Third trimester pregnancy: What to expect

The third trimester of pregnancy can be physically and emotionally challenging. Your baby's size and position might make it hard for you to get comfortable. You might be tired of pregnancy and eager to move on to the next stage. If you've been gearing up for your due date, you might be disappointed if it comes and goes uneventfully.

Try to remain positive as you look forward to the end of your pregnancy. Soon you'll hold your baby in your arms! Here's what to expect in the meantime.

Third trimester pregnancy: Your body

As your baby grows, his or her movements will become more obvious. These exciting sensations are often accompanied by increasing discomfort and other third trimester pregnancy symptoms.

Continued breast growth
By now, you might have an additional 2 pounds (nearly 1 kilogram) of breast tissue. As delivery approaches, your nipples could start leaking colostrum — the yellowish fluid that will nourish your baby during the first few days of life.

Weight gain
By your due date, expect to weigh 25 to 35 pounds (about 11 to 16 kilograms) more than you did before pregnancy. Your baby accounts for some of the weight gain, but so do the placenta, amniotic fluid, larger breasts and uterus, extra fat stores, and increased blood and fluid volume.

Braxton Hicks contractions
These contractions are warm-ups 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.

Backaches
As your baby continues to gain weight, pregnancy hormones relax the joints between the bones in your pelvic area. These changes can be tough on your back. When you sit, choose chairs with good back support. Apply a heating pad or ice pack to the painful area. Ask your partner for a massage. Wear low-heeled — but not flat — shoes with good arch support. If the back pain doesn't go away or is accompanied by other signs and symptoms, contact your health care provider.

Shortness of breath
You might get winded easily as your uterus expands beneath your diaphragm, the muscle just below your lungs. This might improve when the baby settles deeper into your pelvis before delivery. In the meantime, practice good posture and sleep with your upper body propped up on pillows to relieve pressure on your lungs.

Heartburn
During the third trimester, your growing uterus might push your stomach out of its normal position — which can contribute to heartburn. To keep stomach acid where it belongs, eat small meals and drink plenty of fluids between meals. Avoid fried foods, carbonated drinks, citrus fruits or juices, and spicy foods. If these tips don't help, ask your health care provider about antacids.

Swelling
As your growing uterus puts pressure on the veins that return blood from your feet and legs, swollen feet and ankles might become an issue. At the same time, swelling in your legs, arms or hands can place pressure on nerves, causing tingling or numbness. Fluid retention and dilated blood vessels might leave your face and eyelids puffy, especially in the morning. If you have persistent face or eyelid swelling, contact your health care provider.

To reduce swelling, lie down or use a footrest. You might even elevate your feet and legs while you sleep. It can also help to swim or simply stand in a pool.

Spider veins, varicose veins and hemorrhoids
Increased blood circulation might cause small reddish spots that sprout tiny blood vessels on your face, neck or arms, especially if you have fair skin. Blue or reddish lines beneath the surface of the skin (varicose veins) also might appear, particularly in the legs. Varicose veins in your rectum (hemorrhoids) are another possibility.

If you have painful varicose veins, elevate your legs and wear support stockings. To prevent hemorrhoids, avoid constipation. Include plenty of fiber in your diet and drink lots of fluids.

Frequent urination
As your baby moves deeper into your pelvis, you'll feel more pressure on your bladder. You might find yourself urinating more often, even during the night. This extra pressure might also cause you to leak urine — especially when you laugh, cough or sneeze. If you're worried about leaking urine, panty liners can offer a sense of security.

Continue to watch for signs of a urinary tract infection, such as urinating even more than usual, burning during urination, fever, abdominal pain or backache. Left untreated, urinary infections increase the risk of pregnancy complications.

Vaginal discharge
Potentially heavy vaginal discharge is common at the end of pregnancy. If you saturate a panty liner within a few hours or wonder if the discharge is leaking amniotic fluid, contact your health care provider.

Third trimester pregnancy: Your emotions

As anticipation grows, fears about childbirth might become more persistent. How much will it hurt? How long will it last? How will I cope?

If you haven't done so already, consider taking childbirth classes. You'll learn what to expect — and meet other moms-to-be who share your excitement and concerns. Talk with women who've had positive birth experiences, and ask your health care provider about options for pain relief. Tell yourself that you'll simply do the best you can. There's no right or wrong way to have a baby.

The reality of parenthood might begin to sink in as well. You might feel anxious and overwhelmed, especially if this is your first baby. To stay calm, revel in the experience of being pregnant and think about the joy that will come from loving a new human being. Consider:

• Writing your thoughts in a journal
• Talking to your baby
• Taking photos of your pregnant belly to share with your child one day

It's also helpful to plan ahead. If you'll be breast-feeding, gather any supplies you might need, such as a special pillow to use while breast-feeding and a breast pump. If you're expecting a boy — or you don't know your baby's sex — think about what's right for your family regarding circumcision. Consider who'll be your baby's principal health care provider. Make plans for your first few weeks together.

Appointments with your health care provider

During the third trimester, your health care provider might ask you to come in for more frequent checkups — perhaps every other week beginning at week 32 and every week beginning at week 36.

Like previous visits, your health care provider will check your weight and blood pressure and ask about any signs or symptoms you're experiencing. You might need screening tests for various conditions, including:

• Gestational diabetes. This is a type of diabetes that sometimes develops during pregnancy. Prompt treatment and healthy lifestyle choices can help you manage your blood sugar level and deliver a healthy baby.
• Anemia. Anemia is an abnormally low level of red blood cells or hemoglobin, a protein in red blood cells that contains iron. Severe anemia can slow your baby's growth or trigger preterm labor. To treat anemia, you might need to take iron supplements.
• Group B strep. Group B strep is a type of bacteria that can live in your vagina or rectum. It won't make you sick, but it could cause a serious infection for your baby after birth. If you test positive for group B strep, your health care provider will likely recommend antibiotics while you're in labor.

Your health care provider will also check your baby's size and heart rate. Near the end of your pregnancy, vaginal exams can help your health care provider determine your baby's position inside your uterus. He or she might also check your cervix to see whether it's begun to soften or dilate in preparation for birth — although cervical exams aren't a reliable way to predict when labor will begin.

If you have specific desires or preferences for labor and birth — such as laboring in water or avoiding medication — you might want to define your wishes in a birth plan. Review the plan with your health care provider ahead of time to prevent any misunderstandings.

As your due date approaches, keep asking questions. How can I tell the difference between false labor and the real thing? When do I need to go to the hospital? Could I be too late for an epidural? Remember, there's no silly question. Understanding what's happening can help you have the most positive birth experience.

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