The concept of the Fourth Trimester is a fairly new term for one of the most difficult parts of pregnancy. But what is it?

By the time I was pregnant with my first baby, I had been a labor, delivery, and mother-baby nurse, for a couple of years. I knew what to expect throughout pregnancy, labor, and delivery. My postpartum care plan was well-rehearsed along with how I would be taken care of the first two days following the birth of my new baby, and also how I would follow up with my health care provider for my comprehensive postpartum visit six weeks later. I felt bulletproof and ready for what lied ahead.

It was 1:15 a.m. when he was finally here. Labor had started early that morning and I had spent most of the day at home managing my early labor. When I knew birth was getting close, I went to the hospital. It was only three short hours when cries pierced the early June morning. I couldn’t take my eyes off of him as my nurses worked around me, putting me “back together” after the delivery of my first baby boy.

Me finally meeting my new baby

Around 7 a.m. I finally dozed off for the first time. Thirty minutes later, I awoke to the nurse checking my baby’s temperature and taking my vital signs. Now it was time to breastfeed again. “Oh well,” I thought, “I’ll catch up on sleep eventually.” The whirlwind of nurses, lactation consultant appointments, medication times, learning to breastfeed and diaper changes didn’t phase me much. I had my baby in my arms and the hard part was through.

Well, not quite. 

The Fourth Trimester

Pregnancy and childbirth are hard, and we discount how long it will take to heal and recover from these things. Our days in the birthing center, or hospital, are only the beginning of a fourth trimester journey that will take us months of life to travel.

What is the Fourth Trimester of Pregnancy?

The 4th trimester is the term that refers to the first twelve weeks, a three-month period, following childbirth. It was first coined by pediatrician Dr. Harvey Karp who believes a baby’s environment should be much like it was inside the mother’s womb for the first three months following birth. During this time, you and your baby are separate but still one. It is a time of great change, transition, and process not only in your baby but also in you!

Here’s how long the fourth trimester lasts and why swaddling works well during this time.

I believe the fourth trimester is the hardest transition we make into motherhood. New mums experience a period of adjustment during this important time that includes physical changes. Our uterus is shrinking, our breasts are making milk, our incisions from perineal repairs or a c-section are healing, and our body is adjusting to weight and blood pressure changes. Between sleep deprivation, a changing sleep schedule, emotional changes, and the baby blues new moms can really struggle. Postpartum anxiety and postpartum depression can add to these struggles. Whether a vaginal delivery or a cesarean section, the early weeks following childbirth can be difficult for new parents. These changes aren’t simply from the transition that comes with a new baby, a growing family, and a recovering body.

What’s Happening Below the Surface?

Our brain literally changes during pregnancy, birth, and the postpartum period. It’s not simply a theory that motherhood changes us. It’s science. During this time period, our brains are experiencing “brain plasticity,” where they are reformatting more than they are at any other time in our lives. They are eliminating old connections while facilitating new ones, which may also be part of the reason we are more vulnerable to mental health issues such as postpartum depression and postpartum anxiety. And it may be at least one of the reasons that we experience “mommy brain” (also called “placenta brain”). Mommy brain is the term used to describe the way we feel hazy or suddenly forget things.

In other words, there is a good reason we put the milk in the cabinet. 

It isn’t only our brains that are changing by leaps and bounds, it’s also our hormones. Many are dipping. Many are rising, and the hormonal changes will continue for quite some time. Some research even suggests it may take two years for our hormones to settle back into a “normal” pattern.

With the added motherhood comparison effects of social media, the first months of this new life can be a vulnerable time that affects our emotional health in many ways. Family members can be a help or a source of shame and guilt during this time of great change. Being aware of how you are feeling is a great way to help you begin to navigate the choppy waters of physical recovery, infant care, and emotional health. Learning to ask for help when you need it is also very important. When others ask you what you need, you can be prepared to answer with What New Moms Really need after Birth.

What is a fourth trimester?

As a nurse, it bothers me enormously that we in the medical community have placed such emphasis on the six-week postpartum visit. I believe it has given mothers a false expectation they should be “back to normal” by this time. There is much emphasis on care for us throughout our first three trimesters of pregnancy and for our human babies, but little medical attention has been given to the mother’s health in the months following birth. But I have good news.

ACOG (The American College of Obstetricians and Gynecologists) is beginning to recognize the importance of the fourth trimester.

Change is coming Mama! There is a better reach of ongoing care from healthcare providers and medical professionals on the horizon for you, and I couldn’t be happier about it. It is my goal to fan the flames of conversation about this critical time period called the fourth trimester and to help new mothers make this transition as smoothly as possible through education, encouragement, and community.

Would you like to be a part of this journey? I would love for you to join me and to hear your story as I create resources for new mothers to make a better transition through the fourth trimester. Tell my story. (Don’t worry, it’s completely confidential!)

Though the fourth trimester can be the most difficult trimester of pregnancy, it is also one of the most rewarding. I encourage you to be patient with yourself. Give yourself lots of grace as you navigate this new time. Remember that your body is going through tremendous changes and on top of that, you have a new infant you are caring for. Your relationships are changing as well. There is much adjustment taking place and all of this is normal. Reach out for help when you need it. Whether that be talking to a friend, making a counseling appointment, or calling your doctor. Even simply taking five minutes a day to do something you enjoy, such as looking at flowers, drawing a picture, reading a book, or putting your toes in the grass, can increase emotional health by leaps and bounds. Your physical and emotional health matter Mama!

What is the Fourth Trimester?

The fourth trimester is a metamorphosis journey. It completely changes us physically, emotionally, and spiritually. Much like the caterpillar that transitions to a butterfly, so are new mothers. New, but still you! Please know you are surrounded by so many others that have gone through what you have, and you are not alone. Here’s to thriving in your fourth trimester journey!

Here’s a few things I wish I had known during my 4th trimester for me and my husband: Does the first poop after birth hurt? and 7 Things You Should Know About Sex After Birth

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Rachel is a Postpartum Nurse of 15+ years. She is also a Spinning Babies® CPE, Childbirth Educator, Published Author, and Recipe Creator. Rachel's passion is to encourage and empower women in all things related to motherhood.

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