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While pregnancy itself consists of three trimesters, what’s become known as the “fourth trimester” – the first 12 weeks after giving birth – is every bit as important as the previous three as mom and baby adjust physically and emotionally to childbirth. 

The fourth trimester is a critical time for both the new mother and the baby, says Dr. Gamilah Pierre, board-certified obstetrician gynecologist on staff at Silver Cross Hospital in New Lenox. Dr. Pierre was recently featured in one of the hospital’s iMatter Health video podcasts, where she discussed this topic for viewers. 

“It lasts for up to 12 weeks, even longer in some people's estimates,” said Dr. Pierre. “So, it's important that we recognize just because the baby is delivered, nothing just goes back to normal the next day. 

Fourth Trimester Symptoms

“During that time, we need to consider all of the different aspects: how the infant is doing; how the mom is feeding the infant; contraception; sexual function; mood and mental wellness; as well as comorbidities.” 

Dr. Pierre says some patients may have had significant medical problems before they were pregnant or during their pregnancy. Others have had difficult pregnancies and/or babies with health concerns requiring longer hospitalization. 

“So, how does that relate to them after? It’s not just the mental aspect. We are concerned about the rising rates of postpartum depression,” she said. “But really, the fourth trimester encompasses all of the function of return to a pre-pregnant state after a baby has been born. They obviously had a significant change in their life. And really, it takes a lot of questioning, discussions with the mom, and interacting to understand how those changes are being received by them as well as their support team. 

She added, “So, when we see a mom who is not bouncing back as well in the first two to four weeks, then we start to have some concerns.” 

Come Back Sooner

Dr. Pierre said traditionally, a postpartum visit has been scheduled six weeks out from the birth, but no more. 

“We finally recognized that that's just too far out. For the average patient with no medical problems and no complications, we try to encourage them to come back in about two weeks. For a complicated patient, they may be back in three to four days.” 

Dr. Pierre said it’s very important for new moms to reach out to their primary care provider very early after delivering to see how the “baby blues,” the normal hormonal changes after giving birth, are progressing. 

“Those blues should correct themselves in two to four weeks. However, we definitely see a percentage of patients where those blues really morph into something more significant and more serious and more concerning, such as postpartum depression and, even worse, postpartum psychosis.” 

Dr. Pierre said it’s important for the new mother to have a dependable support network, because often, they’re the ones who recognize the signs and the concerns before the patient actually does. And to help give mom a break. 

“You need to have the ability to have some downtime. You have to be able to have someone to help you just for 10 minutes a day, or an hour a day, to be able to walk away and take a shower,” she explains. “And we know having a newborn means that sleep is at a premium. When our bodies don't get sleep and don't get to rest and recover, we don't have as much resiliency. So, it's very difficult to deal with anxiety that could be normal, but we just don't have the resiliency because our bodies are exhausted. 

“And a lot of times, once the mother recognizes that some of the thoughts and the process of these mental changes are normal and common, it's actually reassuring to them.” 

Dr. Pierre said, if the lack of sleep and personal care, including eating properly, begins to affect the new mother, they need to reach out to Silver Cross obstetrics for help. Even if it’s just for reassurance. 

Help is Available

If new mothers have difficulty coming in for scheduled postpartum visits or appointments for concerns, they can set up telehealth visits. That can help doctors and nurses evaluate the situation, including how the mother looks and acts. 

The most important thing, Dr. Pierre said, is to make sure the new mothers realize what they are feeling is normal. 

“It is overwhelming to have a baby. That's the most overwhelming change in your life for anybody,” she added. “So, it's important for patients to recognize it's not all roses and sunshine. This is hard work. These babies don't sleep. They are demanding. They need a lot. Your body's changing. You're having just so many changes. 

“So, the earlier we're able to see patients back postpartum and actually discuss it with them in the third trimester and reminding them that you may have feelings of inadequacy, or you may feel like you're not bonding with your baby, does not mean you're a bad mother. You're not a bad parent. 

“This is normal. And the important thing is to stay in touch with us so that we can work through how you feel and make sure that you’re staying on the continuum of what we think is normal. If we don’t believe it is normal, we can get involved very soon, and we can get moms hospitalized if necessary. 

“Nonetheless, we can work through this, and most women will be successful and be fine, and go on to have additional children, if that's part of their birthing plan.” 

To learn more about postpartum issues, listen to Dr. Pierre’s recent podcast or watch her video podcast by visiting silvercross.org/imatter-health/podcast/.