The Extended Fourth Trimester

Post-partum recovery doesn’t follow a set timeline. It’s a journey. And while some aspects of your well-being may feel better after the historically lauded six-week postpartum recovery period, other parts of your body, mind, and spirit may need more time – and that is 100% normal.

You are not alone, despite what the social media feeds might indicate. Your recovery depends on a multitude of factors, and there’s no one-size-fits-all time frame for how it unfolds.

A Holistic Look at True Post-Partum Recovery: Slow & Tender, Mamas!

How you move through those months – and the next year or two – after your baby is born is a personal story. It’s not a race, and it may take longer than you anticipated before you “feel like yourself” in certain ways. So remember: our mother-centric clinic is here to support you every step of the way.

Let’s take a big picture of what you, your body, and your baby deserve as you plan for an extended fourth trimester and more complete post-partum healing.

1. Six weeks is only a guideline: feeling back to yourself can take longer

If we had to guess where the “six-week” post-partum healing concept came from, we’d say it was largely from a well-meaning population of physicians who never spent nearly a year of their lives growing a baby inside their body, nor had they gone through labor to bring the baby into the world.

While there are a couple of things that we like to see heal up in that period, six weeks is really just the beginning of a longer, more comprehensive healing journey. We sometimes refer to the more extended take on postpartum recovery as The Fourth Trimester.

At your six-week postpartum appointment, we hope to see that:

• Lochia has stopped. Lochia is the postpartum bleeding and discharge that naturally flushes out in the weeks after both vaginal births and C-sections.
• Breastfeeding is progressing. If you’re breastfeeding, the six-week mark is where many mothers and babies start to find their groove (although it can take longer), and that significant discomfort has largely subsided. If not, we’ll ensure you have access to support from lactation consultants to work out any existing concerns.
• Your vagina, cervix, and/or C-section incision are healing well. We want to see that any vaginal tears or stitches are healing well and that you are not experiencing abnormal levels of discomfort.
• General post-partum wellness exam. Of course, we’ll also perform the usual things such as verifying your weight and taking your blood pressure.

It’s also crucial that you’re honest about how you’re feeling in mind, body, and spirit. Resist the urge to say, “everything’s fine…” if it’s not. Having a new baby is hard work, and you deserve comprehensive support as you navigate the extended postpartum period.

2. Seek support from a pelvic floor therapist

Every woman benefits from pelvic physical therapy. Pelvic health is essential for:

• Preventing or minimizing urinary/rectal incontinence.
• Strengthening muscles and connective tissue that were stretched and weakened after pregnancy and labor/delivery.
• Maintaining healthy core strength, which also supports the strength and comfort of your hips, lower back, shoulders, and neck.
• Promotes healthier circulation and oxygenation of the pelvic and reproductive organs, nourishing and healing them as they recover from pregnancy.
• Relieves pelvic pain and can support more regular and comfortable menstrual cycles when they return (usually 6 – 12 weeks for formula feeding and as long as 9 – 12 months for women who exclusively breastfeed).
• Supports C-section recovery.
• Improves sexual pleasure and function

Pelvic floor therapy is about far more than Kegel exercises. Your pelvic PT will personalize your sessions and recommended exercises based on what you’re experiencing and your goals.

3. Post-Partum Nourishment: Give Yourself the Gift of Good Food

Good food means nourishing food. Healing requires nourishment. Firstly, your body is replenishing any of the nutrients it may have lost during pregnancy. Then, there’s the energy to care for a newborn. When you add that to a return to work, daily life tasks, and other family demands, you can see why the body needs to be fed well during this phase.

PLEASE TAKE NOTE: We cannot emphasize enough: This is not a time to uphold a restrictive diet, such as Keto or other low-carb diet trends. Those can wreak havoc on a healing body. If you are concerned about losing pregnancy weight, speak to your obstetrician about the healthy caloric intake and exercise guidelines recommended to achieve a healthy weight goal for your height and body type.

And while maintaining general awareness of healthy postpartum caloric intake is important, we wholeheartedly appreciate the statement, “eat better, not more,” from the AJOG article on pregnancy and postpartum nutrition. The article points out that most women in the U.S. do not meet the recommendations for healthful nutrition before and during pregnancy, let alone afterward.

A nutrient-rich, extended postpartum care diet includes a focus on whole foods, including:

• Fruits
• Vegetables
• Legumes
• Whole grains
• Healthy fats with omega-3 fatty acids (nuts, seeds, and fish).

Consider following the general guidelines for anti-inflammatory meal planning. This concept is not restrictive. Rather, it focuses on nutrient-rich ingredients that nourish the body and support overall healing, reminding us to steer clear of highly processed foods and overindulging in refined sugars. Not only does this reduce inflammation and boost your immune system function, but it can also support you when your periods return, especially if you have preexisting conditions like endometriosis or PMOS (formerly called PCOS). Also, studies show that women whose postpartum diets focus on anti-inflammatory foods have lower risks of postpartum depression.

4. Take Care of Your Heart, Mind, & Soul

You are now the primary caregiver to a newborn, and that is an all-consuming job. However, you’re also riding a hormonal rollercoaster as the body slowly acclimates to post-pregnancy life. If breastfeeding, your hormone balance won’t return to “normal” again until after your baby weans.

Do what you can to support mental/emotional health during this time. Again, the team here at Northwest Women’s Clinic is here to help you in any way we can. We also have referrals to excellent therapists in the area who can help. We also recommend joining a local parent group or club, which can be an amazing resource as you move through the fourth trimester and the extended postpartum period. The women in those groups remind you that you are not alone!

Let go of pre-parenting expectations

One of the best things you can do to support your mental and emotional well-being is to let go of pre-parenting expectations. This includes expectations around:

• How you’re going to feel about parenting.
• What your house should look like.
• Living daily life with a predictable schedule.
• Being able to do everything you used to since you plan to wear your baby.

Be gentle on yourself. Every day is a brand new adventure with a newborn. The less pressure you put on yourself around expectations, the better. Get comfortable with last-minute calendar changes, cancellations, or “Maybe” RSVPs to give yourself the space you need to be yourself (and honor your baby’s needs).

Leverage nature to support you

Nature is a powerful rejuvenator, mindset balancer, and stress reliever. Taking gentle walks outside with your baby, positioning your feeding chairs to face a window with a view outdoors, hanging a bird feeder outside where you can see it regularly, carrying your baby outside before bedtime to look at the stars – all of these offer short (or longer) essential respites from a busy mind, a tired body, and the confines of an indoor, post-partum lifestyle.

Recognize the signs of postpartum depression

Post-partum depression (PPD) can creep up on you, and it affects nearly 20% of mothers. Separate from “The Baby Blues,” which lasts for up to two weeks, post-partum depression settles in and can feel like it will last forever. Symptoms include:

• A consistent sink in mood.
• Crying uncontrollable.
• Difficulty bonding with your baby.
• Unusual levels of anxiety.
• Strong feelings of inadequacy.
• Trouble sleeping (even when the baby is asleep).
• Extreme irritability and anger.
• PPD can even cause feelings of unbridled rage.

Never fake it. There are many resources available to you. First and foremost, your Northwest Women’s Clinic team wants to know your struggles so we can help. There are also local post-partum depression organizations you can connect with or post-partum hotlines you can call 24/7.

Having post-partum depression does not make you a bad mom or an inadequate person. Seeking support is the best thing you can do for yourself and your baby.

Do something that brings you joy for 15 minutes each day

Try to do something that brings you joy or peace for at least 15 minutes each day. Perhaps it’s one of those ways to connect with nature as we mentioned above. However, it can also be something such as:

• Taking a longer shower while your partner has the baby.
• Dancing to your favorite songs.
• Using a mindfulness app to enjoy a guided meditation or Yoga Nidra to help your body relax.
• Send a postcard to someone you love or miss spending time with.
• Think about the small things that bring you joy and find ways to bring more of that into your daily life (here are some simple pleasures you can peruse for inspiration).

Northwest Women’s Clinic Cares for Mothers Beyond 6 Weeks After

Are you pregnant and looking for an OB or midwife who believes in comprehensive care that goes beyond the traditional 6-week postpartum date? Do you need support with postpartum questions or concerns that don’t fit in an expected timeline?

Schedule an appointment with Northwest Women’s Clinic, where you’ll be met with respect, compassion, and resources from our committed team.