The “Fourth Trimester”: when maternal care continues

Holly E. Richter, Ph.D., M.D.After giving birth, a woman’s body changes in a number of ways. However, while some of the changes women experience are common, including pelvic pressure, urgency to urinate and constipation, these symptoms should not be ignored.  

Studies have reported an association between pelvic floor disorders and childbirth, particularly in cases of vaginal delivery. Women who give birth vaginally have twice the risk of stress urinary incontinence, or the loss of urine due to activities such as coughing or running, compared to women who deliver by cesarean section.

Changing health policies and initiatives reflect the urgent need for improved postpartum treatment and care. The American College of Obstetricians and Gynecologists now recommends consideration of postpartum care as an ongoing process — compared to a single postpartum six-week visit — and a more comprehensive postpartum evaluation up to 12 weeks postdelivery, a period often called the “fourth trimester.”

“Women should not ignore changes in vaginal, bladder and bowel symptoms they have during the fourth trimester,” said Holly E. Richter, Ph.D., M.D., professor in the Department of Obstetrics and Gynecology and urogynecologist at the University of Alabama at Birmingham. “Once a baby is born, many new mothers focus solely on their baby’s needs, but may neglect their own care and body changes. There is help for these symptoms during this fourth trimester.”

According to Richter, fourth trimester symptoms that postpartum women need to pay attention to include:

• Urinary leakage, or incontinence: This may include a strong urge to urinate that cannot be controlled, or urinary leakage when laughing or coughing.
• Constipation: The muscles that control your bowels can often be affected by childbirth. Watch for infrequent bowel movements and irregularity.
• Bowel leakage: Damage to the anal sphincter muscles or damage to other pelvic muscles/nerves can reduce bowel control, resulting in bowel leakage.
• Vaginal dryness: There is less estrogen available after birth for several reasons, including breastfeeding.
• Pelvic pressure or backache: You may feel pressure in your vagina, pelvis or lower back, which could be signs of the pelvic organ support weakening.

If you notice these symptoms, you may want to call your OBGYN to discuss treatment or other options for symptom management.

“A woman’s OBGYN is her advocate and can help her identify areas that aren’t normal as her body heals, and provide treatment options for her,” Richter said. “If specialized care is needed, communication to those providers is facilitated and supported.”

Richter encourages women to not let these issues become their new normal after childbirth, even if it may feel uncomfortable talking about such personal subject matters. “Although pelvic floor disorders after birth can negatively affect your quality of life, they can be successfully treated,” she said.