A pregnancy consists of three periods, known as trimesters. Most new parents are familiar with this concept. Folks who have welcomed a new baby have noted milestones and changes unique to each of these periods, but how many parents are aware that there is a crucial fourth trimester?
The word trimester actually does not mean three periods. It originates from the Latin word trimetris, meaning three months. The concept of a fourth trimester was introduced in the late 1970s and then popularized by pediatrician Harvey Karp in 2002 to describe the twelve weeks a newborn needs to adapt to being outside the womb. It is also the time mothers are going through significant physical and emotional changes and both parents (and sometimes, siblings) are adjusting to their new roles.
Human Infants Are Unique
Human infants are born in a state of complete dependence on others – more so than any other mammal. It has been estimated that to be born with the neurological and cognitive development of a newborn chimpanzee, a human fetus would need to remain in utero for eighteen to twenty-one months. This reliance on caregivers is not only necessary for the human infant’s survival, but also is the foundation for social connections throughout a human’s lifespan. Newborns are emerging from a cocoon in which they have ideally been perpetually nourished, housed, and comforted. They always heard their mother’s heartbeat and felt their warmth. They were never hungry or alone. After birth, babies are bombarded with new smells, tastes, and sounds. Newborns are seeking to communicate their need for sustenance as well as human contact, and they are extremely needy. For the first twelve weeks after birth, infants need frequent feeding and near constant human contact. Despite all the books written to the contrary, newborns generally are not going to sleep more than a few hours at a time.
For moms, the fourth trimester is a period of significant emotional and physical transition. For the first few hours after childbirth, someone who has given birth will often experience an emotional high. A baby is naturally awake and alert for the first two hours, as well, and this can be an opportunity for bonding. Afterwards, babies are very sleepy in the first few days, they may even need a little bit of coaxing to nurse or drink from a bottle. Between days three and five, moms can experience an emotional roller coaster – marked by intense emotional highs and lows – that is often referred to as the baby blues. During this time, hormones are in flux and regular sleep patterns are nonexistent. For most moms, this period passes. New moms should reach out to a primary care provider if these feelings persist.
After six weeks, moms are usually experiencing growing confidence and emotional leveling. By twelve weeks, life finds a new normal as babies are beginning to sleep for longer stretches and are interested in their surroundings or simple toys when they are put down. For moms and babies, a routine begins to emerge.
Fourth Trimester in the Real World
We have a lot to learn from cultures around the world. In many places, rituals are observed that honor this time. Latin American cultures observe la cuarentena – a forty-day sequestered period in which new parents focus on healing and bonding with their baby. In China, new mothers observe zuo yue zi, or sitting the month, as a period of rest, dietary, and lifestyle restrictions. A recent qualitative systematic review examined traditional postpartum practices from fifty-one studies in more than twenty different countries. Common themes focused on support for the mother, periods of rest, and nutritional recommendations.
In the United States, corporate America is beginning to acknowledge the importance of time. I have seen a shift, albeit a slow one, in the length of maternity leave that is available to new mothers. I have also seen many companies acknowledge the importance of parental leave for both parents. We still have a long way to go to support families with new babies, especially for mothers who work in the service industry and lower-paying jobs.
Fourth Trimester Strategies for Moms
If you have recently given birth, give yourself grace and find your tribe – whether it is extended family, friends, or community. In The Fourth Trimester Companion, Cynthia Gabriel, PhD, advises new moms to not put themselves in a “bliss guilt vise.” She adds that it is “normal that most of your time taking care of a newborn in the first few weeks feels hard – not wonderful.”
Acknowledge this and find ways to simplify your life. Wear your pajamas or comfortable sweats for the first few weeks. Make yourself a nest on the couch and follow the advice to not go up the stairs more than once a day. Sleep when baby sleeps. This will be different than your usual pattern, but mothering releases hormones that will make you sleepy at all times of day. Take advantage of these hormones and sleep. Get some sunshine. If you head out for a walk and get to the corner and it’s too much, allow yourself to turn around and head home. Tell your partner what you need and how they can help. Let them know that simply being present is worth more than they know. Know that on your low day, they are probably exhausted as well.
During the fourth trimester, the focus should not be on infant sleep. Newborns are not wired to sleep. It should be on parental sleep. Find ways to tag team and give each other breaks. Accept help from everyone. Let people feed you and encourage them to leave the meal on the doorstep. Do not be afraid to limit visitors, particularly in the first few weeks. Feel free to say no to help that is not helpful. Surround yourselves with people who are supportive.
Finally, I cannot emphasize this enough: Ask for help! If a friend or neighbor can come hold your baby for a few hours while you shower or nap, let them. Honor this time as your baby adjusts to this big new world during the fourth trimester.