Pregnancy week 28

Week 28 of Your Pregnancy

At 28 weeks, you've reached the third trimester. And while—for many—this is a time of celebration, you may be feeling new aches and pains. Read on to learn more about week 28 of pregnancy.

It's week 28 of your pregnancy and, believe it or not, you're in the third trimester! This week you'll have a major doctor's appointment and do a lot of testing. You may be diagnosed with anemia or have other symptoms to report and, as your pregnancy progresses, you're probably experiencing new aches and pains. Read on to learn more about week 28 of pregnancy, from what you should expect to how your unborn baby is developing.

Pregnancy Week 28 Quick Facts

  • At 28 weeks, you're 7 months pregnant
  • You have 12 until your due date
  • You're in the third trimester

Your Unborn Baby's Size at 28 Weeks

At 28 weeks, your unborn baby is about 14.8 inches long and weighs about 2.22 pounds. That's nearly the size of a kabocha squash!

week 28

Pregnancy Symptoms Week 28

Welcome to week 28 of your pregnancy. Several majorly uncomfortable symptoms start to crop up during this time, including:

That said, the most common symptom—or complaint—during week 28 of pregnancy is back, pelvic, and/or joint pain caused by changes to the body during the third trimester.

"The hallmark of 28 weeks would be what we call lordosis of the spine. That's when patients feel that their spine curves, and so in order to keep their center of gravity stable, they have to start 'waddling,’" says Cassandra Blot Simmons, M.D., chief of general obstetrics and gynecology at Columbia University Medical Center in New York City. "That can become somewhat uncomfortable and can limit their movement."

This spinal curve can also lead to several other painful conditions. One is sciatica, which is a pinched nerve that can send shooting pains down the butt, lower back, and leg. "It can be pretty uncomfortable and can be one sided or can be on both sides,” says Dr. Simmons. “It can even shoot all the way down to the toes.”

You can also start experiencing sacroiliac (SI) joint pain where the spine meets pelvic bone, or symphysis pubis dysfunction (SPD), which causes pain in the public area, according to Dr. Simmons. All of these painful conditions can be helped by the use of a pregnancy support belt.

In addition, the other major hallmark of pregnancy in the third trimester is heartburn. As the fetus grows, so does the uterus. It starts pushing more on the stomach causing heartburn and potentially also some nausea. 

"Because of the physical space that the baby is taking up, I see a lot of people who come back with sort of nagging nausea, and it's most commonly related to heartburn," says Alex Peahl, M.D., MSc, assistant professor of obstetrics and gynecology at the University of Michigan and co-director of the Michigan Plan for Appropriate Tailored Healthcare in pregnancy. Pepcid can work, along with eating smaller, more frequent meals. 

Keep in mind, symptoms can vary person to person. If you're having a symptom that seems concerning to you, make sure to call your health care provider.

Developmental Milestones

The fetus’ rapidly-growing brain has developed enough to control some body functions, like movements. As fetal development continues, the baby's eyes begin moving and blinking. They are also now colored, though that color can change for up to six months after birth.

The fetus is growing very quickly, actively adding fat and muscle to fill out its still-wrinkly skin. They're also growing bones. Muscle and bones make for stronger kicks and punches.

Prenatal Tests and Doctor's Appointments

Most people have a prenatal appointment around 28 weeks. This marks the first of many more visits, as most health care providers want you to visit every two weeks during the third trimester.

If you have a doctor's appointment at 28 weeks they'll likely test a few things leading up to that third-trimester transition:

  • Glucose tolerance test to screen for gestational diabetes, if you haven’t had one already
  • Blood count to test for anemia
  • Infectious diseases screening for HIV, hepatitis, and syphilis
  • A blood test for Rh antibodies
  • A Tdap vaccine, which protects the baby against whooping cough
  • Depression screening and checking for mood issues

Week 28 brings a lot of testing, and a lot of it is state mandated. These and others are really important to keep you and the fetus safe during delivery.

"That is a time where, in most states, we are checking HIV and syphilis again, because for both of those 28 weeks is a great time to check," says Jeanne Sheffield, M.D., professor and director of maternal-fetal medicine at Johns Hopkins Medicine in Baltimore. "If it's positive, you still have plenty of time to get treatment." Treatment can help prevent the baby from getting the infection at birth.

Syphilis rates are on the rise in the United States and congenital syphilis rates are following. “We're seeing a lot more babies that are being diagnosed with syphilis at birth," says Dr. Sheffield. "Syphilis can be devastating–and it's a big cause of stillbirth. But it's also a big cause of complications after delivery, too."

You'll also have blood tests to check your iron levels. "Knowing that someone has a low blood count going into labor and delivery can help us to optimize that blood count so they're at lower risk of transfusion," Dr. Peahl says. "Up to a liter of bleeding is a normal experience on the labor floor. And so making sure that people are starting from a really good point with their blood count helps them to just recover better from that childbirth experience."

If you're anemic, your doctor will likely tell you to take oral iron supplements. Taking these every other day is just as good as taking them every day and can reduce constipation, a side effect of these pills, Dr. Peahl says.

I've been anemic with both of my pregnancies. This is a common issue that many pregnant people come up against because of the increased blood volume needed to support growing the baby. But anemia can make you feel really tired, slow, and weak.

Also, some high-risk pregnancies may have a growth ultrasound at 28 weeks. Plan to have a full bladder. The technician will take a last look at the cervix to make sure the placenta is clear. They'll measure fetal body parts and the amount of amniotic fluid. And take the fetal heart rate, according to Dr. Simmons.

Common Questions at This Pregnancy Stage

What are the signs and symptoms of preterm labor?

If you are experiencing preterm labor, it is important to get help quickly. But what are the signs? "Regular contractions, or sometimes persistent pelvic pressure, would be a reason to be evaluated by your doctor," Dr. Peahl says. This may feel like abdominal tightening, abdominal cramping, or a low back ache.

Is it normal that my hands and feet are swollen?

"Swelling can be very common, but if there's a sudden, acute change and the swelling is significantly worse, it's always a great idea to contact your maternity care professional to check in," Dr. Peahl says. "It's always a good idea to just have it assessed," as certain conditions like preeclampsia, can cause swelling and can lead to serious complications.

How do I tell Braxton-Hicks from labor contractions?

It can be hard to distinguish Braxton-Hicks contractions from real, labor contractions, but there are noticeable differences. "If you think about it, labor means work. The uterus has to work to push a baby through the pelvic bones, and so when a patient asks me, 'What's the difference between a Braxton-Hicks contraction and a labor contraction,' I remind them that if you don't feel like your uterus is doing work to actually squeeze and push the baby further down the pelvis, then you are likely not in labor," says Dr. Simmons. "If you're not sure, and if you have more than six feelings of strong tightening in the abdomen in an hour or painful tightening in the abdomen every 10 minutes, then you should go to the hospital to be evaluated."

Things You Might Consider This Week

This week, you may have heard that you should be doing kick counts. Not all experts recommend this practice. During my pregnancies, even high-risk ones, my doctors had not told me to do daily kick counts.

As with all things pregnancy and health care, ask your provider about daily kick counts. The recommendations vary and may be different based on your specific pregnancy and risk factors. Generally, experts say that fetal movement should be regular and strong starting around the third trimester.

If you'd like to do kick counts, the general advice is: "You want to feel the baby move about 10 times in a two-hour timeframe—this is a loose recommendation," Dr. Simmons says. "We don't necessarily recommend that a patient panics because they only had nine movements."

If the fetus isn't moving as it usually does, you can use your phone to vibrate your belly, put something cold on the belly or drink something hot, or tap on your belly to see if the baby starts moving. If you're still worried, contact your health care provider.

Now is also a great time to start talking with your doctor about your birth options. Will you be scheduled for an induction or planned C-section? You'll need to consider that in your delivery and recovery plans. If you've had a previous cesarean, ask your doctor if you're a candidate to try to deliver vaginally—if you want to.

If you're breastfeeding or exclusively pumping you'll want to order a breast pump or new parts. Parts like flanges, membranes, and tubing should be replaced on a regular basis. Your provider may have given you a form to apply for a new pump covered by insurance, or you may need to talk to your provider or insurance about coverage. Not every state guarantees coverage.

"I think 28 weeks is a great time to apply for a breast pump. That gives you time to make it through the insurance process, if needed," Dr. Peahl says. "And then you also have the pump at home and so that in the event of an earlier birth, you're ready."

Support You May Need This Week

You'll need child care and time off for your 28-week appointment, the glucose test, and any other lab work. If you need to do a three-hour glucose test, plan for four hours as you'll probably need to stay at the clinic between blood draws.

Start thinking about your birth plan but also your birth logistics. Who will drive to the hospital? Who will watch your other children if you have any? Talk to your partner or loved ones about how things will work.

"Once they've made it through the anatomy scan, they've made it through this round of testing, and things are looking OK with the pregnancy,” says Dr. Peahl. “Now it's time to actually start thinking about that future.”

Head over to week 29 of pregnancy

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