Written by Olivia Nelson
What is the “Fourth Trimester” and why is it important for women to know what to expect and what resources they have available to support them through this period? Provide information and resources so that women can explore this more and have a better understanding of the fourth trimester.
When searching for the definition of “the fourth trimester,” most websites leave you coming up blank. It’s almost common knowledge that these words refer to the period of time after the birth of a baby but does not extend much further than that. Only when searching deeper (onto an article written by a Michigan law school student/scholar) do we find anything closely resembling a technical definition.
The concept of a fourth trimester, drawn from maternal nursing and midwifery, refers to the crucial three to six month period after birth when many of the physical, psychological, emotional, and social effects of pregnancy continue.
The fourth trimester describes a postpartum period of recovery, restoration, and re-imagination. Under this framework, pregnancy and the process of childbearing extend beyond the birth and into the first three months after delivery, and sometimes beyond. Conceptually, the fourth trimester provides important recognition that the transformative process of pregnancy, birth, and motherhood requires time and care during this period of adjustment.
To put it in even simpler terms – we need to be giving our new mothers and birthing parents a resting, nesting and rejuvenating period after childbirth. Women and birthing people generally spend a lot of time preparing for their birth, with a birth plan, antenatal appointments, scans and exercise classes. Women and birthing people also spend much time preparing for their baby, with classes on newborn care, baby showers and endless shopping trips. One thing that women & birthing people tend to forget is the preparation for themselves and their recovery and transition in the postnatal period.
Step 1: Recover physically
When was the last time that you had major abdominal surgery, ran a marathon, pushed something huge out of your vagina (or a combination of the three) and went back to normal life straight after? Women’s bodies are designed for childbirth, but this does not mean that it isn’t a challenging and physically demanding event.
The state of your perineum and vaginal area will rely grossly on the specifics of your birth. Sometimes you might have tearing, or a re-stitched episiotomy (cut to the perineum performed by your medical professional). You might be one of the lucky ones with only severe swelling and discomfort. Whichever applies to you, the importance is to give your perineum the appropriate care and rest in order for it to recover.
Perineum care instructions:
- Keep the area clean! The use of a peri bottle of warm, plain water has shown to be perfect. If you wish, the adding of Witch Hazel or Salt to the warm water has shown to provide soothing for some women. (NB: simple spray peri bottles can be purchased at chemists or online for $4 (give or take), and the slightly more practical squeeze bottles with an angled tube can be purchased for around $12). It is important to rinse / clean the area after every visit to the toilet, just to avoid infection and encourage healing.
- Let it breathe! It is preferable to wear cotton or other natural and porous materials, to allow for and assist in the healing process.
- Change your pads! (Yes it’s totally not glamorous, but you will need to be wearing pads after your birth). Experts recommend changing your pad at least every four to six hours, or more if required.
- Wait before sex!
- Consider seeing a Continence and Women’s Health Physiotherapist sooner rather than later. After a relatively straight forward vaginal birth, it is said that you may resume pelvic floor exercises from day two post birth! Make sure you check with your health care provider, or book in a consultation with a CWH Physiotherapist in order to assess fully and personalise care instructions.
- Be cautious when emptying your bowels in the beginning. Making sure you eat plenty or fresh, clean foods that are full of fibre, you are more likely to protect the area, any stitches or bruises sustained to the rectum.
- Apply warmth! Traditional cultures have always encouraged warmth around any area that needs healing. Apply warm peri tea to your pads for that bit of extra comfort.
- Sleep when baby sleeps! – This is the oldest one in the book, but it is so important! As a new mum or parent, the moments available for sleep are often few and far between. This is made worse by the fact that your parenting journey/transition happens often after a long early labour and sometimes several days without a good night’s sleep. Your body and mind are more likely to be at one with each other (and baby) the more you are well rested.
- Create your sleep environment. Make a sign for your front door so as to warn visitors – “Mum and baby sleeping! Come back later.” Make sure you have block out curtains for those early afternoon siestas.
- Minimise other responsibilities, or “let them go”. The house maybe doesn’t need to be as beautifully organised as when you didn’t have children. Someone else can probably make the cookies for the bake sale at the school. Prioritise YOU!
Extra Physical Recovery Tips:
- Eat warm foods! Add spices that are appropriate for postpartum, such as turmeric (has great anti-inflammatory properties, and is said to stimulate the uterus, helping it return to its before-pregnancy size) or garlic.
- Drink a lot of water! The body needs more water to produce breast milk, but also to rebuild and regenerate faster.
- Eat high fibre foods, and probiotics too! Think lots of healthy, fresh veggies, balanced out with yoghurts, kefir or you could even try kombucha!
- Ease into physical activity. I always recommend you wait for your medical health provider’s okay around your 6 weeks postpartum check-up. From there, we’re looking at being particularly wary of your pelvic floor, and just making sure you’re moving. I always recommend specific postnatal yoga or mums and bubs classes, as long as the teacher or coach has some special knowledge about that period.
- Go for a walk! If you feel like moving and getting outside, going for a walk can do wonders – physically and mentally!
- In England, midwives traditionally supply newborn mothers with cups of tea shortly after birth! We know that this ritual in England is very highly associated with slowing down, taking a break. Find something that allows YOU to disconnect, and maybe fill you with warmth too.
Step 2: Recover Mentally
This can be one of the hardest ones. Through no one’s fault, a lot of women and birthing people find themselves very isolated from their normal communities in the first few months after birth. Some women go through a grieving process, as they’ve lost their ability to do things spontaneously or alone. They aren’t back at work with their colleagues as usual, their sport and fitness communities or classes continue without them, and friends and family stay busy with their normal lives! This is where it is important to ask for help!
Can you call on baby’s grandparents? Can you ask for a postpartum doula to provide some discussion and maybe time for yourself? Or could you use one of the postnatal help resources available to us in Australia.
Here are some resources that are available to you:
I particularly like this resource from Pregnancy, Birth and Baby ; print it out here and stick on your refrigerator.
Step 3: Bond with Baby
An under discussed part of the postpartum healing is bonding with your baby. While in an ideal world, parents form an immediate emotional connection and bond to their baby within 24 hours. In reality, some families experience this immediate bond, and some must work on it.
You are not a bad parent, and there is nothing wrong with you if you feel like it’s hard work to bond with your baby! Everyone is different and remembering that even the way that you give birth can play a big role on how naturally things happen.
SKIN TO SKIN is especially important. The hormone of love (Oxytocin) is naturally released by both yourself and your baby when you are doing skin to skin. This hormone with accentuate the loving behaviours you already have towards your baby, and also creates an “anti-stress” physical effect in both your body and the body of your baby.
Holding, cuddling, talking, smiling, and gently rocking your baby can show your baby that you care, & respond to their cues for comfort in a sensitive way.
Some medical professionals suggest trying to get to know your baby as a unique person, rather than as “a baby”.
As we know, foetuses respond to sounds as early as 19 weeks in utero and will recognise both their parents’ voice as a new born. Remember this when you spend time with your newborn and speaking softly but often with them will not only help your bonding, but also will help forge their future social skills.
Breastfeeding / Chestfeeding
This is a sensitive topic, and we have to recognise that while there are many proven benefits to breast or chest feeding your baby, there are sometimes contraindications or disadvantages in each specific situation that outweigh the advantages.
Breastfeeding or chestfeeding combine some of the classic bonding methods (skin to skin, smell, time together) with the added nipple stimulation (and release of extra oxytocin!). Some preliminary research shows a link between colostrum in the baby’s stomach, and attachment to their lactating parent.
Here is an amazing article about bonding and bottle feeding, giving you some important tips on how to keep that bond up, even though you have chosen not to breast feed or chest feed.
Step 4: Patience, and all is coming!
Between the emotional changes, the bonding, the baby, your perineum, the lack of sleep, the new visitors, you will need to BE PATIENT.
Be patient as it isn’t a quick process, but in the end it is a truly rewarding one. Seek help where possible, think of hiring a postpartum doula, talk openly, and do whatever suits you and your family. Postpartum care and healing is ongoing, not a one off thing!
Namasté and thanks for reading !
My name is Olivia Nelson and I am a Doula who has trained at the Doula Training Academy. If you would like to talk more about your birthing options, please contact me:
- Saru M. Matambanadzo, The Fourth Trimester, 48 U. Mich. J. L. Reform 117 (2014). Available at: http://repository.law.umich.edu/mjlr/vol48/iss1/3
- Currer-Briggs, Practice Development Midwife September 2014
- Oxford University Hospitals NHS Trust
- Currer-Briggs, Practice Development Midwife September 2014Oxford University Hospitals NHS Trust
- WHO Library Cataloguing-in-Publication Data
- Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice – 3rd ed.