Highland Physical Therapy

The 4th Trimester- The best, crazy, messy transition of your life. It’s ok to ask for help

*This post is intended as general wellness information and is not intended to replace medical advice or treatment. Many doctors are changing their thinking on how we support baby, mom and dad in the first three months after birth, which has lead to the term “4th trimester”. Previously, there has been so much focus on the 9 (or sometimes 10) months leading up to a healthy birth, but not as much information or planning for after. Many mothers feel overwhelmed and underprepared for what to expect when they go home from the hospital. This can be an especially challenging time for moms (and new dads) who feel like they have to “get back to normal” or “have it all together”. 

For 9 months, baby is in their perfect environment… eating whenever he or she wants, going to the bathroom whenever and wherever; it is warm, it is safe, there is a constant hum of noise from mom. Then birth….not the most friendly introduction to the world, for you or your little one. There is pressure, pain and sometimes a long recovery. Now baby has longer gaps between feeding, is sleeping in a new place, there are bright lights, and loud sounds. Some experts have described babies in the first three months of life as “fetuses outside the womb” They still need almost constant support from mom, but unlike in the womb, these needs aren’t met automatically. 

According to Kathryn Kelly, NCT, “If you think in terms of the first three months of your baby’s life being a Fourth Trimester, it can be easier to take the pressure off getting back to ‘normal’. You wouldn’t have been trying to rush around tidying the house and welcoming endless visitors when you were heavily pregnant, so don’t put pressure on yourself to do it now.” Some practical suggestions include: trying to get outside most days, eat well, rest as much as possible, get some light exercise and do only the most necessary housework. (1)

This is a great time to lean on the support system around to help you out. This may be a church meal train, or your close friends who ask how they can help. Maybe you have a great network of family close by that can watch the baby for an hour so you can go to the grocery store.
Medically, the 4th trimester (or first 3 months) of your baby’s life are full of doctor visits with close follow ups for function and to catch any emerging conditions right away. This same level of follow up is not as common for new moms, despite the potential injuries from birth, poor sleep, physical and emotional changes due to breastfeeding as well as any potential baby blues. Women typically have a follow up scheduled with their OB-GYN 6-8 weeks after delivery. (2) Some women don’t know that it is perfectly acceptable and normal to call with questions or concerns before that time and to even schedule a follow up as early as 2 weeks if there are concerns.  Some signs and symptoms that would warrant a follow up sooner than 6 weeks:

  • Significant pain that does not seem to be resolving (back, abdominal, pelvic or groin)
  • Continued significant bleeding that does not seem to be stopping or lightening- while it is normal to have regular bleeding for 6-8 weeks, similar to a period, very heavy bleeding (>1 pad/hour) may be a sign of something serious
  • Depression or excessive worry  that does not seem to go away, feels unmanageable,or thoughts of harming yourself or your baby. These feelings can be difficult to deal with, but fairly common, and it is important to get help right away.
  • Severe headache or neck pain that does not get better, although very rare, this could indicate an issue with the blood vessels to the brain. 
In addition to regular medical follow up after delivery, a wellness visit with a pelvic health physical therapist can be ideal for assessing any birth related injuries, as well as to deal with bladder or bowel problems that are left over from pregnancy or have popped up since giving birth. A pelvic floor therapist, especially one that is trained in postpartum care can also assess for diastasis rectus abdominis (a gap in the abdominals that is normal during pregnancy and can take up to a year to heal) as well as help you create a personalized plan for returning to a previous fitness plan or starting a new fitness routine. (1)What is the fourth trimester? | NCTAntenatal Classes & Antenatal Courses For Expecting Parents | NCT
The fourth trimester: What you should know – Harvard Health Blog – Harvard Health Publishing

Kristen Topliff, DPT is a wife, toddler mom and passionate pelvic health physical therapist. While she started her journey treating pelvic floors prior to having children, her expertise has been shaped by her own experiences with pelvic tightness and pain and Diastasis Rectus Abdominis (DRA) after having her two children. She is passionate about helping new moms adjust to the changes in their body after birth as well as get or stay active safely. Kristen is also passionate about helping people overcome pain and barriers to having meaningful sexual wellness.