Your Guide to Postpartum Care In The Fourth Trimester
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Health Concerns

Your Guide to Postpartum Care In The Fourth Trimester

May 4, 2020

Most likely, if you’ve just had a baby, the majority of your health concerns center around your newborn, but postpartum care is just as important—and it’s getting more attention in the medical community. In fact, ACOG has now recommended that women have a postpartum check-in with their OB-GYNs within three weeks of giving birth (instead of the previous recommendation of six to eight weeks), and then another follow-up no later than 12 weeks after birth. But that time in between is just as vital to your wellbeing, and that’s where a little extra support can help. At Parsley Health, health coaches are there to provide nutritional and emotional support during this time, making sure your breastfeeding, nutritional supplements, diet, and exercise plan is working for you, and the doctors can monitor your hormone levels and healing progress. Here’s how you can prioritize your physical and mental health during the fourth trimester. 

What is the fourth trimester? 

The fourth trimester emcompasses the first three months after giving birth. Often, the point of additional care during this time is to recover from birth, of course, but to prepare the parents for the phase of going back to work if they’re doing so, which is often referred to as the fifth trimester. There’s a lot going on in your body during this time, so focusing on postpartum care should be part of your healing journey.

Common side effects women may experience during the fourth trimester include swelling, regardless of whether you gave birth vaginally (in that case, there’s fluid buildup from pushing), or surgically (there is typically fluid buildup from the IV you had), explains Christina Kang, a nutritionist and health coach at Parsley Health San Francisco. Cramping is also typical in the first few days, Kang says, because your uterus is shrinking, and if you’re also breastfeeding, the contracting of the uterus moves even faster. It’s common to have vaginal soreness, if you gave birth that way, and lochia, or postpartum bleeding, which often lasts about six weeks after delivery. Along with those, you may experience symptoms like incontinence (but you may be used to that from pregnancy), and on the other end of the spectrum, constipation, likely from the epidural, if you had one. And don’t panic, Kang says, but you may have some hair loss as well, because of all the hair growth that may have happened during pregnancy—you have to shed it at some point. 

The aftereffects of giving birth aren’t just physical though: Struggles with mental health among new mothers are way more common than you think, and they’re important to pay particular attention to. About 70 to 80 percent of moms go through “baby blues”, which may involve feeling emotional or weepy, sad, anxious, and having mood swings or insomnia shortly after birth. But, if you feel a deeper level of despair, it could be postpartum depression, which affects about 1 in 7 women. Because of all these changes, having a medical and social support system in place can make the transition into motherhood easier.

What does postpartum care look like? 

If you’ve had a low-risk delivery, your regular postpartum care check-up with your OB/GYN may be just fine to monitor your baseline postpartum health. But at Parsley, the doctors and health coaches want to keep a closer eye on your healing process, and answer all the questions you have, which could be anything from hemorrhoids to C-section scars to breastfeeding, Kang says. The health coaches specifically are instrumental in offering emotional and nutritional support. Their goal is to actively listen to each member’s physical, hormonal, and mental health challenges, and to ensure she’s prioritizing her own self-care. 

The health coaches’ next step is identifying anything that delays or prevents healing, Kang explains. If you’re having abnormal bleeding or incontinence, that’s something to bring to your health coach’s attention, and they can refer you to a pelvic floor specialist. Or, if you have abdominal muscles that have torn (also known as diastatis recti), your health coach can recommend a specialist for that as well. On the nutritional side, Parsley’s health coaches will do a deep dive to help the patient replenish nutrients for tissue repair and to load up on nutrients for breastfeeding. Plus, Kang adds, your health coach can help you make sure the breastmilk you’re producing is as nutrient-dense as possible. Nutrients are a huge piece of the puzzle in recovering from birth. 

“I always run at least a nutrient panel during the fourth trimester to see where they’re at. From there, we do a lot of discussion around nutrition and how to build a good supply of breast milk if they’re breastfeeding,” explains Liz Milbank, MD, a physician at Parsley Health in New York. “I’ll also give my postpartum patients reassurance on what to expect around hormonal changes and physical recovery, how to think about pumping, getting back to work, newborn care…we cover all of the bases to make sure she’s healing properly and confident about her role as a new mother.”

Regardless of what’s going on with you physically and mentally during the fourth trimester, Parsley Health’s team of doctors and health coaches are here to support you through it and make sure you get the care you need to feel your best.

7 ways to optimize your postpartum health now

1. Create a postpartum care plan before you give birth. 

It’s smart to plan out your postpartum care before you have the baby, so that you don’t lose sight of caring for yourself afterward. You can coordinate everything from who will help you watch the baby to who will assist you with meals, and how you will set aside time for mindfulness and exercise. Record the logistics in a template like this. This will make it easier for your partner or family members to support you in a concrete way as well. “This seems so trivial, but it makes such a difference when you’re sleep deprived after giving birth,” Kang says. 

2. Prioritize your sleep over (almost) everything else. 

“Sleep is when your body heals itself,” and it should be your number one priority, along with the baby, Kang says. Sure, you can try to sleep when the baby does, but that’s not always as easy as it sounds when you might be struggling with anxiety or many other things on your mind. If you rely on other people you named in your postpartum care plan, you can depend on them for support with childcare or meals while you get some sleep. For those times when sleeping isn’t so easy, download apps for guided meditation—seek out mindfulness and deep breathing exercises specifically for pregnancy and postpartum, Kang suggests. 

3. Pay specific attention to your mental health. 

Not everyone will be feeling the same way mentally after giving birth. Feeling less than elated is completely normal, Kang says. Postpartum can be a stressful time, even in the midst of a joyful occasion. But be alert to more serious symptoms of postpartum depression, don’t be afraid to ask for help. “If you feel like you’re a danger to someone else or the baby, talk to your health coach or healthcare provider about this. They can always refer you to a mental health specialist,” Kang says. 

4. Explore the many possible postpartum self-care practices. 

There are many people who can provide assistance to you during this time. Postpartum doulas are a good option to provide support with things like soothing the baby and any physical aspects of recovery you’re struggling with, Kang says. It’s also worth it to visit a pelvic floor specialist to treat any tearing you may have had during vaginal delivery or abnormal incontinence after birth. On your own, you can explore soothing sitz baths for some relief of perineal or muscle tearing, she suggests. A third specialist that might be helpful is a lactation consultant. “Even if breastfeeding starts off going well, this person can help troubleshoot if you have problems down the line,” Kang says. 

5. Eat a nutrient-dense whole foods diet. 

You should maintain a whole foods-focused diet, which you likely did during pregnancy, in the postpartum months. Protein and healthy fats are key for tissue repair, Kang says. Also, collagen will be important to provide healing amino acids. Drink bone broth, or if you follow a vegan diet, eat foods with spirulina for a collagen boost, she recommends. Foods that help with collagen synthesis are also a plus: That includes leafy greens, Vitamin C-rich foods like strawberries and other berries, and foods containing zinc, such as pumpkin seeds. 

It’s also a good idea to keep up with your prenatal vitamins for six months after giving birth—you need to replenish the nutrients that you lost, Kang points out. Omega-3’s are especially important, so you should take a fish oil supplement if your prenatal multivitamin doesn’t contain it. Iron also is another mineral you need months to replenish in your system. Your doctor can help you determine the right supplements and dosing for you, especially ones that are safe if you’re breastfeeding.

6. Keep up your hydration and keep moving. 

Especially if you’re breastfeeding, staying properly hydrated is really important to ensure healthy milk production, Kang says. She also recommends keeping movement as a part of your routine, even if it’s something low-impact like postpartum yoga. That’s a great way to meet other moms, too.  

7. Be mindful of your hormone levels. 

Everyone’s hormone levels are on a different timeline when it comes to restoring them to what they were pre-pregnancy. Staying tuned in to your emotions and how you’re able to handle them can be just one way to self-monitor how your hormone levels are regulating, Kang says. Diet and sleep is also key in keeping your hormones in balance, she adds. If you’re not feeling well mentally, emotionally, or physically, bring it up to your doctor or health coach. They can use a hormonal test to evaluate if your hormones are balanced, or if you may need additional support in balancing them out. 

Parsley Health is the only medical practice that leverages personalized testing with whole body treatments.

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