The “Fourth Trimester” of Pregnancy

When I visit the homes of new parents for their first few postpartum visits, I'm always amazed by how much baby paraphenalia they have. These brand new babies have more furniture, clothing, toys, bottle systems, etc. than the rest of the family combined. They have their own rooms, decorated to their gender if known, with stenciled animals and foliage, beautifully patterned sheets, brand new cribs, refurbished cribs that have been in the family for generations - everything you could imagine and more. I understand it, but it amazes me because the baby doesn't need any of it for weeks, if not months. There's only one place the baby wants to be (with a few acceptable substitutes), especially in the first few days, and with good reason. Humans aren't born to be immediately independent. We can't walk at birth (unlike many other mammals), we can't feed ourselves, and we can't even keep ourselves warm.

Dr. Harvey Karp, a pediatrician and child development specialist, has termed the initial three months of life after birth the "Fourth Trimester" because babies continue to need, for these few months, many of the same things that they needed when they were in utero, and forcing them to adapt to extra-utero life early can result in fussiness, colic, and frustration (for both parties!) initially, and attachment disorders later on in life. He also discusses the connection between the needs of the baby in this "fourth trimester" and the development of colic, noting that it's fitting that colic seems to dramatically improve at the age of three months, precisely when this period is over. Though there are a lot of different ways to describe this initial period in a newborn's life, I like the idea of a "Fourth Trimester" because it plants the suggestion that this period of time is adjunctive to pregnancy itself. When you consider the first three months of life as an extension of pregnancy, it's not far-reaching to imagine the needs of the baby within that context.

Neonates (brand new babies) actually have very llittle interaction with the world around them. Though some are quite alert, many keep their eyes closed, particularly when it's bright out, rousing only to feed. Their only responsiblity during this initial period is to feed, pee, and poop. We have to do everything else for them, including keeping their new-to-the-outside bodies at an appropriate temperature. They rely on us to keep them warm, dry, fed, and loved. They're used to being surrounded by a warm, pulsating, closed-in environment, and the same sensations make them feel safe once they're born. They want to be close to their moms, to smell their skin, feel their warmth, and hear their heartbeat. In fact, this immediate skin-to-skin contact promotes temperature stability, regulates breathing, facilitates breastfeeding and assists with the initial transition to extrauterine life. I've seen many babies whose temperatures have dropped, or whose breathing has become more challenging in the first hour after birth have those symptoms resolve upon being placed back against their mother's skin. The problem is that though skin-to-skin is well established as being beneficial for both mom and baby, once mom and baby are settled at home, the focus often becomes getting baby on a schedule, working on them sleeping on their own, and establishing their independence.

In these early days, babies will often not sleep unless they're on you or beside you. If you force them to sleep on their own, they will likely get frustrated and over the course of the day, will become fussier and fussier, resulting in crying fits that earn them the label of a "colicky baby". If they're sleeping with you, and spending the better part of the day skin-to-skin, breastfeeding will go more smoothly, your milk will come in sooner and your supply will better match baby's demand, and they will in general be more satisfied. This sounds simple, the idea of lounging around the house for the first few months after having a baby with your new little one attached to you at the hip, but it's a real challenge for many families, particularly when women are so keen to get their babies on a "schedule" and when they feel their own need to get back to their prepregnancy roles. It's also difficult when there are other children in the house, with their own needs that have to be met. It would almost certainly be easier if people began to just expect this for the first three months of the postpartum period, and planned for external support accordingly.

There is clearly no one ideal way to care for your own baby, and though I clearly support the idea of attachment, particularly in the first three months of a baby's life, this may not look the same in every household. Ultimately, you need to work out a system that works for everyone in the family.

Next Month: More on Attachment Parenting and Co-Sleeping