Navigating the Fourth Trimester: Understanding and Overcoming Postpartum Challenges

The birth of a baby can trigger a wide range of powerful emotions, from exhilaration and joy to distress and anxiety. However, it can also lead to something unexpected: postpartum suffering. The postpartum period, often referred to as the “fourth trimester,” begins after the birth of the newborn and generally lasts six to eight weeks, or until the body has returned to its pre-pregnancy state. During this time, significant physical and emotional changes can occur, including hair loss, uterine involution, soreness in the perineum, baby blues, and postpartum depression.

Caring for an infant and adjusting to life during the postpartum period can be incredibly demanding. It’s crucial to monitor how you feel after giving birth and to inform your healthcare provider if anything seems amiss. Many experts recommend having a check-up with a maternal care provider during the postpartum period. They emphasize the importance of prioritizing rest and taking care of your health, alongside caring for your baby.

The American College of Obstetricians and Gynecologists (ACOG) recommends that care with a maternal provider be established within the first three weeks and no later than 12 weeks postpartum. Some women may require more visits depending on their symptoms and severity of their postpartum health issues. For patients with hypertensive disorders of pregnancy, blood pressure should be evaluated daily for 72 hours and again no later than seven to ten days postpartum. Early contact within the first few weeks may also help women meet their breastfeeding goals; among women who experienced early, undesired weaning, 20% had discontinued breastfeeding by six weeks postpartum, when traditionally timed visits occurred.

Although you may notice the physical changes during the postpartum period, it’s important not to overlook the emotional symptoms. The National Institute for Health and Care Excellence (NIHCE) guidelines recommend screening all women for resolution of the “baby blues” at 10-14 days after birth to facilitate the early identification and treatment of postpartum depression.

To optimize the health of women and infants, postpartum care should become an ongoing process rather than a single encounter, with services and support tailored to each woman’s individual needs. This initial assessment should be followed by ongoing care as needed, concluding with a comprehensive well-woman visit no later than 12 weeks after birth. Indeed, in qualitative studies, women have noted that there is an intense focus on women’s health prenatally, but care during the postpartum period is infrequent and late. Rather than the arbitrary “six-week check,” the American College of Obstetricians and Gynecologists recommends that the timing of the comprehensive postpartum visit be individualized and woman-centered. To better meet the needs of patients during this period, postpartum care should be provided either in person or by phone within the first three weeks postpartum to address acute issues.

The postpartum period is a time of adjustment and transition and while pregnancy seems to get more attention, the postpartum period holds equal significance. During this time, be gentle with yourself as you adapt, placing a priority on your well-being and seeking support from your healthcare provider when needed. Even if you feel fine, attending all postpartum checkups is crucial. These appointments offer opportunities to ask questions and for your provider to identify any potential issues.

Jodi Kilburg, ARNP
OB/GYN & Infertility Department
Medical Associates Clinic

Sources:
https://my.clevelandclinic.org