The fourth trimester — the first 3 months after birth — is an enormous amount of change and growth for your newborn as she adjusts to life outside the womb.
Your new bundle of joy has just transitioned from the familiar comfort and noises of your warm, dark womb to an environment that is bright with shifting temperatures, and full of unsettling sights, sounds and smells.
Not to mention, there’s so much for your baby to learn and develop in the coming weeks from controlling her reflexes to developing her senses to learning how to respond to you.
But what about you, the baby’s mom? The fourth trimester doesn’t just present change and adjustments for your baby, but also for healing, tired, overwhelmed moms caring for baby.
In the 12 weeks following delivery, a woman must recover physically from childbirth and adapt to changing hormones, all the while learning to feed and care for her newborn — around the clock.
As we celebrate moms this month, the American College of Obstetricians and Gynecologists (ACOG) is urging sweeping changes in medical practice to improve care for women after giving birth.
There’s a tendency in our medical system to focus on the health and safety of the baby more than that of the mother. The ACOG recently released new postpartum recommendations to reinforce ongoing 4th trimester care for moms, too. It now proposes postpartum care should be an ongoing process, rather than a single encounter 6 weeks after delivery, tailored to each woman’s individual needs.
“Mothers are provided all kinds of care during pregnancy, but once the baby’s born, the frequency of care is decreased at a time when a woman is learning her new role as mom,” said Liz Maseth, an Internationally Board certified lactation consultant for Akron Children’s Hospital. “While learning how to feed her baby, a woman has many questions of her own about her physical recovery. When can we initiate intercourse? Are my current medications safe? What are the signs of postpartum depression?”
During the 4th trimester, women can experience a whole host of postpartum complications, including chronic fatigue, pain and breast engorgement, excessive bleeding, infection, depression, lack of sexual desire and incontinence. So, it’s natural to have lots of questions about what’s normal and what’s not.
Postpartum depression is one of the most common complications of childbearing. If moms wait until the 6-week checkup, they’re already in the throes of it. They may not know where to turn for help or even be able to get help in a timely manner.
“We have to let moms know it’s okay to talk about postpartum depression, and we need to have these conversations before and after delivery,” said Maseth. “Moms may not know the signs that they’re not doing well, and postpartum depression can have long-term effects on the baby.”
After delivery, moms need time to heal themselves, especially if they delivered via a C-section. If any patient has a major surgery, they’re expected to take it easy for several weeks. But for moms who deliver, they have to immediately start caring for their new baby and may not take the time to focus on themselves.
Making matters worse, women are educated on the signs of abnormal postpartum complications immediately after delivery when they don’t yet have the capability to take it all in.
“A woman’s stress hormone levels are so high after delivery that she can only frame certain pieces of information,” said Maseth. “Physiologically and emotionally women can’t absorb all of the information being given to them and may miss pertinent details regarding their health and safety.”
Once baby is born, moms are thrown into caring for her around the clock. Newborns eat 8 to 12 times a day, so mothers, especially breastfeeding mothers, are in a perpetual state of fatigue, which increases the chance for depression, panic attacks and anxiety.
It’s a challenge, especially for first-time moms because they can’t possibly know how to care for an infant. They can take as many classes as they want prior to baby being born, but no one knows exactly what it’s like until they go through it.
“Many hospitals offer 24-hour nurse lines for questions or concerns, but areas with limited resources don’t have these options,” said Maseth. “Instead, many moms get answers from the Internet and mommy blogs, where the information is not always accurate.”
To intercede these potential problems, the ACOG recommends all women have contact with their obstetrician-gynecologist within the first 3 weeks postpartum. Care should then be followed up as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth.
“This movement for ongoing care would improve the health of mom and baby by offering continual assessment of a woman’s physical, social and psychological well-being,” said Maseth. “The first several weeks after delivery are crucial for setting the stage for mom’s long-term health and well-being.”