The Fourth Trimester: 3 Important Tips to Help You Prepare

Thanks to Apex Physical Therapy & Wellness for sponsoring this article. 

Pregnancy is a journey. For some, its blissful, wonderful, and smooth; while others have a bumpy, wild ride filled with ups and downs.

As a mom of four, I’ve experienced both throughout my five pregnancies. Through them all, one thing stands out: pregnancy is just the start of the motherhood journey!

Holding my sweet bundle of joy against my chest for the first time, I was filled with a flood of emotions and adrenaline. As the OB finished stitching me up behind the bright blue drape, I barely noticed the buzz of the delivery room as my emotions twisted between gratefulness, fear, joy, shock, and relief.

My mind replayed the labor and delivery. It did not go how I’d hoped.

My birth plan changed. I feared losing this baby, too. Tears streamed down as I realized that the emotional scars from the miscarried first pregnancy were now resurfacing at the same time as the physical scars from the emergency Cesarean delivery I’d just experienced. My abdomen ached and burned, but I was grateful. Grateful for the wonderful gift of another pregnancy— this one with a much happier ending.   

My baby is finally here. Now what?

A woman I’d looked up to my whole life told me, “Don’t rush to get out of the hospital, Brooke. You’ll never have that much help again.”

So, I took that advice. I stayed. I rested. And I bonded with my baby. But my body was not the same. It was hard to move, lift, and even have a bowel movement.

I’m thankful that I didn’t rush to get home.

Although I didn’t realize it at that time, that was the best thing I could have done for myself. I would soon become my own worst enemy as I returned home with my husband and baby boy.

I jumped right back to the normal household duties: cooking, cleaning, grocery shopping, exercising, and even attempted some work duties. All while holding, feeding, bathing, and changing my newborn.

I ignored the sharp, burning of my scar, the wincing with any trip to the bathroom, and dealt with all the padding needed to absorb the leaking — from more places than I was prepared for!

And I was terrible at accepting help from my husband and others who offered, because I didn’t think I needed it.

What is the “Fourth Trimester?”

My postpartum experience is probably similar to many women reading this right now. Stories like mine are so common that the term “fourth trimester,” aptly named by Dr. Harvey Karp, was coined because the journey to motherhood does not end with birth.

The fourth trimester is a term describing the 12-week period beginning immediately after your baby is born. This is a time of adjustment for both the baby and mother; however, far more resources are available for the baby.

The American College of Obstetricians & Gynecologists (ACOG) has also recognized this term and its significance, but it’s still far from widely recognized. 

Supporting women in the postnatal period has become a focus of our team of Pelvic Floor Specialists at Apex Physical & Wellness and we have developed the following tips: 

Tips for the Fourth Trimester

  1. Plan for 1-3 prenatal appointments with a Doctor of Physical Therapy (DPT) with Pelvic Floor training for prenatal core and pelvic floor assessment using Surface EMG/Biofeedback. This can be used to teach you proper Kegel exercises for effective pushing and less tearing. We can also rank birthing positions that would be best for you to labor in using this technology. And we give great advice for what to expect after baby as well.
  2. Prenatally, schedule a 3-week postpartum check in with a medical provider — that can be your Pelvic DPT, mental health provider, OB/GYN, nurse, midwife, doula, chiropractor, massage therapist, just to name a few. Of course, knowing exactly when your little bundle of joy will arrive can be impossible, but scheduling three weeks from your due date might be a good start. There is a sample of the “Postpartum Plan for Mom” on our website.
  3. Attend a Pelvic PT screening like the “6 Weeks Post When It Matters Most” program at Apex. Lots of great information for pelvic floor, diastasis recti, breastfeeding (mastitis and plugged duct help), body mechanics, and return to exercise help. This is the standard of care for Europe, but not yet in the United States. Help change the culture for a new mom in your life by sharing these guidelines.

Postpartum Healing is a Process

Now, as a mom who has been there four times with a baby (and one time without), I can tell you that each of my journeys had a different healing process.

And I’ve realized that time for mom to heal also needs to be a priority. My hope in sharing my pregnancy journey and tips is to help even one mom feel supported in the fourth trimester. And to educate those reading this to share these tips and support the new moms in your life to normalize fourth trimester care.

If you are a pregnant or new mom, you’re invited to attend our postpartum party event!

Apex Physical Therapy | Postpartum Party Event 

When:  September 23, 2021

Where:  Apex Physical Therapy & Wellness Center, 1420 9th St. E, Suite 407, West Fargo 

Time:  4:00 p.m. to 7:00 p.m.

What:  What a great way to take care of yourself by attending our Postpartum Party! DPTs will be on hand to assess your core muscles for Diastasis Rectus Abdominus (DRA), offer a preliminary chat about any issues you’ve been having with your body, including pelvic floor, and send you with a few quick remedies. Sign up here!

Sign-ups are preferred, but walk-ins are welcome as well! Then continue to visit our lactation consultant, infant & breastfeeding craniosacral therapist, massage therapist, and visit our vendors who are hand-picked for their impact on moms postpartum! We’ve chosen experts to help choose cute clothing to dress up our ever-changing bodies, safe postpartum exercise, cooking nourishing snacks, brewing healthy drinks, and mommy makeover opportunities. Even photos of you looking fab with your little one available! This is our first annual, but we think it’s going to be a hit, so don’t miss it! 

apex physical therapy fargo

No one should feel rushed when it comes to their healthcare. At Apex Physical Therapy and Wellness Center, we allow enough time in each visit for thorough communication and treatment. We are also one of the few physical therapy centers in the Fargo area offering science-based manual therapy. It is this personal touch that sets us apart and fuels our ever-growing list of referrals. At Apex, your needs come first.

Whether your needs are centered around rehabilitation after surgery or injury, chronic pain management, or therapeutic massage, the Apex team is ready to help. Our services are available as outpatient physical therapy at our three facilities located in Fargo, Jamestown, and LaMoure, North Dakota.

About the Author

apex physical therapyBrooke Erstad, PT, DPT, CAPP, is a Board-Certified Women’s Health Clinical Specialist (WCS) with advanced training in pelvic rehabilitation for females, males and children.  Brooke has a Bachelor of Science degree in Exercise Science and a Doctoral degree in Physical Therapy from the University of Mary, Bismarck, ND in 2003 and 2006, respectively.

She is a member of the American Physical Therapy Association section on Women’s Health (APTA SOWH). Brooke is also highly trained in Visceral Manipulation (VM) and Neuromanipulation (NM) through the Barral Institute.  Using VM and NM techniques to treat digestive issues, chronic Headaches/Migraines, kidney diseases, and many other chronic conditions, Brooke has helped many of her patients lead healthier lives.

She also has experience treating pre– and postpartum issues, incontinence, pelvic pain, osteoporosis, fibromyalgia, and other chronic pain syndromes unique to females and pelvic pain, urinary incontinence, and post-prostatectomy dysfunction in males.  Brooke also has advanced training in Pediatric Pelvic Floor Dysfunction including incontinence, bedwetting, constipation, encopresis, and many others.  Brooke continues to seek additional training as well as contributing to the field of Pelvic Rehabilitation and Chronic Pain Management.

Brooke & her husband Bryan have 4 children, Blake, Brogan, Bradie & Beckett.

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