The 4th Trimester: Redefining Postpartum Care

Last May, the American College of Obstetrics and Gynecologists (ACOG), came out with an article about redefining the postpartum visit in order to better serve women. In the article, the ACOG writes about how postpartum care should be an ongoing process and not just a single visit to the doctor’s office. This process can begin right after birth and can last for the duration of the first 12 weeks after birth, which is why these weeks are being dubbed the “4th trimester”:  three trimesters before birth and a trimester for the mother to recover and take necessary steps to heal. The ACOG state that the comprehensive postpartum visit should include a full assessment of physical, social and psychological well-being. The ACOG article has a list of components of postpartum care which includes but is not limited to the following:

  • Mood and emotional well being

  • Infant care and feeding                               

  • Sexuality, contraception, birth spacing                                  

  • Sleep & Fatigue

  • Physical Recovery from birth

  • Chronic disease management

  • Health maintenance

Just one important aspect of postpartum care should entail going to see a physical therapist who specializes in women’s health or pelvic floor dysfunction. Working with a physical therapist will incorporate diastasis assessment, pelvic floor assessment, body mechanics to help carry or lift your baby and modalities or manual therapy for pain relief. Pregnant and postpartum women are at risk for abdominal muscles separating, which must be assessed 6 weeks postpartum to determine if the abs are split or not. Exercises should be progressed safely  in order not to make the separation worse. Women may also experience bladder control issues, incontinence or pelvic pain, all of which can be addressed with a specialized physical therapist.

Although this article was written last May, it is important to spread the word and inform as many women as you know. In France, every woman who has a baby is covered by insurance to go to PT after giving birth just to make sure everything is working as it should be. America should be doing this as well! Pelvic floor physical therapy is just one part that should be incorporated in the 4th trimester. The ACOG took the first necessary steps to start redefining the normal care of pregnant and postpartum women, and now it’s time for us to spread the word.

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”Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists.” Obstet Gynecol 2018;131:e140–50. Accessed March 25, 2019.

-- Dr. Brooke David, DPT