Week 28: You Are Officially in the Third Trimester!

Congratulations — you have reached a major milestone! Two thirds of pregnancy are behind you, and your baby is growing and developing at a rapid pace.

Baby's Development

Size and Growth

• Length: About 36–38 cm from crown to rump
• Weight: About 900–1,100 grams (nearly 1 kg!)
• Comparison: The size of a large eggplant

Remarkable Development

Lungs Maturing

• The baby is practicing breathing by inhaling amniotic fluid
• Lungs are mature enough to function with medical support if born now
• Surfactant (a vital lung substance) continues to develop

Brain Growing Rapidly

• Increases from about 85 grams to nearly 140 grams in the third trimester
• The surface is beginning to develop folds (gyri and sulci)
• Sleep-wake cycles are beginning, including REM sleep (dreaming!)
• The cerebellum is growing particularly fast

Senses Developing

• Eyes: Fully developed, can open and close
• Eyelashes: Fully developed
• Vision: Can perceive light through your belly
• Hearing: Responds to sounds
• Taste: Can taste the amniotic fluid

Movements

• Fewer large rotations due to less space
• Stronger kicks and rolls
• You may notice rhythmic hiccups — completely normal!
• The baby is practicing moving fingers and toes

Your Body

The Uterus Is Expanding

• The top of the uterus is now about 9 cm above the belly button
• Fundal height measurement (bottom of uterus): About 28 cm
• Expected total weight gain so far: About 8–11 kg

Physical Changes

Weight Distribution

• Fat is being stored on hips, back, and thighs through week 30
• These are energy reserves for breastfeeding after birth
• 76% of fat tissue is stored subcutaneously (under the skin)

Skin Changes

• Stretch marks may become more visible
• Linea nigra (dark line) becomes darker
• Melasma (darker pigmentation spots) may increase
• Areolas are darkening further

Blood Volume

• Blood volume has increased significantly
• Provides more oxygen and nutrients to the baby
• Can lead to increased fluid retention

Common Symptoms at Week 28

Shortness of Breath

• Causes:
  • The uterus is pushing up against the diaphragm
  • Hormones (progesterone and estrogen) stimulate respiration
  • Increased blood volume requires more oxygen
• Help:
  • Sit or stand upright
  • Use pillows when sleeping
  • Take breaks during physical activity
  • Symptoms often improve when the baby descends into the pelvis

When to contact a doctor:

• Chest pain
• Heart palpitations
• Severe shortness of breath that worsens
• Blue-tinged lips or extremities
• Wheezing

Sleep Problems

Causes of poor sleep:

• Physical discomfort from growing belly
• Frequent nighttime urination
• Heartburn when lying down
• Restless legs (RLS)
• Back and hip pain
• Vivid dreams

Tips for better sleep:

• Sleep on your left side (best blood flow to the baby)
• Use a pregnancy pillow between your knees
• Pillow behind your back for support
• Avoid large meals right before bed
• Limit fluid intake 2–3 hours before bedtime
• Establish a calming bedtime routine

Braxton Hicks Contractions

• Harmless "practice contractions"
• Feel like a tightening across the belly
• Usually painless or mildly uncomfortable
• Irregular and short (under 1 minute)
• Often go away with a change of activity

Difference from real labor:

Pelvic Pain

Pelvic girdle pain (SPD):

• The hormone relaxin loosens the joints
• Extra weight in the pelvic area
• Pain in the pubic symphysis, lower back, groin, or thighs

Relief tips:

• Avoid activities that worsen the pain
• Take shorter steps when walking
• Keep your knees together when rolling over in bed
• Use a support belt
• Ice pack for 20–30 minutes every 2–3 hours
• Strengthening exercises for the pelvic floor and hips
• Physiotherapy can help

Other Common Symptoms

• Heartburn: Avoid coffee, citrus, fatty food; eat smaller meals
• Constipation: Drink plenty of water, eat fiber, take walks
• Hemorrhoids: Prevent constipation; use witch hazel preparations
• Swelling: Elevate your legs, use support stockings, drink plenty of water
• Swollen feet: Wear comfortable shoes with good support

Important Tests at Week 28

Standard Prenatal Checkup

What is checked:

• Blood pressure
• Weight
• Urine sample (protein and glucose)
• Fundal height measurement (uterus size)
• Baby's heartbeat
• Fetal movements

Discussion of:

• Preparing for breastfeeding
• Your symptoms and concerns
• Mental health
• Any questions you have

Rh Factor and Anti-D Injection

If you have an RhD-negative blood type:

• A new blood sample is taken to check for antibodies
• Your baby's blood type is determined (if not done earlier)
• Anti-D injection: Given at week 28 if the baby is RhD-positive
• Protects against Rh sensitization, which could affect future pregnancies

Talk to your midwife or doctor about whether this applies to you.

Gestational Diabetes Screening

Who is screened?

• BMI over 25 before pregnancy
• Previous gestational diabetes
• A first-degree relative with diabetes
• A previous baby weighing over 4,500 g
• Ethnic background with higher diabetes prevalence (South Asian, Middle Eastern, African)
• PCOS

Glucose tolerance test (OGTT):

1. A fasting blood sample is taken first
2. You drink a glucose solution (75g glucose)
3. A blood sample is taken after 2 hours

Why it is important:

• Gestational diabetes increases the risk of complications
• Treatment significantly reduces that risk
• Managed with diet, exercise, and sometimes medication

Iron Levels

Iron supplements may be recommended based on ferritin levels:

• Ferritin 30–70 µg/L: 40 mg iron daily
• Ferritin below 30 µg/L: 60 mg iron daily
• Ferritin below 12 µg/L: Start immediately

Talk to your midwife about your specific iron levels.

Preparing for Birth

Start Thinking About a Hospital Bag

It is a bit early to pack now (wait until weeks 35–37), but you can start gathering information. A complete hospital bag checklist typically includes:

• Clothes for you and the baby
• Toiletries and comfort items
• Documents and health records
• Snacks and drinks
• Phone charger and camera

Birth Preparation Classes

Week 28 is a great time to start:

Course options:

• Hospital classes: Information about the hospital where you will give birth — most maternity units offer these
• Midwife classes: Many community health services offer classes with a local midwife
• Hypnobirthing: Deep relaxation techniques and mental preparation
• Online classes: A flexible option you can do from home

What classes cover:

• What happens during labor
• Pain relief (epidural, gas and air, natural methods)
• Positions during labor
• Complications and cesarean section
• Breastfeeding and the postpartum period
• The role of the support person

Parental Leave

Parental leave entitlements vary by country. Here are key things to think about universally:

Plan ahead:

• Find out what parental leave you are entitled to in your country
• Notify your employer in good time about your planned leave start
• Learn about how to apply for any parental leave benefits
• Discuss how you and your partner plan to share leave
• Know your job protection rights during and after leave

If you are unsure about your rights, your local HR department, a union, or government websites can provide guidance specific to your region.

Warning Signs That Require Medical Attention

Preeclampsia

Symptoms:

• Sudden or severe swelling (face, hands, feet)
• Persistent headache
• Visual disturbances (flickering, spots)
• Pain in the upper abdomen
• Rapid weight gain
• Reduced urine output

Why it is serious:

• High blood pressure
• Protein leaking into urine
• Can lead to organ damage
• Requires close monitoring

Preterm Labor

Warning signs:

• 6 or more contractions per hour
• Menstrual-like cramps
• Dull, persistent lower back ache
• Pelvic pressure
• Abdominal pain with or without diarrhea
• Change in vaginal discharge (increased, watery, or bloody)

What to do:

• Lie on your side with a pillow behind your back
• Drink plenty of water (dehydration can trigger contractions)
• Time contractions for 1 hour
• Call your doctor or midwife if you have 6+ contractions per hour or other warning signs

Other Signs Requiring Immediate Contact:

• Bleeding (even light)
• Leaking amniotic fluid
• Significant reduction in fetal movements
• Severe or persistent pain
• Fever over 38.5°C
• Severe dizziness or fainting

For Your Partner

• Join a birth preparation class — it gives you confidence and tools to support during labor
• Help plan parental leave together
• Offer a foot massage in the evening — swelling and tiredness are real now

Tips for Week 28

1. Make a birth plan — write down your preferences and discuss them with your midwife
2. Sign up for a birth preparation class if you haven't already
3. Start gathering information about your hospital bag
4. Do your pelvic floor exercises daily — important for birth and recovery
5. Invest in a pregnancy pillow for better sleep
6. Take a pregnancy photo — your bump is beautiful!
7. Plan your parental leave with your employer
8. Continue with prenatal yoga or swimming — helps with pain
9. Drink plenty of water — at least 2.5 liters daily
10. Prioritize rest — your body is working hard!

Useful Tools

• Pregnancy calendar: Follow your baby's development week by week
• Pelvic floor exercises: Start training your pelvic floor now — important preparation for birth and recovery
• Birth plan template: Use /tools to think through your birth preferences
• Contraction tracker: Familiarize yourself with a contraction counter now — you will need it when labor starts

What Awaits in Weeks 29–32?

• The baby continues to grow rapidly
• More organized sleep patterns for the baby
• Increased fatigue for you
• Further birth preparation
• New prenatal appointments

Did You Know?

• Welcome to the third trimester! From now on, the baby grows rapidly — it will roughly triple in weight in the last 12 weeks. Most of the weight gain is fat reserves that provide energy and keep the baby warm after birth.
• Your baby's brain grows from around 85 grams to nearly 140 grams during the third trimester. The surface develops folds that make room for billions of nerve connections.
• Your baby now has REM sleep and is dreaming! Nobody knows what the baby dreams about, but brain activity clearly shows dreaming sleep with active brain waves.

Common Questions About Week 28

What is anti-D, and do I need it?

If you have an RhD-negative blood type, your body can form antibodies against your baby's blood if the baby is RhD-positive. The anti-D injection is given at week 28 to prevent this. Your midwife or doctor will tell you if you need it based on your blood tests.

How do I know if I have gestational diabetes?

The glucose tolerance test detects this. You fast overnight, take a fasting blood sample, drink a solution with 75 grams of glucose, and take a new blood sample after 2 hours. Gestational diabetes can almost always be managed with dietary changes and exercise, and the condition usually resolves after birth.

When should I notify my employer about my leave?

It is generally recommended to notify your employer at least 3 months before your planned leave start. This gives time to plan handover of responsibilities. Learn about the application process for any parental leave benefits in your country and submit applications in good time.

Is it normal to have a lot of shortness of breath now?

Yes, shortness of breath is very common in the third trimester. The uterus pushes the diaphragm upward, and hormones stimulate respiration. Sit upright, take breaks during exertion, and use pillows when sleeping. Contact your doctor if you experience chest pain, heart palpitations, or severe shortness of breath that worsens.

You are doing an amazing job! The third trimester can be demanding, but remember that every week brings you closer to the magical moment of meeting your baby. Take care of yourself!