The Fourth Trimester: A Guide for New Parents

You spend months preparing for the birth of your child – decorating the nursery, buying baby gear, reading books and attending classes. It all leads up to the wonderful moment when your newborn is placed in your arms for the first time. But what often gets overlooked is that this is just the beginning of a huge period of growth and transition, for both parent and baby.

The newborn postpartum phase is sometimes referred to as the fourth trimester. While we typically think of a pregnancy in terms of first, second and third trimesters, the period from birth to 12 weeks is a continuation of everything that pregnancy has led up to, explains University Hospitals certified nurse-midwife and mother of two, Lisa Vagi, CNM.

“We’re getting away from the idea that the journey of pregnancy ends at birth. There’s still a significant period of transition after the baby is born,” says Vagi.

During this period, your body is healing from childbirth and going through changes as your hormones adjust. You are also navigating your new role as a parent, or adjusting to adding another child to the family. You may be establishing breastfeeding (if you choose to breastfeed) and are trying to bond with and take care of your newborn, all while dealing with the lack of sleep that comes with a new baby.

An Emotional Roller Coaster

All of these changes can be overwhelming, and you may not be prepared for how it’s going to feel if you have never been through it before. In the first couple weeks after delivery, the emotional ups and downs are often referred to as the “baby blues”. This is very common, affecting about 80 percent of new moms. But this initial wave of emotions – fueled by big hormonal shifts – usually goes away on its own after about two weeks.

If these feelings last beyond two or three weeks, it could be a sign of postpartum depression (PPD) – which affects up to 20 percent of women. Symptoms include mood swings, sadness and crying, anxiety, inability to concentrate, poor appetite and sleep problems. Other postpartum behavioral health disorders include postpartum anxiety, postpartum post-traumatic stress disorder and postpartum psychosis, which is a rare but serious disorder.

Vagi says symptoms of PPD or other mental health problems should not be ignored and you should talk to your provider if you or your partner notice any concerning behaviors. Seeking help is important because there are many very effective treatment options available to treat maternal mental health symptoms.

Fourth Trimester Affects the Whole Family

While this postpartum period often focuses on the birthing person and baby, the fourth trimester really affects the whole family, including partners and other children. There are multiple ways your partner can support you during your recovery. These include:

• Handling overnight feedings (if bottle feeding) or diaper duty
• Taking care of other children while you feed or hold your newborn
• Taking over household duties such as cooking so you can rest

It is also important to involve older siblings in the routines you establish. Vagi suggests giving them an age-appropriate job or task to help them feel involved and get them excited about the new baby. You can also try to include some one-on-one time with older siblings every day to make them feel special.

Vagi advises talking about these things early in the pregnancy. Have conversations with your partner or family about ways they can support you after the birth. Making a plan ahead of time can make things easier once baby arrives, but flexibility is important, too; the postpartum experience can be unpredictable, so it’s OK if plans have to change.

Easing the Burden

One of the most important things you can do during the fourth trimester is allowing yourself time to heal and navigate your new role. Don’t be afraid to set boundaries with family and friends. Give yourself space to put polite and comfortable limits on visits, for example. But also give yourself permission to accept help. Vagi suggests making a list of ways loved ones can help – whether it is providing a meal, doing a load of laundry, or simply holding the baby while you take a nap or shower.

Other fourth trimester advice includes:

Get adequate rest: While it may seem difficult to get enough sleep with a new baby, rest is important in helping your body heal. Taking naps while the baby sleeps during the day and splitting night duties with your partner can help you get the rest you need.

Nutrition and exercise: Eating a nutritious diet and staying well hydrated will help your body heal and also help with milk production. If you are up for it, exercise can also be great for your physical and mental health. Remember to start off slow, like taking a walk around the block, and don’t start a more vigorous exercise routine until you have been cleared by your provider.

Skin-to-skin contact: Skin-to-skin contact is often done at the hospital or birth center immediately after your baby is born. It helps regulate your baby’s temperature, heart rate and blood sugar, and calms both you and the baby. It also releases oxytocin, or the “love hormone”, which is helpful for bonding with your infant and promotes healing.

Skin-to-skin contact is great to do at home as well. Make it part of your routine, such as after a bath. Vagi noted that as long as it is done in a safe way (no falling asleep with baby in an unsafe place), skin-to-skin is a wonderful way to establish a relationship with your baby while providing physical benefits for both parent and baby. Partners and siblings can also participate in skin-to-skin contact with the new baby.

No two postpartum experiences are the same. You may even find a vastly different experience in your first postpartum recovery versus subsequent pregnancies. Vagi says it’s important to feel comfortable talking to your healthcare provider about any difficulties you are having. Be sure to reach out if you notice any warning signs, either physical or emotional, so your concerns can be addressed.

“There are a lot of great resources available if you need them,” says Vagi. “Just don’t be afraid to ask for help. That’s what your provider is here for.”

Related Links

The women’s health providers at UH provide expert prenatal and postpartum care and a variety of resources to help guide new parents, including childbirth and parenting classes, breastfeeding support, our pregnancy handbook and more.