4th Trimester

Baby books and apps carefully guide you through the entire process of tracking your pregnancy week by week. Some even continue through how to care for baby in the hospital and when you get home. But I have found a gaping hole on the subject of postpartum care, especially for after coming home from the hospital. So much so, that I have made it a habit to create an after care basket for first time moms and include a little instructional chat. I have written briefly about postpartum care in the past here, but I want to elaborate and expand more.

No matter what your birth story looks like, you delivered a baby (or babies)! I have had four different birth experiences and through each process have learned something new. For starters, birth is a natural occurrence that has so many peculiar “normalcies” but can also be unpredictable. One woman’s uncomplicated birth may be completely different from the next, let alone from her fellow friend. So we can’t say “This was my experience so you don’t know what you’re talking about”. Some women experience all kinds of pre-labor including braxton hicks for months on end and prodromal labor for weeks that can sometimes turn intense like I did this time. On the other hand there are some women that don’t feel a thing until they are in active labor. I can’t speak about cesareans from personal experience but that is another basket full of varying experiences from planned to emergency. The bottom line is women need to be more supportive of each other and celebrate each birth story for the miraculous thing that it is, bringing a life into this world.

Part of that support needs to include being more vocal about all of the different experiences and challenges that the “4th trimester” brings. Our bodies change so much through out pregnancy and they don’t just go back over night. There is a whole new list of changes that need to take place as you heal, hormones plummet, and clothing sizes change (up and down).


Afterpains and Going to the Restroom

Some of the first things you will experience physically after giving birth are contractions that are often called afterpains and quite possibly a tricky trip to the restroom to urinate for the first time without a small(ish) human applying pressure.

The afterpains can feel as mild as bad period cramps and as strong as early labor contractions. They are effectively working to first constrict and close the blood vessels where the placenta was attached then to begin the weeks long process of shrinking the uterus back down to its original size called the involution of the uterus. With each pregnancy the afterpains can be increasingly stronger (they have for me). If your nurse offers additional pain medication and you are uncomfortable, by all means don’t try to be a hero! The plus side is that the afterpains subside over a couple of days and are typically strongest while nursing or pumping until they fade away completely.

Going to the restroom for the first time after giving birth can be a rather tricky affair, especially if you have had a catheter, additional swelling from extended pushing, tear, episiotomy, or any other potential variances. In my case, there was some swelling from delivering a larger baby which made me feel like an older gentleman with a prostate problem. There was the sensation of needing to urinate but my body wasn’t cooperating so I asked someone to turn on the sink while I used the peri bottle to help stimulate my body into action. Your nurse may offer stool softeners in the hospital, if not, I highly recommend adding one for a little while along with a high fiber diet to help smooth things over and reduce any unnecessary straining.

Once you get home it will take about a week before bathroom trips become less of an ordeal. It has been very helpful for me to have a postpartum care kit set up in my bathroom. Be sure to bring home that peri bottle along with pads, mesh panties, ice pack, medicated wipes, and chux pads if available. One thing that I tried differently this time was to start with depends for the first several heavy flow days and I don’t know why I didn’t try them sooner. As flow slowed down a little and I started to run low on the sassy underpants I switched to using them overnight and using underwear with big overnight high absorbency pads during the day. It is a good idea to have a variety of pads from extra heavy overnight to panty liners and a few options between. Another great thing to get is medicated wipes. They have witch hazel (a natural astringent) and cooling aloe which makes them the best thing to wipe with while everything is still tender and healing. Other cooling agents that you could employ include New Mama Butt Spray and Dermoplast Pain Relieving Spray.


Tenderness and Engorgement

Whether you nurse, pump, or choose to suppress lactation… you will most likely deal with some breast tenderness and possibly engorgement. I have done all three now and have dealt with varying degrees of engorgement each time. Cold application feels wonderful and warm (shower or wash cloth) helps stimulate let down.

If you are nursing, I suggest using the help of a lactation consultant to ensure a good latch to reduce nipple pain. It typically still takes you and baby about six weeks to get a good handle on things and for supply to even out but should be smooth sailing after that.

For pumping I highly recommend a good nipple cream before and after each session to keep things comfortable. Try not to pump too often when your breasts are painfully full unless you are trying to increase your ounces per day as this will create a demand.

Another thing to mention for nursing and pumping is weight. Some women experience weight loss during milk production and swear by it to help return to their pre-pregnancy weight. Unfortunately for others, myself included, our bodies hoard all the calories and actually gain weight while producing milk. Whichever way your body reacts, just remember to give yourself grace and not try to implement any drastic changes while nursing or pumping.

The category I am newest to and currently in the middle of is lactation suppression. From the time shortly after delivery, and daily since, I have taken a dropper full of sage and kept on a sports bra. I also made peppermint roller balls to apply after I came in contact with Samuel or heard him cry while I was in the hospital. Once my breasts started to fill I applied the peppermint more often, which was nice because it had a soothing menthol feeling. About that time was also when I asked my husband to pick up a head of cabbage so that I could start applying rinsed and dried leaves inside my sports bra. So far there have been about three really engorged days of rough discomfort. Today was the first day with some softer parts but they are still fairly full and sore as I’m not pumping.


Mental Health

This is a topic that I’ve grown passionate about over the past two years. One of the biggest invaluable resources is to have a support system in place and surrounding you before you deliver a baby. Having that support system to lean on if you need any kind of help … it’s huge. If you have a history of anxiety, depression, or postpartum depression, it is also excellent to have a therapist that specializes in birth trauma related issues. I have been blessed with a very gifted therapist and feel like I have a magic ace up my sleeve knowing that she’s in my corner. To round out the trifecta is a supportive and accessible OB/GYN that will see you and discuss your options if you aren’t feeling yourself.

I have been blessed with an iron clad support team all around and as wonderful as that is I realize that the sad truth is my situation is the exception rather than the norm. There have been heartbreaking stories about women trying to access care or medication only to be ignored or treated like a criminal in need of a psych hold. There really needs to be a better understanding about postpartum mental health and women supporting each other through it. Educate yourself on some of the symptoms and differences between postpartum mental health issues and baby blues.

The “4th Trimester” is a time to ease back into life, try not to over due it, and give yourself time to heal. Something I need to remind myself regularly, so you’re in good company!


One thought on “4th Trimester

  1. Pingback: Lactation Suppression | Foster Womb

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