The fourth trimester: what to expect in your first month postpartum

The fourth trimester. You might have heard this phrase during pregnancy, but until you’re living it, it’s hard to truly understand what it means.

Those first weeks after birth are intense, beautiful, overwhelming, and unlike anything else. Your baby is adjusting to life outside the womb, and you’re healing, learning, and navigating a complete upheaval of everything you thought you knew about your body, your time, and yourself.

There will be moments where you’ll stare at your baby and feel such an overwhelming love you could burst. And there will be moments where you feel exhausted beyond measure. Both are part of the journey.

Let’s talk honestly about what to expect in that first month postpartum, because realistic expectations make everything feel more manageable.

What is the fourth trimester?

The fourth trimester refers to the first three months after birth, a continuation of your baby’s development that happens outside your body rather than inside it.

For your baby, it’s a period of adjustment. They’ve gone from the warm, dark, contained environment of your womb to the bright, open world. They’re learning to regulate their temperature, digest food, process sensory input, and communicate their needs.

For you, it’s a period of profound physical recovery and emotional adjustment. Your body is healing from pregnancy and birth. Your hormones are shifting dramatically. You’re establishing feeding. You’re learning to read your baby’s cues. You’re functioning on broken sleep. And you’re doing all of this whilst your identity shifts in ways you couldn’t have fully anticipated.

It’s a lot. And it’s meant to be. But within the intensity, there are moments of pure magic.

The first week: intensity and wonder

Let’s start with the first week, because it’s often the most intense, but also filled with profound moments of connection.

Physical recovery

However your baby arrived, your body has just done something extraordinary and needs time to heal.

You’ll experience:

• Bleeding (lochia): Your bleeding will start off heavy and bright red in the first few days. If you’re soaking through a pad in an hour or passing clots larger than a 50p piece, contact your midwife. Over the following days and weeks, the bleeding will gradually lessen and become darker, more brownish. By week two to three, it often becomes more of a discharge, similar to the end of a period. It’s also normal for bleeding to start up fresh and red again, and this can happen on and off up to 6 weeks postpartum.

• Afterpains: Your uterus is contracting back down to size, which can cause cramping, especially during breastfeeding. These are usually more noticeable with second and subsequent babies.

• Perineal discomfort: If you have stitches, they’ll be sore. Keep the area clean, change pads frequently, and try a warm bath or cool compress for comfort. (Always wash your hands before and after changing pads)!

• Caesarean recovery: If you’ve had a caesarean, you’re recovering from major abdominal surgery. Move gently, take your pain relief, and don’t try to do too much.

• Breast changes: Whether you’re breastfeeding or not, your milk will come in around day 3 to 5. Your breasts might feel very full, hard, and uncomfortable. This settles as feeding (or your body adjusting if you’re not feeding) establishes.

• Exhaustion: The tiredness is like nothing you’ve experienced before. It’s bone deep.

• What’s normal: Heavy bleeding for a few days, cramping, soreness, swelling

• Contact your midwife if: bleeding soaks through a pad in an hour, you pass clots larger than a 50p piece, you have severe pain, signs of infection (fever, foul-smelling discharge, increased pain), or anything that doesn’t feel right.

Feeding your baby

The first week of feeding, whether breast or bottle, is about establishing your rhythm together.

If you’re breastfeeding, your baby will feed frequently, often 8 to 12 times in 24 hours or more. Cluster feeding in the evenings is normal. Your nipples might feel tender as you both learn, but feeding shouldn’t be painful. Your milk comes in around day 3 to 5, and your breasts might feel very full.

If you’re bottle feeding, follow your baby’s hunger cues rather than a rigid schedule. Pace feeds so baby can regulate their intake. Expect roughly 8 feeds in 24 hours initially. Watch for signs of hunger and fullness.

In those first few days, your baby’s nappies will tell you how feeding is going. Expect one wet nappy per day of life (so one wee in the nappy on day one, two on day two, and so on), and at least one dirty nappy each day, progressing from thick, dark meconium to softer, mustard-coloured stools if breastfeeding, or pale brown/yellow if formula feeding.

By day 5, as your milk comes in or your baby takes more formula, you should see heavier wet nappies, at least 5 to 6 in 24 hours.

Both methods require learning. Both deserve support. If feeding feels difficult, painful, or overwhelming, reach out for help early. As an IBCLC, I can support you with personalised guidance, whatever your feeding method.

Weight changes in your baby

It’s completely normal for babies to lose some of their birth weight in the first few days. This happens because they’re losing fluids from birth and getting rid of a full bowel of meconium. Most babies lose around 5 to 10% of their birth weight.

Your baby should be starting to regain weight by and getting close to their birth weight by 2 weeks of age. If they had a slightly larger weight loss, it might be closer to 3 weeks before they’re back to birth weight. Your midwife and health visitor will monitor this and support you if there are any concerns.

Sleep (or lack of it)

Your newborn doesn’t know the difference between day and night yet. They’ll sleep in short stretches, waking frequently to feed.

This is normal. It’s also exhausting.

Rest when you can. Lower every other expectation. Let someone else hold the baby whilst you close your eyes. Accept that you won’t feel like yourself on this little sleep.

But here’s the beautiful part: those quiet night feeds, when it’s just you and your baby in the stillness, can become strangely precious moments of connection.

Emotions in the first week

Around day 3 to 5, as your milk comes in and your hormones shift dramatically, you might experience the “baby blues.” This can look like tearfulness for no clear reason, mood swings, anxiety, feeling overwhelmed, and moments of doubt.

This is incredibly common (affecting up to 80% of new mothers) and usually passes within a couple of days as your hormones settle.

You’ll also likely experience moments of overwhelming love, where you can’t quite believe this tiny person is yours. These feelings can coexist with the tears and the exhaustion, and that’s completely normal.

However, if difficult feelings intensify, persist beyond two weeks, or you’re having thoughts of harming yourself or your baby, please reach out to your midwife, health visitor, or GP immediately. This could be postnatal depression or anxiety, which are treatable with the right support.

Week two to four: finding your rhythm

By the second week, you’re starting to emerge from the initial fog, though you’re still deep in the intensity of early parenthood. You’re also starting to know your baby better, recognising their different cries and what soothes them.

Physical recovery continues

Your bleeding should be reducing, though it might still be present and can fluctuate. Your body is continuing to heal, your uterus is shrinking back down, and you might notice night sweats as your body sheds pregnancy fluid, hair loss (usually starts a bit later but can begin now), continued fatigue, and gradual reduction in soreness or discomfort.

Your six to eight week postnatal check is important. This is your opportunity to discuss any concerns about your physical or mental health, your recovery, contraception, and any ongoing symptoms. Don’t minimize what you’re experiencing. Advocate for yourself.

Feeding is establishing

By weeks two to four, feeding often starts to feel slightly more manageable, though it’s still frequent and demanding.

Breastfeeding might feel more comfortable as both you and baby become more practiced, still frequent with cluster feeding in the evenings common, and occasionally frustrating as growth spurts can mean baby wants to feed constantly for a day or two.

Formula feeding might feel more predictable in terms of amounts and timing, still responsive to your baby’s cues, and like you’re finding your rhythm with preparation and pacing.

If feeding isn’t feeling easier, or if you’re struggling with pain, supply concerns, or overwhelming anxiety around feeds, please reach out. Support exists, and you don’t have to push through alone.

Sleep patterns (still unpredictable)

Your baby is still waking frequently, but you might start to notice tiny patterns emerging. Some babies have a slightly longer stretch at night (maybe 3 to 4 hours). Others don’t, and that’s also normal.

Safe sleep guidelines remain crucial: on their back to sleep, in the same room as you, on a firm flat surface, with no loose bedding or toys.

If you’re bedsharing/ co- sleeping or considering it, please look at safer sleep guidance from The Lullaby Trust. You can co-sleep safely and this is the best resource to read the guidance. Never bedshare if you or your partner have consumed alcohol, taken medication that makes you drowsy, smoke, or if baby was premature or low birth weight.

Your emotional landscape

By week two to four, the initial baby blues should have lifted. If they haven’t, or if you’re feeling increasingly anxious, low, or disconnected, it’s time to speak to someone.

You might also be feeling isolated (especially if your partner has returned to work), overwhelmed by the relentlessness, touched out from constant feeding and holding, grieving aspects of your old life, and deeply in love with your baby whilst also finding it really hard.

All of these feelings can coexist. Motherhood isn’t one dimensional.

You’ll also have moments where your baby does something new, a fleeting smile (even if it’s just wind at this stage!), a content sigh, or simply falling asleep in your arms, and you’ll feel your heart could burst with love.

What about your relationship?

Your relationship with your partner is navigating new territory. You’re both exhausted, adjusting to new roles, and possibly struggling to find time to connect beyond logistics and baby care.

This is normal, and it’s hard. Try to communicate honestly about how you’re both feeling, be specific about what you need from each other, remember you’re on the same team, and accept that intimacy (physical and emotional) might look different for a while.

 

When to ask for help

Here’s the truth: you don’t have to wait until you’re at breaking point to ask for help.

Reach out if feeding is painful or your baby isn’t gaining weight appropriately, your bleeding increases suddenly or becomes very heavy again, you notice signs of infection (fever, increased pain, foul-smelling discharge), your caesarean incision looks red, swollen, or is leaking, you’re experiencing severe or worsening mood changes, you feel consistently overwhelmed or anxious, or anything just doesn’t feel right.

Trust your instincts. You know your body and your baby better than anyone.

Practical tips for the first month

Here are some practical strategies that can help you navigate those first weeks:

Accept help: If someone offers to bring food, hold the baby whilst you shower, or do a load of laundry, say yes. This isn’t the time for pride or proving you can do it all yourself.

• Lower your expectations: The house doesn’t need to be spotless. You don’t need to be dressed and made up. You’re doing enough.

• Prioritise feeding and rest: These are your two main jobs. Everything else is secondary.

• Get outside: Even if it’s just sitting in the garden or walking to the end of your street, fresh air and a change of scenery can shift your mood.

• Stay hydrated and fed: Keep snacks and water within reach. You need fuel, especially if you’re breastfeeding.

• Limit visitors: You’re not obligated to entertain people. If visitors feel overwhelming, it’s okay to say no or keep visits short.

• Connect with others: Whether it’s a WhatsApp group of friends with babies, an online community, or something like our Mama & Baby Cafe, connecting with others in the same season helps combat isolation.

• Be kind to yourself: You’re learning. Your baby is learning. You’re both finding your way together.

What your baby needs in the first month

Your baby’s needs are actually quite simple, even if meeting them feels complex:

• Feeding: Frequent milk feeds, whether breast or formula.

• Sleep: Lots of it, in short stretches, often on or near you.

• Comfort: Your presence, your smell, your voice, your warmth.

• Clean nappy: Regular changes to keep them comfortable.

• Safe sleep environment: Back to sleep, clear sleeping space, same room as you.

That’s it. You don’t need fancy equipment, elaborate routines, or perfect techniques. You just need to respond to your baby’s cues and trust that you’re learning together.

Common concerns in the first month

“Is my baby feeding enough?”

In the first week, check nappies: one wet per day of life, at least one dirty nappy daily. By day 5, expect heavier wet nappies (at least 5 to 6 in 24 hours) and regular dirty nappies. Your baby should be working towards regaining their birth weight by around 2 weeks, or up to 3 weeks if they had a larger initial weight loss. Your midwife and health visitor will monitor weight gain. If you’re concerned, reach out.

“Why is my baby crying so much?”

Newborns cry to communicate. They might be hungry, tired, uncomfortable, overstimulated, or simply need comfort. It’s not a reflection of your parenting. Respond to their cries, try different soothing techniques, and know that some babies cry more than others. If crying feels excessive or you’re struggling to cope, speak to your health visitor.

“When will I feel like myself again?”

Honestly? It takes time. The first month is about adjustment. By 6 to 8 weeks, you might start to feel glimpses of yourself returning. But the truth is, you’re becoming a new version of yourself, and that integration takes months, not weeks.

“Is it normal to feel this overwhelmed?”

Yes. The fourth trimester is intense. If overwhelm comes in waves but you’re generally coping, that’s normal adjustment. If it’s constant, crushing, and you can’t see a way through, that’s when you need additional support.

How I can support you

The fourth trimester doesn’t have to be navigated alone. As an experienced midwife and IBCLC, I offer support tailored to your needs:

• Postnatal home visits: I can come to you in those early weeks, check on your recovery, assess feeding, answer your questions, and provide reassurance in your own space.

• Lactation support: If feeding is painful, challenging, or you have concerns about supply or your baby’s latch, I can provide expert assessment and practical help.

• Ongoing guidance: Whether it’s via WhatsApp, phone, or in person, I’m here to answer your questions and support you through the ups and downs.

• Mama & Baby Cafe: Our monthly gathering is a welcoming space to connect with others in the same season as you, get your baby weighed, ask questions, and feel less alone.

You can find out more about these services on my website or get in touch directly.

You're not alone - I offer support tailored to your needs.

You’re doing better than you think. The fourth trimester is intense. There’s no way around that truth.

But it’s also filled with moments of wonder. The first time your baby grips your finger. The way they smell. Those quiet moments in the middle of the night when the world is still and it’s just the two of you. The overwhelming rush of love that takes your breath away.

Both the hard bits and the magical bits are real. Both matter.

Be patient with yourself. Ask for help when you need it. Trust that it won’t always feel this intense.

And know that you’re not alone. This is what the fourth trimester looks like for so many families, and there’s support available whenever you need it.

Sally x

P.S. If something doesn’t feel right, trust that instinct. It’s always okay to reach out for help, whether that’s your midwife, health visitor, GP, or me. You deserve support through this transition.