Pregnancy in 28th week

Your baby should be about 37.6cm long from head to toe, which is approximately the size of a pineapple. Your baby’s weight should be around 1kg, but will continue to grow throughout this trimester, and even after delivery.

Not that you’ll be able to hear it, but your doctor will tell you how your baby’s heart rate is changing all the time. According to the UK’s National Health Service (NHS), your baby’s heart was beating at:

• Around 110 beats per minute (bpm) in the 5th or 6th week of pregnancy
• It was 170bpm in the 9th or 10th week of pregnancy
• It’s currently around 140bpm
• And it will be around 130bpm at birth

This is nothing to be worried about because this increased heart rate is due to your baby’s tiny heart. After delivery, the baby’s heart rate will settle down to the normal human rate as his or her heart grows to normal size.

The baby’s brain is also quickly developing now, with grooves and every other feature that a human brain has. Brain tissue growth is usually quite rapid around the 28th week.

Hair growth, the development of eyebrows and eyelashes, and weight gain will continue for your baby.

You might want to start tracking the movements of your baby and counting the kicks to ensure you know if and when your baby is feeling unwell. Call the doctor immediately if you notice a drastic change in the baby's movements or if the baby stops moving and reacting to sounds altogether.

The second trimester might have been comparatively easy to handle—it’s known as the golden phase of pregnancy after all. But now that you’ve entered the third trimester of pregnancy, your symptoms are likely to get more intense and you will need to take more rest and care too. 

Your weight will continue to grow and that will lead to a number of issues. You might seem a little out of balance, and your legs and feet might be swollen too. This is likely due to the weight of the baby and water retention, but you should also get your blood pressure checked in case of pre-eclampsia and eclampsia, or other hypertensive issues.

Pregnancy-linked breast pain, belly button pain and leg cramps may trouble you this trimester. And your palms and feet may become very itchy. Talk to your doctor if these become difficult to handle. Also, ask your gynaecologist whether a sleeping bra and compression stockings might be a good idea for you.

Get your prenatal check-up done this week to measure the baby’s heart rate, kick count, fetal movements, and the size of your baby bump. This check-up will also reveal whether your baby is slowly turning to facilitate a head-first (normal) delivery or if he or she is still in a breech position. Breech position and breech birth have a few complications associated with them, so your doctor will prepare you for them and give you your options in the coming weeks.

The first set of tests done after you came to know you’re pregnant would have revealed whether or not your Rh factor is compatible with your baby’s. If not, you will be given an Rh immune globulin injection, also known as RhoGAM, this week. A follow-up injection will be given after you’ve delivered your baby.

The Indian health ministry officially recognises foetuses at 28 weeks or older as viable—meaning the baby has a chance to survive in case of premature labour beyond this point. This is a milestone, and not something you should worry about.

During the second trimester, you might have felt the symptoms of pregnancy to be less intense in nature. This will change in the third trimester, and you’re likely to get a lot more uncomfortable. While symptoms like melasma, sore breasts, bleeding gums, swollen gums, headaches, nosebleed, mood swings, etc., will continue, the symptoms related to pain, fatigue and sleep will get worse. This is largely because your baby—and therefore your baby bump— is getting much larger, and your body is under increased strain as it prepares for delivery in the next 10 or so weeks. The following are some of the symptoms of pregnancy you will have to handle this week (and in the coming weeks).

• Sciatic nerve pain: The sciatic nerve is the largest in the body. It passes under the uterus and runs right down both the legs. With the added weight and pressure of the growing baby on this nerve, the sciatic nerve can swell up and get inflamed. The pain can be constant or may occur in bouts. If this type of pain has been plaguing you since the second trimester and pain management has become an issue, then ask your doctor about other methods of reducing the pain apart from compresses and putting your feet up.
• Round ligament pain: As your belly continues to stretch to accommodate your growing baby, the muscles and ligaments of the abdomen will continue to be strained and pulled during the third trimester. This type of pain is known as round ligament pain, and it’s quite natural. The pain can be located all around your belly or on just one side of your belly. If the pain gets too intense, gets unbearable or starts to spread, call the doctor immediately.
• Varicose veins: A lot of women may start noticing varicose veins in the legs, genitals and rectum, which can be a cause of concern and discomfort. This usually happens during pregnancy because the growing uterus puts pressure on the large vein, known as inferior vena cava, that carries blood back from your legs and feet to the heart. These varicose veins are mostly located in the legs, vulva and the rectum—varicose veins in the rectum are also known as haemorrhoids—and these can be unsightly as well as painful symptoms of pregnancy. If you have varicose veins during pregnancy, you should have a discussion with your doctor about whether or not they will make a vaginal delivery more painful and increase the risks of varicose veins bursting during delivery.
• Braxton-Hicks contractions: Early contractions during pregnancy can be scary. If you are experiencing contractions that don't become more intense with time or that pass when you change your position, chances are that what you’re experiencing are Braxton-Hicks contractions. These false labour contractions indicate that your body is preparing for delivery. Braxton-Hicks contractions are quite normal in the third trimester, but you should definitely talk to your doctor about it. What’s more, you should also time these contractions and their frequency, no matter what week of the third trimester you’re in. This is because water breaking and premature labour and birth are possible during the third trimester, and their contractions can be confused with those of Braxton-Hicks.
• Fatigue: Fatigue is one of the most common symptoms of pregnancy and tends to intensify as the delivery date approaches. Your body is pumping more blood, your weight has continued to increase, your legs and feet are probably bloated, and the other painful symptoms of pregnancy persist. All of this is likely to make you feel exhausted at the slightest of movements. The best way to deal with fatigue in the third trimester is to rest up and get as much sleep and nutrition as possible. (Read more: Proper pregnancy diet)
• Sleep problems: It’s not like you don’t want to sleep during this week, but the painful symptoms of pregnancy and the associated fatigue can keep you awake for a large part of the night. Digestion-related issues and frequent urination during pregnancy make matters worse for sure. You should try comfortable positions recommended to pregnant women during this trimester, and take daytime naps, too, if needed. (Read more: Sleep during pregnancy)
• Digestive issues: You might experience an increase in indigestion during pregnancy and heartburn this week, and acid reflux, gas, bloating and belching are also quite likely to occur. While this used to happen due to hormonal changes during the first trimester, now it’s happening because your uterus has grown and is putting more pressure on your stomach and digestive system. Whatever the cause might be, this symptom needs to be addressed because it can lead to almost constant discomfort. You should consult your doctor about changing your diet and ask if there are any antacids or safe medications you can take to reduce their intensity.

You’re now in the third trimester and every week you cross will ensure that your baby is more developed and ready for delivery. Even if you were to go into premature labour—for reasons like cervical insufficiency—right now, your baby is more likely to survive if proper medical care is provided, and that should be a cause for relief, even if premature delivery is not ideal. Premature labour apart, the following complications might show up during the 28th week of pregnancy.

• Stillbirth: According to the Indian health ministry, stillbirth is the “complete expulsion or extraction of a baby from its mother where the foetus does not breathe or show any evidence of life, such as beating of the heart or a cry or movement of the limbs” after 20 weeks of gestation.
  There are a number of risk factors associated with stillbirth even though its precise causes are not known yet. Thankfully, development in medicine and medical technologies have made it possible to reduce the risk of stillbirth if caught in time.
  Here's what you do to improve your chances of spotting any problems:
  • Make a note of your baby's movements. Alert your doctor if you feel like your baby is kicking much less than usual or not responding to his or her favourite sounds to hear through the womb.
  • If you do see any symptoms like contractions, vaginal bleeding, etc., contact emergency health services immediately.

That said, these things are often out of your control. You should listen to your doctor's advice about taking counselling and medications if this happens to you.

• Hypertensive diseases: Expecting moms have about 50% extra volume of blood which is why they are at risk of high blood pressure or gestational hypertension. This is the reason why a regular check is kept on your blood pressure in the third trimester. Hypertension during the third trimester can lead to a number of related complications like placental abruption, pre-eclampsia and eclampsia. These complications, in turn, can result in premature birth and even stillbirth, so if you see any symptoms come up during this week, contact emergency health services immediately.
• Subchorionic haemorrhage: The chorionic membrane is one of the fetal membranes that protect and support the baby inside the womb. The chorionic membrane helps to form the placenta, and if the placenta gets even partially detached from the uterus, it can lead to some bleeding. This type of bleeding should not be taken lightly during the third trimester, and if you see any signs of it, you should contact your doctor without delay.
• Infections: Pregnant women have a low immune response, which makes them particularly prone to infections like bacterial vaginosis, urinary tract infection (UTI), hepatitis B, hepatitis C, genital herpes and group B streptococcus or GBS bacterial infection. If you have any of these infections, ask your gynaecologist to recommend the appropriate medicines that can reduce or completely negate the effects of the infection on your baby.
• Obstetric cholestasis: Obstetric cholestasis might be rare—this condition affects less than 1% of pregnant women in India—but it can be quite prickly. It leads to itching in the palms and feet, and sometimes other parts of the body. Though doctors don’t yet know the exact cause of obstetric cholestasis, they have linked the condition to the effects of pregnancy hormones on the liver. There’s no treatment for this condition, and it usually becomes better on its own after delivery. In the meantime, if the itching gets to be too much, ask your doctor for salves and creams to soothe it.
• Gestational diabetes: Gestational diabetes is likely to show up between the 24th week of pregnancy and the 28th week of pregnancy, so make sure you get yourself tested this week if you haven’t already. You should be in the clear in the coming weeks, but if you have a history of blood sugar issues, you should still be careful. It’s very important to manage gestational diabetes because it can have long-term implications for your health and that of your baby too.

Entering your final trimester means that you now have to get a lot done, and the pain and fatigue you’re likely to experience this week won’t help you go any faster. So, it’s best to enlist the support of your spouse, family and friends this week to ensure that you don’t get overwhelmed by all that needs to be done to prepare your home for your baby. You should aim to get the following done this week.

• Think about getting the essentials your baby and you will need after the delivery. This could be a long list of things, and new parents might take a while to get everything right. Your increasing nesting behaviour is likely to help you sort this aspect, and a baby shower or meeting with experienced parents (even just your own) might help you figure out things like baby-proofing, diapers, washcloths, baby cot and pram, etc.
• It’s equally important to keep a go-bag ready, with all the essentials you would need in the hospital if your baby decides to arrive a little earlier than you planned. The bag should have spare and comfortable clothes, towels, your medical history and pregnancy reports among any other necessities you and your spouse may need.
• If your baby is found to be in breech position during the prenatal exam this week, your doctor might give you a number of home remedies and methods to try and turn your baby naturally. Be extra careful while attempting these, and make sure you have ample support and the presence of at least one person when you try these.
• Avoid all types of strain and activities that exhaust you. Fatigue and supporting your own weight can be a huge issue in these coming weeks—and your post-delivery life won’t get easier for quite a few months—so you should get as much rest and sleep as possible.
• Avoid raw fish, undercooked meat, stale food, processed foods, excess sugar and salt. Your digestive system is going to go topsy-turvy this trimester and you don’t need to make it any worse by adding food poisoning or infections like salmonella and listeriosis to it.

Believe it or not, every pregnant woman needs more support during the third trimester of pregnancy. This is not only because of the way your body has grown and changed, the symptoms you’re feeling and the exhaustion that might seem perpetual. This is also because this trimester is perhaps the most critical one, and your life will change forever by the end of it. This can be emotionally overwhelming as well.

So, apart from keeping a check on your pregnancy diet and rest this week, you should concentrate on your mental health. Depression during pregnancy and postpartum depression are both very serious issues, and have a huge implication on your health as well as that of your baby and family. Communicate with your spouse or partner if there are any issues you’re facing.

This apart, keep in touch with your doctor and follow all their recommendations to the T. Do not take any medications above and beyond your doctor’s permission. You might also want to join maternity classes or a support group if possible. You should put yourself, your health and comfort above everything else this week and beyond because your baby’s health depends on it.