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Thriving in the Fourth Trimester (FAQs) PART 1

Updated: Mar 14, 2022

The fourth trimester refers to the first three months of a newborn’s life. This is also known as the beginning of the postpartum period for new mothers. The fourth trimester can be both beautiful and terrifying for new parents! There are so many lessons learned along the way that can sometimes only be learned through personal experience. I spoke to friends and family members who are moms and asked them for the top questions they had during the fourth trimester. Here are the first five questions and my answers.

1. How long will I bleed postpartum?

You will likely bleed the heaviest during the first few days after you give birth. During this time, the blood will be bright red in color, and you may pass large clots. I remember reading that the clots should not be bigger than a quarter. However, I vividly remember passing clots larger than a quarter within the first 3 days of birth. The most significant bleeding and clotting is usually over within 10 days (about two weeks), but you may still experience light bleeding and spotting on and off during the first 6 weeks of your baby’s life. The color of the blood will likely go from bright red to shades of brown. If you need more information about postpartum bleeding, check it out here. If you ever have any concerns regarding bleeding, I highly recommend calling your doctor to discuss as soon as you can.

2. Why is my baby breathing funny?

Every mom has to learn the hard way that newborns have the strangest breathing patterns! Even with all my birth prep, I was not prepared for the intense moments of panic every time my daughter stopped breathing for no reason at random times in the day. It was never longer than a few seconds, but it was terrifying to me as a first-time mom. Newborn lungs are brand new, and they are learning to breathe air for the very first time. You may find that your baby does big bursts of rapid breathing in combination with long pauses that can last up to 10 seconds! They tend to breath faster and shallower than adults. A typical newborn takes between 30 and 60 breaths a minute while awake and as low as 20 breaths a minute while asleep. This is in stark contrast to adults who take between 12-20 breaths a minute while awake.

You may also notice that their breathing is “noisy” in the first few days after birth and this is also usually normal. Some babies, especially c-section babies, need more time to clear lingering fluid out of their respiratory tract. Most breathing irregularities will resolve themselves completely within baby’s first six months of life. However, some breathing red flags include whistling or wheezing, hoarseness, stridor or grunting. It is important to act quickly if you notice changes in color and increased work to breathe as this may be a respiratory emergency.

3. How do I care for myself after a tear/episiotomy?

An episiotomy is a procedure where the doctor or midwife purposely cuts the perineum to allow for a quicker/easier delivery. Ideally, this procedure should only be done when medically necessary. Stitches are put in place to repair the perineum after episiotomies. In the case of a tear, doctors and/or midwives will determine the severity of the tear and decide if/how many stitches will be needed to repair the tear. Some tears are mild enough to heal on their own.

Once you are stitched up, the healing process is straight forward (unless other complications arise). Doctors will likely give you oral pain medications to take around the clock for the first few days following birth. These medications usually help with any pelvic discomfort brought on by the stitches as well as cramping associated with your shrinking uterus. You could also take any over the counter pain medication of choice. If you are breastfeeding, I recommend checking with your doctor to ensure that the meds you’re taking are not contraindicated while breastfeeding!

When it comes to tears, I find that less is more when it comes to healing. The perineum heals relatively quickly on it its own. Most of your time will be spent making yourself more comfortable while it heals. Doctors recommend avoiding contact with the perineum as much as possible. It is recommended to spray warm water over the area instead of directly wiping the perineum after using the restroom. Most hospitals will send you home with a refillable spray bottle that you can use every time you use the restroom. They also tend to send home lidocaine/benzocaine spray like Dermaplast that can be used as needed to aid with pain. Some moms and birth workers also recommend freezing disposable pads and using them as needed to for comfort. You can check out a cool rundown on how to make them here!

While most women heal just fine, there is always a risk of infection or other medical complications. Check out this article which gives details on when to call your doctor!

4. Why does my baby have a rash?

About 2 weeks after my daughter was born with perfect, doll-like skin, she started to get a full body rash! It started as just a few bumps on her face, and it quickly covered her head and back within days. I remember being terrified; rewashing all our laundry, trying different creams, desperately asking for advice in Facebook mom groups. It felt like every few weeks, she was getting a new mystery rash on some part of her body. I was completely overwhelmed when I finally got a chance to speak to a truly veteran mom. She patted me on the back and said, “I know you’re trying your best to help her skin, but honestly, most newborns will have some sort of rash at some point in their life”. At the time, it was a hard pill to swallow. It turns out that she was absolutely correct. Newborns are transitioning from life submerged in warm, nutrient rich liquid to a cold and dry environment. They are encountering textures and chemicals that they’ve never encountered before. They experience a steep decline in hormones when they separate from their mothers at birth! All these factors contribute to the development of rashes. I suggest checking out this detailed list of common newborn rashes to help decide whether your child’s rash is worthy of a call to the pediatrician.

5. Am I getting my needs met?

Virtually every mom I speak to says that they wish they asked for help and took better care of themselves during the fourth trimester with their first child. Motherhood can be all consuming and it very easy to ignore your needs while caring for your newborn. It is imperative that you find moments to check-in with your body and ensure that your basic needs are being met. This can be a matter of life or death, as a large percentage of pregnancy related maternal deaths occur in the postpartum period. No matter the circumstances surrounding your birth (e.g., vaginal/c-section, medicated or unmedicated), the physical act of birth is a form of trauma to your body. Your body is the most vulnerable in the fourth trimester and needs the most TLC. Birth workers recommend extending the least amount of energy possible during this time to allow your body to heal effectively. We’ve all experienced the dreaded “mom guilt” when we can’t put our family’s needs first all the time. You can’t pour from an empty cup. It’s so important to find ways to refill your cup as often as possible during this time. Taking better care of yourself will allow you to better respond to your family’s needs.

Examples of prioritizing yourself may include:

1. Having your partner or family member take the baby for an hour so that you can shower and eat a real meal each day

2. Taking a nap instead of doing chores

3. Speaking to a mental health professional

4. Taking a short walk outside daily

5. Taking 30 minutes to do something of interest while someone cares for the baby


I hope this list was helpful! I am not a medical professional and the information I’m sharing is based on my own personal experiences in addition to research that I’ve done on these topics. Consult your doctor immediately if you have any questions or concerns about your health! I will be back next week with more FAQs about the fourth trimester! Were there any questions that you had in your fourth trimester? Leave a comment below!

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