Preparing For The 4th Trimester


During pregnancy, we may spend a lot time preparing for childbirth but very little time preparing for after the birth. The twelve weeks after a mother gives birth are considered the fourth trimester, a time for a newborn to transition from the womb to the world but also a time for a mother to initiate healing and recovery from pregnancy and childbirth.

As a new mother, you may find yourself exhausted, overwhelmed, and unsure of what is normal and what is not for postpartum recovery because little information is provided about aftercare for new moms. As a pelvic health physical therapist, I work with women who wish they would have known more about postpartum recovery and what can help. Here are some strategies to aid in recovery of your abdominal and pelvic floor during your tender fourth trimester.

Perineal Tear or Episiotomy Healing

Perineal tearing or an episiotomy can result in pain in the area and discomfort with urination, bowel movements, and sitting. For the first several days, ice is your best friend.

1. Use an ice pack, bag of frozen peas, or a padsicle (a witch hazel soaked maxi-pad that wear in your underwear) on the vagina for 20-30 minutes several times a day. This can help decrease swelling and inflammation. Taking a sitzbath with a special herb concoction may also feel soothing to healing tissues.

2. Sit on a cushion while pumping or breastfeeding if you have pain at the site of your stitches.

3. Start performing kegels on day one following delivery. This may be the last thing on your mind, but performing these exercises early on and often can actually increase blood flow to the vaginal area to promote healing.

4. Following a perineal tear or episiotomy, you can begin gently massaging your healed around 6 weeks post delivery and with clearance from your medical provider. Use a small amount of vitamin E or coconut oil and gently massaging the healed incision for a few minutes a day. Restoring normal urinary patterns Urination may be difficult initially due to anesthesia, healing tissue, and shock to your pelvic floor muscles. Some common experiences are painful urination, difficulty emptying your bladder or urinary leakage.

1. Drink plenty of water, stand in a warm shower and take some deep breaths, or use peppermint essential oil in toilet water bath to help relax your muscles and initiate your stream.

2. Use a squirt bottle to spray warm water on your vulvar region during and after urination and then pat dry with tissue instead of wiping.

3. Urinary leakage may occur immediately after delivery as well. This should gradually improve and be completely resolved at 3 months.

Promoting Bowel Health

Bowel movements may also be challenging due to the side effect of medication and dehydration.

1. Drink plenty of fluids to rehydrate.

2. Avoid straining by placing your feet on a stool and leaning forward.

3. Exhale through your lips as you gently bear down to facilitate relaxation to your pelvic floor muscles, prevent hemorrhoids or prolapse, and avoid discomfort to incisions.

4. Stool softeners, magnesium or fiber supplements may also be helpful in the first few weeks.

Cesarean Birth Recovery

Following a cesarean section, taking care of your scar and retraining your abdominals right away are essential.

1. Use ice over your incision site for the first week.

2. An abdominal binder is not necessary but some women may find a supportive pair of legging pulled over the abdominal wall to provide suome additional support.

3. Be mindful when getting out of bed by rolling onto your side and pushing up with your arms.

4. Start gentle belly breathing and start walking within the first few days to initiate regaining muscle strength and function.

5. Perform scar massage once scar heals around 6 weeks.

Optimizing Sexual Health

A medical provider will typically suggest you can return to sex after 6 weeks postpartum. Discomfort with intercourse can be common following birth but it is not normal. I do not recommend you “push thorough the pain.”

1. Pain can be due to scar healing or scar tissue. Perform gentle massage to the base of the vaginal opening if you have a scar that is healed. Any bleeding or pain with sex should be reported to your doctor, as additional treatment to the area may be necessary.

2. Your vagina may feel dry due to decreased estrogen from breastfeeding/pumping. Use a water-soluble lubricant or natural oil (coconut oil) during intercourse to help decrease friction.

3. You may have a very low sex drive due to exhaustion, lactation and physical and hormonal changes. Don’t be hard on yourself to return to sex too soon and respect where you in your healing. Checking In with a Pelvic Health Physical Therapist 1. I recommend all women check in with a pelvic health physical therapist starting between 4-6 weeks postpartum.

2. This will entail assessment of your abdominal and pelvic floor muscles and exercises and activity modifications to optimize your healing.

3. Urinary leakage, constipation, prolapse, tailbone or pelvic pain, painful sex, cesarean or perineal scar healing, diastasis recti or abdominal separation and returning to exercise and fitness safely are all topics that should be addressed with a PT.

The 3 months following the birth of your child can be exhilarating, exhausting, adventurous, and overwhelming. So much focus is put on this tiny beautiful human being, rightfully so, but make sure you are also getting the nourishment, care and healing you need. My hope is that this information helps heal not only your pelvic floor, but also your heart and soul during this tender fourth trimester.


Sara Reardon

Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer, a resource for online pelvic health education and therapy to help women worldwide with pelvic health conditions. She is a board certified women’s health physical therapist with a special interest in treating pelvic pain and pregnancy and postpartum conditions. She is a mom, wife, Saints fan and wanna be yogi.

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