Fourth trimester
Transition to the outside – for both parents and babies
No doubt throughout your pregnancy, the arrival of your new addition has been met with eager anticipation; you have moved through the stages of pregnancy (some with more ease than others), with the end goal in sight. The end goal being delivery of your baby; the end goal being the completion of your pregnancy; and while this comes with overwhelming happiness, a previously unknown amount of love and a great sense of relief to have your happy healthy baby in your arms – it is in fact is not the end, but rather just the beginning.
People don’t often talk about the transition to parenthood. Things like lack of sleep are occasionally mentioned from empathising parents that have gone before, and by the time you leave the hospital you may have acquired a new found ability to change a nappy, to swaddle, to recognise feeding cues, and to assess in which stage of transition your baby’s stools are – but that may be in fact the only transition that you are acutely aware of. Becoming a new parent IS a transition, often seemingly a slow one, with many ups and downs. It is a 4-6 (even up to 12) week steep learning curb, one that will see you come out the other side with confidence and coping mechanisms that will ensure that very little other in life will get you flustered. It is a time that you and your baby won’t get back, a time that, while it can be incredibly challenging, is incredibly special and holds immense value for both you and you baby.
I don’t think too many people are disillusioned by the fact that having a baby will change your life; it can be a difficult transition, but it’s worth it. The first few months can be particularly challenging as you just work out what it all means to be a parent, and similarly your baby is just working out what it means to be in the world. A concept of considering this time as a ‘fourth trimester’ allows it all make a little more sense, and acknowledges this to truly be a time of transition, for both parents and babies.
For parents, the most influential factor is being aware; aware of the fact that it is an absolutely colossal adjustment for your baby to make from being in utero to being in this world. The biggest adjustment in fact they will ever go through in life, a world completely unfamiliar, with no learned coping mechanisms. They rely 100% on you, to make this world a more familiar place. So to be aware of this, and further to understand this, allows the first few months to be a more cohesive adaptation.
For a baby, they have grown in an environment that at its largest is about 30cm wide and 40cm long. The have been fed constantly, kept warm, been settled by the constant hum of a mothers voice, the tapping of your heart and the rocking of your everyday movement. As well as having never been in the world before, you can see that they have had the things most comforting and familiar to them removed. Their comfy little house has become a big wide world, and a scary one at that. All they know for comfort is you. If you can replicate these same comforts and familiarities they had inside, the transition becomes smoother, for everyone.
So try not to be too fixated on ‘routines’ or even patterns of behaviours/feeding/sleeping in the first 12 weeks. Take each day as it comes, as there won’t be two the same. Some days will be relatively good, others will be more challenging, but each day both of you are learning, so tomorrow, you’ll know more. You can read all the books in the world while you’re pregnant, but your baby hasn’t read them, so you both have to work out what works together. Here are some things that might not necessarily make the challenging days fewer, but might help you to cope during the difficult times, by simply understanding.
Newborn baby’s feed often. They don’t have any understanding of meal times, nor will they form their own. At times you may notice that a pattern starts to form in intervals between feeds, but then the next day might be very different. And this is OK; tiring yes, sometimes confusing, but normal. The key is frequent baby led feeding. It is essential for breastfed baby’s to establish a supply and demand balance specific to their needs. Some days this may mean feeding every 4 hours, the following day it might be every 2 hours. If you feed as frequently as your baby is demanding, your supply will mimic this. Stimulation to the breast creates milk production and let down; they know exactly what they need, thus there is a reason that your baby’s feeding pattern will change. Sucking is also the most comforting thing for a newborn baby, so occasionally feeding cues may be displayed when they are simply needing comfort; breastfeeding provides so much more than simply transfer of food. Some people may be concerned that they don’t have an adequate milk supply when their baby is cluster feeding or not settling well between feeds – but if your baby is having lots of output and is gaining weight, be reassured that input is adequate. Breastfeeding, while a very natural thing, is a learned skill, and being relaxed and comfortable while feeding, mostly ensured through feeling confident, is essential. Ask the midwives in the hospital to assist you with positioning and attachment, as well as different feeding positions, so that when you go home you have the tools you need. If you have ongoing concerns with position, attachment, concerns about milk supply or baby settling after feeding, consider engaging with a breastfeeding specialist, ether through a private lactation consultant appointment in clinic or in your home.
Newborn babies don’t need or want a sleep environment similar to adults, nor do they know night from day. As adults we like to be able to stretch out, to have a nice soft surface, a comfy pillow, in a dark and quiet environment. A baby doesn’t know, nor need, any of these things. In fact this is the opposite of the environment that they are used to. You may find it more effective to settle the baby using techniques which mimic being ‘on the inside’. Swaddle them with their arms and legs in tight (except if your baby is an arms up kinda guy/gal, which you will find out quickly). Swaddling makes then feel secure, but doesn’t always work once they’re put down into a cot or bassinet, it takes time for them to get used to the feeling of laying flat on their back (although we know this is the safest position for them). So if you are swaddling and putting them down, do it slowly; once they’re settled, place a firm hand on top of them in the cot or basinet and rock or tap them gently, continuing to use soothing sounds. They will learn that this is a safe place, and that Mum and Dad are still here for them, but it can take time. It will seem frustrating that they settle so easily on your chest or in your arms, but it makes sense when we know that this ticks all the boxes of what they know to feel safe and comfortable.
They’re not being naughty when they want to be held – they’re adjusting. You’re not spoiling them by providing what they need. In the newborn period you’re not creating bad habits by allowing them, and therefore you, to transition slowly to life as and with a newborn. You’re not failing as a parent when you can’t work out how to settle them some days, you’re learning to understand their cues; and you’re certainly not selfish for wanting nothing more then some well deserved rest. Despite feeling as though you aren’t doing anything right, have faith in the fact that you are actually the most expert person in what is right for you and your baby, according to your very specific situation.
It is true that you may receive overwhelming amounts of differing, and sometimes conflicting, information from varying health professionals, family and friends – this can seem frustrating, but take parts from each, arm yourself with multiple strategies to allow you and your baby to get in sync, gain confidence, ask for whelp when you need it, and work out what works best for you. Most importantly, be aware that this truly is like a fourth trimester, there are still so many changes and developments your baby needs to go through, and just like carrying them safely in a perfect environment on the inside, you are the perfect person to help them transition through the adjustment to the outside.
Kindred Midwives are available to visit you at home as often as you need for up to 6 weeks after the birth, even if you haven’t had your pregnancy care with us. These are great opportunities to support you and your family during this transition period. Midwives can help with feeding, settling, explaining and assessing normal newborn behaviours, as well as supporting your well being and seeking resources and referral to specific services that may be beneficial to you.
Possums clinic for mothers and baby’s at Highgate Hill is specially designed to assist with the transition to parenting a newborn. Their multidisciplinary team offers both face to face and Skype consultations. The principle clinician of Possums, Dr Pamela Douglas has also recently published her second book – The Discontented Little Baby Book, which explains further the adjustment period of the first 16 weeks of life and provides parents with strategies with transition effectively with their baby. www.possumsonline.com
Your local child health clinic has free drop in clinics on specified days, as well as one on one appointments with either a child health nurse or lactation consultant as needed. Visit www.qld.gov.au/health/children/babies/clinics to find out more.
Pregnancy, Birth and Baby is a government initiative with a very comprehensive and evidence based website, and 24-hour number for support and advice www.pregnancybirthbaby.org.au 1800 882 436
The Australian breastfeeding association also has a very informative website with easy to access articles relevant to common concerns with both mother and baby’s in the newborn period, as well as a 24-hour contact number for feeding concerns. www.breastfeeding.asn.au 1800 686 286 This is also where you will find a list of private lactation consultants for in-home visits.
Pregnancy Counseling Link is a free government funded service based in Brisbane providing support and assistance to parents and support people at any time throughout pregnancy or the postnatal period, and on-going parenting and development through to school age. www.pcl.org.au 1800 777 690
Beyond Blue provides both counseling and resources specific to pregnant women, new mothers, and new fathers. www.beyondblue.org.au 1300 224 636.
Please don’t hesitate to ask for help or chat to someone when you need to. Try and cherish the newborn period as much as you can, prioritising your well-being as well as your baby’s, and be reassured that nobody could be doing a better job for your baby than you.
