UNC Collaborative for Maternal & Infant Health

UNC Collaborative for Maternal & Infant Health

Improving the health of North Carolina's women and infants

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4th Trimester Project

The 4th Trimester project brings together new mothers, health care providers, researchers, and other stakeholders to build knowledge about postpartum health issues.

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Come visit our new site: NewMomHealth.com

Patient-Centered Outcomes Research Institute

(PCORI) Work and Findings

The 4th Trimester Team recently completed a two-year project funded by the Patient-Centered Outcomes Research Institute (PCORI). For background information about the findings from the PCORI work with mothers and key findings, click HERE.

The 4th Trimester Project is changing the way America treats new mothers. Because “Motherhood should not mean risking your health, happiness, or life.”

The phrase “4th Trimester” emphasizes the interconnected physical and emotional relationships among women, infants, and family/others over the days and weeks after childbirth. Our mission is to transform the lived experience of the 4th Trimester through a national movement to spark real, sustained change for women and their families at individual,  community, and national levels.

New 4th Trimester Project website will be coming soon! To stay updated on our latest work, click here, and be sure to follow the 4th Trimester on Facebook and subscribe to the newsletter. 

About

Engagement

Findings


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.

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Key Staff

    Liz Soto, BSN, RN

    Perinatal Nurse Champion
    lizso@email.unc.edu

    Alison Stuebe, MD, MSc

    Co-Director, Maternal Fetal Medicine
    astuebe@med.unc.edu
    919-966-1601

    Kristin Tully, PhD

    Research Assistant Professor
    kristin.tully@unc.edu
    -

    Sarah Verbiest, DrPH, MSW, MPH

    Executive Director, Principal Investigator
    sarahv@med.unc.edu
    919-843-7865

    Suzanne (Yergensen) Woodward

    Communications Manager, Digital Strategist
    SuzanneW@med.unc.edu
    919-843-9336

    Email: SuzanneW@med.unc.edu | Office: 919-843-9336

    Connect on LinkedIn | Follow on Twitter


From the 4th Trimester Project Archives

  • #PreemieChat on Nov 14 at 3pm ET (10/19/2018)
  • Your voice is needed to create the 1st woman-centered, postpartum, self-care website (8/29/2018)
  • Share your story (6/30/2017)
  • Center for Maternal and Infant Health Spring 2017 newsletter (6/30/2017)
  • #MCHChat (6/30/2017)
  • Connection (6/30/2017)
  • Dr. Kristin Tully quoted by Quartz (6/30/2017)
  • Drs. Alison Stuebe and Kristin Tully quoted by Vox (6/30/2017)
  • Dr. Sarah Verbiest quoted by CNN (6/30/2017)
  • ZERO TO THREE Journal (6/30/2017)
  • American Journal of Obstetrics and Gynecology (6/30/2017)
  • Investigators (6/30/2017)
  • Stakeholder meeting (6/30/2017)
  • Newsletter (11/19/2016)
  • Participate in CGBI online survey! (11/17/2016)
  • 4th Trimester Project 2016 Engagement Meeting on YouTube (11/4/2016)
  • 4th Trimester Project poster (10/4/2016)
  • 4th Trimester Project featured in Every Woman Southeast newsletter (9/2/2016)
  • 4th Trimester co-investigator Kristin Tully awarded funding for infant side-car bassinet project (8/30/2016)
  • Moms deserve better care in the 4th Trimester (1/20/2016)
  • What is the 4th Trimester Project? (12/31/2015)
  • Work Plan (12/18/2015)
  • Platforms (12/18/2015)
  • The 4th Trimester (12/18/2015)
  • CGBI Breastfeeding Exclusive (12/18/2015)
  • International Lactation Consultant Association (12/18/2015)
  • Breastfeeding and Feminism (12/18/2015)
  • Patient-Centered Outcomes Research Institute (12/18/2015)
  • Alison Stuebe presents at the Academy of Breastfeeding Medicine (12/18/2015)
  • Alison Stuebe presents at UNC Grand Rounds (12/18/2015)
  • Maternal Mood (12/18/2015)
  • Physical Recovery from Childbirth (12/18/2015)
  • Infant Feeding (12/18/2015)
  • Sleep and Fatigue (12/18/2015)
  • Sexuality, Contraception and Birth Spacing (12/18/2015)
  • Collaboration (12/18/2015)
  • Dr. Alison Stuebe (12/18/2015)
  • Dr. Sarah Verbiest (12/18/2015)
  • Objective (12/18/2015)
  • Dr. Miriam Labbok (12/18/2015)
  • Dr. Kristin Tully (12/18/2015)

UNC Collaborative for Maternal and Infant Health aims to improve the health and well-being of women and families across North Carolina through community partnerships, research and clinical care innovations, and developing new approaches to complex problems.

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