Don’t panic! The fourth trimester does not mean that some women have to endure an additional three months of being overly pregnant. And I think we’re all thankful for that! But the expression, the fourth trimester, is often used to describe the first 12 weeks of the postpartum period. So many people think that once the baby is here, we’re able to just immediately go back to normal. But our bodies have been through the ringer over the previous 9 months and need these 12 weeks to recover, and adjust back to something that resembles normal. Not to mention there is a new baby that needs a bit of time to figure out what it means to be in the world instead of the womb.
All about mom:
Just like in the previous three trimesters there are a handful of symptoms to expect that indicate you’re in your fourth trimester… besides the precious little baby you’re now holding! After all of the changes that occur with your hormones during pregnancy, this is the trimester that gets them all back to their regularly scheduled programming. So as those hormones adjust you’ll feel the effects of that often in the form of pretty intense emotions/mood swings.
Baby blues are a very common occurrence during the first 2 weeks after birth. Up to 80% of women experience this. So if you find yourself with an abundance of mood swings, more anxiety than you’re used to, excessive crying, insomnia or just general unhappiness, know that you are not alone and many women experience this as their hormones balance out. As your hormones level out, and you fall into a routine these feelings of baby blues will typically disappear. If you find that they don’t, that you continue to struggle with feelings of sadness, anxiety, or other feelings and moods that are making it hard for you to function, you may be experiencing postpartum depression and should absolutely speak to your doctor about it as well as your partner or support system.
Along with the emotional symptoms you may be experiencing, there are a plethora of physical experiences you’re probably going through as well. No matter what type of delivery you have, there will be post partum bleeding. This can last up to 6 weeks although it’s heaviest in the first week after birth and the duration is different for everyone.
There will also likely be pain to deal with again no matter what kind of delivery you’ve had. It could be pain from your c-section incision, or from a tear during a vaginal delivery, or just general soreness from birth. Birth is hard work and your body has been through a lot, using muscles that maybe haven’t gotten as much use previously. You can typically take over-the-counter pain medication to address these discomforts, as well as using a combination of ice and heat therapy, but of course speak with your doctor about what is recommended.
Pregnancy and birth are challenging on your pelvic floor and you may find yourself experiencing some incontinence after birth. It may have even started while you were still pregnant. While this may be common, it doesn’t have to be your normal. Speak with your doctor about this and see about getting a referral to a pelvic floor therapist. They can also provide support for women with diastasis recti- the separation of your abdominal muscles during pregnancy. If you’re struggling with this postpartum, physical therapy may be helpful.
Exhaustion is very common in the fourth trimester…and parenthood in general. But those first few weeks can be especially challenging and jarring to the system. As you adjust to less sleep than you’re used to, be sure to lean on your support system. Be vocal about what kind of support you need whether it’s someone to hold the baby while you take a nap, or it’s your partner getting up to give a bottle to give you a longer stretch in the middle of the night. And also know that while parenting will continue to be tiring, the sleep will improve and you won’t always feel like a walking zombie.
All about baby:
A huge part of the fourth trimester is the baby and their adjustment to the world. The idea of the fourth trimester has even been linked to the idea that babies really need four trimesters in the womb but because they arrive after three, we can help them adjust to the world by trying to mimic that environment for them during the first several weeks after they arrive by keeping it dark, calm, and snug. During this time your baby will be figuring out everything…eating, sleeping, being awake, bodily functions, how to be out in the world. Their actions are largely guided by instinct and their reflexes.
You’ll notice in these first few weeks your baby has a natural sucking reflex, which helps them get the hang of eating. They also have something called a rooting reflex. If you stroke the side of your baby’s cheek they will typically turn their head toward that side looking for food. This reflex comes in handy for those with distractible or “lazy” eaters. Your baby also has a grasping reflex which you’ll notice as they hold tight to your finger (isn’t it so sweet?!) or your hair (not so sweet). Who knew such a tiny baby could pull so hard? I’ve determined this is why the “mom bun” is a thing. Well that and general lack of time to do anything else with it.
Have you discovered or tried the stepping reflex? If you support your little one under their arms, lean them forward a bit with their feet on a flat surface they’ll make a stepping motion that resembles walking. This lasts for about the first two months.
Another common reflex you see is called the moro reflex, more commonly known as the startle reflex and it’s exactly what it sounds like- your baby startling. They often flail their arms and legs up when it happens and therefore it can often interfere with sleep since they can startle themselves awake pretty easily. This is where swaddling comes in handy. The pressure of the swaddle helps to dull the startle reflex, giving your little one (and by extension you) some less disrupted rest. This reflex will start to go away around 3-6 months so rest assured they won’t startle themselves awake forever.
Routine is coming!
I know you’re wishing and hoping for routine right now and it can be hard to find one in these early weeks when it seems like your baby is just eating and sleeping whenever they feel like it and not when it’s convenient or when you expect. Please know that no matter how frustrating this is, it’s totally normal! As they get older, things will become more predictable and consistent and you’ll be able to find a routine that works for you and your baby.
In the meantime for those of you that are desperate for some structure I’d encourage you to start by developing a bedtime routine. Sure your baby may not have a true bedtime if they’re waking up every couple of hours but you can begin to build that time into your day with something as simple as bath, pj, book and bed. It may help you feel more grounded and then when your cutie is ready for a true bedtime you’ll already have a routine in place!
All about doctors:
You’re home recovering from your birth, your providers all told you to take it easy and rest, stay in as much as possible. If you had a c-section or a tough delivery you may have even been told not to drive. But spoiler alert, you’ll need to go to the pediatrician almost as soon as you’re home from the hospital. Typically, the pediatrician will do an initial check at the hospital if you deliver at one and then will let you know when you need to return. Most doctors often want you back within the first week to check on the baby’s weight, then again at two weeks and then monthly.
In the first two weeks of my son’s life I took him to the pediatrician three times even after being seen in the hospital- one for his initial appointment, one weight check and then again for his two week checkup. It can feel like a lot, so I encourage you to have someone who can accompany you to these appointments to help you with driving if you need it and also to help you remember what the doctor says since you’ll be dealing with “new mom brain”.
While babies tend to get an excess of doctor’s appointments in the early days, most moms only go to one postpartum appointment, typically at 6 weeks. If you’ve had a c-section some doctors offices will ask to see you sooner for an additional appointment around 2 weeks to check on your incision. At your 6 week check up your doctor will do a pelvic exam to check on how things have healed. They are checking to be sure your cervix is closed and in a typical position, they’ll palpate to confirm that your uterus has gone back to its usual size and they’ll check on any incisions or stitches you may have needed during your birth.
They’ll most likely also want to speak to you about your plans for birth control moving forward, check in on your mental health looking for signs of PPD and will hopefully give you a time to ask any questions you have. If you have concerns about your recovery, or breastfeeding or your birth, definitely bring them up to your doctor and know that you don’t have to wait until 6 weeks. Sure that’s when the scheduled appointment is but you can always request to be seen sooner!
There are often a lot of resources available to new moms that people are unaware of. A lot of these are local so I can’t provide you with the details but I encourage you to check in your area to see if any of these are available to you.
Breastfeeding Support Groups- These are often available for free at hospitals and are typically led by certified lactation consultants which can be a HUGE help if you’re struggling in your breastfeeding journey. If they didn’t tell you about it before leaving the hospital or if you didn’t give birth at the hospital, call the maternity department of the hospital to get the details.
Lactation Consultants- Like I mentioned above, a certified lactation consultant is priceless if you need support or assistance with breastfeeding. You can often find private LC’s that will make home visits or even a virtual visit to give you guidance and this is often covered under insurance!
Le Leche League- There are Le Leche League chapters all over so there is likely one nearby where you live. Again, this is a great support for breastfeeding moms!
Postpartum Doula- You may have heard of hiring a doula for birth, but did you know there are also doulas who specialize in postpartum? This is a dedicated support person that will walk through this postpartum season with you. This is something that typically isn’t covered by insurance (at least not yet!) but may be an expense that’s worth it to you. You can search for postpartum doulas in your area online or get a referral from a local childbirth educator or birth doula.
Maternal Mental Health– If you need mental health support during this time, this site will help you find resources that are local to your area.
Postpartum Support International– This site has resources available for you no matter where you’re located.