AUTHOR: Dr. Meg Henderson, PT
Fourth trimester – you say? What?! I thought pregnancy was only 3 trimesters!
You are correct, but us mamas need to start thinking of that precious time with a newborn as a part of our pregnancies…at least the healing part! The “fourth trimester” is a big-time buzz word right now, and it encompasses the first 3 months of your sweet little one’s life. [Cue elevator music] It’s a time for mamas to connect with their littlest ones, develop that bond, snuggle, rest, sleep, and allow others to take care of you.
That’s not how it really is… “I have other kids to take care of, no family in town, my husband travels, I live in an apartment…” LIFE does not stop when we have a baby!
Keep in mind, though, how that precious tiny baby was born in to this world. No matter what your birth story is, our bodies need time to heal from the “injury” that is childbirth! Soft-tissue injuries, depending on their severity, take approximately 6 weeks to heal. Now, imagine a cut on your arm. If we pulled on it and stretched it every day, do you think it would heal quickly or without a big ole’ scar? NO WAY! Our bodies just birthed a tiny human and a large organ (your placenta) which is an amazing feat in and of itself, and we expect things to just “bounce back” in 6 weeks, all the while lifting heavy car seats, older siblings, vacuuming, and running up and down the stairs? I’m basically enlightening y’all to my first time in the “fourth trimester” rodeo. I did waaay too much, even with only 1 newborn, and did not allow my body to heal. Top that off with a need to return to work at 6 weeks postpartum…and I wondered why I struggled to regain strength after son #2, 4 years later?! I never really regained my strength in the first place! Here are 5 things to consider when becoming more “aware” of The Fourth Trimester (since you can never really “be prepared!”):
It does not matter what type of delivery you had, your body needs 6-8 weeks to heal. You may have a c-section scar or perineal stitches, or maybe you lucked out and only had a 1st degree tear! Either way, our bodies are also healing from the inside out. Our uterus is healing from the wound the placenta left, and I think this is one thing that is often overlooked. If we do “too much” too fast, we can’t expect our body to play along and heal at the same rate. So, realistically, push back that 6-8 week mark to 8-10 weeks if you’ve been chasing around another kid or two! Oh, and embrace those mesh panties and homemade pad-sicles—they do wonders for the healing process!
Just because we are trying to let our bodies rest, heal, drink plenty of fluids, and put in good-for-us nutrition…oh and take care of a newborn, it doesn’t mean we have to avoid all exercise like the plague! You can start working on diaphragmatic breathing during your first week postpartum, in sitting, standing, and lying down! Start with an inhale through your nose, letting your rib cage expand 360* and your belly and pelvic floor relax, and then exhale through your mouth, feeling for the recoil in your pelvic floor and transverse abdominis. This is the first step in retraining your core, but it can also do wonders for stress relief!
These bad boys are going to help you regain the stability in your core and also work out any kinks in the timing of your core system…meaning do the muscles turn on when they’re supposed to? At the end of pregnancy, we are basically just getting by…using any strategy we can to haul the big belly around, get in and out bed, you know what I’m talking about! We need to retrain the core system (diaphragm, pelvic floor, transverse abdominis, and multifidi) to make sure they are all working together as team players again. Ultimately, this will help us to avoid symptoms like leaking! Here’s what you can practice: Incorporate your diaphragmatic breathing with an isometric contraction of your pelvic floor and TA. Inhale, expand the ribs, belly, and pelvic floor. Exhale, draw the pelvic floor up and in, while drawing belly button in slightly without moving your pelvis. Sounds easy…now go try it!
As new mamas in the fourth trimester, there are not many times when we are without baby! We are rocking, shushing, carrying, changing, feeding, snuggling, baby-wearing mamas who also need to be aware of our postures in during this 4th trimester. Not that you need reminding, especially if you are at the end of your pregnancy or a new mama, your posture changes at the end of pregnancy due to the size of the baby belly. This posture doesn’t just magically disappear when baby is born—now you are carrying the weight on the outside! And that weight wiggles and moves! Have a friend or family member snap a candid picture of you from the side while holding your little one and take note of these things. Alignment: Are you shoulders rounded? Is your chin jutting out forward? Is your bum tucked under and you have FAS (Flat A$$ syndrome)? When you’re holding baby, try to think about keeping your ribs stacked underneath of your pelvis, shoulders back, knees slightly flexed, and chin tucked back. In this position, you can actually use your glutes and those deep core muscles you’ve been working on isometrically! Try using proper pillow support while feeding also to prevent upper back and neck pain!
Pregnancy and the miracle of bringing a new baby into the world is really just amazing and a time to cherish! Our bodies are strong and resilient, and I think The Fourth Trimester is just the beginning of learning what we are capable of as women and mamas. We need support from all of those around us, not only to help with the baby, but for us—the mamas! The American College of Obstetricians and Gynecologists (ACOG) recently released a Committee Opinion recognizing the importance of a continuum of care during the Fourth Trimester, including a visit to her postpartum provider within the first three weeks of delivery. It details the importance of a postpartum care team, including physical therapists (YAY!), to support and assist mamas in the physical recovery post-birth. Postpartum is FOREVER, and if we can start to shift our mindset during the Fourth Trimester to rehab our bodies the way we would post-injury, we can avoid a lot of the symptoms that most women take for granted as “just another part of motherhood”.