Exploring the 4th Trimester

Jen Derham
Written by Jen Derham

What to Expect & Why It Matters

You’ve taken the pregnancy test, and now the emotions have kicked in: excitement, fear, joy, love, and apprehension.

You share the joyous news with family and friends, and you begin planning for the birth. You attend all your doctor and midwife appointments, take your vitamins, enrol in antenatal or hypnobirthing classes, join pregnancy yoga, and pay more attention to your nutrition. You learn breathing techniques and the best birthing positions. You research pain relief options and might even write a birth plan. You purchase essential items for the baby: a pram, cot, baby clothes, a rocker, toys, and you start to decorate a beautiful nursery. As you approach your 40th week, you pack your hospital bag and wait patiently (or impatiently) to finally meet the amazing little human you’ve been growing for the past nine months. You feel ready and can’t wait for the journey to culminate in the birth.

But what happens after the baby is born?

Enter the 4th trimester, also known as the postnatal or postpartum period. Clinically, this is considered the first six weeks after birth, but it can extend much longer.

Photo by Jimmy Conover on Unsplash

We spend so much time planning for the birth but often neglect to prepare for what comes next. How will we manage those initial weeks at home with a new born? Our bodies are healing; we’re navigating a feeding journey, whether that’s bottle, breast, or a combination of both. We have visitors calling every five minutes, we’re not getting any sleep, we’re exhausted, we’re forgetting to eat, and we still have all the regular life responsibilities: walking the dog, bringing older children to school, doing laundry, housework, and cooking.

Your partner may return to work a few weeks later, leaving you alone to manage everything and keep a new born alive. Society gives the impression that this transition will be easy, that life will quickly return to normal. But it’s often much more challenging. You might feel like a different person physically and mentally, questioning your sanity and wondering why it seems so hard when others make it look effortless.

So, let’s explore what’s happening during this period and what you can do to make it easier, allowing you to enjoy this beautiful time of bonding with your baby while feeling supported and cared for.

After giving birth, there is a severe decline in oestrogen and progesterone levels. These hormones, essential for maintaining pregnancy, drop rapidly once the placenta is delivered. This hormonal shift can lead to various symptoms, which vary among individuals. Common symptoms include low mood and tearfulness (baby blues), fatigue, anxiety, irritability, and insomnia.

Whether you’ve had a vaginal birth or a caesarean, healing will take place both externally and internally.

Below, I briefly discuss some of the most common things to expect during postpartum:


You may experience afterpains, which usually subside during the first week but can continue if you are breastfeeding. These can feel like milder labour pains but sometimes are just as painful, and they may come as a shock especially if you weren’t informed about them.


The bleeding after birth, known as lochia, is different from a period. It’s a combination of blood, tissues, and mucus produced by the birth, changing in colour and frequency over the weeks. If bleeding subsides and then starts again suddenly, it could mean you’re overexerting yourself. Any persistent bleeding should be investigated by your doctor.

Perineum Pain

If you’ve had a vaginal birth, you may have tenderness around the perineum, which could last longer if you had forceps, an episiotomy, or stitches. A caesarean involves major abdominal surgery, so recovery time is longer, and you may feel soreness, tenderness, and occasional numbness around the incision.

Night Sweats

Significant hormonal changes can cause night sweats or hot flashes. This is normal as your body adjusts hormonally.

Pelvic Floor

Pregnancy hormones soften pelvic floor muscles to support your growing baby, and birth can strain these muscles, leading to tenderness, swelling, or urine leakage in the early weeks. Speak to a pelvic floor specialist if issues persist beyond six weeks and practice pelvic floor exercises under medical guidance.

Emotional Healing

Alongside physical symptoms, mental and emotional changes occur, often harder to pinpoint but equally important.

Baby Blues

The “baby blues” are a common, short-lived mood disturbance starting within a few days postpartum and lasting up to two weeks, caused by a significant drop in oestrogen and progesterone. Symptoms include tearfulness, sadness, anxiety, fatigue, and trouble concentrating. Rest, support from family and friends, and a safe space to talk about your feelings can help. If your mood doesn’t improve after two weeks, contact your healthcare provider.

Postnatal Depression

Postnatal depression (PPD) is a type of clinical depression that affects women after childbirth, with more persistent and longer-lasting symptoms than the baby blues. These can include intense sadness, difficulty bonding with the baby, severe mood swings, feelings of despair or worthlessness, and withdrawal from family. Affecting 10-20% of new mothers, PPD typically begins within the first few weeks but can occur up to a year post-birth. Seeking professional help is crucial, as early treatment can significantly improve outcomes for both parent and child.

Postnatal Depletion

Postnatal depletion describes the physical and emotional exhaustion many mothers feel months or years after giving birth. Unlike postpartum depression, it’s not a clinical disorder but a state of ongoing fatigue and depletion. Symptoms include feeling overwhelmed, brain fog, chronic fatigue, muscle pain, low energy, and anxiety. Causes include nutritional deficiencies, sleep deprivation, hormonal changes, and the physical demands of motherhood. Addressing postnatal depletion involves a balanced diet, rest, physical activity, and seeking support.

Birth Trauma

Birth trauma refers to the psychological distress experienced during or after childbirth due to physically difficult or emotionally challenging experiences. Symptoms significantly impact a mother’s mental health. Causes may include prolonged labour, emergency interventions, perceived loss of control, unexpected outcomes, negative interactions with providers, or previous trauma. Debriefing after birth supports recovery. Some hospitals offer birth debrief services, and therapists, doulas, and midwives trained in birth debriefing can provide private services.

Although all the above may appear daunting, painful, and, let’s face it, just plain awful, I can assure you that the postpartum period is also a wonderful time of transformation, joy, and love. Having a postpartum plan in place will assist you in transitioning with ease while feeling supported, rested, and heard.

Photo by Danik Prihodko

Why is Planning for Postpartum Important?

Planning for postpartum is crucial for the health and well-being of both mum and baby during this significant adjustment and recovery period.

Physical Recovery

  • Healing: Childbirth is physically demanding, and the body needs time to heal. Planning allows for rest and recovery, reducing complication risks.
  • Nutrition: A well-balanced diet is vital for recovery and breastfeeding. Planning helps manage meals and maintain proper nutrition.

Mental Health

  • Preventing Postpartum Depression: Early preparation can help identify resources and support systems to address mental health issues.
  • Reducing Stress: Knowing what to expect and having a plan reduces anxiety and stress, making the transition smoother.

Infant Care

  • Feeding & Sleep: Planning feeding methods and managing the baby’s sleep schedule helps establish routines and ensures nutritional needs are met.
  • Health Monitoring: Scheduling paediatric appointments and understanding infant healthcare needs are crucial for early detection and management of health issues.

Support System

  • Help from Family & Friends: Arranging help with household chores, childcare, or emotional support eases the burden on new parents.
  • Professional Support: Identifying healthcare providers, lactation consultants, and postpartum doulas ensures professional support is available when needed.

Relationship Management

  • Partner Involvement: Discussing roles and responsibilities with a partner improves communication and teamwork, strengthening the relationship.
  • Social Connections: Staying connected with friends and support groups provides emotional support and reduces isolation.

Practical Considerations

  • Financial Planning: Managing finances to cover medical expenses, parental leave, and baby supplies reduces financial stress.
  • Household Organisation: Preparing the home, setting up a nursery, and organising baby supplies make daily life more manageable.
Photo by Toa Heftiba on Unsplash

Long-Term Wellbeing

  • Self-care: Planning self-care activities, like exercise, hobbies, and relaxation, helps maintain overall well-being.
  • Returning to Work: Planning the transition back to work, including arranging childcare and adjusting work schedules, makes the change less daunting.

By proactively addressing these aspects through postpartum planning, new parents can create a supportive environment that promotes healing, reduces stress, and fosters a positive experience for both mother and baby.

My Top Tips For Postpartum

  • Nourish Your Body: Focus on replenishing nutrients, staying hydrated, getting adequate rest, and minimising stress to support hormonal recovery.
  • Ask for Help: Instead of baby gifts, ask visitors to bring meals, make their own tea, or help with chores. Small acts of support can make a huge difference.
  • Set Boundaries: It’s okay to say no to visitors. Prioritise your and your baby’s needs.
Photo by Drew Hays on Unsplash

This period is about healing, bonding, and adjusting. Please remember, you’re not alone in this journey. Reach out to your support system, lean on your partner, and don’t hesitate to seek professional help if you need it.

The 4th trimester may be challenging, but with a little preparation and a lot of love, you’ll come out stronger on the other side.

Main – Photo by Nandhu Kumar on Unsplash