The Fourth Trimester
The publisher gratefully acknowledges the generous support of Jamie Rosenthal Wolf, David Wolf, Rick Rosenthal, and Nancy Stephens as members of the Publisher’s Circle of the University of California Press Foundation.
The publisher also gratefully acknowledges the generous support of the General Endowment Fund of the University of California Press Foundation.
The Fourth Trimester
Understanding, Protecting, and
Nurturing an Infant through
the First Three Months
Susan Brink
UNIVERSITY OF CALIFORNIA PRESS
Berkeley Los Angeles London
University of California Press, one of the most distinguished university presses in the United States, enriches lives around the world by advancing scholarship in the humanities, social sciences, and natural sciences. Its activities are supported by the UC Press Foundation and by philanthropic contributions from individuals and institutions. For more information, visit www.ucpress.edu.
University of California Press
Berkeley and Los Angeles, California
University of California Press, Ltd.
London, England
© 2013 by Susan Brink
Library of Congress Cataloging-in-Publication Data
Brink, Susan (Susan Frances)
The fourth trimester : understanding, protecting, and nurturing an infant through the first three months / Susan Brink.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-520-26712-1 (cloth : alk. paper)
eISBN 9780520954519
1. Infants—Development. 2. Infants—Care. 3. Newborn infants—Development. 4. Newborn infants—Care. I. Title.
HQ774.B755 2013
| 649’.122—dc23 | 2012013037 |
Manufactured in the United States of America
20 19 18 17 16 15 14 13
10 9 8 7 6 5 4 3 2 1
In keeping with a commitment to support environmentally responsible and sustainable printing practices, UC Press has printed this book on Rolland Enviro100, a 100% postconsumer fiber paper that is FSC certified, deinked, processed chlorine-free, and manufactured with renewable biogas energy. It is acid-free and EcoLogo certified.
To Max, Makayla, Maggie, Ariana, Carissa, and Molly
And in loving memory of Nancy
CONTENTS
Preface
Introduction: A Transition from the Comfort of the Womb to the Reality of the World
1. Evolution and the Primitive Brain of a Newborn: Why Infants Arrive Unfinished
2. Crying: The Wakeup Call That Says Everything Has Changed
3. Sleeping: Irregular and Sporadic Sleep Is Normal in the Fourth Trimester
4. Feeding: Breast Milk and Formula
5. Sound: Laying the Foundation for Speech
6. Sight: From Forms to Faces
7. Touch: Pain and Pleasure
8. Physical Development: Getting Ready to Crawl, Walk, and Run
9. Stimulation: Keep It Real, Keep It Simple
10. Mom and Dad: The Parents’ Fourth Trimester
Notes
Acknowledgments
Index
PREFACE
My commitment to write a book about the newborn’s first three months comes from my own life. I married very young and have two daughters and six grandchildren. Yet nothing from my maternal experience or from my professional background as a journalist specializing in science and medicine eased me or my grown children through the sudden shock of being completely responsible for the life and development of a brand-new human being.
On my desk I have photographs that tell the story. The snapshots I took a few days before my daughters became mothers show them proudly posing with their full-term pregnant bodies in profile, their smiles broad and genuine. Then comes a shot of my daughter Jenny, triumphant with her newborn Max, but her smile has become uncertain. The same uncertainty is written on Rachel’s face in yet another snapshot, her eyes wary and full of doubt, posing with one-day-old Makayla. As brand-new mothers, my daughters had had their confidence seriously shaken.
I look at those photographs and recall my own shock decades ago when nurses handed over my firstborn. How could they be so reckless as to entrust a helpless new human being to clueless me?
We all made it through, my daughters and I, as new parents do. Yet I know that for the first three months we relied on trial and error, intuition, dumb luck—and the passing of time.
Three months, said pediatricians, other mothers, friends, and family. Just hang in there for three months, and the mysterious and demanding infant will become more human, more like the baby you imagined. Since embarking on the research for this book, I understand in a deeper way why, during the fourth trimester of development, an infant is not like the baby that people imagine. I want others to be able to do more than just hang in there while they anxiously wait for three months to pass. This book is for parents, grandparents, friends, family members, physicians, and students, every single one of them eager to do the right thing by each infant he or she encounters. I want everyone who is in awe of and in love with a newborn to understand exactly how to protect and nurture an infant during the first three months of life—the critically important fourth trimester.
Susan Brink
Introduction
A Transition from the Comfort of the Womb to the Reality of the World
Like parents everywhere, David and Tammy DiGregorio were under the illusion that they were ready for the arrival of their firstborn child. They knew she was a girl and that they would name her Ava. The West Hollywood parents had carefully gathered an extensive array of newborn equipment, read the recommended books, taken Lamaze classes, practiced panting and breathing for her birth, and attended newborn classes offered by their hospital. And sure enough, the birth, delivery, and hospital stay went off without a hitch.
Then they brought Ava home, and all anxiety broke loose. “I was terrified,” says Tammy. “I was handed this little baby, and it was a complete shock. I was so tired and so scared; I felt like I was in a whole other world,” she continues. “And I was terrified of making a mistake.” As for baby Ava, well . . . “She was like a strange little alien.”1
Such is the coming-home of many, alas most, newborns who are long awaited and eagerly welcomed. Before women even have time to complete a full sigh of relief signaling the end to forty weeks of awkward discomfort, they find themselves facing even greater challenges. Only now, with actual infants in their arms, they have far less control. Ava, like any newborn, was barely equipped to stay alive. Tammy and David were suddenly face to face with the most neurologically immature of all the earth's primates, born months before she was anywhere near ready to function in the world.
Parents around the world who welcome mysterious new life in this way encounter a significant void in up-to-date scientific information about the first days and weeks of infancy. With fingers crossed, they confront their uncertainty and fears.
This book presents