Overview

Week 28 until your baby’s birth, around 40 weeks, is the last stretch until you meet your baby. This article covers everything you need to know to navigate the third trimester. Your baby undergoes many changes this trimester to prepare for life outside your womb. This trimester can be challenging as your belly keeps growing, and you have some new symptoms resulting from carrying more weight. You may also find yourself anxious to have your baby and ready to be done being pregnant. You are almost at the finish line. Learn what to expect at your prenatal appointments this trimester. Find out what to-do items you should work on. Plus, get tips on your partner’s role and how they can support you.

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Weeks 28 to 42

Your pregnancy’s third and final trimester starts at week 28 and goes until your baby is born. While your due date is week 40, you may go to 41 or 42 weeks. The third trimester can bring challenges as everything gets bigger, heavier, and more squished. Many first-trimester pregnancy symptoms you thought you were done with may be returning, like frequent urination, tender breasts, and fatigue. Hang in there and know this is all temporary.

Your Growing Baby

Your baby has continued growing so much in the last three months. They will be packing on the pounds and getting less wrinkly. You may notice more movement in your belly as they get bigger and stronger. Their bones are fully developed, and their central nervous system has matured to the stage where it can control body temperature. Antibodies are passed from you to your little one as they develop their fetal immune system. Your baby will open their eyes, it can detect light, and its eyelashes have formed. They have a firm grasp, perfect for holding onto your fingers once they are born.

Your Baby’s Position

Your doctor or midwife will check your baby’s position toward the end of your pregnancy. Ideally, your baby will be head down. If your baby is breech (sideways or feet down) towards the end of this trimester, there are some things you can do to try and get them to turn. See this episode for more information on optimal fetal positioning and spinning babies. Your provider may offer an external cephalic version, to turn your baby manually. You can always talk with your doctor or midwife about the possibility of breech vaginal birth. Unfortunately, very few care providers in the U.S. are skilled in vaginal breech delivery, and most will recommend a cesarean.

Common Third-Trimester Symptoms

Many of the symptoms in the third trimester are an extension of things you may have already experienced. Some of these symptoms can be more challenging as you get closer to your due date. Plus, some new symptoms may arise.

Physical Changes

By the end of the third trimester, you will likely gain 25 to 35 pounds. This is assuming you were a healthy weight before pregnancy. Some of the weight you gain is your baby, but most is your placenta, amniotic fluid, larger breasts, uterus, extra fat stores, and increased blood and fluid volume.

Breast Changes

Your breasts go through many changes during pregnancy. By the end of the third trimester, you will have around two extra pounds of breast tissue. As you get closer to your due date, your nipples may leak colostrum. This yellowish fluid nourishes your baby in the first few days until your milk comes in. See this article for an in-depth explanation of the changes you can expect with your breasts during pregnancy.

Stretch Marks

Stretch marks may have appeared towards the end of the second trimester and are most common toward the end of your pregnancy. These lines can show up in your belly, breasts, your butt, and even your thighs. Rapid stretching of the skin fibers, hormonal changes, and genetic factors all contribute to stretch marks. While no evidence-based cream, oil, or magic potion effectively prevents stretch marks, keeping your skin moisturized can help with the itching that accompanies this. If you want to massage your belly with creams or oils, there isn’t a downside. Massage has been recommended to improve the appearance of scarring, although I could not locate any evidence that massage truly helped with stretch marks.

Back Pain

Several changes during pregnancy can contribute to back pain. Pregnancy hormones relax the joints between the bones in your pelvic area, which can be tough on your back and hips. Carrying around extra weight can also put additional strain on your back. If you have any issues with your back, please sit on chairs with good support, especially if you are at a desk all day. You can use a pregnancy support pillow when sitting or lying down. Opt for shoes with good arch support, or use insoles to help protect your feet from issues that can come up. You can try a heating pad or an ice pack for some comfort. A prenatal massage may be helpful, or ask your partner for a massage. If you are suffering from back pain that you cannot alleviate, please bring it up with your care provider.

Your Growing Uterus

As your baby grows and your uterus expands, it can put additional pressure on your lungs and other organs. Your growing uterus pushes up on your diaphragm, the muscle below your lungs. You may find yourself short of breath and getting winded quickly. Sitting or standing with good posture can give your lungs more room to expand. If you are out of breath on walks or exercising, slow down and take it easy.

Swelling and Edema

You may notice your ankles and feet swelling more in the third trimester. The medical term for this is edema. The leading cause is your growing uterus putting pressure on the veins that return blood from your feet and legs. This swelling in your legs, arms, or hands can pressure your nerves, causing tingling or numbness. To reduce swelling, frequently prop up your legs and avoid sitting with your legs crossed. If you are at a job requiring you to stand for long periods, try to move around often and ask for a seat if you are uncomfortable. For more information on swelling and edema, see this episode.

Spider Veins and Varicose Veins

As your uterus grows, it can put additional pressure on your veins in the lower half of your body, especially your legs. This causes your veins to work extra hard to circulate up to 50% additional blood volume. On top of this, progesterone can relax your blood vessels.

Spider veins are tiny red or bluish veins that most often appear on your legs but can also appear on other body parts. Other than changing the appearance of your skin, they are painless. Varicose veins are more prominent, protruding veins. Varicose veins have the potential to be uncomfortable. These are hereditary, but the good news is that you can do some things to treat them if they do show up. See this episode for more information on treatment. Spider and varicose veins should go away in the months after you have your baby.

Hemorrhoids

The worst place you can get varicose veins is in the form of hemorrhoids. Hemorrhoids are estimated to affect around 40% of pregnant women, and that number climbs even higher after birth. Hemorrhoids can cause bleeding during a bowel movement, pain, swelling, itching, and general discomfort. The only cure for hemorrhoids is giving them time. You can do a lot to prevent them and find relief in the event you end up with them during your pregnancy or after you have your baby. This episode breaks down how you get hemorrhoids, prevention, and what you can do to treat them during pregnancy and postpartum safely.

More Frequent Urination

All your hormone changes can slow down the urine flow, and as your uterus grows, it can put more pressure on your bladder. Not only does this increase how frequently you have to go to the bathroom, but it also increases your risk of bladder and kidney infections. Contact your healthcare provider if you notice pain when urinating or have a fever or backache. If you have a urinary tract infection (UTI) or kidney infection, you want to treat it right away to avoid any increase in risks of pregnancy complications.

Heartburn

Heartburn is a burning sensation in the upper part of your digestive tract. This is caused by acid going from your stomach into your esophagus. Heartburn is also sometimes referred to as acid indigestion or acid reflux. Heartburn is common during pregnancy, especially in the third trimester. It is estimated that over half of all expecting mothers experience heartburn. Thankfully, there are a lot of diet and lifestyle changes, as well as over-the-counter medications, that can treat heartburn and improve symptoms. This episode explains why you may experience heartburn during your pregnancy and dives into the evidence behind all of the treatments for heartburn so you can safely relieve your heartburn when pregnant.

Increased Vaginal Discharge

Your vaginal discharge may get heavier than it was in the second trimester. You can always use a thin panty liner if this bothers you. Please check in with your care provider if it is green or yellow, has a strong odor, or if you are having pain, soreness, or itching. Those are signs that you could have a vaginal infection.

Fatigue

Fatigue is common during pregnancy, especially in the first and third trimesters. We like to blame hormones for pregnancy symptoms, and fatigue or being tired is no exception. This is primarily due to increased levels of progesterone. In addition, your body increases blood volume, and your blood pressure is lower. You increase your metabolism and lower your blood sugar. Your body is going through many changes, and all those changes take energy. If you are tired, the best thing you can do is rest.

Sleep Issues

Many issues in the third trimester can negatively impact your sleep. Getting in a comfortable position is more challenging as your belly grows. Nasal congestion or snoring can disrupt your sleep. Loud snoring in the third trimester has an estimated 14-45% prevalence. You may experience leg cramps. This sensation is often painful and almost always happens in the middle of the night. About 24% of expecting mothers experience restless leg syndrome. This neurological disorder presents as bothersome sensations in your legs that are relieved when you move them. These sensations are more common at night and are most common in the third trimester of pregnancy.

On the bright side, you can take many evidence-based and straightforward steps to improve the quantity and quality of your sleep. For more in-depth information, see the episodes on evidence-based tips to improve your sleep and troubleshoot sleep issues during pregnancy.

Braxton Hicks Contractions

Braxton Hicks contractions are mild contractions most common in the third trimester. They are usually weak and come and go unpredictably. True labor contractions get longer, stronger, and closer together. If you have painful or regular contractions, contact your healthcare provider.

Third Trimester Prenatal Appointments

You will see your doctor or midwife every other week at the start of the third trimester. Around week 36, your appointments will be weekly. Please do not hesitate to ask them any and every question you have. Check out these five tips to make the most of every prenatal appointment.

Tests

Your doctor or midwife will offer or suggest several prenatal tests during your pregnancy, some of which occur in the third trimester. You may feel like you are continually waiting for the result of some test to return to know your baby is healthy. Most tests are routine, and you have a high probability of everything coming back normal.

When evaluating your testing options, there are a few things to remember. A screening test gives you the likelihood of a condition and may signal that additional testing is needed. You don’t know anything for sure until you have a diagnostic test. All tests vary in their accuracy. Please discuss your testing options, results, or questions with your doctor or midwife.

Fetal Non-stress Test

The fetal non-stress test involves attaching one belt to the mother’s abdomen to measure fetal heart rate and another to measure contractions. Your care provider monitors movement, heart rate, and heart rate reactivity to movement for 20-30 minutes. A non-stress test may be performed after 28 weeks if you feel like your baby is not moving as frequently as usual, if you are past your due date, if there is any reason to suspect the placenta is not functioning adequately, or if you are high risk.

Biophysical Profile

Sometime after 32 weeks, your care provider may recommend a biophysical profile that combines an ultrasound evaluation with a non-stress test. This test is performed if a question about fetal health and well-being results from an examination, symptoms, or your pregnancy is considered high risk.

Group B Strep

Group B strep or GBS is short for group B streptococcus, a bacterial infection. This bacterium naturally lives in the gastrointestinal tract and is present in the vagina or the rectum. According to the American College of Obstetricians and Gynecologists, the prevalence in pregnant women is between 10% and 30%. It is reported to be higher in black women and may vary by geographic location. Most women with group B strep do not experience any symptoms, and usually, this is not a big deal. It can become an issue when you are pregnant and can cause bladder and uterine infections in rare cases. It can cause meningitis, sepsis, pneumonia, or stillbirth in severe cases.

In the United States, it is standard practice to test all expecting mothers in week 36 or 37 for group B strep. This test involves a swab of your vagina and rectum, and the sample is sent to a lab. The treatment for GBS is the administration of antibiotics during labor. This episode covers prevention, testing, treatment, and reducing risks.

Third Trimester Interventions

You may have several interventions or procedures available in the third trimester. Like any procedure, these should only occur with informed consent, which means that your care provider takes the time to explain the risks and benefits and that you can opt in or out. An excellent tool for evaluating any intervention is the BRAIN acronym, which breaks down to five questions you can ask your doctor or midwife.

• Benefits: What are the benefits?
• Risks: What are the risks?
• Alternatives: What are the alternatives?
• Intuition: What does your intuition tell you?
• Nothing: What happens if you do nothing?

3-D and 4-D Ultrasounds

Your care provider may recommend a 3D or 4D ultrasound to examine suspected fetal anomalies, such as cleft lip and spinal cord issues. You may want a 3D or 4D ultrasound for keepsake baby photos and videos. The consensus from ACOG is that ultrasound exams should be performed only for medical reasons by qualified healthcare providers. According to the FDA, ultrasound can heat tissues slightly, and in some cases, it can also produce very small bubbles (cavitation) in some tissues. The long-term effects of tissue heating and cavitation are not known. Therefore, ultrasound scans should be done only when there is a medical need, based on a prescription, and performed by appropriately trained operators. Check out this episode for the evidence on ultrasound safety.

Vaginal Exams

As your due date gets closer, your care provider may offer a vaginal exam to look at your cervix. As your body prepares for birth, your cervix will begin to soften. It opens up, which is referred to as dilating. It also thins, which is referred to as effacing. Your doctor or midwife measures progress in terms of centimeters and percentages. When you are ready to push your baby out, your cervix will be 10 centimeters dilated and 100% effaced. Despite being routine, there are questions about what the results show, the risks involved, and the psychological effects. See this article for a deep dive into the evidence on vaginal exams.

Induction

In a perfect world, you naturally go into labor on your due date. As you probably know, everything doesn’t always go as planned. Many women get an induction to jump-start labor. The key is knowing when induction may be medically necessary and when it may be better to wait it out. There are many ways you can induce labor. This article assesses the evidence on all the methods thought to naturally induce labor. See this article for a breakdown of each method your doctor or midwife offers. There is no one correct answer for everyone on whether to induce labor. Please discuss your options and the risks and benefits with your care provider.

Vaccines

Vaccines are a very controversial and complex topic. The choice to get vaccinated is a decision you should make with your doctor or midwife. If you have questions or concerns about any vaccine, please bring them up with your care provider.

Tdap Vaccine

In the United States, the CDC and ACOG recommend the TDap vaccine in your third trimester between 27-36 weeks. The antibodies your body creates are highest two weeks after you receive the vaccine. The goal of having the vaccine by week 36 is to pass antibodies to your baby before they are born. Tdap provides immunity for tetanus, diphtheria, and pertussis (whooping cough). Sifting through the vaccine evidence can be challenging, especially during pregnancy. This episode dives deep into the evidence on the Tdap vaccine.

RSV Vaccine

In 2023, the American College of Obstetricians and Gynecologists began recommending a single dose of Pfizer’s RSV vaccine (Abrysvo) for pregnant individuals between 32 0/7 and 36 6/7 weeks of gestation, using seasonal administration. For most of the United States, RSV season occurs from September through January. If you are 32-37 weeks, sometime during September through January, your care provider will recommend the RSV vaccine. The goal of the RSV vaccine during pregnancy is to pass antibodies to your baby to prevent RSV lower respiratory tract infection in infants. Stay tuned for a future episode digging into the research on this vaccine. In the meantime, you can read the package insert here.

To-Do Items for the Third Trimester

The last few months are your opportunity to tackle everything you need to be prepared for birth and being a parent. Remember, your due date is only an estimate. To be safe, shoot to complete all the big items by week 37. If you have tasks like planning maternity leave or building your baby registry (Amazon is my go-to for this) that you have not tackled yet, now is the time.

Celebrate with a Baby Shower

The third trimester is when most expecting mothers have a baby shower. This is a celebration of your baby on the way and your transition to a mother. Typically, a friend plans your shower. If no one has volunteered to throw you a baby shower and you want one, please ask someone to throw one or even plan it yourself. See this episode for everything you need to know about a baby shower, including etiquette, planning tips, and ideas to make your baby shower the perfect celebration.

Take a Birth Class

As you get closer to the birth of your baby, you may find yourself anxious and nervous about birth. I strongly recommend taking a childbirth class if you haven’t done so. A class will be a great way to prepare you for what to expect and the best way to manage labor. Aim to complete the course by at least week 37 to finish it before you go into labor. Learning what to expect will give you the confidence to make informed decisions. The more you know, the better.

Plan for Birth

In some sense, you spend your whole pregnancy preparing for birth. Once you hit the last trimester, you are in the final stretch of planning and want to nail down the details of your preferences. If you need to learn about the pros, cons, and evidence on a specific topic, there are many episodes on your birth options. Take advantage of the Pregnancy Podcast website’s search.

Create Your Birth Plan

Creating a birth plan is the best way to get clear on the birth you want. This outlines how you envision your birth and what happens directly following the birth of your baby. A birth plan is much more than a piece of paper you hand to your care provider. It is the process you go through to prepare for your desired birth experience. This process will lay the foundation for preparing for the scenario in which everything goes exactly as planned and what should happen if things do not go as planned. Here are resources to get started:

• Guide to Creating Your Birth Plan
• Get a copy of Vanessa’s birth plan
• Your Birth Plan book
• Become a Premium Member for a FREE copy of the Your Birth Plan book and access to the entire back catalog of episodes ad-free

Prepare for Breastfeeding

While you cannot practice breastfeeding before your baby arrives, there is a lot you can do to prepare. You can see all of the episodes on breastfeeding here. I highly recommend The Womanly Art of Breastfeeding. This book is thick and very detailed. It will prepare you for all the challenges of nursing and serve as a troubleshooting guide throughout your breastfeeding journey.

Prepare for Your Newborn

It easy to get caught up in the consumerism of thinking you need everything when you prepare for a new baby. Marketing draws on your emotions to be a good parent and to keep your baby safe. It can be overwhelming to think about choosing the right products, how much everything will cost, and where you will put everything. This article will explain exactly what you need for your new baby, whether purchasing items or adding them to a baby registry. Plus, you can download the Ultimate List of the must-haves, optional items, and what is unnecessary.

There are episodes on Bringing Baby Home the First Few Days and Bringing Baby Home Troubleshooting.

If you do not know who your baby’s pediatrician will be, that is another to-do item this trimester. See this episode for tips and considerations when choosing a pediatrician.

Perineal Massage

Perineal massage is an exercise you do in the weeks before birth to prevent tearing. The theory behind perineal massage is that stretching this area leading up to your birth will allow it to stretch more easily and without tearing when your baby is crowning. Typically, expecting mothers who choose to do this start in week 34 or 35. The evidence on the efficacy of perineal massage in preventing tearing is mixed. As long as your care provider gives you the okay and you are comfortable doing it, there isn’t a downside. This episode examines the research and has step-by-step instructions.

Eat Dates

The research on the benefits of eating dates towards the end of your pregnancy is promising. Especially concerning the duration of labor and the reduced use of synthetic oxytocin during labor. Based on the research, expecting moms in the intervention groups ate about 6-7 dates per day (60-80 grams). One study had participants consuming dates from 36 weeks, and all others started at 37 weeks. No study has determined the exact quantities and timeframes to eat dates. For an in-depth analysis, see the episode on the research on eating dates.

Pack Your Hospital or Birth Center Bag

As you get closer to your due date, you want to pack your bag for the hospital or birth center. You can download a checklist to make sure you don’t forget anything. I recommend having your bag packed and ready to go by week 37.

Make Postpartum Healing Pads (Padsicles)

Padsicles are postpartum healing pads that you can DIY at home. These are fantastic tools to help soothe sore areas and are quick and easy to make. Adding a few ingredients to feminine pads and freezing them before birth can make you more comfortable once you are home with your baby. This episode answers a question about what recipe to use and gives simple step-by-step instructions to make postpartum healing pads.

Watch Out for Signs of Labor

When you have made it through most of your pregnancy and are in the final stretch, you enter the game of waiting to go into labor. This can be nerve-racking for two reasons. First, you do not know when you will go into labor, and second, you do not know how to tell that you genuinely have started labor and that it isn’t just a false alarm. This episode explains the signs that labor will begin soon and the signs that you are in labor.

Your Partner

Take advantage of more frequent appointments in the third trimester to ask questions and get all the answers you need to make excellent, informed decisions for your baby. Encourage your partner to go to appointments with you. They are half of the equation, and it is a perfect opportunity for them to hear everything firsthand and ask any questions they may have about labor and birth.

Leading up to birth is an excellent time to set expectations and get your partner on board with breastfeeding. There are countless reasons why breastfeeding is amazing for both mom and baby. Breastfed babies are at a lower risk for ear infections, intestinal upsets, respiratory problems, allergies, and dental problems, and their immune system will be stronger. Breastfeeding also produces some hormones that foster a chemical connection between mom and baby and help mom recover from birth better. Your partner’s support of breastfeeding goes a long way.

Whether decorating a room in your home or just carving out a corner for your baby, the nursery is often one of the biggest to-dos for a parents-to-be. If painting involves lifting heavy objects, enlist your partner to help out. Don’t panic if the nursery isn’t 100% done when you enter labor. The American Academy of Pediatrics recommends that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for at least the first six months. It will be at least six months until your baby spends nights in their room.

Make the Most of Your Third Trimester

This last trimester can be physically and emotionally challenging. It can be overwhelming to think about everything you need to learn or complete before you go into labor. Plus, you don’t know precisely when your labor will start or how everything will unfold. Everything will come together and work out. Keep making great choices and moving forward with your to-do list; you will be as ready as possible when your little one arrives. You can also do a lot to bond with your baby during pregnancy before you hold them in your arms.

The last few months are also an opportunity to take advantage of additional time before you become a parent or add another child to your family. Have a date night, finish the book you are reading, and prioritize self-care. Try to set aside some time for yourself and your family before you focus all your attention on a new baby.

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