What is the 4th Trimester?

In medical circles, your due date is referred to as your EDC (Estimated Date of Confinement). This is the time when a woman retreats to rest and recover from the birth of her baby. The moment your baby is born, you enter the rapidly changing world of the fourth trimester, a time when you recover physically, mentally and emotionally from childbirth while at the same time you are caring for your baby. 

Up to 80% of new mothers experience negative feelings or mood swings after the birth of their baby, commonly called the Baby Blues. The feelings may last for several minutes to several hours a day and should be gone by 2 weeks. Symptoms of the Baby Blues may include:

• Weepiness or crying for no apparent reason
• Impatience
• Irritability
• Restlessness
• Anxiety
• Inability to sleep
• Sadness
• Mood changes
• Poor concentration
• Fatigue

The exact cause of the Baby Blues is unknown. It is thought to be related to the hormone changes that occur during pregnancy and again after a baby is born. These hormonal changes may produce chemical changes in the brain.

If those feelings persist past two weeks you may be suffering from postpartum depression (PPD). Up to 20% of new mothers will experience PPD. Symptoms may occur up to a year after giving birth and symptoms can be mild or severe. Postpartum depression does not have a single cause. Research suggests it is caused by a combination of genetic factors, life stress, the physical and emotional demands of childbearing while caring for a new baby, and changes in hormones that occur after pregnancy. Also, women are at greater risk for developing postpartum depression if they have a personal or family history of depression, bipolar disorder or if they have experienced postpartum depression with a previous pregnancy.

Some of the symptoms include:

• Feeling sad, hopeless, and/or overwhelmed
• Fatigue
• Trouble sleeping and eating
• Feelings of guilt and worthlessness
• Losing interest in things that you used to enjoy
• Withdrawing from family and friends
• No interest in your baby
• Thoughts of hurting yourself or your baby

Because postpartum depression can range in severity, it’s very important that any woman experiencing these symptoms talk with her health care provider. Wellness treatment may include medication and/or therapy. At encounters during the postpartum period, whether it’s with your OB, midwife, or other health care provider, such as a lactation consultant, you may be screened for the symptoms of postpartum depression. This will help you talk with your provider about what you are feeling.

It’s often said that we plan for the wedding but not for the marriage. The same can be said of childbirth and the period after. Just like many women write a birth plan to communicate their ideal birth, the weeks and months after the baby comes will need planning too. You and your partner or family will want to write a postpartum care plan in your third trimester. Be open to not yet knowing how long your postpartum period will last and how much time you personally will need. Your birth is unique and what you experienced or didn’t experience shapes how long your postpartum lasts. 

In her book, The 4th Trimester, author Kimberly Ann Johnson lists the five universal postpartum needs of new parents. They are:

• An extended rest period
• Nourishing food
• Loving touch
• Spiritual care
• Contact with nature

Let’s look at these needs in a little more detail. 

• Extended rest period - your recovery takes what it takes. You can’t rush it or cut it short. Your body needs time to recover from the simplest of births to the most complicated.  New mothers around the world are expected to rest for 20-60 days. Only in western countries are new mothers expected to be running the household, going to work, visiting the gym and - oh yes - losing that baby weight by 6 weeks postpartum.
• Nourishing food - Food is medicine. A healthy lifestyle and diet rich in nutrients doesn’t only promote healing in the postpartum period but supports long term health as well. Some foods, including oatmeal, almonds, whole grains, beans and green leafy vegetables, can help increase your milk supply. Many cultures serve the new mother warm soups with spices to promote warmth.
• Loving touch - A woman’s body goes through dramatic physical and hormonal changes during and after birth. You can help your organs return to their proper place, calm those raging hormones and improve your mood with bodywork. Why not ask for gift certificates for a postpartum massage as a baby shower gift?
• Spiritual Care - In most of the world, birth is still considered the territory of women. Being tended to by women of different ages and experiences, like a grandmother, mother, aunt and sister, can soothe your soul, give you knowledge about breastfeeding and baby care and guide you through your fluctuating hormonal state.
• Contact with nature -  Simply taking a walk or sitting on the porch or patio on a warm day will suffice. You don’t even have to go outside, although getting out of the house can improve your mood and well-being (and calm a fussy baby!) In cold weather, you can move your nursing station to a sunny window; take a warm sponge bath with herbal infusions, or enjoy herbal teas. 

A postpartum plan allows you to identify and communicate your needs for the 4th trimester. Here are some suggestions based on Johnson’s five universal postpartum needs:

1. Assemble your tribe - who do you want around you after the baby comes?  Is it your mother, mother-in-law, aunt, sister, or best friend? All of them? Make a calendar for who comes to help on what days. That way you will have access to their wisdom about baby care and breastfeeding for several first weeks.
2. Identify what you need from your tribe - Think of your needs for rest and recovery. You can’t meet those needs by managing your household when baby sleeps. You will need help.  What are the routine tasks that you need help with?  Is it someone to empty the dishwasher, do laundry, provide a meal? Ask for what you need. That may be difficult if you are used to managing things yourself, but we are not superwomen. My mother came to stay for 2 weeks after my baby was born. I thought she was there to do the laundry and clean the house. She thought she was there to hold the little one. That created stress and conflict. The thing is I never told her what I needed from her. Be clear about what you need from the people who are there to support you..
3. Consider other sources of help - What about a postpartum doula? At Aeroflow we have lactation specialists who are also doulas. They can offer on-line support. Online and in-person support groups can help you feel less isolated. You get the chance to talk with other mothers who are on the same journey, pick up tips for the rough days, and learn about baby care and breastfeeding. Aeroflow has an online support group, Mom’s Circle that meets every Monday at 3 pm Eastern time.
4. You need nourishing food - A new baby’s needs are few - feeding, changing, comfort - but they are constant. This can mean there is no time for meal prep. You can find you’ve gone all day with just a snack or even nothing at all. Consider asking friends for a meal train so that hot, nourishing meals are available every day.
5. You need companionship and wisdom - This might be a trusted friend or family member that you can call for a short visit so you can talk about your feelings and how things are going. Bonus points if they are a mom themselves as they will have advice that will help you on your journey.
6. Limit visitors and technology in the early days - Your friends and family will want to see and hold your baby; but a steady stream of visitors can tire you and the baby. Consider turning your phone off, especially in the evening when screentime is most disruptive to your sleep schedule. Try to avoid the computer as well to give you more time for your recovery and your baby.

Your 4th trimester will have good days and bad days. Enjoy the good days and give yourself grace to get through the bad. The day will come when your 4th trimester is in the rear view mirror and you can feel good about how you managed it even if things weren’t perfect.

References

https://link.springer.com/article/10.1007/s00737-008-0030-9

https://www.sciencedirect.com/science/article/abs/pii/S0165032723004007

https://www.sciencedirect.com/science/article/abs/pii/S0193953X1730076X

https://www.scielo.br/j/paideia/a/6WfzwMKzbBKJVHvHRk5nCBP/

https://americanpregnancy.org/healthy-pregnancy/first-year-of-life/how-to-prevent-postpartum-depression/

https://www.psychiatry.org/patients-families/postpartum-depression/expert-q-and-a

https://www.shambhala.com/authors/g-n/kimberly-ann-johnson.html