4th Trimester Wellness: Tips to Thrive in Postpartum


Last month’s topic of matresence, the transition to motherhood that women experience upon having a child, leads nicely into the topic of postpartum health and wellness, another area that is often ignored in medicine. Even without much planning, the baby will come and the postpartum period will commence. Our bodies are amazing like that.  But what if with a little forethought we could improve the chances of success in the 4th trimester, both physically and emotionally? Even if this isn’t your first baby, much can be done to smooth this transition.

4th trimester wellnessThe “Fourth Trimester” includes the weeks, months, and years after pregnancy, between pregnancies, and following a woman’s last pregnancy where many physical & emotional symptoms may arise. This is not a disease. Instead, it falls into a category of normal hormone flux, like PMS and menopause.  Women may experience a range of symptoms on a continuum, like a bell curve, with some women experiencing little to no distress, most experiencing moderate distress, and some significant distress. The degree of distress will dictate the intervention needed, with the goal of re-establishing the foundations of health and wellness post-childbearing.

After delivery, new moms may feel physically and emotionally drained, sometimes traumatized, in the immediate postpartum experience. Pain, discomfort, lack of sleep, attempting to breastfeed, and dramatic changes in hormones can be overwhelming. One in 7 women experience perinatal mood or anxiety disorders, and that does not capture those with mild symptoms, referred to as “the baby blues.” Postpartum issues can last up to 18 months and Dr. Oscar Serrallach states women may not fully recover for up to 8 years. This is compounded by multiple pregnancies and years of lactation. I frequently see patients, moms of 3+,  who have been literally sustaining the life of others for over 10 years. Who wouldn’t be exhausted and feeling like their body is falling apart?

So what can be done to help moms thrive in postpartum? In 2018, the American College of OBGYN published a position paper in support of increased postpartum care, but little has been done to affect a change in this direction. Locally, Matrescence offers classes & support for pregnant moms and this can be a great way to create your own proactive postpartum plan. However, if you find yourself in the 4th trimester without the benefit of having this type of education, all is not lost; there is still much that can be done, mostly by paying attention to your body, hearing what it’s telling you, and then getting the care it needs. 

When people think “postpartum”, they often think “depression”, but mental/emotional symptoms are only one component. As listed below, postpartum symptoms can affect the whole body and, therefore, a holistic approach is typically best. Here are the nuts and bolts of my recommendations for postpartum health:

  • Lactation consultations for mom and partner before/after delivery are more comprehensive than what is typically given at the hospital. There are also breast-feeding groups facilitated by a lactation consultant at the motherhood co. for social connection
  • Sleep is the #1 thing a new mom can do for self care: speeds healing from delivery, prevents mood symptoms, improves energy, decreases stress. Family, friends, or postpartum doulas/nurses can help provide extra support. Acupuncture for mom and sleep training classes at Modern Milk for baby are also very useful. 
  • Proper nutrition is key. If breastfeeding, this is not a time to worry about losing baby weight; emphasis on whole foods diet, with plenty of protein and good fats is key.  This also sets the stage for healthy eating habits for the whole family. Consultation with a nutritionist and meal prep assistance from Tailored Bites can be helpful.
  • Exercise decreases stress, improves mood, increases energy, and offers contact with new moms. Community-based programs like Fit4Mom are great and research shows that the combination of exercise and social interaction decreases symptoms of postpartum mood and anxiety more than either activity alone. A pelvic PT consult with The Pelvic Docs or Kim Byant, PT will ensure a strong pelvic floor prior to engaging in exercise or if there’s pelvic pain or urinary issues. 
  • Postpartum depletion occurs in many women after years of pregnancy & breastfeeding. Symptoms may include:
    • Fatigue
    • Insomnia
    • Poor memory
    • Mood swings
    • Menstrual irregularities
    • Inability to lose weight
    • Urinary & vaginal issues
    • Low libido
    • Hot flashes/night sweats
      • Nutrients: Continuing prenatal vitamins provides most of the nutrients women need in postpartum. Testing can identify nutrients requiring additional supplementation, like D, B12, iron. Omega 3 fatty acids, like DHA, and probiotics can protect against postpartum depletion. 
      • Hormonal testing may be indicated if experiencing depression & anxiety, specifically thyroid, progesterone, cortisol. Herbal support can be considered after weaning, as menses resumes, if preparing for another pregnancy, or if perimenopausal symptoms occur.

If depression, anxiety, and insomnia do not respond to the above interventions or include thoughts of suicide, paranoia, obsessive/compulsive thoughts/behaviors, therapy and/or medications may be needed. Postpartum Support International – AZ includes providers who have completed extra training perinatal mood issues. 

It is my hope that women will be proactive in the 4th trimester by taking time to prioritize oneself to be healthier as an individual, mother, partner, colleague, and friend.  Please check out my website at www.arcadiawomenswellness.com for more information, additional resources and to download a copy of the 4th Trimester Wellness Chart.


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