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A Survival Guide to the Fourth Trimester

What does the postpartum period look like after pregnancy?

If you were to go by the common perception of what pregnancy and birth are like, the story would go a little something like this: mothers experience three trimesters of pregnancy, pop out a baby, take it home, and life begins. And while this impression isn’t exactly false, it also reduces a whole lot of complicated post-partum experiences and feelings into “life begins.”

In reality, we’re starting to learn that the period of time after giving birth - the fourth trimester - is critical in and of itself and should be getting the same attention as the other three trimesters receive. Instead, the focus tends to go on the baby’s needs, often leading to the neglect of what a freshly post-partum mother requires.

The reality is that the process of recovering and rebuilding from birth is just as important as the pregnancy itself for the health, happiness, and growth of both mother and child. We have to start talking about a mother’s needs during postpartum and beyond. So here’s a guide to how you can survive your fourth trimester.

 What is the Fourth Trimester?

The same way that each trimester of your pregnancy lasts approximately three months, the fourth trimester refers to the first three months after birth, from the day your baby is born until you are 12 weeks post-partum.

During pregnancy, the mother-to-be is generally showered with attention and support from friends, loved ones, and doctors. The focus is both on the development and health of the baby as well as the mother’s well-being and preparedness for what is to come. However, once a mum gives birth, almost all of that care and attentiveness that has been given to her becomes focused on the baby alone, often including from the mum herself.

And, of course, it’s important to carefully monitor and care for and love and pay attention to a newborn baby during the fourth trimester - and beyond - but what about the mum? She is going through a major life change, healing from an intense physical experience, and that is all on top of the emotional and mental roller coaster that comes with caring for a brand-new baby.

When you think of it that way, it’s only logical to pay attention to a new mother’s psychological, physical, social, and emotional needs after birth, so why is it that most women’s postpartum care consists only of a single doctor’s appointment six to eight weeks after childbirth? In her fourth trimester, a woman is in need of support and guidance just as much as her new baby is.

What Happens During Your Fourth Trimester?

So what can you and your baby expect to experience during your fourth trimester? What sorts of changes and challenges should you be prepared for?

Your Baby

Let’s start with the newborn baby. The most important thing to keep in mind when trying to understand a baby’s needs during the fourth trimester is the idea of the change in environment. Before birth, the only thing a baby experiences is being in the womb, safely cradled in amniotic sac and fluid. Compared to that, the real world is a major wake-up call.

That’s what swaddling is for: to help your baby feel comfort and security by recreating the feeling of the environment they’re used to. Skin-to-skin contact is also useful in creating a bond and a feeling of closeness between the baby and the mother.

Developmentally, you can look forward to a few common behaviours: crying, sleeping, and eating. As your baby’s only form of communication, you can expect crying to peek during the fourth trimester. They’ll also sleep constantly, up to 18 hours a day, with no ability to discern day from night. And because of their small stomachs and quick digestion, a fourth-trimester newborn will need to be fed every two to three hours.

During this period, your baby will also be developing their senses, with blurred vision slowly transitioning to the ability to discern shapes and be visually alert. They’ll also learn your scent during this time, which is part of why close contact is so important. And while they’re likely to recognize your voice from the womb, a lot of noise will overwhelm a newborn, making it a good idea to be careful about the volume level they’re exposed to.

And You

Now, more importantly - what can the new mother expect to experience and feel during her fourth trimester?

Physically, your body will be in recovery mode after enduring tremendous changes and undergoing the physical demands of housing a fetus. Your abdomen and pelvic floor will need the most strengthening. Kegels, the exercise in which you tighten your pelvic floor muscles, will be important.

An estimated 50 to 60 percent of women experience diastasis recti, a separation of the abdominal wall muscles, during and after pregnancy. This can present as a visible “stomach pooch.” This most often goes away on its own, though exercise, physiotherapy and support garments may be necessary in certain cases.

Of course, if you had a C-section, vaginal tearing, or an episiotomy, a big part of your fourth trimester will be healing from these, which may require careful hygiene, abstaining from sex, healing stitches, avoiding certain physical activities, and caring for wounds. You might experience pain and bleeding, and it can help to wear loose clothing, cotton pants, and menstrual pads.

If you breastfeed, especially for the first time, you may have a learning curve ahead of you, as well as physical symptoms such as breast tenderness, nipple pain, and plugged milk ducts. That’s on top of the other challenges of breastfeeding like baby blues and latching issues.

And while 70 to 80% of women have the baby blues, or short-term feelings of sadness and anxiety lasting about two weeks after birth, about 1 in 10 women experience postpartum depression, a more serious condition. This lasts more than just a few weeks and usually calls for treatment by a medical professional. Symptoms include persistent sadness, feelings of hopelessness and worthlessness, loss of enjoyment in activities you once loved, and frightening, even violent, thoughts.

When you understand what is going on with a new mother hormonally, mood swings don’t seem so unusual. Right after your delivery, estrogen and progesterone levels plummet. To compensate, oxytocin levels surge, though they must regulate later on - which may be a cause of baby blues. Hormone levels will only reset to a pre-pregnancy normal toward the end of the fourth trimester. However, high stress and low sleep can lead to increased levels of cortisol and lower melatonin and serotonin, further creating a negative impact on a mother’s mood.

Tips for Surviving Your Fourth Trimester

When it’s all laid out like that, it may seem a little silly that the postpartum narrative is so focused on the myth of “bouncing back” rather than the crucial focus on healing, transition, and balance for the mother.

These physical, emotional, and hormonal changes are very real and very intense, requiring attention, care, and effort to be devoted to recovery. Here are some practical suggestions for how a new mother can take care of herself during the fourth trimester in light of all of the changes mentioned above.

Get what you need

You’ve probably put a lot of thought into what supplies your new baby will need and stocked up on clothes, diapers, and essentials like car seats, strollers, and baby monitors. But what about the supplies you’ll need? From scar cream and nipple cream to sitz baths and menstrual pads or adult diapers, getting your own supplies ahead of time will make your fourth trimester recovery so much smoother.

Seek support

Just like raising a baby, caring for a new mum can take a village, especially when it comes to medical care. Talk to your obstetric team as early as you can to see what help they can offer you in the fourth trimester. See if you can create an individualized postpartum plan for supporting you as you heal, taking into consideration any physical or mental conditions you may have. Ask for help when you need it, reaching out to family and loved ones and therapists and lactation consultants and night nurses: whomever you need, whenever you need them. You’re not alone in this.

Eat right

Sorry, ladies, the need to have good nutrition doesn’t end after you have your baby. Proper diet and nutrition can do wonders for helping your postpartum body heal. Eating foods high in tryptophan and vitamin B6 like nuts, tofu, and pineapple, can potentially boost your serotonin levels, improving your mood. To help regulate your digestion and prevent haemorrhoids, try to get plenty of fibre and hydration. And make sure to get enough iron and protein to make up for any blood lost during childbirth.

Sleep as much as you can

With a newborn baby that needs to be fed every two to three hours, getting sleep is no easy feat in the fourth trimester. That’s why it’s so important to make it a priority to sleep as much as you can whenever you can. Because though a certain amount of sleep deprivation is unavoidable, the more sleep you get, the better your mood will be and the faster your body will heal. So take naps and ask for help with night feedings, whether that be from a partner or a professional like a night nurse.

Do some self-care

Sure, you might feel like your number one responsibility as a new mother is to take care of your newborn baby, and that’s definitely important, but so is taking care of yourself! So get rid of any feelings that self-care is selfish, because it’s not: it’s necessary. Even small things such as finding time for a relaxing bath and putting on your favourite TV show in the background while you breastfeed can make a difference.

Let yourself heal

Healing has a lot of components to it. Part of it is putting in the work of doing those Kegels, eating nutritious foods, drinking enough water, and getting enough sleep. But another huge part of it is just waiting, taking the time to let your body repair itself at its own pace. It may be hard, but some things really are just a matter of time. So don’t put pressure on yourself or feel bad if you’re not “getting your body back” immediately. Be patient and kind to yourself. After all, you wouldn’t get angry at your baby because it’s taking longer than a year for his or her skull to fully form. That’s just how it works. Same goes for your own healing.

Visit experts

As mentioned above, your pelvic floor and core are likely to need to go through a lot of strengthening and healing after your delivery. Physical therapists who specialize in these regions of the body can be a major help, teaching you all of the techniques you can use to help strengthen your abdominal muscles, support your core, heal your scars, stabilize your organs, and improve back pain and incontinence.

Embrace change

The fourth trimester is one of the most change-heavy time of a woman’s life. Everything is changing: your body, your emotions, and your entire life. If you try to fight that, doing your best to stick to a pre-made plan of exactly how you want to heal, how you want your baby to develop, and how you want your new life to look, you’re setting yourself up for disappointment. It’s not that planning is useless, but you just have to be flexible about it. If you stay open-minded, the fourth trimester can be one of the best lessons you’ll ever get in your life in going with the flow. As long as you feel whole with the decisions you ultimately make, it’s perfectly fine to change your mind.