Rest, Recovery and Exercise in the Fourth Trimester

What to expect from your postpartum body as you begin the journey back into exercise.

During pregnancy, the vast majority of women focus on preparing for childbirth and life with a newborn, and rarely on what to expect in the first months or even year postpartum. That leaves many women underinformed about what’s going to happen inside their own bodies. 

Additionally, learning to love your postpartum body can be hard, and the temptation to “jump back into exercise” when you’re cleared at 6 weeks is often strong. But a body that spent 9 months growing another human may not be ready for certain kinds of exercise and require more healing. We break down what to expect, tackle some myths, and our advice about where and how to start exercise in the fourth trimester. 

What is the fourth trimester?

The fourth trimester is a term first coined by pediatrician Dr. Harvey Karp, and it refers to the 12-week period directly after giving birth. This early postpartum period is viewed like another trimester of pregnancy because human babies are not considered fully developed when they are born. 

Unlike baby giraffes (who can fall an astounding 6 feet upon flying out of the womb and be walking moments later) human babies are pretty helpless when they first exit the womb. If it weren’t for our enormous heads, the theory goes, babies would gestate for much longer. So for our babies, this is a period of tremendous frailty and neediness as they navigate a world they were not prepared to enter.

For moms too, the fourth trimester feels like another term of pregnancy. Many of the physical symptoms of pregnancy are still present: a weak pelvic floor, loose joints, and compromised abdominal muscles. And many of the hormones that were elevated during pregnancy are still lingering, so women often find themselves navigating mental and physical challenges in those early weeks. 

Mental and emotional changes during the fourth trimester

The experience most moms have in those early weeks with a new baby is similar to a rollercoaster ride. There are beautiful, heart-exploding moments with a newborn and the snuggles you’ve been dreaming of for 9 long months. But there’s also inexplicable crying, diaper blowouts, cluster feeding, and if you’re breastfeeding, leaky or engorged breasts. 

With hormones raging, very little sleep, spit-up in your hair, and a brand new baby who needs all the things at the same time and has none of the patience, it’s pretty common to feel overwhelmed. But sometimes this feeling snowballs into something more. If you’re unnaturally weepy and super irritable, you may have the “baby blues.” 

Baby blues are very common - up to 80% of women experience some kind of “funk” or mood change that can be classified as the blues. On average, this feeling should subside in about 10 days. Normally a couple of solid naps or your partner/doula/parents taking the night shift with the baby to let you get a good sleep - plus some light exercise - should help.

If the blues does not ease after 10 days, or you experience additional symptoms like severe mood swings, anxiety or insomnia, and/or disinterest in the baby, it’s time to seek help from your provider. Postpartum depression is not something you can control, but it is temporary and treatable. Seek help if your symptoms are severe and persist for a long time. 

Physical body changes in the fourth trimester 

In addition to navigating the emotional rollercoaster and “mom brain” (a legitimate scientific condition of motherhood, not just you being sleep-deprived and forgetful) your physical body is healing from the process of growing and birthing your baby. Swelling is common during the early weeks of the fourth trimester, as is feeling fatigued as your body goes into recovery mode. 

If you are breastfeeding, your body is also getting geared up for milk production. Managing either an undersupply or oversupply (because who gets lucky enough to just have the perfect amount of milk straight out the gates?!), hydrating enough, and eating enough high-quality calories can be a real mission. Engorgement can be pretty uncomfortable, and leaking everywhere can be pretty inconvenient. 

While it’s all worthwhile, and most of it temporary, it can make an enormous difference to have extra support in the early days as both you and your baby learn to navigate this brave new world. 

Recovery: C-section versus vaginal birth

Recovery after childbirth is very individual and will depend on if there were any complications during delivery, as well as your baby’s temperament and needs. If you have any tearing, for example, you should follow your doctor or midwife’s recommendations for rest while your body does its work to heal and the stitches dissolve. 

Regardless, you will experience some bleeding for 4 to 6 weeks after giving birth, and your uterus, which expanded to nurture and grow your baby, needs a bit of time (again 4 to 6 weeks) to return to its normal size. Swelling in your feet, legs and midsection are all very common as your body processes all the extra water, so expect that to disappear over the course of 1 to 2 weeks. 

For mamas who had a C-section, recovering from this surgery may take a little longer. If you’re extra worried about abdominal recovery after a C-section, know that most of the time this surgery doesn’t require a doctor to cut through muscle. They are cutting through many layers of skin and then moving the muscle out of the way to deliver the baby. So although all the layers of skin need to heal, there’s no reason why you should have more trouble later on when activating your core. 

If you recently gave birth via a C-section or you’re planning to have one and want to know more about what kind of rehab exercises we offer at Studio Bloom, we’ve got you covered mama! Visit our Special Circumstances page to learn more

For recently postpartum Bloom Mamas who have had a C-section, we have a whole series of videos on scar mobility, pelvic floor, and core mobility just for you. 

No matter how you give birth, it’s common to feel “loose” in your midsection as your uterus returns to normal and your organs settle back into place. Using compression panties can really help to stabilize your core when moving around the house or going for walks. Belly bands are wonderful for reminding your brain to turn on your core when doing the functional, everyday moves that require core support.  

Returning to exercise during the fourth trimester

All too often, mamas go zero to one hundred when it comes to returning to exercise. Instead of advice about what kind of exercise actually promotes recovery, many midwives and doctors just clear women for exercise at 6 weeks as long as the bleeding has stopped, tears have healed, or your c-section incision looks good. 

Very rarely does a midwife or ob-gyn proactively check for Diastasis Recti, or provide newly postpartum mamas with a roadmap to recovering core and pelvic floor strength that is a critical precursor to all kinds of other more high-impact exercises. As a result, it’s common for women to create or exacerbate issues with incontinence and Diastasis by skipping recovery and going straight back to doing box jumps, crunches, planks, etc. 

Myth: You need to wait 6 weeks before starting exercise. 

For both vaginal birth and c-section mamas, we recommend beginning to reconnect with your core through breathwork as soon as possible. This can be started as early as day one - or whenever you feel ready. We are talking about re-patterning your breath, learning how to correctly activate your deep core and breathe diaphragmatically. 

Here at Bloom, we’ve designed a guided program for postpartum recovery that will walk you through the entire process of safely returning to exercise, starting with rebuilding that core connection. 

To begin with, these are exercises that can be done from your bed, while nursing your baby. They’re designed to be flexible to make it more achievable and to encourage bonding time with your baby. We also include audio versions of this fourth-trimester breathwork for mamas to use while out walking with the baby, for example.

After a couple of weeks reconnecting with your core and pelvic floor and giving your body time to heal, you may feel comfortable progressing into some more light movement. These can be easy stretching and modified ab workouts specifically designed to help you strengthen your core without overloading it.

Every mama’s postpartum experience is different, and will also vary widely from baby to baby for the same mama. First and foremost, we recommend giving yourself grace as you navigate the early days of recovery, prioritize rest, and listen to your body. 

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