Following months of pregnancy, going through an easy or difficult birth, you finally get to hold your baby for the first time and then…welcome to your fourth trimester.
Everyone will have a different story to tell when it comes to their pregnancy and birth experience, and that’s what makes this process so incredible. If your pregnancy shares any resemblance to mine, it might have gone something like this:
- First trimester – Any excitement I felt was short lived as the morning (or all day) sickness kicked in and I survived on my husband’s home-made focaccia and lemonade. It was around week six I decided (for some unknown reason) chicken was not going to play a part in my pregnancy journey and just the smell made me gag.
- Second trimester – ok I did feel somewhat normal here, the constant nausea subsided, chicken was still banned and my favourite pair of jeans started to feel just that little bit tighter. Overall, this was far my favourite trimester, seeing my baby girl on the 3D scan at 20 weeks made it all worth it.
- Third trimester – it was summer for me so unfortunately all I felt was bloated, swollen, uncomfortable and to be honest completely over being pregnant by this point. My husband would take me to the beach so I could float (taking the pressure off my feet) but spent most of the summer indoors by the air conditioner to keep as comfortable as possible.
After surviving all the ups and downs of pregnancy – I was finally able to give birth, and let me tell you that in itself is a whole story for another day. Between having a c-section and feeding difficulties, I ended up staying in hospital for the next 5 days, so by the time I made it home, my fourth trimester was in full swing!
So what is the fourth trimester and why does it feel so tough for some?
The ‘fourth trimester’ was initially termed by paediatrician Dr Harvey Karp in 2002, through his book ‘The Happiest Baby on the Block’, and is based on Karp’s premise that babies, if given a choice would choose an extra trimester in the womb (exactly what mums would want right?!). Dr Karp then went onto develop the Snoo smart sleeper, designed to sooth babies during these early weeks, when they need help settling and resettling.
But it’s not just about the baby during this time. Paladine, Blenning and Strangas (2019), explain the 12 weeks following birth is what is known as the fourth trimester of the postpartum period. Through their research they have collated a number of health conditions that can impact mothers during this time, some of which include:
- Postpartum depression
- Postpartum haemorrhage
- Endometriosis
- Thyroid disorders
- Issues with breastfeeding
- Postpartum weight retention
- Low libido
- And more…
Some will be fortunate enough to have a smooth recovery after birth, with no real health concerns, leaving them at their best to focus on their new baby. If this is your experience, this is amazing, enjoy your time and cuddles with your new bub; after 9 months of pregnancy, you deserve it!
But if this isn’t your experience and on top of trying to understand your baby, you are dealing with your own health concerns, please know you are not alone, and it is not uncommon. Your baby doesn’t come with a manual, you are probably sleep deprived as you need to feed every 3 hourly (or less) and to have to cope with hormonal changes and potentially other health concerns, can overwhelm anyone at the best of times. For me, I struggled with establishing my milk supply alongside postnatal depression. It’s not an easy journey for some mums and science shows you’re not alone.
The American College of Obstetricians and Gynaecologists (2018) released recommendations on maternal care during this postpartum period, suggesting this is a critical period for both the mother and her baby to establish their long-term health and wellbeing. In their guidelines, they recommend care during the postpartum period should be ongoing, with an initial check within the first 3 weeks followed by a comprehensive check by 12 weeks postpartum. This comprehensive check should assess the mother’s wellbeing across a full range of social, physical and psychological aspects, including, but not limited to:
- 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
Reading through these recommendations really hit home for me and made me reflect on the fact science shows both mama and bubba need a lot of care during this fourth trimester. The published recommendations go through in detail recommended care for mama through this postpartum transition and break down specific areas which need to be assessed. It also suggested that this support needs to be ongoing, rather than an isolated visit. Here in Australia most of us just have at around the 6-week postpartum mark, which make actually not even be close to what we actually need. Take a look at these recommendations if you are unsure what questions/checks you should ask your OBGYN/GP about – it might help prompt you to get this conversation started.
It’s clearly evident there is a need for more ongoing support postpartum, and the fact so many mums around the globe soldier on without it shows how incredible a mama bear can be. But you shouldn’t have to do it without this support and wherever you can, continue to reach out to your healthcare professionals to get the help you need. It’s what you deserve as a mum, and it should be your right to get this help.
Tips to navigate the fourth trimester
Leahy-Warren, Mccarthy and Corcoran (2011) studied first time mothers and researched the relationship between social support, maternal parental self-efficiency (belief you can complete the required tasks to parent your child) and postnatal depression. They found that social support can positively impact a new mother’s mental health during this forth trimester period.
If you are currently navigating your way through this fourth trimester and at a loss for where to start, my best advice is start by asking for help. You are just as important as your baby so make sure you look after you so you can look after your baby. Some of my own suggestions for you to think about include:
- Rely on your support network
- Keep in contact with your OBGYN or GP, and don’t wait until your 6 week check-up if something doesn’t feel right
- Choose a feeding method that works for both you and your baby
- Check in with your child heath nurse regularly – they are an amazing untapped support service.
- Join a mothers group – this wasn’t something I thought would work for me but surrounding yourself with other mums going through similar issues might provide comfort and normalise your world
- Utilise online resources, but don’t over google and overwhelm yourself! Key ones to start with:
- Schedule some alone time for you to catch up so sleep, get some fresh air, read a book, get your hair done or a simple Netflix and chill sesh. Don’t feel guilty about letting someone else help out with bub for a few hours
Not all of these will work for everyone, but these are some of the things that helped me through. You are your best expert; you are your baby’s best expert; follow your intuition and do what is best for you and your family.
Even though it may feel like a struggle at times, the fourth trimester does eventually pass by and your baby will be out of that early newborn stage before you know it. Whenever you can, enjoy the cuddles and savour the moments because before you know it they will be gone.
All the best mama bears,
Elicia xo
References
Karp, H. 2002. The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer. New York: Bantam.
Paladine, H, L., Blenning, C, E., & Strangas, Y. (2019). Postpartum care: An approach to the fourth trimester. Americian Family Physician, 100(8), 485-491. https://pubmed.ncbi.nlm.nih.gov/31613576/
The American College of Obstetricians and Gynecologists (2018), ACO committee opinion, Obstetrics & Gynecology, 131(5), 140-150. doi: 10.1097/AOG.0000000000002633