UT Health Austin ob-gyn answers the most commonly searched questions about the fourth trimester of pregnancy

During the “fourth” trimester, or postpartum period, you’ll likely have many questions about caring for your body and what to expect after giving birth. Emotions, body changes, hormones, and caring for a baby all at once can be daunting. Don’t rely on the internet for answers!

In this fourth installment of a four-part video series, Karla Maguire, MD, MPH, an obstetrician-gynecologist in Women’s Health, a clinical partnership between Ascension Seton and UT Health Austin, answers the most commonly searched questions about the fourth trimester after pregnancy.

How often should I follow-up with my provider after giving birth?

“Routine checkups after delivery are two weeks after delivery and then six weeks,” explains Dr. Maguire. “Sometimes depending on your situation, if there were complications with the delivery such as high blood pressure or other issues, we would want to see you back sooner. Definitely check in with your doctor and see when they want to see you in your particular situation.”

What happens to my body after childbirth?

“I like to tell my patients that it took you nine months to create this baby. It’s gonna take you nine months to get back to normal,” shares Dr. Maguire. “I think it’s really important to give yourself some space and some time to kind of get your body back to feeling normal. Again, the uterus in pregnancy grows a lot and it takes some time to get back to its normal size, plus the muscles in your belly and in your pelvis all are stretched to accommodate the baby. I think the most important thing is just realizing that not everyone can go back to normal immediately and you made a human and that’s a really important job.”

What are ways to ease pain and discomfort after childbirth?

“The nurses in postpartum will start teaching you to take care of any pain that you have after delivery. A lot of women have cramping, which we do give medications for while you’re in the hospital, which sometimes you continue after you go home. Other things like ice packs to sensitive areas can be helpful if you’ve had a C-section, using kind of an abdominal binder, which is basically like a medical compression device on your belly can be helpful,” says Dr. Maguire. “There are also other kind of local medications we can give you if you’ve had a tear.”

When can I begin exercising again?

“Depending on your type of delivery, your doctor will give you specific criteria on when you can start exercising, but if you’ve had a vaginal delivery, some people feel okay doing light exercise like walking and everything two weeks after the delivery, and we want you to stay active. Yoga’s always great postpartum as well,” shares Dr. Maguire. “If you’ve had a C-section, you can start walking as soon as you feel comfortable. But, I wouldn’t do intense exercise with either type of delivery for at least six weeks until you’ve had your post-partum checkup. It’s always important after delivery to listen to your body. And if your body is tired, or it’s telling you not to do a certain kind of exercise, listen, and take the time you need to recover.”

When will the bleeding stop and how much bleeding is too much?

“Every woman is very different. And again, it depends whether you’ve had a vaginal delivery or a C-section, but often the bleeding can go on until you come in for your six-week checkup with your OB-GYN, but it should be getting lighter and lighter with time,” shares Dr. Maguire. “Some women only have a couple of weeks of bleeding, but some people will have more prolonged bleeding. The important thing with bleeding is that if it is very heavy, so if you’re soaking through two pads an hour for two hours, or you have clots, or you have an increased amount of bleeding after you previously had no bleeding, reach out to your doctor to see if they need to examine you and make sure everything’s okay.”

When will my normal menstrual period begin again?

“That depends on a lot of factors. The first thing, whether or not you’re breastfeeding, cause some women who are exclusively breastfeeding won’t get their period until they wean. So it could be up to a year until you get a normal period. However, some women who breastfeed do get a normal period starting pretty quickly after delivery,” explains Dr. Maguire. “Usually, the earliest it would start is within approximately six weeks. I tell my patients to keep track of bleeding and if it seems to be coming monthly then their period has started again. But, it can be a little confusing in the first six weeks to figure out if you’re having a period, or if you’re having normal postpartum bleeding.”

How long should I wait before having sex?

“You should definitely wait until you go to your six weeks check-up with your OB-GYN, where we do an exam to make sure everything is healing well. Then after that, we will let you know if it’s okay to go back to having sexual activity,” shares Dr. Maguire.

What should I do to prevent post delivery infections?

“If you had a C-section, you’re going to have an incision on your abdomen, the nurses in postpartum will talk to you about how specifically to keep it clean, but it’s important to keep it clean and dry,” says Dr. Maguire. “After you shower, pat it dry, wear clothing that isn’t too constrictive on the incision, and then keep an eye on it. Of course, if you see any redness or any drainage from the incision, give your doctor a call to be seen sooner than your postpartum visit.”

“If you had a vaginal delivery, we recommend that you keep the area clean and dry as well. We give you a little squirt bottle to clean up. You go to the bathroom and pat the area dry keeping, the area as clean and dry as possible. Luckily it does heal very well most of the time. But if you have any concerns, of course, let your doctor know,” explains Dr. Maguire.

How common is postpartum depression?

“If you’re term, your contractions should be about five minutes apart, getting stronger and closer together,” shares Dr. Hotlz. “That would be a pretty good sign that you’re going into labor. What I tell my patients who are before term, so that’s before 37 weeks, is to start timing them, and if they are about 10 minutes apart and getting closer together, then you should call your doctor. And if they are definitely five minutes apart, you should consider being seen in the triage.”

Are there any warning signs to watch out for during third trimester?

“Studies have shown that postpartum depression can occur in up to one in ten women,” says Dr. Holtz. “It’s really important to be on the lookout for any symptoms. The first two weeks after delivery, you’re going through a humongous change. You’re a new mom, you’re adjusting to not sleeping much. You’re breastfeeding, which can be new for people, and it’s just a completely new experience.”

“Often with all the hormone changes, you can have what we call the “baby blues” and that’s just feeling sad, crying for no reason, you know, feeling a little tired and down the first two weeks, “explains Dr. Maguire. “If it’s something where you feel like hurting yourself or hurting the baby, you should definitely let us know. After two weeks, if those feelings persist, we start thinking about postpartum depression and of course reach out to your doctor if you’re concerned about it.”

“At UT Health Austin, there is a depression screening tool we use in the office to see if you’re at high risk or low risk for depression. And we can either, help you get set up with counseling, or sometimes we start medication in the postpartum period, but it’s really important to reach out to us because we don’t want you feeling alone during this really important time in your life,” shares Dr. Maguire.

Please remember to contact your ob-gyn with any questions you have related to your pregnancy to ensure you receive answers specific to you and your pregnancy.

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