The Importance of Fourth Trimester Care with Dr. Aasta Mehta

Submitted to Blog

You have been pregnant for 40 weeks with steady doctor’s appointments leading up to your big day. Then you finally deliver! The joy, the excitement…the harsh reality of recovery. The physical, mental and emotional recovery women face after pregnancy is often not talked about and often not scheduled for care. Unlike your pregnancy visits, our postpartum doctor visits are few and far between (think one 6-week post delivery appointment) and most American women are left to heal on their own. Pregnancy care shouldn’t end after the delivery of the baby.

OB-GYN and Medical Officer of Women’s Health for the Philadelphia Department of Health, Dr. Aasta Mehta is a proponent of The Fourth Trimester: the period of about 12 weeks after a woman gives birth. While there is no magical number of weeks a woman takes to recover from delivery, Dr. Mehta emphatically says 12 weeks is not enough.

Dr. Mehta answered our questions about the importance of the fourth trimester on our All Things Conceivable: A Surrogacy Podcast with Nazca Fontes.

NF: What is the fourth trimester and why is it so important?

The fourth trimester refers to the first three months after birth. It is a time when there’s a lot of transition in both the mother’s personal life and of course, a newborn being in the world. We’re really talking about what it means to a woman who has recently given birth in that period of time, what happens to her body and how she’s trying to recover.

NF: What happens to a woman after birth?

Physically, you’ve either given birth vaginally or via C-section and you may be recovering from potential complications. Even if there were no complications, there is still some amount of pain management. Hormonally, there are many changes that are physiological. And then you have the impact of those physical and hormonal changes on your mental health. There may be sleep deprivation that enhances all of these things. And, if you are breastfeeding, that is a full-time job in and of itself. This time period can really take a toll on women and be difficult to navigate. It’s not even that every mother is different; every pregnancy is different. Your second pregnancy may be totally different than your first.

NF: Why is twelve weeks not enough recovery time?

We’ve come up with this 12 week time period that we think people will go back to being the same person they were before pregnancy. With more information and research, we know that’s not the case. It’s just not this magical 12 weeks where all of a sudden things are normal. It’s really dependent on the person as to how much time they need to recover from the childbirth and into a new normal.

NF: Is it possible to prioritize both the baby and the mother’s health?

Babies are dependent on their caregivers and the mom is generally a primary caregiver in our society. And so, if the mom isn’t doing great, how does one expect the baby to be doing great? The babies can’t go get the food themselves. They can’t change their own diaper. If the mom is really struggling with pain or postpartum depression, that’s not going to do the baby any favors. We really need to think about mom as important, if not even a little bit more important. The baby will be okay if the mom is okay, but not necessarily vice versa.

NF: It’s like putting your own oxygen mask on first before you can assist and help others.

Totally. I actually think about that when I’m on a plane and I’m like, yes! To me, this period of after childbirth is the same concept.

NF: Is there a way a woman can set the stage for a strong fourth trimester recovery?

You’re never going to be able to predict the hormonal imbalance and how that will impact your mental and physical health, but you should be as prepared as possible. Having a support network in place and having a postpartum plan, like who’s going to care for the baby at night, or during the day if you need a mental health break, is helpful. There are postpartum plans you can find on Google and work with your doctor to decide on a feasible plan for you and your family. A lactation expert, mental health professionals, and pelvic floor physical therapy are just a few who can offer great support. Postpartum doulas can also be a really great support after delivery.

NF: A very shocking statistic is one third of pregnancy related deaths occur after the first week through the first year after delivery. How can we make that better?

That statistic is the whole reason why I say 12 weeks is not enough. During pregnancy, you’re seeing your doctor regularly and weekly at the end. Oftentimes, people don’t see doctors regularly until they become pregnant, so there may be chronic medical conditions that come to light during pregnancy that we didn’t know about beforehand. During pregnancy, you are optimizing for the health of yourself and the baby to have a good pregnancy outcome. Care is not in place in that fourth trimester and beyond. You have your one visit maybe six weeks afterwards. And by that point, you’ve already recovered to a degree from your childbirth in terms of your C-section or vaginal birth. Maybe you’ve gone through the postpartum blues, which is a pretty normal thing. Then six weeks later, you’re seeing your doctor. So chronic issues you had been optimizing for, like diabetes and high blood pressure are unaddressed; you have your baby and then nothing. The system then picks up for the baby. You have your well baby visits within a week, but what about scheduled visits for the mom? It’s like, well, good luck. We need a better system.

NF: We’re talking a lot about moms and babies and that’s not the case with surrogacy. A surrogate goes into this wanting to help a family. When that wonderful day comes and she gives birth, the intended parents finally have the family that they’ve always wanted. Now, the surrogate has to start another journey into recovery. It’s an exceptional and special moment because she’s not bringing home a baby and having to care for another person. That oxygen mask can go right on her and her only.

Some of the stresses of that postpartum fourth trimester do have to do with caring for your child and the emotional impact of that. But certainly, the physiology also lends itself to the surrogate. The difference in emotions and depression is physiological, regardless of not having the child after birth. So that’s something to understand and not feel like, wait, but I don’t even have the baby, why am I depressed? That is a message that I want people to hear, because your hormones are completely changed after birth.

I think it is important to recognize that even though you were going into this birth experience knowing this was not your baby, that feeling of emptiness might still be there. Regardless of how prepared you are, that potentially could have an impact and having those supports in place to deal with those types of feelings would be important. These feelings are normal and a surrogate should not feel embarrassed if they feel that way.

For everyone, not just surrogates, complications can occur in that postpartum period that can lead to cardiovascular conditions like cardiomyopathy and embolism. Those things can mimic normal changes in the postpartum period. Being really in tune with your body and what you are feeling and knowing what’s normal and what’s not can make the difference. It’s also helpful to have people around you looking out for you as well. I imagine in surrogacy, your family’s not helping as much, because you don’t need help with a baby. But I think having those loved ones looking out for specific medical complications that could occur, can help.

NF: What do you want people to take away about the Fourth Trimester?

Society has sort of put these constructs in place that make it feel like, you know, as a mother, everything that you do now is for the baby and that your health and wellbeing has to be put to the side. I want people to know that that can actually be a really dangerous thing for yourself and for your family. So, take that time to really be in tune with your body as well and not put your own health to the side, because that can have dire consequences. We’re so trained as a society to put our needs to the side. Don’t ignore your own health for the benefit of your baby, because you’re only doing harm that way. There’s no actual roadmap for what’s the right way to recover after childbirth. It’s whatever is the right way for you. There’s no time frame on that. It’s okay to feel like you are struggling and to know you can ask for help.

ConceiveAbilities is fully invested in the physical and mental health of our surrogates and offers surrogates Fourth Trimester care. Learn more about this All-In Surrogate Care and Compensation Package that includes support, monthly care packages and fourth trimester care for full recovery after a surrogate delivers. If you are thinking about becoming a surrogate, take the first step by completing this survey to see if surrogacy is right for you.


Listen to the podcast:


Download the podcast here.


Read more about the Fourth Trimester from Dr. Mehta and Dr. Srinivas in The Fourth Trimester: 12 Weeks Is Not Enough.


Learn more about optimizing postpartum health care from the American College of Obstetricians and Gynecologists.