Third Trimester: Preparing for Labour in Weeks 28–40
The final stretch - Baby is growing rapidly, discomforts peak, and preparations intensify. The third trimester is physically demanding and emotionally complex. Here's what to expect.
What's Happening: Weeks 28–40
The third trimester is primarily a period of growth and maturation. Baby gains approximately 200g per week from Week 28 to Week 40. Brain development, lung maturation, and fat accumulation are the key processes. If you haven't already, use the due date calculator to confirm your estimated delivery date.
Weeks 28–30: Brain and Fat Deposits
Baby
Brain grows rapidly - Its surface becomes more complex (gyri and sulci form). Eyes open and can detect light. Lungs continue maturing. Starts to run out of room to flip - Presentation becoming fixed.
Your Body
Braxton Hicks more frequent. Shortness of breath as uterus pushes against diaphragm. Rib pain common. Fatigue returns.
Weeks 31–32: Rapid Weight Gain
Baby
Baby gaining 200–250g per week. Skin smooths as fat fills in. Most babies settle into head-down position by 32 weeks (but not all yet). Bone marrow fully producing red blood cells.
Your Body
Stretch marks may intensify. Sleep becomes difficult - Can't lie flat, frequent urination. Antenatal classes typically start.
Week 34–35: Lung Maturity Accelerates
Baby
Surfactant production increases significantly. A baby born at 34 weeks has a high survival rate with NICU support. Brain development continues rapidly.
Your Body
Pelvic girdle pain often peaks. Varicose veins or haemorrhoids may appear. GBS test typically offered at 35–37 weeks.
Week 36: Full Term (Early)
Baby
All systems functional. Baby is considered 'early term' from 37 weeks. From 36 weeks, some babies engage (drop into pelvis) - Gives more breathing room but increases pelvic pressure.
Your Body
Lightening (baby drops) may cause sudden ease of breathing but increased pelvic pressure. Some notice increased vaginal discharge.
Weeks 37–38: Full Term
Baby
Officially 'full term'. Lungs, liver, and brain mature. Weight ~2.9–3.3kg on average. Baby gaining about 30g per day. Most of lanugo shed.
Your Body
Cervical changes begin. Cervix softens ('ripening'). Braxton Hicks more intense and frequent. Nesting instinct often peaks.
Week 39–40: Ready to Be Born
Baby
Baby's immune system has developed. Antibodies passed via placenta. Fingernails past fingertips. Head may engage in pelvis. Placenta begins to age.
Your Body
Due date is Week 40 (an estimate - Only 5% deliver on their due date). Labour could begin any time. Signs begin - Show, pre-labour contractions, water breaking.
Week 41–42: Post-Dates
Baby
The placenta continues functioning for most women, but placental efficiency declines after 41 weeks. Foetal monitoring intensifies.
Your Body
Induction discussed at 41 weeks in Singapore. Most maternity units will recommend induction by 41–42 weeks if labour has not started.
Third Trimester Symptoms
Shortness of breath
Uterus pushes up against the diaphragm. Eases after the baby drops (engages) at ~36 weeks.
Sleep propped up. Avoid lying flat. When baby drops, breathing improves noticeably - This is lightening.
Pelvic girdle pain (PGP)
Relaxin hormone loosens pelvic joints. The symphysis pubis or sacroiliac joints become painful. Common in Singapore's heat.
Physiotherapy is effective. A pelvic support belt. Avoid asymmetric positions. Ask your OB for a physio referral.
Frequent urination / leaking
Baby's head on bladder. Pelvic floor weakened by weight and hormones. Stress incontinence on coughing/sneezing.
Pelvic floor exercises started early help. Pads for leaking. Any gush of fluid → go to hospital (waters may have broken).
Swelling (oedema)
Fluid retention peaks in T3. Feet and ankles swell by end of day. Rings may not fit.
Elevate legs. Walk in the morning, not peak heat (1–3pm). If swelling involves your face or is sudden and severe → pre-eclampsia risk, seek medical review.
Sleep problems
Can't get comfortable. Baby kicking at night. Frequent bathroom trips. Restless legs.
Pregnancy pillow (long body pillow). Left lateral position. Keep room cool (Singapore heat disrupts sleep significantly).
Haemorrhoids
Increased blood volume, constipation, and baby's weight on pelvic veins. Very common in T3.
High fibre diet, hydration. Sitz baths. Ice packs. Witch hazel pads. Tell your OB - Prescription creams available.
Braxton Hicks contractions
Irregular uterine tightening, typically painless. Increase in frequency and intensity toward term.
Drink water (dehydration triggers BH). Walk around. If contractions become regular, painful, or are accompanied by leaking fluid or bleeding → call your hospital.
Carpal tunnel syndrome
Fluid retention compresses the median nerve in the wrist. Worse at night.
Wrist splints at night. Hand elevation. Usually resolves postpartum. Severe cases: referral to hand physiotherapist.
Pre-Eclampsia Warning Signs - Call Now
Pre-eclampsia is a serious condition affecting ~5% of pregnancies, more common in first pregnancies, multiple pregnancies, and women with hypertension. It can develop rapidly.
- ⚠Sudden severe headache that does not respond to paracetamol
- ⚠Visual disturbances - Flashing lights, blurring, or loss of vision
- ⚠Severe swelling of hands, face, or legs that appears suddenly
- ⚠Pain under the ribs on the right side (HELLP syndrome)
- ⚠Nausea and vomiting in T3 (after it had resolved)
Tests and Monitoring in the Third Trimester
Repeat FBC + iron studies
Check for anaemia - Particularly important given increased blood volume and if previously borderline.
If positive/abnormal: Iron supplementation if needed. Repeat at 36 weeks if anaemic.
Anti-D prophylaxis injection
Prevents Rh sensitisation if mother is Rh-negative. Standard practice in Singapore.
If positive/abnormal: Administered by nurse or midwife. Second dose given after delivery if baby is Rh-positive.
Growth scan (if indicated)
Checks foetal size, placental function, amniotic fluid volume. Not routine - Typically for high-risk, GDM, or previous IUGR.
If positive/abnormal: If growth is restricted or excessive, monitoring frequency increases.
Group B Streptococcus (GBS) swab
GBS is present in the vagina of ~15–25% of women - Usually harmless to the mother but can cause serious infection in the newborn during birth.
If positive/abnormal: GBS positive: IV antibiotics in labour to protect baby. GBS negative: no prophylaxis needed.
Antenatal visits every 2 weeks
Blood pressure, urine protein, fundal height, foetal presentation, CTG if indicated.
If positive/abnormal: Increasing frequency means closer monitoring - Not a sign of concern.
CTG (cardiotocography)
Foetal heart rate monitoring - Assesses foetal wellbeing when pregnancy goes beyond due date.
If positive/abnormal: If non-reactive CTG or oligohydramnios: induction discussion.
Hospital Bag - What to Pack
Pack your hospital bag by Week 36. In Singapore's climate, lightweight breathable fabrics for both mum and baby. Most hospitals provide basic toiletries and nappies for the first night.
🤱 For Labour
- Your ID card + partner's IC
- Maternity notes / green book
- Birth plan (if prepared)
- Phone charger + portable battery
- Comfortable slippers
- Snacks and drinks for partner
- Lip balm (mouth breathing in labour)
- Tens machine if using
👩 For Mum (Stay)
- 2–3 nursing bras
- Breast pads
- Button-front nightgowns (2–3)
- Disposable maternity underwear
- Maternity pads (extra thick)
- Toiletries
- Comfortable going-home outfit
- Slippers with back support
👶 For Baby
- 3–4 onesies or sleepsuits
- Hat (hospitals are cold)
- Swaddle or muslin wrap
- Approved infant car seat - Installed before admission
- Nappies (hospital usually provides first pack)
- Going-home outfit
Birth Plan
A birth plan is a document (typically 1 page) that communicates your preferences to the birth team. It does not guarantee anything - Labour is unpredictable - But it ensures your preferences are considered and reduces miscommunication under pressure. Read more about your birth options in Singapore, including epidurals, water birth, and home birth eligibility.
Include your preferences on:
Pain management
Epidural yes/no, when you want it offered, any non-pharmacological preferences first (gas, TENS, water)
Labour position
Walking, birthing ball, pool birth (if available at your hospital), preferred delivery position
Foetal monitoring
Continuous CTG (required for epidural) vs intermittent auscultation
Cord clamping
Immediate vs delayed (30–60 seconds). Cord blood banking - If so, private kit should be with you.
Skin-to-skin
Immediate skin-to-skin requested, for how long, before routine checks if baby is well
Feeding
Breastfeeding intention - Direct latch immediately, no formula without consent unless medically necessary
If caesarean is needed
Gentle/family-centred caesarean preferences - Screen lowered for birth, skin-to-skin on table
Visitors
Who is allowed in the room, photography preferences
Signs of Labour - When to Go In
The 'show'
Pink or blood-tinged mucus plug discharge. The cervical seal releasing.
Labour may start hours to days later. No need to rush to hospital unless contractions start or waters break.
Waters breaking (SROM)
Gush or slow trickle of clear/straw-coloured fluid. Often described as 'like wetting yourself but warm and can't stop it.'
Call your maternity unit immediately. Go to hospital within 1–2 hours. Do not put anything in the vagina. If fluid is green/brown (meconium) → go in immediately.
Regular contractions
Tightening that comes and goes in a pattern. Increases in frequency and intensity. Doesn't ease with walking or position change.
The 4-1-1 rule: contractions every 4 minutes, lasting 1 minute, for 1 hour → go in. Use our <a href="/tools/contraction-timer/" class="text-primary underline hover:no-underline font-medium">contraction timer</a> to track timing. For subsequent pregnancies, 5-1-1 or go earlier.
Back labour
Persistent severe lower back pain that comes in waves. Often accompanies a posterior baby (facing forward instead of backward).
Same rule as contractions. Can be more painful and harder to manage. Counter-pressure and all-fours position can help.
Postpartum Planning - Do This Before You Deliver
Arrange confinement support
Book by Week 28–30Traditional <a href="/faq/confinement-singapore/" class="text-primary underline hover:no-underline font-medium">confinement</a> (坐月子 / pantang) typically lasts 28–44 days. Decide: confinement nanny, confinement centre, or family support? Confinement nannies in Singapore book out 6–9 months in advance for popular periods.
Register at a paediatric clinic
By Week 36Your baby will need a first visit within 3–5 days of discharge, then at 1 month. Polyclinics offer subsidised child health checks. Many parents also see a private paediatrician - Register before delivery.
Plan feeding support
Identify before deliveryIf breastfeeding: identify a lactation consultant. LCs can do home visits in Singapore. KKH and NUH have in-hospital LC support post-delivery. BMSG (Breastfeeding Mothers' Support Group) peer support hotline: 6339 3558.
Discuss postnatal mental health
Before delivery<a href="/faq/postpartum-singapore/" class="text-primary underline hover:no-underline font-medium">Postnatal depression</a> and anxiety affect 10–15% of Singapore mothers. Tell your partner what to watch for. Know the support resources (IMH, SAMH, KKH perinatal psychiatry).
Maternity leave paperwork
As early as Week 30Submit <a href="/tools/parental-leave-calculator/" class="text-primary underline hover:no-underline font-medium">maternity leave</a> notice to employer. In Singapore: 16 weeks government-paid maternity leave for eligible employees (child must be a Singapore citizen). Check CPF paternity leave entitlement for partner.
Baby-proof the home
By Week 36Cot, bassinet, or co-sleeper set up. Car seat installed. Medications stored safely. Temperature of hot water tap reduced to < 50°C.
Group B Streptococcus (GBS) - What You Need to Know
Group B Strep (GBS) is a type of bacteria that lives naturally in the vaginal and rectal area of many healthy adults. It is very common. Roughly 15 to 25 percent of pregnant women carry it. In most cases it causes no symptoms and no harm to the mother at all.
The concern is for the baby during delivery. As a newborn passes through the birth canal, there is a small risk of the bacteria causing a serious infection - including pneumonia, meningitis, or sepsis in the first days of life. This is why the swab test is done.
The GBS swab test in Singapore
- •Done at 35 to 37 weeks at your antenatal clinic - KKH, NUH, TMC, or your GP obstetrician
- •A low-vaginal and rectal swab is taken. It is quick and not painful.
- •Results take 1 to 2 days. Your doctor or midwife will notify you.
- •If positive: you will receive intravenous (IV) antibiotics through a drip when you are in labour. This is given at least 4 hours before delivery and is highly effective at protecting the baby.
- •If negative: no antibiotics needed during labour.
Hospital Bag - Detailed Packing Guide
Pack by Week 36. If you go into labour earlier, you want to grab the bag and go - Not scramble around the house. Here is a more detailed list to work through.
For you - Documents and admin
- NRIC (MyInfo card)
- Partner's NRIC
- Insurance card or policy number
- Antenatal notes - your blue book or hospital file
- Birth plan (2 printed copies)
- Hospital booking confirmation
- Paediatrician's name and contact number
For you - Clothes and comfort
- 2 to 3 nursing bras (sized for late pregnancy)
- Breast pads
- Button-front or wrap nightgowns (2 to 3)
- Disposable maternity underwear
- Thick maternity pads
- Comfortable slippers with back support
- Loose going-home outfit
- Light cardigan (hospitals are cold with air conditioning)
- Phone charger and portable battery
- Earbuds for music or podcasts during labour
- Lip balm - you breathe through your mouth a lot in labour
- Toiletries: toothbrush, shampoo, face wash
For baby
- 3 to 5 onesies - newborn and 0 to 3 month sizes
- Newborn mittens and socks (2 to 3 pairs each)
- Baby hat
- Going-home outfit
- Swaddle blanket or muslin wrap
- Nappies - the hospital usually provides the first pack but bring a small one
- Approved infant car seat - installed before you go in
For your partner
- A change of clothes - Labour can last many hours
- Snacks and drinks - The labour ward cafeteria may have limited hours
- A pillow - Hospital visitor chairs are not comfortable for an overnight stay
- Phone charger
- Comfortable shoes if they are spending long hours on their feet
Signs of Labour - The Full Picture
True labour vs Braxton Hicks
True labour contractions
- •Come in a regular pattern
- •Get closer together over time
- •Get stronger and longer over time
- •Do not go away when you walk or change position
- •Often start in the lower back and radiate forward
Braxton Hicks (practice contractions)
- •Irregular - No predictable pattern
- •Do not get progressively closer or stronger
- •Often ease off when you walk, rest, or drink water
- •Tightening feeling but usually not painful
The 5-1-1 rule: when to call the labour ward
Use this rule for first-time mothers. For second or subsequent births, go earlier - Labours tend to move faster.
5
minutes apart
1
minute long
1
hour of this pattern
When your contractions are every 5 minutes, lasting 1 minute, for 1 hour - call the labour ward. Use the contraction timer to track the pattern.
Waters breaking
You may feel a gush or a slow trickle of fluid that you cannot control. It is often warm and clear or very pale straw-coloured.
- •Go to the labour ward within 1 to 2 hours of your waters breaking, even if contractions have not started
- •Note what colour the fluid is. Clear or straw-coloured is normal.
- !Green or brown fluid (meconium) - go to hospital immediately. This may indicate the baby has passed a bowel movement in the womb, which needs prompt assessment.
- •Do not put anything inside the vagina once waters have broken
Bloody show
A pinkish or blood-tinged mucus discharge. This is the cervical mucus plug releasing as the cervix begins to prepare for labour. It is normal and is a sign that things are progressing. Labour may start in hours or a few days. You do not need to go to hospital just for a bloody show unless you are also having regular contractions or fluid loss.
KKH Labour Ward
6394 3000 (24 hours)
Go to: Delivery Suite, Level 1, Women's Tower
NUH Delivery Suite
6779 5555 (24 hours)
Go to: NUH Main Building, Obstetrics Department
Thomson Medical Centre
6590 3111 (24 hours)
Go to: Labour Ward, Thomson Medical Centre
Birth Plan - How to Write One That Works
A birth plan is a written list of your preferences for labour and delivery. It is one page. It uses bullet points, not paragraphs. It tells the midwife and doctor what matters to you - so that when you are in the middle of active labour and cannot easily speak, your preferences are already known.
Both KKH and NUH accept birth plans. Give a copy to your midwife when you arrive at the labour ward. Bring 2 to 3 printed copies.
Key decisions to include in your birth plan
- •Pain relief: whether you want an epidural and at what point, or whether you want to try without first and ask later
- •Who is in the room: partner only, or additional support person. Most Singapore labour wards allow one support person.
- •Delayed cord clamping: ask your hospital if this is available. It is offered at KKH and NUH. The cord is clamped 30 to 60 seconds after birth to allow more blood to transfer to the baby.
- •Skin-to-skin immediately after birth: this supports bonding and breastfeeding. State that you want skin-to-skin in the delivery room before routine checks, if baby is well.
- •Breastfeeding in the delivery room: state that you want to attempt the first latch before baby is taken for weighing and measurements, if possible.
- •No formula without consent: if you intend to breastfeed, include a note that formula should not be given without your agreement unless medically necessary.
- •If caesarean becomes necessary: you can still state skin-to-skin preferences and ask for the screen to be lowered for the moment of birth.
Third Trimester Week-by-Week Checklist
Week 28
- Glucose tolerance test done (if not done at 24 to 28 weeks)
- Start counting fetal movements daily - 10 movements in 2 hours is the general guide
- Notify HR about maternity leave - submit GPML (Government-Paid Maternity Leave) notice
- Confirm partner's paternity leave entitlement with their employer
- Book antenatal classes if not yet done - KKH, NUH, and Birth Matters all offer classes
Week 32
- Pack hospital bag (or at least start a list)
- Finalise birth plan and print 2 to 3 copies
- Attend antenatal breastfeeding class - KKH Breastfeeding Support Service and NUH offer these
- Register at a paediatric clinic or polyclinic for the newborn's first visit
- Install baby's car seat and check it is fitted correctly
Weeks 35 to 37
- GBS swab test at your antenatal clinic
- Confirm baby's position - most babies are head-down by 35 to 36 weeks
- If baby is breech, discuss options with your doctor (external cephalic version or planned caesarean)
- Finalise confinement arrangements - nanny, centre, or family support
- Complete hospital bag
Weeks 38 to 40
- Monitor for signs of labour - contractions, show, waters breaking
- Arrange care for older children or pets when you go in
- Save key numbers in your phone: your hospital labour ward, your doctor, your confinement nanny
- Rest as much as possible - Labour is physically demanding
- Attend all antenatal appointments - visits are every 1 to 2 weeks now
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