Postpartum Care: The Fourth Trimester

Have you ever heard of the Fourth Trimester of Pregnancy?

The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being for both.

What Is The Fourth Trimester?

The fourth trimester is the period coined by Dr. Harvey Karp as the first 3 months, or 12 weeks, after giving birth. The fourth trimester is just as important for a mother’s health as the first three trimesters of pregnancy. Yet this is often when mothers have the least interaction with their health care team—a time when, some experts argue, mothers need it the most. During this period, a woman is adapting to multiple physical, social, and psychological changes. She is recovering from childbirth, adjusting to changing hormones, and learning to feed and care for her newborn. In addition to being a time of joy and excitement, this “fourth trimester” can present considerable challenges for women.

The American College of Obstetricians and Gynecologists (ACOG) recommends that mothers have initial contact with their OB-GYN within three weeks after delivery, followed by ongoing care as needed, and a comprehensive postpartum visit no later than 12 weeks after delivery. They also recommend that a postpartum care plan be developed during pregnancy, so that mothers are better prepared when they go home.

“Those 12 weeks after giving birth are a critical time to focus on Mom and make sure that she is healthy moving forward,” says Mary Rosser, MD, PhD, assistant professor of obstetrics & gynecology at Columbia University Vagelos College of Physicians and Surgeons and an OB-GYN at Columbia University Irving Medical Center/NewYork-Presbyterian.

Advice For Your Fourth Trimester:

The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:

• Look Ahead: Anticipatory guidance should begin during pregnancy with development of a postpartum care plan that addresses the transition to parenthood and well-woman care. Prenatal discussions should include the woman’s reproductive life plans, including desire for and timing of any future pregnancies.

• Continued Care: To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.

• Follow Up: All women should ideally have contact with a maternal care provider within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth.

• Assess: This comprehensive postpartum visit includes a full assessment of physical, social, and psychological well-being. The timing of this visit should be individualized and woman centered.

• Ongoing Care for Complications:

  • Pregnancy Complications: Women with pregnancies complicated by preterm birth, gestational diabetes, or hypertensive disorders of pregnancy should be counseled that these disorders are associated with a higher lifetime risk of maternal cardiometabolic disease.

  • Chronic Medical Conditions: Women with chronic medical conditions, such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, mood disorders, and substance use disorders, should be counseled regarding the importance of timely follow-up with their obstetrician–gynecologists or primary care providers for ongoing coordination of care.

  • Miscarriage: For a woman who has experienced a miscarriage, stillbirth, or neonatal death, it is essential to ensure follow-up with an obstetrician–gynecologist or other obstetric care provider.

It is important to note that, depending on a mother’s personal history and individual needs, they should receive ongoing postpartum care as needed. “It really is no longer a one-size-fits-all approach,” says Rosser. “Just as babies need care and attention during the fourth trimester, so too do mothers. Postpartum care is a crucial time to make sure Mom is safe and healthy so that the baby can be supported in the best possible way.”

At Options Mankato, we care about women before, during, and after pregnancy. We offer education on prenatal care, newborn care, and parenting, and we will journey with parents until their youngest child turns three. Support does not end with the birth of a baby.

Sources: Columbia University Irving Medical Center, The American College of Obstetricians and Gynecologists