New JGH program addresses mothers’ needs in the weeks after childbirth

Fourth Trimester reduces stress by honing skills and supplying practical information

Within days of giving birth to her daughter at the JGH, Maria Rivera received a phone call inviting her to participate in the Fourth Trimester, a new program that provides mothers with extensive postpartum skills and information.

Initially, Ms. Rivera was reluctant. As a first-time mother, she was finding it hard enough to cope with the considerable demands of a new baby, without committing herself to travelling—with her baby, Olivia, in tow—to the Goldman Herzl Family Practice Centre six times over the next three months.

Then reality set in: Why struggle in isolation to track down essential advice about her baby’s health? Why not pose her questions and concerns in person to a wide range of healthcare professionals at Herzl? Why pass up an opportunity to compare her experiences with those of other new mothers?

“It was the best decision I could have made,” says Ms. Rivera about her involvement in the Fourth Trimester this past summer and early fall. She was joined by her husband, Vincent Chicoine, at two of the sessions during his paternity leave.

Dr. Judy Hagshi, founder of the program, says that to her knowledge, the program is unique to Montreal and Quebec—and possibly even Canada.

Its name is derived from a term that was coined about five years ago by the American College of Obstetricians and Gynecologists, says Dr. Hagshi, who is a Herzl family physician with extensive experience in perinatal care. The strong implication is that the weeks immediately after childbirth deserve as much attention as the three trimesters of pregnancy.

Support from a team of experts

For this reason, a nurse and lactation consultant attend every session, along with one additional professional on a rotating basis: a physician (Dr. Hagshi), kinesiologist, social worker, psychologist or pharmacist.

Each two-hour session begins with a free-flowing discussion in which the parents compare notes about their baby’s development. This segues into a talk by the visiting professional, with plenty of time for questions.

Those feelings of confidence and comfort are bolstered by the fact that the mothers received care and counselling at Herzl during their pregnancy, Dr. Hagshi says. Thus, when they return for the Fourth Trimester, they already have a sense of familiarity and trust with the setting and the professionals.

Much of what makes the Fourth Trimester so special, Dr. Hagshi says, is the element of structure in its design: once the mothers have registered in the program, they receive a reminder before each session, just as they do for their other medical appointments at Herzl.

As a result, she explains, the moms see the Fourth Trimester as an important (though warm and friendly) skills-based healthcare experience, and this motivates them to attend all, or most, of the six get-togethers.

Planning a worthwhile trip

Ms. Rivera admits it wasn’t easy having to plan a trip to the JGH for herself and Olivia every other week for three months. “But when you get there, you have these amazing experts welcoming you and giving you exactly the information you need.

“When you get home, you have something to talk about with your partner and you feel proud of having gotten organized enough to leave the house. You also feel way more confident with your role as a mom.”

As a further benefit, the Fourth Trimester plays a key role in supporting maternal mental health, Dr. Hagshi notes. This is because, to a large extent, the advice and skills that the mothers receive have a direct connection to their ability to cope with the pressures of the first few months of parenthood.

For example, she says, the mother may feel stressed because the baby isn’t adequately latching onto her breast or because she’s getting too little sleep, which is often interrupted. These dilemmas, and more, are explored during the various sessions.

“Being able to learn skills does a lot for the mother psychologically,” Dr. Hagshi says. “In addition to finding out what the other mothers are experiencing, she’s able to get first-hand advice about dealing with her problems and lowering her stress level.”

While the Fourth Trimester has found its footing since its launch early in the winter of 2024, it’s at what Dr. Hagshi calls the “pilot-plus” stage. This means it’s accepting patients seen through Herzl’s Family Medicine Obstetrics Group, as well as those who were followed during their pregnancy by other JGH doctors on an ad hoc basis.

However, now that the program is gaining momentum, Dr. Hagshi is hoping to acquire the funds to be able to schedule sessions at least once a week and possibly to streamline the groups to provide care that meets the specific needs of certain cultural communities.

With that objective in mind, Dr. Hagshi has composed a motto that she says encapsulates her vision for the future of the Fourth Trimester: “It takes a village to raise a child; we have the ability and the duty to build the 21^st-century village that raises the child.”