Pregnancy trimesters one, two and three may get all the glory, but there is, in fact, a fourth trimester — and for new parents, it’s potentially the most fraught one of all.
“The fourth trimester refers to the post birth time interval — the first 12 weeks post birth,” explains Dr. Kecia Gaither, who’s double board-certified in OB/GYN and maternal fetal medicine and the director of perinatal services/maternal fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx. The fourth trimester, according to Gaither, “reflects a time interval where many complications can ensue and when most pregnancy-related insurance terminates — just when new parents need provider care the most.”
“The fourth trimester refers to the post birth time interval — the first 12 weeks post birth.”
— Dr. Kecia Gaither, OB/GYN
Gaither also notes that the fourth trimester is when birth parents are managing physical recovery, “while contending with emotional stresses of having a fragile, dependent newborn.”
So, again, this stage can be fraught. From what it is to how long it lasts, here’s the new parent rundown on the fourth trimester.
What is the fourth trimester?
“The fourth trimester refers to the few months that follow birth,” explains Dr. Joanne Armstrong, chief medical officer of Women’s Health and Genomics at CVS Health. “Most people think of pregnancy as over once the baby has been born, but the reality is, the pregnancy journey extends beyond the typical three trimesters.”
It’s during this time, Armstrong continues, that “parents often face many changes to their bodies and normal life routines.” For new parents, the fourth trimester is generally a mixed bag of emotions and the period can be “physically, mentally and emotionally draining.”
“Most people think of pregnancy as over once the baby has been born, but the reality is, the pregnancy journey extends beyond the typical three trimesters.”
— Dr. Joanne Armstrong, chief medical officer
How long does the fourth trimester last?
The fourth trimester usually lasts about 12 weeks, says Gaither, who adds “though the concerns and challenges during this period can last longer, depending on different circumstances.”
Put another way: Depending on a person’s situation, physical or emotional symptoms that crop up during the fourth trimester may extend past the three months. The key is addressing them right away (more on this shortly).
Why is the fourth trimester important?
The focus may all be on baby now, but as Armstrong notes, the fourth trimester is a crucial period for the health of both parents.
“The fourth trimester is an important period in which physical health concerns can grow if not monitored closely,” she says, adding that “over half of pregnancy-related deaths happen after giving birth, and over half of strokes in postpartum women occur within 10 days after leaving the hospital.”
In other words, it’s a time where postpartum care and health visits are non-negotiables, despite the demands of a new baby.
“The 12-week period following birth is a particularly high-risk time, and unfortunately, people often see their providers the least during this period, as opposed to the first three trimesters,” Armstrong continues. “Only 40% of mothers go to a postpartum checkup appointment.”
Most birth parents should see their healthcare provider within six weeks of giving birth, but those with “hypertension-related complications should see their provider for a checkup within 7-10 days following birth, and within 3 days for those with critical cases,” says Armstrong.
The fourth trimester is also a key stage for addressing “maternal mental health problems, breastfeeding difficulties and other post-pregnancy experiences,” as dealing with these issues right off the bat acts as a sort of early intervention, preventing symptoms from getting worse (and hopefully resolving altogether).
What can parents expect during the fourth trimester?
There are a number of physical, mental and emotional changes parents will undergo during the fourth trimester. Having a general idea of what to anticipate can help make the transition less jarring. Here are a few things parents can expect, according to Armstrong and Gaither.
Physical changes to expect during the fourth trimester
According to Gaither, the following physical postpartum issues can arise during the fourth trimester:
- Postpartum bleeding.
- Cesarean or episiotomy healing, which can include pain, soreness or even infection.
- Breastfeeding issues, including supply or latch problems, as well as mastitis, which may result in breast engorgement, redness, tenderness and fever.
- Hormonal flux.
- Blood pressure changes (postpartum preeclampsia), which can present as headaches, blurred vision and/or excessive swelling of the limbs/face.
Mental and emotional changes to expect during the fourth trimester
In conjunction with keeping an eye out for certain physical changes during the fourth trimester, it’s important for parents to monitor their mental and emotional well-being. Here are a few things parents may grapple with, according to Armstrong and Gaither:
Postpartum blues. Armstrong notes that postpartum blues aren’t uncommon during the fourth trimester, affecting about 80% of mothers.
Postpartum depression. Postpartum depression, a much more severe version of the “baby blues,” affects about one in seven women and 10% of men and also generally occurs during this time.
Postpartum anxiety. According to Postpartum Support International, about 10% of new moms will experience postpartum anxiety.
It’s also important to note that, for women from historically marginalized communities, the “challenges during this period can be even greater due to systemic social and economic barriers,” says Armstrong. “For example, Black women are more likely to have maternal mental health challenges than white women, yet are less likely to seek care for their mental health and less likely to receive care even when requested.”
Not feeling “connected” to baby. “Parents may feel guilty for not being overwhelmingly happy following the birth of a new child,” Armstrong says. “However, the fourth trimester is accompanied by changes in hormones and brain activity for women, as well as large shifts to one’s normal routine and usual activities, that can provide mental and emotional difficulties.”
The bottom line
New routines, mounting tasks (and bills), lack of sleep and fluctuating hormones can all contribute to stress, anxiety and even depression during the fourth trimester. Both Gaither and Armstrong note that it’s imperative for new parents to speak with their healthcare provider if symptoms don’t improve — also, moms and dads should try their best to go easy on themselves, particularly during the early days.
“So many parents want to be ‘supermom’ or ‘superdad’ for their child, but mental health challenges are not a sign of failure at parenthood,” notes Armstrong. “They can happen to anyone during this challenging time, as parents attempt to balance their own physical and mental health needs with their new child who requires almost constant attention and care.”
“Mental health challenges are not a sign of failure at parenthood. They can happen to anyone during this challenging time, as parents attempt to balance their own physical and mental health needs with their new child who requires almost constant attention and care.”
— Dr. Joanne Armstrong, chief medical officer
What truly makes a supermom or superdad? Admitting and working through issues. “When parents don’t address their mental health needs during the fourth trimester, there can be severe costs,” Armstrong continues, citing that the top cause of pregnancy-related death is mental health conditions. “Proper postpartum care can set parents up for mental health support throughout the rest of their life.”
“New parents should enlist familial support during the early postpartum period, if possible” Gaither adds. “And if such support doesn’t exist, they should consider outside post-birth sources, such as a postpartum doula, or connect with a social worker who may be able to link new parents with support systems within their locale.”
