Ashli Hull brings both professional expertise and personal experience to her work supporting families through pregnancy, birth and the postpartum journey. As a dedicated maternal and child health professional — and the mother of 14-year-old Kenli — Hull is deeply committed to ensuring that families feel informed, supported and cared for during one of life’s most exciting yet scary transitions. She currently serves as program manager for a Pittsburgh’s Healthy Start Inc. Here’s her best advice for parents entering the “fourth trimester.”
Some people say that “the fourth trimester starts in pregnancy.” What do you think that means?
The fourth trimester is often described as the first 12 weeks after birth, but in many ways, it begins during pregnancy because that is when the preparation should start. Pregnancy is not only about preparing for labor. It is also about preparing for recovery, identity shifts, feeding decisions, relationship changes and support needs. We spend so much time talking about gender reveals, baby showers, nurseries and due dates but not enough time talking about what happens when everyone goes home and your new life as a parent begins. In my experience, the parents [who] feel more grounded postpartum are often the ones who prepared for healing, meals and rest.
In your work, what’s the biggest disconnect between what parents expect postpartum life to be like and what it actually is?
Many parents expect postpartum life to feel joyful, natural and instinctive right away. They think once the baby is here, everything will click. With time it will, but what it often feels
like is exhaustion, emotional ups and downs, healing while caring for a newborn, feeding around the clock and trying to function on very little sleep. Joy can come with moments of grief, overwhelm, confusion and feelings of loneliness. All can coexist. I remind families that struggling does not mean they are failing. Rather, it means they are adjusting to one of the biggest life transitions a person can experience.
What are the most common things that blindside new parents after birth?
Sleep deprivation! People know they may be tired, but they often do not realize how cumulative sleep loss affects mood, patience, memory and confidence. Another surprise is how frequent newborn feeding can be. Many babies feed every two to three hours, and sometimes more often. That can feel relentless if no one prepared you for it. Parents are also often surprised by how emotional they feel, how much their relationship dynamics shift and how physically demanding recovery can be even after an uncomplicated birth.
How does lack of nearby family or support systems impact postpartum recovery?
Support truly matters. When families do not have nearby help, recovery can quickly become survival mode. Parents may skip meals, delay showers, ignore pain, isolate themselves or feel like they have to carry everything alone.
But healing happens better in community. Even if family is not nearby, support can still be built through friends, neighbors, doulas, parenting groups, faith communities and trusted
professionals like a home visitor.
When should parents in our area start looking for a pediatrician? What should parents ask or look for when choosing a pediatrician?
I encourage families to begin looking during the second trimester and aim to choose someone by the third trimester. That gives time to ask questions without pressure. Look for a provider who is clinically strong but also respectful, responsive and willing to listen.
For those who want to breastfeed their child, how can families find a qualified lactation consultant locally?
Start by asking your OB provider, midwife, pediatrician, birthing hospital or local maternal health organizations. Many communities also have breastfeeding support centers, home visiting programs and peer support groups where parents can connect with others who have shared similar experiences.
Look for credentials such as IBCLC or trained Certified Lactation Counselors with strong experience.
What should parents do if breastfeeding isn’t going well — and how soon should they seek help?
Seek help early and often. The sooner support is received, the easier feeding challenges can often be addressed. Early intervention can help families continue breastfeeding longer
if that is their goal. Many parents wait because they think they should be able to figure it out on their own. Please do not suffer in silence. Getting support early can make a meaningful difference for both parent and baby.
How do systemic issues impact maternal and infant health outcomes in this region?
Systemic issues shape health long before labor begins. In Pittsburgh and across Pennsylvania, barriers like limited access to healthcare, unreliable transportation, housing instability, food insecurity, chronic stress and bias in healthcare systems can all increase risks for mothers and babies.
In Allegheny County, we see these disparities clearly. Black infants are more likely to die before their first birthday, and Black mothers experience higher rates of pregnancy-related complications and poorer birth outcomes than white mothers. These outcomes are not because something is wrong with Black families. They reflect inequities in access, treatment and support.
Maternal and infant health is not only about individual choices. It is also about whether families have the support and resources they need to thrive. When families go unheard or are navigating systems without help, outcomes suffer. When families have stable housing, trusted providers, paid leave, breastfeeding support and strong community-based care, outcomes improve.
If you could give every expecting parent a simple “before baby arrives” checklist, what would be on it?
I always say proper planning prevents poor performance. My list would consist of:
• Choose a pediatrician.
• Learn newborn feeding basics.
• Understand postpartum warning signs.
• Prepare easy meals.
• Set up sleeping and diapering spaces.
• Pack your hospital bag early.
• Talk openly with your partner about roles and expectations.
• Make a support list of who can help with meals, laundry, errands and emotional support.
• Identify lactation support.
• Know who to call when you feel overwhelmed.
What local resources or supports should every family have on their radar before delivery?
Before delivery, families should know that they do not have to figure everything out alone. One of the best things you can do during pregnancy is build your support team early so you know exactly where to turn once baby arrives.
A few local resources every family should have on their radar include:
Healthy Start, Inc.
Healthy Start is one of the strongest maternal and infant health resources in our region. This organization offers support during pregnancy and postpartum through programs like home visiting, doulas, breastfeeding support, fatherhood programming, mental health support and connections to community resources. For many families, this can be a life-changing support system.
WIC
WIC is incredibly valuable for nutrition support, breastfeeding help, formula assistance when eligible and healthy food benefits during pregnancy and after baby arrives. Many families qualify and do not realize it.
Lactation Support
If you plan to breastfeed or even think you might, identify lactation help before birth. Having someone to call in those first few days can make a major difference. Trusted local options are Healthy Start Center for Urban Breastfeeding, Pittsburgh Black Breastfeeding Circle and Breastfeeding Center of Pittsburgh.
Postpartum Mental Health Support
Every family should know where to turn emotionally, too. Postpartum mood disorders are common and treatable. Pittsburgh has local support groups and counseling resources for new parents.
A Pediatrician Chosen Before Birth
Do not wait until labor if possible. Choose your pediatrician during pregnancy so that first newborn visit feels less stressful.
Your Personal Village
I always tell families to identify three people before birth:
1. Who can bring food
2. Who can help with chores
3. Who can support you emotionally
If every expecting parent could hear one message from you before their baby arrives, what would it be?
Give yourself grace. You are not just welcoming a baby. You are becoming a new version of yourself. That takes time. Trust your body, trust your intuition, be patient with healing and, most of all, ask and accept support.
Carrie Woodard is a National Certified Counselor, National Certified School Counselor and a Pittsburgh mama of two.
