Fourth Trimester: Postpartum Coping & What You Need to Know

Updated: 12 Dec 2024

New parents go to great lengths to organize and prepare for the arrival of their newborn. Yet, many are still shocked by how confusing and overwhelming caring for an infant truly is. The rigorous, unending demands of a newborn infant can make the first few months feel completely nerve-wracking and absolutely exhausting. This murky stage is often referred to as “the fourth trimester” (commonly written as the "4th trimester"). You’re recovering from pregnancy and childbirth and at the same time trying to figure out how to be a parent while your infant acclimates to life outside your body. Let’s take a look at what you and your baby may be experiencing during the fourth trimester and how to cope.

What Is the Fourth Trimester?

The concept of the fourth trimester is usually credited to pediatrician and author Harvey Karp, MD. In his book, The Happiest Baby on the Block, Dr.Karp theorizes that human babies are born too soon, and unlike other mammals, are born fundamentally helpless. Essentially, they are “fetuses outside the womb.”

Fourth Trimester Postpartum: Week by Week

Dr. Karp explains that humans gestate for only nine months due to their large brain size. Longer gestation would result in a baby being too large to fit through the birth canal. This means human newborns are born before they’re ready, resulting in the need for far more care and attention than most other newborn mammals require. In fact, it takes about 12 weeks for them to adjust to life on the outside.

He also suggests that much of a newborn’s fussy, needy behavior is a result of their inability to self-soothe along with feelings of disorientation outside the womb. Feeding, rocking, swaddling, and even shushing a newborn are soothing because they mimic the soft, rhythmic sensations of they experienced in utero. This explains the significant changes your infant goes through in a fairly short period – from a drowsy, fretful infant to a cooing, smiling three-month-old baby. The fourth trimester is a stage of major physiological and emotional development for your little one.

It’s also a time of change for moms. You experience significant shifts as you adjust to having your own body back. At the same time, you’re figuring out how to care for a tiny new human and deal with all the major life adjustments that come with parenting.

The Fourth Trimester for Baby: What They Experience

Life on the outside is quite an adjustment for babies. They go from tiny, scrunched-up little creatures who sleep all day and can’t lift their own head to a happier, calmer, more alert baby who is starting to show a little personality.

During the first three months, newborns are essentially operating entirely on instinct. Newborn reflexes control everything. Anything your baby does is involuntary or happens without them trying, from eating to sleeping to crying. They can only see about a foot in front of them and can’t clearly see colors. At this stage, babies have jerky movements and spend much of their time curled up in a little ball, still not quite aware that they’re outside the womb now.

By about three months, some of these reflexes begin to fade and their movements become more intentional, such as smiling. They can often raise their head and chest during tummy time and intentionally put their hands in their mouth. Their vision also improves at this point, and they’re able to follow a moving object across the room. By the end of the fourth trimester, your baby will begin to shift into more predictable feeding patterns and perhaps even something that looks like a more regular sleep schedule.

The Fourth Trimester for Mom: What She Experiences

Newborns aren’t the only ones dealing with major life changes immediately after birth. Birthing parents need a little care and compassion as well! The adjustment period in the weeks and months that follow is challenging for many parents.

In the early weeks, you’re dealing with a massive drop in hormone levels, shifting body parts, and lactation. As if that’s not enough, there’s also the standard postpartum bleeding accompanied by a sore perineal area and/or C-section scar to add to the discomfort.

About a month and a half to two months after childbirth, most people are considered physically healed. However, that doesn’t mean you’ll feel like your old self. Your body won’t really be back to its pre-pregnancy form for a while (if ever). If you’re breastfeeding, you may experience engorgement, sensitive or tender nipples, and middle-of-the-night leakage. 

Changing hormone levels can also wreak havoc on a new parent. They can cause mood swings that range from a 10-day bout of “the baby blues” to a more serious (but very treatable) condition called postpartum depression or postpartum anxiety. Talk to your healthcare provider about treatment options if you have symptoms that are making it difficult for you to function normally.

What Week Is the Hardest Postpartum?

For many parents, the first two to three weeks postpartum are particularly challenging. Sleep deprivation, physical recovery, and the steep learning curve of parenting a newborn can feel overwhelming. Additionally, many new moms experience the "baby blues," a short period of mood swings and emotional ups and downs caused by hormonal changes. Recognizing that these feelings are temporary and seeking support can help make this phase more manageable.

Fourth Trimester Postpartum Symptoms

Parents in the fourth trimester experience a wide range of physical and emotional changes. These may include:

• Physical recovery: Whether from vaginal birth or a C-section, the body undergoes significant healing. Common symptoms include soreness, postpartum bleeding, and hormonal shifts.

• Breastfeeding challenges: Engorgement, nipple sensitivity, and leaking milk are common during this time.

• Emotional shifts: Hormonal changes can cause mood swings, anxiety, and even postpartum depression or anxiety. If feelings of sadness or overwhelm persist, it’s essential to seek professional help.

Why the 4th Trimester Is the Hardest for Many Parents

The 4th trimester is often described as the hardest because it involves simultaneous adjustments for both parent and baby. Sleep deprivation, physical recovery, and the constant needs of a newborn can be overwhelming. Acknowledging these challenges and seeking support from loved ones and professionals can help ease the burden.

Tips for Coping with the Fourth Trimester

Though it doesn’t feel like it when you’re in it, the hazy, crazy days of the fourth trimester will not last forever. If you’re struggling, here are a few tips to help you get through it.  

1. Wear Your Baby

Most newborns like being snuggled into a little ball. They literally just spent nine months in that position! Wearing your infant in a sling or baby carrier helps mimic the snug, rhythmic sensations of the womb. Make sure your carrier is designed specifically for newborns and that their nose and mouth aren’t blocked. Another benefit to babywearing: it leaves your hands free to read a book, eat a meal, or check your phone for a precious few moments. (Hey, new parents need a break, too!) 

2. Swaddle

Swaddling helps limit some of a newborn’s instinctive jerky movements and mimics the snug embrace of the womb. During the fourth trimester, it’s a useful technique that can help your newborn feel safer, soothed, and more secure. Learn how to swaddle yourself or invest in a swaddle blanket that can help you get the swaddle just right. 

3. Bounce, Walk, Rock…Just Move!

Newborns love a rocking motion. Remember, they experienced constant movement while they were in the womb. Carry your newborn on a walk outdoors, sit in a rocking chair, or do a little easy bouncing together on an exercise ball. 

4. Practice Self-Care: What Is the 5-5-5 Rule for Postpartum?

Becoming a new parent can be overwhelming. Getting through the fourth trimester means taking care of yourself, not just the baby. Let a partner, family member, or friend help out. Take people up on any offers to do chores or bring you food. Let other people hold the baby so you can sleep or shower.

Try to eat a healthy diet and limit sugar and processed foods. Stay hydrated. Go for walks outside when you can, even if it’s just a short one. Rest as much as possible – fight the urge to catch up on chores while the baby is sleeping.

The 5-5-5 rule for postpartum is a guideline that encourages new mothers to focus on rest and recovery during the first 15 days postpartum:

• First 5 days: Stay in bed as much as possible.

• Next 5 days: Stay around the bed.

• Last 5 days: Gradually ease back into activity.

This approach prioritizes healing and bonding with the baby while minimizing physical strain.

6. Go to Your Postpartum Appointments

The American College of Obstetricians and Gynecologists (ACOG) recommends that all women should ideally have contact with a maternal care provider within the first three weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. These visits are a chance to talk about your worries or difficulties — physical and emotional — and discover ways to help you feel better.

The Takeaway on Surviving the Fourth Trimester and Postpartum Challenges

Eventually, the relentless neediness and unbearable exhaustion of the fourth trimester will be over before you know it. Get help wherever you can and take care of yourself – don’t hesitate to reach out to your healthcare provider for guidance. Though it’s overwhelming when you’re in the midst of it, try to take a deep breath, soak in the moments as much as possible, and get in all the snuggles you can before your little one gets bigger.