The Fourth Trimester of pregnancy and how to embrace it

You’ve put the finishing touches on the nursery, lined the Moses basket with a butter-soft blanket and have a ready stash of nappies, wipes and onesies all washed and ready to go. Try as we may, we can never fully prepare for those topsy-turvy first few months of life with a newborn.

Indeed, when you’re finally cradling your new bundle, you may find your vision of new-mum bliss needs a little adjustment. Wrangling with a Velcro baby who’ll only sleep in your arms, evenings characterised by two solid hours of high-pitched wailing from a colicky tot, and wearing pyjamas around the clock as night blends into day paint a familiar early picture of motherhood. Any honest woman who has been there and done that will assure you that, despite the rush of love you feel for your baby, those first few months are anything but easy breezy. In fact, it can be the most overwhelming time of your life as your little one adapts to life on the outside.

Known as the ‘fourth trimester’, those first three months are essentially an extension of life in the womb. There’s even a theory that human babies are born prematurely, development-wise, as otherwise they’d be too big to birth. Our maternity experience certainly pales in comparison to camels that carry for up to 14 months, manatees that are preggers for 13 months and giraffes that have gestation periods anywhere from 400 to 460 days.

“Humans have evolved to have such large brains and small, tilted pelvises that enable us to walk upright. As a result, we must deliver our babies quite prematurely so that the head of the baby can still fit through the pelvis,” says Amy Vogelaar, lactation consultant and parenting educator, Love Parenting UAE (www.loveparentinguae.com). “Furthermore, newborn humans have brains that are about 25 per cent of the size and capacity that they will be later in life. As their brains are so immature, they are essentially still fetuses on the outside, compared to a newborn cow or a horse, which can already stand and walk, for instance.”

All this goes some way to explaining these baby animal’s instinctive behaviour.

“During the first three to four months, our human babies operate mostly on primitive brain functions – reflexes and instincts – designed to help them survive,” says Amy. “They are learning and developing during that time, just as they did

in the womb, but they mostly require constant physical and emotional contact with their mother, father and other family members who are assisting the mother.”

Read more: ‘Mum Mentality: 5 Newborn firsts to wrap your head around’

Understanding your new world

What can be a real shock for parents is just how time consuming it is to take care of a newborn.

“We often put very high standards on newborns, expecting them to eat and sleep how we would like and forget that they need time to make the transition to their new surroundings,” says Hazel Leonard, lead midwife at Babies and Beyond.

Even for those who are welcoming their second, third or fourth child, it’s easy to forget the huge impact such a tiny tot can make.

“So many mothers picture their new baby sleeping happily in his or her bassinet between three-hourly feeds, but many are really only content in mums arms and often only on the breast,” says Amy. “Human babies have not evolved to sleep separately from their mother at this age. If our ancestors had put their babies in a cradle in a separate cave they would have been eaten or frozen to death. New babies expect to be on their mother’s body and preferably with the breast in or near their mouth at all times. This is their habitat and their normal and is not a sign that they are spoiled or have bad habits. It’s simply how we have survived as a species.”

The other challenging aspect of caring for a new baby is how unsettled they can be by anything from wind to having a nappy changed, taking a bath, being dressed and riding in the car seat. Their grizzly reaction can all feel a million times worse when you’re completely sleep deprived.

“It’s all so new to them – they didn’t have to deal with any of this in the womb and many can become quite irritated or irate with it all,” says

Amy. “After about three to four months they are much better at taking all this in stride although, of course, at that stage other things become a greater issue for them.”

All this is on top of the major physical changes mums endure alongside – many of which can come as quite the surprise.

“Immediately following the birth, the uterus begins a process called involution where it shrinks to its normal size. This causes a bloody discharge known as lochia, which tends to be bright red for the first few days and generally tapers off to a paler colour over the course of two to six weeks,” says maternity expert Lily Kandalaft, CEO of Malaak Mama & Baby Care (www.malaak.me).

Your breasts may start to feel engorged around the third day post-delivery, when they fill up with milk and fluid.

“The best way to find relief from this is to feed the baby frequently and pump out any excess,” says Lily. “You may have a few tiger stripes – stretch marks – post-delivery but don’t panic as with a bit of exercise and eating well, you should get rid of them in time,” she adds.

Hair fall and pimples are also common, as pregnancy hormones flee your body. Yet another eyebrow-raising after-effect is stress incontinence, so if you’re leaking a little when you sneeze, be sure to practise your Kegel exercises. Last, but by no means least – something hardly anyone is brave enough to warn you about – pooping can be difficult, especially for those who’ve had a C-section.

“To help get things moving, stay hydrated, eat high-fibre foods such as fruits and vegetables, and take the stool softener they give you in the hospital,” says Lily. “Hang in there – it’s not easy, but you will make it through the fourth trimester.”

Read more: ‘New mum survival: How to get through those first few weeks with a new baby’

Practical ways to survive and thrive

To navigate this intense period of change, it helps to get your ducks in a row. Even though few companies offer paternity leave in the UAE, it is important your partner takes some holiday, if possible, to be there to support you and bond with the new baby.

If your budget allows, consider hiring some help with cooking and cleaning, too, so you don’t have to worry about dirty dishes stacking up. Plan ahead by filling your freezer with small portions of pre-cooked meals so you can keep yourselves fed without too much shopping and cooking. Once the practicals are taken care of, it’s on to the job at hand.

“Providing a constant, warm, safe environment will benefit your baby enormously,” says Hazel. “Holding your baby, providing an intimate sleep space that’s as cocoon-like as possible and playing white noise are all wonderful and practical soothing techniques. Motion is also extremely important and the use of a swing, baby-wearing or rocking of the baby all help mimic the environment of the womb.”

A skill all new parents should master is the art of swaddling. “We swaddled our son George and kept him surrounded with a rolled-up blanket,” says Joanne Hanson-Halliwell, founder of Small and Mighty Babies (www.smallandmightybabies.com), a support group for families of premature babies.“We tried to emulate the positions and surroundings from his incubator in NICU and felt that being surrounded made him more settled and perhaps he felt safe and secure. A baby surrounded by love, comfort, food and rest is always content, regardless of whether they were premature or not.”

If you’re struggling to figure out why your baby seems aggravated, it’s time to take a closer look.

“Parents should try to be led by the baby’s cues that they are overtired or over stimulated,” says Hazel. “Cues such as gaze aversion – where a baby turns away from an interaction – irritability, or arching of the back all indicate that your baby is reaching sensory overload. As a result, it will be much harder to put your baby to sleep. Babies’ sleep cycles are determined by their wake times, so it is essential that they start their sleep time while they are still happily awake to avoid overstimulation and overtiredness.”

Although, that’s not to say your newborn is not capable of interacting socially and emotionally.

“Babies arrive in the world ready to socially engage and interact and, in fact, actively seek sensory stimulation and form hypotheses about what is occurring in their own world around them,” says Hazel. “Stimulating your baby’s brain through emotional activities such as talking, soothing, singing and touch will enhance the neuronal connections that your baby needs in order to process the sensory information provided. Your baby will also participate in this interaction, which will help to create a solid attachment bond.”

Sharing a loving gaze causes endorphin levels to rise and completes a closed emotional circuit.

“This creates a truly dynamic interactive system and allows the baby to learn how to be with mother and father, resulting in emotional synchronisation,”explains Hazel. “In turn, parents need to be aware of signs that their baby needs to disengage and recover quietly.”

If your non-stop role is turning you into a mombie, make sure you seize every opportunity to catch a bit more shut-eye.

“Sleep when the baby sleeps – nobody does it, but it’s really the only way to survive and thrive,” says Amy. “I found that if I planned to be in bed with my baby for 12 hours at night then even with two-hourly breastfeeds I got a decent amount of sleep. Co-sleeping or bed-sharing safely can mean that you get a lot more sleep than if you are up and down all night feeding the baby.”

And on that note, when it comes to feeding, don’t be afraid to ditch the rulebook.

“Breastfeed on demand or when baby shows any cues of hunger or a need for the breast,” says Amy. “Newborns feel best when they can smell Mum and hear her heartbeat, although Dad makes a good temporary substitute. Just remember, this high-need stage passes quickly, although it feels like it will last forever. Don’t feel guilty or stressed about holding your baby and meeting that need for constant physical contact – it’s normal and it’s the best thing to help them grow and develop well. Before you know it they will be older and less dependent on you and you won’t regret any of the time you spent cuddling that tiny little baby.”

Read more: ’10 things to know about Week One’

Help, I’m doing it wrong!

If you’re finding it difficult, you’re not failing – you’re totally normal!

“Give yourself time to adjust to parenthood,” says Amy. “Studies show that it takes four to six months before new mothers really feel like they know what they are doing and their new normal seems normal. Dads can find it takes even longer. Also, keep in mind that the only constant when it comes to babies is change – whatever your baby is doing this week, it’ll be different next week. Just when you feel you can’t go on, the problem seems to resolve itself. Equally, just when you feel you’ve figure it all out and have become the expert, then baby will change and you will need to figure out the next thing.”

One of the hardest things to get to grips with is the continual sleep deprivation, but if you can let go of expectations, it’ll help to take the stress out of the situation.

“People asking whether your baby is a good sleeper and if they sleep through the night puts a lot of pressure on new mamas,” says Lily. “Follow your baby’s cues and try to implement a general routine that will help guide your day. All babies sleep for longer stretches eventually and if you let go of the expectation that your baby should sleep for eight hours straight by two or three months old, it’ll be a little easier to handle those night wakings.”

Remember that every baby is different and it will take some time to find your groove.

“Think about routines instead of schedules,” says Lily. “Babies are pretty good at falling into a routine and there are simple things we can do to help that along. Encourage your baby to eat her full meals during the day. Make daytime feeds social and lively but keep nighttime feeds calm and quiet to help her distinguish between day and night. Babies usually respond well to a bedtime routine so try to set a consistent one such as bath, massage, getting dressed and then a relaxing bed-time story or lullaby.”

Read more: ‘Newborn 101: Practical advice for new parents from a Dubai midwife’

Getting support

If you’re really struggling, there’s absolutely no shame in asking for help. In fact, it should be encouraged.

“Don’t try to do everything yourself,” says Amy. “New mothers who don’t have support and help from Dad or other family members can be at very high risk of postnatal depression. We didn’t evolve to raise our babies alone in a flat or villa in Dubai – we would have been surrounded by family members with knowledge and experience about babies who would help us by feeding and caring for mum and supporting mum to care for her highly dependent baby. Dads here don’t get enough (or any) time off to be with their new baby, which is very hard for the whole family. Again, the biggest surprise for most new couples is how labour- and time-intensive newborn care is. It really does take at least two adults working full-time around the clock to meet all those needs.

“Facing it as a team seems to work well for many couples – mum breastfeeds and then dad burps the baby or bounces the baby on a birth ball while mum gets a shower or a meal in. Lots of new mothers feel like they should be able to do it all themselves and feel guilty or inadequate if they need to ask for help. But it is not physically possible to do it all yourself and you will only be able to keep that kind of effort up for a limited time. If you don’t let someone help and if you don’t care for yourself, then the whole system breaks down and eventually your baby will suffer.”

If your partner works a lot and you don’t have any family nearby there are plenty of experts on hand to come to the rescue so factor this into your post-baby budget.

“Don’t be afraid to seek professional help once you are at home with the baby,” adds Hazel. “Unfortunately this is not provided by most hospitals, meaning you will have to seek support yourself, however there are some fantastic home-health-care facilities and clinics that can provide midwives, health visitors and maternity nurses to assist you with caring for your newborn.”

It can help immensely to join a mother and baby class or coffee morning so you can meet other women navigating the same stage. Sharing stories can make all the difference to how you feel.

“There is no one right way to raise a baby, so if a book or an expert is making you feel more stressed about parenting, then it is probably not the right route for you,” says Amy. “The secret reality about parenting is that it is mostly a trial-and-error process to figure out what works for your baby and your family. We all have to muddle through, especially in the beginning, to find our own path. Trust your instincts and your heart and evaluate all the advice that you will receive to see if it makes sense to you. We tend to think that everyone else has it figured out already, or that our baby wouldn’t cry at all if only we knew how to do it ‘right’. But, of course, all babies cry and nobody has it all figured out.”

Be mindful, too, that as new parents you will be offered a lot of advice and opinions, which may not always be helpful.

“Try to surround yourself with positive people and remember that parenting may not be complicated, but it is also initially not intuitive, so be kind to yourselves,” says Hazel. “Also, don’t always trust what you read on the internet. When you are sleep-deprived, your absorption of information is less accurate and less helpful, and this may only add to the feelings of isolation and confusion in those early weeks.”

Ultimately, no matter how at sea you feel, hold on to the notion that this is one of the most special and short-lived phases of parenthood.

“The fourth trimester is a time of profound growth and change both in the baby and the mother and it really should be a magical and even sacred time,” says Amy. “There will be tears – baby’s and yours – and there will be exhaustion and shock and anxiety as well, but try to enjoy and savour this period of your life as it will be gone before you know it and you will look back on photos in absolute wonder that your baby was ever that small and needy.”

As Joanne perfectly summarises: “There is so much pressure on mums these days to bounce back to ‘normal’. I wish I could turn back and have listened to my own advice, but I really think staying home and resting with your family and friends is so important. Malls, breakfast dates, park dates, play dates… these things can all wait. Instead, have a hot shower, tie your hair back and relax. You will have a toddler on your hands before you blink.”

Read more: ‘Dubai Mum: “That first rush of love? It didn’t happen for me”‘

The baby blues or PND?

Postnatal depression (PND) will most commonly present during the fourth trimester although, on occasion, it can be identified much later, according to Andrea Guy, pre- and post-natal doula and founder of Out Of The Blues (www.outoftheblues.support), a support group for women affected by postnatal depression.

“Some women develop depression during pregnancy and the symptoms become more intense and overwhelming following birth,” she explains. “Child birth is a time of significant physiological and emotional change. Postnatal baby blues are commonly experienced by 80 per cent of mothers between the third and 10th day after the baby is born, and only last for several days. This is not the same as PND, where symptoms are more intense, severe and persist for a much longer duration.”

Key signs and symptoms of PND may include

• Feeling sad and low • Tearful for no apparent reason • Exhausted • Unable to cope • Irritable and angry • Guilty • Hostile or indifferent to your partner or baby • Anxious and fearful

You may also find that you have

Loss of concentration

Little to no libido

A lack of appetite

A persistent feeling of low mood and being unhappy

Extreme lethargy and tiredness

Severe disruption to the sleep – this happens to all new mums but this describes an inability to sleep even when you have the opportunity to do so

Impaired concentration and attention

Irritability and anger

An inability to derive pleasure from or enjoy anything

Loss of confidence

Negative thinking patterns

Feelings of guilt

Anxiety that there is something wrong with either you or your baby

Feelings of hopelessness and worthlessness

Thoughts about death or that your family would be better off without you

“If you feel you may be suffering from PND, firstly, talk to your husband, family, friends and those around you who can offer you help, support and reassurance,” says Andrea. “Try to ensure you are able to get as much rest as you can. Don’t worry about the housework – there will be plenty of time for that and this is a time for looking after yourself. Plus, make sure you are eating a healthy, balanced diet with plenty of water.”

If feelings persist, contact Out of the Blues for support and discuss how you are feeling with a trusted health care provider, counsellor or psychologist.

“If you are struggling to find a supportive and understanding care provider we’ll be happy to point you in the right direction,” says Andrea.

Read more: ‘Postnatal depression in the UAE: What you need to know and how to seek help’

Boost your breastfeeding know-how

While breastfeeding may be the natural choice, it rarely comes easy to new mums, which can be frustrating – not to mention surprisingly painful at first. It’s recommended that all breastfed babies should be seen by a breastfeeding expert around three to five days after you have left the hospital and again around two weeks later to make sure feeding is going well, baby is getting enough and there are no problems like jaundice that need to be dealt with. Love Parenting UAE’s Amy Vogelaar has the following advice:

1 There are no health visitors here who will automatically come out and visit you unless you set it up and arrange for it. Thankfully, Babies and Beyond, Healthbay Polyclinic and Cooper Health Clinic all offer home visits after the birth and some health insurance plans may even cover these services.

2 Make the most of all the fantastic online resources available, such as Breastfeeding Q&A UAE and our Love Parenting UAE support groups on Facebook.

3 Once you feel ready to get out of the house with baby, join a free coffee morning like the Baby Café run by Cooper Health Clinic or JustKidding’s Breastfeeding Support Group. These are free and facilitated by a midwife or lactation consultant so you can get medical advice as well as social support from other mums.

4 Take a baby massage class or mummy-and-baby yoga class. Here you receive not only information, skills and advice, but also the opportunity to really get to know other new mums. For many of us, the friends we make in these classes during the fourth trimester are the closest friends of our adult lives. Bonding over breastfeeding and baby poop when our oxytocin levels are high and our hearts are open can make for very powerful life-long friendships.

Feeding targets – a guide

Making sure your baby is well fed is a common concern among new mums at this time, but swotting up on the average intake will help put your mind at ease.

“Each baby has different feeding requirements,” says maternity expert Lily Kandalaft, CEO of Malaak Mama & Baby Care (www.malaak.me). “As the days go by, your baby will need little, but increasing, amounts of milk. Breastfed babies don’t need large amounts of milk at each feed. Those who are formula-fed may take larger amounts, as they can’t control their milk intake in the way that breastfed babies can.”

To tell if your baby is feeding well, follow these tips:

You feel your breasts soften during feeds

Your baby has a wet nappy every few hours

You can hear your baby swallowing softly

Your baby comes off your breast on his own

Your baby seems settled after a feed

Your baby’s poops are yellowish in colour

For formula-fed babies, below are some approximate feeding targets according to age:

First day: 5-7ml per feed

Second day: 12-14ml per feed

Third day: 35-38ml per feed

Fourth day: 55-58ml per feed

One week: 65ml per feed

One to four weeks: 90-120ml per feed

Four to eight weeks: 90-150ml per feed

Eight to 12 weeks: 120-180ml per feed

“Remember, babies may lose a little weight after they are born, which is perfectly normal,” says Lily. “They will start to put on weight again by the time they are five days old. Check your baby’s weight every so often to ensure that he or she is gaining weight adequately for their age.”

Sleep/wake routines

The 24-hour clock of a newborn is, quite frankly, all over the place and the sooner we make peace with the fact that they don’t know night from day, the easier it’ll be to relax and go with the flow. Malaak maternity expert Lily Kandalaft outlines a typical routine for a one-month-old:

7am: awake and feeding

9-10am: nap time

10:30am: awake and feeding

11:30/noon-2-2:30pm: nap time

2/2:30pm: awake and feeding

4:15-5pm: nap time (45 mins)

5pm: awake and feeding

6pm: bedtime routine and feeding

7pm-10pm: sleep time

10/10:30pm-11pm: awake and feeding (dream feed)

11pm-4am: sleep time

4-5am: feeding

5-7am: sleep time

Your baby will transition to a slightly more chilled schedule by around the third month.

“Some babies take longer than others to get into a routine but below is a general guideline for those who are three months old,” says Lily. “Essentially, it shows how babies around this age will slowly transition from feeding every two-and-a-half to three hours to stretches of four hours:”

7am: awake and feeding

9-9:45am: nap time

11am: awake and feeding

Noon-2/2:15pm: nap time

2:15-2:30pm: awake and feeding

6pm: awake and feeding

6/6:15pm: bedtime routine and feeding

7-10/10:30pm: sleep time

10/10:30-11pm: feeding (if awake, or dream feed)

11pm-7am: sleep time

Learn the art of swaddling

Being able to swaddle can be a game-changer when it comes to comforting baby in those early weeks.

“When your baby is swaddled, it’s the same feeling as being in the womb, when everything was comfortable, safe and snug,” says Miranda Hilton, CEO of Family Souk Ventures, which distributes aden + anais in the Middle East. “Swaddled babies sleep longer and sounder and experience less anxiety. Plus, it prevents unnecessary wake-ups due to the startle reflex. It eliminates the need for comfort items in baby’s crib, prevents face scratching and mimics touch, which is important for baby, especially when they wake up at night. It also helps maintain the back sleeping position and also reminds tired parents to place the baby on her back to sleep. Swaddling in the hands-over-heart position is the preferred sleeping position for babies as, in this position, they learn to self-soothe and can get back to sleep on their own.”

Follow this step-by-step guide…

Step 1. Fold the swaddle into a triangle and place baby in the centre with shoulders just below the fold.

Step 2. Place baby’s right arm alongside the body, slightly bent. Take the same side of the swaddle and pull it securely across baby’s arm and chest, tucking the fabric under the baby. Leave the left arm free.

Step 3. Fold the bottom of the swaddle up and over baby’s feet. Tuck the point of the fabric into the top of the swaddle.

Step 4. Place baby’s left arm alongside the body, slightly bent. Take the remaining swaddle, and wrap it over baby’s arm and chest, tucking the fabric under baby to secure the swaddle.