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pregnancy & birth

advice from a midwife mum: birth and the fourth trimester

11 minutes

08/10/2020

Looking for more information on the fourth trimester? Midwife and new mum Marie-Louise outlines what to expect after birth and during the fourth trimester.

The 12-week period directly after birth is called the fourth trimester. The fourth trimester is a time of great development for both newborns and parents as they adjust to their new environments and routines. Expert Midwife and new mum Marie-Louise outlines what to expect after birth and during these first 12 weeks - including the support you and your newborn can receive from healthcare professionals during this time.

What to expect immediately after birth

If there are no complications, immediately after the birth you or your midwife will lift your baby directly onto you for skin-to-skin contact as quickly as possible. This is in line with the World Health Organization Guidelines to comfort and calm newborns, helping them adjust to life outside the womb.1

Following skin-to-skin contact, your newborn will be examined by a midwife, weighed and sometimes measured. They will then do some observations on you, such as your pulse and blood pressure, before checking the perineum and vaginal wall. Any tears during birth may need to be repaired with stitches which can feel sore for a few days, but your midwife or doctor will give you the best advise on how to care for your stitches and pain relief should you need it.2

In the birth room, both parents can enjoy skin-to-skin with their baby and you can all cuddle up together, it’s such a precious time! I would recommend continuing skin-to-skin contact throughout the fourth trimester as it’s such a lovely way for you both to bond and newborns absolutely love it. I often tell new parents to have skin-to-skin as early and as often as possible.

Hospital discharge

Following a natural birth, you can expect to be discharged from hospital around six hours after the birth. If you have given birth at home, your midwife will stay for some time to check everything is okay with you and your newborn post-birth, before leaving you to enjoy your first day together.

If you have had a c-section birth, or an assisted birth with forceps, you may be required to stay in hospital for a few nights before being discharged.3 A team of midwives, nurses and doctors will ensure you are properly looked after during this time, and if you have any questions or concerns, remember to speak to them. They are there to support you in your post-birth journey and no question is too small or silly.

What to expect in your fourth trimester once home

How parents feel once they return home can vary, I often find new parents can be excited, emotional and shattered all at once, which is completely normal. Remember that your body and mind has just gone through a monumental change and your hormones are still adjusting too, so don’t be hard on yourself and make sure you rest as much as possible to aid your recovery.

Fourth trimester product essentials

To help prepare for those first few weeks back home, I would recommend you have the below essentials ready and available.

  • Baby wear – including baby grows, socks, hats and shoes

  • Plenty of nappies – your newborn will certainly make their way through them!

  • A blanket

  • Muslin cloths

  • Baby wipes with as few ingredients as possible, such as WaterWipes, the world’s purest baby wipes, which only have 2 ingredients (99.9% water and a drop of fruit extract).

  • Maternity knickers and sanitary pads – you will experience some post-birth discharge and bleeding, so these are essential!

  • Nipple cream

  • Formula – if you’re planning on bottle feeding

Post-natal tests and checks

Once you’re back at home you will continue to be visited by your community midwife and health visitor. Use these visits as an opportunity to ask any questions and to access any physical or emotional support you may need. Typically, these visits from your midwife will occur one day, three days, five days and ten-fourteen days after your baby is born. However, these timings may vary with the current situation and some could take place virtually instead. Rest assured that any time you need a physical check, a healthcare professional will be available to perform that.

During these appointments, the midwife will assess your physical recovery after birth and check your baby’s general health and development including weighing them.4 You will also be offered the ‘heal prick test’ or ‘newborn blood spot screening’ as it is sometimes referred to. This is a blood test for your baby to check for 9 very rare but serious health conditions.4 They will also check how you’re coping emotionally as a new parent. If you are feeling a little low during these first few days don’t feel ashamed or guilty. It is normal to feel overwhelmed or teary during this time, and these emotions will usually settle as you develop into your new routine. If you or your partner feel that you’re struggling emotionally or mentally, please speak to your midwife or health visitor or contact your GP, and they will provide help and guidance. Most women (around 75%) will experience some mood changes in the first couple weeks after having a baby. But for between 12% and 20% of those women, the symptoms will extend beyond the first few weeks of parenthood, edging into a perinatal mood disorder. Please remember there is so much support available, reach out if you need it. Your mental and emotional wellbeing are as important as your physical!

a mother and a baby with a midwife

Fourth trimester firsts and your baby’s development

The first feed

The first feed (particularly if you’re breastfeeding) can be a daunting experience, and as a midwife I’ve seen many parents put unnecessary pressure on themselves for it to go perfectly. Remember it can take a few weeks for you both to get the hang of breastfeeding, in fact it is an ever-evolving journey so don’t worry if it doesn’t go right the first time.

Some key tips to help with latching and breastfeeding are:

  • Always bring your baby to the breast and let them latch themselves. Avoid leaning your breast forward towards their mouth, as this can lead to poor attachment and back ache for you.5

  • Try not to hold the back of your baby's head when feeding. Instead, support their shoulders and neck as this will allow them to tilt and move their head freely.5

  • Ensure your baby's head and body is in a straight line as it’s difficult for them to swallow if their head or neck is twisted.5

  • Ensure you’re comfortable and as relaxed as possible. Use feeding time to sit down with your baby, have a cuddle and enjoy some skin-to-skin.

  • Make sure the babies cheeks look full and not drawn in.

  • Remember, you may get pain and discomfort initially, but this should settle.

During the fourth trimester, your baby will need feeding little and often. It’s fine to feed your baby whenever they are hungry or when your breasts feel full.6 The amount of milk you make will fluctuate and is dependent on how often you feed them, generally the more demand, the more supply! But as a rough guide you should feed 8-12 times a day.6

Some key signs that your newborn is hungry include restlessness, sucking fingers, turning their head and opening their mouth.5 Try to feed your baby whenever you see these cues, as it can be difficult for the baby to latch and feed once they’re crying. However, as a new mum too I know this is not always possible, so don’t worry if your baby does cry for food occasionally. If you have persistent trouble with latching or feeding, remember to speak to your midwife or health visitor, and remember it’s very common to have lots of questions about breastfeeding.

First nappy change

The first nappy change can also be a daunting experience for new parents, but like feeding, it will soon become a second-nature routine.

Try following these 8 nappy changing tips to ensure you understand the best positioning and methods for changing. Also, be mindful of what you’re putting on their delicate skin. Avoid any harsh chemicals, alcohol or fragrance as these can irritate and dry-out the skin. Instead use a wipe such as WaterWipes, as they are designed for baby’s sensitive skin. They contain only two ingredients (99.9% water and a drop of fruit extract) and have been validated by the Skin Health Alliance as being ‘purer than cotton wool and water’, so are perfect for cleansing your newborn.

nappy changing

Crying

Your baby is likely to cry more during the first 12 weeks than at any other time.7 This is because the fourth trimester is a period of great adjustment for them. In the womb babies are used to being fed continuously, rocked all day and sleeping when they want. Every new experience and environment they encounter outside the womb can be a little daunting for them. Whilst each baby is different, there are some common reasons for crying during the fourth trimester listed below:

  • They’re hungry

    Parents are often surprised by how much their little one wants feeding, particularly those babies that are breast fed. This is nothing to worry about and your baby regularly being hungry is completely normal. Some baby’s like to cluster feed to, where they feed with short intervals, and this is particularly common in the evenings.

    If you are bottle feeding, you may find you newborn can go for longer periods of time in between feeds. Again, this is nothing to worry about, just make sure you are feeding them the right amount of milk, so you aren’t stretching their little tummies.

  • Their nappy is wet or dirty

    Parents are often surprised at how much can come out of this tiny person. So, if your newborn is crying, do always check to see if their nappy is wet or dirty, even if it hasn’t been that long since you’ve last changed them.

  • They’re tired

    It can be more difficult than people think for newborns to sleep, especially if they are over stimulated. I would recommend that parents try and spend the majority of the first two weeks at home with their baby to help them familiarise with their new environment, as too much stimulation can lead to over tiredness or unsettled periods.

  • They need winding

    To wind your newborn simply hold them by your shoulder, support their bottom, and run your hand on their back in a circular motion.

Sleeping

Your newborn is also going to sleep a lot during the first 12 weeks. This helps your baby’s brain process all that sensory stimulation when they’re awake.8 It may take your little one a few months to adjust to a regular sleep routine during the fourth trimester, so try to let your newborn sleep whenever they like throughout the day.

Looking after yourself mentally and physically during the fourth trimester

Whilst it’s easy to spend the fourth trimester focusing on your newborn, remember to prioritise your health and wellbeing too. Try and eat three healthy and balanced meals throughout the day and stay hydrated by drinking plenty of fluids. Some mums like to take a postnatal supplement too with DHA to support recovery and enhance milk quality. I would also recommend following GP Stephanie Ooi’s top tips for practicing self-care and having ‘me’ time as this is important for your physical and mental wellbeing too.

Finally, remember that whilst there is a lot of advice and information out there for navigating the first few weeks with your newborn, don’t compare your fourth trimester experience to others, ask for help and support if you need it and trust that you’re doing a great job. Anyone in the early stages of pregnancy can find guidance for navigating the first, second and third trimesters too.

About the Author

Marie-Louise, the Modern Midwife, is an expert Midwife and author. Alongside her professional interest, Marie-Louise has personal experience of going through the fourth trimester and has just given birth to a little girl. She has been regularly documenting her experiences of parenthood on her Instagram.

About WaterWipes

WaterWipes are the world’s purest baby wipes, made with 99.9% water and a drop of fruit extract. For more information on WaterWipes, please visit the WaterWipes homepage.

References

  1. WHO recommendation on skin-to-skin contact during the first hour after birth. Available at https://extranet.who.int/rhl/topics/newborn-health/care-newborn-infant/who-recommendation-skin-skin-contact-during-first-hour-after-birth

  2. NHS - What happens straight after birth? Available at https://www.nhs.uk/conditions/pregnancy-and-baby/what-happens-straight-after-the-birth/

  3. NHS - Caesarean section. Available at https://www.nhs.uk/conditions/caesarean-section/

  4. NHS – Services and support for parents. Available at https://www.nhs.uk/conditions/pregnancy-and-baby/services-support-for-parents

  5. NHS – Breastfeeding positioning. Available at https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-positioning-attachment/

  6. NHS - Breastfeeding first days. Available at https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-first-days/

  7. NHS -Soothing a crying baby. Available at https://www.nhs.uk/conditions/pregnancy-and-baby/soothing-crying-baby/

  8. NHS – Helping your baby to sleep. Available at https://www.nhs.uk/conditions/pregnancy-and-baby/getting-baby-to-sleep/

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