your baby for breathing air after birth. Hiccups are considered a normal sign of healthy development and are nothing to worry about.

Not everyone feels their baby's hiccups, and their frequency varies. Some babies hiccup several times a day, while others rarely do so. The position of your placenta can also affect whether you feel movements and hiccups—an anterior placenta (located at the front of the uterus) may cushion some sensations. If you have any concerns about fetal hiccups or other movements, don't hesitate to discuss them with your healthcare provider.

What Symptoms Are Common at 23 Weeks Pregnant?

Common symptoms at 23 weeks include increased energy levels, visible fetal movements, Braxton Hicks contractions, back pain, leg cramps, swelling in feet and ankles, increased vaginal discharge, vivid dreams, and skin changes. Most symptoms are normal, but severe pain, bleeding, or reduced fetal movement require immediate medical attention.

The second trimester is often called the "honeymoon phase" of pregnancy because many of the uncomfortable symptoms of early pregnancy have subsided, and the third-trimester challenges haven't yet begun. However, this doesn't mean you'll be symptom-free. Understanding what's normal can help you distinguish between typical pregnancy discomforts and signs that warrant medical attention.

Increased energy is common at 23 weeks. The fatigue of the first trimester typically lifts, and many pregnant people feel a renewed sense of vitality. This is an excellent time to complete preparations for baby's arrival, maintain an exercise routine, and enjoy activities that may become more challenging as pregnancy progresses. Listen to your body and rest when needed, but take advantage of this relatively comfortable period.

Vaginal discharge often increases during pregnancy due to hormonal changes and increased blood flow to the vaginal area. Normal pregnancy discharge (leukorrhea) is thin, white or clear, and has a mild odor or is odorless. If your discharge becomes yellow, green, or gray, has a strong odor, or is accompanied by itching or burning, contact your healthcare provider as this may indicate an infection that requires treatment.

Emotional Changes

Pregnancy affects not only your body but also your emotional well-being. Mood swings can occur due to hormonal fluctuations, though they often stabilize somewhat in the second trimester. It's normal to experience a range of emotions about the upcoming changes in your life, from excitement and joy to anxiety about parenthood and the birth process.

Vivid dreams are commonly reported during pregnancy. These may be related to hormonal changes, interrupted sleep patterns, or the psychological processing of the significant life transition you're experiencing. Dreams about the baby, birth, or parenting are particularly common. While sometimes unsettling, these dreams are generally normal and don't predict actual outcomes.

If you're experiencing persistent sadness, anxiety that interferes with daily functioning, or thoughts of self-harm, reach out to your healthcare provider. Perinatal mood disorders can develop during pregnancy and are treatable. Early intervention leads to better outcomes for both parent and baby.

What Prenatal Care Should I Expect at 23 Weeks?

Prenatal appointments at 23 weeks typically include blood pressure monitoring, urine testing, fundal height measurement, listening to the baby's heartbeat, and discussing any concerns. Your healthcare provider may discuss screening tests, glucose tolerance testing (usually done around 24-28 weeks), and begin conversations about birth preferences.

Regular prenatal care is essential for monitoring both your health and your baby's development. During the second trimester, appointments are typically scheduled every four weeks, though this may vary based on your individual circumstances. These appointments provide opportunities to address any concerns, receive guidance on nutrition and lifestyle, and ensure the pregnancy is progressing normally.

At each appointment, your healthcare provider will measure your blood pressure and test your urine for protein and glucose. Elevated blood pressure or protein in the urine could indicate preeclampsia, a serious pregnancy complication that requires close monitoring and management. Your fundal height will be measured to track fetal growth, and you'll have the opportunity to listen to your baby's heartbeat using a Doppler device.

Sometime between 24 and 28 weeks, you'll be offered a glucose tolerance test to screen for gestational diabetes. This condition, in which blood sugar levels become elevated during pregnancy, affects approximately 6-9% of pregnancies and can usually be managed with dietary changes, exercise, and sometimes medication. Early detection and management of gestational diabetes significantly improve outcomes for both mother and baby.

Preparing for the Third Trimester

As you approach the end of the second trimester, your healthcare provider may begin discussing topics relevant to the coming months and the birth. This is a good time to start thinking about your birth preferences, including pain management options, whether you want a support person present, and any specific wishes for the birth environment. While birth rarely goes exactly as planned, having a birth plan helps you think through your options and communicate your preferences to your care team.

If you haven't already, consider enrolling in childbirth education classes. These classes provide valuable information about the stages of labor, pain management techniques, breastfeeding, and newborn care. Many hospitals and community centers offer classes, and online options are also available. Starting classes now allows time to complete them before your due date while you're still comfortable enough to sit through sessions.

When Should I Seek Medical Care at 23 Weeks?

Seek immediate medical care if you experience vaginal bleeding, severe abdominal pain, signs of preterm labor (regular contractions, pelvic pressure, lower back pain), significantly decreased fetal movement, fluid leaking from the vagina, or symptoms of preeclampsia (severe headache, vision changes, sudden swelling). Trust your instincts—if something feels wrong, contact your healthcare provider.

While most symptoms at 23 weeks are normal aspects of pregnancy, certain warning signs require immediate medical attention. Being aware of these red flags can help you recognize when to seek urgent care. If you experience any concerning symptoms, it's always better to be evaluated and receive reassurance than to delay care for a potentially serious issue.

Understanding Preterm Labor

Preterm labor refers to labor that begins before 37 weeks of pregnancy. At 23 weeks, recognizing the signs of preterm labor is particularly important because of the significant difference that even a few more weeks of development can make for a premature baby. Signs of preterm labor include regular uterine contractions (tightening) that occur more than four times in an hour, constant low back pain, pelvic pressure (feeling that the baby is pushing down), abdominal cramping with or without diarrhea, and changes in vaginal discharge (especially if it becomes watery, mucousy, or bloody).

If you experience symptoms of preterm labor, contact your healthcare provider immediately. In some cases, preterm labor can be stopped or delayed with medication, giving your baby more time to develop. If you're at risk for preterm delivery, your provider may administer corticosteroid injections to help accelerate your baby's lung development and reduce the risk of complications associated with prematurity.

What Lifestyle Tips Should I Follow at 23 Weeks?

At 23 weeks, focus on balanced nutrition with adequate protein, iron, and calcium; stay physically active with pregnancy-safe exercises; get enough rest; stay hydrated; and avoid harmful substances. Be cautious with medications, continue prenatal vitamins, and attend all prenatal appointments. Prepare for baby by starting to organize the nursery and baby essentials.

Maintaining a healthy lifestyle during pregnancy supports your well-being and promotes optimal development for your baby. The choices you make now can have lasting effects on your pregnancy outcomes and your child's long-term health. While some adjustments are necessary, many aspects of your normal routine can continue with minor modifications.

Nutrition and Hydration

Your nutritional needs increase during pregnancy to support your growing baby. Focus on a balanced diet that includes plenty of fruits, vegetables, whole grains, lean proteins, and dairy products. Protein is essential for your baby's growth—aim for 75-100 grams daily from sources such as lean meat, poultry, fish, eggs, beans, and nuts. Iron is crucial for the significant increase in blood volume during pregnancy; include iron-rich foods like leafy greens, fortified cereals, and lean red meat, and pair them with vitamin C sources to enhance absorption.

Calcium supports the development of your baby's bones and teeth. If you don't consume enough calcium, your body will take it from your bones to meet your baby's needs. Aim for 1,000 mg daily through dairy products, fortified plant milks, leafy greens, and calcium-fortified foods. Omega-3 fatty acids, particularly DHA, are important for your baby's brain and eye development. Include fatty fish (avoiding high-mercury varieties), walnuts, and flaxseed, or consider a DHA supplement.

Stay well-hydrated by drinking at least 8-10 glasses of water daily. Adequate hydration supports amniotic fluid levels, helps prevent constipation, reduces the risk of urinary tract infections, and may help minimize swelling. Limit caffeine to 200 mg or less per day, and avoid alcohol completely as there is no known safe level during pregnancy.

Exercise and Physical Activity

Regular physical activity during pregnancy provides numerous benefits, including improved mood, better sleep, reduced back pain, and easier labor and recovery. Unless you have a high-risk pregnancy or specific complications, aim for at least 150 minutes of moderate-intensity aerobic activity per week. Safe activities include walking, swimming, stationary cycling, prenatal yoga, and low-impact aerobics.

As your pregnancy progresses, some modifications may be necessary. Avoid exercises that involve lying flat on your back for extended periods, as this can compress major blood vessels. Stay well-hydrated and avoid overheating. Listen to your body and stop if you experience dizziness, shortness of breath, chest pain, or contractions. If you haven't been exercising regularly, start slowly and gradually increase activity levels with your healthcare provider's guidance.