A Mother’s Guide To The Fourth Trimester

The period after birth is an exciting time when friends and family surround to welcome and celebrate your little bundle of joy. Unfortunately, that means it’s easy for everyone, including you, to overlook your emotional and physical needs. The post-partum period is a critically important time for new moms. In this guide, we’re exploring the changes that can happen during the fourth trimester and how you can find support.

What is the Fourth Trimester?

The fourth trimester is a phrase that refers to the three-month period immediately following childbirth, and is often attributed to Harvey Karp, MD, from his book, “The Happiest Baby on the Block.” For both mom and the baby, this period after childbirth is incredibly important for creating daily habits, finding structure in your new relationship, and bonding with your little one. However, the physical and emotional challenges of having just given birth means that the fourth trimester can often be overwhelming. Not nearly enough attention has been paid to this important time when compared with the detailed focus on the trimesters leading up to birth.

For the new little one, these first few months are spent adapting to life outside of the womb. They are learning how and when to eat, how and when to sleep (hopefully), and are developing basic motor skills. In short, they are starting to become small people with an increasing ability to communicate their developing needs. For moms, this period can be a whirlwind of adaptation, with constant and evolving needs from the baby, days on end without restful sleep, and all while your body is still recovering from the physical trauma of childbirth.

What Should Mothers Expect in the Fourth Trimester?

No matter how much or how well you prepare for the period immediately following birth, it is hard to truly be ready. Feelings of exhaustion, failure, or being completely overwhelmed are common. The fourth trimester can be a very humbling experience for even the most informed and prepared mothers.

Physically

Physically, you’ve just been through a difficult experience and have not yet had time to heal. It can take months for your body to recover and adjust to even the smoothest birth scenarios, let alone for those with complications.  This pain and discomfort can sometimes turn simple, everyday tasks and chores into draining and seemingly insurmountable obstacles. With a growing to-do list, this ongoing physical drain can quickly manifest itself as added emotional stress.

Emotionally

Continuing biological changes combined with sleepless nights can lead to overwhelming levels of stress and more serious post-partum concerns. Post-partum medical conditions can be bucketed into three diagnoses that have different symptoms and variations in duration and treatment options:

• Baby blues is the most common post-partum condition, with between 50% to 75% of new mothers experiencing mood swings, sadness, anxiety or trouble sleeping, according to the Cleveland Clinic. Baby blues generally last a week or two and can be treated with extra support from family or outside help as well as rest, good nutrition, and exercise.
• Post-partum depression (PPD), experienced by roughly 1 in 7 new moms, has symptoms that can be more debilitating, and impact the ability of a new mother to care for herself and her baby. Depending on the severity of symptoms and accessibility of treatment and support, PPD symptoms can potentially last up to a year or longer.
• Post-partum psychosis is the third and, thankfully, relatively rare post-partum condition. It is characterized by severe symptoms such as extreme anxiety and suicidal thoughts that develop in the first week after delivery. Immediate help should be secured if these symptoms occur.

What complicates this even further is that these changes are all landing at a time when the clinical and social support structures that had been such an integral part of the pregnancy begin to change. Moms and partners are starting to return to work and there are often fewer check-ins with clinical teams, so it’s not uncommon for new mothers to feel alone or isolated. It’s important to recognize that you will need help, and that you make arrangements to ensure you have the support you need after your baby arrives. Ask yourself and your provider questions like…

• Do I have medical or emotional conditions that are expected to change during the post-partum period?
• Do I need to adjust any of my medications during this time?
• What are the warning signs that my family and I should be aware of?
• Who can step in to help once we’re back to work?

Getting Help in the Fourth Trimester

For too long, the fourth trimester has not been given the attention it deserves. Axia Women’s Health and our trusted team of dedicated, caring, compassionate providers join with the American College of Obstetricians & Gynecologists and others in calling for closer follow-up of women after birth. We’re here to listen and help throughout your pregnancy, into the fourth trimester, and beyond. Additionally, there are wonderful external resources that offer support:

• National Women’s Health Information Center
• Postpartum Support International
• Medline Plus PPD
• Postpartum Health Alliance

Overall, it’s important to give yourself time to heal. Give yourself time to work through these evolving challenges. Give yourself the benefit of the doubt that you’ll get through the long nights, endless feedings, and make sure you enjoy the small victories. So much of the fourth trimester is about connecting with your baby, so give yourself a moment to recognize the progress you and your baby are making as you work your way through these tough moments.

When the fatigue or feeling of being overwhelmed becomes too much, know that we’re also here to help. You’re not alone. Your Axia Women’s Health care team is here for you throughout your journey.