THE FOURTH TRIMESTER

The Fourth Trimester – the first three months of baby’s life (and the first three months of a new mother’s life, whether she is a first-time mother or a seasoned professional) – is a time of transition for baby from being in utero to living outside the womb and, just as importantly, a time of transition for the woman from pregnancy to motherhood. Traditionally the fourth trimester has focused on the baby and not the mother. Alison Steube, MD , of the University of North Carolina / Chapel Hill, summed it up this way: The baby is the candy, the mom is the wrapper.   Once the candy is out of the wrapper, the wrapper is cast aside. Providers and policy-makers alike are realizing that new mothers need care and attention to recover from the physical and emotional aspects of pregnancy, childbirth, and new parenthood. Dr. Steube uses the graphic below to show the many different issues new mothers face.

ACOG TAKES ACTION Recognizing the importance of providing better care to new mothers, ACOG released two important documents in 2018 with the goal of shifting the paradigm for postpartum care from a single 6-week visit to a postpartum process (see chart below). ACOG underscores that the fourth trimester can present considerable challenges for women, including lack of sleep, fatigue, pain, breastfeeding difficulties, and incontinence.

 The postpartum period is often devoid of formal or informal maternal support. American College of Obstetricians and Gynecologists

ACOG Committee Opinion 736 Optimizing Postpartum Care The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and wellbeing. Postpartum care should be an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs. All women should have contact with a maternal care provider within 3 weeks of giving birth, followed up by individualized care, concluding with a comprehensive visit no later than 12 weeks postpartum. Toolkit for Postpartum Care This 94-page companion toolkit includes resources on the key components of postpartum care, including: postpartum complications chronic disease mental health / substance use creating a support system newborn care / feeding healthy weight reproductive planning The toolkit also includes information about reimbursement as well as a sample postpartum checklist for patients to complete before their visit.

What would it look like for mothers to not only survive pregnancy but to thrive? Joia Crear-Perry, MD

The New Mom Health is a new website -- launched by a team from the University of North Carolina / Chapel Hill -- dedicated to helping new mothers find the social, emotional, physical, and economic support needed to successfully transition the postpartum period and into their new identities and lives as mothers. The website contains clear, inclusive, accurate, and comprehensive information about: Self-care, including physical and emotional recovery Caring for baby Building a support system, including connecting with other new mothers

The 4th Trimester Project - The Jordan Institute for... "Motherhood should not mean risking your happiness, health, or life." Our mission is to transform the lived experience of the 4th Trimester through a national movement to spark real, sustained change for women and their families at individual,... Read more jordaninstituteforfamilies.org

Birth is not only about making babies. It is also about making mothers – strong, competent, capable mothers who trust themselves and know their inner strength. Barbara Katz Rothman, PhD

POSTPARTUM PLANNING Why wait until baby arrives to prepare for the Fourth Trimester? Much like a birth plan helps expectant parents think through labor and delivery, a postpartum plan can help them think about the first few weeks postpartum. Topics include sleep, infant feeding, care for other children, meals, and more. Here are a few examples... The Postpartum Plan from Postpartum Support Virginia Postpartum Plan from DONA International Your Postpartum Vacation Prep from Birthful

The way a woman gives birth and the kind of care given to her and the baby points to the key values of the culture. Sheila Kitzinger, midwife

RESOURCES TO SHARE WITH NEW MOTHERS ARTICLES Harvard Health: The Fourth Trimester: What You Should Know The New York Times: A Survival Guide for the Fourth Trimester ScaryMommy: The 4th Trimester is a Real Thing (And It Can Be Rough) The Bump: The Fourth Trimester: How Baby Adjusts to Life Outside the Womb PODCASTS Tales From the Fourth Trimester is dedicated to new parenthood -- because giving birth is just the beginning The 4th Trimester Podcast is about the practical, emotional and social support parents and baby require, helping to set the tone for the lifelong journey of parenting MOTHERLY , the online magazine about all things related to motherhood, has several great articles about the Fourth Trimester: The 4th Trimester Struggle is Real 10 Real Truths About the Fourth Trimester, Mama Welcome to Motherly’s Fourth Trimester Class Creating a Postpartum Sanctuary Plan Is Just As Important As Your Birth Plan The 4 th Trimester Summit includes 40+ presentations focused on three topics: Heal Your Body & Mind, Connect & Nurture Baby, and Grow & Evolve Relationships.

Working with Policy Makers to Address Maternal Mental Health Challenges

MMHLA -- founded in 2018 -- is a nonpartisan 501(c)3 non-profit organization dedicated to promoting the mental health of childbearing women in the United States by advocating for universal education, screening, referral, and treatment of postpartum depression and related maternal mental health (MMH) challenges. Our vision is that all childbearing women in the United States will be educated about and screened for maternal mental health challenges and have access to resources for recovery.

Maternal Mental Health Leadership Alliance | www.mmhla.org ‌ ‌ ‌