A Blog From Your Kaiser Permanente Physicians

There’s a Fourth Trimester of Pregnancy?

Yes! The “fourth trimester” is another way to describe the postpartum period – the first three months after your baby is born. It’s a time of major adjustment for you, your baby, and for everyone else you live with. It can be rough – I wasn’t prepared for it, even though I’m an obstetrician!

In the months leading up to delivery you have regular visits with your obstetrician and lots of time to ask questions. Postpartum, you just have one visit scheduled a few weeks after your baby’s arrival, which isn’t much time to talk about all you’re experiencing.

What makes this time so challenging? So many things! You’re trying to figure out your newborn, who can’t communicate with you except by crying. You’re also trying to recover from delivery – and your hormones are going wild! Some common experiences include:

  • Mood swings or crying for no “real” reason.
  • Swelling in your feet, legs, or even hands.
  • Night sweats that soak through your clothes.
  • Leaking breasts. It can take months before this stops even if you don’t choose to breastfeed. (Between the night sweats and milk leakage, I had to change outfits several times a night!)
  • Pain while sitting or with movement. Whether you had a vaginal delivery or a cesarean section, you’ll experience soreness or pain that’ll take time to heal.
  • Breastfeeding can cause nipple pain until you and your baby learn the best way to latch. Many women have cramping in their uterus while breastfeeding too.
  • Leaking urine when coughing or sneezing, on your way to the restroom, or even when you didn’t realize you had to go.
  • Worrying about whether your baby is gaining weight, sleeping enough, or crying too much.
  • Cluster feeds (nursing every 30 minutes at times) that make you think baby isn’t eating enough (but they’re normal!)
  • Exhaustion from all the above interfering with sleep. You may also be sleep deprived if your baby is cluster feeding or if they haven’t yet figured out day versus night.

Ways you can help yourself:

Take a break! Ask someone else to take care of your baby if possible, so you can nap, shower, eat a snack, and recharge. It’s also okay to let your baby cry in a safe place for a few minutes if you need some time to yourself. I would sometimes put my crying baby in his bassinet, step away, and take a few deep breaths to calm myself down before going back to him.

Go outside. Sunshine and fresh air are good for both you and baby. I found it so helpful to go for a walk every day.

Get Some Light Exercise. You may not be able to lift weights or run until you’re cleared by your doctor but walking, if you can tolerate it, can help boost your mood and help you manage pain. Dancing to music also works!

Talk with a lactation consultant. You and your baby are both learning – it is normal to need some help to get the hang of a pain-free latch. If your nipples are painful, try to spread some breast milk on them at the end of every session.

Don’t worry about pumping right away (if nursing). You only need to start pumping shortly before you go back to work to build up a supply. If you have leaky breasts, you can use a silicone milk collector to catch your letdown from one side while the baby feeds from the other side. This can help you build up a supply too.

Take life slowly. Skip the chores – your dishes, laundry, and housework can wait or be done by your partner, friends, or relatives. One of our lactation nurses, Andrea Windom N.P., says “all you need to be doing in the first month or so is N.E.S.Ting: Nursing (or feeding your baby), Eating, Sleeping, and Talking (to your baby and your support people).” It can seem tempting to give yourself a to-do list since you’re “off work,” but give yourself the space to rest, recover, and enjoy this time.

Join a new parents’ support group. Spending time with other new parents can be a great help!

Remember: this time is brief. I had friends tell me how much they miss the newborn phase and how quickly it goes by. It was hard to believe then, but now I agree! As hard as it feels at times, try to stay in the moment and know that everything will eventually feel easier.

Talk to your clinician if you feel you are struggling emotionally or mentally. Approximately 80% of us get the “baby blues,” or feeling sad and teary the first couple of weeks after the baby arrives.  About 10-15% of us experience what we call postpartum depression. f you have feelings of sadness, anxiety, loneliness, or feel overwhelmed for more than 2 weeks, let your clinician know, because postpartum depression is serious – and treatable. We’re here to help.

The fourth trimester is an exciting time – but it can also be tiring, confusing, and overwhelming. At times, you may feel that you don’t know what you’re doing at all. (I felt this way!) Give yourself the space to get frustrated, feel confused, and not enjoy every minute of every day. Accept help when you need it, and you’ll get through this!

Resources for Parents

How to Clam a Crying Baby

Breastfeeding a Newborn: Tips for the First Few Days

What Do New Fathers Need to Know?

My Doctor Online


Disclaimer: If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.