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The Fourth Trimester: New Guidelines for Postpartum Care

Written by Christina Frome, M.D. on May 9, 2018, 10:51:14 AM

Pregnancy doesn’t end when the baby is born. That may sound like a strange statement, but every woman who has given birth knows that her body and mind don’t immediately bounce back to their pre-pregnancy state postpartum. 

In fact, the American College of Obstetricians and Gynecologists (ACOG) have released new guidelines for postpartum care due to this phase lasting from six to 12 weeks, earning the term “the fourth trimester.” The guidelines are based on the idea that physicians should look at postpartum care as an ongoing process rather than a single follow-up visit shortly after birth. 

The postpartum phase sets the stage for the long-term health and well-being of mother and baby. As a new mom, your body and mind are adapting to an overwhelming number of changes – physically, psychologically, and practically. Your hormones have taken on a life of their own, you’re learning daily about your newborn and his or her needs, and you’re wondering when your body will resemble its previous self again. You may also feel quite alone, with your baby’s father likely unsure how to support your needs. Sometimes this can lead to a feeling of helplessness and exhaustion, putting your health and your baby’s at risk.

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More frequent visits with your OB/GYN for a longer period of time after you give birth can provide a support system to help you better navigate motherhood. 

With as high as 40 percent of new mothers not attending a single postpartum visit, families are becoming increasingly susceptible to incidents of postpartum depression, infant neglect, maternal illness, and poor family planning. More frequent visits during the so-called fourth trimester will make a world of difference, greatly decreasing the chances of a negative outcome. 

Care During the Fourth Trimester

ACOG used to recommend one comprehensive postpartum visit within six weeks after birth, with ongoing care as needed. Under the new guidelines, it now recommends several postpartum visits for up to 12 weeks after birth, with the initial visit within the first three weeks. (Be sure to check with your insurance carrier about postpartum coverage before scheduling an appointment.) The final visit should be a comprehensive consultation tailored to the mother and focusing on an assessment of: 

  • Mood and emotional well-being
  • Infant care and feeding
  • Contraception, libido, and birth spacing
  • Sleep and fatigue
  • Physical recovery from birth
  • Chronic disease management, if needed
  • Health maintenance going forward

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This postpartum care plan helps mom transition from prenatal to postnatal to ongoing well-woman maintenance, and it is particularly crucial for women with chronic conditions. 

Physicians can now focus on more than just a woman’s immediate postpartum health, also providing new moms with emotional support, effective contraception, and family planning. 


Dr. Christina Frome is a board-certified OB/GYN at Kelsey-Seybold’s The Woodlands Obstetrics, Gynecology and Women's Health and at the Spring Medical and Diagnostic Center. Her medical interests include general Obstetrics, menopausal health, and minimally invasive gynecologic surgery, including certification in the use of the da Vinci robot.


Topics: postpartum care, fourth trimester, new guidelines for postpartum care

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