Understanding the Fourth Trimester

By Polly Conner
July 12, 2013

fourth trimester

We have a great and very thorough guest post today from our friend, Holli. I SO wish I would have read this before my first baby! It would have explained so much of what I was feeling and helped me navigate the first few weeks of having a newborn a bit more smoothly. Hope it proves to be as helpful and informative to you as it was for me.  If anything, pass this post on to any of your expecting friends. Hopefully they will soak up Holli’s years of wisdom on postpartum recovery.

As a mother and a postpartum doula I have been helping families prepare for the Fourth Trimester and studying it for eight years. I will give you a list of resources at the end of this post to cover the reading portion. Much of what I am writing here is part of a two hour class I teach on preparing yourself and your family for the Fourth Trimester.

Understanding the Fourth Trimester

Giving birth to babies is not just about babies. Mothers and fathers are also born, big sisters and big brothers are born, families form and change each time a new little baby enters the world. The period of time after a baby is born is called, postpartum, it’s also called the Fourth Trimester.

If you “google” postpartum the only links you will find are for postpartum depression. However being postpartum does not mean you have postpartum depression. If you want to prepare yourself for the Fourth Trimester you have to learn about this the old fashioned way, books and listening to other moms’ experience.

What is The Fourth Trimester?

The three months after baby is born when the mother is healing, the baby is adjusting to life outside the uterus and the family unit changes shape. This time after birth is a continual state of flux for the mother and baby. Most importantly this is the stage of bonding (I also call this the stage of “falling in love”).

The Rules of The Fourth Trimester

1. Be home

2. Listen to your body and your baby

Let’s break this down into two categories, The Newborn and The Mother, and what happens to them during the Fourth Trimester.

The Newborn


Be home- Our culture does not take seriously slowing down, taking time to be home to learn about your new baby. This is why there are inventions for things like, a baby monitor that tells the mother what kind of cry the baby has; hungry, sad, tired… Don’t get me wrong, some of these machines are nice, and moms do need a break once in a while. But bonding with your new little human and learning who they are takes a lot of time that no expensive monitor can do for you.

Even if you have to return to work a short time after baby is born, take time laying in bed with baby, listening to his little noises, watching his little reflex movements, and breathing in his new human smell. This “laying-in” time is also called “falling in love” or “bonding” and it is vital to the healthy development of the mother/father relationship with their new family member.

Lets back up a bit. Back in the uterus, baby was tucked into a utopia habitat for almost 10 months. Baby and mother are one biological unit. Being born is a huge shock to the new baby’s systems and thus they need to be as close as possible to their habitat, the mothers’ body, to feel safe. Like all mammals, we humans too have a habitat: it’s our home, or nest and our family unit. For a newborn human mammal the sense of security comes from skin to skin as with its mother.

Cory Young, a human developmentalist writes on this topic and says:

 This (baby need to be in his habitat) is not a popular notion in a culture that values independence over interdependence. However, as a society that cherishes individual freedoms more than any other, we must respect the process whereby autonomy develops.

Children require ongoing neural synchrony from parents in order for their natural capacity for self-directedness to emerge. A mother’s love is a continuous shaping force throughout childhood and requires an adequate stage of dependency. The work of Mary Ainsworth has shown that maternal responsiveness and close bodily contact lead to the unfolding of self-reliance and self confidence. Because our culture does not sufficiently value interpersonal relationships, the mother/child bond is not recognized and supported as it could be.

The ability of a mother to read the emotional state of her child is older than our own species, and is essential to our survival, health and happiness. We are reminded of this each time a hurt child changes from sad/scared/angry to peaceful in our loving embrace. Warm human contact generates the internal release of opiates, making mother’s love a powerful anodyne

Ways to keep baby close: breastfeed, wear your baby in a wrap or sling, sleep with or near your baby (whichever you are more comfortable with), sing, talk and read to baby, breath in your baby and lay next to your baby, take time to look at each other, carry your baby (in your arms not the bucket carseat), lay your baby on your chest skin to skin (this goes for dads too!).

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The Mother


Be HomeMany cultures around the world take seriously something called “laying-in.” Alice B. Stockham M.D. wrote in 1883: The old tradition used to be that a woman, on no account, must leave her bed before the ninth day…

“Laying-in” or “Be Home” is a period of time that the mother withdraws from normal activity to protect herself from sleep deprivation, to heal from birth, stop her bleeding (lochia) and protect her newborn from overstimulation and infectious diseases. “The attitude towards rapid recovery has combined with the new economics of medical care to put lots of pressure, especially on mothers, to rebound quickly from childbirth rather than to stay attuned to the psychological events and to let them take their course gradually.” Elizabeth Bing (101)

I am not going to tell you you must lie in bed for nine days, but I am going to tell you that if you just pushed a baby out of your “front bottom” as my daughter says (or are recovering from a caesarian) it is vital you are on Bed Rest for FIVE DAYS. Listen up dad, you are to make sure that your wife does nothing more than move from the bed to the couch, to the toilet, to the bed, to the shower, to the couch, to the bed… you get the picture. When she is moving from one place to another, in those five days, she is not to carry anything, someone needs to bring her all her things; water, food, pillows, blankets, the remote control, diapers for the baby, the baby (don’t forget that one). For FIVE whole days the healing mother is not to do anything but be on strict bed rest.

Here’s why FIVE DAYS matters: the mother is healing from 9 months of pregnancy (the job of the pregnant body is the survival of the baby, the post pregnant body has to heal from getting little attention), labor and birth (after birth there is an open wound on the wall of her uterus that must stop bleeding for the first phase of healing to take place). The main goal of this FIVE day’s bed rest is that she slows down her bleeding as much as possible so that she does not stay in a continued state of blood loss, which equals dehydration, physical exhaustion, it can lead to anemia, and dramatic hormonal swings and postpartum depression. Also the quicker her bleeding slows down, the quicker her milk can come in in copious amounts. Being on bed rest will also keep yeast infections and mastitis at bay.

The Baby Blues Explained


Recovering mothers who are not given time to be home resting and being cared for are not able to listen to what their body needs and how to care for themselves. They question if everything is okay, they lose sleep in worry and start a cycle of not understanding what is going on with their body and if she cannot understand what is going on with her body she cannot understand what her baby needs. This combined with plummeting pregnancy hormones and rising lactation hormones creates what is called “emotional vulnerability” or the Baby Blues.

Many mothers experience feelings of elation for the two days, then a huge hormonal transition happens on day three and she often goes from being in a maternal state of bliss to what appears to be a deep depression or unexplained crying and sadness, she is scared, she doubts she is enough for her baby. This is normal! You are not going crazy. What moms need are loving people ready to care for them, listen to them, and space to lay in bed crying at the most beautiful creature they have ever seen.

A postpartum mother needs quiet space to think and figure things out. Don’t read anything you find online. Don’t even get online. You need to be fed good healthy foods, and birthday cake (because you are celebrating a birthday after all). You need to drink lots of water and Mother’s Milk tea (that someone is making and bringing you with a dose of vitamins and M&M’s). You need to feel safe and protected. You need to be hugged and kissed a LOT. If you feel like your little baby is depending on you, you need to have someone you can depend on. The more a mother feels provided for, loved, safe, protected, comforted and reassured the quicker she will heal and get through severe emotional ups and downs. It is really important for Mom, Dad and Baby to lie together in bed listening to each other, to the sounds a new baby makes, counting her tiny toes and laughing at her hiccups. The more time moms dads and siblings have to do this the easier the Fourth Trimester will be for everyone.

Just like with the baby, rule number two will happen if taking rule number one seriously.

Ways to heal a postpartum body:

Rest, drink lots of fluids, eat healthy meals, take warm baths, sleep with or near baby, have a support system already in place that you can call upon to help, have vital phone numbers on speed dial (lactation consultant, your mom, etc), rice socks and ice packs are your best friend, have access to lots of pillows, wear pajamas for five days, drink Mother’s Milk tea, take extra vitamin C to prevent mastitis, eat yogurt to prevent yeast infections and thrush, get lots of hugs and kisses.


Charles Fernyhough is a professor in Developmental Psychology and wrote the book, A Thousand Day’s of Wonder. The topic being what a new little person experiences in their first 1000 days of life. There is a delightful interview by the quirky and fun guys at Radio Lab (http://www.radiolab.org/) where he is interviewed and explains what a newborn sees, feels, and hears. What is it like to be new to the world? After Birth (http://www.radiolab.org/blogs/radiolab-blog/2009/aug/24/after-birth/).

Your Amazing Newborn, by Marshall H. Klaus, M.D and Phyllis H. Klaus, C.S.W., M.F.C.C.

The Post-Pregnancy Handbook: The Only Book That Tells What the First Year After Childbirth Is Really All About—Physically, Emotionally, Sexually, by Sylvia Brown R.N., M.S., C.N.M.

Laughter and Tears: The Emotional Life of New Mothers  by Elizabeth Bing

Primal Health: Understanding the Critical Period Between Conception and the First Birthday by Michel Odent M.D.

Natural Health after Birth: The Complete Guide to Postpartum Wellness by Aviva Jill Romm

Cori Young online article: http://www.mother-2-mother.com/wisdom.html

Ted Talk: The Birth of A Word: http://www.ted.com/talks/deb_roy_the_birth_of_a_word.html

Podcast by Sylvia Boorstein, What We Nurture: http://www.onbeing.org/program/what-we-nurture/242

Podcast by On Being with Sandy Sasso, The Spirituality of Parenting: http://www.onbeing.org/program/spirituality-parenting/230

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6 replies
  1. Janelle says:

    I absolutely love this!! It has completely changed the way I think about this entire process!! I am truly grateful that you posted this!!!

  2. Julia says:

    I am so thankful I read this! You made me feel normal for how I was feeling during the 4th trimester – looking back now, I think that was the most difficult “trimester”.
    I am glad I found your blog – I can’t wait to read more! Thank you!