Daddy or in laws can help to take care of your 19 months old. Daddy, you can ease your wife's burden by letting your first kid (#1) get used to having less attention from mommy and more attention from you or his grandpa/grandma. Whether it be showering or sending #1 to sleep, give everyone some time to get used to a new routine with minimal involvement from mommy. This is so that when your second baby comes along, mommy can focus on attending the baby and your #1 will not feel too left out as he has already get used to his new routine with daddy, grandma and grandpa.
My 2nd baby is at terrible 2 stage now too. What I do is to make sure I stay close to him whenever he is throwing tantrums as he can't regulate his own emotions yet. If I need to carry him, I will carry him by sitting down or lie with him together on bed. Apart from carrying your first born, you can plan some activities for your son to do with your wife e.g. art and craft which does not require a lot of energy and strength during pregnancy, at the same time to have bonding between your wife and son.
When I was pregnant with my second baby, my toddler, too, wanted me to carry her even when I had such a big belly and aching back. I would carry her for a few seconds and then sit on the sofa while letting her sit on my lap and laying down on my chest. It worked. I think sometimes they just want that physical contact as emotional assurance, so any contact would do. :)
Get him involved in the preparation for the new baby. Your wife can bring your son shopping for a present for your elder son and get your elder son to choose a present for his new sibling. There are a lot of bonding activities that your wife can have with your son without aggravating her condition. How about swimming?
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thanks