Maternal-Newborn Nursing · Prenatal Care
Care in the Third Trimester of Pregnancy
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In 30 seconds
The third trimester spans roughly week 28 until birth — the home stretch. The fetus grows rapidly, gains fat, and settles into a head-down position for many births, while the pregnant person's body adapts to carrying a much larger load. Visits typically become more frequent in this trimester (a common pattern is every two weeks, then weekly near term — but schedules vary by provider and risk level, so learn the pattern used in your setting). Care shifts focus from what to expect to how to know when something is wrong and how to prepare for labor and parenting.
This is the trimester of the danger-sign curriculum: Preeclampsia A pregnancy blood-pressure disorder with specific warning symptoms Full entry → warning symptoms, decreased fetal movement, Preterm labor Labor beginning before term Full entry → signs, and Rupture of membranes The amniotic sac breaking ("water breaking") — gush or trickle Full entry →. It is also the trimester of readiness work: birth planning, the newborn's provider, feeding plans, car seats, and postpartum support. For nurses, third-trimester care is largely high-stakes teaching — the difference between "call if you notice X" taught well and taught poorly can change an outcome.
Why this matters
- The highest-stakes complications can announce themselves now. Conditions like preeclampsia (a blood-pressure disorder of pregnancy), placental problems, and preterm labor are detected through measurements, tests, and the person's own reported symptoms — so teaching what to report is a safety intervention.
- Fetal movement is a daily well-being check. A noticeable decrease in movement is a classic reason to seek evaluation; teaching how to monitor it (per the care team's protocol) empowers the pregnant person.
- Late screenings have specific timing. Group B streptococcus (GBS) A common bacterium some people carry vaginally without symptoms Full entry → screening near term identifies colonization so that intrapartum antibiotics can be offered per current protocols — a classic "why timing matters" example.
- Recognizing labor is practical literacy. Knowing True labor Progressive contractions producing cervical change Full entry → from Braxton Hicks contractions Irregular, non-progressive practice tightenings Full entry →, and what to do when membranes rupture, prevents both panic and dangerous delay.
- Birth and postpartum preparation reduces anxiety and improves experience — for the pregnant person, the partner, and the new family.
- Scope-of-practice note: protocols for kick counts, visit intervals, screening timing, and teaching content vary by institution and jurisdiction — the nurse follows the care plan and verifies local policy.
The college version
Core Concepts
More frequent visits, trend-based assessment
Late-pregnancy visits track the established trends: blood pressure, weight, urine studies, fundal height (growth), and fetal heart rate. Later visits may also assess fetal position and presentation (often head-down as term approaches). The nurse also asks about movement, contractions, fluid leakage, and new symptoms — questions that are themselves a screening tool.
Fetal movement awareness
By the third trimester, movement is expected to follow a pattern the pregnant person can recognize. Many care teams recommend formal kick counts (counting movements over a set window) if the person notices a change — the exact method follows the provider's or institution's protocol. The key teaching: know your baby's pattern, and report a significant decrease rather than waiting. Decreased movement is evaluated, not dismissed.
Late-pregnancy screening: Group B strep and more
Near term (commonly around 36 weeks, timing varies), most settings screen for Group B streptococcus (GBS), a common bacterium that can be carried vaginally without symptoms. GBS colonization is not an infection of the pregnant person; its significance is that it can rarely be transmitted to the newborn during birth. When colonization is detected, current protocols typically include offering antibiotics during labor. Nurses teach the why (protecting the newborn) without quoting drug names, doses, or protocols — those belong to the provider and current guidelines.
Signs of labor — and signs that are not labor
- True labor: contractions that become regular, stronger, longer, and closer together, often with low-back or pelvic pressure; progressive cervical change (effacement and dilation).
- False labor / Braxton Hicks: irregular, non-progressive tightenings that ease with rest, position change, or activity; they do not produce progressive cervical change.
- Bloody show Blood-tinged mucus as the cervix begins to change Full entry →: a small amount of blood-tinged mucus as the cervix begins to change — often a sign labor is approaching, but any significant or bright-red bleeding warrants evaluation.
- Rupture of membranes ("water breaking"): a gush or steady trickle of fluid; the person should contact the care team promptly, since management after membrane rupture follows protocol (including timing concerns).
Danger signs: the third-trimester report card
Classic teaching includes calling the care team promptly for: significant vaginal bleeding; leaking fluid; regular contractions before term (possible preterm labor); decreased fetal movement; severe or persistent headache; visual changes (blurring, spots); sudden or severe swelling of the face or hands; and upper-abdominal pain. These overlap heavily with preeclampsia warning signs. The exact list is individualized by the care team, and nurses frame it without alarm: "These symptoms usually mean nothing — but when they happen, we want to know right away."
Preterm labor awareness
Labor beginning before term is a leading reason for special newborn care. Teaching includes recognizing the general signs — regular contractions, low backache, pelvic pressure, change in vaginal discharge — and emphasizing that early evaluation is always better than waiting. Management of preterm labor is provider-directed; the nurse's teaching scope is "report and come in for evaluation."
Birth and postpartum preparation
Third-trimester nursing care pulls everything together: finalizing the birthing place choice, writing a flexible birth plan, choosing the newborn's pediatric provider, installing the car seat, planning newborn feeding, and arranging postpartum support. Anticipatory guidance also covers recovery, mood changes (including postpartum depression risk), and where to get help. Preparation turns anxiety into action items.
Common Confusions
| Do Not Confuse | With | Difference |
|---|---|---|
| True labor | Braxton Hicks contractions | True labor = regular, progressive contractions with cervical change; Braxton Hicks = irregular, non-progressive, ease with rest/position change |
| Lightening | Baby "falling out" | Lightening is normal settling into the pelvis before birth — increased pelvic pressure and easier breathing are expected |
| Ruptured membranes | Leaking urine or increased discharge | Fluid from membrane rupture is often continuous and odorless; a trickle can be mistaken for urine — report suspected rupture promptly |
| GBS colonization | GBS infection | Colonization is common and asymptomatic; its significance is newborn exposure at birth, managed by protocol |
| Decreased movement, once | Fetal well-being problem | One quiet period can be normal (sleep cycles); a persistent change from the baby's pattern warrants evaluation |
| Danger-sign teaching | Scaring the patient | Framed correctly, it empowers: "usually nothing — but call right away" reduces both alarm and delay |
Eli explains
The same idea, in plain words
Explain it like I’m 10
In the last three months, the baby grows big and strong and settles into position, and the pregnant person's belly gets really round. Visits happen more often, and the nurse teaches the person to be a "baby detective": feel the kicks every day, know the baby's pattern, and call right away if something changes — like fewer kicks, bleeding, or a big headache. They also practice for the big day: what real contractions feel like, what to do if the water breaks, and how to get everything ready at home.
Worked example
At a 34-week visit, the nurse reviews the danger-sign list with Dana, who nods along. The nurse doesn't just hand her a paper — she asks, "What would you do if you had a headache that wouldn't go away?" Dana shrugs: "I'd take a nap." The nurse gently corrects: "In late pregnancy, a severe or persistent headache — especially with vision changes — is one of the symptoms we ask you to call about, even if you think it's nothing. We'd rather check and send you home than have you wait." Two weeks later, Dana calls the triage line for exactly that symptom, is evaluated, and a blood-pressure problem is caught early. This is the heart of third-trimester nursing: teaching so well that the right phone call gets made at the right time. (Note: the nurse described when to call, not a diagnosis or treatment — evaluation decisions belonged to the care team.)
Key takeaways
- Third trimester ≈ week 28 to birth; visits typically become more frequent (commonly every 2 weeks then weekly — varies by setting and risk).
- Fetal movement patterns matter: teach the person to know the baby's routine and report a significant decrease promptly (kick-count methods follow the care team's protocol).
- GBS screening near term (commonly ~36 weeks) detects colonization so intrapartum antibiotics can be offered per current protocols — colonization ≠ infection.
- True labor vs. Braxton Hicks: progressive, regular, strengthening contractions vs. irregular, non-progressive tightenings that ease with rest or position change.
- Rupture of membranes → contact the care team promptly; management after membrane rupture is protocol-driven.
- Preeclampsia warning signs (severe headache, visual changes, upper-abdominal pain, sudden severe swelling) are classic third-trimester teaching — report, don't wait.
- Preterm labor signs (regular contractions before term, low backache, pelvic pressure, discharge change) warrant immediate evaluation.
- Readiness work: birth plan, pediatric provider, car seat, feeding plan, postpartum support — all part of nursing anticipatory guidance.
- No protocols from memory: kick-count methods, screening timing, and danger-sign lists are individualized — follow the care team's plan and institutional policy.
Check yourself
6 review questions from the chapter. Try each one, then open the answer.
Why do visits typically become more frequent in the third trimester?
Show answer
Because risk rises as pregnancy progresses: growth, blood pressure, fetal well-being, and labor readiness need more frequent monitoring, and late complications are detected through trends plus the person's reported symptoms.
What is the key teaching about fetal movement, and what should a person do if movement decreases significantly?
Show answer
Know the baby's normal pattern of movement and report a significant, persistent decrease promptly rather than waiting — evaluation is the response, and kick-count methods follow the care team's protocol.
What does a positive GBS screening mean — and what does it not mean?
Show answer
It means she carries the bacterium vaginally without symptoms (colonization); it does not mean she or the baby is infected. It matters because current protocols typically include offering antibiotics during labor to reduce newborn exposure.
How would you teach a patient to tell true labor from Braxton Hicks contractions?
Show answer
True labor contractions become regular, stronger, longer, and closer together and produce progressive cervical change; Braxton Hicks are irregular, non-progressive, and ease with rest or position change.
List four third-trimester symptoms that warrant a prompt call to the care team.
Show answer
Examples: significant vaginal bleeding; leaking fluid; regular contractions before term; decreased fetal movement; severe/persistent headache; visual changes; sudden severe swelling; upper-abdominal pain. (List is individualized by the care team.)
A patient at 32 weeks says she feels "pressure and a dull backache that comes and goes." Why is this worth a call rather than reassurance?
Show answer
Because regular contractions, low backache, and pelvic pressure before term are classic preterm-labor warning signs — early evaluation is always safer than waiting, and reassurance is only appropriate after assessment.
Study tools & related lessonsKey vocabulary · Related
Key vocabulary
- Lightening
- The baby settling lower into the pelvis as term approaches
- Bloody show
- Blood-tinged mucus as the cervix begins to change
- Rupture of membranes
- The amniotic sac breaking ("water breaking") — gush or trickle
- Braxton Hicks contractions
- Irregular, non-progressive practice tightenings
- True labor
- Progressive contractions producing cervical change
- Group B streptococcus (GBS)
- A common bacterium some people carry vaginally without symptoms
- Preterm labor
- Labor beginning before term
- Preeclampsia
- A pregnancy blood-pressure disorder with specific warning symptoms
Sources & references
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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