The Fourth Trimester: How to Take Care of Yourself After Childbirth

Congratulations! You gave birth, and now your sweet bundle of joy is in your arms. Those nine months of pregnancy may be over, but your body hasn’t finished adjusting to motherhood. You’re now in the fourth trimester, the 12 weeks after birth when your body will work hard to heal from major physical and emotional changes.

“We know newborns need lots of care, but we often forget about mom in that fourth trimester state. So we encourage moms and their partners, as well as providers and families, to start expanding their thoughts as to what happens to mom after the baby is born and how we can help her,” says UNC Health OB-GYN Tiffany M. Flanagan, MD.

Here are the biggest changes you can expect after childbirth and what you can do about them.

Vaginal Care and C-Section Recovery

If you had a vaginal tear and stitches during childbirth, the area may be painful for a few weeks. And if you had a cesarean section, you’ve undergone major abdominal surgery. It can take up to six months for the nerves in the abdominal area to heal completely. As if all that weren’t enough, many women also develop hemorrhoids after delivery.

What you can do: Vaginal tissue has a great blood supply and will heal quickly. Keep the area clean and squirt yourself with warm water after you use the bathroom. Alternating ice packs and warm tub soaks will help with the pain and the healing process. If you’re still hurting six weeks after childbirth, talk to your doctor. If you had a C-section, follow your doctor’s instructions carefully to make sure your body has an opportunity to heal fully. If you notice redness around your incision or fluid leaking, call your doctor. For hemorrhoids, try witch hazel pads and alternating ice packs and warm soaks in the tub.

Aches and Pains After Childbirth

You may experience headaches because of shifting hormones, lack of sleep and stress. Backaches are common because of the extra weight of full breasts and from lifting and carrying the baby.

“You also can bleed for up to eight weeks, which in and of itself is draining, literally and figuratively,” Dr. Flanagan says.

What you can do: Take ibuprofen for headaches. If they don’t get better, call your doctor—headaches can be a sign of high blood pressure. For backaches, ibuprofen will also help, as will wearing a supportive bra and taking care with how you carry and feed your baby. (For example, carry your baby in a sling rather than a car seat, and use pillows as props during breastfeeding.) Heating pads and a warm bath should feel good, too.

Leaky Bladder

Many women experience urine leakage, called stress incontinence, after childbirth. For most women, the problem will gradually improve after a few weeks.

What you can do: Try Kegel exercises to strengthen your pelvic floor muscles. This can stop urine leakage. If you are losing large amounts of urine or continue to have incontinence beyond eight weeks after birth, see a urogynecologist. Many treatments are available.

Breast Problems

Your breasts go through a lot in the first few weeks after childbirth, especially if you’re breastfeeding. It’s common to deal with breast engorgement, which is when the breasts are too full of milk, as well as sore and cracked nipples, plugged ducts and a painful infection of the breast tissue called mastitis.

What you can do: Use ice packs and ibuprofen to soothe engorgement. If you’re dealing with clogged ducts or mastitis, try massage, feeding your baby often or applying a heating pad. (For mastitis, you’ll also need antibiotics to treat the infection.) Changing feeding positions every time you nurse can help with sore nipples. After your baby is finished eating, express a few drops of milk and gently rub it on your nipples; let them air-dry or wear a soft cotton shirt. Vegetable shortening or coconut oil can also help nipples heal. If the pain gets worse, contact your OB-GYN or primary care provider. Hospitals, OB-GYN and pediatric offices may have lactation consultants on staff to help.

Fatigue

Babies have different internal clocks than adults, which means you may be waking often to feed or change your baby. In fact, most newborns wake up about every three hours and need to be fed, changed and comforted. The rigors of labor and delivery combined with frequently waking to care for a newborn can cause postpartum fatigue.

“Pregnancy and delivery take a toll on your body. That’s why we call it labor—it’s laborious,” Dr. Flanagan says.

What you can do: Sleep when the baby sleeps. Although it is nice to have visits from friends and family or to use quiet time to be productive, these are not essential. If possible, let someone else take care of all responsibilities other than feeding your baby and taking care of yourself.

Mood Changes and Postpartum Depression

New moms may experience the “baby blues”—they feel sad and cry easily during the first one to two weeks after delivery but are still able to function. This means you still eat, bathe and take care of your baby, but you feel down.

“This is directly correlated to a dive down in hormones. One of the steepest dives we have in some of our major hormones are in pregnancy and delivery, so we go from very, very high amounts of estrogen and progesterone to some of the lowest amounts, and we do that in a very short period of time,” Dr. Flanagan says.

Some moms—about 1 in 8—experience much stronger feelings and have postpartum depression. The hormone changes after birth can alter your brain chemistry, which can be serious and can prevent you from caring for yourself and your baby.

“Postpartum depression goes beyond that 10- to 14-day period after childbirth and impacts your ability to care for yourself. It is constant sadness or crying easily, not eating or not wanting to eat, poor focus, and lack of desire to care for your family or your infant,” Dr. Flanagan says. “You’re in the bed, and you’ve been in the bed, under the covers, lights out, for two days.”

What you can do: Remember that it’s natural to have mixed feelings about motherhood, and don’t beat yourself up for feeling negative emotions. Be honest when talking to your healthcare provider about how you’re doing, and get help right away if you need it.

“Call your OB or family provider or go to an urgent care—just make sure you tell someone,” Dr. Flanagan says.

You can call (919) 966-5217 to make an appointment at the UNC Center for Women’s Mood Disorders, and national hotlines are available 24/7 so you can call from home and be directed to resources to help you. If you are suicidal, get help immediately by calling 911 or the National Suicide Prevention Lifeline at (800) 273-8255.


For more tips on how to have a healthy fourth trimester, visit NewMomHealth.com, which is also available in Spanish at SaludMadre.com.