Your Comprehensive Guide to the Fourth Trimester
During pregnancy, childbirth is seen as the finish line, the culmination of 40+ weeks of planning and preparation (not to mention pregnancy symptoms!). You’ve had your due date circled on the calendar, and you’re doing everything in your power to ensure a safe labor and delivery, including creating a birth plan and asking seasoned moms for advice.
But once the baby’s here, you’re ushered into the postpartum period. Some people refer to the postpartum period as the “fourth trimester,” or the 12 weeks following birth. People often forget how essential your physical, mental and emotional wellness is during this time. There’s a lot of focus on the baby during the postpartum period, but we’re here to focus on you. That’s why in this guide, we will answer questions and guide the transition from pregnancy to parenthood.
What is the “Fourth Trimester?”
The fourth trimester is the first 12 weeks postpartum; it’s just one part of the postpartum period, which begins as soon as you give birth. It describes the time it takes for the mother’s uterus to return to its pre-pregnancy state, which is typically between six and eight weeks. However, we now know that it takes a bit longer for hormones to return to their pre-pregnancy state.
There are such significant emotional changes during this time that some people refer to it as the “fourth trimester.” This suggests a period of 12 weeks, versus the six to eight weeks it can take for physical normalcy.
What is Happening During these 12 weeks?
There are many physical, emotional and psychological changes. And you’re navigating them all while taking care of a new baby. Breastfeeding, your first period, wound healing and establishing new routines are just a few of the changes taking place.
We’ll break them down by time period and what to expect in the first 12 weeks of postpartum care, so you have an idea of what the first three months postpartum may look like.
The First Two Weeks After Giving Birth
A lot is happening to your body and mind during the postpartum period. Some changes happen to every woman who gives birth, while others are specific to vaginal birth or C-sections. Here’s an overview of the first two weeks after giving birth and tips on taking care of yourself.
Postpartum Bleeding
Whether you have a vaginal birth or a cesarean, you can expect to experience some postpartum bleeding. During pregnancy, the lining of the uterus becomes super thick, but it thins after delivery and removal of the placenta. The result is a type of discharge called “lochia,” which is a term for blood, mucus, and uterine tissue.
This bleeding can last up to six weeks, and you should use pads, not tampons, for comfort, safety and healing.
Cramping
Postpartum cramping is, unfortunately, standard while you’re healing. It is caused by the uterus shrinking down to its pre-pregnancy size and shape. The resulting pain can be dull or sharp and may last two to four days after labor and delivery.
If you had a C-section, there will likely also be some pain and soreness at the sight of the incision. A heating pad may help relieve discomfort, and over-the-counter anti-inflammatory medications such as ibuprofen can also be effective. Be sure to consult your healthcare provider before taking any medication.
Perineum
After childbirth, it’s common to feel stinging or burning when you urinate, especially during the first couple of weeks. Nine out of 10 women who give birth vaginally experience some degree of perineal trauma (lacerations, small tears or cuts), which usually heals on its own within a few weeks. Proper perineal care can ease discomfort, promote healing, and reduce the risk of infection.
Tips for Perineal Care After Childbirth
- Use a peri bottle filled with warm water to rinse the area while urinating—this dilutes urine, reduces stinging, and gently cleanses the skin.
- Apply ice packs in the first 24–48 hours to help reduce swelling and soreness from tearing.
- Take sitz baths (warm, shallow baths) to soothe the area and improve blood flow, which can speed healing.
- Gently pat dry instead of wiping after using the bathroom to avoid irritation.
- Wear loose, breathable underwear and change pads frequently to keep the area clean.
Baby Blues & Mood Swings
Hormones, lack of sleep and adjusting to this significant life change can make women especially prone to mood swings, baby blues and postpartum anxiety. In general, these feelings only last the first few weeks postpartum; if they last longer than that or worsen, that could be a sign of postpartum depression, and you should contact your healthcare provider immediately.
Weeks Three to Six
Three weeks after giving birth, your body is still recovering, but the pain should be less intense, and you should be improving each day. And while you’re still very likely sleep-deprived, you’ll start settling into your new normal.
The 6 Week Postpartum Visit
About six weeks is the standard timing for the first postpartum check-up. Use this time to share any challenges or concerns and ask questions. Your recovery matters just as much as your baby’s health, so don’t shy away from being transparent and honest with your provider.
What to expect at 6-Week postpartum appointment
During the six-week check-in, your provider will cover your mental and physical health, healing and offer contraceptive options. Here’s a brief overview of what you can expect:
- Your provider will examine your abdomen, perineum or C-section incision to check on your healing progress and address any pain, bleeding, urinary leakage, or bowel issues.
- Expect questions about mood, anxiety, sleep, and fatigue to screen for postpartum depression or anxiety. They can also connect you with support if needed.
- Your provider may ask about feeding, newborn care challenges, and whether you’re getting enough help with meals, chores, or transportation.
- Together you’ll discuss when it’s safe to resume sexual activity, how to manage pain or low libido, and which birth control options fit your needs and future pregnancy plans.
- Your provider will review any pregnancy-related conditions (like high blood pressure or gestational diabetes), explain your ongoing care needs, and help set up routine visits or referrals to reduce future health risks.
Exercise After Pregnancy
If you gave birth vaginally, you can usually start light movement a few days after delivery. If you had a C-section, a complicated birth, or extensive perineal tearing, you’ll likely need to wait at least four to six weeks to resume any exercise. When in doubt, speak with your provider about safely exercising.
Weeks 7-12
Weeks 7-12 are firmly outside the “immediate recovery” phase. You may be returning to work or getting the hang of breastfeeding. This stage is about rebuilding your strength, checking in on your healing, and making a plan for the months ahead.
Your First Period Postpartum
The bleeding that takes place immediately after delivery (called lochia) is different than your first postpartum period. Breastfeeding women will likely remain period-free while they are breastfeeding because a hormone called prolactin, which helps your body produce breastmilk, also stops your period.
If you’re not breastfeeding, you will likely get your first period sometime within the first 12 weeks after giving birth. Those first few periods may be heavier, irregular or have more symptoms like cramping. This is fairly normal and should level out over time.
Contraception & Sex
Even if you haven’t yet had your first postpartum period, there’s still a chance you can get pregnant, so discuss birth control options with your healthcare provider. Having sex again after birth is a personal and clinical decision.
Returning to Work
If you’re planning to go back to work, this is a great time to set up a postpartum return-to-work plan. Ask your provider about tips for pumping or breastfeeding at work, managing fatigue, and balancing your physical recovery with job demands. You can also start building routines at home, like meal prepping for new moms or lining up childcare, to make the transition smoother.
Postpartum Mental Health
About 70-80% of women experience sadness or mood swings at the two-week mark postpartum. If you still feel sad beyond that or your mental health declines further, there may be something more serious going on.
PPD vs Baby Blues
Postpartum depression is not the only emotional issue women may face after giving birth. Postpartum anxiety, postpartum post-traumatic stress disorder, and postpartum obsessive-compulsive disorder can also occur. Here are some signs to watch for:
- Loss of interest or pleasure in things you usually enjoy
- Sleeping too much or too little
- Feelings of worthlessness or guilt
- Fatigue
- An inability to concentrate
- Suicidal ideation or recurring thoughts of death
Baby blues are temporary and go away within the first few weeks after giving birth, whereas PPD can last much longer and more closely resemble regular depression.
Postpartum Post-Traumatic Stress Disorder
Sometimes, a challenging labor experience, like an emergency C-section or sudden blood transfusion, can leave emotional wounds as well as physical ones. The traumatic experience can cause postpartum PTSD. You might have upsetting memories or dreams, trouble sleeping, or feel constantly on alert. If this happens, you’re not alone, and it’s not your fault. Talking with your health care provider or a mental health professional can help you heal.
How to Access Care And Support
If you ever feel like you might harm yourself or your baby, call or text the 24/7 Suicide and Crisis Lifeline at 988 right away. Please also reach out to your OB/GYN about any challenges you’re having. There’s no shame in what you’re going through, and you don’t have to face it alone. Your provider wants to hear about all your physical or emotional struggles, big or small.
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