Ask the expert: The fourth trimester, feeding, sleep and unsettled babies - £100 voucher to be won

[MaddyMumsnet]

The early weeks with a newborn - often called the “fourth trimester” - can be a time of huge adjustment. From frequent feeding and unpredictable sleep to crying and unsettled behaviour, it’s completely normal to have lots of questions as you get to know your baby.

We’ve invited Clare O’Brien, midwife and pediatric sleep consultant, to answer your questions about navigating life with a newborn, including feeding, sleep, routines and understanding unsettled babies.
You might want to ask:

• Why is my newborn so unsettled - and how can I soothe them?
• How can I tell if my baby is feeding enough?
• What’s normal when it comes to newborn sleep?
• When (and how) should I start thinking about routines?

Clare will be posting answers throughout April. Share your question by 13/04/2026 for your chance to win a £100 VEX voucher (T&Cs apply).

About Clare:
‘Clare is a registered midwife with over 12 years experience, including 5 years as aReproductive health and childbirth research lead. She has additional training in newborn behavior, bonding, reflux, allergies and sleep, and sits on various advisory boards of professional and consumer facing publications. She is the founder of ‘The Motherhood Midwife’, which supports new parents with feeding, sleep, routines and unsettled babies, and is a BioGaia ambassador.’

Hi @Chickenpotnoodle, Great question! From around 8-12 weeks, your baby will start producing their own melatonin (the sleep hormone) and their circadian rythems start to form. What we want to do is start to support this biological development. You can start by 'bookending' your night and day with a regular bed time and get up time to help build that circadian rhythm. I have a 4th trimester guide that talks through the 5 steps to set up good sleep foundations in the 4th trimester if you would like further support on this. Just visit my website www.themotherhoodmidwife.co.uk

Hi @LadyLapsang . I'm so sorry to hear about your experience. Unfortunately there is a bit of a postcode lottery when it comes to feeding teams and tongue tie services. Very few midwives are tongue tie trained and therefore it is often not picked up before you leave hospital. Then getting a referral to the feeding team after discharge depends on your hospital policy. Its definitely worth writing in a complaint through your hospitals PALS team to try and lobby your local NHS trust to change this.

Thank you

Hi @JacCharlton , These all sound like very normal symptoms of the fourth trimester. In the first 4-8 weeks, it is very normal for baby to sleep in short bursts distributed alsmost evenly between night and day and cluster feed a lot too. Around 8-12 weeks, baby starts to produce their own melatonin (sleep hormone) and their circadian rhythems start to develope. At this stage, bookending night and day (getting up and going to bed around the same time every day) can help to form a bit of a structure. Keeping the enviroment dark, calm and quiet at night can also be helpful. I have a 4th trimester sleep foundations downloadable guide on my website that you might find useful. https://www.themotherhoodmidwife.co.uk/downloadable-guides._ I also talk through some soothing techniques on my instagram page which might be helpful too. https://www.instagram.com/reel/DWUZnTDjPyt/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA==_

Hi @ruqiya1965 , This can be normal, but should be monitored closely by your midwife. Other signs baby is getting enough is at least 6 wet and at least 4 dirty nappies a day. I would advise her to get some support from the feeding team if there is one to help her build supply too.

Hi @Backatasda , This is very normal for babies still in the third trimester. You may have heard of the term 'the witching hour' where babies become very unsettled in the evening. This is because cortisol rises throughout the day. Fussy behaviour when they are fed and clean can often be a sign of tummy discomfort, so I would alway recommend winding them well and then trying some skin to skin contact or a warm bath to sooth them in the evening. Try and ensure they don't get overtired and look out for those first signs of tiredness (staring into space, jerky movements, fussing) and try to support them off to sleep. You cannot make bad habits at this age, lots of cuddles and comfort is completely normal.

Hi Saffysabir, It really depends on how old baby is. But if they are days/early weeks and not reached birth weight yet, i would recommend getting in touch with your feeding team for some support. We do need to be waking baby for their feeds if they dont wake during this early period.

Hi @Maycottage , A breastfed baby under 6 months should not be given any water unless for medical reasons under the supervision of a doctor. Your breastmilk is there to both quench their thirst and nourish them, there is no need for water in addition to milk. Babies tummies are so small that if you give them water, it may fill them up but actually they aren't getting any nutrients and can become unwell.

Hi @Hattiesbag , There is no set age for this but as a general rule, wait until your milk is in, your baby is able to attach to the breast with minimal assitance and is feeding well. Generally this is around 2-4 weeks old. At this stage you can introduce a bottle should you wish. I have a really helpful combi feeding series on my instagram that talks through the best techniques. its linked here: https://www.instagram.com/reel/DXe6koNOOsm/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA==

Hi @Junkoenoshima , I would recommend continuing to feed on demand, but you can build some structure to your day if you would like. its only around 8-12 weeks that a baby sets their circadian rythem and starts to produce their own melatonin (sleep hormone), so this is the time to introduce some light structure if you want to. I have a really helpful guide on the first 5 steps whichis linked here: https://www.themotherhoodmidwife.co.uk/downloadable-guides

Hi Haleyscomets, This is definitely down to personal preference. However I do think a side by side cot in the early weeks is most practical for settling and ease of access for night feeds and then a stand alone cot in their room after 6 months.

Hi @CopperPan great question and this is always tricky. First thing to accept is that things wont be exactly the same when you have a toddler to juggle, however, the younger sibling gains so much for the older sibling it makes up for it! I would recommend having a small box of exciting new toys that are saved just for when you are feeding the baby. This way your toddler is happy and distracted for some of the feeds with thier new toys. Snacks or TV can also be good distraction, asking for help and sometimes giving them a doll to 'feed' too can be useful.

Hi @Salemaxo , Yes the guidance is 6-8. Could it be that you are missing that they are wet as well as dirty? Sometimes its hard to see that they are also wet. If not I would recommend chatting to your health visitor or midwife and make sure the the baby's weight is tracking

Hi @alshareif , No dummy’s aren’t a ‘bad’ thing, they can be a really useful tool for some babies. As they get older it is best to only use them for sleep to avoid it affecting their speech. In terms of head shape, if it is cone shaped due to the birth, this usually rectifies in a few days, for anything else, I would speak to your midwife/health visitor or GP as special pillows aren’t usually recommended as they increase the risk of SIDS.

Hi @Britanniahouse , You can't ever really know how much they are getting when they are breastfeeding, however signs they are getting enough is plenty of wet and dirty nappies (at least 6 wet within 24hrs, dirty depends on the age), getting them weighed regularly to ensure they are following their weight centiles. In terms of food, other than limiting caffeine and alcohol, there is nothing you have to avoid. Having said that, some babies are sensitive to what a mum eats, so you may notice baby is windy or uncomfortable after particular foods. In terms of suppliments, you need to be taking a vitamin d suppliment, if you had a large blood loss at birth, it might be worth asking your midwife to check your iron levels and possibly take an iron suppliment if needed. Otherwise a healthy and varied diet is best.

Hi @BiddysShed, premature babies have slightly more immature guts and can be prone to tummy issues like trapped wind and are at a slightly higher risk of things like cows milk protien allergy and reflux. If they are persistently unsettled, it may be worth having a chat with your GP about this. I have lots of helpful videos on how to soothe a baby on my instagram. https://www.instagram.com/the.motherhood.midwife/

Hi @HannahP1209, no you cant overfeed a breastfed baby! signs that they are getting enough include at least 6 heavy wet nappies a day (poo's vary by age, but at least 3-4 at 1 month old) and getting them weighed regularly to ensure they are following their centiles. If you are concerned at all, its best to seek support from your midwife, health visitor or feeding team.

@MaddyMumsnet @EllieSmumsnet @LibbyMumsnet

The winner for this has still not been picked.

The winner of this threads VEX voucher was @alshareif - Thank you to all who took part in the discussion with Clare 😊!