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What To Expect During the ‘Fourth Trimester’

When you’re pregnant, you might not be thinking about how you’ll feel in the months after you give birth.  But the “fourth trimester” is a time of radical change for your body, and you may face unexpected physical and emotional changes.

Emotional Upset and Anxiety

It’s common to underestimate how emotional you will feel in the aftermath of delivery. A new baby brings feelings of excitement, but the new responsibilities may also trigger anxiety, fear and sadness.

Know that it is OK to:

  • Ask for help from friends and family
  • Start talk therapy
  • Reach out to your gynecologist if symptoms feel beyond your control

If you’re suffering with depression, it may be post-partum blues, or it may be more serious. Talking to a mental health professional can provide clarity and a path forward.

Unpredictable Bleeding

Your menstrual cycle will be irregular following delivery. You may bleed more than anticipated, with bleeding lasting for days, much like a prolonged period. It’s also possible that your period will disappear entirely due to the hormone prolactin. The longer you breastfeed, the longer you will skip having a period.  Be aware skipping periods does not mean you do not ovulate – you can still become pregnant during this time.  It is only when you quit breastfeeding, causing prolactin to decrease and your milk supply to dwindle, that your menstrual cycle will return to normal.

Impact of Interrupted Sleep

You most likely expected sleepless nights after bringing home your baby, but you may not have realized how a lack of sleep affects you. When you’re overtired, you may be more likely to experience anxiety, tearfulness or other heightened emotions. The general wisdom about this time in your life is to rest when the baby rests. A newborn doesn’t have a circadian rhythm yet, so they may sleep at random hours. It can be hard for many new parents to allow themselves to sleep during the day, believing they must be productive or keep to a more typical sleep schedule. However, the longer you go without rest, the worse you will feel. During this time, anything you can do to get more sleep, such as installing blackout curtains, may be well worth the effort.

Milk Leakage

Your body will respond to any baby who cries. If your brain picks up that signal, it thinks it’s your baby that needs comforting and starts releasing milk as a strategy to help soothe the baby.

Discomfort with Your Body

Many women are uncomfortable with their bellies, which remain swollen in the weeks and months after delivery. The uterine muscles must relax for the womb to grow unobstructed. Just as it took time for your belly to grow, so, too, will it take time — up to three months — for it to shrink again. The process of feeding your baby signals to the uterus that you are no longer pregnant, and cramps may be felt as the uterus contracts. This is another reason for increased bleeding. If you can, try to return to whatever physical activity you did before pregnancy as this will expedite the process and ease discomfort.

Vaginal Dryness

Intercourse may be more uncomfortable in the months after childbirth. Your hormones trigger a host of changes in your body, including vaginal dryness and decreased interest in sex. An easy solution is lubrication to make sex more comfortable. Longer term, if you’re contending with a lack of interest in your partner, know that you’re not alone. You’re caring for another human, which is a huge adjustment. For most women, a desire for sex returns with time. If it doesn’t, you may want to experiment with various solutions, from talk therapy to short-term childcare to help you catch up on sleep.

Larger Feet

When you have a baby, your body and belly have increased blood flow. That blood travels from the uterus to other tissue spaces. Thanks to gravity, the spaces most susceptible are your feet, which may swell up to half a shoe size, needing as much as 12 weeks to return to normal. You can elevate your feet to help with the swelling, but the best cure is time. As your body adjusts, your feet may go down in size, but also may not.

Increased Appetite

You may be hungrier than usual, especially if you are breastfeeding. Nursing your baby requires a huge surplus of extra calories. However, as soon as you stop breastfeeding, you’ll need to carefully monitor your eating if you want to avoid gaining weight.

Brain Fog

It’s common to feel like you can’t recall things that you used to remember easily. You may worry about the persistence of “mommy brain,” but know that your mental sharpness will return.

Overall, this time is challenging, as so much is changing. It can also change for the better. This is a great time to make new friends, especially with new moms who might want to join you to walk your babies together or meet for other activities. You may also want to explore groups centered on baby activities to receive emotional support for these new struggles. The more that you learn that other new moms face these same challenges, the more you will realize that everything you’re going through is normal.

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