Your baby and the fourth trimester
The “fourth trimester” can be overlooked as a pregnancy progresses and the arrival of your baby becomes imminent. Especially for first time parents the arrival of your baby can be the most exciting time of your life and at the same time be difficult because of the challenges, the worries and the big change that lies ahead.
In order to navigate this eventful time as easily as possible, it is important to be as fit and well, both physically and mentally, at the end of the pregnancy as possible.
“Birth is not the end of the journey but rather just the start. That is why I believe that one of the goals is to keep the disturbance to your sleep patterns as minimal as possible. It means that we aim for a smooth and easy delivery as part of your birth plan.”
Postnatal care in the fourth trimester
Postnatal care initially focuses on breastfeeding. It will take around 72 hours for your milk to arrive and it is normal to feel a little anxious before it does. The fantastic postnatal midwives at SJOG Subiaco Hospital in Perth will guide you through this and specialist Lactation Consultants are available to assist if you have any difficulties.
Traditional postnatal care lasts for 6 weeks after your baby is born. By this time your uterus and pelvic organs are back to normal size.
I believe that you deserve the right level of postnatal support and care and as your obstetrician, I am available to help after your baby is born not just up to 6 weeks postnatally but also beyond that time.
Postnatal care & recovery: tips and tricks
Core strength and pelvic floor exercises:
Through your pregnancy, I encourage you to maintain a good level of physical activity. Walking, swimming, hydrotherapy, yoga and pilates are all activities that pregnant women can do right through until delivery.
Finding time for this becomes even more important in second and subsequent pregnancies. This will reduce third-trimester aches and pains and greatly assist in the immediate postpartum recovery. Your body will guide you as to when returning to exercise is appropriate. Initially, rest is likely to be best. Most women will find that by six weeks they are ready to gradually return to their preferred physical activity.
If you notice a change in your pelvic floor function then a Women’s Health Physiotherapist can assist in restoring normal pelvic floor function. These are physiotherapists with special training in the management of pelvic floor conditions.
Resuming your sex life:
Resumption of all normal activities will take time after the delivery of your baby. In the postnatal period, your libido is likely to disappear for a while. This is normal. It may take 6, 12 or 18 months to return to normal. A good night sleep or two will help enormously. While you are breastfeeding your estrogen levels are very low and the vagina will not have the same level of lubrication as normal. When intercourse does resume, take things slow, perhaps use a water or silicone-based lubricant and most importantly have a laugh, don’t take things too seriously.
Working on other aspects of your relationship is important during this time. It takes two people to create a baby and fathers benefit immensely from getting their hands dirty!
The happiest fathers are those who are most involved in their children’s care and the earlier this starts the better.
Vaginal bleeding after birth:
The textbooks say your bleeding will last about three weeks, one week with heavier red blood, slowing in the second week, fading to a brownish loss on week three before stopping. The reality is that bleeding may stop a little quicker than this if you are lucky or may last a little longer.
Patience is needed sometimes. The involuting uterus and endometrium are very delicate and easily damaged.
It’s critical to avoid postpartum D&C. Dilation and curettage is a procedure to remove tissue from inside your uterus sometimes performed when heavy bleeding occurs. Avoiding a D&C helps prevent an uncommon complication, Asherman’s Syndrome, which can compromise your future fertility. Sometimes an infection can develop in the uterus after birth, usually in the second week after your baby was born.
If you feel unwell, have signs of infection like fever or shakes, an offensive vaginal loss or much heavier bleeding than expected, you should call the labour ward and return there as soon as possible for assessment.
This is one of the most important aspects of all obstetric care and signs of anxiety or depression will be monitored throughout your pregnancy. Often “postnatal” depression is a continuation of depression present through the pregnancy. Diagnosing depression or other mood disorders in pregnancy can allow us to start the appropriate treatment early enough so that when your baby arrives you are feeling at or close to 100% and you’re more able to cope with the demands your baby will make on you.
This is where I consider it part of my role as your obstetrician to make the time and listen to how the changes affect your daily life, your relationship and how you feel about the journey. My patients tell me that it helps to feel that there is time to talk. It’s not just about the tests and your pregnancy as a process…it’s also about your emotions and your life.
We will make sure that we keep an eye on how you and your partner are navigating the emotions that come with expecting a child.
I work in close coordination with a number of Perinatal Psychiatrists who have experience in the management of anxiety, depression or other psychiatric or psychological illnesses than can occur in the postnatal period. If you have an existing mental health condition I will manage this in coordination with your existing supports. Often a preconception visit can allay any anxiety that may exist about falling pregnant and starting a family.
For more information, visit PANDA, Perinatal Anxiety & Depression Australia.
Why Dr Richard Murphy for postpartum care?
You often hear people talk about the magic of childbirth. This extraordinary aspect of life is why I chose my specialty as an obstetrician and a fertility consultant. I consider it my mission to help you experience birth and the start of your new life with your child in the best possible way. During your pregnancy, we make sure we build trust and nurture a safe space to manage concerns and obstacles together. Postpartum care (in simple terms being there to support you after your baby is born) is an essential part of my role as your obstetrician.