The term “fourth trimester” refers to the period of approximately three months following childbirth. While technically not a trimester in the traditional sense, it is a term often used to describe the transition period for both the newborn baby and the mother as they adjust to their new life. What to expect during this period?

During the first weeks and months after giving birth, newborns are adjusting to the life outside the womb and experiencing rapid growth and development. Babies are also developing their senses and learning to bond with their caregivers. For mothers, the fourth trimester can be a challenging time physically, emotionally, and mentally. They are recovering from childbirth, adjusting to hormonal changes, and learning how to care for their newborn.

The fourth trimester of pregnancy is also known as the postpartum period. Rest and support during the weeks and months following birth are imperative.

Why is the fourth trimester hard?

The first weeks and months after giving birth can be a magical yet challenging time. While bringing a new life into the world is profound, mothers often feel overwhelmed and under-supported as they navigate healing, breastfeeding, lack of sleep, shifting hormones, and the demands of newborn care.

Today, the care for the mother after childbirth represents one of the most tangible black holes within our healthcare systems.

Historically, across cultures, communities would gather around the mother to ensure she could restore her energy and transition into this new stage of her life. Some cultures named the postpartum time to signify its dignity and right of care: the first 42 days after birth are called the “Sacred Window” in Ayurveda and this special time is also referred to as the “Month of Gold” in traditional Chinese medicine and among Chinese-speaking communities across the globe today. Not by accident, on every continent, traditions, rituals and guidelines focused on honouring, protecting and caring for the newborn mother exist.

Yet, in the vast majority of the “modern” world, those traditions seem to have been forgotten and the importance of the immediate postpartum ignored. This has actual repercussions for the health and well-being of the mother and baby, and, we dare say, our society. Up to 20% of mothers worldwide fall into postpartum depression, 35% experience Post Traumatic Stress Syndrome symptoms after labour, and, by far, the majority of new moms experience a postpartum reaction. Postpartum reaction is also referred to as an ‘existential transformation’, where new moms feel like everything is turned upside down. Scientific research is only recently beginning to show that those instances can be significantly alleviated if the mother is allowed to rest with her newborn and be taken care of for the first weeks after birth.

When does the 4th trimester start and when does it end?

The postnatal period starts immediately after childbirth, and ends around six weeks after childbirth, although it can vary depending on individual circumstances and healthcare provider recommendations. Some aspects of recovery and adjustment may extend beyond the initial six-week period. It’s important for mothers to continue to prioritize self-care and seek support as needed during this transition.

The first mention of the term the “fourth trimester” was in 1973 in Margot Edwards’ article, The Crises of the Fourth Trimester. However, despite using the term in the title, the author provided no definition or explanation of the concept. Sheila Kitzinger, midwife, social anthropologist and natural birth activist, wrote about the “fourth trimester” in 1975.

The concept lay dormant for the decades that followed but it has regained popularity over the last few years. It refers to the first three months after birth when new mothers and babies undergo profound changes, likened to an additional time of gestation. Recently it has also been picked up by the medical world; medical studies show a shift from a maternal healthcare system mainly shaped around prenatal care and childbirth, towards a system recognizing the importance of the “fourth trimester”. 

In a committee opinion from 2018, the American College of Obstetricians and Gynecologists pointed out that “[i]n addition to being a time of joy and excitement, this “fourth trimester” can present considerable challenges for women1.

“The fourth trimester is a conceptual framework drawn from maternal nursing and midwifery that reconstructs pregnancy to include a three to six month period of rest, recovery, and transition after the birth of a child. This concept […] provides an alternative paradigm for understanding the nature of pregnancy beyond the presumption that pregnancy is a “natural” event that “biology” defines. It focuses on the crucial social, emotional, and psychological transition process that occurs after the birth of an infant.”2

The personal is political

“Care of mothers after childbirth […] is an issue of universal social importance”.3 Postnatal care can no longer remain isolated as a personal issue. The way we take care of newborn mothers affects the entire society and must find its place high on the political agendas of practically every country. Healthcare systems, insurance companies, policies governing maternal and paternal paid leave, local, national and international governments need to engage in the realization of this profound and necessary change.

Good postnatal care is inherent to a healthy society.

That’s why Postnatal Doula Training is so important for us. With over eight years of experience, PSN is trusted by doulas, nurses, midwives, mothers, and birth professionals across the world. Sign up to our newsletter to be notified about our next trainings!

  1. American College of Obstetricians and Gynecologists (ACOG). 2018. ACOG Committee Opinion No. 736: Optimizing Postpartum Care, Obstetrics & Gynecology: May 2018 – Volume 131 – Issue 5 – p e140-e150 doi: 10.1097/AOG.0000000000002633 ↩︎
  2. Matambanadzo, Saru M. 2014. “The Fourth Trimester”. University of Michigan Law Reform 117. Available at: https://repository.law.umich.edu/mjlr/vol48/iss1/3, p. 120 ↩︎
  3. Allison, J. 2016. Golden Month: Caring of the World’s Mothers After Childbirth. Beatnik Publishing: Auckland. ↩︎