The Third Trimester of Pregnancy: Pain and Insomnia

Medically reviewed by Janine Kelbach RNC-OB on March 10, 2016Written by Rachel Nall, RN, BSN, CCRN on March 15, 2012

The third trimester is a time of great anticipation. In a few short weeks, your little one will finally be here. Some of the symptoms during the third trimester can include insomnia and pain. It’s important to know what’s normal and what’s not, particularly when it comes to the discomfort you may feel over the course of the third trimester.

Though insomnia and pain certainly aren’t pleasant, but there’s an end in sight. Soon, you’ll be welcoming your new baby to the world.

Why Does Pain Occur During the Third Trimester?

Pain can occur in seemingly every part of your body during the third trimester. From your back to your hips to your stomach, there are many places that may be sore and uncomfortable.

Abdominal Pain

Stomach pain in the third trimester can include gas, constipation, and Braxton-Hicks contractions, or false labor. While these can cause some abdominal discomfort, they shouldn’t cause excessive amounts of pain.

Abdominal pain that’s more severe and concerning can be due to a urinary tract infection, preeclampsia, which is a condition that causes high blood pressure during pregnancy, or a placental abruption, which is a condition that occurs when your placenta separates from your uterus too early.

Call your doctor if you experience:

Lower Back and Hip Pain

As your body goes through further changes in preparation for childbirth, hormone levels increase so your connective tissue loosens. This enhances flexibility in your pelvis so your baby can pass through the birth canal more easily.

However, women frequently experience hip pain as the connective tissue loosens and stretches. Lower back pain can also occur along with hip pain, as posture changes may cause you to lean more toward one side or another. Sleeping on your side with a pillow between your legs may help to relieve this pain because it opens the hips slightly.

Try these tips

  • take a warm bath
  • apply warm compresses or an ice pack, but avoid the abdomen
  • get a prenatal massage
  • sit in chairs with good back support
  • take an over-the-counter pain reliever, such as acetaminophen, to reduce soreness and discomfort

Call your doctor if the pain becomes severe or if you feel pressure radiating toward your thighs. These could be signs of preterm labor. You should also contact your doctor if your pain is accompanied by stomach cramping, contractions that occur roughly 10 minutes apart, or vaginal discharge that’s clear, pink, or brown.


Your sciatic nerve is a long nerve that runs from your lower back all the way down to your feet. When pain occurs along this nerve, the condition is known as sciatica. Many women experience sciatica during pregnancy because the enlarged uterus presses down on the sciatic nerve. This increased pressure causes pain, tingling, or numbness in the lower back, buttocks, and thighs. It may affect one side or both sides of the body. While the pain of sciatica is uncomfortable, it shouldn’t hurt your growing baby.

You may be able to ease the pain by stretching, taking a warm bath, or using pillows to position yourself as comfortably as possible.

Vaginal Pain

Vaginal pain during your third trimester can make you feel anxious and stressed. You may wonder if your baby is coming or if the pain is a sign that something’s wrong. The answer depends on the severity of the pain. Some women experience sharp, piercing pain in the vagina. This could potentially indicate that the cervix is dilating in preparation for delivery.

You should call your doctor immediately if you’re experiencing any of the following:

  • severe vaginal pain
  • intense pain in the vagina
  • intense pain in the lower abdomen
  • vaginal bleeding

Even if these symptoms turn out not to be cause for concern, it’s best to get a confirmation from your doctor.

Why Does Insomnia Occur During the Third Trimester?

Insomnia is a sleep disorder that makes it difficult to fall asleep or staying asleep on a regular basis. Chances are, both of these symptoms may affect you at some point during your third trimester.

According to the National Sleep Foundation, approximately 97 percent of women reported waking up an average of three times per night at the end of their pregnancies. Of the women surveyed, 66 percent reported waking up five or more times per week.

There are several factors that can contribute to insomnia in the third trimester.

Baby’s Growing Size

During the final trimester, your baby is getting much larger. This can make it more difficult to breathe while sleeping and harder to find a comfortable position. The lower back pain you may experience during pregnancy can also affect your ability to get a good night’s sleep.


Your sleep may also be impacted by snoring. An estimated 30 percent of women snore during pregnancy due to swelling of the nasal passages. The baby’s increased size also puts additional pressure on the diaphragm, or breathing muscles. While some moms-to-be can sleep through the snoring, others may wake themselves up with their snoring.

Leg Cramping and Restless Legs

You may start to develop leg cramping and restless leg syndrome in the third trimester. Cramping can occur as a result of too much phosphorus and too little calcium in the body. Restless leg syndrome, or the overwhelming need to constantly move your leg, can be a symptom of an iron or folic acid deficiency. For this reason, it’s important to let your doctor know if you’re experiencing the symptoms of restless leg syndrome. These can include:

  • an uncomfortable sensation in the legs
  • a strong urge to move one or both legs
  • nighttime leg twitching
  • sleep interruption

Your doctor may want to perform certain blood tests to determine the cause of restless leg syndrome.

Preventing and Fighting Insomnia

Insomnia can be a challenging condition. However, there are some steps you can take to get better sleep in your third trimester. These include the following:

  • Sleep on your left side to promote blood flow to your baby. Place a pillow underneath your belly to support it. If you experience heartburn or acid reflux while lying flat, add extra pillows under your upper body.
  • Avoid sleeping on your back when possible, as this restricts blood flow.
  • Avoid foods known to contribute to leg cramps, especially carbonated and caffeinated beverages.
  • Drink plenty of water to help reduce cramping.
  • Share your symptoms with your doctor. If you do experience nasal swelling that causes snoring, your doctor may want to run certain tests to ensure it isn’t a symptom of preeclampsia, or high blood pressure.
  • Stretch your legs before going to bed. Try straightening your legs and flexing your feet to help reduce leg cramping that keeps you up at night.
  • If can’t fall asleep, don’t force it. Try reading a book, meditating, or doing another relaxing activity.


It’s best to avoid taking medications for insomnia, but if other remedies don’t appear to be helping, you can try using a short-term sleep aid. The only safe sleep aids to use during pregnancy include zolpidem (Ambien), eszopiclone (Lunesta), and diphenhydramine (Benadryl). Make sure to consult with your doctor before you start using these medications.

While you can expect some sleep disruptions during your last trimester, talk to your doctor if they’re happening on a daily basis or if you can’t seem to sleep more than a few hours each night. Sleep is important for both you and your growing baby.

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