Trimesters: Fourth Trimester
A fourth trimester? Doesn’t “trimester” necessitate only three?
Well, yes, however, many people refer to the first three months postpartum as being the “fourth trimester.” This is a time where your body is in a final transition back to your prepregnancy hormones, your body is recovering from giving birth, and your baby is experiencing a whole new set of challenges and transitions.
What does the fourth trimester mean for mom?
In the fourth trimester, your body is healing, your hormones are balancing out again, new hormones are causing your body to do new things…lactate, you are likely not getting enough sleep or rest, and you now have a human life to take care of. You are physically and emotionally drained. You are exhausted and worn out. You look at your sweet, new baby and he is beautiful and perfect and you are not sure you are cut out for the job. You are tired, feel ill-equipped, and possibly anxious and depressed.
Everything you are feeling is one hundred percent normal. You are not a failure, you are not going to fail your child, you are the perfect mother for your child. Things will get easier. Show yourself grace, ask for help, and learn to rest in the peace that God does not make mistakes. He has not given this child to you as a mistake. He will give you what you need to be a good mother, even when it feels like He has forgotten about you.
Edema is swelling due to water retention. You will notice this mostly in your feet, ankles, hands, and face. This is more common in hospital births, especially C-section births, where IV fluids are administered. Your body will start to get rid of the excess fluid within a few days and you will probably notice an increased frequency to urinate. If you do not start noticing a reduction within a week, the swelling gets worse, or there is swelling in only one side, call your doctor or go to the ER immediately, it could be a sign of a more serious condition.
This bleeding will continue for about six weeks. You will not be able to wear a tampon and the bleeding will be quite heavy in the first week or so. Invest in one or two packages of Depends and/or the super massive pads. If you develop a fever or have more intense uterine pain, call your doctor immediately or go to the ER, it can be the sign of a more serious condition.
This may last up to six weeks. If you tore or had an episiotomy, you may experience more soreness than if you had not. Try sitting in a sitz bath and padsicles (witch hazel soaked pads that are frozen).
Pain medications can cause constipation. Add to that your nether regions are pretty swollen and due to the pain you are afraid that you may further damage yourself by pooping or that your insides may fall out if you push, going “number two” may not be on the top of your priority list but it really needs to be. Your insides will not fall out, you are not going to damage yourself, and, yes, it probably isn’t going to feel good the first few times. However, the longer you wait, the worse it is going to be. Drink tons of water, eat fiber-rich foods like fruits and veggies, and take a stool softener.
This is when you sneeze, cough, or laugh and a little urine comes out uncontrolled. You are not gross, you are not broken, you are normal. The muscles that normally help control this problem have been stretched out and your bladder has been displaced due to carrying your baby. You should notice this issue improve greatly in about six to eight weeks. Some women, especially after multiple births, may always have this issue. You can strengthen these muscles by doing Kegel exercises. If you continue to have this problem, speak with your physician or midwife. There are physical therapy regimens and surgeries that can help but for now, show yourself some grace and know that this is one of the less attractive merit badges of motherhood.
This cramping, aka “after pains,” is due to your uterus returning to normal size. These cramps range from mild to as intense as a few of your contractions during labor. These are normal and good. They are typically more intense right after birth. After the placenta detaches, your uterus contracts to close off the blood vessels that were connected to the placenta. The contracting of the uterus is what keeps you from hemorrhaging. Oxytocin, which your body produces while breastfeeding, is what causes contractions. This explains why you will notice them becoming more pronounced while feeding your baby. This cramping usually only lasts a few days after delivery.
- Engorged breasts
About two to five days after birth your milk will come in. Until your body regulates to how much milk your baby needs, you will be producing quite a bit. This will cause your breasts to almost “over fill” with milk. Your breasts may feel like hard rocks and they may ache. Make sure you wear a supportive bra both during the day and at night. Nursing on demand will train your body to how much milk you need to produce for your baby. You can pump for relief but do not make this a habit or your body will think you need to produce that much.
- Hair loss
During pregnancy, you probably noticed your hair not falling out and looking much thicker. This is due to all the exciting hormones flowing through your body. About a month to five months after giving birth, these hormones go away or dissipate and you may notice a lot of hair falling out. Don’t worry, though, extreme hair loss is very rare and your regular hair loss/growth cycle should resume within a few months to a year. If you are concerned, you can ask your care provider to check your thyroid. Hypothyroidism can cause increased hair loss.
- Skin lightening
You may have noticed places on your skin darkening during pregnancy: the line from your belly button to your pubic area or maybe on your face sometimes referred to as “pregnancy mask.” These places should start to lighten up and return to normal. This lightening can be very slow, longer than a year, and some women never see it completely fade.
- Baby blues/Postpartum depression (PPD)
Due to all of the hormones and lack of adequate sleep, it is very common for mothers to experience what is commonly called “baby blues” for a few days or a few weeks. However, if it lasts longer and/or becomes more than just “the blues,” you should seek help from your care provider, a therapist, or counselor. Postpartum depression is very common and nothing to be ashamed about. It is not due to weakness of character or mean that you are broken. However, you do need help. The sooner you get help the better the situation will be for everyone.
What does the fourth trimester mean for baby?
This is a whole new world for you baby. He has been nice and warm floating in a dark and relatively quite environment for nine months. Now he is suddenly exposed to this huge, bright, cold, and loud world. That has got to be quite a shock. It is almost like baby is experiencing a bit of PTSD for the first few months in this new and scary world.
While in your womb, your baby enjoyed all the jostling every time you moved. He will still like this outside of the womb. It is popular to use your birth ball even after your birth to rock and bounce your newborn. Never violently shake your baby but gently rocking, jostling, and bouncing is often very comforting to your baby. This is one reason why so many babies calm down and fall asleep while riding in the car.
Even though he became a bit cramped near the end, your baby enjoyed his snug apartment during those first few months of his life. Swaddling is a great way to mimic this comforting and reassuring environment outside of your body. Below is a great video on several ways to safely swaddle your baby.
Although your baby is an adorable bundle with lots of sweet rolls, he is still learning to regulate his body temperature. Make sure you are keeping your baby bundled up but be careful of overheating.
Your body wasn’t exactly a noise free zone, but it did come with an interesting and soothing soundtrack. For nine months, he has enjoyed hearing your heart beat, your blood flow through your aorta, your intestines processing food, your tummy grumble, and your and your husband’s voices. White noise makers can help your baby feel more at home. If you sang any songs during your pregnancy, your baby will recognize those songs now. Singing and sweetly talking to your baby will be a huge comfort to him now. He will even recognize dad’s voice so encourage him to sing to his child, as well.
Babies have a very developed sense of smell, even more so than adults. They can even tell the smell of their own mother’s milk over others. Baby wearing can be very comforting to your baby. He will feel safe and secure feeling your warmth, hearing your voice, and smelling you.
“Don’t Worry About Creating ‘Bad’ Habits: Yup, it’s true—you cannot spoil a newborn! No matter how much you rock, cuddle, wear, or hold your baby, she is going to turn into an independent little person. Children are not spoiled by love and affection; they thrive on it.” (Becoming Mamas)
If you haven’t read or watched “The Happiest Baby on the Block” by Harvey Kapp ( book | video ), then you should order it today! Some of it may seem a bit cheesy but trust me, this will be a sanity saver.
If you are needing a little extra help or advice, I recommend contacting a postpartum doula and/or finding a new moms group or lactation group. The wisdom and support these other women can offer will be quite valuable. You do not have to go it alone. Find friends who can help you navigate these new waters.
The fourth trimester isn’t really a trimester but calling it one seems to indicate that this is a time to give yourself grace as you recover and transition into the role of motherhood. It also gives baby the time to learn about his new home and develop a routine that works for both of you.
Yet You are He who brought me forth from the womb;
You made me trust when upon my mother’s breasts.
Upon You I was cast from birth;
You have been my God from my mother’s womb.
If you are in the Denton, TX area and are interested in hiring a doula for your birth experience, contact me today to schedule a free consultation. If you enjoyed this article, you may be interested in checking out my Comfort Measures in Labor page.