When your third trimester finally hits, it may feel like your to-do list is already miles on: nursery prep, baby shower thank-you notes, putting together a birth plan (and a postpartum plan!), so you don’t we list all the now most frequent appointments with your birth provider to ensure everything goes smoothly. Between tracking kick counts and pre-wash bottles, it’s very important to de-stress and enjoy this sweet moment, but there are a few more things to add to your list: answering your most pressing questions after your provider’s birth plan, including third-trimester vaccinations, which are critical to protecting your newborn after birth.
Because babies’ immune systems are still developing, they are not eligible for many childhood vaccinations at birth. This vulnerability makes maternal vaccination during pregnancy vital to protect newborns from certain preventable viral diseases. Vaccination toward the end of pregnancy serves a dual purpose: you give your baby vital protection while in the womb, and you continue that protection after birth. This strategy, known as maternal immunization, creates a protective shield for the newborn during the most vulnerable period.
The antibodies you develop in response to vaccination can cross the placenta, effectively arming your baby with a temporary but powerful immune defense. This passive immunity can last for several months after birth, bridging the gap until your baby can get his own shots. (The timing of maternal vaccines is carefully chosen to maximize this transfer of antibodies to the fetus.) Additionally, if you choose to breastfeed, you will likely transfer some antibodies through breast milk, further strengthening your baby’s immune system.
We talked to Hasra K. Snaggs, MD, MPH, FACOGDirector of Clinical Research and Vaccine Development at Pfizerwho leads clinical studies on maternal immunization, to share more about third-trimester vaccinations to consider, along with other questions to get answered in the final months before your baby arrives. As always, if you have questions about your unique pregnancy and health history, be sure to bring them up with your birth provider.
8 Important Questions to Ask Your Third Trimester Dates
The third trimester starts at week 28 and lasts until week 40 (or when you give birth!). Here are questions to write down in advance and bring with you to your third trimester prenatal appointment.
1. What tests are usually done in the third trimester?
Around the beginning of your third trimester, your provider will likely recommend that you get a glucose test to check for gestational diabetes, says Dr. Snags, along with a standard blood panel to check for iron deficiency anemia (which is common in pregnancy) and your blood type.
“Between 35 and 36 weeks, routine blood work may include testing for sexually transmitted infections (HIV, syphilis, gonorrhea, and chlamydia), evaluating your urine to check for infection, and having a vaginal and rectal swab (culture) taken to the screen for group b streptococcus (GBS), a bacterium commonly found in the vagina and gastrointestinal tract, but can pose a risk to infants at birth and up to 90 days after birth,” she notes. If you are positive, you may need to take antibiotics at the time of delivery to protect the baby from infection.
2. What vaccines should I have before my baby is born?
The Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend certain vaccines during pregnancy to protect both you and your unborn baby from illness, Dr. Snags explains. She tells Motherly, “One benefit of maternal vaccination is that you help protect your baby from day one, since babies’ immune systems can’t develop sufficient immune defenses against infections until they’re older.”
In the US, the CDC recommends four vaccines during most pregnancies: Tdap, flu, Covid, and RSV. Dr. Snags notes, “Other vaccines may also be recommended in some cases,” so it’s important to discuss with your doctor what is necessary for your particular situation.
Maternal vaccines are usually given in the third trimester because, as Dr. Snaggs, “Vaccines cause your body to make antibodies that can prevent certain viruses and bacteria from entering your body’s cells. And some of these antibodies can be passed on to your unborn child, protecting against disease after birth.”
The timing of these vaccinations is crucial for optimal protection. Here’s a general guide to when to get which vaccines:
Tdap vaccine: Between 27 and 36 weeks
- Aims to prevent whooping cough
- Grandparents or other close relatives who will be in contact with the infant are recommended to also receive a Dtap booster near the baby’s due date.
Maternal RSV vaccine: Between 32 and 36 weeks
- Pfizer’s RSV parent vaccine Abrysvo is recommended seasonally between September and January
- Protects babies from RSV from birth to 6 months of age. “This is when babies are at the highest risk of severe disease and complications from RSV. a time when they are most vulnerable,” shares Dr. Snags.
Covid vaccine: Any time during pregnancy
- The CDC notes that pregnant women are more likely to become very ill from Covid compared to those who are not pregnant with an increased chance of complications affecting both the pregnancy and the newborn, says Dr. Snags. Vaccination is one of the best ways to protect yourself and your baby from serious diseases.
- Recommended for everyone 6 months and older, including pregnant women
- It can be administered at any stage of pregnancy
Flu shot: Any time during pregnancy when it’s flu season
- Recommended during flu season (October to May)
- Important note: Pregnant women should discuss the benefits and risks of vaccination with their healthcare providers early in pregnancy to address any questions or concerns
3. What do I need to know about creating a birth plan?
Going into labor and delivery with a general knowledge of your birth preferences can be helpful so you don’t get caught out if unexpected problems arise. Creating a birth plan can help some parents-to-be feel like they have some control over the process—with a document to point to—but it’s important not to get too attached. The best birth plans have some built-in flexibility. “Starting an early conversation around your birth plan is important so expectations are clear, with the understanding that changes may occur to protect mother and baby,” says Dr. Snaggs. The key? “Have meaningful conversations with your healthcare provider” to ensure you feel comfortable and supported throughout. Reviewing a birth plan ahead of time at your third trimester appointments with your provider can help get everyone on the same page.
4. How often should kick counts be taken?
Do you love feeling those tiny (but mighty!) baby kicks? Kick counts can be used as a tool for expectant parents to assess fetal movement. ACOG says kick counts can be used to assess the general well-being of their developing fetus. Dr. Snaggs points out that there are several protocols available, including one that looks for 10 distinct movements over a 2-hour period, but that you should seek guidance from your birth provider on what specifically they suggest you watch for.
5. What are the signs of premature labor?
“Women are considered menopausal starting at week 37 of pregnancy,” explains Dr. Snags. “During your prenatal visits, your provider can walk you through the signs and symptoms of labor, which include regular painful contractions and/or the rupture of your amniotic sac [known as your ‘water breaking’] with increasing dilation and effacement of your cervix.’ If these start before 37 weeks, it is considered preterm labor and you should seek medical help.
“Sometimes, women can have false labor pains or Braxton Hicks contractions, so it’s important to contact your provider if you think you might be in labor,” she suggests, as they can help you tell the difference between Braxton Hicks and true. labor contractions.
6. What are the third trimester signs that could mean something is wrong with my pregnancy?
“Preparing for your baby’s arrival is an exciting time,” says Dr. Snaggs, “But your provider can discuss times when you may need to get immediate care, such as if you experience heavy vaginal bleeding, significant abdominal pain, a change in your baby’s movements, or increases in your blood pressure.” Basically, trust your gut. If something doesn’t feel right or looks different from what you’re used to, contact your provider immediately.
7. What should I know about childbirth?
“Postpartum care is just as important as the care you receive during pregnancy and during labor and delivery,” reminds Dr. Snags. She recommends talking to your doctor or midwife about what to expect during your hospital or birth center stay right after birth. You will need at least 6 weeks of physical recovery after birth (or more, depending on your delivery—and some documents now recommend 12 weeks), during which your physical activity should be limited. Will you need extra hands during this time? Ask for their recommendations on how to include and involve family members, which can be especially helpful.
Similar to how you created a birth plan, it’s important to sit down with your partner and create a postpartum plan. What will the night shifts be like? Will you start pumping right away? Where will the baby sleep in the first months? Who will be responsible for taking care of other responsibilities, such as older children and pets? Planning this ahead of time can help open the door for clear communication about your needs down the road.
8. Will a lactation consultant be available at the hospital or birth center?
Likewise, don’t forget to ask what resources will be available to you immediately after birth. As you begin your feeding journey with your infant, will a lactation consultant be on hand or does your birth provider have references to share? Do they recommend that you meet with a lactation consultant before birth to talk through important information and gain a foundation of understanding about breastfeeding? Do they suggest you have a can of formula just in case? Now is a good time to ask any questions you may have about feeding, especially if it’s your first baby. Remember, your healthcare provider is there to provide you with a resource — so ask all questions.
