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What to Expect in Your Third Trimester
You made it through the hellish first trimester and got past the second relatively unscathed. You are now in the final stretch and are wondering what you can expect during the final three months before your little one arrives. The third trimester of pregnancy—weeks 29-40—is debatably the most challenging of the three trimesters. You may have experienced some of these symptoms in the previous months, but most of them, like abdominal, back, and leg pains, are amplified in comparison. In this article, I will describe common symptoms of the third trimester, why they occur, and what you can do to cope.
Symptoms of the Third Trimester
- Excessive hunger and weight gain
- Hot flashes and chills
- Leg cramps
- Dizziness and nausea
- Back pain
- Pelvic and cervical pain
- Braxton-Hicks contractions
- Swollen, painful breasts
- Bleeding gums and toothaches
- Varicose veins
1. Excessive Hunger and Weight Gain
It's not just feeling like eating a snack; it's feeling like you haven't eaten in weeks, even if you just had a feast. This excessive hunger is perfectly normal and can simply signal the need for more nutrients and energy—not only for you but for your developing baby.
However, there are two common concerns with this increased appetite. The first is that there is less room in your stomach and increase risk of reflux because the baby pressing against your stomach. The second is the concern of gaining too much weight. To address these two concerns, it's important to be aware of what, when, and how much you eat.
How Much Weight Do You Gain During Pregnancy?
Women typically gain weight at 2-4 lbs/week during the first trimester and about 1-2 lbs for the second and third trimesters for a total of 25-35 lbs at the end of pregnancy.
Ways to Cope
You and your baby need more nutrients, but there's only so much you can eat at a time. The best strategy is to eat several small portions of nutrient-dense foods. Meal-planning in consultation with a licensed nutritionist, dietician, or doctor is advised, but here are some general guidelines to keep in mind.
- Eat foods high in fiber: Fiber not only promotes regular bowel movements but is also more filling, helping keep cravings at bay. Quinoa, oatmeal, chia seeds, and fruits with skins are some great sources of fiber.
- Maintain a balance of protein and carbohydrates: Protein is particularly important for growth and development, and carbohydrates are the main source of energy.
- Get enough vitamins and minerals: This promotes healthy development. In particular, you should be getting enough calcium, iron, and folic acid (B9). Whole grains are a great source of healthy carbs, iron, and folic acid.
- Don't forget the fats: Healthy fats (mono- and polyunsaturated fats) maintain good cardiovascular health, promotes nutrient absorption, and helps you feel full faster. Nut butters, almonds, avocado, salmon, and olive oil are examples of great sources of unsaturated fats.
- Drink water: Staying hydrated can keep you feeling full between meals.
- Eat foods high in volume: If you've eaten enough calories but you still feel hungry, eat low-calorie foods that take up a lot of room. This helps you feel full and prevents excess weight gain. Some examples are cucumbers, strawberries, melons, and popcorn.
- Stay active: Regular exercise maintains a healthy body, weight, and can prevent many of the other discomforts associated with pregnancy. Talk with your doctor about what sorts of activities you can safely do. Some common ones include yoga and swimming.
2. Hot Flashes and Chills
Many women report feeling hot or overheating during the third trimester of pregnancy. You may be sweating all the time and feeling like no matter how many items of clothing you take off, you can’t help but feel like you’re melting. It can get so bad that it disturbs your sleep and makes you wonder if you have a fever or are just plain crazy. Don’t fret—hot flashes are perfectly normal, and your body temperature will return to normal once your baby is born. There are a few possible causes:
- Increased metabolic rate
- Fluctuating hormones
- Dilated blood vessels
- The baby’s own body temperature
Increased energy demands raises your basal metabolic rate, giving off excess heat in the process. You also produce more blood and increase your blood flow to sufficiently supply your baby with nutrients. This leads to blood vessel dilation that can make your skin warm to the touch. Your baby’s body temperature can also increase your internal temperature. There is not much you can do to prevent this, but there are many ways to manage it.
Ways to Cope
- Wear less/light layers and cool fabrics.
- Turn on fans and air conditioning.
- Drink iced water.
- Try breathing exercises and other relaxation techniques.
Feeling cold is a less common symptom of the third trimester, although some women do report fever-like chills and pains. There is no definitive cause, but the most common culprits are an infection or hormonal dysregulation. Poor blood circulation can also cause you to feel cold, especially at night, in addition to other symptoms discussed below (e.g. dizziness, leg cramps, varicose veins, and headaches).
Regular exercise and strategic body positioning when sitting or lying down can help reduce or prevent chills during pregnancy. Getting up and walking around frequently promotes blood flow as does lying on your side rather than on your back. Lying on the left side enhances the return of blood and fluid to the heart for re-distribution throughout the body," says Dr. Tami Prince, an Ob/Gyn at the Women's Health and Wellness Center of Georgia
Tip #1: Drink Plenty of Water
Staying hydrated can minimize migraines, leg and uterine cramps, and stave off hunger.
It is common and completely normal for pregnant women to suffer from insomnia, especially in the third trimester. In fact, according to a 1998 National Sleep Foundation poll, "78% of women reported more disturbed sleep during pregnancy than at other times." This manifests as difficulty falling asleep as well as waking one or multiple times during the night.
The causes are linked to some of the other symptoms of the third trimester:
- Pain and general discomfort
- Nocturnal fetal movement
- Leg cramps or restless leg syndrome
- Frequent urination
- Heartburn or GERD
- Hormonal changes
- Vivid dreams
How It Affects You and Your Baby
Although your sleep may be disturbed, most likely, your baby's isn't. However, if you are regularly sleeping less than 6 hours/night can be detrimental. Short sleep is associated with an increase in the stress hormone cortisol and inflammation, possibly resulting in increased anxiety and decreased ability to cope with pain, both of which can worsen insomnia. A 2010 article published in Sleep Medicine Reviews found that reduced sleep may result in longer labor and increased rates of preterm births and Cesarean sections.
Ways to Cope
Every person is different, so treatment depends on what causes your sleep disruptions. Most of the suggestions will be covered in more detail in the sections below, but here are some general tips for improved sleep:
- Change your sleep position: Sleeping on your side with a pillow or a rolled-up towel between your legs for support can reduce pain and discomfort.
- Wear loose, comfortable clothes: Less restriction and more breathability can help keep you cooler and more relaxed.
- Avoid drinking too much water before bed: This helps reduce the urge to urinate in the middle of the night.
- Eat small, light meals: This helps reduce heartburn.
- Take short naps during the day: Power naps (e.g. 20-minute naps) help you feel rested, but longer naps may further disrupt sleep patterns and worsen insomnia.
- Clear your mind: Anxiety regarding your baby, your pregnancy, and even your difficulty sleeping can make it hard for you to fall asleep. Try taking a warm bath, taking a walk, breathing and meditation techniques, or listening to soothing sounds.
- Try sleeping aids: If all else fails, sleeping aids will help you fall asleep, although they are generally not recommended. Tylenol PM and Benadryl are considered safe during pregnancy. Other sleeping aids should be discussed with your doctor.
4. Dizziness, Nausea, and Vomiting
Although dizziness, nausea, and vomiting are more common during the first trimester, for some women, they can persist throughout pregnancy or reoccur in the third trimester. Common causes include:
- Pressure from the growing baby on the stomach
- Pressure from the growing baby on the vena cava (poor circulation)
- Low blood sugar
- Varicose veins
- Anemia and iron deficiency
How It Affects You and Your Baby
Dizziness doesn't directly affect your baby, but it can indirectly cause injury by increasing your risk of falling. Constant vomiting may lead to dehydration and malnutrition, although these can easily be managed at home.
Ways to Cope
If you feel lightheaded, lying down can alleviate the symptoms and prevent risk of injury. Here are some tips to improve blood flow and prevent dizziness.
- Avoid standing for long periods of time: This prevents blood from pooling in your legs. Find time to lie down or elevate your legs. If this is not possible, walking around or doing calf raises helps pump blood back up to the heart and promotes circulation.
- Avoid lying down on your back: Pressure from your baby can constrict blood flow in the major blood vessels that run along the spine. Lying on your left side is preferable.
- Stand up slowly: This gives your body enough time to adjust the blood flow.
- Stay hydrated and eat small, frequent meals: This helps maintain steady blood pressure and blood sugar levels.
- Eat iron-rich foods: If you are anemic, speak with your doctor for treatment advice. Your doctor may suggest you eat iron-rich foods or take iron supplements.
- Keep yourself cool: Wear loose, unrestrictive clothing and avoid hot showers or baths. Heat causes your blood vessels to dilate, lowering your blood pressure and reducing blood flow to the brain.
When Should You Be Worried?
If you feel dizzy and nauseous and your blood pressure is abnormally high—above 140/90 mmHg—you may have preeclampsia, or toxemia. Preeclampsia is characterized by high blood pressure and high urine protein content and typically occurs after week 20 of pregnancy, most commonly in the first pregnancy. If left untreated, your doctor may be required to induce labor, sometimes resulting in premature birth. You can manage your blood pressure by drinking more water, reducing salt intake, lying down, and taking blood pressure medication.
5. Leg Cramps
I'm not just talking about the irritable feeling of restless leg syndrome. I'm talking about wake-you-up-in-the-middle-of-the-night, catch-you-any-time-of-day, excruciating leg cramps that make your blood curdle. Some women confuse them with the passing of a blood clot, while others feel like a snake is crawling under their skin and tearing it apart. The exact cause is not known, but some experts speculate that it could be muscle fatigue from the added weight during pregnancy.
Although these leg cramps and spasms aren't dangerous, they can be extremely painful and can contribute to insomnia. Leg cramps most commonly occur in the calf and generally result from depleted electrolytes and minerals like potassium and magnesium.
Ways to Cope
- Stretch regularly: Stretching can alleviate cramps and prevent new ones. Stretch your calves multiple times throughout the day.
- Stand in front of a wall with one leg in front of the other.
- Bend the front leg and lean forward, supporting yourself with your arms while keeping your back leg straight and heels on the ground.
- Hold the stretch for at least 30s—ideally for 1-2 minutes.
- Do the same for the other leg.
- Stay active: Getting up and walking around promotes blood flow and can prevent cramps from occurring.
- Try massaging your legs: This can also promote blood flow and loosen any tight muscle knots.
- Rest with your legs straight and elevated.
- Drink lots of water.
- Make sure you get enough potassium and magnesium.
Tip #2: Stay Active
But only if you are cleared by your doctor. Activities like yoga and swimming, or even just walking around, promotes circulation, reduces excess weight gain, increases flexibility and strength, and can help you better support the growing weight of the baby.
6. Back Pain
Pregnancy can put a lot of strain on your lower back. The added baby weight in the front forces you to use your back to support yourself. This fatigues your back muscles and changes your posture as you are more likely to lean forward or to one side. Your expanding uterus also stretches the abdominal muscles, weakening them and adding to the added stress on the lower back.
Ways to Cope
Fortunately, there are many strategies you can use to minimize and even prevent lower back pain during the third trimester.
- Stretching and strength training: This doesn’t necessarily mean weightlifting. Prenatal yoga can increase the flexibility and strength of the hips and legs, improving posture and support and reducing stress on the lower back. Stretching will reduce tension on the back muscles.
- Try swimming: The water will support the weight of the baby and take the load off of your joints, including your back. The water can also have a relaxing and cooling effect. Swimming is a great, low-impact way for pregnant women to stay active.
- Bend your knees and squeeze your glutes: When standing, keeping your knees bent engages your leg muscles more to keep you upright. Likewise, contracting your glutes and tucking your buttocks under your hip decreases the load on the lower back and moves it to your hip and leg muscles.
- Avoid staying in one position for long periods of time: Whether you’re sitting, lying down, or standing, it’s good to change position frequently or get up and walk around.
- Wear comfortable shoes: Having good support for your feet can translate to better support of your knees, hips, and back.
- Use pillows while lying down: Pillows are your best friend. Use them to support your abdomen and legs.
Tip #3: Lie Down on Your Left Side
This position promotes even blood flow throughout the body and encourages blood flow to the placenta. It also takes the pressure of the baby off of your spine, major blood vessels, and nerves.
7. Pelvic and Cervical Pain
Sharp pains in the lower abdomen and groin can make you feel like a jab or an electric shock. However, these are a normal part of pregnancy. In fact, you may have already dealt with this during your second trimester. There are many ligaments surrounding the uterus to provide support. The round ligament, which attaches the front of the uterus to your groin, is one that is most susceptible to strain. Sudden movements like coughing, sneezing, or laughing may cause pain on one or either side of the lower abdomen.
Growth of the uterus and the weight of the baby may also destabilize the pubic symphysis, where the two pubic bones join at the bottom of the pelvis, leading to symphisis pubis dysfunction.
In addition, as your body prepares for childbirth, your pelvis and cervix will relax and expand thanks to the release of a placental and uterine hormone called relaxin. It softens the connective tissue in the pelvis and dilates the cervix. These expansions, combined with the added pressure and movement from the baby, can cause a lot of pain in the area.
Ways to Cope
- Avoid sudden movements: If you feel like coughing or sneezing, bend forward or flex your hips to avoid straining any ligaments.
- Wear a pelvic support garment: This can support the weight of the baby and relieve pressure on your pelvis.
- Exercise regularly: Strengthening your abs, glutes, and leg muscles can help you support the expanding uterus. Stretching and prenatal yoga are also a great options to help you adapt to the changes.
- Take pain-relievers: Acetaminophen (Tylenol) is considered safe for pregnant women, but again, should only be used if absolutely necessary—when all other methods fail.
When Should You Be Worried?
If the pain persists or increases, or it is accompanied by other symptoms such as bleeding, swelling, dizziness, or vomiting, you should call your OB/GYN immediately. These could be signs of preterm labor or other conditions such as hernias, appendicitis, or uterine ruptures.
8. Braxton-Hicks Contractions
Sometimes called false labor contractions or "practice contractions," Braxton-Hicks can start in the second trimester but more commonly occur in the third trimester. They are generally not painful, although this can vary depending on a woman's pain threshold. Increased activity—from you or the baby—can trigger Braxton-Hicks contractions as can dehydration. Nevertheless, these contractions are a normal part of pregnancy and are nothing to worry about.
Ways to Cope
If you are experiencing false labor contractions, here are a few ways to alleviate the discomfort:
- Stay hydrated: Regularly drinking water can minimize contractions caused by dehydration.
- Reposition: Contractions can sometimes stop when you reposition. Occasionally switch which side you lie on.
- Apply heat: A warm pad or bath can help relax the muscles.
- Take a walk: If activity doesn't worsen contractions, sometimes, getting up and walking around can stop the contractions.
False Labor or True Labor?
Some women will confuse Braxton-Hicks contractions with labor contractions, but there are many key differences, mainly that Braxton-Hicks contractions are weaker, more irregular, and don't get closer together.
When to Call Your Doctor
Although Braxton-Hicks contractions are not a cause for concern, do keep an eye on them and note any changes. If your contractions occur at regular intervals, get closer together, and gradually become stronger and more painful, you may be going into labor. You'll know it's true labor when you experience strong contractions (can feel like strong menstrual cramps) every five minutes, when contractions persist despite walking or repositioning, and when your water breaks.
9. Sore, Painful Breasts
Although not as commonly occurring as during the first trimester, some women do report soreness or pain in their breasts late in the pregnancy. The causes are very much the same: increased growth of milk ducts in preparation for feeding can make your breasts grow one or more cup sizes. There's really no way to prevent this, but you can manage the changes. Invest in new, larger bras—preferably made of cotton or other natural fabric. Sports bras are a good option; you should aim to get enough support without being too tight. Avoid bras with underwire.
The growing baby takes up a lot of space in the abdominal cavity and can press on various organs like the stomach. This not only reduces the amount of food you can eat, as discussed above, but can push the stomach contents up the esophagus. Meanwhile, increased estrogen and progesterone levels cause the lower esophageal sphincter (LES) to relax, making it easier for the stomach contents to go the wrong way.
Ways to Cope
- Eat smaller meals: Your stomach can't store too much food anyway. Eating several smaller portions throughout the day helps minimize bloating and avoid heartburn.
- Avoid spicy and acidic foods: Spicy or citrusy foods and drinks may increase your chance of acid reflux.
- Avoid caffeine: Caffeine relaxes the LES, making reflux more likely.
- Don't lie down immediately after eating: Lying down can make it easier for your stomach content to flow backwards. If you must lie down, prop yourself up with cushions or pillows.
- Drink milk: If you are experiencing heartburn, eating or drinking neutral or slightly basic foods and drinks like milk or yogurt can minimize the burning sensation.
Tip #4: Eat Small Meals
Eat 5-6 small meals rather than three large meals. This helps keep cravings under control, reduces the risk for heartburn, and aids better digestion.
11. Bleeding Gums and Toothaches
Swelling and inflammation can reach the gums due to the increased blood production and blood pressure associated with pregnancy. This can make you more susceptible to bleeding and toothaches. If your gums are bleeding frequently or you have constant toothaches, call your dentist or doctor immediately.
Ways to Cope
- Pain-relievers: Again, acetaminophen can keep pain at bay, but should only be used if the pain is unbearable.
- Maintain oral hygiene: Prevention is the best treatment. To prevent infections that can lead to gingivitis or periodontitis, thorough brush and floss twice a day and use alcohol-free mouth rinse.
"Women should continue with regular dental check-ups and cleanings," advises Dr. Prince, "preferably during the second trimester."
Headaches are also common during pregnancy. During the first trimester, they are largely due to fluctuating hormones and elevated blood pressure. In the third trimester, it is mostly due to strain on the shoulder and neck muscles because the weight of the baby is changing your posture. Headaches during pregnancy can also be caused by:
- High blood pressure
- Lack of sleep
Ways to Cope
- Drink lots of water: Drinking water helps restore your fluid levels, especially in your brain, and can alleviate headaches.
- Work on your posture: Focus on keep your back straight, head up, and shoulders back. Yoga can help immensely with improving your posture as well as your strength and flexibility.
- Get a massage: Massaging the head, neck, shoulders, and back can improve circulation and release tension in the muscles which may be strained from carrying the extra weight of the baby.
- Apply ice or heat: This is largely for immediate, temporary relief, but it is extremely effective.
- Lie down: Laying down evens out the blood pressure throughout your body.
When Should You Be Worried?
Headaches in the third trimester may also be due to a condition known as preeclampsia, an increase in blood pressure due to constricted blood flow to the placenta. If your headaches are accompanied by blurred vision, sensitivity to light, nausea, shortness of breath, and abdominal pain, contact your doctor immediately.
Tip #5: Relax!
You've been through a lot already, and there is still a lot going on now, but it's important to take some time throughout the day to empty your mind. Meditate, practice breathing exercises, or go for a walk.
13. Varicose Veins
Varicose veins can be itchy and painful, although they are rarely harmful. As mentioned in the section on dizziness and lightheadedness, the growing baby can press on the vena cava, the main blood vessel that brings blood from the lower body and lower torso back to the heart. This, in combination with dilated blood vessels, makes it easier for blood to pool in the legs, leading to the appearance of blue-purple veins along the legs and possibly in the groin and rectum (hemorrhoids).
Some women are also more likely than others to get varicose veins because it can be hereditary.
Ways to Cope
- Avoid standing or sitting for long periods of time: Regularly changing position and moving around promotes blood flow. Your leg muscles act as pumps to move blood back to the heart.
- Avoid sitting with your legs crossed: This minimizes the possibility of constricting any blood vessels.
- Lie down on your side: This shifts the weight of the baby off of your back, where the two largest blood vessels are situated.
- Wear compression stockings: The compression reduces swelling and helps return blood flow back to the heart.
- Elevate your feet: Whether you're sitting or lying down, elevate your feet to encourage blood flow back to the heart.
Constipation during pregnancy is common and usually occurs because of pregnancy hormones that relaxes smooth muscle. This decreases the action of the digestive system to move food through the digestive system. It rarely poses a danger to you or your baby. However, it can cause a lot of discomfort and even pain. Straining also increases risk of other problems such as hemorrhoids or pulled muscles in the pelvic region.
Ways to Cope
- Increase your fiber intake: Aim for 25-30 grams of fiber daily. Fiber absorbs water and bulks up your stool, making it softer and easier to pass. Great sources of fiber include legumes, bran, oatmeal, chia and flax seeds, whole grains, fruits with skins and vegetables.
- Stay hydrated: Drink 10-12 cups of water a day.
- Remain active: Yoga, swimming, or even just taking a walk can help get things moving.
If these remedies do not help, speak to your doctor about possibly taking stool softeners to ease your constipation.
Other Symptoms of the Third Trimester
These are less talked about, but they are not uncommon.
Your baby is about to be born. You've done everything you can do to prepare for the magical moment, but you still feel like you're not ready. The extent of worry and anxiety vary for women, though some of the most common anxieties are:
- Feeling like something is going to fall out (mucus plug, baby, ect.)
- Feeling like you're going to go into labor with no warning signs
- Feeling like you're water is going to break
- Feeling like you're going to be sick
- Feeling like you're going to have contractions
- Worrying that something might be wrong with the baby
- Worrying that you might have the baby too early or too late
These feelings are natural. You've gone through so much already, and having a child is a big responsibility, but this is most likely you psyching yourself out. Try to stay motivated and productive during these final weeks. However, if you have any concerns or doubts, always go and get checked out.
You may lose your car keys, misplace your sunglasses (even though they're on your head), forgot about your regular bill pay and over drafted your bank account, you may be late for all your regular appointments even though you planned for them in advance.
Being forgetful is almost an understatement for many women going through the third trimester. It can occur because of lack of sleep and the many changes you are going through. If you've been hit hard by what is sometimes called "momnesia," make sure to take plenty of time to rest. There's no reason to beat yourself up over what you can't keep track of. It may also help to write things down to help you keep track of tasks and important dates.
Even if your blood sugar is working well enough to pass a glucose tolerance test, that doesn't mean you won't have blood sugar problems. This is because your pregnancy hormones can work against the action of insulin, which can overwork your pancreas. Even if you are within the normal limits, having higher insulin resistance can contribute to a feeling like you need to eat constant carbs and a feeling of constantly being tired. This is because your body isn't able to make use of the carbohydrates coming into your body, and it signals you to get more even if you have plenty.
As your baby grows stronger and turns into their birthing position, they can push and kick against your organs and your ribs. In addition to all the problems discussed above that can come with a growing uterus, a stray kick or punch from the baby can bruise your ribs. There are a few ways to reduce the pesky rib pain he best thing you can do in this situation is to get extra calcium and keep cold drinks on hand to help get your baby to move away from your ribs a bit. You can also try sitting or lying down in different positions.
Pregnancy Symptoms of Each Trimester
Swollen, painful breasts
Baby starts to move
Bleeding gums and toothaches
Fisher, RS, Roberts, GS, Grabowski, CJ, and Cohen S. (1978). Inhibition of lower esophageal sphincter circular muscle by female sex hormones. American Journal of Physiology, Endocrinology and Metabolism. 234(3): E243. https://doi.org/10.1152/ajpendo.1978.234.3.E243
Mayo Clinic staff. (2017, April 14). Pregnancy week by week. Mayo Clinic.
Patel, Shivani, M.D. (2016, May 31). 8 third trimester pains and how to deal with them. UT Southwestern Medical Center.
Pregnancy Pains and Discomforts. BabyCenter.
Pregnancy Wellness. American Pregnancy Association.
Second Trimester Symptoms. Parenting.
UI Children's Hospital staff. (2017, March 9). When you need to gain more weight during pregnancy. University of Iowa Stead Family Children's Hospital.
WebMD staff, reviewed by Traci C. Johnson, MD. (2016, Aug. 22). Third Trimester of Pregnancy. WebMD.
Dr. Tami Prince
- The article has been modified since this review was written.