The third trimester goes from weeks 28 until your baby’s birth, around 40 weeks. If you are in your third trimester, congratulations, you are in the home stretch until you get to meet your baby. This trimester can be challenging as your belly keeps growing, and you have some new symptoms as a result of carrying around more weight. You may also find yourself anxious to have your baby and ready to be done being pregnant. Your baby is also going through many changes this trimester in preparation for life outside of your womb. You are almost at the finish line. This episode covers everything you need to know about the third trimester to navigate the last few months of pregnancy and go into your birth with confidence.

For a week by week breakdown of what is going on with you and your baby, check out the 40 Weeks podcast.

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Third Trimester Overview

The third trimester goes from weeks 28 until your baby’s birth, around 40 weeks. If you are in your third trimester, congratulations, you are in the home stretch until you get to meet your baby. This trimester can be challenging as your belly keeps growing, and you have some new symptoms as a result of carrying around more weight. You may also find yourself anxious to have your baby and ready to be done being pregnant. Your baby is also going through many changes this trimester in preparation for life outside of your womb. You are almost at the finish line. This episode covers everything you need to know about the third trimester to navigate the last few months of pregnancy and go into your birth with confidence.

Third Trimester To-Do List

The last few months is your opportunity to tackle all the things you need to be prepared for birth and being a parent. Remember, your due date is only an estimate. To be on the safe side, shoot to have all of the big items done 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. The third trimester is also typically when you have your baby shower. According to traditional baby shower etiquette, a close friend plans your shower. If no one has volunteered to throw you a baby shower and you want one, please ask a friend.

Planning 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 you 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. There is also an app for the podcast on the Apple app store or Google Play store, and the app has a great search function to look for episodes on a specific topic. See a list of episodes relating to birth below.

Factoring COVID-19 into Your Plan

At the time of this writing, COVID-19 is still having a significant impact on prenatal care and birth. You can see all the episodes on COVID-19 here, and a few geared towards birth and your baby are listed below.

Take a Birth Class

As you get closer to the birth of your baby, you may find yourself anxious and nervous about the birth. If you haven’t done so already, I strongly recommend taking a childbirth class. A class will be a great way to prepare you for what to expect and the best way to manage labor.

Create Your Birth Plan

The best way to get clear on the birth you want is to create your birth plan. This process is much more than making a list of preferences on a piece of paper and handing it to your doctor or midwife.

For a shortcut to creating your birth plan check out the Your Birth Plan book. This is a step-by-step guide with short chapters on the pros, cons, and evidence for all of your options. The book includes sample plans for everything from home birth to a cesarean. Plus, there is a template you can download and customize. This book walks you through how to choose the birth preferences that are right for you and how to work with your care provider to get their support. The Your Birth Plan book is available as a paperback on Amazon, electronically on Kindle, or PDF on the Pregnancy Podcast website. There are always some things out of your control and surprises that can come up during your labor. For this reason, you should have a backup plan. If you would like to see the birth plan and backup plan I used for my son’s birth, you can get a free copy here.

Packing 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.

Preparing 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. If you want to be really prepared, I highly recommend The Womanly Art of Breastfeeding. This book is thick and very detailed. It will prepare you for all of the challenges that can come up with nursing and serve as a troubleshooting guide throughout your breastfeeding journey.

Preparing for Your Newborn

There are infinite things you can buy for a new baby. The truth is you could survive with a car seat and diapers. If you have a home birth, you wouldn’t even need a car seat. Check out the episode on preparing for a baby for the things that can make being a new parent easier. As much as you prepare, there are going to be some surprises. Below are some episodes to prepare you for a new baby.

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

Common Third Trimester Symptoms

Many of the symptoms that come up in the third trimester are an extension of things that came up in the second trimester. As you get closer to your due date, some of these symptoms can be more challenging. Plus, some new things may come up that you have not experienced yet.

Physical Changes

By the end of the third trimester, you will likely gain between 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 of it is your placenta, amniotic fluid, larger breasts and uterus, extra fat stores, and increased blood and fluid volume.

Breast Changes in the Third Trimester

Your breasts go through many changes during pregnancy. By the end of the third trimester, you will have somewhere around an extra two pounds of breast tissue. I know this can sound overwhelming if you aren’t thrilled about your breasts getting larger. On the bright side, this means your body is preparing to breastfeed.

As you get closer to your due date, your nipples could leak colostrum. This yellowish fluid is what nourishes your baby in the first few days until your milk comes in. Colostrum is like a superfood for your baby, so it is a good thing that your body is producing it. If you leak at all, it shouldn’t be enough to soak through a bra and a shirt. If you are leaking, you can use disposable or reusable breast pads. These also come in handy in the first few weeks of breastfeeding when leaking is most common.

Back Pain

There are several changes during pregnancy that 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 make sure you 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.

Swelling and Edema

You may notice your ankles and feet swelling up 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 place pressure on your nerves, causing tingling or numbness. To reduce swelling, frequently prop up your legs and try to avoid sitting with your legs crossed. If you are at a job where you are required to stand for long periods, try to move around often and if you are uncomfortable, ask for a seat. For more information on swelling and edema, see this episode.

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, which is the muscle just below your lungs. You may find yourself short of breath and getting winded easily. Sitting or standing with good posture can give your lungs more room to expand. If you find yourself out of breath on walks or when exercising, slow down and take it easy.


Heartburn often gets more frequent in the third trimester. To get some relief, eat small meals and drink plenty of fluids (mostly water!) between meals. If you avoid fried foods, citrus fruits or juices, and spicy foods, that should also help. Some heartburn medications are considered safe during pregnancy. As always, run any medicine even if it is available over-the-counter by your doctor or midwife. You may also find taking a digestive enzyme after meals to be helpful.

Varicose Veins

Increased blood circulation might cause tiny red veins, known as spider veins, to appear on your skin. You may also notice varicose veins, which show up as blue or reddish lines beneath the skin’s surface, often on the legs. If you have painful varicose veins, you can elevate your legs frequently, and that should help.

The worst place you can get varicose veins is in the form of hemorrhoids. The best way to avoid this is to prevent constipation. Drink plenty of water and make sure you have adequate fiber in your diet. Hemorrhoids are also common after birth. For more remedies on how to alleviate discomfort from hemorrhoids, see this episode.

Frequent Urination

Your bathroom trips aren’t going to get any less frequent as you near the end of your pregnancy. You will feel more pressure on your bladder as your baby moves deeper into your pelvis. You will probably find yourself going to the bathroom more often. It is also possible to leak a tiny bit of urine when you laugh, cough or sneeze. If you’re worried about leaking, use a thin panty liner.

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.

Braxton Hicks Contractions

Braxton Hicks contractions are most common in the third trimester. These mild contractions are your body practicing for the real thing. They’re usually weak and come and go unpredictably. True labor contractions get longer, stronger, and closer together. If you’re having contractions that are painful or regular, contact your health care provider. Contractions are just one of many labor signs you will eventually see when you go into labor.

Third Trimester Doctor Appointments

Your appointments with your care provider will be more frequent in the last three months. You will see your doctor or midwife every other week. 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 out of every prenatal appointment.

Tdap Vaccine

In the United States, the CDC and ACOG recommend the TDap vaccine in your third trimester between 27-36 weeks. I know it can be challenging to sift through the evidence on vaccines, especially during pregnancy. See this episode that is a deep dive into evidence on the Tdap vaccine.

Group B Strep

Between week 35-37, you will likely have a group B strep test. Group B strep is a bacterium that naturally lives in the gastrointestinal tract and is present in the vagina or rectum of about 25% of all healthy adult women. Once you have this bacterium, it does not mean you will always have it, and it can come and go. Most women colonized with group B strep do not experience any symptoms, and usually, this is not a big deal. Unfortunately, it has the potential to cause some serious complications if you pass it to your baby. Check out this episode for more information on what is involved in the testing, how to treat group B strep, and how you can reduce the risks to your baby. There is even some research showing that you may be able to lower your risk of group B strep by taking a daily probiotic.

Third Trimester Interventions

As you get closer to going into labor, your doctor or midwife may offer some interventions. 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 opt-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?

 Vaginal Exams

As your due date gets closer, your care provider may offer a vaginal exam to take a 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 results’ psychological effects. For a deep dive into the evidence on vaginal exams, see this article.


In a perfect world, everything works like it is supposed to. Your body is ready, your baby is fully mature and ready for birth, and you naturally go into labor on your due date. As you probably know, everything doesn’t always go the way we plan, and many women end up getting 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 of the methods thought to induce labor naturally. See this article for a breakdown of each method offered by your doctor or midwife. There is no one right answer for everyone on whether to induce labor. Please discuss your options, along with the risks and benefits, with your care provider.

Your Growing Baby

Your baby continues 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. Your little one will open his or her eyes, and eyelashes have formed. They can detect light entering their eyes. They have a firm grasp, which is perfect for holding onto your fingers once they are born. To hear about everything going on this week in your pregnancy, check out the 40 Weeks podcast.

Your Baby’s Position

Towards the end of your pregnancy, your provider will also check your baby’s position. Ideally, your baby will move head down. If your little one isn’t head down yet, don’t worry. They still have time to move in the right direction. 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. For more information on optimal fetal positioning and spinning babies, see this episode. You may also be offered an external cephalic version, a procedure done by your care provider to turn your baby manually. You can always have a conversation 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.

Try to Relax and Enjoy

This last trimester can be physically and emotionally challenging. It can be overwhelming to think about all the things you need to learn or get done 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, and 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 having some additional time before you become a parent or add another child to your family. Have a date night, finish the book you are reading, make self-care a priority. Try to set aside some time for yourself and your family now, before it grows by another person, and you focus all of your attention on a new baby.

Thank you to the amazing companies that have supported this episode.

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