Admittedly, the idea of a “fourth trimester” in pregnancy and childbirth is a new one for most people. But is the concept really that new? A deeper dive into maternal health and well-being might uncover that it is one that deserves a closer look.
When one thinks about pregnancy, they think of three trimesters, and health care delivery systems revolve around those three trimesters. But isn’t there a need for a fourth trimester following childbirth? The fourth trimester is the 12 weeks following the birth of a baby.
Not everyone is familiar with this time, but all parents and their newborns experience this phase. It is a time of great physical and emotional change as babies adjust to being outside the womb, and parents adjust to the new demands of parenthood.
When babies arrive, mothers and fathers quite often shift their whole focus to their newborns, often overlooking their own health and wellbeing -- especially the health of the mother.
Most people would agree that newborns require a significant amount of time and care. Many parents become overwhelmed in the first few postpartum weeks by the demands of feeding and looking after a tiny new human being.
Combined with the physical recovery and hormonal changes after giving birth, it's normal for new parents to feel exhausted. Even after faithfully following their health care provider’s advice, listening to family members (and neighbours!), reading multiple pregnancy, and parenting books, and delivering a baby, new parents, especially mothers, don’t always feel 100% themselves.
Many women experience changes as a result of giving birth: Bladder control issues, which can result in involuntary urination during sneezing or coughing; sleepless nights can cause new mothers to feel much older than their actual age; and anxiety and depression can creep in, and all too often, mothers feel ashamed to ask for help.
Some feel burdened by the expectation of being the quintessential perfect mother, while their child becomes the centre of their family's world. Sometimes these health impacts can be overwhelming to new mothers.
Despite a steady decline, 196 out of every 100,000 women who have live births in Bangladesh die during pregnancy, while giving birth, or within 42 days of giving birth. Surviving childbirth in Bangladesh does not mean that a mother is medically out of the woods. According to the Bangladesh Demographic and Health Survey 2022, approximately 62% of women seek postnatal care within 42 days of giving birth.
That means one third of women in Bangladesh do not seek any postnatal care within this prescribed time. In addition, according to the preliminary results of the Bangladesh Health Facility Survey 2022, the average readiness score of facilities for delivery and newborn care was 6.8 (out of 13) among the World Health Organization (WHO)-specified 13 items.
This illustrates how the country’s health care system is also not as well-prepared to handle women’s postpartum conditions, many of which have life-long medical consequences -- from physical pain and discomfort to psychological anguish.
As a result, many women surrender and believe these healthcare risks are normal when giving birth. But that isn’t the case and there is a growing global focus on prioritizing care for mothers just as much as infants, especially during that first year after childbirth, according to a 2020 paper published at the BMC Pregnancy Childbirth.
Unfortunately, postpartum problems are often not spoken about, especially when it comes to psychological needs after the birth of a baby. Cultural attitudes and stigma silence conversations about women’s sexual and reproductive health. Women are told that their new baby should bring them happiness. New parents often prioritize their role as parents, forgetting that they are also a couple.
A facility-based study supported by the Global Affairs Canada (GAC), the non-communicable diseases control program of the Ministry of Health and Family Welfare’s Directorate General of Health Services, and implemented by icddr,b found that while 69% of women felt depressed during the antepartum period, it rises to 80% during the postpartum period. Anxiety is also widespread, impacting about 75% of women during ante and postpartum periods, with anxiety and depression levels increasing with age.
According to a 2018 study published by BMC Pregnancy and Childbirth, one source of anxiety and depression is the emotional distance between partners. During pregnancy, husbands often feel (or are often made to believe) that pregnancy is a female issue and should be handled by female members of the family.
This attitude can lead to husbands living their normal lives, often moving to another room to give their wives more privacy, which can result in couples drifting apart, with mothers feeling alone and often suffering from depression and anxiety.
But there is another side of the coin as well. There are husbands and parents-in-law who treat the mother respectfully, like a gift along with the child. A woman’s husband, her family, and health care provider should recognize the signs of anxiety and depression among postpartum mothers. Women may not be too exhausted or anxious to advocate for themselves alone or might not even recognize the need to seek help.
Returning to the concept of a “fourth trimester,” it’s important to understand that, just like during pregnancy, the first 12 weeks after childbirth can be challenging for new parents, especially for a mother’s health and well-being. Providing new mothers with the same level of love, care, respect, and empathy during and after pregnancy and childbirth is vital.
Attention must also be dedicated to the psychological health and needs of mothers, fathers, and newborns. And one of the most important things a new parent -- and those around them -- can do during the fourth trimester is give themselves time to physically and mentally heal and navigate their new roles.
As the World Mental Health Day is celebrated globally in October, it is critical that those in the “fourth trimester” not be left behind.
Aniqa Tasnim Hossain is an Assistant Scientist at icddr,b. Shusmita Khan is Knowledge Management and Communications Specialist, Data for Impact (D4I) || Carolina Population Center, University of North Carolina at Chapel Hill.
This Op Ed was produced with the support of the United States Agency for International Development (USAID) under the terms of Data for Impact (D4I) associate award no. 7200AA18LA00008, which is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with Palladium International, LLC; ICF Macro, Inc.; John Snow, Inc.; and Tulane University. The views expressed do not necessarily reflect the views of USAID or the US Government. The study cited in this op-ed was funded by the Department of Foreign Affairs, Trade and Development (DFATD), through AdSEARCH by icddr,b, (SGDE-EDRMS-#9926532).
