The Fourth Trimester: Prioritizing Women’s Postpartum Healing

With the focus on a new baby, it can be easy for new parents to overlook postpartum recovery. The period from birth to three months after delivery – the fourth trimester –  is as significant as pregnancy for women’s health, says Robin Berringer, a certified nurse midwife with ProMedica Physicians Group. “New mothers’ bodies need time and care to recover from the demands of pregnancy and childbirth, whether the delivery was vaginal or through C-section. Postpartum care is critical to a woman during that important transition in her life.”

Key Recommendations for Postpartum Healing:

  1. Rest, rest, rest!  
  2. Eat nourishing, healthy foods. The few weeks following birth is not the time to focus on losing weight.
  3. Drink lots of water. Drinking more fluids helps you lose the water weight that builds up during pregnancy.
  4. Start walking as soon as you have clearance (usually within the first 24 hours after delivery). Try for a little more each day! Walking helps with constipation, boosts circulation, and improves muscle tone and mood.
  5.  Accept help. Enlist support from family, friends, and community resources.
  6. Avoid smoking, alcohol and drug use as the body heals.
  7. Listen to your body. It may take longer than six weeks (sometimes months) before you feel ready for activities such as intense workouts or sexual activities.
  8. Don’t forget to start planning for contraception!

Common Postpartum Concerns and Care
Numerous studies show that new parents feel unprepared for the physical changes that happen after giving birth. Here is a quick guide to the most common concerns and care tips:

Perineum
Concerns: This area between the vaginal opening and the anus can have pain, swelling, tearing, and stitches.
Care: Ice Pack, pillow for sitting on, witch hazel pads, sitz baths, warm water squirt bottle before and after urinating to ease discomfort and keep area clean. 

Pelvic Floor
Concerns: Stretched, strained, or injured pelvic floor muscles which support the uterus, bladder and rectum. May cause you to urinate when sneezing, coughing, or laughing.
Care: Kegel exercises and pelvic floor physical therapy. 

Vaginal Bleeding
Concern: A heavy flow is typical and will likely ease up after 3-10 days.
Care: Wear a menstrual pad (no tampons). 

Cramping/Afterpains
Concern: Uterine contractions are part of the natural healing process, but can be painful.
Care: Heating pad and over-the-counter pain reliever. 

Breast tenderness
Concerns: Sore, engorged breasts.
Care:

  • If not nursing, wear tight fitting bras, use a cold compress, and avoid heat
  • Frequent nursing or pumping 
  • Warm washcloths or shower before feeding or pumping
  • Cold wash clothes between feedings
  • If you have pain when feeding, seek out a lactation consultant. 

Hemorrhoids and Constipation
Concern: Pain and itching around the anus; inability to move bowels.
Care: Over-the-counter hemorrhoid cream, witch hazel, increased fluids and fiber. Avoid straining and do use stool softeners if needed.

Diastasis Recti
Concern: Separation of the left and right sets of abdominal muscles or a lower abdominal protrusion that doesn’t resolve after 12 weeks postpartum.
Care: Muscle retraining with a pelvic floor physical therapist. Traditional abdominal exercises can worsen the condition.

Emotions
Concern:

  • Hormonal changes can cause emotions to be more intense
  • 70-80 percent of women experience mild sadness (also known as the “baby blues”).
  • Postpartum depression is a serious condition

Care: Seek professional help If baby blues last more than a couple of weeks. 

Beringer emphasizes that postpartum recovery isn’t just physical – all aspects of a person’s wellbeing are impacted. “It’s physical, emotional, and social,” she says.

Follow-up appointments with a health provider create the opportunity to address issues before they become more serious.

“Go see your provider. Follow up. The baby has appointments, and most moms make it to those, but they can sometimes forget about themselves.”

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