Third Trimester Checklist: Your Week 28–40 To-Do List

The third trimester can feel like a sprint after the relative calm of the second. Appointments accelerate, the baby grows half a pound a week in the final stretch, and there is a real and finite list of things that need to happen before labor begins. What follows is a week-band checklist grounded in ACOG clinical guidance and the Cleveland Clinic's fetal development timeline — organized so you can work through it without doubling back.

This article is general information, not medical advice. Talk to your OB, midwife, or other licensed provider about your specific situation, especially regarding any symptoms or decisions about screening and testing.

What should I be doing at weeks 28–32?

This early window is about establishing habits and getting the groundwork laid well before the final push.

Start kick counts at week 28

From approximately 28 weeks onward, consistent fetal movement is one of the most important indicators of well-being your provider will ask you to track. The most widely recommended method is the count-to-10 approach: sit or lie on your left side at roughly the same time each day (often after a meal, when the baby tends to be active), and count distinct movements — kicks, rolls, jabs, flutters — until you reach 10. Most healthy fetuses reach 10 movements in well under two hours. If you don't reach 10 in two hours, try again after something cold to drink, then call your provider if you still can't. A sustained change from your baby's normal pattern matters more than any individual count.

Prenatal visits at weeks 28–36: every two weeks

Your visit frequency moves from once monthly to every two weeks starting around week 28. At these appointments your provider will measure fundal height, check blood pressure (tracking for preeclampsia), review fetal position, and discuss how you're feeling. If you were Rh-negative and received a Rh immunoglobulin (Rhogam) injection at 28 weeks — common ACOG practice — confirm it's on your chart.

Weeks 28–32 checklist

• Begin daily kick counts (10 movements within 2 hours)
• Schedule biweekly prenatal appointments through week 36
• Confirm Rhogam injection at 28 weeks if Rh-negative
• Enroll in a childbirth education class (in-person or virtual)
• Begin researching and ordering key nursery items — lead times on cribs and mattresses can be 4–8 weeks
• Review your health insurance: understand your deductible, out-of-pocket maximum, and newborn add-to-policy deadline (often within 30 days of birth)
• If you plan to breastfeed, confirm your breast pump is covered under insurance (the ACA mandates coverage) and order it now
• Start a sleep positioning routine: ACOG and the Royal College of Obstetricians and Gynaecologists both advise avoiding supine (back) sleeping after 28 weeks; left-side sleeping optimizes venous return and uteroplacental blood flow

What needs to happen at weeks 33–36?

This is the busiest preparation window. Nearly every major logistical task — the birth plan, the hospital bag, the car seat — should be completed by the end of week 36.

The GBS swab at 36–37 weeks

Group B Streptococcus (GBS) — a bacterium that colonizes the gastrointestinal and genitourinary tracts without causing symptoms in most adults — is carried by between 10–30% of pregnant women in the United States. Per ACOG's Committee Opinion (2020, endorsed by the AAP, ACNM, and SMFM), universal screening via a vaginal-rectal swab is recommended at 36 0/7 to 37 6/7 weeks of gestation. Results collected at this window remain valid for up to five weeks, covering the period through 41 weeks of gestation.

A positive GBS result is common and manageable. Women who test positive receive intravenous penicillin G at the onset of labor (5 million unit loading dose, then 2.5–3 million units every four hours until delivery). This prophylaxis has reduced the U.S. rate of early-onset GBS disease in newborns from approximately 1.8 per 1,000 live births in the pre-screening era to approximately 0.23 per 1,000 today — an 80%+ reduction. If you have a penicillin allergy, tell your provider before the swab so the antibiogram can be run and an alternative protocol (cefazolin, clindamycin, or vancomycin depending on allergy severity) can be planned.

Build your birth plan — by week 34

A birth plan works best as a one-to-two-page document that you discuss with your provider before you arrive in labor. Cover: your pain management preferences (epidural, nitrous oxide, natural methods, water immersion), whether you want to move freely during labor or prefer an IV line, your pushing position preferences, perineal support preferences, and — critically — your newborn care decisions: delayed cord clamping (ACOG supports this for at least 30–60 seconds in uncomplicated deliveries), immediate skin-to-skin, vitamin K injection, eye drops, and feeding plan. Bring multiple printed copies to the hospital.

Install the car seat and pack your hospital bag — by week 36

Hospitals will not discharge a newborn without a properly installed infant car seat. Have your seat installed and inspected by a certified Child Passenger Safety Technician (CPST) before week 36. Many local fire stations and hospitals offer free inspection events.

Your hospital bag should also be packed and ready by week 36 — labor can begin at any time from this point forward. Key items: ID and insurance card, your birth plan, a going-home outfit for you (loose, comfortable), two sizes of newborn going-home outfits for the baby (newborn and 0–3 months), nursing bras, toiletries, phone charger, and snacks for labor.

Weeks 33–36 checklist

• Complete your birth plan and review it with your provider at a prenatal visit
• Have the GBS swab done at 36–37 weeks — note your result and the protocol if positive
• Install and inspect the infant car seat
• Pack your hospital bag by week 36
• Tour your birth setting (many hospitals and birth centers offer tours — call to book early)
• Confirm your pediatrician — many pediatric practices require a pre-birth meet-and-greet registration visit
• Finalize nursery setup: crib assembled, mattress in place, bassinet or bedside sleeper in your room for the first weeks
• Stock postpartum supplies: perineal bottle, witch hazel pads, stool softeners, maxi pads (no tampons), nursing pads, lanolin or nipple butter
• Plan and arrange childcare for existing children during labor and the hospital stay
• Prepare and freeze a week or two of easy meals for the postpartum period
• Address maternity leave paperwork — many employers and state programs require advance notice

What do I need to monitor and know at weeks 37–40+?

From week 36, prenatal visits move to weekly. Your provider will check fetal position (approximately 3–5% of fetuses remain in a non-cephalic, typically breech, position at term), cervical change, and your overall well-being. This is also when you learn to distinguish true labor from Braxton Hicks contractions.

Know the 5-1-1 rule

For first-time mothers, the standard clinical guideline for when to head to the hospital is the 5-1-1 rule: contractions every 5 minutes, each lasting at least 1 minute, for at least 1 hour consistently. The one-hour window filters out irregular Braxton Hicks clusters. If you've given birth before, talk to your provider — second and subsequent labors move faster, and many providers advise leaving at a 6-1-1 or even 7-1-1 threshold.

Regardless of contraction pattern, go to the hospital immediately for: rupture of membranes; green or brown amniotic fluid; heavy bleeding; a dramatic drop in fetal movement; or any symptom of preeclampsia — sudden severe headache, visual disturbances, right upper-quadrant pain, or acute swelling. Per ACOG's patient FAQ on labor, never hesitate to call your provider out of worry about a false alarm.

Going past 40 weeks

Only about 5% of babies arrive on their precise due date. ACOG Practice Bulletin No. 146 (reaffirmed 2024) defines late-term as 41 0/7 to 41 6/7 weeks and postterm as 42 0/7 weeks or beyond. Induction can be considered from 41 weeks and is recommended by 42 6/7 weeks. For women who go past 41 weeks on expectant management, ACOG recommends twice-weekly fetal surveillance (non-stress tests or biophysical profiles) beginning at 41 0/7 weeks. A 2024 randomized trial found that membrane sweeping from 38 weeks onward produced spontaneous labor in 91.4% of swept women versus 72.9% of controls, and reduced the need for formal induction by 68% — making it a safe, low-technology option worth discussing with your provider at your 38-week visit.

Weeks 37–40+ checklist

• Confirm fetal position with your provider — discuss external cephalic version (ECV) if the baby remains breech
• Ask about membrane sweeping at 38 weeks if you want to reduce the chance of needing a formal induction
• Know your hospital bag location and have a confirmed plan for getting to the birth setting at any hour
• Time contractions using a phone app for 60 minutes before calling — unless immediate-departure criteria apply
• At week 41+, confirm your surveillance schedule (twice-weekly NSTs or BPP) and understand your induction timeline
• Rest when possible — labor is a physical event, and sleep in these final weeks is a genuine resource