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The 4th Trimester: What Is It and What Can We Do To Make It Successful?

pelvic floor physical therapy postpartum pregnancy recovery stress management Mar 30, 2023

The 4th Trimester. What is it?

The American College of Obstetricians and Gynecologists (ACOG) defines the 4th trimester as birth to 12 weeks postpartum. The goal of bringing awareness to this timeframe is to improve and optimize the health and quality of life of women and their infants. The idea being the care of the mother should be an ongoing process and not a one-time six-week check-up. Unfortunately, even with these guidelines, ongoing support is not prevalent and not a standard of care.

What should we do?

Educate, prepare, and focus on the recovery of the mother! 



In a study looking at birth experiences they found that, “The majority of responses mentioned feelings of being un/misinformed by healthcare personnel, being disrespected and objectified, lack of support, and various problems during childbirth and postpartum. Fear, loneliness, traumatic stress, and depression were recurrent themes in participants’ responses. As the actions of healthcare personnel can substantially impact a birth experience, the study findings strongly suggest the need for proper policies, procedures, training, and support to minimize negative consequences of childbirth.” Rodríguez-Almagro J, 2019, et al.

SO! What can we do in response? We can educate and prepare for the birth experience so the birthing person is not blindsided by the event. Let’s educate on what the emotional experience of birth is (aka hormones), let’s educate on how to move the body to help the baby progress through labor, let’s educate on different strategies of pushing, let’s educate on comfort measurements and options during labor, and let’s educate the birth partner so they can be aware of how to participate. Let’s change the narrative and have the birthing person be a participant and not a passenger in the delivery of their baby. 



Preparation is key. Oftentimes when preparing for a baby, we focus on the nursery, the clothes, and all the “things.” What we tend to drift away from is focusing on the birth giver. Throughout pregnancy I think it’s important to be as prepared as possible for this life changing event. What does preparation look like? Finding your support system. Some support systems you could consider include a postpartum doula, mental health therapist, nutritionist, and pelvic health physical therapist. It is also important to set up boundaries for family and friends and make sure your significant other is on the same page. 

Another thing of importance is preparing your mind and body for labor. Practice varying breath strategies in stressful situations, or practice varying laboring positions and comfort techniques, so you have a better understanding of what your body feels good with. 


Focus on YOUR recovery

This is so important. Remember your body just went through significant changes and there should be emphasis on how your body is recovering. This can look like using any of the resources you have already prepared, but more importantly, trying to take time out of the day to do self care.



How can pelvic health physical therapy help?

There are approximately 4 million births in the US each year. ⅓ -¼ birth givers report pelvic floor muscle dysfunction within the first year of delivery and beyond. This idea that you should deal with it because it is common is not okay. Evidence shows physical therapy is an effective, low-risk, therapeutic approach for pelvic floor dysfunction and diastasis (Critchley et al, 2022).

When we consider how the health and wellness of athletes is considered. For example, with ACL or knee injuries, we have LOTS of research on prevention and programs to promote prevention. If the injury does occur, we have protocols and guidelines to promote excellent recovery and return to sport. 

At Athletes’ Potential, we believe this is exactly what we need throughout pregnancy, the 4th trimester and beyond! To be honest, it can take up to a year to feel like we have recovered from pregnancy and delivery due to lack of ability to recover properly, increased demands, change in nutrition needs that are not being met, and decreased awareness on how to properly progress yourself back to what you love to do. If you are in the Columbus or Atlanta area and are wanting to improve or prepare for your 4th trimester, we can help you!


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Thanks for Reading! 




Critchley CJC. Physical Therapy Is an Important Component of Postpartum Care in the Fourth Trimester. Phys Ther. 2022 May 5;102(5):pzac021. doi: 10.1093/ptj/pzac021. PMID: 35225339.


Rodríguez-Almagro J, Hernández-Martínez A, Rodríguez-Almagro D, Quirós-García JM, Martínez-Galiano JM, Gómez-Salgado J. Women's Perceptions of Living a Traumatic Childbirth Experience and Factors Related to a Birth Experience. Int J Environ Res Public Health. 2019 May 13;16(9):1654. doi: 10.3390/ijerph16091654. PMID: 31085980; PMCID: PMC6539242.

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