What is the Fourth Trimester?

Meera Varma Simões, MD, FACOG

The “fourth trimester” is a catchphrase used to describe the postpartum period, defined as the first 12 weeks after delivery. The first trimester of pregnancy is from conception to 14 weeks; the second trimester is 14 to 28 weeks and the third trimester is 28 weeks until delivery. Maybe it would make more sense if pregnancy was divided into quarters.

The weeks after delivery are a critical time that rightfully deserve attention. A common misconception is that delivery is the “hard part.” What is really hard is going home with a myriad of physical changes and a new baby that did not come with an instruction manual. While all moms go through a normal adjustment period, your obstetrician or midwife can help guide you. They can explain what can be expected, as well as the symptoms or complaints that need further evaluation or treatment.

What do new parents experience during this period?

As a new parent, you will experience a variety of changes when you bring your newborn home. There are some common concerns among new parents, including:

  • mood changes, such as anxiety and depression
  • infant care and feeding
  • contraception and birth spacing
  • lack of sleep and fatigue
  • physical recovery
  • management of other medical conditions

You should feel free to discuss all these concerns with your provider.

Are there warning signs of something more serious?

You or a family member should immediately call 9-1-1 if you experience any of the following as they may indicate a life-threatening condition:

  • chest pain
  • trouble breathing
  • a severe headache
  • vision changes
  • slurred speech
  • confusion
  • drooping of the face
  • arm weakness

There are other conditions that may be a sign of something that needs medical attention. Call your doctor if you have:

  • heavy bleeding
  • a fever greater than 100.4F  
  • calf pain or calf swelling, especially in one leg
  • increased pain, drainage or redness from a C-section incision or vaginal stitches
  • burning with urination
  • breast pain or breast redness
  • feelings of sadness or hopelessness

How can I prepare for the fourth trimester?

Your answers to the following questions can help guide you in preparing for the arrival of your baby and those important first weeks.

  • How do I plan to feed my baby?
  • Who will be our pediatrician and dentist?
  • Am I at risk of postpartum depression or anxiety?
  • What will I do to prevent pregnancy and what is my ideal family size?
  • Which of my family and friends are available to help me once I am home?

Can postpartum care improve health?

The answer is a resounding yes. While new mothers are instructed to return for a six-week postpartum visit, many need follow up care in the first few days and weeks after discharge from the hospital. This is especially true for patients who had preeclampsia (high blood pressure) either before or after delivery.

Severe medical complications can happen in the postpartum time frame. Women who suffered a postpartum stroke, often did so within 10 days of hospital discharge. Around the world, half of childbirth related deaths happen after delivery. Many of these cases could be prevented with close follow up and management of medical problems like high blood pressure.

While it is not a comfortable subject to discuss, it is important for you to be aware of these risks, because with close follow up your provider can treat postpartum preeclampsia, infections and other medical complications. It is human nature to minimize symptoms and to not want to go back to the doctor’s office or hospital when you just got home, but this can be dangerous. Your provider can help and wants to hear from you.

Being a new parent, you will experience the joys and challenges of those first few weeks home with your new baby. Having an awareness and appreciation for the fourth trimester is important. Remain in contact with your obstetrician or midwife to address your concerns so you can have a healthy transition into your family’s exciting new chapter.

For more information on our services and how we can help you, visit our website: Lifespan Physician Group-Obstetrics and Gynecology.

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