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Postpartum: the “Fourth Trimester” of the Pregnancy Journey

A newborn cry announces the arrival of a new life into the world this side of the uterus. For nine months, the baby has been nestled in the safety of his or her mother’s womb, now to be delivered into the security of his or her mother’s arms. Postpartum, also known as the “fourth trimester,” is sometimes a part of the pregnancy journey that is taken for granted. Baby is here, but now what?

Whether mommy and baby’s birth journey involved a vaginal birth or a c-section, this time can be filled with many new emotions, questions, wonders, and challenges.

What is all this craziness going on post-delivery?” “Is my baby supposed to look like that?” “Breast or bottle — I don’t want to be judged!” “Are these changes to my body normal?” “Am I enough for my baby? These are just a few questions we will explore as we discuss the postpartum stage in your pregnancy journey. If you didn’t get a chance to read about the first trimester, second trimester, or third trimester, you catch up in our previous blog posts:


As a new mother clings tightly to her newborn in amazement. She can’t but help to notice the bustle around her. There is still a placenta to be delivered and cord blood to be collected. The obstetrician or midwife will look to see if any repair needs to be done in the vaginal/perineal area or, in the case of a cesarean section, repairing the surgical site. The nurse will be assessing the baby, and of course there is clean up of you and the room because birth is messy. Over the next one to two hours, the nurse will check your uterus by pushing down on your fundus (top of the uterus) to make sure it is firm and your lochia (the bleeding post-delivery) is a normal amount.


During this period, it is important to do as much skin-to-skin as possible with baby. Skin-to-skin helps to transition the baby to his or her new environment by helping to regulate baby’s body temperature and breathing. It also encourages the baby to want to breastfeed.

If a woman has had a cesarean section, she should still be able to have that skin-to-skin bonding time. She should talk to her nurse about her desire to do skin-to-skin and possibly breastfeed baby while still in the operating room. You will find that most facilities are accommodating to this request. If for any reason mom is not able to do skin-to-skin with baby, baby can experience the same benefits (minus the breastfeeding) from skin-to-skin with daddy or another support person in the room.


Seeing your newborn immediately after birth may leave you with some question about their appearance. Here are some of the most asked questions from parents about their newborn:

  1. Will their head stay like that? No, the bones in the baby’s head are designed to move around, molding to the birth canal to allow baby to be born; baby’s head will typically go back to its normal shape over the first 2 days.

  2. Does cutting the baby’s umbilical cord hurt the baby? No, there are no nerve endings in the umbilical cord. They do not feel anything. Also, it’s important to note: a parent does not need to do anything to the baby’s umbilical cord. It will dry up and fall off all on its own. But do remember, sponge baths only until the umbilical cord does fall off. SIDE NOTE ABOUT BATHS: Most likely the nurse will delay bathing the baby after delivery — not before four hours post-delivery and sometimes even longer. Delaying the bath helps to insure they have regulated their body temperature, and it also aids in building their immune system by allowing mom’s natural microorganisms to remain present on baby’s skin.

  3. Is it normal for my baby’s hands and feet to have a bluish color? Yes, this is called acrocyanosis and can be present during the first two days after birth. However, if you notice baby has a bluish appearance other than just his/her hands and feet, this is not normal and the parents should seek immediate healthcare for their infant.


If you’re a first time mom (and even if it’s not your first time), it’s normal to have many questions. There is so much to learn during postpartum, and it’s perfectly fine to ask for help! Here are a few more common questions about:

  1. How should I feed my baby? The only right answer to this question is: “Feed your baby.” Yes, breastmilk is better than formula and provides many health benefits. However, moms have many reasons they may choose to formula feed, and that’s absolutely OK. Her baby is being fed, and that is what is most important. As a community we need to support these new mommies and their families with encouraging words and love, not our own opinions and judgment.

  2. What changes might a new mommy experience with her postpartum body? – Lochia: As mentioned above, women will experience lochia after giving birth. A women will typically have lochia for up to six weeks after delivering her baby. The lochia will initially be red in color (blood), but it will lighten up to a pinkish and then almost like brown/clear color over the next few weeks. If at any time a woman notices that her lochia is heavier than her normal period, she is passing blood clots the size of a small plum or larger, or that it has a fowl odor, she should contact her obstetrician/midwife immediately. – Uterus shrinking: This new mommy will probably notice that her body looks to be in her second trimester of pregnancy. This happens because her uterus was stretched to accommodate her growing baby. It’s important to remember that it took nine months for her uterus to grow, and it will take some time for her uterus to shrink back to its original pear sized shape. Mommies may notice period like cramps as this process is occurring. – Breast changes: Next, she will notice changes in her breasts. With in two to five days after giving birth, her body will go from producing colostrum to breast milk. When her breast milk arrives, she will most likely experience engorgement. This means that her breast will become very full of milk and firm to touch. For some women, engorgement can be uncomfortable, but for others it can be a painful experience. Cold compresses to the breast can help. Avoid heat or hot showers. Although the heat may feel good initially, the heat increases the blood flow to the breast which will increase milk supply and encourage further engorgement. Don’t worry — this phase doesn’t last forever, and your milk supply will adjust to your baby’s needs. Please be aware: if at any time a woman experiences engorgement accompanied by a red, warm/hot-to-touch painful area on her breast, possibly even accompanied by a fever, she should call her healthcare provider as she may have developed mastitis. Mastitis is an infection in the breast tissue typically caused by a clogged milk duct or sometimes a bacterium that has entered the breast and is seen most in the first three months of breastfeeding. Her doctor will probably order antibiotics and recommend that she continues to breastfeed as it is beneficial to the healing process. – Postpartum Depression: It is also important to remember that the change in a woman’s hormones coupled with lack of sleep may cause some moms to feel overwhelmed or depressed. This can be normal. However, if these feelings last beyond two weeks or a mom feels like harming herself or her baby, she should seek help from her healthcare provider immediately as she may be suffering from postpartum depression.

Moms, allow yourselves time to heal. Take this time to just relax and enjoy the time with your new bundle of joy. Also, make sure to take advantage if any one offers to bless you with a food train or other assistance around your house. Don’t be afraid to ask for help — it takes a village!

Remember, you are enough for your baby! A child is a beautiful gift from God, and He has equipped each parent with the specific ability to raise that child. Parents, give yourself grace; God does. With each new baby comes a learning curve. He or she is a distinct human being with his or her own personality, and it will take time for both mom and baby to learn about each other. Try to enjoy the process, and let yourself grow in your love for your baby as you learn and discover this new stage of life.


Thank you for taking the time to follow along with us as we discussed the journey of pregnancy these last several weeks! We hope this has been a helpful resource to you. More than anything, we hope you know you’re not alone. Whatever stage you find yourself — whether early in your pregnancy or in the thick of parenting — Life’s Choices is here to walk beside you.

If you’re seeking more resources to help you through your pregnancy, postpartum, parenting, relationships and more, Life’s Choices offers completely free classes on a variety of topics. From free childbirth classes to parenting classes and beyond, we encourage you to sign up for one of our free classes, or please contact us today with any questions. We would love to support you and be a free resource to you!

“Children are a gift from the Lord; they are a reward from Him.” Psalms 127:3


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