Fourth Trimester Tips
Did you know that the time after you give birth to your baby is called the “Fourth Trimester?” The first three months after delivery is a time when there are enormous changes happening in your body. You’ve spent the last nine months growing and nourishing your new baby inside. Now you are continuing to support your baby once they’re on the outside, so this is a time where you need to focus on taking excellent care of your physical self.
Your body needs physical, emotional, and nutritional support during the Fourth Trimester to transition from pregnancy to postpartum in a healthy and uncomplicated way.
There are countless physical changes happening in the postpartum stage! Your uterus is contracting and shrinking back to its non-pregnant size. While this is happening, you’ll be experiencing ‘lochia,’ which is the postpartum blood flow that can last approxiametly 2 to 6 weeks. Your abdominal muscles and skin will also be coming back together. If you had any perineal tearing or delivered your baby by c-section, those wounds will be healing, too.
Around Day 3 of postpartum, your breastmilk will come in, which often causes breast tenderness and swelling. Your hormones are all shifting from pregnancy hormones to non-pregnant hormone levels. If you’re breastfeeding, there are hormones that promote milk production to account for, as well. As you can see, there is a lot happening all over your body!
What are the best ways to support your physical body during the postpartum? The best thing you can do for yourself in the first two weeks after your delivery is: rest. Your body needs that time to recover from all the work it accomplished during pregnancy and delivery. In those first couple of weeks, rest and feeding your baby is a priority!
Change your pad every time you go to the bathroom, but after the first couple of days, most women notice their bleeding significantly decreases if they are taking the time to rest. The more active you are during the initial weeks postpartum, the heavier your bleeding will be and the longer it will last.
In the initial postpartum period, everything in your midsection can feel really strange. Your baby is on the outside, so there’s notably more space inside than there had been! Wearing Motif Medical’s postpartum recovery garment can make you feel more comfortable in your own skin during this transitional time. This recovery garment provides gentle compression around your abdomen and pelvic floor for additional support to your core. It can help you keep good posture and even help reduce your postpartum bleeding. Most of the new moms I’ve worked with have greatly appreciated the feeling of compression around their abdomen after birth—it makes them feel more stable and comfortable as their body rearranges everything inside their belly.
If you delivered your baby by c-section, I recommend Motif's bandage system to help heal and protect your wound! Your incision site is going to be sore and tender. Sneezing and coughing can be awful! But wearing a compression garment, bandage sytems, or utilizing a pillow and applying counter pressure can keep you more comfortable while your body is healing.
While you’re comitted to resting, you can start re-connecting to your pelvic floor. Practicing 3-D breathing every morning and evening is perfect for this. Those deep breaths will help relax your shoulders and gently engage your abdominal and pelvic floor muscles. You can do these breathing techniques while sitting in bed, so you can incorporate this into your day as soon as you want to after birth.
How do you do 3-D breathing? When you first try it, it can help to place your hands on your ribs--like setting your hands on your hips, but only higher. Once you are comfortable, close your eyes and inhale. Think about the air filling your lungs, first up in your chest and then down in your abdomen. As you breathe, you should feel your chest rise, your lower ribs expand all the way into your back, and at the peak of your breath you should feel gentle pressure down on your pelvic floor. Now begin to exhale slowly and feel your pelvic floor lift. Notice how your ribs lower and how your chest falls down. Congratulations! You have experienced a 3-D breath.
Once you get the go ahead from your provider, you can start doing more targeted pelvic floor exercises. There are some phenomenal online programs to help tone this muscle set after birth, but you’ll get even more specific advice if you find a local pelvic floor physical therapist to work with. They will assess your body and give you exercises that will be the most beneficial to help you regain optimal performance of your pelvic floor. I hope this recommendation doesn’t intimidate you--I really believe everyone should see a pelvic floor physical therapist after they give birth! Those muscles do so much to support the baby during pregnancy and delivery, so why wouldn’t we want to provide them individual attention after birth? Many European countries include pelvic floor PT care in their postpartum care plans. I wish the United States would do the same!
Remember those hormones I mentioned earlier? They are literally going up and down like a roller coaster in the postpartum, so some new moms feel like they’re on a roller coaster of emotions. It’s not all in your head! In fact, it is a natural postpartum change. Feeling emotional ups and downs, crying, and even having some anxious thoughts happen during postpartum. These are called “Baby Blues” and can last for about two weeks. What isn’t normal is for you to be feeling sad, depressed, or anxious all day long. Your emotions shouldn’t keep you from eating, sleeping, or enjoying hobbies that would typically make you happy in life. Those would be signs of a postpartum mood disorder that you would want to contact your provider so they can help you get the support you need to recover.
Remember those hormones I mentioned earlier? They are literally going up and down like a roller coaster in the postpartum, so some new mothers feel like they’re on a roller coaster of emotions. It’s not all in your head! In fact, it is a natural postpartum change. Feeling emotional ups and downs, crying, and even having some anxious thoughts happen during postpartum. These are called “Baby Blues” and can last for about two weeks.
What isn’t normal is for you to be feeling sad, depressed, or anxious all day long. Your emotions shouldn’t keep you from eating, sleeping, or enjoying hobbies that would typically make you happy in life.
Those would be signs of a postpartum mood disorder that you would want to contact your provider so they can help you get the support you need to recover.
How can you support your emotional self during postpartum recovery? Find supportive people to talk to. While becoming a parent for the first, second, or any number of times doesn’t mean it’s easy. Emotional support is essential to help you explore the thoughts and emotions you can experience in this transition. Postpartum support groups or breastfeeding support groups are perfect for this. The people you meet there will be in the same stage of life as you are and experiencing the same struggles, joys or maybe they were having that issue last month and can give you some advice. Either way, it is beneficial to know that what you’re going through is normal . Remember, you aren’t alone in figuring it out! Joining a postpartum group is a perfect way to give yourself postpartum support.
If you had a difficult birth or a birth that went differently than you had planned and you’re trying to process that, I recommend a book, “Birth Story Brave ” a guided journal for you to work through by yourself, at your own speed. This book will assist you in acknowledging the disappointments and joys you may feel when you meet your baby. How you mentally process your birth matters, but those emotions are often complex and can also feel conflicting. Not everyone will understand why it matters so much to you—don’t listen to them. Birth is an extremely vulnerable and personal event in our lives! You are entitled to feel however you want about the experience you had. The book “Birth Story Brave ” can help you process those feelings and emotions so that you find peace with how your birth story went.
Pumping & Hand Expression
Pumps and hand expression are great ways to build and replenish supply as they can be used regardless of how well baby can stimulate and feed. A baby’s stimulation is preferred and the body is typically more reactive, however, the frequency and ability of a baby is not always part of the equation. These are tools to get the job done in a controlled way so that when you practice later with baby, you can focus solely on them. It can also be a great priming of the nipples to help baby attach if they’re struggling!
- Use a pump or hand express for 10-15 minutes on each breast several times a day. Ideally, at least eight times in 24 hours. Swapping sides every few minutes may be more effective than a longer session on one side.
- Expressing at least once at night will provide extra stimulation as this is when levels of milk-making hormones are highest. This also means that you don’t go for a long period without pumping. Remember frequency is key!
Support, Support, Support
Learning the basics also provides a gauge on progress made with relactation, how much supplementation is needed as things change and progress, and what additional help may be needed. Painful latches, for instance, need to be addressed by a lactation consultant or counselor (IBCLC, CLC).
They can also help guide you on goal setting, expectations, and monitoring weight gain in the baby. Weight checks are also used to determine milk removal before and after a feed. This is also called a “weighted feed.” Any deficits between what was drunk from the breast and what is still needed per feeding can be measured and properly supplemented by pumped breast milk and/or infant formula, depending on your individual needs.
Other tools to help baby back to the breast are nursing supplementers, also known as a supplemental nursing system (SNS), which use a tiny tube taped to side of the nipple, and is slowly fed breastmilk or replacement to encourage suckling and stimulation at the breast. This helps with latching and milk supply stimulation.
Normal feeding frequencies can be overwhelming for any mom to wrap their head around. It’s quite normal to feel discouraged and overwhelmed when doing the same without having the gratification of milk expression. Setting healthy and achievable goals, adjusting expectations, and prioritizing mental health can be the very things that make or break your experience. Make sure to seek out help from a lactation professional and support groups.
What to Know About Relactation
- Menses may come, go, or be irregular when supply fluctuates, builds, or stops.
- Postpartum depression and anxiety may be coupled with breastfeeding cessation.
- Until, or if, full supply thresholds are met, your baby needs supplementation.
- Side effects of milk supply fluctuation also include mood and emotional swings- lean in on your support groups during this time!
- Galactagogues may be suggested to support breast milk production. Many IBCLCs recommend avoiding products containing fenugreek, as they can cause a lot of gas and can interfere with heart conditions.
- It does not have to be all-or-nothing. Millions of mothers maintain a status of partially breastfeeding/providing breast milk while supplementing. Supplementing can be with human milk or infant formula.
- This will not be an overnight cure. Supply development takes weeks even without gaps.
- Some days will be better than others. This is true even for mothers with a developed breast milk supply, so remember to have grace for yourself and your body!
Information provided in blogs should not be used as a substitute for medical care or consultation.