The Fourth Trimester

Let’s talk about the importance of the fourth trimester, shall we?

That math doesn’t add up, you say? How can there be four of a threesome? Well, we’re realizing that the amount infants and parents develop during the first three months after birth actually warrants the identification of an additional trimester. Dr. Harvey Karp, author of The Happiest Baby series, originally coined the term ‘fourth trimester’ to describe newborns’ needs after leaving the womb. You may be familiar with the “5 S’s”: swaddle, side- stomach, shush, swing, and suck.

Rightfully so, a lot of focus goes toward a baby’s development. During pregnancy, parents ask themselves, “How many weeks are they?,” “How big are they?,” “If I do have gestational diabetes, how does that impact the baby?” After the baby is born, the attention on them only grows. All of that makes a lot of sense because babies completely depend on their caregivers, and they’re oh so very cute.

We know, though, that a mother’s (and other caregivers’, in many ways) health and wellbeing directly influence a baby’s development. That goes for during pregnancy and afterward. See this post on diet for a detailed example. Women may find the period of time just after the baby is born to be a particularly challenging one. In addition to all that’s lovely about having a newborn, the pregnancy glow has ended, hormones are shifting, sleep is waning, and stress can build. 

The American College of Obstetricians and Gynecologists (ACOG) has gone so far as publishing an opinion that medical care should extend beyond the three trimesters of pregnancy, beyond the typical postpartum visit at six weeks, and up to 12 weeks after birth. While this recommendation presents a challenge (as it is now, as many as 40% of women don’t attend a single postpartum appointment, and insurance doesn’t always reimburse providers for the six week visit), it certainly addresses a need.

First, ob-gyns provide more health care for women than any other physician group. It makes sense that they’d provide as much care as possible while they already have a woman engaged and while she’s going through one of the biggest transitions of adulthood. That’s just good preventative care. Second, think about the relationship between a woman and her OB. There’s an attachment that develops throughout pregnancy, and returning to the office can feel warm and therapeutic during a chaotic time.

ACOG recommends OBs schedule their first postpartum appointment within the first three weeks postpartum. A final postpartum visit should be scheduled by the twelfth week, and visits should be planned in between to meet each individual’s needs. At the conclusion of postpartum care, an OB should assess the following: 

• mood and emotional well-being
• infant care and feeding
• sexuality contraception and birth spacing
• sleep and fatigue
• physical recovery from birth
• chronic disease management
• health maintenance

Let this list be a playbook, since women are the coach of their team after all. (Not sure what I mean? Read this post on effective communication with providers.)

Beyond medical care, women benefit from special attention during the fourth trimester. Their body is recovering and may seem unfamiliar. They may experience some challenging emotions. They’re learning what it means to be a mother in the context of all their other roles, including being a person who has needs themselves. And all the while, they’re wanting to bond with their baby. It may be impossible to know what will feel helpful before the time comes, but research has shown us a few things that stand a good chance.

• Identify a support network. Medical providers, family, friends, community groups, and mental health professionals can all play important roles in a woman’s recovery, adjustment, and growth. It may also be helpful to find lactation consultants and other experts who can address specific concerns.
• Pay attention to diet, physical activity, smoking, alcohol use, body image, and symptoms of depression. Follow any medical recommendations on diet and physical activity, and see this post [link] for more details on signs of depression and anxiety you may notice. These six areas seem to be most related to the health of mothers and their babies in the first year postpartum, and in preventing chronic health conditions.
• Take 5 minutes. Remember that a shower can do wonders, not just for your cleanliness but also for your mood. Look for moments to rest and soak up something beautiful, meaningful, or fun.
• Accept help when it’s offered, and tell people how they can help. If people want to bring food or do the dishes, let them. And if others haven’t realized how impactful those gestures could be, they may appreciate someone letting them know. People often worry about burdening others, but letting a helper know how they can be of service can actually be a great gift.
• Reach out for support as soon as possible. The sooner you notice that things are off track and actively cope, the sooner you can get back on track.