How to navigate the fourth trimester - Ruth Health

How to navigate the fourth trimester

Fast facts:

  • The first 12 weeks after childbirth are classified as the fourth trimester, which is no less important than the other three.
  • Our society doesn’t put nearly enough emphasis on a mother’s recovery in this crucial postpartum period.
  • Other cultures have traditions to celebrate and support the birthing person and honor this important time.
  • Health experts have called for a greater focus on the fourth trimester through the lens of maternal health, to support consistent postpartum care.

Childbirth is both the end of your pregnancy journey and the beginning of a new life chapter. The next phase is filled with immense physical and emotional changes for you and your baby.

While other cultures have traditions to celebrate and support birthing people in early postpartum, our society doesn’t adequately recognize a mother’s recovery during this time. 

The standard postpartum check-up doesn’t happen for at least six weeks. At this point, many women have already navigated common postpartum challenges from mood swings and the baby blues to breastfeeding problems. Unfortunately, this is often without support from a healthcare professional.

Many people aren’t aware that the first 12 weeks after childbirth are classified as the fourth trimester. And it’s no less essential than the other three. 

Fortunately, the conversation in the U.S. is starting to catch up with the reality of postpartum life. The American College of Obstetrics and Gynecology (ACOG) has called for a greater focus on the fourth trimester specifically through the lens of maternal health to support consistent postpartum care.

Let’s take a look at all that happens during the 4th trimester for mother and baby, and how it’s observed around the world.

What is the fourth trimester?

The fourth trimester is the transitional time between childbirth and 12 weeks postpartum. During this time your baby adjusts to life outside the womb and you adjust to life with your newborn.

Here’s a snapshot of some of the developmental changes that a newborn may experience during their first three months.

  • Maturing of the senses and sensory development — By the end of the fourth trimester, many babies progress from being able to see light and dark objects within an 8-10-inch radius to focusing on smaller items and processing colors.
  • Physical growth and muscular development — Throughout the fourth trimester, a baby’s reflexes may become more controlled. For instance, they may gradually become able to lift their head, push up with their arms, and stretch their legs.
  • Adjusting to the outside worldIn addition to processing sights, sounds, and smells, your baby is transitioning from the warmth of your womb — and the constant protection of amniotic fluid — to a colder environment.

Your newborn isn’t the only one experiencing rapid growth and change.

Here’s what the fourth trimester often looks like from a mom’s perspective.

  • Physical recoveryA dinner-plate-sized wound is healing inside your uterus, which is also shrinking back to its pre-pregnancy size (up to 500 times smaller). In addition, your pelvic muscles and tissues are recovering from major trauma. Those who delivered by c section have the additional challenge of healing from major surgery.
  • Hormonal changesEstrogen and progesterone levels decrease rapidly as breastfeeding related hormones prolactin and oxytocin increase. These changes can affect your sleep, energy, appetite, and concentration.
  • New responsibilities and identity shiftCaring for your baby around the clock is a significant transition from day-to-day life during the first three trimesters.

It isn’t uncommon to experience mental health challenges amid this whirlwind of emotions and physiological changes. 80% of new moms experience mood swings, sadness, crying spells, and anxiety — referred to as the baby blues — for a couple of weeks starting around 2-3 days after childbirth. 

As many as 1 in 5 women experience postpartum depression (PPD), which is longer-lasting and more severe than the baby blues.

PPD is characterized by ongoing mood swings, fatigue, and other symptoms that can affect your ability to take care of yourself and your baby.

How is the fourth trimester recognized in different cultures?

Other cultures have long recognized the significance of the 4th trimester, with traditions that celebrate the birthing person, and newborn, and provide support during the transition.

  • The Chinese tradition of Zuo Yuezi translates to sitting a moon cycle or doing the month
    • This period focuses on a new mother’s healing as she enters the fourth trimester. It includes limiting outside visitors, avoiding the cold, and prioritizing rest. 
    • Both of the newborn’s grandmothers typically stay with the birthing person and prepare meals for thirty days.
  • In Latin American cultures, the first 40 days after childbirth — la cuarentena — are treated as a time of rest and recovery for new moms. 
    • Other friends and family members take on household responsibilities to allow the birthing person to focus on her well-being and care for her newborn. 
    • In recognition of the physical changes that happen during this period, the birthing person wraps their midsection with a faja to help organs return to their pre-pregnancy state.
  • In the Netherlands, a nurse specially trained in postpartum care — and covered by insurance — called a kraamzorg supports a new mom for up to eight hours a day for the first eight days after birth. 
    • In addition, a kraamzorg cares for other children and assists with laundry and meal prep. 
    • The kraamzorg also acts as a liaison between the birthing person and the rest of their medical team.
  • In Japan, a new mom spends up to eight weeks recuperating at her mother’s home in a period called Ansei. 
    • If there are older children, other relatives will take on their care during this time.

How can I have a better postpartum recovery?

While the fourth trimester is accompanied by many physical and emotional challenges, there are ways to prioritize your care and well-being.

Asking for help is important in early postpartum. Support from friends, family and trusted birthing professionals such as a doula or lactation consultant can ease the transition.

Ask A Doula by Ruth Health is a new service that offers unlimited texting access to a doula. You can get personalized support with postpartum planning, feeding, and anything else pregnancy or postpartum-related. Spaces are limited, so sign up today!

  • Nutrition — Load up on warm, nutrient-rich foods that support your physical recovery and nourish your well-being.
  • Support — You don’t have to navigate the challenges of the fourth trimester on your own.
    • Lean on your inner circle for help with household needs, meal prep, and diaper changes.
    • Find an in-person or virtual group to connect with other moms experiencing similar challenges.
    • If you’ve chosen to breastfeed, work with a lactation consultant to ease the transition and address any breastfeeding challenges.
  • Rest and recovery — You’re likely sleep-deprived from your baby’s sleep routine and nursing needs. Take advantage of any opportunities to rest during the day, even if it’s just a few minutes of alone time to take some deep breaths.

The first postpartum check-up is typically scheduled for six weeks after childbirth.

However, it’s important to connect with your doctor immediately if you experience any of the following symptoms:

  • Persistent, excessive bleeding after delivery (e.g., bleeding that soaks more than one pad in an hour without slowing or stopping)
  • Fever
  • Foul-smelling vaginal discharge
  • A hard or painful lump in the breast
  • Chest pain
  • Difficulty breathing
  • Lower abdominal pain
  • Severe headache
  • Pain, swelling, or tenderness in the legs
  • Extreme pain anywhere in the body
  • Dizziness, lightheadedness, or fainting
  • Chills
  • Fast breathing or heart rate
  • Nausea or vomiting
  • Confusion or disorientation

Our team has used the following resources to navigate their own postpartum journey.

  • The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions, and Restoring Your Vitality by Kimberly Ann Johnson
  • Life After Birth: A Parent's Holistic Guide for Thriving in the Fourth Trimester by Diane S Speier
  • The Fourth Trimester Companion: How to Take Care of Your Body, Mind, and Family as You Welcome Your New Baby by Cynthia Gabriel
  • The First Forty Days: The Essential Art of Nourishing the New Mother by Heng Ou
  • Moms on Call by Laura Hunter and Jennifer Walker

We’re here for you

At Ruth Health, we understand that nobody knows what you need better than you. We’re here to help you prioritize self-care while navigating the fourth trimester and beyond, and to ensure that you’re never alone in this journey.

We provide expert, evidence based maternal advice so that you can make the best decisions for yourself. Learn more about pregnancy, postpartum, and everything in between at

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