28 Weeks Pregnant: Your Baby's Development & Third Trimester Changes

How Is My Baby Developing at 28 Weeks?

At 28 weeks, your baby measures approximately 37-38 cm (14.8-15 inches) from head to heel and weighs around 1000 grams (2.2 pounds). The most significant development this week involves the brain, which is forming complex grooves and ridges (gyri and sulci), and the eyes, which are now open and responsive to light.

Your baby has now reached a significant milestone in their development. At 28 weeks of pregnancy, your little one is approximately the size of an eggplant or a large head of lettuce. The past few weeks have seen dramatic changes in your baby's appearance and capabilities, transforming from a tiny embryo into a recognizable little person with developed features, responsive senses, and increasingly coordinated movements.

The third trimester marks a period of rapid growth and refinement. While the major organ systems have been established during the first and second trimesters, the coming weeks focus on maturation and weight gain. Your baby will more than double their weight between now and birth, adding crucial fat stores that will help regulate body temperature after delivery.

One of the most fascinating aspects of development at 28 weeks is the transformation occurring in your baby's brain. The brain tissue continues to grow substantially, with the surface beginning to develop the characteristic wrinkles and folds seen in a full-term infant. These grooves, called gyri and sulci, dramatically increase the brain's surface area, allowing for more neural connections and greater cognitive capacity.

Eye Development and Vision

A remarkable milestone occurs around week 28: your baby can now open their eyes and begin to practice seeing. While the womb is generally dark, some light can filter through your abdominal wall, especially if you're in bright sunlight or a well-lit room. Your baby may turn their head toward or away from this light source, demonstrating early visual reflexes.

The retinas have developed enough to detect light and shadow, though full color vision won't develop until after birth. Eyelashes and eyebrows are now present, giving your baby's face a more complete appearance. The eyes themselves have developed the ability to produce tears, though they won't cry tears until after birth when the tear ducts fully mature.

Brain Development and Neural Connections

The brain is experiencing explosive growth during this period. Neural connections are forming at an incredible rate, with billions of neurons developing synapses that will eventually control everything from breathing and heartbeat to complex cognitive functions. The brain now shows distinct sleep and wake patterns, including periods of REM sleep during which your baby may be dreaming.

Research suggests that babies at this stage can recognize familiar sounds, including their mother's voice and heartbeat. Some studies indicate that babies may even respond to music and can distinguish between different languages based on rhythm and intonation patterns. This auditory development lays the groundwork for language acquisition after birth.

Lung Development and Surfactant Production

One of the most critical developments at 28 weeks involves the lungs. While the respiratory system has been developing throughout pregnancy, this week marks a significant milestone: the lungs begin producing surfactant in meaningful quantities. Surfactant is a crucial substance that prevents the tiny air sacs (alveoli) from collapsing when the baby breathes.

This surfactant production is one of the main reasons why babies born at 28 weeks have much better survival rates than those born even a few weeks earlier. While premature babies may still need respiratory support, the presence of surfactant significantly improves their outcomes. Hospitals with advanced neonatal intensive care units (NICUs) report survival rates of 90-95% for babies born at this gestational age.

Movement and Position

Your baby is quite active at 28 weeks, though space in the womb is becoming more limited. You may notice distinct kicks, punches, rolls, and even hiccups. Many babies settle into a head-down position around this time, though it's completely normal if your baby is still breech or transverse - there's still plenty of time for them to turn.

The amniotic fluid surrounding your baby peaks at around 28 weeks before gradually decreasing toward the end of pregnancy. This fluid allows your baby to move freely, helps maintain a constant temperature, and provides cushioning and protection. Your baby regularly swallows amniotic fluid and practices breathing movements, further developing their digestive and respiratory systems.

What Changes Are Happening to My Body at 28 Weeks?

At 28 weeks, you may experience Braxton Hicks contractions, increased shortness of breath as your uterus expands, back pain, leg cramps, and swelling in your feet and ankles. Your body is working hard to support your growing baby, and these symptoms, while uncomfortable, are generally normal parts of third-trimester pregnancy.

The third trimester brings a new set of physical changes and challenges as your body adapts to accommodate your rapidly growing baby. Your uterus has expanded significantly, now reaching several inches above your belly button. This growth puts increasing pressure on surrounding organs, leading to several common symptoms that many pregnant women experience during this stage.

Understanding these changes can help you distinguish between normal pregnancy discomfort and symptoms that warrant medical attention. While most third-trimester symptoms are completely normal, knowing what to expect and when to contact your healthcare provider is an important part of prenatal care.

Braxton Hicks Contractions

Many women begin noticing Braxton Hicks contractions around 28 weeks, though some experience them earlier. These practice contractions cause your uterus to tighten and harden for 30 seconds to two minutes before relaxing. Unlike true labor contractions, Braxton Hicks are usually irregular, don't increase in intensity over time, and often stop when you change positions, rest, or drink water.

Braxton Hicks contractions serve an important purpose: they help prepare your uterus for the work of labor by toning the uterine muscles. While they can be uncomfortable, they shouldn't be painful. If you experience more than four contractions in an hour, or if contractions become painful, regular, or are accompanied by other symptoms like vaginal bleeding or fluid leakage, contact your healthcare provider immediately.

Shortness of Breath

As your uterus expands upward, it pushes against your diaphragm, reducing the space available for your lungs to expand fully. This can cause feelings of breathlessness, especially when climbing stairs, exercising, or lying flat. While uncomfortable, this shortness of breath doesn't mean you or your baby are getting inadequate oxygen - your body has adapted to breathe more efficiently during pregnancy.

To manage breathlessness, try sleeping propped up on pillows, practicing good posture to give your lungs more room, and taking breaks during physical activity. In the final weeks of pregnancy, many women experience some relief when the baby "drops" lower into the pelvis in preparation for birth.

Back Pain and Pelvic Discomfort

Back pain affects the majority of pregnant women, and it often intensifies during the third trimester. The growing weight of your belly shifts your center of gravity forward, causing your back muscles to work harder to maintain balance. Additionally, the hormone relaxin loosens the ligaments throughout your body, including those in your spine and pelvis, which can contribute to discomfort.

To alleviate back pain, focus on maintaining good posture, wearing supportive footwear, and avoiding standing or sitting in one position for extended periods. Prenatal yoga, swimming, and gentle stretching can help strengthen supporting muscles. A pregnancy support belt may also provide relief by helping distribute the weight of your belly more evenly.

Leg Cramps and Restless Legs

Many pregnant women experience leg cramps, particularly at night. These sudden, painful muscle contractions often affect the calves and may be related to changes in circulation, mineral imbalances, or the additional weight you're carrying. Restless leg syndrome - an uncomfortable urge to move your legs, especially when resting - also becomes more common during the third trimester.

To reduce leg cramps, stay well-hydrated, stretch your calf muscles before bed, and maintain adequate intake of calcium, magnesium, and potassium through your diet. When a cramp occurs, gently stretching the affected muscle and applying warm compresses can provide relief. If cramps are severe, frequent, or accompanied by swelling or redness in one leg, contact your healthcare provider to rule out blood clots.

Swelling (Edema)

Mild swelling of the feet, ankles, and hands is extremely common during pregnancy, particularly in the third trimester. This edema occurs because your body retains more fluid during pregnancy, and the growing uterus puts pressure on blood vessels that return blood from your lower body. Swelling is often worse at the end of the day, in warm weather, or after standing for long periods.

To manage swelling, elevate your feet when possible, avoid standing for extended periods, wear comfortable shoes, and stay physically active to promote circulation. Drinking plenty of water actually helps reduce fluid retention. However, sudden or severe swelling, particularly if accompanied by headache, vision changes, or upper abdominal pain, can be a sign of preeclampsia and requires immediate medical attention.

Why Is Counting Baby Kicks Important at 28 Weeks?

Starting around 28 weeks, healthcare providers recommend monitoring fetal movements by counting kicks. You should feel at least 10 movements within 2 hours, though most babies will reach this goal much faster. Decreased fetal movement can be an early warning sign of potential problems, making kick counting an important tool for monitoring your baby's well-being.

Fetal movement monitoring, commonly called "kick counting," becomes particularly important during the third trimester. While you've likely been feeling your baby move for several weeks, the 28-week mark is when many healthcare providers recommend starting formal kick counting as a way to monitor your baby's health between prenatal appointments.

Your baby's movements provide valuable information about their well-being. An active baby is generally a healthy baby. While the character of movements may change as your baby grows and space becomes more limited (fewer dramatic kicks and more rolling or stretching), you should continue to feel regular movement throughout the third trimester.

How to Count Baby Kicks

Choose a time when your baby is typically active - many babies are most active after meals or in the evening. Sit comfortably or lie on your left side in a quiet environment where you can focus on your baby's movements. Count each kick, roll, flutter, or swish as one movement. Your goal is to feel at least 10 movements within 2 hours, though most babies will reach this number much faster, often within 15-30 minutes.

Try to perform kick counts at approximately the same time each day, as babies develop their own activity patterns. Keeping a simple log or using a kick-counting app can help you understand what's normal for your baby. This baseline understanding makes it easier to notice if something changes.

When to Contact Your Healthcare Provider

Contact your healthcare provider immediately if you notice significantly reduced movement, if you don't feel 10 movements within 2 hours, or if your baby's movement pattern changes noticeably. Reduced fetal movement doesn't always indicate a problem, but it warrants prompt evaluation. Your healthcare provider may recommend coming in for a non-stress test or ultrasound to assess your baby's well-being.

Don't hesitate to contact your healthcare provider if you're concerned about your baby's movements, even if you're not sure something is wrong. It's always better to have your concerns addressed and receive reassurance than to ignore potential warning signs. Healthcare providers understand that pregnant women may have frequent concerns and would rather evaluate you unnecessarily than miss something important.

What Tests Are Done at 28 Weeks Pregnant?

At 28 weeks, common prenatal tests include the glucose tolerance test to screen for gestational diabetes, Rh antibody screening for Rh-negative mothers, and routine blood pressure and urine checks. If you're Rh-negative, you'll likely receive an anti-D immunoglobulin (RhoGAM) injection this week to prevent antibody formation.

The 28-week prenatal visit typically includes several important tests and screenings. These assessments help your healthcare provider monitor both your health and your baby's development, identifying any potential issues that may require additional care or monitoring during the remainder of your pregnancy.

Glucose Tolerance Test (GTT)

If you haven't already completed glucose screening, week 28 is typically when the glucose tolerance test is performed to check for gestational diabetes. Gestational diabetes is a form of diabetes that develops during pregnancy and affects approximately 2-10% of pregnant women. If untreated, it can lead to complications including large birth weight, preterm birth, and increased risk of cesarean delivery.

The glucose tolerance test involves drinking a sweet glucose solution and having your blood drawn to measure how your body processes sugar. Depending on your healthcare provider's protocol, you may have a one-step or two-step test. If your results indicate gestational diabetes, don't panic - with proper management through diet, exercise, and sometimes medication, most women with gestational diabetes have healthy pregnancies and babies.

Rh Factor Testing and Anti-D Injection

If your blood type is Rh-negative (such as A-, B-, AB-, or O-), you'll receive special attention during pregnancy. The Rh factor is a protein found on the surface of red blood cells. If you're Rh-negative and your baby is Rh-positive (inherited from the father), your immune system could potentially recognize your baby's blood cells as foreign and develop antibodies against them.

To prevent this, Rh-negative women receive an injection of anti-D immunoglobulin (commonly called RhoGAM) around 28 weeks and again after delivery if the baby is Rh-positive. This injection prevents your immune system from developing antibodies that could harm your current pregnancy or future pregnancies. Before the injection, your blood will be tested to ensure you haven't already developed antibodies.

Regular Monitoring

Your prenatal visits during the third trimester will include routine monitoring of:

• Blood pressure: To check for signs of preeclampsia, a potentially serious condition characterized by high blood pressure and protein in the urine
• Weight gain: To ensure you're gaining weight appropriately for this stage of pregnancy
• Fundal height: The distance from your pubic bone to the top of your uterus, which helps assess fetal growth
• Fetal heartbeat: Listened to with a Doppler device to confirm your baby's heart is beating normally
• Urine protein and glucose: To screen for preeclampsia and gestational diabetes

Additional Screenings

Depending on your individual circumstances, your healthcare provider may recommend additional tests at 28 weeks. Women with certain risk factors may have more frequent ultrasounds to monitor fetal growth, amniotic fluid levels, or placental function. If you've had previous pregnancy complications or have certain medical conditions, your care plan may include specialized monitoring.

When Should I Seek Medical Care at 28 Weeks?

Contact your healthcare provider immediately if you experience vaginal bleeding, severe abdominal pain, sudden severe swelling (especially of the face or hands), severe headache, vision changes, regular contractions, fluid leaking from the vagina, or significantly decreased fetal movement. These symptoms could indicate serious complications requiring prompt evaluation.

While most third-trimester symptoms are normal parts of pregnancy, certain warning signs warrant immediate medical attention. Understanding when to seek care is an essential part of ensuring both your health and your baby's well-being. Trust your instincts - if something doesn't feel right, it's always better to be evaluated and reassured than to ignore potentially serious symptoms.

Signs of Preterm Labor

Preterm labor is labor that begins before 37 weeks of pregnancy. Recognizing the signs early gives healthcare providers the best chance to delay delivery and administer treatments that can help your baby if early delivery is unavoidable. Signs of preterm labor include regular contractions (more than 4 per hour), lower back pain that doesn't go away, pelvic pressure or feeling like your baby is pushing down, abdominal cramps (with or without diarrhea), and a change in vaginal discharge (especially if it becomes watery, mucus-like, or bloody).

If you experience any of these symptoms, contact your healthcare provider immediately. Preterm labor doesn't always lead to preterm birth - many women who experience preterm contractions go on to deliver at full term with appropriate treatment.

Signs of Preeclampsia

Preeclampsia is a serious pregnancy complication characterized by high blood pressure and usually protein in the urine, typically developing after 20 weeks of pregnancy. It affects approximately 5-8% of pregnancies and can progress rapidly if not properly managed. Warning signs include severe headaches that don't respond to medication, visual disturbances (blurred vision, seeing spots, sensitivity to light), sudden swelling of the face and hands, upper abdominal pain (especially on the right side), nausea or vomiting in the second half of pregnancy, and sudden weight gain (more than 1-2 kg or 2-4 pounds in a week).

Preeclampsia requires close monitoring and may require early delivery to protect both mother and baby. Regular prenatal care helps detect preeclampsia early, which is why attending all scheduled appointments is so important.

How Can I Take Care of Myself at 28 Weeks?

At 28 weeks, focus on getting adequate rest, staying active with gentle exercise like walking or swimming, eating a balanced diet rich in iron and protein, staying hydrated, and continuing your prenatal vitamins. Practice relaxation techniques for stress management, start preparing for labor and delivery, and don't hesitate to ask for help when needed.

The third trimester can be both exciting and exhausting. Taking care of yourself becomes increasingly important as your body works harder to support your growing baby. Establishing healthy habits now will help you feel your best during these final months and prepare you for the physical demands of labor and the early postpartum period.

Rest and Sleep

Getting adequate rest is essential during the third trimester, though it often becomes more challenging as your belly grows. Sleep disturbances are common due to difficulty finding a comfortable position, frequent urination, heartburn, and general discomfort. Sleeping on your left side is often recommended as it improves blood flow to your uterus and may help reduce swelling. Using pillows to support your belly and between your knees can make side-sleeping more comfortable.

Don't feel guilty about taking naps when you need them or going to bed earlier than usual. Your body is working hard, and rest is not a luxury - it's a necessity. If sleep problems are severe or persistent, discuss them with your healthcare provider.

Nutrition and Hydration

Eating a balanced diet becomes particularly important during the third trimester when your baby is growing rapidly. Focus on iron-rich foods (lean meats, beans, spinach, fortified cereals) as your blood volume increases and your baby builds iron stores. Protein supports your baby's growth and helps maintain your energy levels. Calcium remains important for bone development, and omega-3 fatty acids support your baby's brain development.

Staying well-hydrated helps manage swelling, prevents constipation, and supports the increased blood volume your body requires. Aim for at least 8-10 glasses of water daily, more if you're active or it's warm. Limiting caffeine and avoiding alcohol remain important throughout pregnancy.

Exercise and Movement

Unless your healthcare provider has advised otherwise, moderate exercise remains beneficial throughout the third trimester. Walking, swimming, and prenatal yoga are excellent low-impact options that can help manage weight gain, reduce discomfort, improve mood, and prepare your body for labor. Regular movement also helps maintain circulation and may reduce the risk of blood clots.

Listen to your body and modify your activities as needed. You may find that you tire more easily or need to reduce intensity as your pregnancy progresses. Avoid activities with fall risk, contact sports, or exercises that require lying flat on your back for extended periods.

Preparing for Baby's Arrival

Week 28 is a good time to start practical preparations for your baby's arrival if you haven't already. Consider taking childbirth education classes, touring the hospital or birth center where you'll deliver, and discussing your birth preferences with your healthcare provider. Start thinking about your support system for labor and the postpartum period, and don't hesitate to ask for help from family and friends.

If you're planning to breastfeed, consider attending a breastfeeding class or speaking with a lactation consultant. Preparing your home for baby - setting up the nursery, washing baby clothes, and gathering essential supplies - can help you feel ready and may be easier to accomplish now while you still have energy and mobility.

Frequently Asked Questions About 28 Weeks Pregnant