The Fourth Trimester: Raising Awareness and Delivering 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, and not nearly enough attention has been paid to this important time when compared with the ongoing, detailed tracking and focus of the trimesters leading up to the birth.

For the new little one, these first few months are spent adapting to life outside of the womb in this loud, bright, and noisy world they now find themselves a part of. They are learning how and when to eat, how and when to sleep (hopefully), and are developing basic motor skills while learning how to get the most of those new vocal cords. 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 for the dramatic emotional and physical changes your body undergoes in such a short time. Feelings of exhaustion, failure, or being completely overwhelmed are common, and as Dr. Hirsch notes in the video, the fourth trimester can be a very humbling experience for even the most informed and prepared mothers.


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, and with a growing list of things that need to be done, this ongoing physical drain can quickly manifest itself as added emotional toil.


As the first few months of motherhood progress, continuing biological changes start to take their toll, and when combined with sleepless nights, the marathon of feeding, and sleep training and all the joys and challenges that brings, this period 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:

What complicates this even further for so many is that these hugely impactful changes are all landing at a time when the clinical and social support structures which 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 have fewer check-ins with clinical teams, so during this time it can be very easy for new mothers to feel alone or isolated. It is so important that you recognize early on that you will need help in this time, and that you talk to your doctor and social supports to discuss your concerns and make arrangements to get the help you’ll need after the baby has arrived. Ask yourself and your provider questions like…

Getting Help in the Fourth Trimester

For too long, the fourth trimester has not been given the recognition and evaluation it warrants. Axia Women’s Health and our trusted team of dedicated, caring, compassionate providers like Dr. Hirsch join with the American College of Obstetricians & Gynecologists and others in calling for closer follow-up of women after birth, specific recommendations based on each individual maternal case, and emphasizing a need to evaluate reimbursement to support individualized, continuous postpartum care for each new mother. Axia’s providers are here to listen and help throughout your pregnancy into the fourth trimester and beyond. But what is most important is that you recognize that you are not alone, and that you do have help, and that asking for it is not only okay, it is important. You owe it to yourself and the relationship you are building with your baby. Here are a few useful links to get started looking for help:

Beyond the help available from these sources, your doctor, and your social supports, important is that you look to yourself and your own expectations of what should happen. Give yourself time to heal. Give yourself time to work through these evolving challenges and recognize that you can find help. Give yourself the benefit of the doubt that you’ll get through the long nights, endless feedings, and “why are you still crying?” moments, 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.

After the baby arrives and the fourth trimester begins, so much of everyone’s attention is focused on this beautiful new addition to your family. It can be all-too easy for everyone, including you, to overlook your emotional and physical needs during this time of adaptation. As you are making plans coming into the birth, be sure to include discussion about post-partum concerns and what signs of PPD look like so that those closest to you during the fourth trimester  — your partner, friends, family —can identify if you need help. When the fatigue or feeling of being overwhelmed becomes too much, know that we’re also here to listen and help, and that you are not alone.

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