Promoting Maternal and Infant Health in the 4th Trimester.

The “4th trimester” refers to the transition period after childbirth when infants are adjusting to life outside the womb and mothers are adjusting to new parenthood. This critical period is marked by significant biological, psychological, and social changes, which are currently insu! ciently supported. The 4th trimester perspective draws attention and calls for resources to address overlapping maternal health domains. Multiple issues intersect during this critical time: maternal mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from childbirth; and medications, substances, and exposures. By comprehensively addressing these interconnecting needs, service providers can improve health and well-being across two generations. The term 4th trimester reflects the transition period that occurs after childbirth and during the first few months of new parenthood. Newborns require months of intense, “womblike” nurturing for optimal growth and development (Karp, 2012). A perspective of the postpartum period as the 4th trimester views the mother and infant as deeply interconnected, behaviorally and physiologically (Ball & Klingaman, 2007). The transition to motherhood necessitates substantial transformation for women, who are simultaneously experiencing unique and changing hormonal shifts and expanding roles and responsibilities. As Kitzinger (1975) noted: There is a fourth trimester to pregnancy and we neglect it at our peril. It is a transitional period of 3 months after birth when many women are highly vulnerable, experience confusion and despair and during which anxiety is normal and reactive depression commonplace. (p. 118) Although some families transition smoothly to postpartum life, many others do not. To support these families, providers must focus on ways to advance the integration and tailoring of health care and other services for mothers and infants within the context of their diverse family and community settings. The 4th trimester approach makes clear that infants need to be held and cared for. For example, the sensory stimulation facilitated by prolonged skin-to-skin contact promotes growth, weight gain, temperature regulation, feeding readiness, and reduced crying (Moore, Bergman, Anderson, & Medley, 2016), but cultural understandings of infants are often mismatched to these needs. Further, providers may not recognize or encourage close contact with infants, nor view infant behavior as shaping the health and well-being of the parents. The concept of the 4th trimester moves the conversation forward from treating mothers and infants as separate individuals to considering them as mutually regulating dyads. In practice, clinicians, home visitors, and other practitioners typically assess either the needs of the child or the needs of the woman; instead, providers must consider one’s needs in the context of the others’. The neglected postpartum health and wellness of new mothers must be elevated and addressed with tailored services, better research, and social support. In this article, we make the case by describing the unique health concerns women experience in the fourth trimester as overlapping domains (Figure 1). In addition, we describe barriers to health and maternal role adaptation. We conclude with Copyright © 2017 ZERO TO THREE. All rights reserved. For permission requests, visit www.zerotothree. org/permissions