The fourth trimester—the 12 weeks after giving birth—is just as important for a mother’s health as the first three trimesters.
Yet this is often when mothers have the least interaction with their health care team, a time when, some experts argue, mothers need it the most.
The American College of Obstetricians and Gynecologists (ACOG) recommends that mothers have initial contact with their OB-GYN within three weeks after delivery, followed by ongoing care as needed, and a comprehensive postpartum visit no later than 12 weeks after delivery. They also recommend that a postpartum care plan be developed during pregnancy, so that mothers are better prepared when they go home.
A Comprehensive Postpartum Checklist
1. Physical recovery.
After delivery, there is a lot of soreness and healing that takes place. It is important for patients to have a full physical exam during their postpartum visit. A patient who had a tear during a vaginal delivery will need a thorough exam to make sure everything is healed. For C-section deliveries, the stitches need to be looked at to ensure they’re healing.
2. Infant care and feeding.
Postpartum appointments also are a chance to assess how a baby is doing and whether they are feeding properly. Breastfeeding is healthy for both infants and moms, but not everyone has instant success. If, after two or three days, there is a lot of pain, Mom is unable to breastfeed, or the baby is not gaining weight, seek support from a lactation consultant.
3. Sleep and fatigue.
Mothers will be very fatigued in the first few weeks after delivering a baby. Experts advise new mothers fit in sleep whenever possible, such as when the baby is sleeping. Resist the urge to do chores around the house when your newborn is sleeping; instead, take a nap yourself. Consider enlisting your partner in nighttime feedings so that you can get a good night’s sleep. Perhaps a family member or friend can help with babysitting once or twice a week or running errands while you get some much-needed rest. Don’t be afraid to ask for help if you are not getting enough sleep to function. Sleep deprivation should slowly get better over time. If it does not and instead gets worse, call your doctor.
4. Mental health and well-being.
It is normal to feel a bit of sadness seven to 14 days after birth—as many as 80% of women experience these “baby blues.” After all, a mother’s hormones are shifting, there is lack of sleep, and mothers are adapting to a new baby. “But if it goes beyond 10 to 14 days and people feel an overwhelming sadness or hopelessness, or a mother has so much anxiety or worry that they even think about not existing anymore, that may be a sign of postpartum depression,” says Rosser. “Those are reasons to get help immediately.”
5. Sex and family planning.
Returning to sex should be a personal decision. “Usually, it’s OK at six to eight weeks if everything is healed, or whenever Mom feels ready,” says Rosser. “What is important is that partners have open communication. Sex may be a bit different, so it is good to be open to it being different and take your time.”
When it comes to contraception and family planning, Rosser urges patients to have a plan in place before the baby arrives. Do not consider breastfeeding a form of contraception. “Before you become sexually active again, talk with your provider about birth control. Many patients will opt for an IUD right after delivery so that they don’t have to worry about an unplanned pregnancy immediately after birth.”
6. Diet and exercise.
It is important for new moms to nourish their bodies with healthy, whole foods (lots of fresh fruits and vegetables, lean protein, and whole grains), drink plenty of water, and begin moving their bodies as they feel ready. For those who have had a vaginal delivery or a C-section, an excellent place to start is simply walking: Go outside and walk around the block. Ease into it and build up your physical activity. Those who have had a C-section should check with their doctor about when to resume more strenuous physical activity.
Eating well and moving helps the body heal and recover. Healthy babies need healthy, well-adjusted mothers. If Mom is not well, then she is not going to be able to care for her baby and her family the way that she might want.
7. Chronic disease management.
Postpartum visits are an opportunity to recognize risk factors for conditions like heart disease or obesity and to check that complications during pregnancy such as high blood pressure or diabetes are resolving. It’s about educating, empowering, and motivating the patient and encouraging a healthy lifestyle that is consistent.
8. Know the warning signs.
One-third of maternal deaths occur after the birth of the baby, from one week through one year after delivery, according to the Centers for Disease Control and Prevention. Black women are three to four times more likely to die of a pregnancy-related cause than white women. It’s a sobering statistic that OB-GYN experts are working diligently to change by raising awareness of certain warning signs.
Seek medical attention immediately if you have any of the following symptoms:
Mothers who are considered high risk—those with diabetes, high blood pressure, obesity, or another chronic health condition—should be extra vigilant about any signs and symptoms that are not normal.
Just as babies need care and attention during the fourth trimester, so too do mothers. Postpartum care is a crucial time to make sure Mom is safe and healthy so that the baby can be supported in the best possible way.
Source: Mary L. Rosser, MD, PhD, also directs the Integrated Women’s Health program at Columbia University Irving Medical Center. She is co-chair of the New York State Expert Panel on Postpartum Care and is a member of the American College of Obstetricians and Gynecologists’ (ACOG) Presidential Task Force on Redefining the Postpartum Visit.
New Mama Deck and Hack Decks™
Think of the New Mama Deck as a "Women's Circle" in a box. It is designed by women who've set an intention to support one another through this critical change and transition period. The New Mama Deck encourages women to be their most authentic selves. It's made and designed by experienced moms who offer advice in the form of prompt cards. This advice is good for a mom's mental health, as well.
Our New Mama Deck offers sound advice and wisdom (from a distance and without pressure or judgment) and tips and tricks to make this phase of life a little easier. Learn from others who have done this before you. It will help make the transition easier.