The Fourth Trimester

The fourth trimester is defined in pregnancy books as the idea that the first three months of life should essentially be an extension of life in the womb for the newborn.  It starts in the hospital; it is better for the baby to stay with the mother.  Mother and baby bond and the mother takes her cues regarding establishing new routines from the baby rather than trying to force upon the baby a routine that may not fit.  This gives them both time to adjust to “life on the outside.”  But when the baby dies, this period is missed, glossed over.  The mother does not receive time to adjust as there is no baby to adjust to.  She is expected to pick up and move on as if nothing happened.  They leave her in the labor and delivery ward, because the regular nurses on other floors aren’t specialized in postpartum care.  She stays up all night listening to other babies crying, other mothers taking care of their children, and she is constantly reminded that there is no baby for her.

The other mothers on the floor are starting their fourth trimester, but she is standing still.


Someone slid a tray in front of me with soup and water.  I dipped the tip of my spoon into the soup, but the noodles were congealed.  Leaning over the bowl, I sniffed briefly before making the decision that it was not worth my eating.  I didn’t feel like eating ever again.  My cousin had come with flowers, and was talking to the husband and his parents.  I sat in the middle of their conversation, but I wasn’t really talking.  I smiled and nodded in all the right places, but I had never felt so alone in my entire life.  She was gone suddenly, and I couldn’t recall a single word that had been spoken.

People were moving around me and talking throughout the room, but everything was hazy.  The nurse who had been present for the delivery introduced me to the night nurse.  They checked my vitals for what had to be the tenth time in the two hours since the birth, and then they disappeared.  My body and my aftercare were apparently quite important, and yet, I was invisible.

The friends we had picked to be the godparents drifted in.  As they crossed the room, a dividing curtain drifted back to reveal the plastic bassinet next to the bed where a newborn would sleep.  They hadn’t taken it out.

There was no newborn inside.


When you are expecting a baby, especially your first, people find it helpful to fill you in on all the little facets of pregnancy and birth.  The first thing they tell you is that childbirth will hurt.  A lot.  They aren’t lying.  I’ve heard it referred to as taking your lower lip and stretching it over your head, and though I haven’t tried this particular activity, I can’t imagine it even comes close.  I don’t know of anything that does.  The pain will go away though, once you hold your baby in your arms.  Now this is a lie, as it does not take into consideration those who do not get a living breathing baby.  For us, the pain does not vanish.  The next thing they tell you is that stretch marks will eventually go away.  Another lie.  Sure, they fade and turn a freaky white color.  But they never disappear, not completely.  Yet another thing I remember learning is that you burn a lot of calories when you breastfeed, and that many women lose baby weight in this manner.  I’m fairly certain this is true, based on research I did pre-pregnancy.  For me, however, this was yet another lie.

Some things, people just don’t talk about.  For instance, they don’t tell you that one percent of pregnancies end in stillbirth, which is defined as death after twenty-four weeks.  They don’t tell you that things don’t always go the way they’re supposed to, because they only prepare people for the best possible outcomes.  They don’t tell you that your body postpartum will be irrevocably changed.

A stillbirth baby, especially at full-term, is such an unexpected and sudden loss that people often forget you have gone through the birthing process and need to recover just like any other woman.  You might receive pain killers, but they don’t tell you what they are for.  They don’t tell you that you’re going to hurt like hell as your womb shrinks back to its normal size and shape.  They don’t tell you that you might need help with simple physical tasks.  They don’t tell you that you will bleed for weeks after, and that your cycle will change forever.  They are more concerned with handling your grief than with handling your body after the baby is gone.  All of the little details go by the wayside in favor of making sure that you are “okay” and that you are not going to walk out of the hospital and throw yourself in front of a bus.


The first thing I was able to articulate, once the epidural had fully worn off and the people were gone, was that I had to go to the bathroom.  The nurse helped me to get up by having me grab the bed rail and then swing my legs one at a time over the side of the bed.  They were still tingling from the drugs.

She asked if I wanted a shower.  I nodded.  She guided me into a chair outside the bathroom and then buzzed around hanging up towels and getting things inside the shower ready.  She put some shampoo and soap on the little ledge in the corner, then laid out my new underwear and gown.  As she left, she told me to pull the chain in the shower if I got into trouble.  I nodded, but she had already shut the door.

I stripped out of my gown, carefully depositing it into the hazardous materials bin along with the underwear someone must have put on me at some point.  I shut the lid, hoping I could pretend that the blood on both garments was just a dream.  It took me at least a minute in my daze to figure out how to operate the tap within the shower, but I finally got it on and cranked it as far as it would go.  The noise was almost deafening after the time I had spent removing my clothes in complete silence.  I stuck my head into the water, shampooing and rinsing my hair.  The hot water felt wonderful, rinsing away even for a moment the reality of the situation.  I didn’t realize how hard I was crying until the grief became so overwhelming that I sank down on top of the shower seat.

I turned off the tap, standing and wrapping myself in a towel.  Reaching out with one hand, I rubbed the steam from the mirror.  I dropped the towel and turned first one way, and then the other.  My body looked almost normal.  Heavier most certainly, and differently shaped.  But almost normal in that there was no more pregnancy belly.  Almost as if it hadn’t happened.


The biggest thing that no one told me when I lost my son was that my breasts would still produce milk.  It wasn’t really anything I thought about once he was gone, not until it happened.  My body didn’t understand that I didn’t have a baby anymore; it’s not like I could explain it or make this natural process stop.  I called my OB right away, they made me wear a sports bra that was several size too small with cabbage leaves shoved inside.  They apologized for neglecting to inform me, but it meant nothing.  To add insult to injury, not only did I not have a baby, I stank like cabbage.  My body had betrayed my mind.   As a society, we are largely concerned with how we look.  And here I was with the body that comes after having a baby, and no baby to show for it.  I had a ring of pudginess around my middle that had never been there before as well as a plethora of stretch marks.  No amount of exercise would make those things going away, not completely.  I was shaped differently, inside and outside.  I was different.  And this went unacknowledged.


The bill from the hospital came a few weeks later.  It cost us nearly eleven thousand dollars to not bring home a baby.  I crumbled the bill up and threw it at the wall before realizing that the husband would want to see it.  I retrieved it from where it had fallen behind the couch, smoothed out the edges, and placed it face down on the coffee table for him to read when he got home.

I paced around the apartment, restless and bored, before turning on the Wii and coming to the decision that this was as good a time as any to begin exercising again.  I had the misguided notion that I could get my pre-baby body back.

I was still doing step aerobics when he got home.  I didn’t want to see his face when he caught wind of the bill.  Eleven thousand dollars.  Who knew?

I burned over five hundred calories doing step aerobics, and I did them every day for a long time.  I started running again.  But I couldn’t get my life back; I couldn’t even get my body back, not the way it had been.  Clothes shopping became the bane of my existence once again.  In the month after the birth, I had an event that required I purchase a dress.  I had just had a baby.  Even though he was gone, I had had a baby.  I had all of the extra weight but nothing to show for it.  I thumbed through the racks aimlessly, attempting to be interested but having an incredibly difficult time engaging.  I pretended to be enthralled with a few choices and vanished into a dresser room.

I stepped into a dress that was the size I had been pre-pregnancy.  It wouldn’t even zip.  I threw the hanger against the wall of the dressing room so hard that it broke and fell to the floor in pieces.

That seemed fitting.  I hated my body, and found myself massively ashamed by my inability to make the clothing fit.


A normal fourth trimester:  snuggling with the newborn, feeding on demand, lacking in sleep, and developing routines.  Maybe beginning to exercise.

My fourth trimester:  going home with my son in a box, planning a funeral, and then going back to work and moving on in a society that had a difficult time acknowledging he had even existed.  And exercising.


The Fourth Trimester Bodies Project is a photo documentary created by Ashlee Wells Jackson, a mother and photographer from Chicago, Illinois.  After going through a traumatic pregnancy and birth, Ashlee now wants to change the way that women view their bodies postpartum by creating this project to help women learn to love the changes that occur in their bodies.  She is photographing women in the Chicago area, and hopefully other areas as well, to put all of the images into a website, gallery, and eventually a published book.  The tagline of her website is “dedicated to embracing the beauty inherent in the changes brought to our bodies by motherhood, childbirth and breastfeeding.”  I don’t know why it took so long for someone to embrace this idea.

While the project is intended for women with living babies, Ashlee’s mission touched me all the same.  She mentions in her introduction to the project that while women are accepting of the changes that occur in their bodies during pregnancy, it can be harder to adjust to the fact that their body just won’t be what it used to be once the baby is born.  Women carry the scars of childbirth forever, even those who have lost their babies.  And the women who have lost their babies are an often passed over category.  Their fourth trimester is a radically different, yet in some ways the same, period of life.  Many women hate their bodies after.

To a woman who has experienced a stillbirth, her post-pregnancy body feels like adding insult to injury.  It’s hard enough to try to carry on with day to day activities, but to not be able to wear your old clothes is horrible.  Dieting and exercise while grieving is complete and utter torture.  When she looks down, she sees the flabby belly that used to hold a baby.  And sometimes it is easier to deal with those feelings of body hatred over the feelings of loss.  It is easier to just let people assume that because you are not carrying a newborn to show for it, you are simply fat.  That’s just wrong.  It’s wrong to hide.  There is an idea circulating our society that, no matter what the reason, it is wrong to be fat.  It isn’t fair.  Ideas like this just perpetuate sadness in women, particularly those that already hate their body after an infant death.  But in reality, it doesn’t matter what size we are.  We can’t always help the things that happen within our bodies; many things are out of our control.  We are all beautiful, and any woman who is willing to give up her body for almost a year to create a tiny little human is all the more wonderful for that.  Regular birth, traumatic birth, c-section, stillbirth, any birth—all of these women are heroes for their experiences.  This should be recognized, not put down.

The Fourth Trimester Bodies Project is such a beautiful idea because it brings to light the idea that there is absolutely nothing wrong with a post-pregnancy body.  Whether you have a baby at the end or not, there shouldn’t be body hatred at all.  It should be acceptance of the battle; it should be acknowledgement of what was rather than a desperate effort to erase it.  No woman should have to be ashamed of her body after the experience of pregnancy.  No woman should have to be ashamed of her body at all.

(The URL for Ashlee’s website is  This project is an amazing idea.  And you should donate to it, if you are able.)

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4 thoughts on “The Fourth Trimester

  1. cafecasey says:

    This is such a heartbreaking piece and so well written. I remember reading a piece by a mother in Mothering magazine years back. The woman had pictures, and talked about the grieving process. I still remember the baby’s name was Charlotte. You, and Charlotte’s mom, are right–that’s a little person, and all the moms and dads need so much love and support. I can’t imagine… And you’re right, no one should ever have shame about her body. I love the Dove self-image material for that reason.

  2. disp4324 says:

    My heart broke a million times reading this post. Society as a whole doesn’t know how to comfort the grieving. People are uncomfortable, often asking how you are and telling you to call them should you need anything… Grieving is a process and although people are well intentioned, they often don’t know how to support someone in your situation. Please know my heart goes out to you and you are in my thoughts and prayers.

  3. My heart aches with each and every one of these stories. I can actually feel the grief emanating from them. I pray you find some comfort in your days ahead.

  4. Phenomenal idea!
    Praying for you. You really summed it all up beautifully.

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