Congratulations on your new little one and welcome to the fourth trimester!
The fourth trimester, the three-month period after your baby is born, is considered to be a continuation of your pregnancy. During this time, you’ll establish yourself as a source of comfort for the newest member of your family. At the same time, you’ll be faced with a myriad of changes as your body recovers from childbirth, complete with emotions that may change you forever.
Newborn Development in the First Three Months
Your baby’s brainstem – which handles basic instincts and life-sustaining functions like breathing, body temperature, hunger, sleep, heart rate, digestion, and fight, flight, or freeze reactions – is fully developed at birth. While these functions are at work, they can’t yet be regulated by the baby alone, and babies need their caregivers' coping abilities to shield against danger and overstimulation.
At some point during the first three months, you’ll notice your baby startles less and breathes more steadily. Some babies practice early mechanisms for self-soothing like twirling hair, rubbing eyes, or sucking on pacifiers. Little by little, movements become less jerky and more controlled. Through practice and repetition, your baby gains strength to prepare for major milestones like rolling over and crawling.
Each baby develops differently, but generally, by three months, a baby may have learned to:
- Hold their head up without support
- Raise their head and chest when lying on their stomach
- Focus on your face intently
- Follow the path of moving objects
- Smile socially and react to the sound of your voice
- Babble, make cooing noises, or imitate sounds
- Stretch and kick legs when lying down
- Recognize familiar people at a distance
- Express discomfort through facial expressions and body movements
- Grasp objects with their hands with increasing coordination
- Turn their head toward a noise
- Imitate facial expressions of caregivers
- Bring their hand to mouth to explore items
- Grasp and shake hand toys
Newborn babies might seem like they don’t do much other than eat, sleep, and poop, but the brain is like a sponge, soaking up the experience of living and rapidly forming connections. Here are some ways you can engage with your baby during this time:
- Make a point to have some daily tummy time, even if it’s just a few moments on a play mat.
- Give your baby plenty of opportunities to lie on their back (perhaps outside in the shade, staring up at the trees).
- Play peek-a-boo.
- Converse with your baby, pausing for them to “respond.”
- Narrate what you’re doing throughout the day, even during diaper changes.
- Take advantage of caregiving activities to connect fully with your baby.
- Sing soothing lullabies, while dancing and hugging your baby.
- Make a habit of smiling when you notice your baby watching you.
- Read simple, bright, high-contrast picture books.
- Let your baby grab onto your finger.
Be sure to take loads of pictures during this time, as you’ll want to remember all of the adorable moments; plus, your baby may be intrigued by the camera!
Fourth Trimester Challenges
One of the most difficult things to cope with in the fourth trimester may be your baby’s crying. The truth is, ALL babies cry – even so-called “good babies.” Crying is a primal survival mechanism; it’s how your baby releases tension and communicates their needs, whether they’re hungry, tired, or wet. The sound of crying also helps them block out other noises, visual stimulation, and intense feelings. Responding to these cries in a warm, nurturing way helps forge a strong parent-child bond.
Sleep deprivation is another challenge you’ll encounter in the newborn days, especially in the early weeks when your baby might not understand the difference between day and night. Newborns rarely stay asleep for more than two to four hours at a time. This may change by six to eight weeks of age, although middle-of-the-night feedings will often continue until six months of age or older. Once social distancing is over, try to take others up on their offers of help so you can get some much-needed sleep.
Feeding can be another challenge. Babies have tiny stomachs, so they drink small amounts frequently throughout the day (and night!). Growth spurts around seven to ten days after birth and between three and six weeks of age mean cluster feedings, where you feel like you’re feeding your baby every hour. The digestive system and gut flora are still developing, so it may seem like every feeding where the baby doesn’t doze off ends up in a battle against gas and discomfort. Some helpful remedies are baby massage, bicycling the legs, and various burp techniques.
Your Physical Changes
Aside from the challenges of caring for a new baby, your body is also going through a ton of changes post-birth. Every pregnancy and delivery is different, but no matter your experience, you’ve just done an amazing thing! Give yourself the time and grace to heal. Common physical changes postpartum include:
- Appetite Changes – You may find that you’re never hungry or that you’re starving all the time. Breastfeeding can make you especially hungry, so keep some healthy snacks nearby!
- Baby Blues – Oxytocin, prolactin, and endorphins give you a dose of euphoria that helps you fall in love with your baby. Hormones peak around three days and may drop suddenly, leaving you weepy, frustrated, anxious, or hopeless. If these feelings take center stage and don’t go away, talk to your doctor about postpartum depression.
- Breast Pain – Engorgement when your milk comes in can be terribly uncomfortable for some women. This will improve once your body figures out how much milk to produce. Warm compresses and pumping can help relieve the fullness, and cool compresses after breastfeeding can reduce inflammation.
- Body Dysmorphia – You might imagine your bump will immediately vanish and you’ll go home from the hospital in your favorite pair of jeans. For some of you, that might be true. For others, you may still look six months pregnant. Be gentle on yourself. You’ve just grown a human. Eat foods to nourish your body and give yourself time to heal.
- Digestive Changes – Digestion tends to slow after birth. Your first bowel movement may not come for three days. If you’re feeling uncomfortable, taking a stool softener and drinking more fluids can help. Eat soft foods like applesauce, yogurt, and smoothies to ease the transition.
- Headaches – Hormonal changes, lack of sleep, and forgetting to eat can bring on headaches postpartum. Make sure to reach out to your health care team with any questions.
- Incision Soreness – Cesarean incision soreness or pain in the vaginal stitches can persist for many weeks postpartum. Numbness is normal for several months. Try an abdominal binder and comfortable underwear to help with sitting, lying down, and walking. Holding a pillow to the incision site when coughing, sneezing, or laughing can help to reduce pressure and discomfort.
- Infection - If you develop a fever, red streaks along the breast, chills, nausea, and body aches, you may have a type of breast infection called mastitis, which should be treated by your health care provider right away.
- Loss of Bladder Control – Exercises like Kegels may help strengthen the pelvic floor muscles. Consider wearing pads or disposable adult underwear if necessary.
- Loss of Libido – Doctors recommend at least six weeks of abstinence from sexual activity to allow enough physical healing time. Mentally and emotionally, it could be a lot longer before you’re ready to be intimate again. No matter how you’re feeling, make sure to keep communication open with your partner.
- Nipple Soreness – Breastfeeding may come with challenges, including nipple soreness. Using lanolin or nipple butter before and after feedings may help. Don’t hesitate to contact an International Board Certified Lactation Consultant (IBCLC) to work on positioning and latch (virtual sessions are available!).
- Uterine Pains – As your uterus shrinks back down to size, you may experience contractions or cramps. You may feel these sensations during breastfeeding sessions as a sign of your milk letting down. This should subside after a few days or weeks.
- Vaginal Bleeding – Vaginal bleeding occurs whether you’ve had a vaginal or cesarean birth, and it could be intense. Call your OBGYN if you notice an abnormally large clot or if you soak through a pad every hour for several hours straight.
- Set up a nursing station in a comfortable part of the home. Put essentials in a divided plastic caddy: a water bottle, nipple butter or lanolin, clean breast pads, cell phone and charger, a small journal and pen, burp cloths, hair ties, lip balm, and healthy snacks.
- Set up a caddy for the bathroom. Stock it with heavy-duty pads, Tucks pads, a squirt bottle, comfortable underwear, and wet wipes. If you had a cesarean birth, add incision cream. Your hospital might provide some of these items for you to take home.
- Once social distancing is over, allow visitors if you’re up for it—and let them help! These first weeks are important for bonding with your baby, but if you want visitors, don’t hesitate to take them up on their offers to help. People love to hold newborns, so take advantage and grab a shower or nap!
- Keep a running list of items you need to buy. In the first few weeks after birth, you’ll probably find yourself needing more items for your baby, such as swaddles, sleep sacks, burp cloths, diapers, sleepers, and onesies, as well as comfortable loungewear, pajamas, or nursing bras for yourself.
- Visit the pediatrician. A pediatrician should examine your baby in the hospital, but you’ll also likely need to stop by the office sometime in the first week or two. A schedule of visits might be two days, two weeks, two months, four months, six months, nine months, one year, 15 months, 18 months, and two years.
- Have a doula, nurse, or lactation consultant visit. A visit (even a virtual visit!) from an experienced care provider will give you much-needed reassurance and answer questions that inevitably arise.
- Write in your baby book. Keep a baby book near your breastfeeding station for a few moments of quiet contemplation once your little darling falls asleep. It’s best to tackle this while your memory’s still fresh, but don’t put pressure on yourself. Even jotting down a few memories will be something you’ll cherish years later.
- Go to your six-week postpartum check-up. Postpartum care can help you manage your recovery, decrease the risk of complications, and answer any health concerns you may have.
What Kindred Bravely Moms Remember About the Fourth Trimester
Every woman will experience the fourth trimester differently, but hearing from others can be helpful if you're feeling overwhelmed. Talk to the women in your life who have been there, or reach out to the amazing moms in our Facebook group, KindredMamas. Knowing that you have a supportive community can make all the difference in the world.
To get you started, here are some fourth-trimester memories that KB Moms have shared:
- “The first three months were rough, but it got so much better after that. I was nursing on demand during this critical time for milk production. My breasts were leaking everywhere! I was sleeping on towels and wearing breast pads with a sleep bra to bed. Harvey Karp’s 5 S’s helped so much, as did babywearing. I was constantly holding, rocking, babywearing, and bouncing on a yoga ball, which was one of the only things that calmed my babies in the first couple of months. Taking a bath with baby in the evening relaxed us both.
For the first several weeks, there was no schedule. The baby’s circadian rhythm didn’t match mine. Night was day, and day was night. I tried to remain patient, knowing that it would get better. It took about three months for the new baby to develop a natural schedule. Having lived inside me for nine months with every single need met 24 hours a day, life was considerably harder for my baby on the outside where there were so many smells, loud noises, bright lights, and people. Sometimes I had to tell people they couldn’t hold or touch the baby. People may disagree, but I was trying to do the best thing for the baby and my new family.” – Shantel
- “I wore my baby in a Moby Wrap basically the entire fourth trimester. We used the Five S’s from Happiest Baby on the Block a ton. I didn’t sleep much. Our community was super helpful, holding baby so we could nap or shower, bringing food, etc. Once we got out of that stage with our first, life became so much easier. The first few months were for sure the hardest stage.” - Sydney
- “The fourth trimester was an emotional roller coaster! My oversupply took months to regulate. My son also had colic, and it was a vicious cycle of trying to feed him, him getting sprayed with milk, and then screaming and crying while I frantically tried to express my letdown into a towel. I love him but was pushed to the edge of sanity with the amount of crying. I was afraid to go out in public because I never knew when he was going to erupt, and I couldn’t nurse easily outside of the house because we were only successful with the side-lying position.
Thankfully, I had my mother-in-law to help, and she was able to calm my son with such ease. It was amazing, but I also felt jealous and inadequate that I couldn’t reliably calm him. He hated babywearing and would only sleep on my chest. The breastfeeding group I attended weekly was such a blessing—it was the only place I was comfortable going, knowing that no one would judge me if my baby cried the entire time. I was scared, but relieved, to go back to work when he was 14 weeks old.
Later, my daughter was a dream compared to my son! She slept almost anywhere and would even stay asleep if I moved her. I wore her in a Moby Wrap from the beginning and she loved it. We fell into an easy nursing rhythm. She was easygoing and easy to calm. My mom stayed with me for three weeks after I gave birth and cooked every meal, which was amazing. Watching my son fall in love with his sister was truly magical to see. He was so excited. One day, while cuddling his sister, he said, ‘Mom, the best place to love is a baby.’ ” - Hannah
Congratulations on making it through your pregnancy! You are an amazing mama already, and the journey is just beginning.