Pregnancy is a journey full of miracles, changes and challenges. The third trimester in particular, i.e. the last three months before the birth, is an intense phase for many women. The body prepares for birth, the baby grows rapidly and physical and emotional complaints often increase. One complaint that many pregnant women experience in the last trimester of pregnancy is upper abdominal pain. This can be harmless, but it can also indicate serious complications.
In this magazin , we look at all aspects of the third trimester, the causes of upper abdominal pain, the baby's development, the changes in the mother's body and practical tips for everyday life, the household and mental well-being.
What does the third trimester mean?
The third trimester of pregnancy begins at 28 weeks' gestation and ends with the birth, which usually takes place between 37 and 42 weeks' gestation. These last three months or so of pregnancy are characterized by profound physical, emotional and organizational changes. For the expectant mother, this phase not only means preparing mentally and physically for the birth, but also increasingly coming to terms with her new life as a family.
Physical and hormonal changes
The third trimester of pregnancy begins at 28 weeks' gestation and ends with the birth, which usually takes place between 37 and 42 weeks' gestation. These last three months or so of pregnancy are characterized by profound physical, emotional and organizational changes.
For the expectant mother, this phase not only means preparing mentally and physically for the birth, but also increasingly coming to terms with her new life as a family.
1. changes in the musculoskeletal system
As the pregnancy progresses, the ovaries release more of the hormone relaxin. This acts on ligaments and joints, primarily in the pelvic area:
- Relaxation of the symphysis (pubic symphysis) and the sacroiliac joints leads to increased mobility in the pelvic area. This enables better passage of the child through the birth canal.
- At the same time, this can lead to instability, pain in the lower back or pelvic area - especially when straining or standing for long periods.
- The spine also has to adapt: The altered statics often lead to increased lordosis (curvature of the lumbar spine), which promotes back pain.
2. respiratory system and lung volume
The growing uterus pushes the diaphragm upwards:
- Inspiration (inhalation) is restricted, but the tidal volume increases to ensure the oxygen supply for mother and child.
- Many pregnant women report a certain amount of shortness of breath from the 7th-8th month onwards, primarily during physical exertion.
3. circulation and metabolism
The heart and circulatory system must also continue to adapt:
- The blood volume has reached its peak (approx. 40-50% more than before pregnancy).
- The heart rate increases slightly and the cardiac output remains high.
- The increased pressure in the legs caused by the uterus can lead to water retention (edema), varicose veins or vena cava compression syndrome - especially when lying on your back.
4. digestion and other organ systems
The pressure on the stomach and intestines leads to:
- Heartburn, as stomach acid can flow back into the esophagus more easily.
- Constipation due to slowed bowel activity as a result of hormonal changes (progesterone effect).
- More frequent urge to urinate, as the bladder is more compressed.
5. psychological and emotional preparation
A decisive phase also begins mentally:
- Many pregnant women now experience a stronger bond with their unborn child and feel intense movements (the baby's movements are now particularly pronounced).
- Thoughts are increasingly revolving around birth, motherhood and breastfeeding - partly associated with anticipation, partly with insecurities or fears.
Emotional challenges
In addition to the physical changes, the psychological aspects should not be underestimated. Many expectant mothers experience a mixture of anticipation, uncertainty and exhaustion in the third trimester.
The final spurt to the birth can be emotionally demanding, especially if symptoms such as tiredness, insomnia or upper abdominal pain are added to the mix.
The baby's development in the third trimester
In the third trimester, the unborn baby goes through the decisive phase of its development. From the 28th week of pregnancy, the fetus not only becomes larger and heavier, but also prepares intensively for life outside the womb.
In these last weeks before the birth, many of the child's bodily functions mature, an impressive process that often fills expectant mothers with deep fascination.
Growth spurt and weight gain
The baby gains a lot of weight in the last trimester of pregnancy. While it usually weighs between 1,000 and 1,200 grams at the beginning of the trimester, it reaches an average weight of around 3,200 to 3,500 grams by the time it is born.
The body fat that is stored during this phase helps the newborn to regulate its body temperature and energy supply after birth.
Maturation of organs and bodily functions
The complete development of vital organs is particularly important in the third trimester:
- Lungs: In the weeks before birth, the lungs mature and begin to produce surfactant, a substance that prevents the alveoli from collapsing after birth.
- Central nervous system: The brain is growing rapidly, forming new connections and increasingly controlling bodily functions such as movements, reflexes and sleep cycles.
- Digestive system: The digestive organs prepare for their function, even if they only become fully active after birth.
- Immune system: Antibodies are transferred from the mother to the baby via the placenta, which provides the first protection against infections after birth.
Baby's movements and activity
Although the space in the womb becomes increasingly limited as the baby grows, it is usually still very active during this phase. Many women report strong kicks, stretching movements or hiccups.
These movements can be accompanied by pain or discomfort, especially when kicking against the diaphragm or in the right upper abdomen. It is important that the baby's movement pattern does not suddenly change drastically: A noticeable decrease in activity should definitely be clarified by a doctor.
Rotation into the birthing position
Between the 32nd and 36th week of pregnancy, most babies assume the so-called cephalic position, i.e. the position with the head down towards the pelvis. This birth position is ideal for a vaginal birth. However, some babies initially remain in the breech position (with their bottom facing downwards), but often turn before the 37th week.
Personality development in the womb?
Scientific studies indicate that babies react to external stimuli while still in the womb: Voices, music, light and the touch of the abdominal wall can be recognized and in some cases even recognized.
Some babies show clear sleep-wake rhythms, react calmly or actively to certain voices: the first indications of character traits that can be observed later.
First conscious reactions
The baby begins to react to sounds and light. Many mothers report that the fetus calms down when familiar voices speak or music is played. Hiccups are also often noticeable in the third trimester.
Pregnancy symptoms at the end of pregnancy
In the third trimester of pregnancy, the expectant mother's body undergoes a number of profound changes. These affect not only the musculoskeletal system and the internal organs, but also the cardiovascular system, the skin, the hormonal balance and the psyche.
Many of these adjustments are necessary to provide the baby with optimal care and to prepare the body for the upcoming birth. At the same time, however, they can also be accompanied by discomfort that impairs the quality of life in the last trimester of pregnancy.
Growth of the uterus and spatial displacement
The uterus reaches its maximum size in the last trimester and in many women reaches up to the costal arch. This causes the adjacent organs such as the stomach, liver, intestines, bladder and lungs to be displaced. This change can trigger the following symptoms:
- Upper abdominal pain, especially due to pressure on the stomach or liver
- Heartburn and a feeling of fullness after eating
- Shortness of breath, especially when lying down or during exertion
- Increased urge to urinate due to pressure on the bladder
Increase in weight and fluids
In the third trimester, the expectant mother gains an average of 4 to 6 kilograms - depending on her initial weight, diet and water retention. The weight is distributed between the baby, amniotic fluid, placenta, the enlarged uterus, additional blood volume and fat reserves. The increased pressure on the leg veins and hormonal influences often lead to water retention (oedema) in the feet, hands and face.
Tip: Keeping your legs elevated, wearing comfortable clothing, drinking plenty of fluids and moderate exercise (e.g. swimming or walking) help to combat edema.
Hormonal changes and their effects
In the last trimester, pregnancy hormones continue to have a strong influence on the body. The hormone relaxin loosens ligaments and joints, which is an important preparation for birth, but can also lead to instability and pain in the pelvic area.
Progesterone and oestrogen promote blood circulation in the skin, influence the nervous system and can increase symptoms such as mood swings, sleep problems and skin changes.
Changes in the skin and connective tissue
Many pregnant women develop visible changes to their skin and tissue in the last trimester:
- Stretch marks (striae) on the stomach, breasts and thighs due to severe skin stretching
- Pigment changes, such as the linea nigra (vertical dark line on the baby's belly)
- Increased sweating due to hormonal changes and higher metabolism
Creams with almond oil or vitamin E and gentle massages can help to improve the feel of the skin and keep the tissue elastic.
Digestion, metabolism and appetite
The slower metabolism and the displacement of the stomach and intestines in the last weeks of pregnancy often lead to:
- Heartburn (due to reflux of stomach acid)
- Flatulence and constipation
- Cravings or loss of appetite
Small, high-fiber meals, sufficient fluids and exercise can help to alleviate these symptoms.
Circulation and cardiac output
The blood volume in the third trimester is around 40 to 50% higher than before pregnancy. The mother's heart is working at full speed to supply both herself and the baby with oxygen and nutrients. Many women report in this phase:
- Dizziness or circulatory problems
- Tiredness, exhaustion and hardly any energy
- occasionally also from palpitations
Periods of rest, a nutritious diet and sufficient sleep are particularly important at this time.
Musculature and skeleton
The growing belly puts strain on the back and pelvic floor muscles. This leads to:
- Back pain, primarily in the lower back
- Tension in the neck and shoulders
- an increased risk of sciatica
Exercise, warmth, gentle stretching exercises or pregnancy yoga can have a supportive effect here.
Changes in sleep behavior
Restful sleep becomes a challenge for many women in the third trimester. The reasons for this are
- Frequent urge to urinate
- Uncomfortable lying due to the large belly
- restless thoughts or worries before the birth
- nocturnal calf cramps
Tip: Nursing pillows or special pregnancy pillows help you to find a comfortable side position. Relaxation rituals in the evening can help you fall asleep.
Emotional and psychological changes
The approaching due date often brings mixed feelings: joy, impatience, worries or fears about the birth or the new life with the baby. These emotions are normal and should be allowed.
- Many women experience this phase as more sensitive and vulnerable.
- Talking to your partner, midwife or friends helps
- Relief at home or at work can stabilize the mind
Overview of common complaints in the third trimester
- Upper abdominal pain
- Lowering contractions
- Back pain
- Water retention
- Insomnia
- Shortness of breath
- Tiredness and exhaustion
- Digestive problems
- Carpal tunnel syndrome (tingling in the hands)
- Hot flushes and increased sweating
These symptoms are to a certain extent part of pregnancy, but should always be considered in context and clarified with your doctor if you are unsure.
Dealing with lowering contractions
Contractions typically occur from the 36th week of pregnancy and are a sign that the body is preparing for birth. They help the baby to sink deeper into the pelvis - often a noticeable signal that the end of the pregnancy is approaching.
These contractions are irregular and usually not painful, but can manifest as a pulling sensation in the lower abdomen or back. Many pregnant women report that they "pull downwards" and that breathing is easier afterwards - an indication that the baby's belly has descended.
What helps with lower contractions?
- Heat: A hot water bottle, heating pad or a relaxing bath can help to relieve muscle tension.
- Light exercise: walks or pelvic mobilization on the exercise ball stimulate blood circulation and promote the baby's natural descent.
- Relaxation techniques: Breathing exercises, meditation or pregnancy yoga promote calm and serenity.
- Rest periods: Taking enough breaks and elevating your legs relieves the strain and helps the body to adapt.
If the contractions become regular, stronger and more painful or are accompanied by back pain, discharge or blood, medical advice should be sought immediately - it could already be labor pains.
Dealing with sleep problems
Insomnia is one of the most common issues in the third trimester of pregnancy. Many pregnant women struggle to find a comfortable sleeping position - be it because of their large belly, the urge to urinate at night, calf cramps, heartburn or spinning thoughts.
These sleep disturbances are normal, but should not be underestimated. Especially in the final spurt before the birth, the body needs a lot of rest to regenerate.
Tips for better sleep in the last trimester of pregnancy:
- Side sleeper pillows or nursing pillows: They support the stomach, back and legs, especially in the left side position (promotes blood circulation).
- Relaxing evening rituals: a warm foot bath, quiet music, reading or gentle stretching exercises prepare you for a good night's sleep.
- Light, early evening meals: How to minimize heartburn.
- Herbal teas (e.g. lemon balm or lavender): Gently support relaxation (in consultation with the midwife).
- Dark, quiet bedroom: freshly ventilated, at a pleasant temperature and without screen light.
A short nap or power nap during the day can also help to compensate for the sleep deficit at night and recharge your batteries.
Upper abdominal pain in the third trimester
Upper abdominal pain occurs relatively frequently in the last trimester of pregnancy. The pain can be stabbing, burning, dull or cramp-like. It can occur on one side, in the middle or on both sides.
Possible harmless causes
Stretching the ligaments
The ligaments that hold the uterus are stretched. This can cause pulling or pressing pain.
Digestive problems
The hormonal slowdown in digestion and the displacement of organs can lead to flatulence, constipation and heartburn.
Infant movements
The baby can kick directly against the liver or stomach with its movements, which can cause pain in the upper abdomen.
Serious causes: When should caution be exercised?
HELLP syndrome
HELLP syndrome is a complication of pregnancy that requires immediate medical attention. Symptoms are:
- Severe pain in the right upper abdomen
- Nausea, vomiting
- Visual disturbances, headaches
- Increase in blood pressure
Pre-eclampsia
Pre-eclampsia is characterized by
- High blood pressure
- Protein in urine
- severe water retention
- Pain in the right upper abdomen
When to see a doctor? Take warning signs seriously
Immediate clarification necessary for
- sudden onset of severe upper abdominal pain
- Fever, chills
- Visual disturbances, flickering
- Severe nausea or vomiting
- Pain that radiates to the back
Regular preventive check-ups
Regular monitoring of blood pressure, weight, urine levels and CTG can help to detect many complications at an early stage. The maternity record provides valuable information for doctors and midwives.
Everyday life and household in the third trimester
Keeping an eye on the energy balance
Tiredness increases, the body demands more rest and recuperation. Nevertheless, many women still have to run the household or look after children.
Tips for relieving stress in everyday life
- Plan and prioritize tasks
- Accept or organize help
- Plan time for breaks
- Lie down or elevate your legs more often
Role of the family and partnership
Understanding and support from partners, children or friends are particularly important at this time. Good communication helps to understand the needs of the mother-to-be.
Domestic help during pregnancy
Who is entitled?
In the event of complications or a threat of premature birth, the doctor may prescribe home help. The health insurance company often covers the costs if:
- the pregnant woman can no longer manage the household independently due to medical conditions
- no other person living in the household can help
Benefits of domestic help
- Cleaning
- Purchasing
- Cooking
- Childcare
Such help can save valuable energy and focus on your own well-being and preparation for the baby.Birth preparation in the last trimester
Packing your hospital bag
From the 34th week, the bag should be ready for the delivery in the clinic or birth center. The following are important:
- comfortable clothing
- Documents (maternity passport, health insurance card)
- Hygiene articles
- Clothes for the newborn
Create a birth plan
A birth plan can help you to record your wishes regarding the birth, birth position and care. It facilitates communication with the medical staff.
Courses and advice
- Birth preparation courses
- Breastfeeding advice
- Baby care courses
Mental health: between anticipation and fear
Understanding ambivalent feelings
Many pregnant women experience a rollercoaster of emotions in the third trimester. Anticipation alternates with uncertainty and exhaustion.
Dealing with psychological stress
- Conversations with trusted people
- Exchange in groups or forums
- Professional advice for persistent stress
Preparing for life with a baby
Initial equipment and organization
Some examples of the basic equipment:
- Clothing (size 50/56)
- Diapers, changing mat
- Sleeping possibility
- Baby carrier or baby carriage
- Nursing pillow or bottle
After the birth: what can parents expect?
- Midwife care
- Medical checks
- Parental allowance and formalities
- Organization of everyday life with the newborn
Checklists and tables
Symptoms: Harmless or alarming?
| Symptom | Harmless | A visit to the doctor is advisable |
|---|---|---|
| Drawing pains in the abdomen | ✓ | |
| Sudden severe pain | ✓ | |
| Headache | ✓ For visual disorders | |
| Water retention | ✓ (moderate) | ✓ with rapid increase |
| Shortness of breath | ✓ | ✓ with persistent confinement |
However, if you are unsure, you should always consult your doctor.
Conclusion: Well informed through the third trimester
The last trimester of pregnancy is a special phase in which many things come to a head: the development of the fetus, changes in the body, preparation for the birth and life with the baby. Upper abdominal pain is one of the complaints that should be monitored particularly carefully.
With good medical care, timely precautions, mindful treatment of their own bodies and practical help around the house, expectant mothers can start the final spurt stronger and well prepared. And the understanding and support from those around them also help to ensure that this special time with the baby is remembered as a positive period in life.
