Here we are at the home stretch and let me tell you, this part of pregnancy is no joke. The third trimester starts at week 28 and goes all the way to delivery which could be anywhere from week 37 to week 42. Your baby is getting bigger every day and you’re probably feeling every ounce of that growth.
I’m not gonna sugarcoat it because the third trimester can be rough. You’re excited to meet your baby but also exhausted, uncomfortable and maybe a little nervous about labor. That’s completely normal. Let’s talk about what prenatal care looks like during these final weeks and how to prepare yourself for the big day.
Your Appointment Schedule Ramps Up
During the third trimester your prenatal visits become more frequent. From weeks 28 to 36 you’ll see your provider every two weeks. Then from week 36 until delivery you’ll go every single week. I know it feels like you’re constantly at the doctor but there’s a good reason for all these check ins.
At each appointment they’re monitoring you and your baby closely to catch any potential complications early. Your blood pressure gets checked every time because preeclampsia risk increases in the third trimester. They’ll also check for swelling in your hands, feet and face which can be another sign of preeclampsia.
The fundal height measurement continues at every visit. By now your uterus has grown so much that it’s probably pressing on your ribs. If the measurement seems off either too big or too small your doctor might order an ultrasound to check on baby’s size and amniotic fluid levels.
You’ll still pee in a cup at every appointment to check for protein and glucose. Yeah it gets old but these quick tests provide important information about your health. Protein in your urine combined with high blood pressure could indicate preeclampsia which needs immediate treatment.
Around week 28 you might have another blood draw to recheck your iron levels and blood count. Many women become anemic during pregnancy and it’s especially common in the third trimester when your blood volume is at its peak.
Group B Strep Test
Between weeks 35 and 37 you’ll be tested for Group B streptococcus which is a type of bacteria that about 25 percent of women carry in their vagina or rectum. Having Group B strep doesn’t mean anything is wrong with you but it can be dangerous for your baby during delivery.
The test itself is quick and painless. Your provider will use a swab to collect samples from your vagina and rectum. I know it sounds awkward but it takes like ten seconds and then you’re done. Some providers let you do the vaginal swab yourself which makes it less uncomfortable.
If you test positive for Group B strep you’ll receive antibiotics through an IV during labor. The antibiotics protect your baby from getting infected as they pass through the birth canal. You’ll need to get to the hospital early enough in labor to get at least one full dose of antibiotics before delivery.
Checking Baby’s Position
Starting around week 32 your provider will check your baby’s position at each visit. They do this by feeling your belly and figuring out where the baby’s head, back and bottom are located. Most babies settle into a head down position by week 36 which is ideal for vaginal delivery.
If your baby is breech meaning their bottom or feet are down instead of their head your doctor will discuss your options. Some providers are comfortable delivering breech babies vaginally but many recommend a cesarean section because it’s safer. You might be offered an external cephalic version which is when the doctor manually tries to turn the baby from the outside.
I had a friend whose baby was breech at 34 weeks and she was freaking out. Her doctor told her not to worry yet because babies often flip on their own before 37 weeks. Sure enough her little one turned head down at 36 weeks without any intervention.
Non Stress Tests and Biophysical Profiles
If you’re considered high risk or if you go past your due date you might need additional monitoring called non stress tests or biophysical profiles. These tests check on your baby’s well being and make sure they’re tolerating the pregnancy environment.
A non stress test involves wearing two monitors on your belly for about 20 to 40 minutes. One monitor tracks your baby’s heart rate and the other tracks contractions. They’re looking for accelerations in the baby’s heart rate which indicate the baby is doing well. You’ll probably be given a button to push every time you feel the baby move.
A biophysical profile combines a non stress test with an ultrasound. The ultrasound checks your baby’s breathing movements, body movements, muscle tone and amniotic fluid levels. Each category gets a score and the total score tells your provider if your baby is happy in there or if delivery should be considered.
These tests sound scary but they’re actually pretty routine for certain situations. If you’re having twins, if you have gestational diabetes or high blood pressure or if you’re past 41 weeks you’ll likely have them done. The goal is just to make sure everything is still going well.
Third Trimester Symptoms Nobody Warned You About
Let’s talk about the not so glamorous parts of the third trimester because you need to know what’s coming. Heartburn and indigestion can be brutal as your growing uterus pushes your stomach up into your chest. Eating smaller more frequent meals helps. I basically lived on Tums during my last few weeks.
Sleep becomes nearly impossible. You can’t get comfortable, you have to pee every two hours and the baby decides to practice karate at 3am. A good pregnancy pillow is essential. I slept propped up on like five pillows trying to find any position that didn’t hurt.
Braxton Hicks contractions start ramping up in the third trimester. These practice contractions feel like your belly is tightening and getting hard. They’re usually irregular and go away when you change positions or drink water. Real labor contractions get progressively longer, stronger and closer together.
Swelling in your feet and ankles is super common especially at the end of the day. Elevate your feet when you can, avoid standing for long periods and drink plenty of water even though it seems counterintuitive. If the swelling is sudden or severe or if your hands and face swell up too call your doctor right away.
Shortness of breath happens because your uterus is crowding your lungs. Your baby will drop lower into your pelvis in the last few weeks which gives you more room to breathe but then you’ll feel even more pelvic pressure.
Preparing Your Birth Plan
Now is the time to think seriously about how you want your labor and delivery to go. A birth plan is basically a document that outlines your preferences for pain management, interventions, who you want in the room and immediate postpartum care.
Some things to consider for your birth plan include whether you want an epidural or want to try natural pain management techniques. Do you want intermittent fetal monitoring or continuous monitoring. What positions do you want to labor in. Do you want delayed cord clamping. Do you want immediate skin to skin contact with your baby.
I spent hours researching and writing this detailed birth plan and then labor went completely differently than I expected. That’s okay though. Having a plan gave me a starting point and helped me communicate with my medical team. Just remember that birth plans are guidelines not guarantees and flexibility is key.
Talk through your birth plan with your partner and your provider. Make sure everyone is on the same page about your priorities. Your doctor or midwife can also tell you which preferences are realistic at your hospital or birth center and which might not be possible.
Packing Your Hospital Bag
You should have your hospital bag packed and ready by week 36 just in case your baby decides to come early. I put mine by the front door at 35 weeks and it gave me so much peace of mind knowing I could just grab it and go.
For you pack comfortable clothes for labor, a robe, slippers, toiletries, phone charger, snacks and something comfortable to wear home. Hospitals provide those mesh underwear and giant pads but bring your own if you prefer. Don’t forget your insurance cards, ID and any paperwork your hospital requires.
For your partner pack snacks, a change of clothes and their own toiletries. Labor can last a long time and they need to stay fed and comfortable too. A pillow and blanket for them isn’t a bad idea either since hospital chairs aren’t exactly cozy.
For baby you need an outfit to go home in, a blanket and a properly installed car seat. The hospital will provide diapers, wipes and basic baby care items during your stay. Don’t go overboard packing baby stuff because you honestly won’t need much.
Signs of Labor You Need to Know
As you get closer to your due date you’ll be hyperaware of every twinge wondering if this is it. True labor has some pretty clear signs but early labor can be confusing especially if it’s your first baby.
Regular contractions that get longer, stronger and closer together are the main sign of labor. Time your contractions from the start of one to the start of the next. Most providers want you to come to the hospital when contractions are five minutes apart lasting one minute each for at least an hour.
Your water breaking is another sign of labor though only about 15 percent of women experience this before contractions start. If your water breaks you’ll feel a gush or steady trickle of fluid. Note what time it happened and what color the fluid is then call your provider. You’ll need to deliver within 24 hours once your water breaks to reduce infection risk.
Losing your mucus plug can happen days or even weeks before labor starts so it’s not a reliable sign on its own. It looks like thick bloody or brown tinged discharge. Gross but normal.
Some women experience back labor with intense lower back pain that comes and goes with contractions. If you’re having regular painful contractions even if they’re not in your belly call your provider.
When to Go to the Hospital
Knowing when to actually head to the hospital is one of the biggest sources of anxiety for first time moms. You don’t want to go too early and get sent home but you also don’t want to wait too long and deliver in the car.
Generally you should go to the hospital when your contractions are five minutes apart lasting one minute each for at least one hour. This is called the 5-1-1 rule. Some providers might give you different guidelines based on your specific situation or how far you live from the hospital.
If your water breaks go to the hospital even if you’re not having strong contractions yet. Same thing if you’re bleeding heavily or if you notice decreased fetal movement. Better to get checked out and be sent home than to wait too long.
Don’t feel embarrassed if you go to the hospital and you’re not actually in labor. False alarms happen all the time and the medical staff won’t judge you. They’d rather check you and send you home than have you deliver in the parking lot.
Final Weeks Before Baby Arrives
The last few weeks of pregnancy feel endless when you’re uncomfortable and ready to meet your baby. Try to use this time to rest as much as possible even though sleep is difficult. Take naps when you can and don’t feel guilty about it.
Meal prep and freeze some easy dinners for after the baby comes. You’ll be exhausted and overwhelmed those first few weeks and having food ready to heat up is a lifesaver. I made like ten lasagnas and froze them and we ate them for weeks.
Spend quality time with your partner before your family expands. Go out to dinner, see a movie, do whatever you enjoy together because date nights become a lot more complicated once you have a baby. Cherish those last peaceful moments as a couple.
If you have other kids at home prepare them for the baby’s arrival. Read books about becoming a big brother or sister and involve them in getting the nursery ready. Make sure they know who will take care of them when you go to the hospital.
The third trimester is tough but you’re almost there. Every day you’re one day closer to holding your baby and that makes all the discomfort worth it. Stay strong mama because you’re about to do the most amazing thing your body was designed to do. Understanding how prenatal care supports you through every stage of pregnancy helps you feel confident as you approach delivery day. And if you’re wondering what you should be eating during these final weeks to support your baby’s development, check out our complete guide to pregnancy nutrition by trimester for specific recommendations.
Carlene R. Priddy offers strategic advice and practical guidance for governorsbefore, during, and after their mandatesto strengthen governance and public leadership.