The Fourth Trimester

By Dr. Brooke Meinema, DPT, FAFS

Delivering a baby is a major ordeal. Our bodies have gone through pretty dramatic changes during our pregnancy: postural changes, hips widening, ligamentous laxity (increasing instability), breast changes, on top of general fatigue from growing another living being. Follow this up with delivery, whether vaginal or cesarean, and you have yourself one exhausting and body-altering year! The “fourth trimester” has been a term used to describe the postpartum period (after the third trimester and delivery) while our bodies continue to change and adapt to their new roles. The fourth trimester is still a time of great changes within our bodies and a recovery time from delivering a baby.

It’s very common to experience pain, instability, incontinence, or discomfort with sex after having a baby, but just because something is common doesn’t mean you have to accept it as your new normal. Getting in to see a pelvic floor physical therapist to help you along this process can be a game-changer. I understand it can feel a bit awkward or embarrassing to bring up some of these concerns to your provider, but just know this: we hear it every day! You are not alone in dealing with incontinence (fecal or urinary), pain with intercourse, or just feeling wobbly in general. Many women are unsure how to start exercising again, or even what exercises are safe for them to perform. As your healthcare providers, we want you to feel comfortable bringing these questions or issues up so we can set you up on the path to being you again. I have so many women ask “is this normal” because we often aren’t given very clear expectations on what we should expect our bodies to feel like afterward delivery, and our goal is to change that!

Any woman who has had a baby should see a women’s health physical therapist. Our body has so many changes during pregnancy, after delivery, and during the fourth trimester. Our breathing mechanics change, our posture changes, our pelvis changes (I mean, dilating to 10 cm is no joke), and, if you’ve had a C-section, you have major abdominal surgery to recover from! All of these changes need to be addressed to help you have a full, healthy recovery and return to your (new) normal life. Other countries have been more proactive about the mother’s recovery, and my hope is for us to get on their level. For example, in France, all birthing parents automatically receive a referral for pelvic floor therapy (as well as in-home postpartum care)! Wouldn’t it be nice to automatically get treatment early on without stigma or judgment?!

Postpartum physical therapy is so much more than just doing Kegels. While Kegels can be helpful for some, it isn’t always helpful for others (see my previous blog on Kegels for more information about this). Sometimes we need more strength, but sometimes our body needs to down-train our pelvic floor muscles (help them relax instead of squeezing them tighter). We also want to be able to coordinate our pelvic floor control with normal daily tasks (not just lying on your back and squeezing your muscles, but getting up and moving, too!). A women’s health physical therapist can guide you to reconnect with your core musculature, helping return to regular activities, addressing the change in breathing mechanics, and, yes, increasing the strength and reducing discomfort through your pelvic floor.

All of that being said, my goal is to encourage new parents to seek postpartum care after delivery, normalize these conversations surrounding your recovery, and advocate for yourself (and your loved ones).

If you would like to meet with one of our Women’s Health specialists to find out more about how physical therapy can help you during the fourth trimester, give us a call at 616.847.1280 and request a Women’s Health Assessment.