The Fourth Trimester of Pregnancy

The fourth trimester of pregnancy typically focuses on the three months after childbirth. If you search about information on the fourth trimester you will notice that this time focuses on the baby’s needs and its’ transition from life in the womb to our world.

There is an abundance of advice in how to feed, care and love your baby, but very little describes how women should cherish their post baby bodies in this critical healing period. In fact, healing after childbirth can take up to 18 months, but it is the first 3 months I want to focus on, as starting a woman’s restorative journey immediately after birth is vital to secure health for the longer term.

Thanks to social media, there is a common misconception that women should do everything in their power to get back into their skinny jeans as quickly as possible post birth. The strategies women use to achieve this unhealthy aim almost certainly retards the healing process and could trigger further setbacks to achieving their goals.

There are so many factors to consider when looking at the postnatal challenges woman face; from energy levels and hormone balance to nutrition and mental wellbeing. Let’s start by looking immediately after the baby is born. Whether you have experience a home or hospital birth, have birthed your baby naturally or have been assisted, there are some self-care tips that will help you cope with the demands of being a new mum.

Your body changed dramatically during pregnancy and now the body needs to start its process in returning everything back to normal state. The following advice can help you to put together your healing toolkit, much like your labour bag you packed ready for your baby’s birthday.

Homeopathic arnica tablets are excellent at drawing out bruising and speeding up the healing process. This is not only for areas of bruising that can be seen, but for tissues that may have been damaged in the uterus, bladder, cervix, rectum and vagina. These can be taken from before birth, so from you due date or a couple of days beforehand, and definitely immediately post birth, for up to 4-6 weeks.

The digestive system has been sluggish and women often experience constipation and haemorrhoids as a result of Relaxin and Progesterone hormones. It can take a while for you to feel that everything is working smoothly. The first thing to help with excess wind (which is especially common with a caesarean birth) is to drink fennel tea and chew a few fennel seeds post meal. This can also help in increasing milk production if you are planning to breast feed. Using a rocking chair helps the motility of the gut and also calms down the autonomic nervous system that is responsible for releasing our fight or flight hormones.

Gut health is so important for energy levels, quality of sleep and mental ability. Supporting the system with probiotics is a great move, especially if you were given antibiotics during or after childbirth. Take either 2 acidophilus tablets after breakfast daily, or think about growing your own water kefir (or get you partner or a friend to do this for you initially) which is a live probiotic you can make for pennies. Also reduce the amount of unnatural sugar consumed daily as this weakens the gut bacteria.

Good nutrition is paramount to healing and it is so common for women to overlook their own diet due to time, tiredness and putting their baby first. Planning ahead goes a long way to ensuring you eat good nutritious food and you can start this in your pregnancy. Getting your weekly shop delivered to your home saves hours of going to the supermarket and picking, packing and unpacking your food. Buying good quality and organic food where possible reduces the introduction of added pesticides, hormones and additives to the body which weakens the body’s immunity and damages cells. Eating a variety of salads with good quality protein in the summer months and home prepared soups in the winter are quick and easy ways to get nutrition into the body and support the restorative process.

All heavily processed foods are designed to give a quick fix to slumped energy levels but they in fact make the problem worse as this causes sugar highs and lows in the blood, so you feel even worse a few hours after indulging in a cake or biscuits. These foods also weaken the immune system making you more vulnerable to colds and coughs. Try and eat clean, which means that the food you consume is as close to its original form as possible.

Wheat and gluten causes abdominal bloating due to fermentation in the intestines so these should be limited and/or supplemented with alternatives such as buckwheat, quinoa and polenta.

Making your own sweet treats such as fridge flapjack or rolled nutriballs are totally nutritious, stopping the cravings and keeping energy levels stable.

Supplementation with vitamins and minerals is important if you feel your diet doesn’t cover all the elements of good nutrition. There are several important vitamins and minerals that help with the restorative process in the fourth trimester and beyond. The nutrients Vitamin D, Zinc, magnesium and omega 3 oils will help with quality sleep, brain function, strength, cell integrity, reduction of inflammation, and the absorption of other essential nutrients.

Collagen protein contains essential amino acids and so is a great supplement for repair of the supportive connective tissue such as the tissue between the abdominal muscles and in the perineum.

Passing urine can be uncomfortable, especially if you have stitches, so ensure that your urine is as dilute as possible by drinking plenty of fluids as concentrated urine is more acidic and can irritate the tissues in the vagina and perineal areas. It is helpful to pour a jug of tepid water with a couple of drops of lavender and tea tree mixed in it as you urinate to help keep the area clean and to promote healing. Use a cool pack (such as an ice block or peas wrapped up in a towel) and place this on your perineum for 5-10 minutes once or twice a day to reduce swelling and give some comfort.

You will lose a lot of fluid in the first few weeks as you have accumulated 50% more circulating blood volume to cope with pregnancy demands. You will still need to drink large amounts of fluid to help the cells rejuvenate as water is the main component of our body’s cells. The amount of fluid you should aim to be drinking in the first few weeks is 2-5 litres per day and can be a mixture of filtered water, herbal teas such as peppermint or camomile (which are good for digestion and calming the mind) and fresh juices such as beetroot (which is great for the blood) Fizzy drinks, tea and coffee should be avoided where possible as these drinks hinder the healing processes of the body and upset hormone balance.

Untitled drawing9Bowel movements can be a daunting task so it is important to make elimination as easy as possible. A first bowel movement can take days, especially if you had an epidural anaesthetic so increasing fluid intake will help to soften the stools and make passing them easier. Prune juice and green juices (celery, spinach, cucumber, apple, ginger, and lemon) are all great at helping gut motility ensuring bowel movements are easier and regular. Massaging your abdomen with circular movements in a clockwise direction will help soften the stools and help waste products move towards the colon and rectum. When opening your bowels ensure your knees are higher than your hips, as this reduces the number of angles in your colon making it easier to go. You can put your feet on a couple of toilet rolls or put your feet on a small child’s step.

With both of these elimination processes, your pelvic floor is involved. The pelvic floor muscles have been through a lot, supporting the weight of the pregnancy, and if you experienced a vaginal birth, they will have stretched from the birth and possibly also suffered some trauma to the muscle and skin tissue. It is essential that the pelvic floor muscles are exercised to prevent possible incontinence of urine and faeces and possible prolapse of the cervix, vaginal wall or bladder later on. These exercises can be started within the first 24 hours after childbirth. Try a few squeezes initially to gauge the sensation and movement felt and continue daily to notice the changes that occur.

Correct technique when performing pelvic floor exercises is important to help restore correct function. When lifting the pelvic floor, imagine that you are lifting the front and back passage and sides of the vaginal wall as if they were the four corners of a handkerchief. Focus on each corner individually at first and then start to pull them altogether. At the same time as you lift the muscles of the pelvic floor, focus on breathing out. These techniques help to recruit more muscles fibres when and therefore bring better tone and strength to the pelvic floor. This method should also be employed when picking up your baby or at any other time when you will put stress on your pelvic floor.

One of woman’s biggest issues after having a baby is her post birth belly. Immediately after birth the abdominal muscles which were laying against your growing uterus are now overstretched and have most certainly separated and need gradual help in restoration. One fact that women need to accept is that no pregnant belly is ever the same as before, but with the right work it can become strong and fully functioning again.

The first thing to be aware of is your breathing technique. Are you breathing from your upper chest, your diaphragm or your belly? Belly breathers are putting more stress against their abdominal wall (if you think of the average number of breaths being around 28,000 per day!) so be aware of your breathing when you are standing, sitting and laying down.

To strengthen your abdominals you must first quit any typical abdominal exercise you used to do. Crunches and planking just won’t work and puts further pressure on an already weakened area. Instead you must think smart and strengthen you muscles in your daily activities for at least the first couple of months before embarking on specialist exercises that restore your core and don’t hinder your progress.

In either a sitting or standing position, place your hands either side of your belly button and take a deep breath in and as you breathe out, hiss like a snake. You should feel your abdominal muscles contract. Repeat this placing your hands above and below your belly button. You should feel some activation throughout the whole abdomen. This activation should improve with time and practice.

With this exercise you have engaged your abdominal muscles in the SET position. This technique will also recruit the muscles in the back that support the abdominal area. This is the tension required when carrying out ANY strenuous activity, such as taking the buggy or car seat out of the car, picking your baby out of the cot and even getting out of the bath. Now that you have mastered this you then need to incorporate your pelvic floor activation. As you breathe out and lift your pelvic floor, create the SET tension in your abdominals. In everything that you do, you must engage your core so that it works for you and becomes stronger.

As long as there is no prolapse from the vagina or doming of the abdominal wall, pain, bleeding or numbness in these areas you may start a bespoke exercise regime that will advance your strength in these areas. Exercise classes really do come last to all the other elements mentioned and should ideally be commenced 10-12 weeks after any type of birth. Returning to ‘normal’ exercise classes too soon, without employing any of the care strategies will render women ill-prepared for the work they are tasked with and if the wrong exercise is undertaken this can hold back essential healing processes.

All of these elements go towards your self-care. In caring for yourself you are not only helping your restoration process, you are a better functioning mother for your new born. Self-care is never selfish, it is essential to you and your baby’s wellbeing. Time out is essential to your growth as a new mum and will support your self-care. Having your hair done, getting a pedicure or a postnatal massage, or getting a friend or family member to take baby out in the buggy so you can have a sleep in the day are special times and are not at all indulgent. Giving yourself time for you gives you space to think about your life and priorities. It can help with healing your mind-set if you are particularly fatigued or exasperated and enable you to cope better with daily challenges.

With all the advice given for the first 3 months here, it is important that self-care continues way beyond this period and that you never lose sight of how important it is to nurture and cherish yourself during this amazing time in your life.