Pregnancy and the Fourth Trimester

By Julie Vargo, Editorial Contributor

Just like parenting doesn’t end when your child grows up and leaves home, pregnancy doesn’t end when they place the baby in your arms. Delivery triggers another pregnancy-related period for moms called the fourth trimester.

This time of discovery and recovery kicks in once the baby is born and can last up to a year postpartum. “The fourth trimester is often overlooked in discussions about pregnancy and birth,” says Dr. Megan Gray, an OB-GYN at Orlando Health Winnie Palmer Hospital for Women & Babies. “As a result, new moms are not ready for the emotional and physical changes that occur.”

Reality Check

A survey by Orlando Health found that 25 percent of women did not have a plan to manage their own health after giving birth and more than 40 percent felt overwhelmed, anxious or depressed.

That’s not surprising when you consider unrealistic expectations versus the reality of bringing a new baby home. The vision of idyllic days peacefully cuddling a newborn give way to real-life moments where babies wake at all hours, experience colic or have trouble breastfeeding. Mom is often exhausted, uncomfortable and possibly even in pain. Hormones fluctuate wildly. Other children demand attention and care. If abnormal bleeding, postpartum anxiety or any complications with the baby’s health occur, stress only skyrockets.

“When baby arrives, a woman’s priorities shift away from herself and self-care slips to the bottom of the to-do list,” says Dr. Gray. “Women may have trouble balancing care for everyone, including themselves. But self-care is not selfish. New mothers must focus on their own recovery as well.”

You’re Not Alone

What’s a new mother to do? “Sometimes women who have just given birth simply need some reassurance that what they’re going through is normal,” says Dr. Gray. “They may require additional support – something as simple as getting more sleep or some help around the house. But talking with your doctor immediately about any physical or emotional concerns is important to surviving this challenging time.”

Start by planning for your own fourth trimester care when you are pregnant. Talk with your obstetrician or midwife about what to expect after delivery. Compile a list of who and when to call for problems after delivery. Lactation consultants, postpartum doulas or night nurses are excellent help for new mothers. Schedule follow-up appointments for yourself within three weeks postpartum. Have a plan to manage sleep and self-care.

Survival Strategy

Caring for yourself after delivery is essential for overall health, says Dr. Gray. “Take some time every day to focus on you. If something is bothering you, speak with your doctor or midwife.”

She also suggests that new moms:

  • Ask for and accept help. Delegate specific tasks -- like taking older children to the park, walking the dog or emptying the dishwasher -- to friends and family. 

  • Avoid rushing recovery. Some women feel physically recovered six to eight weeks after giving birth. For others, it takes longer before they feel like themselves again.

  • Eat a nutritious diet while you recover, especially if you are breastfeeding, and drink plenty of water.

  • Sleep when the baby sleeps. Most women underestimate how fatigue will affect them.


“Carving out time to care for yourself can be tricky with a newborn at home,” says Dr. Gray. “But it is critical to healing and treating issues like abnormal bleeding and postpartum anxiety.”

Most importantly, relax. “There is no such thing as the perfect mom, so don’t put too much pressure on yourself,” says Dr. Gray. “In order to take the best care of your baby, you have to take the best care of yourself, whether that’s seeing your doctor, setting aside a couple of hours for yourself or simply asking for help.”

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