What is the Fourth Trimester?

Dr. Harvey Karp coined the term "Fourth Trimester" to refer to newborns, ages 0 - 3 months. This recognizes that human babies are more like marsupials than other mammals; they aren’t really able to survive without us. Think about how horses are born able to walk. Due the size of human brains and skulls, our babies are born relatively sooner, when their heads can still fit through the mother’s pelvis. Understanding how underdeveloped our babies truly are helps us to better care for them. By the way, this is one reason why babies love being worn snuggly close to their parents.

Thankfully, we have started paying more attention to parents and recognizing that this is a critical stage for OUR health, development and mental health, as well. In May 2018, the American College of Obstetricians and Gynecologists (ACOG) redefined the standards of postpartum care. When I had my first baby, I was shocked that my doctor, who had monitored me every week of the end of pregnancy, dropped all focus and said, “See ya in six weeks!”

It made me feel as though I was completely unimportant compared to the baby, who I promised to bring to the pediatrician in a few days and every two weeks after that. The ACOG finally recognizes that women who have given birth need comprehensive care in the fourth trimester. (And yes, they called it the fourth trimester!) Furthermore, they recommend looking at physical AND emotional well-being. You can read their statement here.

I’d like to also mention that the fourth trimester is a critical time for birth partners and adoptive parents as well. There are obviously huge physical changes after delivery, but non-birthing parents are going through massive life transitions, too. We also think there are (albeit more subtle) hormonal shifts happening for partners, as well as sleep deprivation. I will refer more to moms in this article, but please know that most of this applies broadly.

What can moms expect in the fourth trimester?

Anthropologist, Dana Raphael, started using the term “matrescence” in the 1970s to mark the developmental stage of becoming a mother. She noticed the transition lasted from preconception to pregnancy and birth, whether through birth, adoption or surrogacy, and beyond. Matrescence recognizes that the birth of a child also marks the birth of a mother. Becoming a mother can be just as awkward, messy and vulnerable as adolescence.

In general, I find people come to therapy when they feel overwhelmed. Stress is when we feel the demands on us are greater than our perceived ability. Of course new parents feel overwhelmed! The stakes are incredibly high. We are responsible for keeping vulnerable, precious little creatures alive. It is a 24/7 job, with little prior training.

On top of that, many new moms add a layer of guilt. If they aren’t living up to their expectations, they may feel like they are failing as a mom. Many think that being a mom and breastfeeding should come naturally, and when they don’t, question their value and worth as a woman.

How will this course help with the fourth trimester?

Here, we will unpack the “reproductive story.” Almost all of us have had a story, a narrative we have imagined since our own childhood, of what it would be like to become a parent. I’m betting few have told themselves, “I’m going to have three miscarriages, two failed IVF rounds, anxiety during pregnancy, an extended NICU stay, birth trauma, mastitis, etc….”

Guided journaling, which we will do, like therapy, is a place to grieve the loss of that story, and of the life and identities we have lost. We get to come to terms with our new, integrated persona, and start to love our new self.

Journal Prompts:

As I mentioned, distress comes when your expectation of yourself and motherhood don’t match reality.

Take some time to check your expectations. Did you imagine you would be instantly balancing baby, home, exercise, work and other responsibilities, and post the beautiful proof on Instagram daily?

What has the Fourth Trimester been like for you?

Are you judging yourself more harshly than you would judge a good friend?

Journaling vs. the comment section

Comments are currently turned on for many sections of this course. Keep in mind that any comments you write here are visible to ALL participants of the course, not just you. Please take some time to think about when you will want to write in your private journal and when you want to share with the fourth trimester community here.

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