The fourth trimester is a way of describing the 12-week period immediately after you’ve had your baby. Every mother and their newborn baby will go through this, but not everyone recognises it. It is a time of great physical and emotional change as you adjust to your new life as a mum and as your baby adjusts to being outside the womb.
This is an often-forgotten period, but it is just as important as pregnancy itself. Although the “fourth trimester” is not a scientific term, it is an extension of pregnancy and a time of significant changes to a mother’s body, some of which can be unexpected.
Having a baby can be the most exciting experience of your life, but it can also be daunting, scary and lonely at times. Remember communication is key. Talk to family, talk to friends, talk to your GP. You are not alone, but you may need to ask for help.
Tiredness often comes hand in hand with having a newborn. It can exacerbate many physical and psychological symptoms which makes life harder. To try and reduce tiredness try and sleep when you baby is sleeping, consider sleeping in a different room to your partner so you can both try and get some good quality sleep. Even considering a night nanny/friend/relative to look after your baby occasionally at night can give you some respite if needed.
20% of mothers suffer from postnatal depression, which occurs mostly commonly within the 2 – 8-week period after birth (although can occur up to a year postnatally). It is therefore important to ask for help if you are feeling down, anxious or unable to cope.
As well as counselling and medication, self-help therapy can be helpful. This could involve online therapy programmes through the IAPT service, Reading Well books on prescription, or various apps through the NHS app library (such as Calm and Headspace). The following websites may also be useful:
Partners should not be forgotten, as it is thought up to 10% of partners can also suffer from postnatal depression.
This is a check-up for both mother and baby that GPs do at about 6-8 weeks after birth. It is to ensure there are no problems after delivery and to answer any questions. It covers physical, psychological and social issues.
To get the most from your appointment:
In the three months following childbirth, a third of women suffer from urinary incontinence, but it can be embarrassing to discuss with your GP. In addition, bowel incontinence should not be forgotten as it can severely impact quality of life, long term health, relationships and employment. It is important therefore to talk to your GP about these issues as there are options to help including doing pelvic floor exercises or being referred to a women’s health physiotherapist. A useful app called Squeezy can help remind you to do pelvic floor exercises.
You can have sex as soon as you and a partner both feel ready, there’s no ‘right time’. Having a baby can be both physically and emotionally demanding, so don’t feel pressured or put pressure on yourself to have sex before you’re ready. However remember you can get pregnant again from 21 days post birth. You can get contraception at the time of delivery, from a postnatal ward, at your 6-week GP check (or make an earlier appointment with your GP) or from a contraception or sexual health clinic.
Exercise is important to improve both physical and mental wellbeing. It can help you lose weight, improve back pain and strengthen pelvic floor muscles to reduce the risk of incontinence (leaking urine). It can improve mood and energy and reduce the effects of postnatal depression. Start with gentle exercise, such as walking, Pilates or yoga, as soon as you feel ready, as well as continuing pelvic floor exercises. If your bleeding gets heavier or you feel very tired, you may be overdoing it. It’s sensible to wait until your 6-week check before starting anything more strenuous. It’s also important to check whether your tummy muscles have separated, as this can be made worse by certain exercises.
Postnatally, good nutrition’s important to help strengthen and repair your body as well as giving you the energy to look after your baby. It can also help with mood, tiredness, weight loss and breastfeeding. In addition don’t feel pressured to lose weight immediately, your body needs time to recover after the birth. It’s realistic to aim to be back to your pre-birth weight within 6 to 12 months of the birth. The best way to lose weight is to eat varied, healthy foods, start gentle exercise and set achievable goals that work for you. If you’re breastfeeding, this can also help with weight loss.
Giving birth is a life changing event, even more so during a pandemic. As a GP and mother I want to help raise awareness of the postnatal period (also known as the fourth trimester) and support other mothers during their postnatal journey. I have written an information booklet with the Family Planning Association for both GPs and mother and we are in the process of publishing one focused on the newborn.
Interested in learning more about the author? Read more articles from Dr Eloise Elphinstone:
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