Third Trimester Starts at Week 28: Swelling, Breathlessness and What's Normal Now

Congratulations you have made it to the third trimester. The final stretch. From week 28 until your baby arrives, you will see, feel, and experience more rapid change than at any point since the early first trimester.

The third trimester brings new symptoms alongside your growing excitement. Here is your honest, practical guide to what is happening and what needs your attention.

Your baby at 28 weeks

Your baby now weighs approximately 1 kilogram and is around 38cm long. A significant amount of growth and development still lies ahead. Your baby will roughly triple its weight between now and birth.

• Eyes are now fully open and can respond to light and dark
• Brain development is accelerating rapidly billions of new connections are forming
• The lungs are maturing your baby is making practice breathing movements using amniotic fluid
• Your baby is accumulating fat under the skin this will give them the round, chubby appearance at birth
• Bone marrow is now producing red blood cells independently

Source: Cleveland Clinic – Third Trimester Fetal Development | Northwestern Medicine

New third-trimester symptoms to expect

Swelling (Oedema) – especially in the feet and ankles

Mild swelling of the feet and ankles is one of the most common third-trimester symptoms, affecting approximately 75% of pregnant women. It happens because:

• Your body is retaining more fluid than usual
• Increased blood volume and slower circulation in the legs
• Your growing uterus compresses the major veins in the pelvis, slowing blood return from the legs

Normal swelling: Puffiness in the feet and ankles that is worse at the end of the day, better in the morning, and more noticeable in hot weather or after standing for long periods.

Warning signs that require immediate medical attention:

• Sudden or severe swelling, especially if it appeared rapidly
• Swelling in the face, particularly around the eyes
• Swelling in one leg only (possible DVT, blood clot)
• Swelling accompanied by headache, visual disturbances, or upper abdominal pain these together are warning signs of preeclampsia

Source: ACOG – Preeclampsia and Hypertension in Pregnancy Guidelines 2022 | FOGSI

Shortness of breath

Feeling out of breath after climbing a flight of stairs or even having a conversation? Completely normal. Your uterus is now pressing upward against your diaphragm, reducing the space your lungs have to expand. Additionally, your body is circulating 40–50% more blood, which means your heart and lungs are working significantly harder.

Relief: Rest. Use pillows to keep yourself more upright. Slow down. Shortness of breath that is sudden, severe, or accompanied by chest pain or palpitations is not normal to call your doctor.

Increased back and pelvic pressure

Your baby is now heavy enough to put noticeable pressure on your lower back, pelvis, and bladder. This is the stage where many women feel "heaviness" in the pelvic area normal as the baby begins to descend slowly over coming weeks.

Difficulty sleeping

Getting comfortable in bed becomes increasingly challenging. Your left-side sleeping position with pillows (as described in Week 25) remains your best approach. Some women find a semi-reclined position propped up against pillows more comfortable in the later weeks.

Managing swelling in Indian summer heat

Swelling is significantly worse in hot, humid Indian weather a reality that Western pregnancy guides completely ignore. Here are practical relief strategies for Indian mothers:

• Elevate your feet: Whenever sitting, rest your feet on a stool or cushion. At rest, lie on your left side with feet slightly elevated on a pillow.
• Cold water foot soak: Soaking feet in cool water for 15 minutes provides immediate relief. Add a few drops of peppermint oil for a cooling effect.
• Compression socks: Maternity compression socks help push fluid back up from the legs. Particularly useful in summer.
• Stay hydrated: Counter-intuitive but true drinking more water helps your kidneys flush out retained fluid.
• Reduce salt intake: Excess sodium worsens fluid retention. Cook with less namak and avoid processed, packaged foods.