The Most Commonly Searched Questions About the Fourth Trimester of Pregnancy
UT Health Austin ob-gyn answers the most commonly searched questions about the fourth trimester of pregnancy
Video by: Emily Kinsolving and Alyssa Martin
Written by: Rocky Epstein
During the “fourth” trimester (birth to 12 weeks postpartum), or postpartum period, you’ll likely have many questions about how to care for your body and what to expect after giving birth. Dealing with changes in your emotions, body, and hormones while caring for your new baby all at once can be daunting. Don’t rely on the internet for answers!
In this fourth installment of a four-part video series, Karla Maguire, MD, MPH, an obstetrician-gynecologist in Women’s Health, a clinical partnership between Ascension Seton and UT Health Austin, answers the most commonly searched questions about the fourth trimester after pregnancy.
“Routine checkups after delivery are two weeks after delivery and then six weeks,” explains Dr. Maguire. “Sometimes, depending on your situation, if there were complications with the delivery, such as high blood pressure or other issues, we would want to see you back sooner. Definitely check in with your doctor and see when they want to see you in your particular situation.”
“I like to tell my patients that it took you nine months to create this baby, it’s gonna take you nine months to get back to normal,” shares Dr. Maguire. “I think it’s really important to give yourself some space and some time to get your body back to feeling normal, again. The uterus in pregnancy grows a lot, and it takes some time to get back to its normal size. Plus, the muscles in your belly and in your pelvis all are stretched to accommodate the baby. I think the most important thing is just realizing that not everyone can go back to normal immediately. You made a human and that’s a really important job.”
“The nurses in postpartum will start teaching you to take care of any pain that you have after delivery,” explains Dr. Maguire. “A lot of women have cramping, which we do give medications for while you’re in the hospital, which, sometimes, you continue after you go home. Other things like ice packs to sensitive areas can be helpful. If you’ve had a C-section, using an abdominal binder, which is basically a medical compression device on your belly, can be helpful. There are also other kinds of local medications we can give you if you’ve had a tear. There are things your doctor can do to make you more comfortable.”
“Depending on your type of delivery, your doctor will give you specific criteria on when you can start exercising,” says Dr. Maguire. “But if you’ve had a vaginal delivery, some people feel okay doing light exercise like walking and everything two weeks after the delivery, and we want you to stay active. Yoga’s always great postpartum as well. If you’ve had a C-section, you can start walking as soon as you feel comfortable. But, I wouldn’t do intense exercise with either type of delivery for at least six weeks until you’ve had your postpartum checkup. It’s always important after delivery to listen to your body. And if your body is tired, or it’s telling you not to do a certain kind of exercise, listen and take the time you need to recover.”
“Every woman is very different,” shares Dr. Maguire,” and again, it depends on whether you’ve had a vaginal delivery or a C-section, but often the bleeding can go on until you come in for your six-week checkup with your ob-gyn, but it should be getting lighter and lighter with time. Some women only have a couple of weeks of bleeding, but some people will have more prolonged bleeding. The important thing with bleeding is that if it is very heavy, so if you’re soaking through two pads an hour for two hours, or you have clots or you have an increased amount of bleeding after you previously had no bleeding, reach out to your doctor to see if they need to examine you and make sure everything’s okay.”
“That depends on a lot of factors,” explains Dr. Maguire. “The first thing, whether or not you’re breastfeeding, because some women who are exclusively breastfeeding won’t get their period until they wean. So, it could be up to a year until you get a normal period. However, some women who breastfeed do get a normal period starting pretty quickly after delivery. Usually, the earliest it would be is within six weeks or so. I tell my patients to keep track of their bleeding, and if it seems to be coming monthly, then their period has started again. But it can be a little confusing in the first six weeks to figure out if you’re having a period or if you’re having normal postpartum bleeding.”
“You should definitely go to your six-week check-up with your ob-gyn, where we do an exam to make sure everything is healing well,” says Dr. Maguire. “Then, after that, we usually let you know if it’s okay to go back to having sexual activity.”
“If you had a C-section, you’re going to have an incision on your abdomen,” explains Dr. Maguire. “The nurses in postpartum will talk to you about how specifically to keep it clean, but it’s important to keep it clean and dry. After you shower, pat it dry, wear clothing that isn’t too constrictive on the incision, and then keep an eye on it. Of course, if you see any redness or any drainage from the incision, give your doctor a call to be seen sooner than your postpartum visit.”
“If you had a vaginal delivery,” continues Dr. Maguire, “we recommend that you keep the area clean and dry as well. We give you a little squirt bottle to clean up as you go to the bathroom. Pat the area dry and keep the area as clean and dry as possible. Luckily, it does heal very well most of the time. But if you have any concerns, of course, let your doctor know.”
“Studies show that postpartum depression can occur in up to 1 in 10 women,” shares Dr. Maguire. “It’s really important to be on the lookout for any symptoms. The first two weeks after delivery, you’re going through a humongous change. You’re a new mom, you’re adjusting to not sleeping much, you’re breastfeeding, which can be new for people, and it’s just a completely new experience.”
“Often, with all the hormonal changes,” continues Dr. Maguire, “you can have what we call the “baby blues,” and that’s just feeling sad, crying for no reason, feeling a little tired and down the first two weeks. Definitely, if it’s something where you feel like hurting yourself or hurting the baby, you should definitely let your doctor know. After two weeks, if those feelings persist is when we start thinking about postpartum depression.”
“Of course, reach out to your doctor if you’re concerned about it,” says Dr. Maguire. “There is a depression screening tool we use at Women’s Health to see if you’re at high risk or low risk for depression. We can either help you get set up with counseling, and, sometimes, we start medication in the postpartum period. But it’s really important to reach out to your doctor, because we don’t want you feeling alone during this really important time in your life.”
“During pregnancy, we recommend that you get your COVID vaccine, your flu vaccine, and the Tdap vaccine,” shares Dr. Maguire. “If you haven’t gotten those in pregnancy, for any reason, it’s important to talk to your doctor to see when you should get them postpartum. We also check some labs at your first prenatal visit to see if you’re immune to rubella and varicella, which is chickenpox. If you’re not immune, then we go ahead and usually give those vaccines postpartum. So definitely check with your doctor to see if you need additional vaccines postpartum.”
Please remember to contact your ob-gyn with any questions you have related to your pregnancy to ensure you receive answers specific to you and your pregnancy.
<br>Explore answers to the most commonly searched questions about the first trimester of pregnancy (VIDEO).
<br>Explore answers to the most commonly searched questions about the second trimester of pregnancy (VIDEO).
<br>Explore answers to the most commonly searched questions about the third trimester of pregnancy (VIDEO).
For more information about Women’s Health or to schedule an appointment, visit here.