Commonly asked questions about the fourth trimester

The fourth trimester is defined as the first three months of your baby’s life, where you get to know them and help their transition to the outside world. Whether you are a first-time mum or have had babies before, every fourth trimester involves change and learning. Support from your village will make the fourth trimester a little easier for you and your partner. You and your baby are in a period of adapting to this huge change, so give yourself credit and rest. 

Below are a few commonly asked questions that come up frequently for midwives regarding the fourth trimester.

Afterbirth pains or cramps are a normal physiological process after you give birth. Your body has spent nine months growing your baby, and your uterus has expanded with your baby over this time; now it has to contract back down to its original size. This process is called involution, the shrinkage of an organ. Afterbirth pains are short sharp cramps as your uterus contracts back down to its original size and are a response to the hormone oxytocin. You may experience afterbirth pains for 2-3 days after the birth of your baby, and is associated with vaginal bleeding. A lot of first-time mums will not feel afterbirth cramps, but with every subsequent baby your uterus has to contract down a bit more, and you will most likely experience afterbirth cramps that get more noticable with every pregnancy and birth. 

As afterbirth pains are a response to oxytocin, when you are breastfeeding, you will release this hormone and are likely to feel these cramps. Ways to ease or manage afterbirth pains is to use a heat pack (especially when feeding), take analgesia, particularly an anti-inflammatory, prior to feeding and also a warm shower after breastfeeding can help. Sometimes mums need stronger pain relief for afterbirth pains also, so chat with your midwife, OB or GP if needed.

Yes, you will have vaginal bleeding after a vaginal birth and a C-section. This is a normal process after you have a baby due to the blood vessels in your uterus being exposed after the placenta is birthed. Over time your uterus contracts down and closes off these blood vessels; as it does this, your vaginal bleeding will become less and less. 

Vaginal bleeding can last up to six weeks. The first 1-3 days after baby is born, bleeding will be bright red and heavier. After this, your blood loss will get less and may lighten to a pink colour, and then eventually become spotting before stopping altogether. Your bleeding may be heavier when you first get up in the morning, after breastfeeding or after exercise. If you are consistently soaking a pad in less than an hour, or you have large clots bigger than a golf ball, you should notify your healthcare provider or seek medical advice. 

Depending on what type of birth you had will influence what position is most comfortable for breastfeeding after birth. After a vaginal birth, your perineum can be quite tender and sore, particularly if you had a tear or stitches. In this situation, side lying is the recommended position so you avoid sitting on your bottom to feed. Side lying is a great comfortable position, especially for night feeds. For this position, you are simply lying down on your side in the middle of the bed with baby on their side close to you, tummy to tummy and their nose opposite to your nipple. Rest your arm above your baby’s head, do not rest baby on your arm or a pillow. Most babies latch easily in this position, and is fantastic in the early days when sitting upright may be uncomfortable on your perineum.

After a C-section, obviously, your wound is going to be the most tender. When breastfeeding after a C-section, your midwife may recommend a traditional cradle hold or the football hold, depending on your pain. The football hold is when you have your baby’s body tucked around your side instead of across your front. If baby is attaching to the right breast, their head will be at the breast supported by your right hand and his/her body will be around the right side of your body and their feet towards your back. Line their nose up with the nipple and bring them close when they open their mouth wide. Using the football hold can be comfortable after a C-section to avoid baby laying on your tummy or you can also try side lying if it is comfortable.

Having a baby is a huge emotional rollercoaster, with some days filled with love and joy and others with stress and frustration. The biggest difference between baby blues and postnatal depression (PND), is that baby blues is a short-term emotional response in the first week after birth, and PND is an ongoing low mood lasting weeks or months after having a baby. 

The baby blues is a completely normal feeling to have around 3-5 days after having your baby. Over 80% of mothers will experience baby blues, which is an adjustment reaction displayed by a depressed mood. Signs include feeling sad, irritable, tired, anxious, teary and a lot of mood fluctuations. Baby blues is short-term, lasting 24-48hrs and co-insides with hormonal changes and your breastmilk coming in. During this time, accept support from your partner and those close to you so you can rest, be kind to yourself and talk about how you are feeling. 

PND affects 1 in 5 mamas in the first year of your little ones life; it develops due to a combination of factors and, if not identified, can get worse and interfere with parenting and the bond with your baby. Symptoms include constantly feeling low and sad for no reason, feeling worthless or inadequate, lacking energy, loss of appetite or over-eating, having little or no interest in things that used to bring you joy, difficulty focusing and concentrating, and feeling incapable of caring for your baby. It is normal to feel a small degree of stress as you begin to adjust to new changes in your world, but if negative thoughts and feelings begin to impact your ability to function or last more than two weeks, please seek support. 

Knowing where to get help is really important. As well as talking to family, friends, fellow mama’s or a healthcare professional that you trust, other branches of support include; PANDA, Peach Tree, Mind the Bump, Beyond Blue.

Your baby simply wants to be close to you. Your baby has just spent nine months tucked up in your safe, warm and dark womb, it is not surprising that they will love anything that replicates the womb or being close to you. When it comes to newborns and helping them settle in their own sleeping environment, you will need to assist them in adapting to extra-uterine life, a whole new world for them. To help your baby with the transition, give them love, warmth and attention. Your baby may settle better if you create a womb-like environment through swaddling, using white noise, rocking them to sleep, having skin to skin or giving them a warm bath.

Swaddling is a simple strategy that replicates the womb and helps to relax your baby and make them feel warm and secure. You can use a light muslin wrap, swaddle or alternatively a sleep suit. Once baby is swaddled, give them a cuddle while rocking or patting their bottom and turn on white noise or meditation music. Sounds that are similar to inside the womb can be relaxing for your baby. In the womb, baby constantly heard sounds including your heartbeat and breathing, therefore they tend to like background noise when it is time to sleep. There is evidence to state that white noise can reduce the length of time that it takes for a child to fall asleep, therefore it can help to settle your baby. Another great method, is to use a baby carrier or pram with some more movement. Lastly, your womb was dark, so often baby will settle easier in a room that has dimmed lighting or is completely dark. Always remember, your baby is only this little once, it can feel frustrating but it is completely normal, and you are doing such an amazing job! 

Blog originally written for my friends at Lovekins.com