Newborn On Deck! My Quick Preparatory Review Of The Fourth Trimester

Over in my neck of the woods, we’re about to embark on the newborn stage/fourth trimester for the third time. Despite having navigated this stage of development twice before, I felt the need to quickly review some key components of newborn care and postpartum expectations. (It’s amazing how quickly we forget things that we thought were ingrained into our minds!) While I was reviewing, I thought it might be helpful for some of you if I shared my flyby highlights. So, without further ado, here’s your quick guide to the fourth trimester.

What IS the Fourth Trimester?

The Fourth Trimester is a term created by pediatrician and best-selling author of “The Happiest Baby on the Block” Dr. Harvey Karp. The term refers to the first three months of a baby’s life post-delivery. Dr. Karp suggests that during these first several months of life, a newborn acts more like a fetus than an infant. And if we, as parents, recognize this fact, and treat our newborns accordingly, they will be calmer than otherwise and become “the happiest baby on the block”.

You’ll have to read his book to get into all the nitty-gritty for why he suggests this and how you can help make the transition into life post-birth smoother for your baby. A super quick recap, that doesn’t do his explanation full justice, is this: for the first several months of life, a newborn mostly eats, sleeps, and empties their bladder and bowels. They have very little engagement with those around them. It isn’t until roughly the three-month mark that babies will start to be more aware of their environment, to explore moving their bodies, and to begin socially engaging activities such as smiling at their parents. (Please really do read his book! Like I said, this quick explanation does not do his book the justice it deserves nor does it give you the insight into your newborn that you deserve!)

Other people have latched onto the concept of the fourth trimester. They have used that terminology to apply to situations beyond those Dr. Karp writes about in his book. For example, the fourth trimester has also been used to describe the initial postpartum changes for a woman’s body and mind. The first several months post-delivery bring a whole boatload of changes such as post-birth bleeding, milk production, hormonal adjustments, new sleep patterns, new ways of interacting with partners and friends, etc.

(Potential) Newborn Characteristics and Quirks

Newborns are experiencing everything outside of the womb for the first time and it can be a tricky transition! Many of their bodily functions are being used for the first time. Additionally, they are being exposed to lights, sounds, textures, temperatures, oral sustenance (milk) and movements that are new to them. All of this “newness” can create reactions that are particular to the newborn phase and not often seen beyond the first several months of life. Here’s a quick list of some of what your baby might exhibit during the newborn phase:

• Blue skin in hands and feet
• Shaking/quaking/jerky arm and leg movements
• Hiccups/frequent yawning
• Rapid or slightly irregular breathing patterns
• Lots of crying
• Baby pimples
• Black thick poop for first few days then bird seed poop/mustard colored (for breastmilk fed babies) or brown/clay colored (for formula fed babies)
• Crossed, puffy, gunky, and/or swollen eyes
• Folded ears, birth marks, swollen/stretched head and other signs of birth trauma
• Soft spots on their head that “throb” at times (due to the blood vessels so close to the surface of their head)
• Swollen genitals and breast tissue on both girls and boys
• Vaginal discharge in girls
• Frequent spit up

In this post, I won’t go into why all of these things occur but I would like to add a disclaimer: if you have any concerns about anything on this list, please bring them up with your pediatrician! They can either reassure you or dive deeper to see if something truly is off with your newborn’s development. Better to err on the side of caution.

A Note Regarding Newborn Weight Loss

Some parents grow concerned about the initial weight drop their baby has between birth and their first doctor visit. They worry that their child isn’t getting enough food or that they’re doing something wrong. Please rest assured that this weight loss is expected and typical and, unless it is an exceptionally large loss of weight, doesn’t signal any underlying problems.

Newborn Sleep

Here’s a reminder, just in case you’ve forgotten: newborns don’t have the same sleep patterns as their parents! As you’re approaching the birth of your child, keep that truth firmly fixed in your mind. Mentally prepare for disruptions to your sleep.

Newborns sleep 14-18 hours a day, broken up into multiple segments of roughly 3 hours sleep to one hour of awake time (Karp, 2003, p 213). Be prepared to sleep in three-hour chunks at night. And, to get the sleep you need to function, adjust your morning wake up time and your go to bed time accordingly.

You also might be alarmed as you watch your newborn sleep during this fourth trimester time frame. About half of their sleep might seem calm and peaceful while the other half might trouble you. Your baby might have irregular breathing, limp limbs, and/or jerky movements. Don’t be overly concerned with this night and day difference in sleep. It can be explained by the difference in REM sleep and quiet sleep (Karp, 2003, p 214). Again, I’m not going to dive into the details of it but please know it’s a normal and expected sleep pattern.

Newborn Feeding

There’s a LOT that can be said about feeding a newborn. Because this is just a flyby review of the fourth trimester, I’m only going to touch on a couple things. (Source: Feeding Matters Questionnaire)

• Newborns usually eat 8 times in 24 hours (that’s roughly every three hours, corresponding to their sleep/wake cycles but it could be anywhere from 2-4 hours apart)
• They should be calm and alert during their feeds
• They usually take 20-30 mins per feeding
• Some babies may need breaks during their feeds to breath, burp, or otherwise regroup for a minute before being ready to continue their meal
• Your baby is most likely getting enough milk if they are steadily gaining weight and have 6-8 wet diapers in the first couple of months of life.  

If you have concerns about your child’s feeding, the referenced questionnaire from Feeding Matters is a helpful, professional tool to get you started. And, as always, bring up concerns with your child’s doctor.

Newborn Fussiness

As mentioned above, newborns cry a lot! It’s a given hallmark of the fourth trimester. However, just because it’s an expected part of their growth, doesn’t mean we can’t take steps to figure out their needs and to help calm them. This section will hopefully help you figure out what on earth your child might need at any given time.

Initial Steps

Some of the first steps you might take to help your fussy baby might include:

• Changing their diaper
• Feeding them
• Putting them down for a nap
• Rocking and cuddling them
• Providing a pacifier

Subsequent Steps

If those steps don’t provide relief, you might be at a loss for what else to try. Here are a few other ideas as well as clarifications for common misconceptions:

• According to “Happiest Baby” (Karp, 2003, p 52), too much quiet isn’t necessarily a good thing for a newborn! They’re used to the loud sounds of your uterus…swishing of amniotic fluid, thrumming of your blood, beating of your heart, whooshing of your lungs, rumbling of your voice…Your baby was constantly surrounded by rhythmic, soothing noise. Try to re-create a rhythmic, consistent background noise and/or movement for your baby instead of trying to achieve silence and stillness.
• At times, you may be unsure if your baby is hungry or not. At such times, Dr. Karp recommends doing the pacifier test. “If your baby is hungry, she’ll probably only suck a pacifier for a minute before crying, as if to complain, ‘Hey, I ordered milk–not rubber!’ However, if she just wants some comfort, she’ll happily suck on the pacifier for a good long while” (Karp, 2003, p 174).
• Constipation is another source of fussiness in babies. There are many reasons your child might have constipation, especially if they have colic or if their formula isn’t the right one for them. We won’t cover those reasons now. However, if your baby seems to have chronic constipation, make sure you and your doctor create a plan to help your baby feel more comfortable. For the baby with inconsistent/non-chronic constipation, you can help relieve pressure in their abdomen and get their bowels moving in many ways. One common technique is by bringing their bent legs up to their bellies. Then gently, but firmly, rotate their legs in the air, like they’re peddling a bicycle.
• You might have heard that swaddling helps a fussy baby. And for some babies, swaddling alone does help them calm down. However, Dr. Karp teaches that swaddling is most effective in combination with other soothing techniques. He writes “…swaddling is not meant to calm your baby! Its purpose is to stop his flailing and to help him pay attention to the other “S’s”, which will soothe him” (Karp, 2003, p190). These other S’s, which are explained in great detail in his book, include side-stomach position, shush, swing, and suck.

Note: if your baby cries for least three hours a day, for more than three days a week, and lasting for three weeks or more and is unable to be calmed, despite trying all of the above, make sure to speak to your pediatrician regarding colic or other health concerns. Also, please ask friends and family for help so that you can take a much-needed break from the crying before you reach a breaking point. There is NO shame in asking for help and recognizing your limits.

Well, there you have it. My quick flyby review of the fourth trimester. It is by no means a deep dive and is mostly just a review for my own benefit. But hopefully its helpful for at least one other person out there.

Best of luck in your parenting journeys! (And wish me luck as well!)

Xoxo,

Briana

Hello! I’m Briana!