If you've been pregnant, then you know what that last trimester of pregnancy is like. Feet sticking in your ribs. Reflux that won't stop. Not being able to talk without breathlessness. Moving seems like an insurmountable task. You think once this is all over, you'll be free to have your body back. But then you deliver your baby, and the 4th trimester hits. This is the trimester nobody talks much about. But it is every bit as important as the other 3 trimesters.
So what the heck is the 4th trimester?
The 4th trimester is the period between the birth of your baby and 12 weeks postpartum. This trimester is a time of immense change and adjustment for you and your baby. And the transition is sudden- you go from being pregnant to not being pregnant in a matter of hours. Your baby is learning how to survive outside the womb. Your body is balancing hormones as it shifts out of pregnancy mode and working on restoring all body functions back to “the new normal.”
Most moms feel totally unprepared for this trimester. It's a wild journey. The sleepless nights. Adjusting to taking care of a newborn. Breast engorgement. Recovery from stitches. Pain. Bleeding. And a whole host of other physical and emotional changes no one talks about, and the healthcare community glances over.
The emotional challenges of the 4th trimester.
After birth, a mom's world turns upside down. You just had a baby, your hormones are shifting, and the self-doubt is real. You're filled with questions like:
What is this little human trying to tell me?
Why is he crying?
Why won't she sleep?
Does her skin look normal?
Is it normal for my baby to sleep this much?
While trying to figure all this out, you're wondering if you're breastfeeding right. Is your baby getting enough to eat? Are you doing enough? All while running on empty from the sleepless nights and lack of eating from being too damn tired to eat. Yeah, I've been there too. It's no wonder that according to the American Academy of Psychiatry, 1 in 7 women experience postpartum depression, 17% experience postpartum anxiety, and 70% experience the "baby blues."
Having a support system in place to help you during this time is essential. If you feel you have postpartum depression or anxiety, please reach out to your healthcare provider for help.
Physical Challenges of the 4th trimester.
Let's state the obvious- you just GAVE BIRTH! Despite what some may say, your body needs time to heal. You're discharged from the hospital after vaginal or Cesarean birth and now need to take care of a tiny demanding human, and you're exhausted.
You have pain from things like:
Postpartum uterine contractions
Hemorrhoids
Stitches
Swelling
Learning to breastfeed
Breast engorgement
Pelvic pain
Hormone changes and fluctuations have you feeling wack-a-do, causing mood swings and night sweats.
Perhaps now you're experiencing incontinence or constipation from pelvic floor trauma. No one tells you about these things before you give birth OR how to deal with them. And this has to change.
A lack of continuity of care.
The United States is severely behind in its postpartum and maternal care compared to other countries. 79% of maternity leave for mothers in the U.S goes unpaid. Forcing some moms to return to work at 6 weeks postpartum, not being able to afford lack of pay for the 12 weeks leave FMLA will afford.
This lack of paid maternity leave reduces time to bond with your baby, increases a mother's feelings of guilt and inadequacy, and forces a return to the workforce before your body has a chance to heal.
And the absence of healthcare services for a mom during this time is outrageous as well. You just birthed a baby, perhaps even have stitches from tearing, an episiotomy, or a C-section, and are sent home without a second look for up to 6 weeks. Women go through this trauma of birthing a tiny human. Then are left to "fend for themselves" by our healthcare system. They leave it up to new moms and dads who are unfamiliar with this situation to identify the signs of psychological issues and any abnormalities going on with their physical bodies.
At all of the prenatal visits, there is minimal education about what the 4th trimester is, what's normal healing and what isn't, or how to identify postpartum depression. Thankfully, The ACOG has recently recommended a reduction in wait time for a postpartum check-up from 6 weeks to 3 weeks to improve the continuity of care from pregnancy to postpartum.
How to heal and survive in the 4th trimester.
Momming is hard. Momming in the 4th trimester is even harder. It’s unreasonable to expect moms to go through this alone without support. And that's why I'm here -to help change the care that moms get after birth. We as healers and healthcare providers need to start supporting momma's in the period immediately following birth - not just in the weeks leading up to it.
You probably got tons of advice on taking care of your baby. I bet very few of you got advice on taking care of yourself and what unexpected things might be awaiting as you recover. Knowledge is everything in preparing for postpartum.
Tips for surviving the 4th trimester.
Make a plan.
Work with a pelvic floor physical therapist before you give birth to begin strengthening your body for labor and recovery afterward. Continue to work with this therapist postpartum to help guide you as you start the healing process. I offer a perinatal bundle to walk you through every stage of pregnancy and postpartum from the expertise of a doctor of movement and a 3-time survivor of the 4th trimester.
Create your support system.
Talk to your partner about what support you think you will need postpartum. Talk to family and friends about how they can support you during this time. This could be things like
Meal prep or grocery shopping - this can be as simple as picking up your curbside order.
Household chores - as easy as starting or transferring a load of laundry.
Holding the baby so that you can nap, do self-care, or shower.
I highly recommend working with a lactation consultant to make sure breastfeeding gets off to a solid start.
Don't feel bad for reaching out to your healthcare provider - your general physician, your OB or midwife, or even me - your PT! Discuss with them your postpartum care BEFORE birth. Ask what to expect and when to call if you're worried.
Taking these steps can put your mind at ease and help reduce your stress and anxiety as a new mom.
Take time for yourself.
Yes, this is extremely hard to do with that sweet little angel to watch 24/7. But you need to sleep, eat, and take time for self-care as well. You can't be the best mom you can be without fulfilling your basic needs as well as your baby's.
Move.
It sounds simple but can seem daunting when you're tired and just wanna hold that little baby. Some easy ways to fit some movement are:
Take baby for a walk in the stroller or while babywearing
Go for a walk alone - you’ll be amazed at how refreshed you feel when you arrive back home!
Use my Top 5 Pregnancy and Postpartum Exercise Guide to begin transitioning back to exercise
It doesn't have to be vigorous movement. Gentle movement and staying consistent are the best ways to begin the healing journey.
Reconnect to your pelvic floor.
Pregnancy causes your inner core musculoskeletal system to go out of sync. We need our abdominals, pelvic floor, and diaphragm to all work together for optimal function of this system so that we can move, poop and pee, have sex, and even breath! Piston breathing is the best, most efficient, and easiest way to gently reconnect these pieces together. You can even start to do this immediately after birth!
The takeaway.
The 4th trimester is a difficult period of adjustment where you may not be sure what's going on or how to deal with it. Surrounding yourself with a support system and healthcare professionals like a pelvic floor physical therapist can greatly improve the postpartum healing process.
Some things a pelvic floor PT can work on with you include:
Pelvic floor trauma
Scar tissue and adhesions
Incontinence issues
Constipation issues
Positioning techniques for breastfeeding
Return to sex postpartum
Pain with sex
And the list could go on and on. Healing your body is so important after birth. You are worth the time and energy it takes to help healing occur.
If you have any questions about healing in the 4th trimester, please reach out and let me know! As always, you can grab my Top 5 Pregnancy and Postpartum Exercises to start your healing journey. If you're suffering from abdominal separation, consider my CORE+ Healing Diastasis Rectus Abdominus Masterclass to heal diastasis recti postpartum.
References:
https://www.aafp.org/afp/2019/1015/p485.html
https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression
https://www.nytimes.com/2021/10/25/upshot/paid-leave-democrats.html