What is the “fourth” trimester?

Have you heard of people talking about the “fourth” trimester? What is it?

You might have noticed that during your pregnancy everything was very much focussed on your baby arriving - your labour and delivery, and you probably couldn’t really think about much more than what was going to happen on that day - the day you went into labour and actually gave birth.

It’s not surprising that you felt that way, after all it’s a major event and for first-time parents, something you just can’t quite imagine! It’s as though everything almost stops at that point.

However, the reality is that pregnancy, birth and the first few months after your baby is born are more of a gentle transition from one phase to the next. If we look at this time from pregnancy into the early months postpartum as a fourth “trimester” it's much easier to understand how you and your baby are deeply connected in both behaviour and physiological need.

Sadly, the ways of western culture do not support these needs as well as they could.

Why is there a fourth “trimester”? 

• Compared to many other mammals, us humans are quite exceptional - our babies are born incredibly immature and incapable. Humans are born with quite undeveloped brains; if human babies were not born until their brain was more mature and able, your pregnancy would be quite a bit longer and your baby would be too big to fit down the birth canal. But because of this immaturity at birth, your baby requires lots of “womblike” nurturing. Our human babies really do rely entirely on their parents and caregivers for survival.

• Before your baby is born, he or she is held in an environment that has dim light and muffled sound from the outside, they can hear your heart beat and the noises of your body, their entire body and their limbs are completely supported and held in wonderful, warm amniotic fluid, no feeling of hunger. Can you imagine what it is like when they are born? Bright lights, loud sounds, odd feeling fabrics against their skin, their limbs and body no longer supported in warmth, varying temperatures… feeling hungry, feeling their body digesting and eliminating. Wow!

• This is not just about your baby though. It’s about you too. Until you had your baby, you weren’t a parent, but now you are. You go through a process of change too! For you to be able to meet the powerful needs of your baby, you will need to be able to focus almost your entire attention on them…. So who is looking after you? Some cultures have wonderful ways of doing this, but in our western culture we tend to not look out for new parents - do you feel this? Your instincts may be telling you that you want to be a certain way with your baby, and yet the demands of “society” get in the way of this… Sometimes there feels a lot of pressure to get back to “normal”, be able to be out and about doing “things”, almost as though you never actually grew and birthed a whole new human at all!

What changes does the baby experience and how can we help? 

Temperature

In the womb: your baby is in a steady environment of warmth.

After birth: temperatures are variable, there will be repeated, unexpected times of feeling cold (eg. at nappy change time).

How can you help? Try the things that you would to help when your baby baby cries.

• Keep your baby warm but don’t overheat them. For example, hats are not needed indoors.

• Minimise the amount of time your baby is totally naked (expect during skin to skin). Young babies don’t need many baths at all, a warm wash cloth can deal with the bits that really need a wash.

• Enjoy lots of skin to skin time. This will help regulate your baby’s temperature, breathing and heart rate. Did you know that your (the birthing parent’s) chest will warm up to help keep your baby warm if they are chilled?

• Cuddle and hold your baby, keep them close. It’s impossible to spoil a baby by cuddling or holding them “too much”.

Food and hydration

In the womb: your baby has a steady supply of everything they need through the umbilical cord.

After birth: your baby will experience feelings of hunger and thirst for the first time. They are depending on you to be fed.

How can you help? Follow your baby’s feeding cues and feed on demand rather than trying to find a routine or ask your baby to wait longer between feeds. Expect this to be quite frequent, day and night, especially when your baby is young or having growth/development spurts. It’s helpful to know that it is not possible to over feed a baby when breastfeeding, so always offer the breast.

Light

In the womb: your baby will have been in a mostly dark environment with odd times of slightly brighter light when you undressed, showered, etc.

After birth: your baby will be exposed to brighter, harsher lighting in comparison to that experienced while still inside you.

How can you help? A small number of babies, but certainly not all, become upset if exposed to too much light or other visual stimulus. If you think this is happening for your baby, try taking them to a calmer and darker room for a little while and see if that helps them calm. New babies do need to spend time in daylight though, as this helps to reduce jaundice, so don’t be tempted to keep the curtains closed for most of the day.

Sound

In the womb: your baby will be used to the muffled sounds from outside your body as well as the noise of your various organs, including your heart beat and digestive system - it’s not quiet in there!

After birth: sounds will be sharper than your baby has experienced so far, but they will also miss the sounds of being inside your body - your heart beat would have been a consistent and steady beat that they will have become very used to as their “normal”.

How can you help? The easiest way is to keep your baby close to you as much as possible, lots of cuddles, singing and talk to them, and make “shh shh shh” sounds. When you hold your baby against your chest it will be easier for your baby to hear the familiar rhythm of your heart beat.

Day and night patterns

In the womb: your baby will not really have had any concept of day or night while they were inside you.

After birth: young babies do not have a circadian rhythm so they have no understanding of day and night. Coupled with frequent feeding 24/7, babies need to wake often at night. Sleep is something that babies all learn at different ages and is a developmental process, in the same way as other developmental stages take place, eg. crawling, walking, talking, toilet training.

How can you help? Responding to your babies needs at night in the same way as you would during the day will help your baby feel safe and secure. Seek out support from family and friends to do some of the other things that you would usually do so that you can focus your time and energy on your and your baby, eg. shopping, cooking, laundry, housework.

Body pressure/support

In the womb: while your baby is still inside you, their entire body and their limbs and held and supported.

After birth: your baby is unable to support their body and has little control over their limbs. Babies often feel insecure once they lose the warmth and protection of your all-encompassing womb.

How can you help? You will notice that your baby is much happier and more settled when you keep them close, and held in your arms or laying against your chest/abdomen. You can also “wear” your baby in a well-designed baby carrier. Check out this website for guidelines on how to wear your baby safely, carriers and other information.

Pain

In the womb: at some point in development babies are able to feel pain before birth, but generally babies do not feel pain in the womb.

After birth: the natural process of birth and birth interventions can be painful for babies. Some babies find fabrics, labels and fasteners on clothes irritating or uncomfortable; babies may also experience pain or discomfort from wind or gas in their digestive system.

How can you help? It has been shown that keeping your baby skin to skin with you and breastfeeding can help to reduce their pain. For example, it is recommended to breastfeeding during medical procedures such immunisations or blood taking.  

Being alone

In the womb: your baby has never experienced being alone until they were born - you’ve always been there. Their every need was met, almost before they even felt they needed something.

After birth: your baby may show signs of distress and upset when they are left alone. This is something they have never experienced before, it feels unnatural to your baby and may raise their stress hormones.

How to help? Try to keep you baby close to you as much as possible with lots of cuddles and safe baby wearing whenever you can. There will obviously be times when you just can’t hold your baby (eg. when you’re in the shower), and that’s ok!

As you will have no doubt noticed, a lot of this “fourth trimester” is about keeping your baby close, giving them lots of reassurance, and responding to their needs. These things all help to foster confidence and independence as your baby grows, and you will soon be wishing that your independent toddler would sit down for a cuddle again!

But don't forget to look after you too. Make sure you gather your supports so that you can focus on your transition to parenthood as well as following your instincts in looking after your baby. Let others deal with the shopping, cooking, and laundry.