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OB Gyn Associates of Iowa City and Coralville

The Fourth Trimester: A Care Guide for Moms

The first three months after a baby is born is sometimes called “the fourth trimester,” in reference to the critical stage of growth for the very immature newborn. A newborn baby is developmentally very helpless and high maintenance. But even though newborns require an enormous amount of care and attention during these months, we must not neglect the moms! 

As a new mom, you must adapt to multiple changes in yourself as well, and you’ll need immense energy to do so. You have to recover from childbirth, adjust to changing hormones, and learn to feed and care for your newborn–with major physical and emotional challenges to navigate through it all. 

Physical Changes:

Your skin is itchy and stretched, your belly is squishy and wobbly, your breasts and nipples are almost unrecognizable, and it feels like your abdomen and back muscles scarcely remember how to hold you upright. You may have difficulty defecating at first (that first postpartum poop can be so intimidating!), while urinary incontinence has you peeing way too easily. You may have stitches or a cesarean incision to care for, all while bleeding for up to 4-6 weeks postpartum. Dealing with these symptoms on very little sleep can make recovery feel impossible. 

You are not alone. Talk to your doctor about any symptoms that are bothering you and let us help. In the meantime, gather some supplies that can help you feel more comfortable as you heal and settle into your new role. 

Physical Support Checklist:

❏     Sitz bath

❏     Witch hazel pads

❏     Hemorrhoid cream

❏     Extra-long pads

❏     Comfortable underwear

❏     Soft, stretchy clothing

❏     Stool softeners

❏     Water

❏     Frequent snacks

❏     Healthy food

❏     Moisturizing lotion

❏     Nipple cream for sore nipples

❏     Phone number and email of a local IBCLC lactation consultant or breastfeeding support group if you’re breastfeeding

❏     Mother’s Milk Bank of Iowa for supplementation

Keep an eye on any red-flag signs: fever, large clots or heavy bleeding, pain, or other symptoms of infections. If you experience any of those symptoms, call your doctor immediately. You can call us at (319) 337-3193.

Emotional Changes:

Mood swings and periods of weepiness are so common after having a baby that they have their own name: the baby blues, or postpartum blues. The baby blues usually get better within 1–2 weeks without any treatment. However, feeling chronically sad, depressed, overly anxious or guilty, or having thoughts of harming yourself or your baby can be signs of postpartum depression or anxiety (PPD or PPA). This can occur up to 1 year after having a baby, but it most commonly starts about 1–3 weeks after childbirth. This doesn’t mean you’re crazy or a bad mom—postpartum depression or anxiety is never your fault. But it is treatable, so don’t ignore it. If you think you may have postpartum depression, or if your partner or family members are concerned that you do, it is important to see your health care provider as soon as possible. Do not wait until your next checkup.

In addition to the baby blues, you may also experience a lack of sexual desire, feelings of doubt or insecurity about your new role as a mother, or stress about how to balance your work and home life. All of these feelings are normal, but that doesn’t mean you have to struggle through them without help. Speak up about your feelings with your partner, friends or family, and your doctor. We can help support you or offer treatment if things are not improving. 

Emotional Support Checklist:

❏    Let your people help you. If you have a partner, tell them what would be most helpful to you. 

❏    Focus on rest and baby care. Eating and sleeping frequently should be daily goals for both you and your baby!

❏    Take pictures of your baby, and get in some of them, too.

❏    Hold your baby. Breathe in their newborn scent–it helps with bonding!

❏    Limit visitors if they feel overwhelming to you.

❏    Ask visitors to help with cleaning or meals.

❏    Talk with friends or family about your feelings, both positive and negative. 

❏    Call your doctor about anything that feels off. Don’t wait for your postpartum checkup if something is bothering you.


Postpartum care visits with your obstetrician-gynecologist can help you navigate the challenges of motherhood, both the physical and emotional changes you are going through. 

For all women, a comprehensive postpartum visit should take place 6 weeks after birth. We will discuss reproductive options and make a plan to ensure you can receive your desired form of contraception. The visit will include discussions about infant feeding, postpartum weight retention, sexuality, physical activity, nutrition, and a full assessment of your physical, social, and psychological well-being. This is an opportunity for you to ask questions about your birth, your body, and your future health. We can talk about anything you need help with. Let us help support YOU during this critical time.