The third trimester, weeks 28 to 40: body, mood and getting ready

Who leads what from 28 weeks?

Your obstetrician or midwife leads the pregnancy itself: the scans, the blood pressure checks, the position of the baby, the birth. We are your baby’s doctor, and our part starts the day your baby is born. The two overlap at the prenatal visit, which is free and usually booked between 28 and 32 weeks. You meet Dr. Viswanadham, see the office and ask whatever you want to ask. The AAP recommends it during the third trimester. Sign up here.

The task list for these weeks, choosing a pediatrician, Tdap, RSV, the car seat, the sleep space and what happens at the hospital, is in our third-trimester checklist, with sources. This guide covers the rest: your body, your mood, money and work, preparing for the birth, preterm labor and going past your due date.

What is my body doing between 28 and 40 weeks?

Most of what feels alarming in these weeks is mechanical. The uterus presses up against your diaphragm and down on your bladder, and the hormone relaxin loosens the ligaments in your pelvis.

• Shortness of breath after little effort, because there is less room for your lungs. It often eases near 36 weeks, when the baby drops lower.
• Swelling in the feet and ankles by evening, and tingling in the hands from fluid pressing on a nerve at the wrist.
• Back and hip ache, and an unsteady feeling when you walk. That is relaxin doing its job, not a sign something is wrong.
• Heartburn, a smaller appetite and broken sleep. Smaller meals, an earlier dinner and sleeping propped up on your side are what most people find helps.
• Practice contractions that tighten the whole belly and then stop. They get stronger through the third trimester.
• More discharge, some leaking colostrum, and losing part of the mucus plug. None of those means labor that day.
• Sudden swelling in the hands or face is the one exception on this list. That one gets a phone call, not a wait.

How much should my baby be moving?

By 28 weeks you know your baby’s pattern: the hours they are busy and the stretches they sleep. Near the end the movements change character, more rolling and stretching than sharp kicks, because there is less room. What matters is your baby’s own pattern, not the type of movement. If it slows down, or feels different to you, call your obstetrician that day and be ready to go in. Do not wait until morning. March of Dimes is blunt about why: the most common sign of stillbirth is that the baby stops moving and kicking, and it says to call right away. Some obstetricians ask for daily kick counts; ask yours whether they want you counting, and how.

Which vaccines do I need while I am pregnant?

Your obstetrician gives these at a prenatal visit. They all work the same way: your antibodies cross to your baby and cover the months before your baby can be vaccinated.

• Tdap, between 27 and 36 weeks of every pregnancy, preferably early in that window. CDC recommends it in each pregnancy because the antibodies fade and each baby needs their own. This is what protects a newborn from whooping cough.
• RSV. CDC recommends every baby be protected one of two ways: the maternal RSV vaccine at 32 to 36 weeks, given September through January in most of the country, or an RSV antibody shot for your baby. Most babies do not need both.
• Flu. CDC recommends a flu shot, not the nasal spray, at any point in pregnancy. It protects your baby against flu in the first months too.
• COVID-19. CDC recommends vaccination in pregnancy and says your antibodies help protect the baby. Most babies hospitalized with COVID-19 were born to mothers who were not vaccinated during pregnancy.

Bring the dates to your baby’s first visit, so we can plan the rest of the schedule.

Is it normal to feel this low or this anxious?

Being tired and short-tempered at 34 weeks is ordinary. Depression is a different thing, and it is common: March of Dimes puts perinatal depression at up to 1 in 7. Watch for sadness or flatness lasting more than two weeks, crying most days, losing interest in what you used to enjoy, or thoughts about death. Your obstetrician screens for this at prenatal checkups, but say it out loud rather than waiting to be asked. Counseling counts as treatment, and treatment works.

Fear of the birth is its own thing, and close to universal in a first pregnancy. Naming what you are afraid of, the pain, losing control, an unplanned cesarean, something that happened last time, turns it into something you can raise with your obstetrician. Postpartum Support International runs a helpline at 1-800-944-4773, in English and Spanish, that covers pregnancy and not only afterwards.

What can I do about money and time off?

Split the list into what has to be ready before the birth and what can wait. The car seat and a safe place to sleep cannot wait. Most of the rest can.

1. Ask your employer in writing what your leave is, how much of it is paid, and by when you have to file.
2. Find your insurance plan’s deadline for adding a newborn and write it down. On Georgia Medicaid, report the birth straight away so your baby has an ID before the first visit. Our insurance page lists the plans we take.
3. Apply for the programs you qualify for now rather than after the birth, because they take time.

Georgia WIC, from the Georgia Department of Public Health, provides food on an eWIC card, breastfeeding support, nutrition counseling and referrals. Pregnant women, new mothers, infants and children under 5 can qualify; the WIC line is (800) 228-9173. Childcare and Parent Services, or CAPS, is Georgia’s childcare subsidy: eligible families get help paying for licensed childcare and pick their own provider, through Georgia Gateway or 1-833-4GACAPS. Call daycares while you are still pregnant, because the waiting lists around Alpharetta are long.

How do I get ready for the birth itself?

A birth plan is a short list of preferences, not a contract. One page is plenty: who you want in the room, what you want for pain relief, what you want done with the baby in the first hour, and what you would want if the plan changes. Write it so it still works if you end up with an induction or a cesarean.

Then use it to ask your obstetrician what is actually bothering you. When do they usually induce. What happens if the baby is still breech at 36 weeks. Tell your support person plainly what you want from them, because “be supportive” is not instructions. If the fear is bigger than a conversation can settle, ask for a referral to a therapist.

What are the signs of preterm labor?

Preterm means birth before 37 weeks. ACOG says that if you have any of these before 37 weeks, do not wait: call your obstetrician right away or go to the hospital.

• Regular or frequent contractions or tightening of the uterus, including tightening that does not hurt
• A change in vaginal discharge, watery, mucus-like or bloody, or much more of it than usual
• Your water breaking, as a gush or as a trickle
• March of Dimes adds constant low backache, pelvic or lower belly pressure, and belly cramps that may come with diarrhea

For about 3 in 10 women preterm labor stops on its own. When it does not, treatments can delay the birth or reduce the risk for the baby, and they work better the earlier you are seen. If your baby comes early, the hospital’s newborn team cares for your baby first, and we take over at discharge.

What if I go past my due date?

Few babies arrive on the due date, and anywhere from 37 to 42 weeks is normal. ACOG calls 41 weeks up to 42 weeks late term, and past 42 weeks postterm. Between 40 and 41 weeks you may not need any testing. At 41 weeks your obstetrician may start testing, often weekly or twice weekly, and may recommend inducing labor. Have that conversation at your 39 and 40 week visits, before you are sick of being pregnant.

What happens in your baby’s first days?

Call or text us the day you leave the hospital. We see your baby 2 to 3 days after you go home, to check weight, feeding and jaundice, and we hold same-week slots for newborns. Bring the discharge papers and your insurance card. After that visit, the free monthly newborn baby massage workshop is an easy first outing.