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From womb to world - the fourth trimester

Updated: Feb 5


I’m not sure about anyone else, but I sure did seem to get taught a lot of information to prepare me for the birth of my first baby, but in retrospect, none of it really prepared me for what life would look like when I came home from hospital and was plunged into what is known as ‘the fourth trimester’ - the first 12 weeks after birth.


Empowering parents in whatever way they need during this time of transition, is something I love doing as part of my work as a sleep consultant working one to one with families. I definitely cannot do justice to everything that happens during this time in just one blog, but I’ve tried to put together a little guide to exactly what the fourth trimester is and what you can expect from you and your baby, so hopefully no one feels unprepared, or anxious during this period.


The transition from womb to world


If you carried your baby to term, they’ve just spent 9 months in your womb safe and secure, soothed by the sound of your heartbeat and movement, constant muffled sound around them, naked (but at an optimum temperature), with nourishment on tap, sleeping when they want to.


As soon as they’re thrust into the big wide world, all these familiar things are suddenly taken away from them - so it’s no wonder they can get a little bit upset sometimes!


Think about it. Your baby is now moving around in a space much, much bigger than they’ve been used to, they now have to signal to you when they’re hungry (the only way they know how), they’re clothed and may either be too hot or too cold and have to signal that to you (the only way they know how,) if (in non Covid times) lots of visitors want to hold them, they’re not close to you and your familiar heartbeat and sounds - the list goes on.


Put in this context, it makes total sense that to get through the fourth trimester for both you and baby, the biggest priority has to be on closeness and bonding - making the transition from womb to world as pain-free as possible.


Lots of skin-to-skin time really helps with this transition. I think a lovely thing to do for both of you is co-bathing. The water is nice and relaxing and soothing for both of you and if your baby does need a little rinse after birth, they’re likely to be much calmer bathing in your arms.


You CANNOT spoil your baby with too many cuddles


Whatever you think you’ve heard or read, you cannot cuddle or be close to your baby too much in those beginning weeks as they adjust to the world. It is your touch and closeness alone that has the ability to calm and regulate them. If they cry every time you try and put them down, this is COMPLETELY normal as they want to be close to you.


So, just to be PERFECTLY clear. You’re not ‘making a rod for your own back’ by:

  • Holding your baby too much.

  • Letting your baby sleep on you (during the day safely, when someone can keep an eye on you).

  • Feeding your baby to sleep.

These are all TOTALLY normal and what your baby expects and are the easiest way to help you both through this period of adjustment.


I understand you may have been made to believe your baby will NEVER sleep in the cot (if that’s what you want) if you hold them too much now, but that is simply not true. It is only by feeling safe and attached that a baby will eventually feel secure enough to snooze in their own sleep space.


Based on this, it makes more sense to concentrate on attachment and security in these early weeks as the building blocks to future independent sleep.


I understand we can all get to a stage where we feel a bit touched out, or as though we need to get on with something else when we’re ‘trapped’ with a baby sleeping on us. Given their need for closeness, I find slings in the fourth trimester during the day a total lifesaver. They give your baby the closeness they crave while leaving you with your hands free to get on with other jobs (if that’s what you want to do).


Just make sure you follow the TICKS rules for safe babywearing:


Tight.

In view at all times.

Close enough to kiss.

Keep chin off the chest.

Supported back.


And you're good to go!


Layering sleep associations


If you’re genuinely concerned your little one will become too reliant on one cue to get to sleep and this concerns you enough to keep you up at night, you can always introduce some habit stacking. You’ll probably find that you're instinctively doing it anyway.


Instead of just feeding your baby to sleep for example, you can shush and rock or pat them too at the same time, so they’re used to some other sleep associations. If and when in the future you want to get rid of say feeding to sleep, this will hopefully be much easier when you have some other sleep associations your little one is used to that you can slowly peel away.


Feeding in the fourth trimester


As we all know, as well as sleep, feeding totally dominates a newborn's time. If they’re not sleeping, they’re probably awake and hungry for a feed. Your baby's tummy is super tiny, so they will wake frequently for feeds - day and night. The great news is, this is a perfect time for bonding and attachment, which as I just explained above, is of huge importance and should be the number one priority in the fourth trimester.


So if you’re struggling with the amount of feeding, trying to reframe it as this time of bonding, I think can help some people. Really engage in eye contact when you’re feeding your little one (if their eyes are open!), to help with this bonding. If you’re bottle feeding, limit the amount of people the baby is passed around to for feeds so they can really engage with you.


I know the feeding can feel utterly relentless during the fourth trimester and that lots of people have feeding difficulties. If you are struggling, I would urge you to seek some help from an IBCLC lactation consultant.


I know this bonding doesn't always feel natural or instantaneous for everyone - that's also totally normal, just make sure you're speaking to someone or seeking help if you're feeling this way. I haven't covered postnatal depression in this blog (as I said at the start, the limits of what I could write about in these first 12 weeks are pretty boundless), but please do reach out to your health care visitor or normal doctor if you need some help.


TOP TIP: Before you settle down to feed, make sure you go to the toilet and have something comfy on to wear. Create a little feeding basket next to the chair you’re going to feed in which has easy access to water and snacks, your phone and a charger and the remote control if you’re planning to watch some TV. If they do settle down to a contact nap after the feed, at least you'll be prepared!


How much can I expect my baby to sleep?


Babies actually sleep a lot in those early months, but because they have no circadian rhythmicity (the body’s biological clock), their sleep/wake pattern is very erratic - which means often they’re not sleeping when you would naturally be wanting to - hence the feelings of sleep deprivation!


They also don’t produce their own sleepy hormone - melatonin (although human breast milk does contain tryptophan – the precursor to melatonin) predictably until about 3 months, or have a predictable, consolidated or reliable napping pattern - making everything seem a bit all over the place, to say the least.


Short sleep as a protective mechanism


I sometimes think it can be easier to deal with the often erratic short bouts of sleep a newborn can have - especially over night - when we understand the protective nature of this sleeping pattern.


Bear with me while I go a little bit sciency on you, it will be worth it!


You see, newborns have a short sleep cycle of only about 30-40 minutes and most of that time is spent in REM sleep (active sleep) - the preference for which seems to be for brain development.


We know that the blood flow to the brain almost doubles during REM sleep, with almost all of the blood flow being directed to the part of the brain that controls automatic breathing. This shorter, lighter sleep cycle probably protects infants from SIDS.


When we know the protective nature of WHY our newborns are waking frequently, it makes it a little bit easier to rationalise when we’re seriously tired.


Helping your baby know night from day


So your little one's circadian rhythm won’t mature until around 4 months - which is often linked to the four month sleep regression (I have a blog on that if you need to read up on it), but there are things you can do before then to help them along the way.


It’s all about broad spectrum daylight people. Make sure you’re getting your little one outside in the light as much as possible and keeping it light and bright in the house when you’re indoors.


Having normal activity levels during the day with normal amounts of noise and light is important. Think about it, they were used to that level of noise in the womb in the day and if you shut them off from light and noise during the day, how will they see any difference to what you’re trying to achieve at night? Night in contrast should be a 12 hour stretch of quiet, reduced stimulation in the dark.

Other things to try and include:

  • Have a predictable and brief pre-sleep routine i.e. the same song, a sleep phrase, or a lullaby.

  • Try white noise.

  • Use a sling (as explained above).

  • Try swaddling (more info on this below).

  • Try shushing and patting (layering those cues as explained above).

  • Warm the baby’s bed before placing them down for sleep (I LOVE a hot water bottle for this trick and think it works a dream).

  • Sleep with a muslin, then place this in your baby’s sleep space to reassure them.

  • Try massage with a non fragranced, cold pressed extra virgin coconut oil.

  • Consider the use of a side-car/co-sleeper crib.

  • Avoid ‘blue light’ (from screens).

After the first 4 weeks


The transition in those first few weeks are INTENSE, but after the first four weeks with your newborn hopefully you’ll have established feeding (if you are still struggling then please consider reaching out for some feeding support from a lactation consultant). Your baby will still be waking a lot in the night for feeds, this is still totally normal and not something to worry about.


Unfortunately, it is also in this time that colic and reflux may occur, which can of course interfere with sleep. I will do a separate blog all about this in the future. But in the meantime, please do get in touch if you need some help with this.


Other things you may notice:

  • Your baby may be more wakeful in between feeds, and begin to want to interact with you more.

  • They MAY develop a predictable napping rhythm – usually of 4 naps per day (you can read more about naps in my blog).

  • The awake interval may be slightly longer than in the newborn period.

  • Their bedtime may begin to move earlier.

At this age, you can begin to introduce a familiar nap and bedtime routine – keeping it very short, calm and predictable. It will naturally elongate as your little one gets older and can tolerate being awake for longer - it is consistency that is key.


You may have to try a few things and see what your baby likes. For example, some little ones just really don’t get on well with a bath, instead you can always have a bath earlier in the day and include something calming like some baby massage instead.


Try including 2-3 of the following:

  • Bath

  • Massage

  • Lullaby

  • Feed

  • Sleeping bag

  • Cuddle/rock

I speak a lot to my clients and on my social media about following your baby’s individual cues. So in these times of wakefulness instead of trying to stick to a strict routine you’ve downloaded that has convinced you will give you all more sleep - invest the time to pick up on your little ones individual sleepy cues and carve out your own routine.


A bit more on swaddling


I’m pretty pragmatic about swaddling. I never even considered it with my first baby as he seemed ok with what we were doing. But I noticed very early on with my second that her startle reflex was quite strong and caused her what seemed like multiple unnecessary wake ups. I gave it a try and found it really helpful.


So, if you want to swaddle, just make sure:

  • Not to swaddle too tight.

  • A thin muslin cloth is perfectly adequate.

  • Don’t swaddle for co-sleeping.

  • Make sure they don’t get too hot.

  • Never swaddle the head.

  • Wrap loosely round the hips, never tightly.

  • Give plenty of opportunity to roll around on the floor unrestricted, so your little one can learn how. to control and organise their reflexes and voluntary movements.

Here comes the important bit:


Once your baby can roll - do not swaddle them.


That’s because there’s a risk they could become stuck on their fronts and not be able to roll back.


It’s advisable to start to loosen the swaddle to gradually wean your baby off by about 12 weeks. Now I know this can be difficult, so there are some things you can do to wean off slowly:

  • You could make the swaddle a little bit looser over a few nights until you get rid of it completely.

  • You could go for the one arm trick, release one and see how they tolerate that and then the other.

  • Replicate the pressure of swaddling by gently holding your little ones hands on their chest and slowly releasing so they don’t startle as easily.

A little bit more on safe sleep


I’m sure you’ve all read up on safe sleep and know the basics. But I can’t write about the fourth trimester and not cover it. So, always make sure your baby is placed to sleep on their back at the foot of the cot or moses basket - a proven position to reduce the risk of SIDS since it was introduced as part of the ‘back to sleep’ campaign in the early 1990s.


Make sure you’re not layering your little one with too many blankets which could cause them to overheat. It is because of this that some parents find baby sleeping bags super handy, as you get a guide on how many layers to put on the baby in relation to the tog of the bag and the temperature of the room.


The official guidelines are to have your baby in the same room as you for at least the first six months, but the AAP guidelines now suggest one year. You’ll find being closer to your little one for night feeds easier than having to go into another room anyway, so convenience wins here too.


TOP TIP: I know sleep pods have become super popular recently and lots of parents love them. Unfortunately, they're not recommended for safe sleep and are therefore best avoided.


A little bit more about co-sleeping


There’s been a lot of scaremongering about bed sharing in the past, but research has shown if the safe criteria below are met, there’s actually no difference in the rates of SIDS between babies who bed-share and babies who sleep in cots.


Most cases when babies die of SIDS, there is a known risk factor, such as pillows, smoking or the baby sleeping between the parents.


The reality is, a lot of parents may end up bed-sharing at some point for whatever reason, even if they didn’t plan to. So it's best to be aware of these guidelines even if you don’t plan to bed-share, just in case you end up doing it.


La Leche League explains the ‘safe sleep seven’ for co-sleeping:

  1. No smoking

  2. Sober parents

  3. Breastfeeding mother

  4. Healthy full term baby

  5. Sleeping on the back

  6. Don’t overheat

  7. Safe, firm sleeping surface

The breastfeeding is important here. Research shows that a breastfeeding mother forms a more protective C shape around the baby in the bed and whether it is lighter sleep or hormone related, seems to respond more to the baby. Co-sleeping is a big topic, I’ll cobble a blog together on it, but please do get in touch in the meantime if you would like any guidance on this.


And last but not least...can I drink coffee?


Saving the most important question for last! If you’re breastfeeding, you may be worried whether or not you can still drink coffee. Well, the good news is, there’s no reason not to continue - just like with anything, make sure you’re not drinking it to excess.


Now everyone’s definition of excess will be different I know, but if it’s making you wakeful and jittery, then it’s probably too much. If in doubt, just monitor your baby for signs of excessive alertness and reduce if required.


If you would like to take advantage of my Parenting Support and Sleep Education package, then please do check out my sleep support packages, or hop on your free 15 minute introductory call. Or in the meantime, head over to my Instagram page for all my latest free help and tips.

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