Third trimester overview: What it is and what to expect

What the third trimester actually is

The third trimester runs from week 28 through to the birth. For many, it can feel like the longest stretch of pregnancy. Your body is working hard, the pace of prenatal appointments picks up and there is often a growing awareness that birth, postpartum and baby are coming quickly. That doesn’t mean you can’t prepare as much as possible. In fact, starting the preparation now can help make the transition into birth and postpartum feel a little less overwhelming.

Why this stage can feel harder than people expect

The third trimester is frequently described from the outside as exciting, but the inside experience is often more complicated. Sleep becomes harder. The body feels different week to week. There may be growing pressure (from others or from yourself) to have things ready, to feel a certain way or to enjoy this more than you are. For some people, the third trimester also brings a heightened anxiety about the birth itself, about becoming a parent or about how things will go. If you’re carrying a difficult experience from the past, those feelings can be more intense. This is a common part of late pregnancy for many people, and it deserves acknowledgement. If you've been pregnant before, remember that every pregnancy has its own story. What you experienced last time doesn't necessarily shape how this one unfolds, and it's common for the third trimester to feel quite different from what you remember.

Your body in the third trimester

The physical changes of the third trimester are significant, and many of them affect sleep, mobility and day-to-day comfort in ways that are hard to prepare for.

Common experiences include:

• Back and pelvic pain
• Shortness of breath as the uterus grows
• Increased pressure in the pelvis and bladder
• Swelling in the hands and feet
• Heartburn and indigestion
• Difficulty sleeping/resting

If you’re feeling exhausted in a way that you could have never imagined, you’re not alone. In this trimester, your body is doing a huge amount of work all at once: your heart is pumping about 50% more blood, you may be dealing with body aches and difficulty finding comfortable sleep positions, and your baby’s growth is placing real demands on your energy and nutrients. Something else you might notice are Braxton Hicks contractions — irregular tightenings of the uterus that are not yet labour. These are typically painless or mildly uncomfortable, and don’t follow a regular pattern, like labour would. This doesn’t mean they’re meaningless — they’re actually doing the work to prepare your body for the big day. If you’re experiencing Braxton Hicks contractions and finding them uncomfortable, try drinking some water or emptying your bladder, as both dehydration and a full bladder can trigger them. Strenuous activity can also bring them on, so slowing down and resting may also help. If you’re unsure whether what you’re experiencing is Braxton Hicks and you’re concerned about early labour, contact your care provider or call 8-1-1 for advice.

When to seek same-day care

Contact a healthcare provider or call 8-1-1 if you experience any of the following:

• Heavy vaginal bleeding
• Sudden, severe abdominal pain
• Signs of preeclampsia, a pregnancy complication that can include sudden swelling in the face or hands, a severe headache that doesn't go away, vision changes, dizziness, high blood pressure or pain under the ribs. This requires a same-day assessment.
• Your baby's movements have significantly decreased or stopped: if you notice a change in how often or how strongly your baby is moving, contact your provider the same day. Do not wait.
• Fluid leaking from the vagina before labour begins If you’re unsure whether something is urgent, reach out to a care provider. In Newfoundland and Labrador, you can call 8-1-1 to speak with a nurse at any time. Call 9-1-1 for emergencies.

Your mental health in the third trimester

Physical changes get most of the attention in late pregnancy, but your emotional health deserves equal attention. Anxiety in the third trimester is very common. You may be worried about the birth, about the health of the pregnancy, about how you will cope as a parent with a new baby, or about how your relationship or family will change. For some, the anxiety is manageable. For others, it sits heavily and persistently, interfering with sleep or making it hard to enjoy much of anything. A low mood that doesn't lift, or anxiety that stays with you most of the time, is worth talking to a care provider about. Although we hear most often about mental health challenges in postpartum, they also often happen during pregnancy. This can include depression, anxiety, OCD (a condition involving unwanted, intrusive thoughts and repetitive behaviours) and others. They can begin at any point during pregnancy, and the third trimester is no exception. About one in four birthing people in Canada experience some kind of perinatal mood concern across the pregnancy and postpartum period. You don’t need to be in crisis to ask for support — in fact, a conversation with your care provider can prevent things from getting worse.

If you are already living with a mental health condition, the third trimester is a good time to revisit your care plan with your provider or mental health clinician. This is especially important if you’re on medication: medical guidelines are clear that stopping medication abruptly during pregnancy is not recommended. If you have questions about your medication, speak with your prescriber before making any changes. Many medications are safe to continue in pregnancy, and the risks of untreated illness are real. It’s also really common to feel some anxiety or fear about birth. For most of us, it’s unfamiliar and unpredictable, so it makes sense that your mind tries to prepare for what it doesn’t yet know. In this case, knowledge truly is power. One way to ease childbirth anxiety by replacing the fear of the unknown with preparation. Creating a birth plan gives parents an opportunity to research their options, understand medical interventions and learn what to expect, minimizing scary "what-if" scenarios. This is a process that can be done in consultation with your care provider or with the help of a counsellor or doula who works specifically with people preparing for birth. If you’re dreading labour and delivery in a way that feels overwhelming or extreme (sometimes called tokophobia), this is something to raise directly with your provider.

For partners and non-birthing parents

This stage of pregnancy can bring its own emotional complexity if you’re the partner or support person. You may be watching someone you love carry significant physical and emotional weight that you can’t seem to alleviate for them. You may also have your own feelings about the upcoming birth, your role as a birth support or your transition into parenthood. Your mental health in this period matters too. If you’re struggling, that’s worth acknowledging and seeking out support. One thing you can do this week: ask your partner an open question, like "How are you really doing with all of this?", and listen without jumping to fix it.

You may also want to speak honestly with them about how you’re feeling and reach out to other trusted support people for help.

Starting to prepare for what comes after

The third trimester is the right time to begin or continue preparing for the postpartum period. This isn’t about having everything perfectly organized or feeling 100% ready. It’s about starting important conversations and putting support systems in place before those early, exhausting days when healing and caring for a newborn takes up most of your energy. One of the most useful things you can do is identify or arrange for postpartum support. It can be a small group of people who know they’re part of your support circle and who you feel comfortable asking for concrete help. This may look like help with meals, with sleep, with company, with anything that matters to you. You may also consider more formal support like counselling and doula supports that can provide informational, emotional and practical support during the postpartum period. Mental health challenges often start or increase in the postpartum period, even if you felt completely fine during pregnancy. These mental health challenges generally respond well to treatment. Knowing this now can make it easier to recognize if something shifts after birth and to reach out for help sooner.

Your medical care in the third trimester

Prenatal appointments become more frequent in the third trimester, typically every two weeks from week 28 to 36, and then weekly from week 36 onward. These visits are a good opportunity to raise anything on your mind, including how you’re feeling emotionally. Your care provider should ask about your mental health at these appointments. If they don’t, you can bring it up. Validated screening tools like the Edinburgh Postnatal Depression Scale (EPDS), a brief questionnaire used to help providers better understand how you’re doing, may be offered. If you have a history of mental health concerns, it’s particularly worth asking about screening if it has not been offered. If you’re not sure who your care provider is or how to access prenatal care in Newfoundland and Labrador, your primary care provider (a family doctor or nurse practitioner with a Family Care Team) can guide you. If you don’t currently have one, you can register through Patient Care Connect NL at patientconnect.nlchi.nl.ca. Our [Services Finder] can also help you find what is available in your area.

This article was developed using sourced educational content from Canadian Perinatal Mental Health Trainings (CPMHT), and informed by the collective knowledge and expertise of CPMHT professionals and Karen Clarke, BA, MSW, RSW, Doula (Open Book Doula, Counselling and Consulting Services), as well as the following cited research and clinical practice guidelines: