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9 tips for the often-forgotten fourth trimester

Eloise Elphinstone
GP specialising in women's health

The fourth trimester refers to the 12 week period immediately after you’ve had your baby. It’s a time of great physical and emotional change as your baby adjusts to being outside the womb and you adjust to your new life as a mum. Despite this, it is rarely given the emphasis it deserves, dwarfed by pregnancy and birth. So, although not a scientific one, the fourth trimester can be an empowering term that allows new mums to recognise and talk about the significant changes that take place in this time.

With that said, here are my top tips for the fourth trimester.

1. Ask for help

Having a baby can be the most exciting experience of your life, but it can also be daunting, scary, and lonely at times. Remember that communication is key. Talk to family, talk to friends, and talk to your GP. You are not alone, but you may need to ask for help.

2. Sleep when the baby is sleeping

Tiredness usually comes hand-in-hand with having a newborn. Tiredness is not great in and of itself, but it can also exacerbate many physical and psychological symptoms. You can reduce tiredness by trying to sleep when your baby is sleeping. This is easier said than done, but really is worth it. You might also like to consider sleeping in a different room to your partner so that you can both get some good quality sleep. Even getting a friend, relative, or night nanny to look after the baby for a few hours can give you some respite.

3. Look after yourself and keep an eye on your mood

20% of mothers suffer from postnatal depression, which occurs most commonly within the two to eight week period after birth (although it can occur up to a year after birth). It’s a scary statistic, but it also means that you’re truly not alone and there’s nothing to be ashamed about if you’re not feeling very well.

It’s so important to ask for help if you’re feeling down, anxious or unable to cope. As well as counselling and medication, self-help therapy can be helpful. This could involve online therapy programmes through the IAPT service, Reading Well Books on Prescription, or various apps through the NHS app library, such as Calm and Headspace.

The following websites may also be useful:

  • www.mind.org.uk, which is a general mental health charity.
  • www.apni.org, which stands for the Association for Postnatal Illness.
  • www.pandasfoundation.org.uk, which offers community-based support for people struggling with perinatal mental health.
  • www.home-start.org.uk, which helps families with young children through challenging times.
  • www.family-action.org.uk, which supports families going through difficult periods.
  • www.familylives.org.uk, which also supports families.

4. Remember that partners can get postnatal depression too

It’s thought that about 10% of partners also suffer from postnatal depression, so keep an eye on how your partner seems to be and talk to them if you’re worried.

5. Make sure you attend your six to eight week check-up with your GP

You’ll get invited to this check-up by your GP between six and weeks after birth. The appointment is to see how both you and your baby are getting on, covering physical, psychological, and social issues, and to answer any questions you might have.

To get the most from your appointment:

  • Take a list of questions with you to ensure everything is covered and all your questions answered.
  • If possible, take somebody with you to help with your baby so you can focus on getting all the help you need.
  • Ask reception to see if they can book you with somebody experienced in postnatal health.
  • Bring any hospital letter from your birth and medical with you to the appointment.
  • Remember to bring the red book for your baby.

6. Do your pelvic floor exercises

It’s very normal to have a weakened pelvic floor after pregnancy and childbirth. To strengthen your pelvic floor, practise pelvic floor exercises regularly. In fact, there’s a useful app called Squeezy that can help remind you to do your pelvic floor exercises.

In the three months following childbirth, a third of women suffer from urinary incontinence. A significant proportion also experience bowel incontinence, which can severely impact quality of life, long term health, relationships, and employment. Even though it’s so common, many women find it embarrassing to discuss with their GP. But please know that there are many options for improving these symptoms, so do speak to your GP about them. They might suggest doing regular pelvic floor exercises or refer you to a women’s health physiotherapist, for example.

7. Don’t forget about contraception

You can have sex as soon as you and a partner both feel ready - there’s no ‘right time’. Having a baby can be both physically and emotionally demanding, so don’t feel pressured or put pressure on yourself to have sex before you’re ready. However, remember you can get pregnant again from 21 days post-birth.

You can get contraception at the time of delivery via your postnatal ward, at your six to eight week GP check-up, or from a contraception or sexual health clinic. You can also make an earlier appointment with your GP, anytime.

8. Reintroduce some gentle exercise where you can

Although you might not feel up to jumping into a strict workout routine for a while, introducing some gentle exercise when you’re ready such as walking, Pilates, or yoga is a great idea for improving both physical and mental wellbeing.

If your bleeding gets heavier or you feel very tired, you may be overdoing it. It’s sensible to wait until your six week check before starting anything more strenuous. It’s also important to check whether your tummy muscles have separated (diastasis recti), as this can be made worse by certain exercises.

9. Try to eat as well as you can

Postnatally, good nutrition is important to help strengthen and repair your body as well as giving you the energy to look after your baby. It can also help with mood, tiredness, and breastfeeding.

Don’t feel pressured to lose weight immediately after giving birth; your body needs time to rest and recover. You might be back to your pre-birth weight within six to 12 months of the birth, but everyone’s different. The best way to lose weight is to eat varied, healthy foods, start gentle exercise, and set achievable goals that work for you. Breastfeeding can also help with weight loss.

Giving birth is a life changing event, but it’s so important that we don’t forget about the fourth trimester, which many find harder than pregnancy and birth.