The third trimester (weeks 28 through 40) is the most physically demanding stretch of pregnancy, and “surviving” it comes down to managing discomfort, staying on top of a busier prenatal schedule, knowing what’s normal versus what’s not, and getting yourself ready for labor. Here’s what actually helps.
Managing the Aches and Swelling
Back pain is one of the most common third trimester complaints. Pregnancy hormones loosen the connective tissue holding your pelvic bones in place, and your growing uterus stretches out your abdominal muscles, removing the support system your lower back usually relies on. When you sit, choose chairs with solid back support. If you’re standing for a while, rest one foot on a low stool to shift pressure off your spine. Abdominal support garments from maternity stores take some of the load off, and alternating a heating pad with a cold pack on sore muscles can make a real difference.
Swelling in your legs and feet tends to get worse as the uterus compresses blood vessels, slowing blood flow back to your heart. Prop your legs up whenever you can, wear compression socks, and avoid standing in one spot or sitting with your legs crossed for long stretches. Hemorrhoids, which are essentially varicose veins in the rectal area, often show up now too. Soaking in a warm bath helps with the pain and itching. Eating more fiber and drinking plenty of water keeps things moving and reduces the straining that makes hemorrhoids worse.
Heartburn gets more intense as the baby crowds your stomach upward. Eating smaller meals more frequently, staying upright for at least 30 minutes after eating, and skipping spicy or acidic foods before bed are the simplest fixes.
Getting Better Sleep
Sleep gets harder with every passing week, but your position matters more than you might think. A large meta-analysis of over 3,000 pregnancies found that falling asleep on your back after 28 weeks roughly doubled the odds of stillbirth, likely because the weight of the uterus compresses a major vein that returns blood to your heart. The good news: right-side sleeping showed no increased risk compared to left-side sleeping. So either side is fine. The key is simply avoiding your back as your go-to position.
Pillows are your best tool here. A body pillow or a regular pillow wedged behind your back can keep you from rolling onto your back overnight. Another pillow between your knees takes pressure off your hips and lower back. If you wake up on your back, don’t panic. Just roll to your side and go back to sleep. What matters is the position you fall asleep in, since that’s where you spend the most time.
Eating for the Final Stretch
Your calorie needs are highest now. The CDC recommends about 450 additional calories per day during the third trimester compared to your pre-pregnancy intake, up from roughly 340 extra in the second trimester. That’s not a huge jump, maybe an extra substantial snack or a slightly larger meal. Focus on protein, iron-rich foods, and calcium, since your baby is building bone density and putting on about half a pound per week during these final months. Staying well-hydrated also helps with the swelling, constipation, and headaches that tend to pile up in this trimester.
Tracking Your Baby’s Movements
Starting around 28 weeks, paying attention to fetal movement becomes an important daily habit. The most common method is simple: pick a time when your baby is usually active, start a timer, and count until you feel 10 movements. Most babies hit that number well within two hours. Kicks, rolls, jabs, and stretches all count.
The goal isn’t to hit a magic number every single time. It’s to learn your baby’s normal pattern so you can notice if something changes. Fewer movements, weaker movements, or an unusual surge in activity can all be worth paying attention to. If your baby’s pattern shifts noticeably, go to the hospital for evaluation. Don’t wait for your next scheduled appointment, and don’t worry about calling after hours.
Prenatal Visits Pick Up
Your appointment schedule gets busier in the third trimester. From week 28 through 36, expect a visit every two weeks. After 36 weeks, you’ll go weekly until delivery. These visits typically check your blood pressure, measure your belly, and monitor the baby’s heart rate.
One key screening happens between 36 and 38 weeks: the Group B Strep (GBS) test. GBS is a common bacterium that’s harmless to you but can be passed to your baby during labor. About 1 to 2 babies out of 100 get sick when the mother carries GBS and doesn’t receive antibiotics during delivery. If you test positive, you’ll receive antibiotics through an IV during labor, which dramatically reduces that risk. If you’re allergic to penicillin, let your provider know before the test so they can plan alternatives.
Braxton Hicks vs. Real Labor
Braxton Hicks contractions are common in the third trimester and can feel convincingly real, especially if it’s your first pregnancy. Here’s how to tell the difference:
- Pattern. Braxton Hicks contractions are irregular and don’t get closer together over time. True labor contractions come at regular intervals and gradually increase in frequency.
- Duration. Braxton Hicks can last anywhere from a few seconds to two minutes but stay unpredictable. True labor contractions last 30 to 90 seconds and get progressively longer.
- Intensity. Braxton Hicks stay the same or get weaker and fade out. True labor contractions build in strength over time.
- Response to movement. Braxton Hicks often stop if you change position, walk around, or rest. True labor contractions continue regardless of what you do, and may even get stronger with movement.
A useful shortcut: if you can sleep through them, they’re Braxton Hicks.
Preparing Your Body for Labor
Starting at 35 weeks, daily perineal massage can reduce your risk of tearing during a vaginal delivery. You or your partner can do this at home. It takes a couple of weeks of consistent practice before you’ll notice increased flexibility in the area. It’s not the most comfortable routine, but research from the Royal College of Obstetricians and Gynaecologists supports it as one of the few things you can actively do to lower tearing risk.
Staying active matters too. Walking, swimming, and prenatal yoga help with circulation, back pain, and stamina for labor. Even short walks make a difference if longer exercise feels impossible at this point.
Warning Signs That Need Immediate Attention
Preeclampsia is a serious pregnancy complication that develops after 20 weeks, most often in the third trimester. It’s diagnosed when blood pressure reaches 140/90 or higher along with protein in the urine. But you won’t know your protein levels at home, so the symptoms to watch for are:
- Severe headaches that don’t respond to rest or hydration
- Visual disturbances like blurred vision, seeing spots, or light sensitivity
- Upper abdominal pain, typically under the ribs on the right side
- Sudden swelling in your hands and face (not just the gradual ankle swelling that’s normal in late pregnancy)
- Nausea or vomiting that starts in the second half of pregnancy
Any combination of these symptoms warrants an immediate call to your provider or a trip to the hospital.
Packing Your Hospital Bag
Most people suggest having a bag ready by 36 weeks. Beyond the obvious (ID, insurance card, phone charger, going-home outfit), a few items are easy to overlook:
- Heavy-flow pads. Hospitals provide them, but you may prefer your own brand. Postpartum bleeding is significant and lasts for days.
- Breast pads. You’ll need these whether or not you plan to breastfeed, because your breasts will leak.
- A sports bra. Useful during labor if you plan to use a birth pool, and afterward for breast support.
- A nursing pillow. Reduces strain on your arms, neck, and back during feeding, whether breast or bottle.
- Rice in a sock. Fill a sock with uncooked (not instant) rice. It can be heated or frozen and provides surprisingly good pain relief during contractions and recovery.
- Baby mittens. Newborns often have longer nails than you’d expect and will scratch their own faces.
- An installed car seat. Hospitals will not let you leave without one. Have it assembled and properly installed in the car before you go into labor, not in the trunk waiting to be figured out.