The Fourth Trimester

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The Fourth Trimester

The trimester all moms long for: the fourth. This trimester was first named by pediatrician Harvey Karp, MD. It originated from his theory that all human mammals are born nearly helpless, meaning they require much more attention and care than most mammals do. Creating a constant need to be held, rocked, fed, and shushed; all stemming from the fact that babies are still adjusting to real life away from the mother’s womb. Not only is the precious newborn baby experiencing infinite amounts of changes, but so is the recovering mother. Changes for the mother include physical, mental, emotional, and hormonal changes. While most people focus on what is happening with the baby, I feel it is equally important to focus on the recovering mother. If the mothers aren’t receiving the care they need, how are they supposed to possibly provide the best care for their newborn or other children in the household?

For the sake of this blog, let’s focus on the physical part of the recovering mother. Being a mother of a two year old, a seven month old baby, and practicing as a Physical Therapist Assistant treating pelvic floor dysfunctions, I am fortunate enough to understand how crucial it is for a mother to properly recover following this beautiful and unforgettable event. Pregnancy creates changes in our body in more ways than one might expect, and it doesn’t stop once the baby has joyfully arrived.

First let’s discuss what the pelvic floor is. The pelvic floor is made up of muscles, ligaments, and tendons that act like a hammock to support the uterus, the bowel, and the bladder. With vaginal delivery being the most common mode of childbirth, it has been associated with the increased incidence of pelvic floor dysfunctions later in life. These dysfunctions include, but are not limited to, stress urinary incontinence, overactive bladder syndrome, pelvic organ prolapse, and fecal incontinence. But what if there was a way to decrease these instances from happening?

I want to draw your attention toward pelvic organ prolapse following a vaginal delivery. During pregnancy, the abdominal muscles are naturally weakened and stretched out in order to allow room for the growing uterus. Due to decreased abdominal support, the pelvic floor takes on a ton of pressure. In addition, a surge of hormones flow through the body during this time to help lengthen and relax our joints and ligaments. The combination of increased strain and the ligamentous stretching, along with pushing during childbirth, puts a toll on the pelvic floor. This in turn can result in prolapse. This occurs when the fascia and ligaments can no longer do their job to support the pelvic floor. Ding, ding, ding, prolapse can begin occurring even before the birthing process.

So, how can one avoid creating or further increasing pelvic organ prolapse following delivery? The answer to this question can be rather simple, however, oftentimes new mothers are not educated about protecting their pelvic floor prior to discharge from the hospital.

The reason I am writing this blog is because I experienced an “ah-ha” moment when being discharged after delivering my youngest daughter. The nurse was going through the instructional check-list and when she got to the bullet that highlighted home activities, I was instructed that I DO NOT have a weight restriction due to the sole fact that I did not have a cesarean section. Being respectful, I did not say a word, but the bells were blaring in my ears. Did she really just say I do not have a weight restriction when I return home? Is this the reason why we see a higher incidence of pelvic organ prolapse?

After this happened to me, I have become incredibly passionate about sharing my knowledge with new mothers about the importance of caring for themselves physically following this incredible and unforgettable event. So, to all the mothers out there that were told this at the time of discharge, or have yet to be told this, you absolutely DO have a weight restriction. This makes it very difficult but also very crucial for mothers who are caring for young children when they return home. Try putting yourself at an advantage by having young children come to you, have them sit on your lap or near you, and have a spouse or family member help with lifting the older sibling. It is important for your toddler to understand that “mommy has an ouchy” and lifting them could cause more pain. The reason weight restrictions are so crucial is that during delivery the cervix dilates to 10 centimeters and this does not close up immediately after delivery; it takes days to weeks before the cervix goes back to relatively normal, hence why physicians wait six weeks before performing their postpartum check up.

The first weeks of the postpartum phase should be focused on connecting with your breath, now that there is no longer another human occupying that space. Think of deep belly breathing and adding slight core contractions as you exhale (for further information regarding connecting breath, refer to:

Also, getting up and moving around the house, drinking plenty of water, and absolutely avoiding any lifting that is heavier than your baby can protect the recovering pelvic floor. It is okay to go for brief walks as your body tolerates. An increase in vaginal bleeding and uterine pain is a great indicator that you are pushing yourself too hard. Most importantly, give your body some grace, you just had a miracle created in you; so take the time to enjoy that miracle. I would suggest sleeping while the baby is sleeping, but anyone who has been a mother knows this isn’t going to happen. Most of all, take time for self-care.

After your six-week check up, it is very beneficial to attend pelvic floor physical therapy in order to assist in returning to physical activity and exercise. The therapists will be able to assess the pelvic floor, check for diastasis recti (abdominal separation), and provide a safe and effective home exercise program that will set you up for success without experiencing pelvic floor dysfunctions later on in life. You deserve to take this time for yourself in order to be the best mother for these amazing miracles.