By: Natasha K. Sriraman, MD, MPH, FAAP, FABM, PMH-C
If you’ve been preparing for pregnancy and childbirth, you may have come across the idea of a "4th trimester." This is something that more and more expectant parents and some health-care professionals are talking about. But you may not be entirely sure what it means, or how to prepare.
What is the 4th trimester?
The 4th trimester refers to the first 12 weeks after birth, when newborns are adjusting to life outside the womb and parents are learning new routines, feeding patterns and ways to soothe their baby.
As a pediatrician and mom of three, I wholeheartedly agree that the first 12 weeks or so of your child’s life are a very special time, full of changes and challenges and yes, sometimes surprises. Here are some insights to help you through this time with as much ease as possible. (By the way, these tips work equally well for adoptive parents who are caring for newborns.)
Challenge #1: Comforting babies as they adjust to the outside world
I distinctly remember when my oldest was only a few weeks old and I was holding her in my arms rocking back and forth, as many new parents do, and she just wouldn’t stop crying. No matter what I tried, nothing would calm her down. But it’s nothing that we as parents are doing wrong. Trust me.
Little ones often feel overwhelmed by the sights, sounds, and sensations they encounter right after birth, but there are many ways you can comfort them as they adjust.
Swaddling gives your infant the same snug, secure feeling they experienced in the womb. Use a lightweight receiving blanket to wrap your baby, tucking in the ends to create a comfy little cocoon. When it’s time for sleep, always place your child on their back. (Learn more about the AAP’s safe sleep guidelines here.)
Rocking and swaying is another great way to comfort your newborn. Spend time together in a rocking chair or simply move side-to-side while standing or walking while holding your baby. To give your arms a rest, you can use a sling, soft carrier, or even a stroller to create the gentle motion your newborn craves.
Skin-to-skin contact creates a very special feeling of special closeness. Cuddling your newborn on bare skin gives them the chance to take in your scent and the sound of your heartbeat, which feels warm and familiar. The dad/non-birthing parent can also do this—it is nice to give mom a break, especially if she is breastfeeding.
Challenge #2: Feeding your newborn during the first weeks after birth
Whether you are breastfeeding or bottle feeding, don’t wait for a scheduled time to feed your newborn. Remember that they received continuous nutrition inside mom, so responding to hunger signals as they arrive is reassuring. There will be plenty of time later to help your baby adjust to a more regular routine, but for now, follow your baby’s cues.
Your baby’s pediatrician will be closely monitoring your baby’s weight in those early days and weeks. Whether you’re nursing, pumping, or formula feeding, this is where you tell others how they can help you. Feeding a newborn is a full-time job.
If you’re nursing and you’re having trouble getting your baby to latch or not sure if your baby is getting enough to eat, consider reaching out for help from a lactation consultant. There are also physicians trained in breastfeeding medicine. Using formula? Be sure to follow the directions to a T and throw away any leftovers after each feeding.
Also, it’s OK if you end up needing to do some combination of breastfeeding and formula-feeding. The AAP recommends breastfeeding exclusively for the first 6 months, with continued breastfeeding alongside complementary foods for 2 years or longer as mutually desired by parent and child. But there are a lot of reasons why this might not be possible, as well as families for whom this might not be possible.
Challenge #3: Creating a soothing bath time routine
Floating in water is like being inside the womb, so little ones may feel soothed by the experience of their first bath. But some little ones fuss and cry at bath time, possibly because their skin is super sensitive to temperature changes and they are just getting used to this whole bathtime thing!
If your infant fusses at bath time, remember that doesn’t mean you’re doing it wrong. They will gradually adjust to this and other parts of their new routine as their senses develop. Try wrapping your newborn in a soft, warm towel right after undressing them, with another pre-warmed towel ready when lifting them out of the water.
Baby bath time is also the perfect time for you to talk and sing to your baby, creating a special feeling of closeness for both of you. Remember, in those early weeks, you can simply wipe down your baby while giving your newborn a full bath every other day. I particularly enjoyed giving my newborn an infant massage. Baby massage can calm your fussy baby while helping soothe the baby to sleep.
Challenge #4: Ensuring that you get TLC, too
The challenges of caring for a newborn can feel endless. Whether you’re parenting as a pair, going it alone, or relying on another trusted adult, those first few weeks usually bring a huge uptick in sleep loss, anxious feelings, and sometimes creeping doubts about your parenting skills.
Although your own needs may feel less urgent than your baby’s, they're really one and the same. Calm, healthy, well-rested parents are in the best position to care for their newborns. And you deserve to enjoy this special time in your child’s life.
It may comfort you to know that 50% to 80% of new parents experience the mood shifts we called "the baby blues." Although hormonal shifts set birth moms up for strong postpartum emotions, these feelings can overtake partners and adoptive parents, too. No one is immune to the overwhelm that can result from attending to a newborn’s every need. If that’s you, don’t wait for your routine postpartum visit to share any health concerns with your medical team.
You might also be struggling with the demands of breastfeeding or finding it nearly impossible to get enough sleep. You may find that you can’t keep up with the dishes or laundry and that even little things are setting you off. You may not be coping all that well with the havoc that this tiny beautiful creature has brought to your life. You (or your partner) might be moving from the baby blues into postpartum depression and/or anxiety, which affects 20% of birth mothers.
- Sleep whenever you can. Yes, you’ve heard this advice—and like many new parents, you may have ignored it. But sleep is crucial for your physical and emotional health, keeping your immune system strong and your mind calm. Say "yes" when others offer to take over so you can get some uninterrupted rest.
- Eat and drink mindfully. It’s tempting to stuff yourself with caffeine and carbs for a quick energy boost, but your energy levels will be steadier if you take a more balanced approach to nutrition. Make a list of healthy foods you love and keep them on hand. If you have a partner or household helper, ask them to prepare well-rounded meals and snacks you can grab anytime.
- Accept allllll the support. It’s hard to give up tasks you handled before your baby arrived, but there’s magic in letting others help out. It gives you time to concentrate on yourself and your little one, taking in the pleasures of this unique time. Give yourself a guilt-free pass to accept any and all help your family, friends and community offer.
- Get the treatment you need. Whether this is peer support, group or individual therapy or medication, just know that there is no shame in asking and getting for help. And remember, you do not have to choose between taking medications and breastfeeding.
- Seek immediate help for difficult feelings. If you are having thoughts of harming yourself or your baby, call the National Suicide Prevention Lifeline by calling or texting 988. Don’t wait, because these thoughts are a sign that you need expert help right now.
If you are not in crisis but would welcome extra support, call the National Maternal Mental Health Hotline at 1-833-943-5746 anytime, day or night. Postpartum Support International is another resource you can reach by calling or texting "Help" to 1-800-944-4773.
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About Dr. Sriraman
Natasha K. Sriraman, MD, MPH, FAAP, FABM, PMH-C is the author of the American Academy of Pediatrics (AAP) book, Return to You: A Postpartum Plan for New Moms. She is a mother of 3 who has cared for thousands of children and families, sharing honest perspectives, medical guidance and sage advice to help parents navigate the intense changes that happen in the first few months after a baby arrives. Dr. Sriraman is a member of the Committee on the Psychosocial Aspects of Child and Family Health, the AAP Council on Communication and Media is the Past-President of the Virginia Chapter of the AAP.