The Fourth Trimester

From extensive prenatal care with weekly doctor’s appointments to infrequent, scant support after birth, the challenges that come with the transition into the fourth trimester are often forgotten.

The fourth trimester is considered the first 12 weeks after birth, a wonderful, but vulnerable time for a healing mother. After a routine birth without complications, it is likely you’ll have 1 appointment with your doctor 6-8 weeks later. By this time, you may have already endured incision pain, exhaustion, day-to-day movement without abdominal muscle support, and possibly the challenges that come with breastfeeding and pumping - navigating recovery on your own. 

The early weeks following birth are a critical time for healing and mental and physical health. As a pelvic floor physical therapist and postpartum coach, I see firsthand that providing education on what to expect, what is normal, and what should resolve and when, is empowering for a woman to feel in control of her body and recovery. 

Postpartum healing is different for everyone. For many women, the 6-week postpartum visit is adequate, while for others they may struggle with symptoms like significant pelvic pressure or heaviness and urinary incontinence all before they even speak with their doctor. Regardless of one’s healing experience, every postpartum woman can benefit from support during the first 6-8 weeks simply for preventative care and education.

What is common postpartum is not necessarily normal, so don’t let anyone tell you that peeing your pants is your new norm. By failing to educate women on the distinction between what is common and what is normal postpartum, we are leaving many to suffer in silence with urinary incontinence, fecal incontinence, painful sex, diastasis recti, pelvic organ prolapse, and other symptoms of pelvic floor dysfunction for months or years postpartum. As your postpartum coach and buddy, I’ll tell you what you should expect, what you can do preventatively, and when to seek care.

In the early postpartum period, regardless of how you birthed your baby, you may experience perineal pain and swelling, postpartum bleeding, a sensation of nonexistent abdominal muscles, a tender or sensitive cesarean incision, and urinary incontinence due to a healing pelvic floor. Within a few weeks postpartum, you should expect these symptoms to begin to resolve. They are common, but not normal beyond 4-6 weeks postpartum. If they don’t improve or if they get worse, seek care from a pelvic floor therapist in-person or virtually. Fortunately, pelvic floor therapy treatment can help significantly! Find local therapists at pelvicrehab.com or reach out to me for support. 

At your 6-week postpartum appointment, your OB will assess if your uterus has returned to its pre-pregnancy size and if incisions are well-healed, and you’ll discuss birth control options. Hopefully, you’ll discuss postpartum mental health, and if you don’t, I encourage you to request a screen or resources. If all is well, you’ll be cleared to return to exercise and sex. 

Now, what?

In recent research, less than one half of women reported that they felt they received enough information and education about postpartum depression, nutrition, exercise, and sexual function. You likely will not have a musculoskeletal assessment or be educated on core and pelvic floor exercise progressions to safely return to workouts. Your OB isn’t an expert in your return to exercise, and that’s okay! That’s why a referral or resources for a qualified pelvic floor therapist or rehab program is necessary to support you.

Research has changed for returning to exercise in the early postpartum period. It is now recommended to begin gentle exercise within a few days of an uncomplicated, vaginal birth. While it is generally safe to perform intentional exercises (with expert guidance!) after a cesarean birth, consulting with your OB after cesarean or complicated pregnancy or birth is recommended. Updated guidelines are to start with gentle core exercises with an appropriate, gradual progression to moderate-intensity or higher level exercise, such as running and lifting. Early core and pelvic floor rehab is essential in supporting our daily movements and preparing women for when it is time to move forward with exercise. This rehab can be a game changer for managing or preventing postpartum depression, returning to exercise, and preventing pelvic floor and core dysfunction. 

The early postpartum period should include retraining your breathing patterns, deep abdominal muscle and pelvic floor activation to help familiarize your nervous system with these muscles, and gentle abdominal exercises with a progression overtime of core and glute strengthening and functional movements to progressively overload safely. By working on this early on, you’ll be stronger and better prepared, both physically and mentally, when you’re cleared to exercise at your 6-week visit. 

So, why would we wait 6 weeks?!

I’m so passionate about supporting women during their fourth trimester transition. It truly lights me up, which is why I created the Early Postpartum Recovery and Movement Program, to fill in the gap for navigating the fourth trimester and flip the script to help you feel in control of your postpartum recovery. It’s an 8-week program to help you prioritize your postpartum healing and physical recovery by taking the guesswork out of core rehab, returning to exercise, and preventing pelvic floor dysfunction. 

Registration opens every other month, but since you’re still here with me reading this blog, I’d love to give you the special gift of the code word to bypass the waitlist and sign up any time. Click here for more details and to sign up, and use the password postpartumvip to join me. If you would prefer 1:1 support virtual or in-person, you can reach me at m@yourcoreconnectpt.com.

Thanks for coming!

ABOUT DR. MARISA RAGUSO

Dr. Marisa is a physical therapist specializing in orthopedics and pelvic health. She is originally from Bronx, New York, where she earned her Doctorate of Physical Therapy from New York Institute of Technology. She has furthered her education in pelvic floor and postpartum rehabilitation with Herman and Wallace Pelvic Rehabilitation Institute. She utilizes manual therapy skills and interventions such as Active Release Technique (ART), internal pelvic floor muscle treatment, myofascial release, joint mobilization, and an individualized progression of therapeutic exercise.

Dr. Marisa believes in bridging the gap between orthopedic and pelvic floor physical therapy, as well as treating her patients holistically for optimal health and well-being. She is passionate about advocating for women with pelvic floor dysfunction and transforming postpartum recovery.

How to contact Dr. Marisa:

Email: m@yourcoreconnectpt.com

Phone number: 347-377-0335

Website: www.yourcoreconnectpt.com

Social Media: Dr. Marisa’s Instagram

Reference:

Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to Mothers (SM) III: new mothers speak out. New York (NY): Childbirth Connection; 2013.