‘4th trimester’ can be overwhelming for new moms
When Megan Gray of Winter Park became a mom in 2016, she thought she was prepared. A board-certified obstetrician-gynecologist, Gray had already counseled dozens of women through pregnancy and the postpartum months. She knew post-delivery was a time for physical and emotional healing, and bonding with her baby.
Then the practitioner became the parent. Her delivery and recovery period was complicated after an emergency cesarean delivery. Once home with her newborn, Gray became hyper aware of the lack of empathy and basic support for women during their first few months postpartum.
“I was overwhelmed by the new responsibility. I was exhausted after my labor experience … I was in pain. I was scared,” Gray said. “On top of it all, I realized that I had not been preparing my patients well for the hardest part of having a child — the fourth trimester.”
Gray was inspired to write the book “The Forgotten Trimester,” which went on to become an Amazon bestseller.
The period of time Gray is referencing in the title of her book covers the three to four months immediately following delivery. While babies are born, they need to adjust to life outside the womb. It is an intense time of transition for the mothers, too.
“It is a time when women’s bodies are getting back to normal. They are making the transition from being a woman to being a mom, learning about a new body and learning about all of those new responsibilities,” Gray said. “This all happens, by the way, as new moms are super fatigued.”
Gray’s observations complement a theory developed by Dr. Harvey Karp that he coined “the fourth trimester.” Karp, an Assistant professor of pediatrics at the Keck School of Medicine at the University of Southern California and a fellow of the American Academy of Pediatrics, suggests that newborns are born about three months before they are ready for the world. When they come out, their digestion is not up to par, they don’t know how to sleep like normal humans and they are helpless and dependent on their parents and caregivers. As Karp points out in his research, newborns are not supposed to sleep through the night at a few weeks’ old, and they are biologically wired to spit up and be gassy when they eat breastmilk or formula — among other behaviors.
Many of these behaviors are things that new parents feel they must “fix” with interventions such as sleep training and other tasks. Those additional pressures go against what babies are designed to be like at first, Karp says.
Gray says that her own field of medicine has fallen short in preparing pregnant women for the real pressure that follows giving birth — both emotionally and physically.
“We haven’t done a very good service to women seeing them back six weeks after they’ve had a baby. Postpartum depression happens in the first four or five weeks and so we completely miss that time to intervene,” Gray said.
The Centers for Disease Control reports that one in nine U.S. women will suffer postpartum depression and that 70 percent to 80 percent experience a less-intense “baby blues” period.
It isn’t just the chance of depression that is an issue, though. Other postpartum issues such as mother-baby bonding, shifting family responsibilities, breastfeeding and body image should receive more attention and intervention options from health-care providers.
“I would envision seeing women more frequently, sending professionals to women at home during that time, programs to assess and help with sleep and more,” Gray said.
And though modern motherhood is connected in new ways through technology, there can be a loneliness that tends to accompany new parenthood.
“As society has gotten more and more individualistic and less ‘village-like,’ new motherhood has become a lonely time. Women are often left to themselves,” Gray said.
Stephanie Landi is a licensed clinical social worker with Orlando Health. She holds a certificate in Maternal Mental Health from Postpartum Support International.
“One of the biggest pressures out there right now is to be the perfect mother, right from the start. We aren’t having open conversations in our society about the fact that motherhood is hard, even for the prepared and supported parents,” Landi said. “It is a learning process for baby and for mom, and you aren’t supposed to know everything the moment the baby is born or when you get pregnant.” The mothers Landi counsels often express surprise at some of the parts of early motherhood that no one warned them about.
“Moms are surprised at things such as hair loss, changes in how they carry their weight, skin discoloration, incontinence and constipation,” Landi said. “They feel that if they were educated on these changes, that they may have been better prepared to handle them both physically and emotionally.”
Sleep deprivation is a real health issue in the early months, yet mothers often feel the pressure to still do all of the other housework, plus care for the new baby.
“Most moms act as the CEOs of the family and are trying to keep up those responsibilities, take care of a baby, work, be a good friend and more,” Landi said.
Maura Rowin is a registered nurse and the owner of Fit4Mom Celebration, a prenatal and postnatal fitness program with locations nationally. Exercise incorporates stroller and babywearing techniques and women are encouraged to talk to each other.
“Postpartum wellness encompasses so much more than physical fitness. Mamas also need take care of themselves mentally, emotionally and spiritually,” Rowin said. “Motherhood can be challenging and even isolating at times, so finding a great support system can can make all the difference.”
Rowin says that the fitness component of Fit4Mom is a way to connect moms on a deeper level and get them into group settings with like-minded parents.
“With a new baby, just getting out the door can be a huge achievement,” Rowin said. “There is always strength in numbers, and finding a great support system of fellow mamas who understand you can make a huge positive difference.”
When it comes to better support and understanding the “forgotten trimester” time of a woman’s pregnancy journey, support from others makes a big difference.
“Don’t arrive unannounced, don’t expect them to be the host,” Gray said. “Hold the baby so mom can shower or nap. Help do chores.”
Putting any responsibility on a new mom, even when it comes to expressing her own needs, is often overwhelming. Instead, look for ways to help them proactively.
“Don’t ask a new mom what she needs. Tell her that you’ll do something specific. Tell her you want to drop off dinner on Wednesday night, drop off some freezer meals before or after the baby arrives, or see if she is OK with you coming by one day for a few hours to let her sleep or shower,” Landi said. “When you ask her how it is going, ask her how it is really going, and don’t expect her to say it is always amazing and that she is treasuring every moment.”