What Pregnant Moms Need to Know About the ‘Fourth Trimester’

For many women, what happens during the first six weeks after childbirth can be surprising. Doctors at U-M are shining a light on this time.

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Author | Rene Wisely

Pregnant moms spend a lot of time learning what to expect from pregnancy and how to care for their newborns.

But while pregnancy anecdotes and birth stories take top billing at baby showers and get-togethers, girlfriends and family members tend to leave the challenging aspects of the "fourth trimester," the first six weeks postpartum, left unsaid.

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"Changes that happen to a woman's body during and after childbirth are not usually widely discussed with soon-to-be moms," says Carolyn Swenson, M.D., a gynecologist who specializes in female pelvic medicine and reconstructive surgery in Michigan Medicine's Von Voigtlander Women's Hospital urogynecology program.

"There are so many exciting things to look forward to with a new baby. But pregnancy and childbirth can also have some less-than-desirable effects on a woman's body, especially her pelvic floor," Swenson says.

"I hear from a lot of moms that, 'Gosh, nobody ever told me about this. Everyone told me how great it is to have a baby, but nobody told me that I'd have to wear diapers too.' Incontinence can be really distressing," she says.

Specialized care for new moms

Swenson and Michigan Medicine colleagues offer specialized services for moms after childbirth, including help with pelvic floor problems, through the Healthy Healing After Delivery Program.

About 15 percent of new mothers need treatment for childbirth ailments such as urinary and fecal incontinence, complications from obstetrical tears, pelvic pain and other pelvic floor issues, Swenson says.

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"It's unique to have a specialized postpartum clinic focused on pelvic floor disorders. We coordinate services with experts in physical therapy, lactation and psychiatry," she says. "It's a real benefit to so many women."

Katherine Pasque, M.D., is another Michigan Medicine physician who specializes in caring for moms after they've given birth. Pasque — herself an obstetrician and gynecologist — struggled with breastfeeding, specifically overproduction and pain.

"I realized I was the kind of doctor people would be going to with questions about postpartum care, and I had no idea what to do to fix my own issues," Pasque says.

That led her on a journey to find the answers. She became an international board-certified lactation consultant — one of several lactation consultants at Michigan Medicine, but the only one who is also a practicing OB — a process that involved more than 90 hours of breastfeeding education.

Ask your pediatrician, call your OB — the important thing to remember is that there are no questions you can't ask. More often than not, there are tips and resources we can suggest to help you along the way.
Carolyn Swenson, M.D.

Strength in community

Pasque and her outpatient breastfeeding clinic have become a destination for mothers and babies with breastfeeding issues.

Their approach includes a pre-emptive Centering Pregnancy program at Briarwood Center for Women, Children and Young Adults designed to help solve issues before they arise.

SEE ALSO: 5 Things I Wish I Knew About Breastfeeding Before My Baby's Birth 

Pasque's new group-based prenatal care session brings together six to 10 women — some new moms, some veterans — who have due dates within four weeks of one another to discuss the struggles of pregnancy, childbirth and the postpartum period.

Pasque hopes these groups get together outside of her office after childbirth so the new mothers can help each other by sharing what worked for them.

"It's a community, and they can be a support system for each other," Pasque says.

Both Pasque and Swenson say getting a support system in place before birth is the key to navigating the fourth trimester.

They offered other tips to make the transition easier:

Navigating the fourth trimester

Know that help is out there. Whether it's breastfeeding trouble or sleep deprivation, experts are ready to throw a lifeline when needed. Seek that help. Just having a lactation consultant watch a baby latch on can ease any fears of mom feeding baby incorrectly.

"It's easier to make the decision to get help when you have that list of where to turn to for help ready before a baby arrives," Pasque says.

Focus on what works for you and your baby. From your pediatrician to the nurse at your OB-GYN's office, everybody doles out different advice. Whose do you take? Try them all to find what works, Pasque says, and keep your and your baby's health in mind.

"I have three kids, and every one of them needed different things," Pasque says.

Keep a bedside box. Pasque's favorite gift she received was a box to put at her bedside to help ease baby's middle-of-the-night wake-ups. It included diapers, wipes, onesies, nipple pads, Vaseline and the like.

"I'd reach over (to a nearby bassinet) and get the baby, change the baby in bed and feed the baby," Pasque says. "If you have that box there, it means your feet never have to hit the floor in the middle of the night, making it easier to fall back to sleep."

Consider if lanolin is right for you. Lanolin, a popular gift at baby showers, is a natural substance used to prevent nipples from cracking, blistering or drying out from breastfeeding. Pasque says Vaseline is tolerated easier. She has many new moms who come into the office with rashes because they are allergic to lanolin.

Stock up on healing supplies. Warm-water sitz baths, ice packs, doughnut pillows, peri bottles (i.e., squirt bottles to rinse with water instead of wiping after toileting for the first few weeks) and 100 percent cotton pads help heal the vaginal trauma caused by delivery, Swenson says.

Consider physical therapy or massage. If incontinence issues arise, see a physical therapist who specializes in pelvic floor exercises to strengthen the muscles that hold up the bladder and uterus, Swenson advises. Therapists will ensure the exercises are done properly, and they have gadgets that monitor progress.

SEE ALSO: How to Do Better Kegels at Any Age

"It's more in-depth with better results than having a patient do Kegels on their own," Swenson says.

Sometimes new moms can't feel when they have to urinate, Swenson explains. "This happens because there is a lot of pressure from the fetus pressing on the nerves that supply the bladder and the pelvic floor," she says. "The rest of the tissue can get bruised or swollen, and it takes time for the nerves to recover," sometimes two or three weeks.

Moms who delivered by cesarean section also may benefit from a therapist massaging the incision scar. The tightness of the collagen fibers in the skin can make bending over painful, among other issues. Manipulating the tissue can promote blood flow and accelerate healing.

Avoid constipation. Chronic straining, especially if mom had a perineal tear, can put tension on the stitches and is hard on the pelvic floor muscles, Swenson says. She suggests using a laxative like Miralax (rather than a stool softener) daily until the constipation subsides. It's safe for breastfeeding moms as well.

Try walking. If it still hurts to walk nearly a month after giving birth, see a doctor. The spine could be out of alignment, or a pelvic bone may have broken during delivery, Swenson says.

Watch for postpartum depression. More intense than baby blues, which is marked by crying, sadness, anxiety and feeling overwhelmed, postpartum depression affects 13 percent of mothers and may appear a year after giving birth. Extreme irritability, insomnia and fear of the baby getting hurt in unusual ways are symptoms that are sometimes dismissed.

"I had a patient who couldn't sleep because she feared the ceiling falling on her newborn," Pasque says. "You might not think that is a sign of depression, but it is."

Most importantly, Pasque and Swenson agree that help is never more than a phone call away.

"Ask your pediatrician, call your OB — the important thing to remember is that there are no questions you can't ask," Swenson says. "More often than not, there are tips and resources we can suggest to help you along the way."

More Articles About: Women's Health childbirth Breastfeeding and bottlefeeding Pregnancy Postpartum Depression Von Voigtlander Women's Hospital obstetrics
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