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At 28 weeks pregnant, you are entering your third trimester, which—drumroll please—means you’re in the home stretch of your pregnancy! As the excitement and anticipation builds over these last 12 weeks of pregnancy, so can uncomfortable pregnancy symptoms. In fact, many experts note that third trimester symptoms are often the “most painful” of all the pregnancy symptoms! That’s because your almost-cooked baby is getting bigger and bigger, increasing the stress on your body. But there’s absolutely no need to panic! Instead, read up on all the ways your body changes during the third trimester, what risks and symptoms peak in the third trimester, and how to feel your best as you sprint waddle to the finish line.

When does the third trimester start?

Most providers—and The American College of Obstetricians and Gynecologists (ACOG)—agree that the third trimester starts at 28 weeks of pregnancy and extends until you give birth, which is usually between 39 and 40 weeks of pregnancy. There are 12 weeks in the third trimester.

Third Trimester Symptom: Swollen Feet and Ankles

Pregnancy swelling, aka edema, tends to kick in around week 30 of your third trimester and worsen as your due date nears, particularly at the end of the day and during hotter weather. (Research shows that 67% of moms-to-be have edema in their third trimester.) Swelling gets worse in the third trimester because you’re churning out more of the hormones that cause fluid retention and you have about 60% more blood circulating than you did pre-pregnancy. Not helping matters is the fact that your expanding uterus is now putting an extraordinary amount of pressure on the large vein that returns all that blood to your heart called the inferior vena cava. The result: Fluid accumulates in your body leaving you swollen, especially your legs, ankles, and feet.

How to Treat Third Trimester Swelling

Getting off your feet as much as you can is, by far, the best thing you can do for pregnancy swelling. Aim to sit down and elevate every couple hours for 10 minutes—and especially a few hours before bed. Prop your feet on a few pillows while you’re at it. This’ll help gravity do its job and pull fluid from your legs back into your circulatory system. Warning: All that fluid will be filtered through your kidneys, which means you’ll be peeing it all out! That’s why you shouldn’t wait till bedtime to start elevating. For more help easing your third trimester swelling…

  • Wear compression stockings.

  • Avoid crossing your legs.

  • Sleep on your left side to take pressure off the inferior vena cava.

  • Stand or walk in a pool up to your neck to help compress tissues in the legs.

  • Exercise regularly.

  • Stay cool in hot or humid weather.

  • Wear loose clothing so as not to restrict blood flow.

Should I see a doctor about third trimester swelling?

While mild pregnancy swelling in your feet and ankles is perfectly normal, if the swelling comes on quickly and is painful—especially if only one leg is impacted—you could be experiencing deep vein thrombosis (aka: a blood clot) and need prompt medical attention. A sudden increase in swelling might mean your blood pressure is higher than normal. That, too, requires a doctor’s attention.

Third Trimester Symptom: Insomnia

By the third trimester, that ever expanding bump of yours can make it particularly tricky to find a comfortable sleeping position. You’re also at an elevated risk for nighttime leg cramps during your third trimester which is not conducive to a restful night. Plus, that extra estrogen coursing through your body can cause some parents-to-be to develop rhinitis (swelling of the nasal tissue), which is associated with sleep problems. So, it’s no surprise that at least 42% of expectant moms report experiencing insomnia in their third trimester. (Some reports put the number closer to 80% suffering from third trimester insomnia.)

How to Treat Third Trimester Insomnia

Pregnant or not, we all know that proper sleep hygiene is key to a good night’s rest. That means go to bed and wake up at the same time every day, keep your room dark and free of distractions, and turn off all electronics about 30 to 60 minutes before lights out. (No more revenge bedtime procrastination!) The Sleep Foundation notes that meditation and playing white noise may help lull you to sleep in your third trimester, too. (PS: SNOObie is a doctor-designed white noise machine and a mediation-helper all in one.)

More ways to help third trimester insomnia:

  • Sleep on your left side, knees bent, with a pillow under your belly (or between your legs) and a rolled-up blanket at the small of your back.

  • Keep your bedroom between 60 and 68 degrees Fahrenheit to accommodate your warmer body temperature.

  • If you can’t sleep within 30 minutes of going to bed, get up and do a non-screen activity like reading a book.

  • Drink 8 to 12 eight-ounce glasses of water daily to help stave off nighttime leg cramps. (Avoid liquids about two hours before lights out to keep overnight peeing to a minimum.)

  • Consider speaking to a therapist about cognitive behavioral therapy (CBT). Research has shown that CBT, whether in person or online, can reduce insomnia during pregnancy—and may help prevent postpartum depression and reduce insomnia and anxiety in new parents up to six months after they give birth.

Should I see a doctor about third trimester insomnia?

If your pregnancy sleep issues are chipping away at your ability to function during the day, do not hesitate to reach out to your healthcare provider who can refer you to see a therapist for CBT. Experiencing insomnia during pregnancy your third trimester doesn’t just make you crabby, it’s associated with a 30% increased risk of preterm birth, plus a host of other issues, including preeclampsia, extended labor, and increased likelihood of a cesarean section. While treating insomnia during pregnancy with medication is often not advised (not even melatonin!), your provider may suggest extra folate or calcium, or perhaps the medications zopiclone or trazodone (aka Imovane and Desyrel). A 2020 report noted that the use of either of these sleep medications “may be justified.” (Learn more about pregnancy insomnia and get pregnancy sleep tips.)

Third Trimester Symptom: Heartburn and Reflux

A whopping 90% of pregnant folks develop symptoms of gastroesophageal reflux disease (GERD) by their third trimester. GERD most often results in heartburn, but it can sometimes lead to nausea and vomiting, too. Reflux is yet another third trimester symptom that you can at least partially pin on your growing uterus. This time it’s pushing up on your stomach, leaving less room for food. Another culprit: An uptick in the pregnancy hormone progesterone can cause the muscle between your stomach and esophagus to relax too much, allowing stomach acid to flow in the wrong direction.

How to Treat Third Trimester Heartburn and Reflux

The best treatment for third trimester heartburn and GERD is prevention. To help sidestep this uncomfortable late pregnancy symptom, eat five small meals a day instead of three larger ones—and eat slowly. Drink water between meals, not during meals. Limit fried, spicy, and acidic foods. It’s smart to stop eating about two to three hours before going to bed. This’ll give food time to leave your stomach before you lay down. Elevating your head has been shown to help avoid nighttime reflux. 

If you missed your window of prevention, try these tricks to tamp down you third trimester heartburn or GERD:

Should I see a doctor about third trimester heartburn and GERD?

If you’re considering taking over-the-counter heartburn relievers, like Tums or Maalox, you should connect with your healthcare provider first. Reach out if you’re already taking these nonprescription heartburn helpers, but they’re not working—and/or if your reflux doesn’t appear to be related to something you ate. Both of these things may point to something more serious, such as preeclampsia.

Third Trimester Symptom: Back Pain

Up to 70% of women experience pregnancy back pain, and 74% of pregnancy back pain occurs in the third trimester, which is no surprise to pediatrician Dr. Harvey Karp, author of The Happiest Baby on The Block. “Starting around 30 weeks in your third trimester, your baby may start putting serious pressure on your lower back,” he says. “To accommodate the extra weight you’re carrying around, your amazing body will make several adjustments. For example, your spine will curve more, which shifts your center of gravity to prevent you from toppling over.” The catch? That center-of-gravity shift may cause you to lean more to one side or another, which then may lead to even more lower back or hip pain.

How to Treat Third Trimester Back Pain

While there’s not much you can do about your growing baby or the pregnancy hormones, there are steps you can take to ease your third trimester back pain, such as:

Should I see a doctor about third trimester back pain?

If your third trimester back pain lasts more than two weeks, it’s a good idea to call your healthcare provider. They might recommend acetaminophen or other treatments or refer you to a specialist. “A physical therapist or pelvic floor specialist can recommend exercises, like pelvic tilts and cat/cow pose, to help,” says Dr. Karp. “That said, anytime your back or tailbone pain is severe, talk to your doctor.” And if your back pain is accompanied by vaginal bleeding, fever, cramping, contractions, or a burning while you pee, call your healthcare provider immediately. These could be signs of a urinary tract infection or preterm labor.

Third Trimester Symptom: Cramping

Don’t freak out! Experts assure that third trimester cramps are normal. Cramps at this stage in pregnancy could simply mean your body is making more room to accommodate your baby-to-be. At the same time, late pregnancy cramps may be indicative of Braxton Hicks contractions— which is false labor—or honest-to-goodness labor! (Learn more early labor signs.) Experts note that Braxton Hicks cramps are more likely to occur in the afternoon or evening, after physical activity or sex. While round ligament pain is often the cause of an achy, crampy abdominal and groin pain, know that this type of cramping is usually not behind your late pregnancy cramp. (Round ligament pain peaks during the end of the first trimester and in the second trimester.)

How to Treat Third Trimester Cramping

Before you move to treating your late pregnancy cramps, you’ll need to decipher if you’re experiencing Braxton Hicks or true labor. Unlike cramps associated with true labor that get stronger, more intense, and more painful, Braxton Hicks feels like period cramps during pregnancy. They’re mild, irregular, and don’t progress. Braxton Hicks cramps are often only felt in the front of the abdomen or one specific area, but cramps associated with labor start in the mid-back and wrap around the tummy toward your midline. If your late pregnancy cramps are due to Braxton Hicks, try the following to help ease your passing discomfort:

  • Change your position. So, if you’re walking around, sit or lay down. And if you’ve been sitting for an extended stretch time, go for a walk.

  • Find your relaxation sweet spot. If that’s taking a bath, getting a massage, or even just napping or reading a book, it can help quell the discomfort.

  • Since dehydration may cause Braxton Hicks, it’s a good idea to drink water. (Learn more about the importance of hydration in pregnancy.)

Should I see a doctor about third trimester cramping?

If the above late-pregnancy cramp quellers don’t lessen your discomfort—or “if your cramps/contractions are happening at regular intervals, are increasing in strength, and if you’re feeling any pain at all, definitely call your care provider,” says Dr. Karp. Contact your midwife or physician if you’re experiencing any vaginal bleeding or leakage—and/or if there’s a noticeable change in fetal movement (less than 10 movements every two hours).

Third Trimester Symptom: Hemorrhoids and Varicose Veins

Up to 40% of pregnant people get hemorrhoids, especially in the third trimester. Varicose veins are also fairly common in the third trimester. Why? Remember how all that increased blood volume causes third trimester swelling? Well, it causes your veins to swell, too. That means come the third trimester, spider veins may suddenly appear on your arms or face, varicose veins appear on your thighs, and veins in your rectum swell enough to cause hemorrhoids. Normal pregnancy weight gain, constipation, growing pressure from your uterus, and an uptick in progesterone all pile on your chances of third trimester hemorrhoids.

How to Treat Third Trimester Hemorrhoids and Varicose Veins

The good news is varicose veins and hemorrhoids usually resolve on their own after you’ve had your baby. In the meantime, try some simple changes to avoid varicose veins: Adjust your position often, and avoid long periods of sitting or standing, and uncrossing your legs can all help. Elevating your feet, snoozing on your left side, and wearing compression socks help, too. 

The best way to avoid late pregnancy hemorrhoids is to stave off constipation with plenty of hydration, a fiber-rich diet, and regular physical activity. More ways to get relief include:

  • Lay on your side to take pressure off your pelvic area.

  • When seated, use a donut pillow.

  • Don’t strain when using the bathroom.

  • Try a sitz bath where you soak in warm water a few times a day. (You can buy a small basin that fits over your toilet.)

  • Apply cold packs to minimize swelling.

  • Use witch hazel or baking soda to reduce itching.

  • Read more strategies for relieving hemorrhoids in the third trimester.

Should I see a doctor about third trimester hemorrhoids or varicose veins?

Even though varicose veins are rarely a worry, you should still point them out to your healthcare provider at your next visit—especially if they’re causing you discomfort. Definitely contact your doctor or midwife if you’re experiencing any pain, swelling, and/or redness in your leg—which could be signs of a blood clot—or if there’s any bleeding or open sores near the vein.

As far as hemorrhoids go, your doctor be able to prescribe a laxative, hemorrhoid cream, or a fiber supplement that can help ease discomfort. (Always check with your provider before taking any over-the-counter medications, including those for hemorrhoids and constipation.) And while a little bit of bleeding from hemorrhoids is usually harmless, if you spy any blood in your stool, let your doctor know.

Third Trimester Symptom: Dizziness

Feeling lightheaded or dizzy during your third trimester—or any part of your pregnancy—is not unusual. After all, your blood pressure is lower than normal (though not as low as it was in the middle of your second trimester) and your ballooning uterus is pressing on the inferior vena cava (the large vein that brings blood to your heart), which reduces blood flow to your brain.  Plus, when fluid pools in your legs instead of circulating through your body, dizziness is often the result. At the same time, anemia—which causes dizziness among other symptoms—occurs in up to one third of women during the third trimester.

How to Treat Third Trimester Dizziness

There are a few basic lifestyle tweaks that can help avoid third trimester lightheadedness, like wearing good ol compression stockings, changing your position often, always standing up slowly, and avoiding lying flat. Eat regular, healthy meals to avoid blood sugar drops and stay hydrated. In addition, if you feel dizzy in the moment, you can sit down, bend over, or lie on your side and breathe deeply to increase blood flow to your brain.

Should I see a doctor about third trimester dizziness?

The American Heart Association warns that dizziness during the third trimester could be a symptom of a high blood pressure-related disorder such as preeclampsia, which is a potentially serious condition. So, if your dizziness worsens and/or goes hand in hand with other third trimester symptoms, like swelling in your hands, feet, legs, and/or face, and/or headaches, blurred vision, racing heart, shortness of breath, and nausea—get checked right away. Other accompanying symptoms that warrant a call to your physician: pale skin, super low energy, feeling cold, irregular heartbeat, and/or cravings for non-food items like ice, dirt, or clay. These signs often point to iron deficiency anemia in pregnancy.

  

Get Fourth Trimester Ready:

 

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REFERENCES
  • Jackson Health System: Understanding Each Trimester of Your Pregnancy
  • American College of Obstetricians and Gynecologist (ACOG):  How Your Fetus Grows During Pregnancy
  • The Nemours Foundation, KidsHealth: Can Pregnant Women Do Anything to Reduce or Prevent Swollen Ankles?
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  • The University of Texas Southwestern Medical Center: 8 third trimester pains and how to deal with them
  • Mayo Clinic, Pregnancy week by week: What causes ankle swelling during pregnancy — and what can I do about it?
  • Mayo Clinic, Pregnancy week by week: What causes leg cramps during pregnancy, and can they be prevented?
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  • The University of Chicago Medicine: GERD and Pregnancy
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  • The global prevalence of low back pain in pregnancy: a comprehensive systematic review and meta-analysis. BMC Pregancy and Childbirth. December 2023
  • Mayo Clinic, Pregnancy week by week: Back pain during pregnancy: 7 tips for relief
  • OSF Healthcare System: Braxton Hicks vs. contractions: Why am I cramping?
  • WFMC Health: When Should Cramps During Pregnancy Be Worrisome?
  • Mayo Clinic, Pregnancy week by week: 3rd trimester pregnancy: What to expect
  • Cleveland Clinic: Third Trimester
  • Braxton Hicks Contractions. StatPearls January 2024
  • Cleveland Clinic: Hemorrhoids During Pregnancy
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  • Nationwide Children’s Hospital How to Handle Dizziness During Pregnancy
  • Penn Medicine Lancaster General Health: Pregnancy Got You Dizzy? It Could be Your Blood Pressure
  • Merck Manual: Anemia in Pregnancy
  • American Heart Association (AHA): Dizziness during pregnancy: When is it a concern?

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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.