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The Importance of the Fourth Trimester

Focusing attention on the postpartum mother


Photo Credit: Shutterstock

I recently attended a baby shower for a woman 20 years younger than me. Guests excitedly ooh’d and ahh’d as the soon-to-be mother unwrapped boxes to reveal soft blankets, bottles of all sizes, and onesies in assorted colors. Throughout the luncheon I kept thinking, “Why don’t we shower the mother with things she will need for herself after the baby is born?” Don’t get me wrong, babies need lots of gear. Knowing what I know now, mothers do, too.

Pediatrician Harvey Karp, M.D., coined the phrase “the fourth trimester” and theorized that human babies are born about three months too early. It brought understanding and awareness to infants’ physical, emotional, and social needs as they learned to live outside the womb. Over the last several years, medical professionals broadened the theory to include mothers in this term. The multitude of changes within the new mother’s body and mind underscore the reason for the expansion in understanding.

Trends in maternal healthcare show an increase in the holistic approach to caring for moms. The American College of Obstetricians and Gynecologists (ACOG) now advises that new moms connect with their ob-gyns several times during the 12 weeks after birth, with the first checkup within three weeks. You can learn more here. This checkup identifies any physical concerns for the mother, such as high blood pressure or breastfeeding complications. It also gives insight into the mother’s mental health and can identify needed resources, such as therapy or a referral to a lactation consultant. The healthcare system has even started to recognize the benefits to postpartum home visits. While newer in the U.S., home visits are common or standard in other developed countries.

Cindy Rubin, M.D., owner of In Touch Pediatrics and Lactation, shares how today’s journey into motherhood differs from the past in several ways:

  1. Historically, women weren’t in the workforce in the numbers they are today. They didn’t feel the pressure of needing a return-to-work plan. Most women are not fine to return to work at six weeks postpartum. Their bodies need more healing, their minds need more time to clear, and they need more bonding time with baby. “We haven’t changed our ways when it comes to supporting women in the postpartum period, yet we live changed lives,” says Rubin.
  2. Social media puts pressure on mothers and how they view their parenting. Information is available 24/7, and it’s not always the most accurate or supportive. Constant information and the addictive nature of social media increase the mental load new mothers experience. It can cause more harm than good, especially for new moms comparing themselves with images of the “perfect” mother on their Facebook feed. “We see new moms with clean homes, dressed with makeup on, smiling, and relaxing. These are not realistic images and make new moms feel like they are somehow failing at their job of being a parent,” says Rubin.
  3. New mothers may not understand the value of the “village” nor want to accept it. Today’s generation grew up believing they could and should have it all—work, family, social life. Having a baby means a loss of control and independence, and a full-time job added onto the previous responsibilities before baby. If a new mother is not ready for the overwhelming changes and challenges, she may decline help once the baby arrives, worrying others will view her as weak or not a good mother. New moms need support and affirmation that asking for help is both okay and necessary.

If you know someone expecting a baby, spend time with them during the pregnancy thinking about the time after the baby arrives. Experts share these strategies to prepare for the fourth Trimester:

  • Build your village—contact family, friends, neighbors, and colleagues to establish who can provide support during the first few months of baby’s life. Identify support services, such as doulas or lactation consultants, collecting their contact information ahead of time. Help can come from unusual sources at times, too, so stay open-minded to offers from those you might least expect it from.
  • Create a to-do list—the key to this? Put a pad or paper or Post-it notes in every room. That way when you think of the “to-do,” it does not matter where you are, you can easily grab paper to write down your ask. When help in the form of visitors comes to the house, simply direct them to the lists and ask them to select what chore or errand they want.
  • Get comfortable with unfinished chores—this is a tough one for many women, so preparation ahead of time ensures the reality of it will be easier to accept. Having a baby is a loss of both control and independence. This means your kitchen floor may not be clean and finishing the laundry may take several days. What matters is spending time with the baby and yourself. Outsource what you can, and everything else can wait—you and your baby can’t.
  • Self-care—A burnt out mom isn’t capable of being a good mom. It might seem easier to let self-care go. In the long run, it’s vital to a new mom’s mental health. Do not feel guilty. Go to lunch with a friend, get a massage, have a date-night with your partner. Know that it’s okay to use a sitter to schedule your own self-care.
  • Stick to your guns—stay true to what you need for your baby, yourself, and your household. Don’t let others influence you—you are in charge! If you don’t want anyone holding your baby, then say “no” when visitors ask to hold her. If you want to keep trying to breastfeed, ignore the well-intended folks telling you to use formula. Building confidence in saying “no” before the baby arrives will make it easier to navigate when you face the situation in real time.
  • Keep it in perspective—In the midst of hormonal recalibration, sleep disturbance, the lack of a schedule, and the general upheaval that a new baby can bring, it’s important to remember that some relief may be afforded in knowing the current situation is temporary. “Not unlike the distorted image a mirror reflects when we look at it too closely, a little bit of distance can offer a clearer picture that this phase, as challenging as it can feel, will indeed pass,” says Dayna Kurtz, LCSW, CPT, psychotherapist and author of Mother Matters. “Hormones shift, children sleep (eventually), and routines emerge.”
About The Author
Katy Peterson

Katy is an executive sales leader who has spent 15-plus years in the healthcare field. She lives in Milwaukee, WI, with her husband and five children. Katy has a passion for health and wellness, especially as it relates to nutrition and women’s health. When not working, she loves to spend time with family and friends. She also likes to read, write, and practice yoga.