UAE Pregnancy: What is the fourth trimester? And how to survive it in Dubai

Known as the ‘fourth trimester’, those first three months are essentially an extension of life in the womb. There’s even a theory that human babies are born prematurely, development-wise, as otherwise they’d be too big to birth. Our maternity experience certainly pales in comparison to camels that carry for up to 14 months, manatees that are pregnant for 13 months and giraffes that have gestation periods anywhere from 400 to 460 days.

“Humans have evolved to have such large brains and small, tilted pelvises that enable us to walk upright. As a result, we must deliver our babies quite prematurely so that the head of the baby can still fit through the pelvis,” says Amy Vogelaar, lactation consultant and parenting educator, Love Parenting UAE (www.loveparentinguae.com). “Furthermore, newborn humans have brains that are about 25 per cent of the size and capacity that they will be later in life. As their brains are so immature, they are essentially still fetuses on the outside, compared to a newborn cow or a horse, which can already stand and walk, for instance.”

All this goes some way to explaining these baby animal’s instinctive behavior: “During the first three to four months, our human babies operate mostly on primitive brain functions – reflexes and instincts – designed to help them survive,” says Amy. “They are learning and developing during that time, just as they did in the womb, but they mostly require constant physical and emotional contact with their mother, father and other family members who are assisting the mother.”

Suddenly, time changes all meaning

What can be a real shock for parents is just how time consuming it is to take care of a newborn.

“We often put very high standards on newborns, expecting them to eat and sleep how we would like and forget that they need time to make the transition to their new surroundings,” says Hazel Leonard, a UK-qualified midwife living in Dubai.

Even for those who are welcoming their second, third or fourth child, it’s easy to forget the huge impact such a tiny tot can make.

“So many mothers picture their new baby sleeping happily in his or her bassinet between three-hourly feeds, but many are really only content in mum’s arms and often only on the breast,” says Amy. “Human babies have not evolved to sleep separately from their mother at this age. If our ancestors had put their babies in a cradle in a separate cave they would have been eaten or frozen to death. New babies expect to be on their mother’s body and preferably with the breast in or near their mouth at all times. This is their habitat and their normal and is not a sign that they are spoiled or have bad habits. It’s simply how we have survived as a species.”

The shock of being outside the womb

The other challenging aspect of caring for a new baby is how unsettled they can be by anything from wind to having a nappy changed, taking a bath, being dressed and riding in the car seat. Their grizzly reaction can all feel a million times worse when you’re completely sleep deprived.

“It’s all so new to them – they didn’t have to deal with any of this in the womb and many can become quite irritated or irate with it all,” says Amy. “After about three to four months they are much better at taking all this in stride although, of course, at that stage other things become a greater issue for them.”

The physical changes for mum

All this is on top of the major physical changes mums endure alongside – many of which can come as quite the surprise.

“Immediately following the birth, the uterus begins a process called involution where it shrinks to its normal size. This causes a bloody discharge known as lochia, which tends to be bright red for the first few days and generally tapers off to a paler colour over the course of two to six weeks,” says maternity expert Lily Kandalaft, CEO of Malaak Mama & Baby Care (www.malaak.me).

Mum’s breasts may start to feel engorged around the third day post-delivery, when they fill up with milk and fluid.

“The best way to find relief from this is to feed the baby frequently and pump out any excess,” says Lily. “You may have a few tiger stripes – stretch marks – post-delivery but don’t panic as with a bit of exercise and eating well, you should get rid of them in time,” she adds.

Hair fall and pimples are also common, as pregnancy hormones flee your body. Yet another eyebrow-raising after-effect is stress incontinence, so if you’re leaking a little when you sneeze, be sure to practise your Kegel exercises – and do have a check-up with a woman’s health physio if it continues, as stress incontinence is not something mums should need to live with (insurance often covers physio appointments). Last, but by no means least – something hardly anyone is brave enough to warn you about – constipation can be a problem, especially for those who’ve had a C-section.

“To help get things moving, stay hydrated, eat high-fibre foods such as fruits and vegetables, and take the stool softener they give you in the hospital,” says Lily. “Hang in there – it’s not easy, but you will make it through the fourth trimester.”

How to plan for the first few weeks of a newborn

To navigate this intense period of change, it helps to get your ducks in a row. The UAE has now introduced five days of paid parental leave that can be used by men as well as women, and it is important your partner takes some holiday, if possible, to be there to support you and bond with the new baby.

If your budget allows, consider hiring some help with cooking and cleaning, too, so you don’t have to worry about dirty dishes stacking up. Plan ahead by filling your freezer with small portions of pre-cooked meals so you can keep yourselves fed without too much shopping and cooking. Once the practicals are taken care of, it’s on to the job at hand.

“Providing a constant, warm, safe environment will benefit your baby enormously,” says midwife Hazel. “Holding your baby, providing an intimate sleep space that’s as cocoon-like as possible and playing white noise are all wonderful and practical soothing techniques. Motion is also extremely important and the use of a swing, baby-wearing or rocking of the baby all help mimic the environment of the womb.”

Providing a constant, warm, safe environment will benefit your baby enormously. Holding your baby, providing an intimate sleep space that’s as cocoon-like as possible and playing white noise are all wonderful and practical soothing techniques.

- Hazel Leonard, Dubai-based midwife

A skill all new parents should master is the art of swaddling. “We swaddled our son George and kept him surrounded with a rolled-up blanket,” says Joanne Hanson-Halliwell, founder of Small and Mighty Babies (www.smallandmightybabies.com), a support group for families of premature babies. “We tried to emulate the positions and surroundings from his incubator in NICU and felt that being surrounded made him more settled and perhaps he felt safe and secure. A baby surrounded by love, comfort, food and rest is always content, regardless of whether they were premature or not.”

Fourth Trimester troubleshooting: Why is my baby crying?

If you’re struggling to figure out why your baby seems aggravated, it’s time to take a closer look.

“Parents should try to be led by the baby’s cues that they are overtired or over stimulated,” says Hazel. “Cues such as gaze aversion – where a baby turns away from an interaction – irritability, or arching of the back all indicate that your baby is reaching sensory overload. As a result, it will be much harder to put your baby to sleep. Babies’ sleep cycles are determined by their wake times, so it is essential that they start their sleep time while they are still happily awake to avoid overstimulation and overtiredness.”

Although, that’s not to say your newborn is not capable of interacting socially and emotionally.

“Babies arrive in the world ready to socially engage and interact and, in fact, actively seek sensory stimulation and form hypotheses about what is occurring in their own world around them,” says Hazel. “Stimulating your baby’s brain through emotional activities such as talking, soothing, singing and touch will enhance the neuronal connections that your baby needs in order to process the sensory information provided. Your baby will also participate in this interaction, which will help to create a solid attachment bond.”

Sharing a loving gaze causes endorphin levels to rise and completes a closed emotional circuit.

“This creates a truly dynamic interactive system and allows the baby to learn how to be with mother and father, resulting in emotional synchronisation,”explains Hazel. “In turn, parents need to be aware of signs that their baby needs to disengage and recover quietly.”

If your non-stop role is turning you into a 'mombie', make sure you seize every opportunity to catch a bit more shut-eye.

I found that if I planned to be in bed with my baby for 12 hours at night then even with two-hourly breastfeeds I got a decent amount of sleep.

- Amy Vogelaar, mum of two and lactation consultant

“Sleep when the baby sleeps – nobody does it, but it’s really the only way to survive and thrive,” says Amy. “I found that if I planned to be in bed with my baby for 12 hours at night then even with two-hourly breastfeeds I got a decent amount of sleep. Co-sleeping or bed-sharing safely can mean that you get a lot more sleep than if you are up and down all night feeding the baby.”

And on that note, when it comes to feeding, don’t be afraid to ditch the rulebook.

“Breastfeed on demand or when baby shows any cues of hunger or a need for the breast,” says Amy. “Newborns feel best when they can smell Mum and hear her heartbeat, although Dad makes a good temporary substitute. Just remember, this high-need stage passes quickly, although it feels like it will last forever. Don’t feel guilty or stressed about holding your baby and meeting that need for constant physical contact – it’s normal and it’s the best thing to help them grow and develop well. Before you know it they will be older and less dependent on you and you won’t regret any of the time you spent cuddling that tiny little baby.”

"Help, I’m failing at parenthood!"

If you’re finding it difficult, you’re not failing – you’re totally normal!

“Give yourself time to adjust to parenthood,” says Amy. “Studies show that it takes four to six months before new mothers really feel like they know what they are doing and their new normal seems normal. Dads can find it takes even longer. Also, keep in mind that the only constant when it comes to babies is change – whatever your baby is doing this week, it’ll be different next week. Just when you feel you can’t go on, the problem seems to resolve itself. Equally, just when you feel you’ve figure it all out and have become the expert, then baby will change and you will need to figure out the next thing.”

Keep in mind that the only constant when it comes to babies is change – whatever your baby is doing this week, it’ll be different next week. Just when you feel you can’t go on, the problem seems to resolve itself.

- Co-founder of Love Parenting UAE Amy Vogelaar

One of the hardest things to get to grips with is the continual sleep deprivation, but if you can let go of expectations, it’ll help to take the stress out of the situation.

“People asking whether your baby is a good sleeper and if they sleep through the night puts a lot of pressure on new mamas,” says Lily. “Follow your baby’s cues and try to implement a general routine that will help guide your day. All babies sleep for longer stretches eventually and if you let go of the expectation that your baby should sleep for eight hours straight by two or three months old, it’ll be a little easier to handle those night wakings.”

Remember that every baby is different and it will take some time to find your groove.

“Think about routines instead of schedules,” says Lily. “Babies are pretty good at falling into a routine and there are simple things we can do to help that along. Encourage your baby to eat her full meals during the day. Make daytime feeds social and lively but keep nighttime feeds calm and quiet to help her distinguish between day and night. Babies usually respond well to a bedtime routine so try to set a consistent one such as bath, massage, getting dressed and then a relaxing bed-time story or lullaby.”

Getting support in the UAE when things are tough

If you’re really struggling, there’s absolutely no shame in asking for help. In fact, it should be encouraged.

“Don’t try to do everything yourself,” says Amy. “New mothers who don’t have support and help from Dad or other family members can be at very high risk of postnatal depression. We didn’t evolve to raise our babies alone in a flat or villa in Dubai – we would have been surrounded by family members with knowledge and experience about babies who would help us by feeding and caring for mum and supporting mum to care for her highly dependent baby. Dads here don’t get enough (or any) time off to be with their new baby, which is very hard for the whole family. Again, the biggest surprise for most new couples is how labour- and time-intensive newborn care is. It really does take at least two adults working full-time around the clock to meet all those needs.

“Facing it as a team seems to work well for many couples – mum breastfeeds and then dad burps the baby or bounces the baby on a birth ball while mum gets a shower or a meal in. Lots of new mothers feel like they should be able to do it all themselves and feel guilty or inadequate if they need to ask for help. But it is not physically possible to do it all yourself and you will only be able to keep that kind of effort up for a limited time. If you don’t let someone help and if you don’t care for yourself, then the whole system breaks down and eventually your baby will suffer.”

If your partner works a lot and you don’t have any family nearby there are plenty of experts on hand to come to the rescue so factor this into your post-baby budget.

“Don’t be afraid to seek professional help once you are at home with the baby,” adds Hazel. “Unfortunately this is not provided by most hospitals, meaning you will have to seek support yourself, however there are some fantastic home-health-care facilities and clinics that can provide midwives, health visitors and maternity nurses to assist you with caring for your newborn.”

It can help immensely to join a mother and baby class or coffee morning so you can meet other women navigating the same stage – a browse on Facebook or Instagram should throw up plenty of due-date related local groups where you can join online or via WhatsApp for mutual support. Sharing stories can make all the difference to how you feel.

I wish I could turn back and have listened to my own advice, but I really think staying home and resting with your family and friends is so important.

- Joanne Hanson-Halliwell, founder of Small and Mighty Babies

“There is no one right way to raise a baby, so if a book or an expert or acquaintance is making you feel more stressed about parenting, then it is probably not the right route for you,” says Amy. “The secret reality about parenting is that it is mostly a trial-and-error process to figure out what works for your baby and your family. We all have to muddle through, especially in the beginning, to find our own path. Trust your instincts and your heart and evaluate all the advice that you will receive to see if it makes sense to you. We tend to think that everyone else has it figured out already, or that our baby wouldn’t cry at all if only we knew how to do it ‘right’. But, of course, all babies cry and nobody has it all figured out.”

Be mindful, too, that as new parents you will be offered a lot of advice and opinions, which may not always be helpful.

“Try to surround yourself with positive people and remember that parenting may not be complicated, but it is also initially not intuitive, so be kind to yourselves,” says Hazel. “Also, don’t always trust what you read on the internet. When you are sleep-deprived, your absorption of information is less accurate and less helpful, and this may only add to the feelings of isolation and confusion in those early weeks.”

Ultimately, no matter how at sea you feel, hold on to the notion that this is one of the most special and short-lived phases of parenthood.

“The fourth trimester is a time of profound growth and change both in the baby and the mother and it really should be a magical and even sacred time,” says Amy. “There will be tears – baby’s and yours – and there will be exhaustion and shock and anxiety as well, but try to enjoy and savour this period of your life as it will be gone before you know it and you will look back on photos in absolute wonder that your baby was ever that small and needy.”

As Joanne perfectly summarises: “There is so much pressure on mums these days to bounce back to ‘normal’. I wish I could turn back and have listened to my own advice, but I really think staying home and resting with your family and friends is so important. Malls, breakfast dates, park dates, play dates… these things can all wait. Instead, have a hot shower, tie your hair back and relax. You will have a toddler on your hands before you blink.”

HOW TO BOOST YOUR BREASTFEEDING KNOW-HOW

While breastfeeding may be the natural choice, it rarely comes easy to new mums, which can be frustrating – not to mention surprisingly painful at first. It’s recommended that all breastfed babies should be seen by a breastfeeding expert around three to five days after you have left the hospital and again around two weeks later to make sure feeding is going well, baby is getting enough and there are no problems like jaundice that need to be dealt with. Love Parenting UAE’s Amy Vogelaar has the following advice:

1) There are no health visitors here who will automatically come out and visit you unless you set it up and arrange for it. Thankfully, Babies and Beyond, Healthbay Polyclinic and Cooper Health Clinic all offer home visits after the birth and some health insurance plans may even cover these services.

2) Make the most of all the fantastic online resources available, such as Breastfeeding Q&A UAE and our Love Parenting UAE support groups on Facebook.

3) Once you feel ready to get out of the house with baby, join a free coffee morning (or find a virtual one) like the groups run at Healthbay Polyclinic, Kings College Hospital Dubai, Love Parenting UAE, Malaak and Babies & Beyond. These are often free and facilitated by a midwife or lactation consultant so you can get medical advice as well as social support from other mums.

4) Take a baby massage class or mummy-and-baby yoga class. Here you receive not only information, skills and advice, but also the opportunity to really get to know other new mums. For many of us, the friends we make in these classes during the fourth trimester are the closest friends of our adult lives. Bonding over breastfeeding and baby poop when our oxytocin levels are high and our hearts are open can make for very powerful life-long friendships.