My Post partum journey- The 4th trimester/ The forgotten one
Updated: Oct 8, 2019
All too often the 4th trimester, and in my eyes, the most important trimester for both mum and baby is often overlooked. We invest so much time in the antenatal period trying to maintain a healthy pregnancy and prepare our bodies for the labour and birth that lies ahead, but what about the aftermath?!
This is a journey of self discovery and the steepest learning curve you will ever encounter. There will be no more days off, no more sleep ins and definitely no more “Me time” (you really will wonder what you did with your time before having a baby – imagine you thought you were busy back then!!!) For me the 4th trimester was definitely the toughest. I sailed through pregnancy and just assumed I would “bounce right back”. Why wouldn’t I? I mean, I was a very fit, healthy and active individual before so this shouldn’t take me long. Oh how wrong was I…😳
Firstly, because I had ended up with an emergency C-section it was a bit of a waiting game until the feeling returned in my legs (tick, tock, tick, tock, tick tock….helloooo epidural i have a baby to attend to!!!)… I had just been through the toughest 24 hours of my life and now here I was bed bound, catheter insitu and a little mini human (all 9lb of her!!) suckling on my breasts.
No recovery time for me! Looking back, one of the best things I did prenatally from 37 weeks was hand express colostrum. The midwives were able to feed my little girl through the colostrum filled syringes which was a huge relief for me as I knew she was getting all those lovely antibodies to protect her whilst giving me the opportunity to get some much needed ZZZZZs that first night Click here for more on expressing colostrum
Day one post-partum, I will never forget getting out of bed. I turned onto my side and I literally felt like my insides had fallen out! I had to scoop my tummy back up and regain my composure. What was this?! Was this normal?! It definitely didn’t feel right but I didn’t have much time to think about me! It was all about my beautiful little girl and learning all those new skills; breastfeeding, nappy changing, bathing…etc which I needed to master to be able to care for her. I wasn’t the priority, she was.
On reflection, I was so very wrong. We need to learn to prioritise our own recovery especially in the early post-partum period when our bodies are continuing to undergo significant changes. Not only is there the physical healing process taking place,there is also the rapid changes in hormonal levels – heard of the day 3 blues?! , the cracked nipples, the sleep deprived nights causing utter exhaustion, and the realisation that another little humans survival rests completely on your shoulders. These are HUGE physical, emotional and social demands to be placed on a body that is still trying to RECOVER. We need to RESPECT our bodies and give ourselves some LOVE and TLC.
Yes! Mummies need to be mothered too.
Remember, a happy healthy strong mummy has a lot more to offer than a wounded soldier who marches on fighting battles they are not fit to fight… By prioritising your recovery you are prioritising your Baby.
Looks can be deceiving
Within the first few weeks after having my little girl I stepped on the scales and the reading shocked me – 7st 13 😳!! I had always been a healthy 8 ½ stone pre-pregnancy. What was going on?! Where was all my muscle mass?! Anyone I met would have commented on how great I looked so soon after having a baby and how lucky I was that I had no weight to lose. I didn’t feel very lucky. Truth be told I felt awful. I found simple tasks a huge effort. Getting in/out of bed, standing upright and just simply caring for my baby was both mentally and physically exhausting. I found I developed neck pain and struggled with picking my little girl up or playing with her on the floor. I didn’t have the abdominal (“Core”) support when bending over and so all the effort went to the muscles around my neck.
Diagnosing Diastasis Recti
As a Physiotherapist and Pilates Instructor of course I was doing my pelvic floor (PF) exercises from Day 1 but I remember trying to do my PF exercises in 4 point kneeling looking in the mirror… when I engaged my PF- nada. No Transversus abdominal co-contraction at all. Just a pouch of loose muscle that drooped down like a hammock. I couldn’t achieve pelvic control with the very basic Pilates exercises and when I sank my fingers into my tummy it felt like sinking sand that just kept going deeper and deeper until I could feel the pulsation of my abdominal artery. I knew this meant i had quite a significant diastasis (separation of the abdominal muscles) which was confirmed with the head lift test where I could fit 4 of my fingers between the two borders of my Recti muscles. (For more information on diastasis and to see how to test Click here ).
As you can imagine I felt so far removed from the healthy, strong physique I was used to. I called on the expertise of my good friend and Womens health physio, Grainne Donnelly from ABSolute.physio who has since written a fantastic informative blog on The deal with diastasis, and from across the globe we conversed and she did put my mind at ease.
Studies have recorded 100% prevalence of abdominal separation at 35 weeks gestation. With a prevalence of 35-39% still having separation 6months postnatal (BO et al 2014).
That early post partum liaison with a specialist physiotherapist knowledgeable in postnatal recovery was vital in my journey both physically and mentally. It confirmed I needed to invest time in ME and really strip everything back to the very basics. Breathing. Diet. Posture. Task breakdown. Most recovery happens within the first 8-12 weeks post partum and it is this early period where you need to be protecting yourself and aware of the increased stresses you are placing on your body.
At this stage in my physiotherapy career I hadn’t developed the passion I now have for womens health. Perhaps it is my own experience of diastasis and the slow recovery postnatally that has led me down this pathway, or the lack of awareness and support out there for other women in the same position as me. There is so much that can be done to promote recovery of diastasis particularly in the early post partum period but equally there can be catastrophic consequences for those that are not aware of the issue and load too early, ultimately increasing the diastasis and potentially increasing susceptibility to pelvic floor issues and prolapse.
My long road to recovery
At 8 weeks post C-section I joined a postnatal mum n baby class but found the exercises being performed within this class were pitched at way too high a level. I would have struggled with these exercises prenatally, never mind postnatally! Thankfully, I had the awareness and knowledge of what I needed to modify in order to make it safe for me, others around me did not. This frustrated me. These ladies were doing their best to recover postnatally and get back being active but unfortunately were doing more harm than good to their bodies. This is one of the main drivers that has contributed to the successful development of the postnatal classes we have at Mid Ulster Pilates & Physiotherapy. Not only do we need to educate our pre and post partum ladies, we need to educate everyone else that may encounter these ladies in anyway during their recovery phase. May that be fit pros, midwifes, Gps, Health visitors… if we all take a small responsibility in imparting good knowledge and understanding we can all together make a difference 💪
At 3 months postnatal I flew home from Australia to see family and friends and spend some much needed time at home. At this stage Mary Angela (my sister and partner in crime at Mid Ulster Pilates & Physiotherapy) was 4 months ahead of me on her postnatal journey and looked fantastic.
She was out running, doing fitness class and taking her Pilates. I was jealous. I had a baby who wouldn’t sleep, spewed up all my breastmilk after feeds and a body that felt if you blew a gust of wind at me I would crumple and fall over.
I remember one morning, actually it might have been the afternoon, but I was still in my Pyjamas, after a rough night sleep with the baby. In Mary Angela swooped all fresh faced for a wee visit. Within 5 mins I could hear this rhythmical thudding noise coming from the kitchen and when I peaked around the door there was Mary Angela jumping her way through a T25 exercise DVD. I just wanted to punch her!!!! It wasn’t Mary Angela’s fault I couldn’t do what she was doing but it is so hard not to compare yourself to others.
Everyone’s postnatal journey is different and we all encounter our own wee hurdles along the way. We must remember, our babies are precious wee blessings and for those of us that are lucky enough to experience the antenatal/postnatal journey we should embrace each hurdle that we come across with strength, courage and resilience 💪. No matter how tough a journey we have had, we should always be grateful that we have been given the opportunity to be a mummy 🙏
Now let me introduce my little rascal Maggie Grace that caused all the drama coming into the world and whom i have a feeling has a lot more drama to cause me in the years to come 🙈…
There is not a “one size fits all” postnatal rehab programme. It must be individual. Whilst I had abdominal diastasis, I was functional (I could control it) and I had no incontinence or prolapse issues which I am very thankful for. I had identified the issue very early on which allowed me to seek the appropriate professional advice and start my rehab straight away. I recovered relatively well from my C-section operation and whilst my overall recovery was slow, it was steady.
It wasn’t until I moved home from Australia (8 months post partum) and I upped the frequency and intensity of my Pilates classes that I started to notice huge differences in my physique. My posture improved, I felt more mobile, and I regained the strength I had been yearning for. The numbers on the scales finally started going up (yes UP!!!!). I was regaining my muscle mass and my diastasis had significantly closed. I felt energised….and what better way to celebrate feeling strong, confident and back to full fitness than to fall pregnant again with Baby No 2 😬 …
….and so the journey begins again…although this time it will be different. This time I have awareness. This time I am more knowledgeable. This time i am preparing for all FOUR trimesters..
So, for anyone embarking on their postnatal journey it is vital to become informed and educated so as to help facilitate your own recovery, increase your body awareness and reduce the number of hurdles you may face along the way. If this information helps just one person, then I have achieved one of my goals by starting this blog. Or as my mum calls it, a blob 😂!!! Never feel alone in your postnatal journey. At Mid Ulster Pilates & Physiotherapy we love working with all our postnatal mums and educating and empowering them in their own recovery. Remember, you have just given birth. Listen to your body. Respect your body and most importantly give your body TIME TO RECOVER.
Kathy 😘 xxx
Commence your Pelvic floor exercises immediately and don’t give up on them! They have a significant role to play in your early postnatal recovery.
Breathing. Try and restore normal breathing patterns as soon as possible. Use the exhale to help activate Pelvic floor. Do not breath hold. Aim for a relaxed ribcage to improve alignment. (Click here for a fantastic video on importance of breathing)
Posture is key. During pregnancy the ribcage expands to allow room for baby, your breathing becomes altered and your pelvis can sink into a more anterior tilted position putting pressure on your spine. It is highly important to address these issues, as alignment is key in order to balance forces, pressures and regain optimal recruitment of the abdominals, gluts, diaphragm and pelvic floor.
Take care with Daily tasks when feeding baby, getting in/out of bed and lifting. Do not place undue stress on the already weakened/stretched abdominal muscles.
Bowel habits. Ensure you are not overstraining as this can cause increased abdominal pressure. Think about your diet and position to improve bowel motions(Check out “Squatty Potty” video here).
Diet: Eat lots of protein in order to stimulate collagen repair
Keep hydrated! Fluid intake is super important in order to improve the viscosity of blood and therefore delivery of oxygen in order to promote recovery. It is also extremely important for breastfeeding mums in order to maintain supply
Sleep: In those first few months your baby really NEEDS you and it can be difficult functioning on minimal sleep. Our advice is to take daytime naps when you can. Sleep is so important to assist with your recovery.
Socialise: It is so important to get out and about and have adult conversations in order to maintain a good mental state. Motherhood can be overwhelming so make sure and engage with others.
Be smart about what form of exercise you return to initially. Rebuild your foundations before thinking of placing increased demands on your body
Finally, get in contact with us here at Mid Ulster Pilates & Physiotherapy as we would love to be able to guide you safely and progressively through your postnatal journey!
Yours in health,
Mary Angela & Kathy xxx
(Mid Ulster Pilates Instructors & Physiotherapists)