The Fourth Trimester of Pregnancy: What to Expect

Congratulations! You’ve just welcomed your new baby into the world, and you’re starting to get to know this familiar little stranger. The first three months post-partum are often referred to as “the fourth trimester.” The fourth trimester is the period where the baby is adjusting to the transition from the womb to the outside world. It is also a huge physical and mental transition for the post-partum individual. It’s both an exciting and challenging time.

Reproductive psychiatrist Alexandra Sacks, M.D, uses the term matrescence to describe the transition to motherhood. Sacks compares this transition to adolescence—with your hormones running wild and your body behaving in ways unfamiliar to you. Puberty is something most people understand and can empathize with. However, there is little understanding for a new mother during this similar transition—most of the care focuses on the baby and less on the recovering postpartum individual. Mothers are expected to be joyous and natural in their new role, despite the fact that they, too, are going through a lot of changes.

Just like pregnancy, nothing can prepare you for how you will respond to the first few months of postpartum life. Staying informed and aware of what can happen is important. Even more important is being open and honest with those around you so they can best support you.

Here’s what can happen in the fourth trimester, week by week.

The Fourth Trimester: Postpartum weeks 1+2

Body and Mind

The first two weeks postpartum revolve a lot around rest and healing. The progress of your healing during these weeks will depend on whether you delivered vaginally or via c-section, and how smoothly it went. Take things slow.

Some physical changes you may notice include:

  • A swollen labia
  • Heavy vaginal discharge and bleeding, called lochia
  • Decreased swelling in your face, arms, and legs
  • Pregnant-looking belly as your uterus takes time to contract and shrink
  • Fuller breasts as your breast milk comes in between days 3 and 5
  • Constipation for several days after delivery

Mentally, your mind feels like mush. The first couple of days you are running on adrenaline. Eventually, the lack of sleep starts to creep in and the foreignness of parenthood is more present and frustrating. Most women experience feeling the baby blues in the first two weeks.

How to cope—Say yes to support

After my first baby, I was so determined to remain in control that I refused help in the first couple of weeks after his arrival. I felt like I was failing if I couldn’t do it all myself. I was sad, exhausted and overwhelmed. The second time around, I learned to let go. I realized accepting help wasn’t a failure, it was healthy. The saying is true—it takes a village. Lean on your support system to rally around both you and your baby.

Practice saying yes when people offer to help and give them something to do. If they want to hold the baby, excuse yourself to take a shower or lie down. If they are staying for a while, have them change out your laundry, do some dishes, or bring groceries or prepared food. It can be uncomfortable to ask for help but people genuinely want to know how they can help you during this time. Take advantage of this help. You need love and care during this time too.

Your baby

Once your baby is born, start skin-to-skin contact as soon as you can. Skin-to-skin creates bonding between the two of you and gives the baby a feeling of safety. They’ve just come from very tight living quarters to wide open spaces. This transition is scary for a baby.

Generally, newborns will sleep for 8–9 hours during the day and 8 hours at night—note that these are not consecutive hours! Their little stomachs will want nourishment often—typically every 2–3 hours. The first few poopy diapers will consist of a tar-like substance called meconium. Meconium is made up of material your baby was ingesting in the womb. It’s sticky and hard to clean—you’ll look forward to regular bowel movements soon.

The Fourth Trimester: Postpartum weeks 3 + 4

Body and Mind

Breastfeeding can feel like the most unnatural natural process. It takes a lot of work, time, and energy.

You’re starting to learn what works for you and your baby. As with pregnancy, well-meaning people will offer advice and guidance that may differ from what you are doing. There’s no harm in trial and error. If something isn’t working, try something new. Your baby is constantly changing and so are their preferences.

Some common breastfeeding issues to look for include:

  • Thrush: a yeast infection in the breast or nipple. Your nipples may burn, feel itchy, or like pins and needles. Your baby can get thrush too. Though extremely painful for the breastfeeding individual, it is harmless, and medication will treat it.
  • Plugged ducts: a painful, swollen lump in the breast with redness on the surface of the skin. Plugged ducts are due to insufficient draining of the milk due to engorgement, poor latch, skipped feeding, or restrictive clothing.
  • Mastitis: caused by unresolved plugged ducts. A fever in combination with plugged duct symptoms likely signals mastitis.

Have the number of a breastfeeding consultant on hand in case any questions or concerns arise. It’s better to be prepared rather than scrambling to find someone when you’re in pain.

How to cope—Soothe your breasts

Make sure you keep yourself as comfortable as you can when you breastfeed. The more relaxed you are, the more at-ease your feeding baby will be.

  • Find a comfortable seat
  • Grab a regular pillow or a special breastfeeding pillow to give yourself some support during feedings
  • Wear clothing that allows for easy feeding access
  • Keep snacks and water nearby, especially during the marathon feedings
  • Apply a good nipple cream between feedings to help with sore, cracked, or blistered nipples.
  • If you feel more comfortable wearing a cover in the company of others, go right ahead! But know you have every right to breastfeed without it.

Your baby

Does your baby go through periods of the day where they seem to want to eat non-stop? This back-to-back feeding schedule is called cluster feeding, and it typically happens closer to the evening. Cluster feeding can occur when your baby is getting ready for a longer sleep stretch. You may notice more stretches of awake time during the day, and longer sleep at night.

The Fourth Trimester: Postpartum weeks 5 + 6

Body and Mind

You’ve hit the 6-week checkup milestone. Your OB or midwife will:

  • Check any stitches you may have had to ensure they have healed properly
  • Give a vaginal exam to ensure your reproductive organs are back to their pre-pregnancy placement
  • Evaluate your emotional wellbeing
  • Ask about pain or discomfort
  • Address breastfeeding issues
  • Provide preferred birth control
  • Inquire about bladder leaking

Postpartum incontinence is a normal thing women experience, but it is not something you have to suffer through silently. Your healthcare provider should be able to point you in the direction of a pelvic floor therapist to help manage your incontinence.

If everything appears to be healing appropriately, you can resume exercise, sex, heavy lifting, and other normal activities.

How to cope—Check-in with yourself

Emotions and hormones are running high during the postpartum period. Eighty percent of women report experiencing the “baby blues,” feeling sad, weepy, and stressed during the first few weeks of postpartum. According to the CDC, one out of 10 women in the United States experiences postpartum depression. These statistics show that most women find themselves emotionally struggling when becoming a mother. Check-in with yourself and seek help if you feel like you might have PPD.

In the midst of the excitement, anxiety, stress, and tiredness of taking care of your baby, it’s easy to forget to take care of yourself. You are adjusting to this new role of parent, this new postpartum body, and a balance of your former and new identity—a lot of learning is happening. Write this down: “Self-care is not selfish.” Plan ahead to allow yourself to do something only for you. Taking care of your mental health is another way to show up for yourself and care for your family at the same time.

Your baby

Gassy grins shift to real smiles! Your baby is starting to show signs of engaging with you with smiles, grunts, and gazes toward you. They are also beginning a big growth spurt around this time so you can expect an increased demand for food and some sleep regression.

The Fourth Trimester: Postpartum weeks 7 + 8

Body and Mind

You’re starting to feel a bit more familiar with your new routine. You may be looking forward to returning to some of your normal activities, and you may feel a little nervous about others—like sex with your partner. Sex with your partner can feel different, and that’s OK. The most emotional pain can come from trying to experience pleasure exactly how you used to. Instead, try new things together to find what feels good right now.

It’s common for breastfeeding moms to continue to have a decreased libido until they wean their baby. After weaning, your libido will return, but it can take a while to feel yourself again fully.

How to cope—Be open and honest

The baby is the center of your universe, but you must preserve your other relationships. It’s OK if you aren’t ready to have sex with your partner. Set your own timeline and reevaluate as needed. In the meantime, explore other ways to connect. Sex does not have to equal penetration. Finding ways to connect intimately are important during parenthood. Moments of intimacy and connection remind you that you both exist outside the world of parenting. Plus, it’s a fun reminder that you are both on the same team.

While sex and postpartum present some challenges to get through (nothing says sexy like a spontaneous milk stream to the face), the more open and honest you can be with your partner about what feels good and what needs to slow down, the better experience you both will have.

Your baby

Can you believe your baby is already two months old? They will have their first round of vaccinations at this time. It’s not fun for either of you, but most pediatricians will help ease your nerves and walk you through the process.

Their eyesight is improving now. Grab some board books. Books with bold contrasting images are great attention grabbers for this age. It’s never too early to read to your little one!

The Fourth Trimester: Postpartum weeks 9 + 10

Body and Mind

You may be looking at your body with a skeptical eye. It can be frustrating to feel that your body is still not how it once used to be. Remember, your body has gone through a significant change and despite the celebrity mom depictions and diet industry’s marketing, losing weight quickly is not a goal that should be part of your postpartum life.

Your body did some of the strongest, most impressive work it’s ever done. Turn your focus from what it once was, toward what you want it to be going forward.

How to cope—Find what makes you feel good

Rather than focus on getting your “pre-baby” body back with quick-fix diets, focus on supporting your postpartum body. Find what feels good for you. Listen to what your body wants, whether it’s getting outside to move, eating the foods you crave, or allowing yourself to rest. The key is to do what makes you feel good. Not because you want to lose weight fast. It’s too early to cut calories, especially if you are breastfeeding. Give yourself some grace and practice loving yourself where you’re at now. The truth is, your body will never truly be what it once was, and that is nothing shameful about that.

Your baby

Around week 10, your baby’s schedule is starting to become a little more predictable. They are typically following an eat-play-nap routine throughout the morning, and again in the afternoon and evening. You and your baby may thrive on the routine but don’t be afraid to deviate from the normal every so often.

The Fourth Trimester: Postpartum weeks 11 + 12

Body and Mind

You’ve made it to the end of the fourth trimester! By now your preconceived notions of what your entry to motherhood would look like have been thoroughly challenged.

You have felt the simultaneous feelings of being crazy in love with your baby but also completely overwhelmed by them.

Parenting is not fun sometimes. It’s messy, expensive, frustrating, and time-consuming. Alexandra Sacks refers to this time as an emotional tug of war. Our oxytocin pulls us to our baby, but at the same time, our memories are a reminder of our other identities of what we used to be, pulling us away. This push/pull is difficult and your sense of ambivalence during these moments is a normal part of the process.

How to cope—Remember who you are

Make a list of all the things you loved to do before baby. Reading, hiking, board games, happy hours, adventures with friends, traveling, spontaneous nights with your partner…the list goes on. Post it around your house to remind yourself of the things that make you, you. They’ll help show you that you exist outside of your role as a parent in this transition stage.

Your baby

Your little one is becoming more and more social with you and others around them. Talk to them, mimic their expressions, and continue to read to them. You’ll also notice they have a little more control of their neck and are less of a bobblehead. Work on encouraging their neck muscles by practicing tummy time exercises.

Your postpartum journey doesn’t end here. Parenthood is always changing and testing us. Enjoy this time and don’t beat yourself up too much during the harder moments. You know yourself and your baby the best, trust yourself, care for yourself, and rally around other women navigating this life stage.

Featured image by Barbara Alçada

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