The Fourth Trimester

4th Trimester: How to feel Successful Postpartum

The fourth trimester is a term coined by pediatrician Dr. Harvey Karp. It is the first three months postpartum. This is an adjustment time for the whole family and a time for newborns to get acclimated to life outside their mothers’ womb.

Feeding Your Baby

Infants must feed every two hours, even during the night. Each feeding is typically 14 minutes and no more than 30 minutes.

Colostrum, first breastmilk, is produced during pregnancy. Colostrum ensures you have milk for the first breastfeeding, which should occur within one hour of giving birth. After the placenta is expelled, transitional milk begins being produced.

Combined with soaking more than one period pad per hour for 24 hours, a mother’s milk not ‘coming in’ days after giving birth are signs placenta fragments may have been retained. This is an emergency. So, if your breasts feel ’empty’ or if your milk supply hasn’t increased by day 4, be sure to tell a healthcare provider.

Finally, mature milk arrives. There are many factors that may delay production of mature milk, including medications given to the mother during labor and delivery. Don’t become discouraged if the process is going slowly. Expression, using your hands or a pump, is an effective way to increase breastmilk supply. Even if your newborn is too tired postpartum to breastfeed or must go to the NICU, hand express. One of the biggest predictors for ample milk supply later on is whether milk was expressed within two hours of giving birth.

Sleeping with Your Baby

Infants should sleep in their own crib on their back with no extra pillows or blankets. It is helpful if the baby sleeps in the same room with his/her parents. That way, parents can attend to a crying baby quickly then go back to sleep themselves. Babies do not sleep through the night until four months old; and even then, there are typically 1 to 2 nighttime wakings per night. Mentally accepting nighttime wakings as a part of your life beforehand may help adjust to this period in your life.

To not feel exhausted, it is recommended that the primary caregiver, usually mother, ‘sleep when the baby sleeps,’ including during the day. Another strategy is for the primary caregiver to stay in bed for extra sleep, if he/she has been up with the baby. So, if you stay up with the baby three hours during the night, sleep in for an extra three hours in the morning. Still, another strategy is for the father to take over evening feedings using a cup or spoon while mom goes to bed early. That way, mom has gotten ahead on sleep by the time the baby has his/her first nighttime waking.

Soothing Your Baby

Skin to skin is a wonderful strategy for soothing a crying baby. Both parents can do it and baby will nestle in close for some much-needed bonding time. Skin to skin should be practiced before each breastfeeding.

Kangaroo Mother Care (KMC) is not just cute. It is so effective at reducing the risk of numerous health conditions that it is recommended to be practiced in all neonatal intensive care units (NICUs). KMC is known to reduce mortality by up to 36% in premature infants.

Another soothing strategy is to swaddle. In swaddling, a three-point wrapping method is used to tuck baby snuggly into a blanket. This is said to mimic the womb and ease baby’s transition to life outside his/her mother’s uterus. Some say to swaddle infants during sleep. As a possible risk factor for SIDS, I do NOT recommend swaddling a sleeping baby. Swaddling is for when babies are awake, and a caregiver is keeping a watchful eye.

Colic is a condition in which an infant cries for hours a day without a known medical reason. It has been associated with gastrointestinal difficulty in babies. So, burping after each feeding and reducing allergenic food (nuts, soy milk, cow milk, etc.) intake in a breastfeeding mother to reduce transfer to baby have been suggested as strategies for reducing colic. It can take two weeks to see the effect of changing a mother’s diet on the comfort of her breastfeeding infant. Infant massage also is being touted as a method for reducing crying and increasing bonding between parents and infants. Infants usually grow out of colic by four months old.

Physical Activity

Tummy Time! The fourth trimester is a time of immense development. Your baby goes from pretty much helpless to still helpless but able to sense and interact with the world. Tummy time is essential to this development. During tummy time, infants are placed on their abdomens for 3 to 5 minutes, 2 to 3 times per day, while awake and a caregiver is watching. This physical activity allows the babies to practice holding up their heads and leaning on their arms. This strengthens the baby’s muscles and enables the process of rolling over and eventually crawling. Tummy time also prevents flat spots on the back of the head. You can extend the length of tummy time per day depending on your baby’s ability to hold themselves up and to their liking. Like swaddling, tummy time is another activity that should be done only when infants are awake, and a caregiver is keeping a watchful eye.

Finally, take it easy on yourself. Having a newborn in the home is an adjustment for everyone. Even if you’ve had children before, each child is different, and you must grow and learn together what works for your unique relationship.

Wisdom The Sweetness