fourth trimester program helps new moms: ‘just because the baby is out doesn’t mean the pregnancy transition is over’

among her responsibilities as a family doctor, judy hagshi followed women during pregnancy and helped to deliver their babies. as she prepared to give birth to her first child 26 years ago, “i thought i had it in the bag.“and then my daughter was born and it hit me like a truck. i was so overwhelmed — and so shocked that i was so overwhelmed,” recalled hagshi, a staff physician at the jewish general hospital's goldman herzl family practice centre."i felt like i was drowning and couldn’t even ask for help.”all new mothers feel overwhelmed to some degree. but it took hagshi months to recover and more than a decade to even talk about the difficulty she’d had adjusting to her new role as a mother.with her second and third babies, she knew what to expect. yet reflecting 10 years ago on how she struggled when her eldest was born, "i said: 'no one should have to suffer like i did. we have to do something.'"slowly, hagshi developed a program at herzl to help make the transition to motherhood easier. the idea of the fourth trimester program, which she founded and directs, is that the weeks immediately following childbirth — the so-called fourth trimester — merit as much attention as the three trimesters of pregnancy.“towards the end of pregnancy, women have weekly visits with their doctor — and then the baby is out and it’s ‘we’ll see you in six weeks,’” said hagshi, 55. "but just because the baby is out doesn’t mean the pregnancy transition is over.”why not speak openly about the challenges new mothers face, she reasoned, and offer support to smooth the transition as much as possible? “i didn’t want women to have to seek us out. it is so difficult to ask for help: i wanted it to be handed to women on a silver platter. you have gone through probably one of the biggest transitions of your life. we are going to give you a community."ideally mothers join the program, which meets in a group, soon after giving birth. "we aim to provide information and support before many women even get to their postpartum visit, which generally is six weeks after delivery,” said hagshi, who shifted her focus to perinatal mental health about four years ago after years as part of the herzl's family medicine obstetrics group.“we want to empower women at a time when they may feel overwhelmed by their new roles and responsibilities.”the program brings together experts who provide both practical skills and mental health support in four consecutive weekly sessions at herzl: a pelvic-floor physiotherapist, a psychologist, a pharmacist and a social worker. nurses attend some sessions to answer general medical questions.many mothers join the program, now in its third year, two to four weeks after giving birth and "we talk a lot about this adjustment period, about how the whole dynamic is changing. we offer a lot of support," said elana zelikovic, a pediatric dietitian and infant feeding specialist and the program's associate director. she facilitates each session, which features a presentation by an expert followed by a q&a period.the baby is important, hagshi tells mothers, but “we are here to make sure you are ok."

naomi salama planned to join the fourth trimester program the week after the birth of her first child, daughter talia hazan, in february. then she gave birth — and realized: “oh, this is really hard."that first month, i was just in a complete haze of panic and crying and hormones,” she recalled. (estrogen and progesterone levels drop quickly after childbirth and often cause temporary mood swings, weepiness and anxiety.)six to eight weeks after her daughter's birth, salama, 28, was ready. the program, she said, "was a great opportunity to leave the house."at the sessions, "one question would roll organically into the next topic and another question, and someone would say, ‘oh, me too!' it’s just so validating."salama, a teacher, had attended a pre-birth orientation session by hagshi. "she was very much like, ‘i had no idea what i was doing and i felt completely isolated and it was hard,'" salama said. "that’s the whole reason she started the program. it's a great concept."i think every place where women give birth should have a program like it."the fourth trimester program is available only to the jewish general community; many women learn of it through flyers in their doctor’s office or posters around the hospital. initially for herzl patients alone, it expanded to women giving birth through the hospital's obstetrics department and those whose babies were in the neonatal intensive care unit.audrey boily had her son, gabriel, in early january at the jewish general and joined the program when he was about four weeks old. initially, "i just wanted to populate my schedule after giving birth, and to have something to go to every week," she said.“when you start out as a mom, often you have a lot of questions about breastfeeding. it was useful to have those questions answered by professionals, but also good to see that other new moms had the same questions and worries,” said boily, 30.“you're not sleeping. you need to deal with your partner and with family. there is the hormonal drop. it was more about feeling supported and about knowing that, the next week, i would meet these moms and feel less lonely."zelikovic answered her questions about breastfeeding and boily liked “her openness and her being so welcoming.”and the pelvic-floor physiotherapist session was useful "to have a base of how to take care of yourself after giving birth. she would give us simple exercises ... i play ultimate frisbee and i wanted to go back to sports and to get back to my friends." boily returned to sports after four months.in addition to providing information, each session is an opportunity for a wellness check, said zelikovic — as in, “how are things with sleeping, feeding, your mother-in-law?”

most participants bring their babies. "at first, i left my baby at home to be in a space where i could focus on learning about my baby and having conversations with adults," said boily, a lawyer. "it also gave me a break." she did, however, bring gabriel to her group's final session.it was “heartwarming” to see mothers with their babies and some grandmothers in attendance, she said.“i also made friends through the program," she said. "we are all moms and all on mat leave and the five of us see each other fairly often. we get together with the babies: we have gone walking, for coffee and to a pool."said zelikovic, 35: "there really is this craving for the village, for community — even if you are not all exactly in the same place. you see the evolution within a month and you see the confidence build." it's helpful for new mothers to meet moms whose babies are a couple of weeks older than theirs and who say "we were there."arielle morgan, a family doctor at herzl, was in the fourth trimester's first cohort, in early 2024. her daughter, sophie, was eight weeks old. morgan was a resident in family medicine at the time and hagshi, her supervisor at herzl, had recommended the program."even hearing from other moms that they were having similar struggles was helpful," said morgan, 34. "the program gives you confidence and some skills to get started."it was helpful to chat with other mothers and useful to hear from experts. "i do remember feeling so much uncertainty and questioning and anxiety — and you are so exhausted and everything is so emotional at the beginning. you can’t believe you are responsible for this little being," she said."you are followed so closely during pregnancy — and then you leave the hospital with a baby and feel alone."morgan, who is expecting a second child in october, had followed pregnant women and infants as a medical resident and "i expected i would have a leg up on some of the other moms. but even being a doctor doesn’t necessarily train you for the challenges of being a new parent."financial and human resources from the hospital helped get the program started: hagshi credits herzl head nurse mina ladores and herzl chief dr. mark karanofsky for their input and collaboration. outside specialists are paid through community donations to the hospital foundation, and several of the program's clinicians work at herzl. recently, some funding was secured from the hospital's auxiliary.the fourth trimester program costs about $25,000 a year to run; with funds unavailable through government, “we need financial support in order to sustain and expand the program to reach more people,” hagshi said."it takes a village to raise a child. we have the ability, and the duty, to build the 21st-century village that raises the child.”to learn more, go to herzl.ca, click on services, and scroll down to fourth trimester program. to register, contact rose at 514-340-8222, local 24728.