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The Fourth Trimester: Changing How We Care for New Mothers

The idea of a fourth trimester is something of a paradox in itself.

“Linguistically, it makes no sense,” says Bethany L. Perry, MD, an obstetrician-gynecologist at Abington Hospital - Jefferson Health. “But when you think about it, it’s actually perfect for what we’re trying to describe. Oftentimes, this postpartum period—or fourth trimester—is paradoxical for new moms as well.”

The fourth trimester that Dr. Perry alludes to is a relatively new medical concept that refers to the psychological and physical changes that new mothers experience after they give birth.

“Society is telling these new moms that this should be a blissful, incredibly happy time,” says Dr. Perry. “But in reality, a lot of our patients struggle through this period of transition, as they may have existing medical problems exacerbated, or have new ones develop.”

Dr. Perry says that in promoting the concept of the fourth trimester, the American College of Obstetricians and Gynecologists (ACOG) is trying to focus a lens on the time period that comes after birth, and construct new ways to help patients be “great new parents and happy and healthy individuals as well.”

Expanded Treatment for New Mothers

The typical course of treatment for new mothers after they leave the maternity ward, says Dr. Perry, is a checkup after six weeks. This six-week period has been used as an estimate for when a new mother’s body has returned close to baseline. Typically at this time, the uterus has returned to its regular size, a breastfeeding routine has been established and hormones associated with pregnancy have metabolized out of the body.

“That one visit is not nearly enough,” says Dr. Perry. “The current recommendation by ACOG is that the mother goes in for a checkup within the first three weeks, preferably one in the first week and then another within the next two.”

With this proactive approach, Dr. Perry says new mothers get off on a better foot than before. Medical and psychological issues that may not have been detected until the traditional six-week checkup can now be identified much earlier, and as such, treatment can begin sooner.

Realistic Expectations

It’s important for new mothers to be aware of the challenges that may come along upon their return home, back to the life they knew before becoming pregnant.

“Particularly with social media today, society's expectations of what new motherhood is supposed to look and feel like can be unrealistic,” says Dr. Perry.

She gives the social media buzz about breastfeeding as an example. “With patients who can’t breastfeed for whatever reason, or choose not to, a lot of guilt and feelings of anxiety can be put on their shoulders. They may start to ask questions about themselves like ‘Am I a good mom?’ and ‘Am I doing what is right for my baby?” says Dr. Perry.

The biggest piece of advice that Dr. Perry says she can give to new mothers is to realize that there is a large community of people who want to help them and see them succeed in motherhood.

“Whether it be a new mother support group or a breastfeeding support group, there are so many resources at Abington, and also at the local and community level. Nobody should have to go through this alone,” says Dr. Perry.

To learn more about our Maternity Education program and the resources available, click here.

If you or a loved one experience severe mood swings, exhaustion or a sense of hopelessness following childbirth, be sure to call your physician.

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