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The Fourth Trimester of Pregnancy Explained

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The Fourth Trimester

Described as “the fourth trimester” by the American College of Obstetrics and Gynecology, postpartum care is critically important–both for a healthy baby and for healthy parents.

Whitney Nelson, DO, from LRFM, sees patients at Lakes Regional Healthcare for issues related to the fourth trimester of pregnancy. According to Dr. Nelson, the fourth trimester is the period of time during which new moms transition from pregnancy to motherhood. She said, “It begins after delivery until one year postpartum and is marked by many hormonal, physical, and emotional changes, not to mention the changes to schedules and routines.” 

This fourth trimester can be a stressful, joyful, exhausting, and amazing time. Your physician will generally schedule a follow-up appointment with you to return six weeks after your baby is born. While most doctor’s appointments around these early weeks are devoted to ensuring your baby is healthy, this six-week follow up is dedicated to your health and wellbeing. It’s a chance to check in and see how you’re doing, postpartum. 

What to Expect During Your Fourth Trimester

Technically, the postpartum period is usually defined as the first six weeks after you have given birth. But many patients and providers alike think of your fourth trimester as lasting up to twelve months after giving birth.

During the first postpartum six week period, you can expect some unique challenges and changes as your body heals, establishing a new normal. 

Dr. Nelson said some common things for women are after delivery or pelvic floor issues. She said, “A fair amount of relaxation happens during pregnancy and as babies are born. Urinary incontinence and pelvic floor support issues are pretty common, yet something that can be treated.”

Here’s some of what you can expect during your first six weeks postpartum.


Your provider will encourage you to breastfeed your new baby, largely because evidence shows that breastfeeding offers significant benefits to both the mother and baby, including:

  • Lower risk of gastrointestinal tract infections in the baby.
  • Fewer damaging ear infections.
  • Diminished risk of postpartum depression for parents–and improvements in overall mood.

It’s important to remember that breastfeeding is a learned skill. This means parents can expect a learning curve. To help make this transition a little smoother, some providers may offer classes or other instructions on how to breastfeed. Additionally, individuals that have trouble expressing milk can sometimes benefit from treatments and therapies.

While breastfeeding may convey significant advantages, it won’t be the right fit for every parent. So be sure to talk to your provider about how to best nurture your baby’s growth and health.

Postpartum Depression

Postpartum depression is the single most common complication resulting from childbirth. Up to 13% of women report having experienced postpartum depression–and many studies suggest the actual number could be much higher. Those with a family history of postpartum depression have a 25% chance of developing symptoms.

Some depression, or “blues,” after childbirth is relatively normal. These post-delivery blues are largely due to a combination of hormonal changes, lack of sleep, and new stressors. Up to 70% of women experience these blues. However, postpartum depression tends to be more severe and last longer–especially without treatment.

Postpartum depression can occur anywhere between childbirth and one year after your baby was born. In general, postpartum depression carries the following symptoms:

  • Loss of interest in activities that previously brought you joy
  • Having a sense or feeling of worthlessness
  • Thoughts involving self-harm or harming others
  • Lack of interest in or involvement with your baby

Postpartum depression is a serious condition, and it’s one that you should bring to your provider’s attention if you notice symptoms. Treatment can help alleviate symptoms and get you back to enjoying your time with your baby.


It’s entirely normal to have some amount of vaginal bleeding during your fourth trimester. This bleeding can vary–some days heavier and some days lighter. You may also notice some discharge, called lochia, after your delivery. This is all entirely normal–and should go away in roughly 6-8 weeks.

However, you should keep your provider aware of how much you are bleeding. If your bleeding is particularly heavy, your physician may perform an examination to ensure the bleeding is normal. 

Be Sure to Ask Questions

The fourth trimester can be incredibly exciting for a new parent. It’s your chance to get to know your new baby. And there will be plenty of new and interesting challenges. That’s why it’s important that you take advantage of your six week appointment to ask questions and get the health care information you need. Some of those questions may include:

  • Are there vaccines or medications I should start taking?
  • Should I change the quantity of any of the medications I am currently taking?
  • Is vaginal dryness normal? And are there any treatments that can help?
  • When should I schedule my next well-woman visit?

You can also ask about anything else that’s bothering you or worrying you. Some providers suggest that you write down these questions ahead of time so they’re easier to remember (especially if you’re feeling a bit sleep deprived, which you probably will be).

Taking Care of Your Health Beyond the Postpartum Trimester

When you meet with your provider, you can take some time to discuss your overall health and what your prognosis for future pregnancies may look like. Every pregnancy and birth will be different. Some complications could make future pregnancy more difficult, while others may have no impact. It’s a good idea to have a frank discussion with your physican about your future.

During your fourth trimester, you’ll transition from pregnancy to parenthood. During this new stage of your journey, you can work with your doctor to keep your wellness on track as you encounter the new and joyful challenges of parenthood. To schedule a fourth trimester follow up, call 712-336-3750.


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