UNC Health Care
Mother holding her newborn baby after labor in a hospital.

What You Need to Know About the “Fourth Trimester” After Childbirth

You did it! You gave birth, and now your baby—that sweet bundle of joy—is in your arms. Those nine months of pregnancy may be over, but you’re realizing that birth isn’t the finish line.

You’re now in the so-called fourth trimester, the 12 weeks after birth when a woman’s body works hard to heal from major physical and emotional changes. Alison Stuebe, MD, an associate professor with the UNC Department of Obstetrics & Gynecology, and Sarah Verbiest, DrPH, a public health social worker with the UNC School of Social Work, let you know what to expect. 

Aches and Pains After Childbirth

Many moms complain of aches and pains after childbirth. You may experience headaches because of shifting hormones, lack of sleep and stress. Backaches can be related to the extra weight of full breasts and sometimes how new moms carry their babies.

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 help, too, as will wearing a supportive bra and taking care with how you carry and feed your baby. (Examples: 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 leak urine, 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 pelvic floor muscles. This can stop urine leakage and may make sex more enjoyable. If you are losing large amounts of urine or continue to have incontinence beyond six to 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 breasts are too full with milk, as well as sore and cracked nipples, plugged ducts and 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 a heating pad. (For mastitis, you’ll also need antibiotics because it’s an infection.) Changing position every time you nurse can help with sore nipples. After your baby is done 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 is getting worse, call the UNC Warmline at (984) 974-8078 or toll-free at (866) 428-5608 to reach lactation consultants.

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’ve 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: The good news is 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 with 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’ve had a C-section, follow your doctor’s instructions carefully to make sure your body has a chance 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 with soaks in a tub of warm water.

Sex

Many women find that their sex drive in the months after giving birth is low. This is normal; you may be tired and sore in the first few weeks, and hormonal changes can play a role as decreased levels of estrogen result in less natural lubrication for up to six months.

What you can do: Dr. Verbiest suggests talking with your partner about your feelings. “Your desire for intimacy with your partner will likely be increased if you are rested, not feeling overwhelmed, and if you feel like your partner is helping you.” When you are ready to be intimate again, use lots of lubrication.

“Your desire for intimacy with your partner will likely be increased if you are rested, not feeling overwhelmed, and if you feel like your partner is helping you.”

Birth Spacing

Couples should think about birth control in advance, even if they aren’t feeling ready to have sex yet. Some women can get pregnant again weeks after having a baby, and it is possible to get pregnant if you’re breastfeeding.

What you can do: Talk with your partner about your plans for future babies (if any). Then, talk with your health care provider about an approach that is right for you. Research shows that mothers and babies are healthier when couples wait at least 18 months after giving birth before getting pregnant again. If you’re not using another birth control method, Dr. Stuebe recommends having a few condoms on hand, just in case. “It’s rare for the baby to be asleep and both mom and partner to be in the mood for more than a few minutes,” she says. “You don’t want to spend those minutes searching for a condom.”

Losing the “Baby Weight”

Despite what celebrities seem to do, according to the tabloids, you don’t lose “the baby weight” immediately after childbirth. (Your uterus alone will take six weeks to shrink back to its normal size.) Many women find that going back to their pre-pregnancy weight is not easy, and it’s especially difficult when you’re tired and stressed.

What you can do: “If you’re trying to lose weight after pregnancy but you’re too exhausted to exercise, try to get more sleep instead of stressing about not losing the weight as quickly as you’d like,” Dr. Stuebe says.

“We can’t expect women to be back in our skinny jeans at two months.”

“We can’t expect women to be back in our skinny jeans at two months.” Losing weight slowly is a good approach—aim to lose about 2 to 4 pounds per month until you’ve reached a weight that is healthy for you. Eating fruits and vegetables and taking stroller walks are two good first steps.

Mood Changes and Postpartum Depression

New moms may experience the “baby blues,” meaning they feel sad and cry easily during the first one to two weeks. Some mothers—about 1 in 8—experience much stronger feelings and have postpartum depression. The hormone changes after birth can alter brain chemistry, which can be serious and can prevent you from caring for yourself and your baby. “If you find you can’t fall asleep even when your baby is sleeping, or you are having frequent scary thoughts, that can be a sign that your brain is not being your friend,” Dr. Stuebe says. “If you’re concerned, talk with your provider. Postpartum depression is common, and with help, you will get better.”

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 health care provider about how you’re doing, and get help right away if you need it. You can call (919) 966-5217 to make an appointment at the UNC Center for Women’s Mood Disorders.

 You Don’t Have to Take It All on Yourself

A final word of advice from Dr. Stuebe and Dr. Verbiest: Find your village. Newborns are cute, and they are also a huge amount of work. That’s why, throughout human history, cultures have rallied around new mothers and babies to provide care and support in the weeks after birth. Some anthropologists have suggested that alloparenting—sharing responsibility for infant care—is a fundamental part of what makes us human. Those traditions have faded in modern life, and that leaves many moms feeling isolated.

What you can do: Before your baby arrives, talk with your partner, family and friends about how they can help in those first few weeks. Instead of fancy onesies and baby gifts, consider asking friends and relatives to drop off meals or do a load of laundry. Take a childbirth class so you can meet other couples who are expecting at about the same time. Once the baby arrives, meet up with other moms through baby massage classes and moms’ groups, such as the programs at the Women’s Health Information Center.

For more tips on how to have a healthy fourth trimester, follow the 4th Trimester Project on Facebook.

Alison Stuebe, MD, MSc, is an associate professor of maternal-fetal medicine at the University of North Carolina School of Medicine and a distinguished professor of infant and young child feeding at the UNC Gillings School of Global Public Health.

Sarah Verbiest, DrPH, MSW, MPH, is a clinical associate professor at the UNC School of Social Work and the executive director of the Center for Maternal & Infant Health in the UNC School of Medicine. She leads the 4th Trimester Project.