Care in the 4th Trimester

The first 12 weeks after you give birth are considered the 4th trimester. This early postpartum period can be so difficult – mentally, physically, and emotionally. You are probably sleep deprived, you may have pain, and your body is healing, all while you are navigating how to care for a newborn. It can be a little overwhelming to say the least.

With all that is going on, care for your body can often take a back seat during this time and is often very limited. You go from seeing your provider biweekly or weekly during your pregnancy to seeing them likely only ONCE around 6 weeks after you give birth!

This has always blown my (Dr. Emily’s) mind. The shift of focus in healthcare goes from caring for your body and your baby inside of you to really just caring about your baby. We love our babies, but what about your body? You just “ran the marathon” of child birth or had a major abdominal surgery (C-section), and you only see your provider once?! You’re healing as you should, the doctor asks? Great! You then get a greenlight to do whatever you want to do now.

But what should you be doing during the 4th trimester? Women are often not told what to do or how to restore their body. Many are left to just figure it out on their own. This can lead to frustration, unintended challenges and confusion. Let’s discuss.

Where to Start in the 4th Trimester

It will take a long time to restore your strength, mobility, and posture, and that’s ok! These changes in your body took 9 long months to occur. It’s going to take AT LEAST 9 months to feel “back to normal.” It takes most women 12-15 months to get to this place. Be patient with your body!

There is a lot of progress you can make in these first 3 months of the 4th trimester. Knowing where to start can be so helpful. Here is a general guideline for exercises to begin with during the 4th trimester.

First 2 weeks postpartum:

• Rest and recover!
• Ice, ice, and more icing (perineal ice packs are fantastic for pain and healing, and you can also use them on C-section scars).
• Go on short, frequent walks when you feel ready. Begin with just 3 to 5 minutes. Just being upright and going on walks can help activate your pelvic floor and aid in recovery.

Weeks 2-6 postpartum:

• Begin this phase whenever your body feels ready for something beyond light walking.
• Begin this phase whenever your body feels ready for something beyond light walking.
• Breathing – Your diaphragm was pushed up and has not worked properly for the past several months. Practice getting your entire diaphragm functioning again. The following is a fantastic tool to demonstrate the concept of 360 Breathing.

• Posture – Work on your posture. Remind your body what good upright posture feels like. Baby was pulling you forward for the past several months. Focusing on restoring good posture will aid in healing your pelvic floor and diastasis recti (abdominal separation). Having good posture is especially important to prevent the onset of back or neck pain when feeding your baby, carrying your baby/a car seat, changing your baby’s diaper, etc.

• Reconnect with your abs – Your abs were significantly stretched out during pregnancy. Try these 2 exercises below to begin getting your abs to function correctly again. Working on your ab activation and strength will also help repair a diastasis recti (abdominal separation). If you’re unsure whether you are experiencing diastasis recti, here is a simple DIY test. We can provide a more thorough assessment in person as well.

• Activate your pelvic floor – Your pelvic floor had to handle a tremendous amount of pressure over the past 9 months. It doesn’t matter if you had a C-section or a vaginal delivery, your pelvic floor will need some work. Practice Kegels in several different positions. Note: Some women develop tightness in their pelvic floor during pregnancy, labor and delivery, or postpartum. If Kegels are uncomfortable or you experience pelvic pain, it is important that you see a pelvic floor physical therapist first to calm your muscles prior to strengthening them.

• Strengthen your glutes – Our glutes are important for stabilizing our pelvis and likely weakened during pregnancy. Strengthening the muscles surrounding your core will be helpful in restoring the function of your pelvic floor and abs

• If you had a C-section, begin massaging your scar around 6 weeks postpartum.
• As your body feels ready, progress to more difficult bodyweight exercises that strengthen your abs, glutes, and hips. Below are 2 examples of this.

Weeks 6+ postpartum:

• Begin with low to moderate intensity, low impact, 10-30 minute sessions of your exercise of choice, 3 days per week.
• Gradually and slowly increase intensity, time, reps/sets, and impact as your body can tolerate.
• When bodyweight exercises are feeling easy and you are experiencing no leaking, heaviness, or pain, begin adding weights.

Check out this blog post How to Return to Exercise Postpartum to learn more about progressing beyond this point and getting back into more intense exercise or your sport.

Listen to Your Body during the 4th Trimester

Often after having a baby, the advice women are given is to “just listen to your body.” But what does this mean? As you are returning to activity and exercise during this 4th trimester, there are symptoms you should watch for. These indicate you may be doing too much or that you may need to seek care from a pelvic floor physical therapist to address issues that arise.

The symptoms to watch for during the 4th trimester include:

• Leaking
• Heaviness
• Pain
• Increased bleeding
• Coning/doming in your abs

When to See a Physical Therapist in the 4th Trimester

If you are experiencing any symptoms (leaking, heaviness, pain, coning/doming in the abs) beyond 6 weeks postpartum, you should seek out pelvic floor physical therapy. These symptoms are not normal beyond the first few weeks postpartum, and they all can be fixed! The sooner you get them addressed, the faster you will be able to resolve your issues and prevent them from returning in the future.