The fourth trimester is a way to describe the 12-week postnatal period immediately after giving birth, and is a huge adjustment period for baby, parents and family. It’s difficult to know what to expect.
The truth is, during this time, you are in need of as much guidance and support as your baby is. How much guidance and support heavily depends on your individual circumstances – your mode of delivery is just one huge factor that can determine how the next 12 weeks (and beyond) will look for you. Even the difference between a normal vaginal delivery (with or without episiotomy) and an assisted delivery (e.g. forceps) is normally very significant for your recovery. Even the difference between a planned c-section and an emergency c-section is huge. Even the most straightforward births take healing.
Of course, this is without taking into account any unexpected serious complications, such as traumatic births or extended hospital stays for you or baby. If you are affected by this, your postpartum recovery has completely different physical and mental challenges and barriers. If you have suffered birth trauma, as with any traumatic event (sexual assault, car accident, witnessing violence) this can trigger symptoms of PTSD and it is so important to know that you are not alone and help is out there: visit The Birth Trauma Association website for support.
Don’t underestimate the power of sleep and stress on your hormones. Alongside the huge obstacle of physical recovery from 9 months of pregnancy and then childbirth, throw in certain exhaustion & hormonal chaos. Most women also experience (to varying degrees) baby blues, anxiety, bleeding, postnatal depression, feeding challenges, adjustments in family relationship dynamics, self-doubt, to name but a few. Not forgetting looking after the newborn who is completely reliant on you for every basic need – how anyone does this alone is completely beyond me. But women are just truly incredible, resilient, amazing. You honestly leave me in awe on a daily basis.
It makes me want to wring necks when I hear the narrative focused on the myth of “bouncing back” rather than the crucial focus on healing, transition, and restoring balance for the mother. The idea that we should be preoccupied with how our bodies LOOK as opposed to how they FEEL and FUNCTION is quite clearly some patriarchal bullshit rooted in the multi-billion pound diet industry designed to make women feel like their only purpose in life should be to obediently take up less space (I’ll stop there because I’ll get carried away). The important message here is; you deserve space and time to heal. You deserve to be patient and kind to yourself. You do NOT deserve to worry about your weight, or stretch marks, or getting back to looking like “your old self”. The LAST thing you need is guilt about what you should/shouldn’t be eating, and what exercise you should/shouldn’t be doing.
NB: if you are trying to lose weight, this is not something you should feel guilty about and is completely valid! It is your body and I am ALWAYS an advocate for informed choice and support all my clients to reach their goals. However, your motivations and processes for weight loss are so important, and in the early postpartum period, it should not be your primary concern. This fantastic TED talk from Aussie trainer/martial artist/gladiator Tiffiny Hall says it all and is well worth a watch.
Here’s a statistic that doesn’t sit well with me: one third of women will have urinary or bowel issues (symptoms of pelvic floor dysfunction) at 6 months postpartum. These women are almost twice as likely to develop postpartum depression. We deserve better. You have already made so many sacrifices in order to get to where you are; your health and well-being should not be one of them.
Your GP should ask you directly at your 6-week check whether you are having any troubling or concerning symptoms with your bladder or bowel (unfortunately I know this doesn’t happen for the majority of women). We know that unless women are asked directly, they are often too embarrassed to initiate this conversation. You would be forgiven for thinking that you’re the only one having to deal with symptoms like this, as it’s rarely something I hear people speak about. The highlight reel that social media portrays doesn’t help! Remember, painful pooing and ice packs on vaginas aren’t very Instagram worthy. Doesn’t mean it’s not happening – the statistics don’t lie.
The baby has up to 8 routinely planned doctor visits over the first year- a brand new mother has one. And this rarely includes a physical exam, let alone a comprehensive one that assess the main structures that have been compromised by pregnancy and childbirth. This is why Mummy MOT is so important and so valuable. We will listen, comprehensively assess any symptoms you have, your abdomen, pelvic health, core muscles and pelvic floor – and not only give you diagnosis / reassurance, but individualised and specific advice about what you need to focus on, in order to reach where you want to be.
The fourth trimester is a huge period of adjustment for your entire family. I cannot stress enough how crucial it is to take your time to recover, prioritise self-care, and let other people look after you. Here are my tips you may find helpful to read/send to a mum you care about:
1. Use your support network – including professionals
Your family and friends will want to support you in any way they can. And you will need it. Ask for help; and ask often. Try and talk openly about how you’re feeling. There is no “right way” to recover from birth, find your way by enlisting the help of your loved ones. Prioritising your well-being is crucial; you’ve most likely heard the saying that you can’t pour from an empty cup. Putting yourself first is a BIG ask for most new mums but it is the only sustainable way forward. Listen to your needs, then act to fulfil them. Delegate this to others where necessary. Just make sure you are well taken care of.
On this note; PLEASE reach out to a health professional if you are struggling in any way. There is always help/guidance/advice available.
2. Process what has happened
Birth should be empowering and wonderful. And it often is. But we all know it can also be the opposite; traumatising, frightening, confusing. If you have any lingering questions or concerns about what happened during your birth, you should absolutely talk to a professional about it. The last thing you need is wasted energy spent on pondering “what ifs” or feeling angry. At Warwick Hospital, there is a Birth Experience Listening Service, and most maternity services will offer something similar. This is a very good opportunity to have a face-to-face appointment with an experienced midwife who will be able to listen, explain and answer your questions, as well as signpost you in the right direction for help if you need it.
3. “Exercise” little and often
This should (and will be) a blog post in itself. Exercise capacity will vary hugely depending on the individual. Pelvic floor rehab exercises are safe to start on DAY ONE after giving birth, even with a (worst case scenario) surgical repair of a fourth-degree tear. If you’ve had a c-section, pelvic floor exercises are still very important as they have lengthened & weakened from the effects of pregnancy; not just labour.
Throughout the first week or two, focus on connection with your body, and start a few gentle activation exercises around your core. Deep breaths count as exercise. Another favourite is the posterior pelvic tilt; it’s simple and can be done lying, sitting or standing. Just a couple of reps here and there are enough at this stage, 1 or 2 are better than none!
If you feel able to, walking/being upright is a very good start. Try and slowly build up the amount of time you are able to manage, firstly round the house, then venturing out when you feel ready!
4. Perfect poo technique
Going for a poo can take on a whole new meaning in the early days when it feels like your insides might fall out. Diet, hydration and movement are key to preventing constipation; but some practical tips for the postpartum poos:
· Raise your feet on a step, so your knees are above your hips
· Bulge out your abdomen and breathe deeply throughout the process
· Hold your hand firmly over your vagina and perineum (or hold a small flannel/sanitary towel) for some support
· Don’t strain – however tempting this may be. Take your time!
5. Enjoy it
The fourth trimester may be magical for some and absolutely dreadful for others. It may be something you’d do over in a heartbeat or something that you hope you never have to experience again. Either way, it’s an incredibly special and precious time with your newborn – and however awful it feels at the time, it will hopefully be something you can eventually look back on fondly. You may feel like you don’t know what you’re doing and you’re constantly one step behind – but guess what, most people do. Cherish the little moments that make your heart swell and saviour that newborn smell. If you’re doing the best you can, at that moment, then you’re doing amazing.
As always, I’d love to hear from you if you have any feedback or questions. If you are in doubt about whether physiotherapy can help you, please contact us for further information, as I promise there’s always help available!