The 4th trimester: helping your baby adjust to life outside the womb.
We measure pregnancy over nine months divided into thirds: the first trimester is a secret time, when an embryo develops into a foetus hidden away from the outside world; in the second trimester news of the pregnancy is shared and celebrated and preparations begin; in the third trimester the focus moves to the impending birth and plans made for labour and delivery. We commemorate the arrival of the newborn as though the journey has ended. But for the newborn, an even bigger transition must now be made.
“Birth no more constitutes the beginning of the life of the individual than it does the end of gestation. Birth represents a complex and highly important series of functional changes which serve to prepare the newborn for the passage across the bridge between gestation within the womb and gestation continued out of the womb.” (Montagu, 1986, 57)
Adjusting to life outside the womb is probably the biggest change we experience in a lifetime, yet little thought is given to how that transition is made. What is often referred to medically as the postnatal period, has been better described as The Fourth Trimester by Harvey Karp, renowned paediatrician and author of “The Happiest Baby on the Block”.
The Fourth Trimester, roughly the first twelve weeks, is also described as exterogestation: literally Gestation Outside of the Womb. Compared to many other mammals, humans are born in a very immature state. While some herd animals need to stand and walk within hours after birth, human infants can barely support their own head! It is even suggested, in comparison to other mammals, that humans would need another twelve to eighteen months in the womb to reach neonatal maturity! But I doubt any of us would be up for a 27-month long pregnancy, let alone the prospect of birthing a toddler. And therein lies the problem.
Karp suggests that humans have evolved to birth at least three months prematurely, as the typical newborn skull and typical maternal pelvis are basically incompatible beyond 42 weeks. Leaving us with babies who are mature enough to survive outside the womb by breathing on their own but not independently capable of any other aspect of survival.
Human society has long understood the special needs of newborns and their mothers in the early weeks after birth: the 40 days has traditionally been a period where new mothers are secluded and nurtured by the women of their community, while others take on her domestic and familial responsibilities. But modern western lives have gradually worn away these traditions for most mothers.
Womb Service
Consider life in the weeks leading up to birth. Your baby never experiences hunger, cold, silence, stillness or isolation. They are held increasingly firmly by the strong muscles of the uterus. Their digestive system is still. They are rocked by the gentle movement of their mother, even as she sleeps. Her presence is constant, her heartbeat and other body sounds a rhythmic soundtrack. Light and sound are muted.
It is relatively simple to create a familiar environment for your baby. Pinky McKay, best-selling author of titles including Parenting By Heart and Sleeping Like a Baby, describes the newborn’s needs as “womb service”. The parents’ goal is to replicate those conditions to allow a gentle transition into life. She describes them as the five Ws:
Warmth
Wrapping
Wearing your baby
Water
Womb sounds
Do Try This at Home!
Skin-to-skin contact.
The first hours after birth are important for mothers and babies to connect, begin breastfeeding and get to know each other. Ideally this period is spent in uninterrupted skin contact. However, the benefits of skin contact are on-going, and it is never too late to begin. Hours, days – even weeks – after birth you will find placing your baby directly against your own or another family member’s chest is calming and reassuring. Parents, siblings and grandparents can all use this simple technique and even small amounts of contact can relax all involved.
Have a bath
After nine months floating in amniotic fluid, it is no wonder a bath can relax a new baby. You can share a bath with your baby or bath them alone but make sure you keep the water deep and warm. Ask your midwife or child health nurse how to hold your baby securely and help them float. Deep bathing is a technique which especially calms sensitive babies and sometimes they relax enough to fall asleep in the water!
Co-sleeping
The definition of “co-sleeping” is sharing a room with your baby.
“Bed sharing” is appropriate for some families while others will have a bassinet or cot alongside the adult bed. The safest place for your baby to sleep is in their own safe sleeping place, for all sleep night and day. Red Nose recommends sleeping baby in a cot next to the parents' bed for the first six to twelve months, as this has been shown to lower the risk of sudden infant death.
Studies have shown around 80% of parents will bring their baby into the adult bed at some stage in the first 6 months. Even if bed-sharing is not your plan, you need to know how to minimise risk and how to create a safe sleeping space for your baby.
Find the current guidelines for Sharing a Sleep Surface with a Baby at rednose.org.au or ask your midwife or child health nurse for guidance
Babywearing
One of the earliest human tools was a sling to carry a baby, likely made from animal skins. It has even been suggested that this invention around 2.2 million years ago contributed to the evolution of the human brain! For most modern parents, baby carriers are a useful tool to settle a baby while they get the shopping done or cook dinner. But for others, the ancient art of babywearing allows their infant an experience close to that of the womb.
The rhythmic movement for a baby held against your chest while you walk is familiar and can help an infant to relax and fall asleep. That continued movement will often allow uninterrupted transition from one sleep cycle (around 40 minutes) into the next. And babywearing allows adults to care for others or perform basic household tasks and self-care while baby sleeps.
Choosing a baby carrier from the available options can feel overwhelming. Local babywearing groups – community collectives of experienced parents sharing their knowledge, and private babywearing consultants offering a fee-based service are reliable sources of safe and comfortable baby carriers, slings, wraps and other babywearing designs. South Eastern Babywearing Group offers free support to parents on the Mornington Peninsula and Melbourne’s south east.
Breastfeeding
Breastfeeding is much more than a way to feed a baby. It offers a source of food, hydration, comfort, reassurance and sleep, creating a womb-like experience. You cannot over-feed a baby at the breast. They can keep coming back as often as they need. Even if you are not fully breastfeeding your baby, you can offer the breast whenever they seek it, confident you are meeting a need. Day and night, the breast reconnects your baby with the comfort of the womb.
If you are feeding your baby by bottle, a technique known as “bottle nursing” means you can give your baby an experience closer to breastfeeding by keeping them close, feeding skin to skin and practicing paced bottle feeding, allowing them to pause and feed comfortably. This is especially helpful for fathers, grandparents and siblings if giving an occasional feed of expressed breastmilk, donor milk or formula when mother and baby are separated. In these early days, most feeds should be given by the mother or other primary carer as feed times are an important bonding opportunity.
White noise
White noise is any constant, sound which masks sudden and unpredictable noises in a space. Many adults and children find listening to white noise helps them relax and fall asleep. Babies often find these sounds remind them of the constant sounds of their mother in the womb. Although you can invest in special machines which play white noise and womb sounds for your baby, there are free or cheap apps available to use on your phone which serve the same purpose! Or you can turn on a fan or other household appliance in the background while you sooth and settle your baby.
Gentle Swaddling
Swaddling is an old word for wrapping an infant in cloth. In many northern hemisphere societies, babies were traditionally tightly swaddled with multiple layers to keep them warm in fiercely cold climates. Some incorporated a cradleboard, a combination of swaddling, crib and baby carrier in one.
In warmer climates, light shawls or thin blankets were wrapped around babies to offer security and replicate the tight embrace of the womb. In some cultures, elaborate techniques were passed from mother to daughter and involved vast lengths of fabric.
In the modern western world, swaddling has come to be associated not only with blankets but also full body suits which replace traditional bedding. Most parents and health professionals now refer to this as “wrapping”
It is important to follow safety guidelines when wrapping a baby before sleep. You can find current advice at rednose.org.au. Tight wrapping of a baby’s legs and hips is not recommended as it has been associated with conditions like developmental dysplasia of the hip (DDH). Your midwife or child health nurse can show you safe and comfortable ways to wrap your baby for sleep or settling.
These early weeks of life will see the most rapid development of a child’s life. By three months, your baby looks and behaves in a more mature, coordinated manner. They interact with those around them and are engaged in their world. The baby in those photos from the first week is almost unrecognisable compared to this smiling, rounded little person. They have graduated from the fourth trimester and are ready for the next adventure.
