Postpartum care: the fourth trimester

During pregnancy, you may have daydreamed about life after bringing your baby home. Maybe you imagined rocking your newborn to sleep or seeing their first smile. There will be times like that. But many new moms aren’t aware of the fourth trimester – the three-month period after giving birth that can be a significant adjustment period. You may experience many emotions and physical sensations as your body recovers from giving birth.

Find out some of the things you might expect during the fourth trimester. Remember that it’s common, and you’re not alone – anyone who has given birth has likely experienced some of these things as well. And keep in mind that most of these symptoms typically subside in the coming months.

While settling into the routine of having a newborn, moms also need to remember to care for themselves. That includes getting a 6-week postpartum checkup. Roughly 40% of women don’t do so according to the American College of Obstetricians and Gynecologists,¹ but it’s an important step in the recovery process. It’s an opportunity to talk through what you’re experiencing, physically and emotionally, with your doctor.

The following physical sensations may be less worrisome when you’re prepared for them. And it may also help to know that other moms have gone through the same thing.

“If you gave birth vaginally, don’t be surprised if your torso aches – you use a lot of muscles when delivering a baby. Your perineum – the area between your anus and your vagina – will likely be swollen and sore from pushing,” says G. Thomas Ruiz, M.D., lead ob-gyn at MemorialCare Medical Group in Fountain Valley, California. And you may have developed hemorrhoids – also from pushing – so it might hurt to sit or have a bowel movement. 

If you had a C-section, the incision on your abdomen will probably hurt. A C-section is a major surgery that cuts through abdominal muscles, so the recovery tends to take a couple weeks longer than from a vaginal delivery.  

No matter how you delivered your baby, your uterus will slowly shrink back down to its normal size afterward and you may experience cramping. All those painful sensations will gradually subside as your body heals, but it may take some time. 

If you breastfeed your baby, your nipples will likely be sore. “Chafing is really, really common,” explains Dr. Ruiz. There are creams and ointments that can help. Your breasts might also be engorged and painful when your milk comes in, about 3 to 5 days after giving birth.

Because of all the hormonal changes your body has been through, night sweats and bloody vaginal discharge – also known as lochia – are symptoms you may experience. Lochia is made up of blood, mucus and uterine tissue from the birthing process. Bleeding may be heavy for the first few days but typically tapers off over a few weeks.

“It’s normal to have this discharge for about six weeks or so postpartum,” says Natalia Hailes, a doula and the coauthor of Why Did No One Tell Me This? The Doulas’ Honest Guide for Expectant Parents. “It starts like a heavy period and can increase if you’re moving around a lot or overdoing it before your body has healed.” 

“Having big feelings is not only normal but completely expected,” says Hailes. Part of that is your hormones. But it’s also “lack of sleep, changes to routine, physical healing and a whole emotional reworking of how we see ourselves in the world now that you’re a parent,” she adds.

You may have moments when you’re over the moon with joy. You may also have times when you feel sad, tired, overwhelmed or anxious as you adjust to the newest family member, Hailes explains.

Don’t be surprised if you find yourself crying a lot, says Dr. Ruiz. These feelings are normal during this time. Just let the emotions come and don’t be too hard on yourself.

While most fourth trimester symptoms will pass on their own, there are a few that may need your or your doctor’s attention.

So-called “baby blues” – mood swings, crying, trouble sleeping – last for a few days to a few weeks after birth. But postpartum depression can last for months or even a year, and the feelings can be more intense. About 10% to 15% of new moms get postpartum depression, says Dr. Ruiz. That’s about 1 out of every 9 moms.² Some of the signs include:

• Sleeping too much
• Eating too much or not at all
• Not being able to bond with your baby or feeling down on yourself
• Feeling sad all the time or too scared to leave the house
• Not being able to cope or go through your normal everyday routine
• Fear of hurting yourself or your baby³

If you’re nursing, your breasts can get infected, says Dr. Ruiz. It’s called mastitis. It can develop because of cracked nipples, latching problems, plugged ducts, a yeast infection or milk not draining completely. You may notice a reddish, wedge-shaped lump or streaks of red on your breast. You may also develop a fever and body aches. 

If it hurts when you sit down to pee, it may be a sore perineum. But sometimes after giving birth, you can develop a UTI. Some of the symptoms of a UTI include:

• Persistent urge to pee
• Experiencing a burning feeling or pain while urinating
• Noticing blood in your urine
• Passing a small amount of urine even though it feels like you really have to go

Dr. Ruiz and Dr. Hailes recommend to their patients to have the following supplies on hand:

• A perineum bottle. This is an upside-down water bottle to squirt on your bottom or vagina after you go to the bathroom. It’s much more comfortable than toilet paper while you’re healing.
• Witch hazel cooling pads or ice packs to soothe your perineum and bottom.
• Lidocaine spray, if you had a perineum tear during childbirth.
• A cushion. It’s comfier to sit on something soft for the first few weeks while your bottom heals. A nursing pillow can double as a cushion.
• Stool softeners. You’ll likely be constipated for a few days after childbirth, and you don’t want to bear down to go.
• Nipple cream or balm (like lanolin) to keep your nipples from cracking.
• A breast pump if you’re breastfeeding (your insurance will likely cover it). Eligible UnitedHealthcare members may request a breast pump.
• Sanitary pads for postpartum lochia. You can’t use tampons – and you won’t want to.

Stock up on supplies that you think may help make your experience easier. The main thing to remember: taking care of yourself is important for your well-being, and it can help you be the best and strongest mom you can be. Talk to your doctor to learn what may be right for you based on your individual medical needs.