Aug. 30. 2019
McKel Kooienga, MS, RDN, LDN

McKel Kooienga, MS, RDN, LDN

Founder of Nutrition Stripped® and the Mindful Nutrition Method™

What is the fourth trimester of pregnancy and why is it so important to understand for new mothers?

Health professionals and new mothers alike are starting to emphasize the importance of this time period, and for good reason too. Here we’ll discuss the fourth trimester as it relates to nutrition and the many other facets of your life.

From the day you find out you’re pregnant to the moment your water breaks, all of your time and energy is put into the safe arrival of your new child. What you eat, how you move and even the planning of the nursery, it’s all baby-centered.

It makes sense, right? You want to ensure the healthiest pregnancy possible, so you do everything in your power to make sure that happens. But what about after the baby is born? Don’t we want to ensure that the baby is cared for in the best way possible? In order for all of this to happen, the mother’s physical and mental health needs to be taken care of as well.

Historically speaking, this is the piece we so often unintentionally neglect.

What Is The Fourth Trimester?

The fourth trimester of pregnancy is the transitional, postpartum period after the baby is born, specifically the three months following birth. This is a big transition period for both the mother and the baby.

In some respects, both the mother and the baby are learning how to live daily life in a completely new way. For the baby, this means life outside of the womb. For the mother, it means learning how to balance her life alongside that of the baby’s.

At this time the mother is experiencing a multitude of changes. From physical, anatomical changes to sleep deprivation and new familial responsibilities, all the while caring for a brand new human. The potential feelings of overwhelm can climb.

Nutrition Needs In The Fourth Trimester

The mother’s mental and physical health are put to the test during the fourth trimester of pregnancy. Breastfeeding difficulties, postpartum depression, frequent headaches, and backaches are just a few of the many complications women face during the fourth trimester (1).

Nutritionally speaking, the primary focus is traditionally once again on the baby. Is the mother eating enough to breastfeed? Is she getting enough iodine and iron? These are exceptionally important topics to consider, in fact, we have previously discussed breastfeeding and nutrition here if you would like to learn a little bit more about the subject.

After considering breastfeeding and the baby’s nutritional adequacy, we need to remember that the mother needs proper nutrition too. In order for you to be the best mother possible, your health needs to be a top priority.

Replenishing Nutrient Stores

After birth, the mother’s body has an exceptional amount of recovering to do. Think about it, she has just given birth to a child. This means tissue tearing, blood loss and possible surgical wounds with cesarean delivery. And don’t forget — the mother’s body has also been the sole source of nutrition for another human for the past nine months.

What nutrients does the mother need to replenish?


Just as we discussed in our Pregnancy 101 article, calcium is a particularly important micronutrient throughout the many phases of pregnancy.

The baby needs calcium from the mother to ensure proper development. Because of this, regardless of whether or not the mother is consuming enough calcium, the baby will pull it from her body one way or another (especially during the last three months of pregnancy).

Essentially, if the mother isn’t consuming her recommended amount of calcium (1,000 – 1,300 mg/d depending on age), the baby will draw the calcium it needs from the mother’s bone. And unfortunately, most women do not consume enough calcium to meet their daily needs (2).

Calcium is also particularly important to consider when breastfeeding. Women may lose 3-5% of their bone mass during the breastfeeding period.

So what does this mean for the fourth trimester? The mother needs to replenish calcium. Excessive calcium loss in the bone can lead to osteoporosis — bone loss associated with fragile bones and an increased risk of fracture. To avoid this, eat plenty of leafy green vegetables, almonds, tofu, and salmon.


Blood loss during pregnancy can vary depending upon the particular type of delivery. With a traditional vaginal birth, the mother generally loses about 500 ml of blood or half of a liter. Cesarean delivery, on the other hand, leads to about a full liter of blood loss. Additionally, when compared to iron levels during pregnancy, mothers’ iron levels tend to decrease during the postpartum period.

All of this means the mother needs to ensure adequate iron intake during the 4th trimester. Inadequate iron levels can cause fatigue, depressive symptoms and even altered cognition (3). Beans, lentils, tofu, spinach, and even cashews all contain iron. When consuming plant-based iron, be sure to have an orange or another source of vitamin C to help out with absorption.


Protein has a variety of different functions in the body, but we’re particularly concerned with its role in the healing process during the fourth trimester of pregnancy. As your body recovers from childbirth, in order for your tissue to repair and grow you need to have enough protein in your diet.

This is even more important if you’re breastfeeding. When breastfeeding, an additional 25g of protein per day on top of your usual 0.8g/kg/day is recommended (4).

A variety of protein sources such as nuts, legumes, tempeh, tofu, nut butter, and animal proteins should support the new mother both with protein and minerals.

Lifestyle Factors

The entire person needs to be taken care of to truly feel recovered and replenished. What do I mean by the entire person? Let me give you an example case from my past Wellness Coaching client.

There is a new mother who decides to really focus on her nutritional intake during the postpartum period after having a cesarean delivery. She has a supportive healthcare team including wellness coaching, eats a well-rounded diet and supplements when it’s needed — point being, she has nutrition needs met.

Yet all the while she doesn’t feel supported by friends and family is no longer exercising as she used to, is extremely anxious all the time, is only getting three hours of sleep at night and is experiencing beginning signs of postpartum depression. She feels guilty about these feelings because she’s a new mother and says she “shouldn’t” be feeling this way. After she realizes that it’s not just about nutrition, she also leans into paying attention to counseling for her mental and emotional health and chats with her doctors as well.

Nutrition is the catalyst to support overall health, but it’s not the only pillar of health to tend to. We know that every part of the body is connected — including mental, emotional, and spiritual health. In order to properly heal during the fourth trimester, mothers need to take care of themselves just as they take care of the new baby.

Self-care and support is a necessity for new moms in the fourth trimester.

So how can a new mother who feels she has a million new things on her plate manage to fully take care of herself?

Fourth Trimester Care

Just a few days after the baby is born, the pediatrician appointments start and continue on a monthly basis. Each appointment is scheduled in advance and carefully planned in accordance with the baby’s development.

One last time, what about the mother? On average, most women won’t check in with their doctor until 4-6 weeks after birth. Not only this, but most mothers won’t really plan ahead for anything regarding themselves, all of the focus is placed on the baby.

Now don’t get me wrong, a heavy focus on the baby and the baby’s needs is undoubtedly crucial. My point in bringing this up is to simply note that significant focus needs to be placed on the mother as well!

New Mother Plan

As your planning out the nursery and scheduling the baby’s doctor appointments, take some time to plan ahead for the fourth trimester of pregnancy as well. Mara Acel-Green, LICSW has created a great template for this.

A plan will allow you to anticipate the kind of support you may need. It is also a great way to start building your medical team; do you have any preexisting medical or mental conditions that may need extra attention? When should you schedule your first postpartum checkup?

Just like any other new phase in your life, the postpartum phase is new, exciting and terrifying all at once; creating a plan can significantly minimize the later component.

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I would love to hear from you – have you heard of the fourth trimester before? Are you currently pregnant, in the postpartum phase or the friend of a new mother? As always, you can also connect with me outside of the website on Instagram @nutritionstrippederica and if you need 1-1 support, fill out the Wellness Coaching application so I can support you on your health journey.

Erica Carneglia, MS, RDN, LDN