Pregnancy in 33rd week

It is important to note that this is the final phase of your baby’s growth and development. The bones, organs and muscles of your baby should now be formed completely with a few small changes needed to ensure that the baby is ready for the outside world. The remainder of his/her nails and hair must have developed at this point. The placenta would still continue to ensure adequate nourishment and oxygen supply for the baby. But still, the baby would practice his/her breathing by consuming some amniotic fluid.

In the 33rd week, the brain development of the baby is faster than ever before—forming intricate connections between the neurons (fundamental cells of the nervous system). The astonishing thing to note is that your baby may be able to recognise the difference between night and day, aligning his/her sleep cycle with the mother.

The baby’s immune system is also improving rapidly, with the baby getting a large number of antibodies from you to fight off those nasty newborn infections.

At around 33 weeks of gestation, the baby is usually the size of a watermelon. The length of the baby would be around 42-43 cm from top to toe. In terms of weight, it would be in excess of two kilograms. Your baby’s bones are gaining strength and the wrinkles in the baby’s skin are filling up with fat—only the baby’s skull still remains compressible and pliable to allow the baby to manoeuvre his or her way out through the mother’s birth canal when the time for delivery comes. You also might feel a reduced frequency of “kicks” as compared to the previous weeks of gestation.

You may have to face some challenging and unpleasant symptoms this week. You should be careful and be aware of these symptoms and know some basic solutions to help you deal with any of them:

• Difficulty breathing: Your enlarged uterus would make it difficult for the lungs to expand sufficiently to inspire (take in) the adequate amount of air. You should avoid activities that might lead to exertion and therefore difficulty breathing; for example, running or jogging, weight lifting and climbing too many stairs.
• Difficulty balancing your body: As expected, you are heavily pregnant now. The increased mass and weight can affect your sense of balance, making it more difficult to maintain it. Some of you might feel clumsier than before. Hence, you should wear shoes with flat soles which are comfortable for you and help to maintain your balance. You should try to wear these to work as well. Also, take support whenever and wherever possible: hold the railing while climbing the stairs and get support bars put in the toilet.
• A higher energy requirement: Your basal metabolic rate is going to increase drastically. This would lead to the heating up of your body to keep up with the demand for energy. The only unwanted effect that is noticeable is warm skin and it should resolve on its own (spontaneously) sooner or later. 
• Headaches: You might not be able to get enough hydration and this can lead to some episodes of headache. It can make your head spin and throb. You should consume about three litres of water in a day. This might make you use the toilet every 20-30 minutes but that is nothing to worry about at this stage. 
• Pain: Back pain during pregnancy and pain in legs during pregnancy (sciatic nerve pain) may also be observed.
• Sleep problems: Sleep during pregnancy can be elusive, especially at this stage. While sleeping, you may experience some vivid dreams as well. In case of vivid dreams about the delivery of your baby, get up, drink a glass of water, use the toilet and go back to sleep on your side with pillows to support your back and belly. Make sure you discuss these dreams with your spouse and friends next morning for some support. 
• Mood swings: You may have been experiencing pregnancy mood swings since the first trimester but they can increase drastically this week.

The third trimester can be difficult for some pregnant women. Others, on the other hand, may not experience these symptoms. Melasma, sore breasts, bleeding gums, swollen gums, headaches, nosebleeds and mood swings might give you a tough time this week. 

The following symptoms can be intense: 

• Sciatic nerve pain: As your baby bump grows, your womb could press down on the sciatic nerve that runs through the lower spine, the back of your hips, thighs and legs. This pain is common in pregnancy, especially in the second half. The pain may be constant or you could experience it in bursts or episodes. Use a hot compress on the painful area and put your feet up to get some relief. If the pain becomes too much, ask your doctor about other methods to reduce pain. Do not take any medicines, including over-the-counter painkillers, without talking to your doctor first. The US Food and Drug Administration has cautioned against the use of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen and diclofenac after the 20th week of pregnancy, as these medicines can cause low amniotic fluid (oligohydramnios) and kidney problems in the unborn child. Oligohydroamnios can lead to intrauterine growth restriction, preterm birth or labour complications like cord compression in the second-half of the pregnancy. The FDA caution does not cover NSAIDs administered directly into the eye.
• Round ligament pain: By now you might already be familiar with a sharp or deep pain just below your belly and in your groin when you laugh or sneeze or cough, thanks to round ligament pain during pregnancy. It is a very common symptom of the later stages of pregnancy when your growing uterus stretches the ligaments (connective tissue) holding it in place. The pain may be focused on one side or be felt all across the belly. Try walking a little to ease the pain. Call the doctor if the pain becomes too intense, becomes unbearable or starts to spread. 
• Varicose veins: As your weight increases, so do some of the weight-related issues. Varicose veins develop when the vein which carries deoxygenated blood back from your feet and legs to the heart (inferior vena cava) gets pinched and inflamed due to the increasing weight and pressure in your abdomen. This leads to the formation of bluish, inflamed vein clusters that can be painful. Varicose veins during pregnancy are mostly located in the legs, vulva and rectum. Varicose veins in the rectum/anus are also known as haemorrhoids. Talk to your doctor about managing them with haemorrhoid cream or pads or a rectal suppository.
• Braxton-Hicks contractions: Also known as false labour contractions, these contractions may become less intense when you shift positions or over the next few minutes. If the contractions become more frequent, rhythmic (they occur at a set time interval) and intense, visit your doctor.
• Fatigue: Fatigue tends to intensify as the delivery date approaches. The reason: you weigh more, your body is pumping more blood, you have late-term symptoms and you still need to stay active and ensure your daily activities are not affected. 
• Digestive issues: Indigestion during pregnancy, heartburn, acid reflux, gas, bloating and belching are also very likely this week as your growing baby presses on your stomach and pushes the abdominal organs up. Pregnancy hormones like relaxin also slow down digestion in this phase of pregnancy. Consult your doctor for medications and antacids that are safe to take during pregnancy. Eat smaller meals more frequently and make sure to sit upright when you eat, to reduce symptoms.

Read more: Breast changes in early and late pregnancy

During the 33rd week of pregnancy, you should be 10-15 kilos heavier than your usual weight. This weight increase would be more if you are carrying twins. Your symphysis fundal length (length of the belly from pubic bone to the top of the uterus) would touch around 35-38cm. You should be ready to moisturize your skin in case it cracks up or dries.

Polyhydramnios (increased amniotic fluid volume) could be observed around the 33rd week—if you feel your weight has increased more than the expected number, ask your doctor for some advice.

The following complications may be seen during the 33rd week of pregnancy:

• Stillbirth: Developments in medicine and medical technologies have made it possible to reduce the risk of stillbirth. If you have symptoms like contractions and vaginal bleeding, or if you haven’t felt the baby move or kick that day, etc., contact your doctor immediately. Stillbirth that occurs between the 28th week of pregnancy and the 36th week of pregnancy is known as a late stillbirth.
• Hypertensive diseases: High blood pressure is never a good thing to have, but high blood pressure during pregnancy (gestational hypertension) can pose quite a number of difficulties. If unchecked and uncontrolled, hypertension at this stage could cause complications like:
  • Placental abruption: When the placenta becomes partially or completely detached from the uterus, this is known as placental abruption. Your doctor may give you some medicines to help the baby develop faster or do an emergency C-section if necessary
  • Pre-eclampsia: A potentially life-threatening condition typically—but not always—marked by hypertension and proteinuria or protein in urine
  • Eclampsia: High blood pressure plus seizures
• Subchorionic haemorrhage: Bleeding can occur if the placenta gets partially detached from the place where it originally attached to the uterus. The chorion is the outermost foetal membrane. It has foetal blood vessels and finger-like projections or villi to increase surface area for exchange of fluids and gases with the mother.
• Infections: In the third trimester especially, you need to be alert to infections like bacterial vaginosis, urinary tract infections, hepatitis B, hepatitis C and genital herpes. See a doctor immediately in case you see symptoms of any infections during pregnancy. If you haven’t already had tests or if you are at high risk for infections like hepatitis B, HIV, chlamydia, gonorrhoea or syphilis, ask your doctor if you should get the tests done now.
• Placenta previa: The placenta forms very early on in the pregnancy. It attaches to the wall of the uterus, where it forms special channels to get blood and nutrients for the growing baby. In case the placenta attaches to the uterus in such a way that it covers some or all of the cervix, it can cause problems during delivery. Placenta previa normally resolves on its own by the 20th week of pregnancy, but if it doesn’t, you will require frequent ultrasound scans and the baby would probably be delivered by a cesarean section.

There may be some occasions during the 33rd week of pregnancy when you feel overwhelmed by all that’s left to do. Talk to family and friends. Take the support of your partner. You could become breathless and tired quickly at this stage, so enlist the help of loved ones to get the following things done during this week:

• Diapers, washcloths, baby bed, disposal bags, oilcloths, bathing essentials: there are so many things to shop for! (Read more: How often should babies take a bath?)
• Whether you have your delivery at full term (39-40+6 weeks of gestation) or end up going into premature labour, you’ll thank yourself for getting a hospital go-bag ready in advance. A fresh set of clothes and essentials apart, you should carry your medical history and pregnancy check-up results for all the trimesters in the bag to help the doctor during your experience of childbirth. 
• This is no time to be indulging in heavy exercise and workouts. A walk for 20 minutes or so every day should be enough exercise for your third trimester. Practice yoga and pelvic floor exercises only if your doctor recommends them. (Read more: Exercises during pregnancy)
• If you have an older child, talk to him or her about the baby. Get your child involved in picking out the baby’s clothes, bottles, toys, books—whatever they are most enthusiastic about. Make provisions for who will look after your older child while you are at the hospital and let your child know these plans in advance.