Pregnancy: What to Expect in Your Third Trimester (Week 27 - End of Pregnancy)

Baby's Growth & Development in the Third Trimester

During your third trimester, (between 28–40 weeks gestation) your baby experiences major transformations as it rapidly gains weight, its organs mature and their once transcalent skin takes on a new appearance.

In fact, your baby gains one and one-half times their weight in the home stretch. At the beginning of the trimester, he or she weighs about three pounds and is around 17 inches long. Throughout the next few months, your baby grows from the size of an eggplant to a small pumpkin. Fine, soft hair on baby's body starts to go away, mainly from the face, while their skin is still covered by a white creamy coating for protection.

At this point in the pregnancy, the baby is often in the head-down position. You’ll feel most of their kicks under your ribs. Since there’s little room left in the uterus, you may notice more arm and leg movements, but less rolling over from baby.

Fetal Movement: Feeling Baby’s Kicks

For a few weeks now, baby has been able to twist, turn, stretch, roll and kick. Baby may stay in the same position and be active at the same times each day. Each baby has its own pattern of movements, and you’ll likely notice routine periods of activity and sleep. They’ll sleep 20 to 45 minutes at a time and may suck their thumb.

Baby may have a certain time when they’re very active. Often, this is your bedtime. You may feel a series of jerks or jolts, too. This may be the baby's hiccups. Overall, you’ll feel more turns and twists with less kicks and jabs.

The important thing is to know what’s normal for your baby, so you can tell your provider if something is different. Call your provider if you don't feel your baby move all day, or if it takes longer from one day to the next to count ten movements.

Mother's Health: Pregnancy Changes in the Third Trimester

Baby's activity and position

At this point in your pregnancy, your baby's kicks and twists are strong and sometimes painful. You may find that your baby settles in a position that’s painful for you. At times, you may get relief by changing your position. The baby may change position, too, and give you some relief. In the last month of pregnancy, you may notice fewer kicks and more squirmy movements as your baby runs out of room. You may even notice jerking motions (like hiccups) that can last a few minutes. This is nothing to worry about. It’ll stop shortly and won’t hurt either of you.

Backache

As your pregnancy progresses, your posture changes to make room for your expanding womb, making lower backache common.

At-home remedies for low backache relief:

• Wear low heeled shoes with good arch support
• Exercise and stretch your back muscles
• Bend at the knees to lift items or have someone do it for you
• Get off your feet for a break
• Sit in chairs with good back support
• Wear an abdominal support garment
• Use a heating pad

Constipation

Your enlarged, growing womb is now pressing on your intestines — slowing your digestion and movement of food. Pregnancy hormones can also cause the digestive tract to relax and function more slowly. Hard stools are likely to happen and may get worse.

At-home remedies for constipation relief:

• Exercise daily
• Try not to eat gas-forming food, such as fatty fried foods
• Chew your food slowly and drink more fluids
• Drink a lot of water
• Try a hot drink first thing in the morning to ease hard stools (herbal tea, or lemon water)
• Add whole grains, such as bran, fresh and dried fruits and raw vegetables to your diet
• Try an over-the-counter stool softener such as Colace (docusate sodium), Metamucil (psyllium) or Citrucel (methylcellulose) that may be safely taken during pregnancy

Dental care

Because of hormonal changes that can affect your teeth and gums during pregnancy, it’s a good idea to have them cleaned again before you have your baby.

Heartburn

Heartburn, along with a sour taste in your mouth, is common in pregnancy.

At-home remedies for heartburn relief:

• Don’t overfill your stomach
• Eat six small meals
• Try not to eat fatty, fried or spicy foods
• Drink less with meals
• Try not to bend over or lying down after meals — go for a walk
• Don’t eat just before bedtime and sleep propped up with pillows if heartburn is worse at night
• Try antacids like Tums, Rolaids or Mylanta

Hemorrhoids

Hemorrhoids are dilated, twisted blood vessels in and around the rectum. You may notice more in the last month of pregnancy. They can cause pain, itching and bleeding during a bowel movement.

At-home remedies to prevent and treat hemorrhoids:

• Lie on your side with your hips on a pillow
• Keep soothing witch hazel pads, ice packs or Tucks in the fridge to use
• Trying Preparation H and/or Anusol HC can help with uncomfortable symptoms
• Keep your stools soft by drinking more and adding fruits, vegetables and fiber to your diet
• If your stool is hard, use an over-the-counter stool softener such as Colace (docusate sodium) or Metamucil (psyllium)

Rest assured that hemorrhoids often get better without treatment shortly after giving birth.

Leaking urine

Stress incontinence, which is leaking urine when you laugh, sneeze or cough, is caused by increased pressure on the bladder.

Trying these steps for Kegel’s exercises can help with leaking urine while pregnant:

• Firmly tighten the muscles of the pelvic floor as you would to stop urinating midstream
• Next, hold for a slow count of three
• Slowly release the muscles, relax and repeat
• Breathe slowly — don’t hold your breath
• Repeat 25 times, two to three times a day

Kegel exercises can be done anytime, standing or sitting. Drinking less will not keep you from leaking urine or help you sleep through the night. It’s important to drink enough fluids (6-8 glasses a day) when you’re pregnant.

If you need a pad to keep your underwear dry due to the leakage, you may have a leak in your bag of waters, which warrants calling your doctor to get checked out.

Pelvic pressure or pain

Groin pain can be due to stretching of the round ligaments that help support the womb. Pelvic pressure can be from the baby's head being low in the pelvis. It’s important to discuss sudden onset or severe pelvic pain with you care team.

Shortness of breath

Though you breathe more air in and out of your lungs during pregnancy, you may sometimes feel as if you can’t catch your breath. This feeling comes from the womb pressing on the diaphragm and crowding the lungs. Relief comes when the baby settles low in the pelvis. Until then, sit or stand up straight, and sleep with your shoulders propped up. If there’s a major change in your breathing, or if you have a cough or chest pain, call your provider right away.

Sleeping

Leg cramps, hard breathing, painless contractions, a pressing need to go the bathroom and a kicking baby may make it hard to sleep. Try taking naps and using extra pillows to support your back and legs.

Stress and feelings of nervousness

It’s common to feel stressed and nervous when you’re pregnant. This is true for most women, no matter how much they’ve planned and wanted to be pregnant. People in your life may also feel stressed. For example, your partner or loved ones may be worried about you, the baby and about parenthood. If you have other children, they may be nervous about how a baby will impact their time with you. Talking with your provider about your worries and fears can be helpful.

Swelling

Pregnancy can cause fluid to collect in your soft tissue. Your feet, ankles, hands and fingers may swell. This is most common at the end of the day. Much of the swelling should go away after a good night's sleep.

At-home remedies to reduce swelling:

• Don't stand in place for too long
• Avoid foods that are high in salt (like potato chips)
• Walk and flex muscles in your lower legs
• Prop up your feet when you can
• Try to sleep with your feet slightly higher than your heart by placing a pillow under your legs
• Wear support socks and good, supportive shoes
• Make sure stockings and shoes aren’t too tight
• If your fingers are puffy, remove your rings before they get too tight
• Lying on your left side helps move extra fluid
• Let your provider know if you have a sudden increase in swelling, your face becomes very puffy or swelling doesn’t get better after a night's rest

Signs of Early Labor

Pregnancy should last about 40 weeks from the first day of your last period. Babies born early may have more health problems and require a longer hospital stay. The earlier your baby is born, the more health problems he or she may have. If preterm labor is recognized in time, it may be possible to stop the labor or give you medicines that help baby’s lungs work better if he or she is born early.
Early warning signs of preterm labor include:

• Cramps, like during your period, (constant or comes and goes)
• Low, dull backache that comes and goes
• Pelvic pressure (feels like the baby is pushing down)
• Increased or different vaginal discharge (mucous-y, watery or blood-tinged)
• Painful uterine contractions, four to five times in one hour; feels like the baby is “balling up” inside, your uterus feels hard, then soft
• Leaking fluid
• Diarrhea, nausea or indigestion

What to do if you experience signs of preterm labor:

• Lie down on your side for an hour and drink 2-3 glasses of water or juice
• Take two extra strength Tylenol
• Soak in warm water in the bathtub for 30 minutes
• If the symptoms go away, you can go back to light activity but not what you were doing before symptoms started

If you’re leaking fluid, symptoms get worse or stop and come back after an hour, call your provider immediately. If preterm labor is discovered early enough, it may be stopped, or there may be time for medication to help your baby breathe better before he or she is born.

Difference Between True and False (Braxton-Hicks) Contractions

Braxton-Hicks contractions:

• An overall tightness or slight cramping in your abdomen
• May be felt very high up, or you may feel them across the middle
• Often brought on by lots of motion or being active
• May start out of nowhere, last a short time and go away
• No gradual increase or peak in intensity
• No pain, just tightness
• Go away if you drink water or sit down for a while

True contractions:

• Feel very low, either in front or back, and sometimes wraps around the abdomen
• A strong tightness that grows in strength, peaks, and drops off again
• Doesn’t go away or change if you move around, sit down or drink water

When to Call Your Doctor in the Third Trimester

If you experience any of the following, it’s best to call your provider to ensure you and baby are safe and healthy.

• Vaginal discharge that’s watery, bloody or mucus-like
• Your water breaks – either a gush or a trickle
• Pain or cramps in your back or pelvis, similar to menstrual cramps
• Contractions that happen in a regular pattern and get closer together over time
• Fever or a severe headache
• Major change in your breathing, or you have a cough or chest pain
• Severe or persistent nausea
• Bleeding heavily from the vagina (other than bloody mucus or spotting)
• Constant, severe pain – contractions should have some relief between them
• Baby is moving less often

Preeclampsia, a potentially serious pregnancy complication, can happen after 20 weeks of gestation. This condition is characterized by elevated blood pressure and signs of organ dysfunction, most commonly affecting the kidneys and liver.

Call your provider right away if you have any of the following signs of preeclampsia:

• Swelling of the face or hands
• A headache that will not go away
• Seeing spots or changes in eyesight
• Pain in the upper abdomen (near your ribs) or shoulder
• Nausea and vomiting
• Sudden weight gain
• Trouble breathing

As you navigate your second trimester, rest assured that our compassionate and knowledgeable care team is here to support you every step of the way. If you’re ever concerned about changes occurring in your body or have questions about your growing baby, always contact your care team.

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