4th Trimester Project

What is “the 4th trimester?”  The 12 weeks following delivery, a woman must recover from pregnancy and childbirth, adapt to changing hormones, body image and role, learn to feed and care for her newborn and navigate relationships and expectations with her partner, family, friends, co-workers and other children if she has them. Mothers with limited resources must also access services for themselves and their infants within a system that is often complex and not consumer-centered.

During this 4th Trimester, many women and their families experience considerable, interrelated biopsychosocial challenges that are insufficiently supported by health care providers, employers and the community.

Our Team

This work is being conducted by Drs. Sarah Verbiest, Alison Stuebe, and Kristin Tully at the Center for Maternal and Infant Health and the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill. The 4th Trimester Project was funded by the Patient-Centered Outcomes Research Institute. Our goal was to bring together mothers, health care providers, and other stakeholders to define what families need most during the transition home with newborns through the first 12 weeks postpartum. We are continuing our efforts to define and explore what families need most during the 4th Trimester.

Our original research team (pictured above): Ben Goodman (4th Trimester partner), Sarah Verbiest (4th Trimester Project), Monica Simpson (4th Trimester partner), Alison Stuebe (Co-Investigator), Miriam Labbock (Co-Investigator), and Kristin Tully (Co-Investigator)

4th Trimester Project Investigators in June 2017 (pictured above): Drs. Ben Goodman, Alison Stuebe, Kristin Tully (Bethany), and Sarah Verbiest

In the Media

• Dr. Kristin Tully quoted by Quartz: Kristin Tully says there’s a “definite lack of preparation for the fourth trimester—and the maternity unit is not the place for women to learn.” Dr. Tully says their project’s goal is to “improve what information is provided and when, and how support is provided.” For starters, she says mothers need to “be given a summary of …
• Drs. Alison Stuebe and Kristin Tully quoted by Vox: “In an ideal world women would get home visits or their family members would get paid leave to attend to them,” says 4th Trimester Project Investigator Dr. Alison Stuebe. “If we’re not going to have that, we need some touchpoint from the health care system to replace that village that is no longer part of …
• Dr. Sarah Verbiest quoted by CNN: “The significant differences in how babies are getting a start in life speak to larger issues, such as health care access, that need to be dealt with by our society,” says 4th Trimester Project’s Dr. Sarah Verbiest. “All of our sweet babies and families should get to have the best start.”
• Drs. Sarah Verbiest, Kristin Tully, and Alison Stuebe published “Promoting maternal health in the 4th trimester” in the ZERO TO THREE Journal. “Health care providers may not recognize or encourage close contact with infants, nor view infant behavior as shaping the health and well-being of parents. The concept of the 4th trimester moves the conversation forward …
• American Journal of Obstetrics and Gynecology: Drs. Kristin Tully, Alison Stuebe, and Sarah Verbiest published “The fourth trimester: a critical transition period with unmet maternal health needs” in the American Journal of Obstetrics and Gynecology.

A Patient-Centered Outcomes Research Institute (PCORI) 4th Trimester Project included the formation of a multidisciplinary research team, a detailed and thoughtful recruitment strategy to include postpartum patients, clinicians who provide postpartum care, and stakeholders representing community groups, postpartum health programs, public health and researchers. The project included an ongoing analysis of data using an iterative process to identify thematic categories across the two years of the project. The project engaged with postpartum mothers on a number of webinars discussing various postpartum issues to better understand the needs women and families have during this period.

PCORI 4th Trimester Project engagement meeting was held at the Museum of Life and Science in Durham, NC on June 2, 2017. Fifty stakeholders attended, including 15 mom partners, clinicians, health department staff, home visiting nurses, implementation scientists, and researchers. The focus of the day was next steps in measuring the maternal transition through the 4th Trimester and developing research proposals to test ways that the US health care system can better serve families.

The 4th Trimester Project is examining key themes:

• Maternal mood
• Infant care and feeding
• Sleep and fatigue
• Physical recovery from childbirth
• Sexuality, contraception, and birth spacing
• Medications, substances, and environmental exposures

Here is what is clear from this research:

Postpartum care is too little, too late for many women.

Postpartum health care, education and services should be tailored to women’s experiences, preferences and constraints.

Active listening, strengths-based approaches, and shared decision-making are essential.

Healthcare should be compassionate, equitable and culturally sensitive.