Fourth Trimester Survival Guide: what it is and how to thrive.

 

What is the fourth trimester?

We hear a lot about the three trimesters of pregnancy, but not a lot about the fourth trimester that comes after the birth of your baby. The first 12 weeks following the birth of your new baby is known as the fourth trimester; a critical time in development, nourishment and recovery for not only the baby but the new mother. The fourth trimester extends beyond the societal stereotype of the "six week check" that in a way confines the ideal that women are healed from birth in a short six weeks. And the fourth trimester can last for as long as you need, only you know when you are ready. 

As a practicing midwife and mother myself, I really do encourage all new mothers to prioritise and plan their fourth trimester with great attention to self care, recovery and nourishment. 

A slow fourth trimester ensures self care, recovery and nourishment to hold the new mother in this transformative role whilst easing the transition of the newborn from womb to world. 

I as a mother have had two beautiful daughters and two vastly different experiences in my fourth trimester. I was only 22 when I had my first daughter, during this part of my life I was not a registered midwife at this point. A mere two weeks after her birth I was back at University and my casual nannying job, in those first twelve weeks after her birth, I was depleted, anxious and having a lot of breastfeeding difficulties. Fast forward to my recent second birth, I consciously prepared for a slow fourth trimester and I can only say that this preparation has led me to having a fulfilling, nourishing and empowering fourth trimester experience. (We outline how to survive AND THRIVE during the fourth trimester below). 

What happens during the fourth trimester and how long does it last? 

What happens to the mother during the fourth trimester?

Your body is recovering from the growth of your uterus and involuting to its prior size, whilst sloughing off afterbirth and uterine lining - known as lochia. Lochia is postpartum bleeding and can last up to six weeks post birth regardless of mode of birth.

If you have had tearing or an episiotomy your wound will be healing during this period. Muscle fibers will be repairing and intertwining where you tear or episiotomy site is located.

If you have had a belly birth/surgical birth, you will be recovering from major abdominal surgery.

If you are breastfeeding, on top of recovering from your babies birth you are also in a caloric deficit and need to nourish you body with additional calories and filling foods. Breastfeeding will burn an additional 500 calories a day, this energy requirement uses more fuel than you brain does.

On day 3 the postpartum drop in hormones that contributes to the baby blues coincides with milk production is the largest hormonal shift your body will ever experience, it can leave you feeling teary, overwhelmed and anxious. The hormone drop is comparable to taking 100 oral contraceptive pills a day and then stopping. 

This hormonal shift will impact you even if you have chosen not to or are unable to breastfeed.

These feelings are normal for a few days, however if they persist beyond a week please use the helplines (PANDA, Beyond Blue, Australasian Birth Trauma)

Gray matter in the maternal brain has changed during pregnancy and now in this postpartum phase shift once again to inhibit secure attachments and bonding with your new baby.

Societal pressures may support the idea of returning to sex especially around the ‘six week check”, it is normal to have a low libido in the post partum period. High prolactin levels that support milk production impact estrogen levels therefore impacting libido.

You are also adjusting to your role on limited sleep! 

Helping your baby through the fourth trimester

During the fourth trimester your baby does not know they are a separate being to you, they have known the comforts of the womb for their entire existence and now are learning to adjust to their new world. Helping your baby to feel connected to you whilst gently easing their transition into infancy can be done by simulating a womb like environment. As a mother and midwife, the following tips helped me greatly in the fourth trimester:

Feeding

Whilst breastfeeding is natural, it does not come naturally to all. You and your baby are working together to ensure a good latch and nutritive feeding, sometimes this can be incredibly difficult. When I sit and reflect with my patients on home visits or in the postpartum, often feeding is what has thrown the most hurdles. 

It is quite normal to have sensitive nipples in the first few days of breastfeeding, however it is not normal to feed through pain.  When issues arise in  your breastfeeding journey it is so important to know who forms your safety net, weaving your safety net will allow you to access help when needed. 

Two incredible resources to utilise during your postpartum period when feeding difficulties arise include contacting the Australian Breastfeeding Association on 1800 mum 2 mum. You can also find a lactation consultant potentially near you through www.lcanz.org/find-a-lactation-consultant.

Our midwife endorsed New Mum Breastfeeding Support Box will also help get you over some of the fourth trimester breast feeding hurdles.  

For your baby during the first trimester their stomach will grow from the size of your pinky nail to an egg, On average your baby will want to feed between 6-8 times within a 24 hour period, although there is no definition of normal this average is the closest to it. 

It is very normal for babies to lose up to 10% of their birthweight within 72 hours from birth as mature breast milk supply has not establish yet. As they wait for the "milk to come in", they have fat reserves to help combat this and feeding on demand is important to help your milk supply learn its rhythm.

Babies also sucked in the womb, on fingers, on amniotic fluid, sucking provides pain relief and comfort. Feeding also boosts the bond with you and your baby by means of oxytocin production, this allows the love hormone to blossom and triggers your milk ejection reflex too!

Skin-to-skin contact

Skin to skin from birth is known as the golden hour, and is linked to better breastfeeding outcomes, reduction in stress levels, temperature regulation and blood sugar stabilisation.  Both parents can enjoy skin to skin, I love encouraging Dads to pop their shirt off and have a cuddle with bub to also help them bond and expose baby to different microflora to help gut microbiome develop subsequently boosting immunity. 

Skin to skin can be given to your baby at any point in your postpartum journey and is particularly useful during periods where your baby may be unsettled. 

You can increase skin to skin in your everyday routine like sharing a shower or bath together. 

Swaddling

Another womb mimicking technique is swaddling. 

Swaddling can calm baby and recreate a snug and pleasant environment much like the womb. As newborns are born with immature reflexes, wrapping and swaddling your baby will stop them from waking themselves due to their immature startle reflex. Your new baby has not quite worked out that they have arms yet and this primitive reflex causes them to flay their arms about, that will most certainly wake them when not swaddled. Swaddling also encourages mums to sleep babies on their backs which is recommended for safe sleep. You can also transfer your unique smell onto a swaddle wrap which will add to reassuring and settling baby as they are born with a full sense of smell, it is a pleasant reminder for them that you are near by. 

Babywearing and Movement

A practice dear to my heart, baby wearing similar to swaddling can mimic the same sensations as the womb- gentle movement- heartbeat sounds- breath sounds. Babywearing during a walk or even around the house is a gentle way to mimic the womb like environment. Your baby has danced along with you to the ebb and flow of your day to day life when they were in your womb. Babywearing is a practical way to help your baby through the fourth trimester. Baby wearing is great for getting out and about, taking a morning stroll with your baby in the morning light. 

Bathing:

There is something truly restorative and womb like for a baby when immersed in a warm deep bath.  Bathing is a brilliant ritual to add to your routine when your baby is a week or so old, you can pour your baby a bath every 2-3 days to help settle them.

You can place a flannel or face washer over your babies arms in the bath to further reduce their startle reflex, this makes for a more peaceful calming bath.

As midwives we advise to delay bathing your newborn for at least 3 days following their delivery. The vernix on their skin is protective and full of skin nourishing proteins and does not need to be immediately washed away.

Baby Massage:

Practicing baby massage after birth is another lovely hands on technique that can calm your baby and help aid digestion. Massaging your baby from head to toe and across their stomach in a clockwise direction can help them with windy bellies. You can use your Sisters and the Sea blossoming belly oil for baby massage.

The fourth trimester survival guide (so you can indeed thrive!) 

The fourth trimester requires the same amount of preparation as a mindful conception and pregnancy. The process of recovery and nurturing your body and mind is crucial not only for your health and wellbeing but your baby also. Societal expectations and stereotypes weigh heavy on the new mother and thriving in your fourth trimester relies on squashing such pressures. When we normalise the fourth trimester as going beyond the six week check, we will come to appreciate holding the new mother. 

Self care tips for the fourth trimester

So here’s our ‘how to’ guide when it comes to not only preparing for and surviving the fourth trimester but thriving: 

- Stock your pantry and freezer with nourishing meals, ask your friends and family to set up a meal train or laundry train.

- Be realistic about the mess your home will see, and do not be afraid to normalise the mess. Free time is better off nourishing your mind and body, the laundry can wait. See what house hold chores you can eliminate for the next 8 weeks and only do those that are absolutely necessary. Take it  easy on yourself, mothering and recovering is a full time job.  

- Nap when ever you can! It can be tempting to fold laundry or do dishes when baby is sleeping but rest and relaxation is paramount to healing and your health. Even if you just put your feet up, pop on an eye pillow and listen to a guided mediation or yoga nidra for 20 mins.

- Take a relaxing and healing salt bath (with baby if thats your only option). Our postpartum bath soak will help you relax, recover and repair. 

- You will be spending a lot of time at home so create your nest. Create a comfortable space that you love spending time in where everything you need is easily accessible and you feel happy and supported.  Have everything you need at hand; a water bottle, feeding pillows, a snack basket full of healthy protein rich treats, a good book or magazine, phone charger and a device to listen to music and podcasts, self care item for you ie mist spray to freshen up, pads, peri spray etc. 

- Invest in your own self care, rather than excessive "stuff" for baby, as all baby really needs is a happy, heathy, thriving mother. Our New Mum care boxes encourage self care during the fourth trimester.

 Postpartum recovery

Postpartum recovery involves healing in both the physical and emotional state.

Your recovery is not reliant on the simple six week check, birth is so personal and not one single birth is the same. For some their birth can be completely unmedicated and others may require a lot of intervention. 

Invest in holistic services like in home massage and osteopathy and as mentioned before a postpartum doula is a great support person who can offer support through nutritional meals and natural therapies.

Natural remedies to help with recovery after birth include;

- Postpartum healing bath soaks to soothe tired muscles, help with skin repair and inflammation and calm the nervous system.

- Peri sprays for tearing of the perineal area. 

- A heat pack (we use our eye pillow) for after pain cramps and sore breasts.

-  Herbal teas for supporting emotional wellbeing, restoring nutrients and supporting breastfeeding. 

- Flower essences for promoting bonding and stress relief.

Visitors

It is also helpful to have a think about how you may want to navigate visits from family and friends before baby arrives so you can feel in control and not over whelmed when the time comes.

Open honest conversation with friends and family about expectations around postpartum. Everyone is so keen to visit the new baby. Do not be afraid to prioritise purposeful visits, it is okay to ask somebody to do the dishes, sit with you, clean your kitchen. Those who visit you are not guests, they are not there to be made cups of tea and cuddle your baby. Set these boundaries early. As a midwife I often encourage visitors to support the new parents and engage in a visit to them rather than 'hold" the baby, this can actually exhaust your new baby and cause them to be quite unsettled later on. The energy and personal signature each person carries can be felt by your new baby.

For some mums, visitors are a welcome companion, while others may find it disruptive and exhausting. How you feel is completely individual and may change from day to day depending on how you and your baby are fairing.

It's a good idea to let visitors know that your schedule may change suddenly and you may have to reschedule at the last minute. A pre-made sign for the door is helpful here, for example Baby and Mum Sleeping, to let visitors know to call again at another time. 

Although it doesn't come naturally to most, asking for help or taking up an offer of help is absolutely ok. It may take a little practice, but asking your guest to bring you something useful ie take away food, groceries, a coffee will make both your day and theirs as you will feel supported and they will feel like they are helping and making a difference. 

Establishing your support network of family and friends is essential but often easier said than done in our modern society. A blessingway is a great way to gather your village before baby arrives, to make a visitors roster, to organise a meal train and to discuss your expectations of visitors. A postpartum doula is a wonderful support option if family or friends don’t live close by. 

 Best foods postpartum 

REPLENISH 

Nourishing, nutrient dense & easily digestible "Whole Foods" are essential to help the mother recover and heal after birth, support her mood and hormones, and ensure enough energy and milk production to nurture baby. Whole Foods are food as close to their natural state as possible, refined as little as possible.

WARMTH 

Slow cooked meals, broths and soups often feature in traditional cultures for postpartum recovery. They are easy to digest and absorb. Bone broth is extremely nutritious and mineral dense. It contains gelatin, which is very soothing and healing to the digestive system. Adding bone broth to stews, soups, sauces etc lifts meals to the next level nutritionally.

NUTRIENT DENSE FOODS 

Liver (must be organic) is so nutritious, it is rich in all B vitamins, easily absorbed IRON and omega 3 fats.

Quinoa & buckwheat are both considered superfoods as they are packed full of vitamins and minerals.

Dulse flakes and seaweeds are mineral (especially iodine) dense.

GREAT FATS

Replenishing fat stores after pregnancy is essential, especially if you are breastfeeding. Eat plenty of oily fish, coconut oil, ghee, hemp seeds, chia seeds, linseeds eggs, avocado, tahini, raw nuts (brazil, walnuts), seeds (pumpkin, sunflower) & nut butters.

Our Magic Cacao adaptogen powder is an easy way for new mother's to add incredible tonic herbs and mushrooms for energy and nervous system support into their everyday. 

Herbal teas are also a great way to aid digestion, enhance sleep and vitality and look after your nervous system.

Beyond the fourth trimester- preventing post natal depletion. 

It’s a demanding job from the beginning. Pregnancy, labour and breastfeeding takes a huge toll on a women’s body both physical and emotionally. Nutrient demands are increased and hormones are going through the roof. Throw in long term sleep deprivation, the pressure of juggling all the balls all the time, long term nutritional deficiency and inadequate self care and you can end up with postnatal depletion.

Symptoms of postnatal depletion can include anxiety, low (or no) libido, hyper-vigilance (that wired but tired feeling), reactive, jumpy, foggy headed, overwhelmed, frustrated and vulnerable. 

Many of the principles for supporting new mothers during the fourth trimester are helpful in supporting mothers in the early years of motherhood also (ie- rest, warmth, nourishment, support) and reduce the risk for postnatal depletion. 

Birth is only the beginning, a slow fourth trimester where the mother is supported, nourished and cared for so she is in the best place possible to heal and care for her new born baby, decreases the risk of postnatal depression and postnatal depletion down the track.