From physical changes to symptoms of concern, here’s everything you need to know about the first three months postpartum. 

The fourth trimester is a really important, extraordinary and overwhelming time—though it often doesn’t get as much attention as it should. These three months right after giving birth are crucial for your physical recovery, emotional adjustment, and getting used to life with a newborn. 

Along with the joys and challenges of caring for an infant, mothers may find themselves needing additional support and guidance during the postpartum period. Along with lactation consultants, postpartum doulas, therapists, pelvic floor physiotherapists, Naturopathic Doctors can be of invaluable transition into parenthood and readjust to your once again, changing hormones.  

As a Naturopathic Doctor who specializes in fertility in BC, I am honoured to be the ally to new moms during this time, offering gentle, informed care. By focusing on balancing your hormones and optimizing your overall health with a holistic approach, we can help make the fourth trimester a more comfortable and positive experience for you.

What is the fourth trimester?

The fourth trimester refers to the first three months following the birth of your baby, a period crucial for both recovery and adaptation as your body transitions from pregnancy to postpartum life. This time is marked by significant physical and hormonal changes, including the shrinking of the uterus, fluctuations in hormone levels, and the adjustment to new sleep and feeding routines. It’s an essential phase to focus on because it affects your overall well-being and sets the foundation for long-term health. Attending to your body’s needs during this period—through proper rest, nutrition, and self-care—helps to facilitate recovery, supports emotional stability, and ensures that you are physically and mentally prepared for the challenges and joys of motherhood. Prioritizing this transition allows you to heal more effectively and fosters a positive start to your new role as a parent.

What physical changes should I expect during the fourth trimester?

During the fourth trimester, your body goes through a lot of changes as it shifts from pregnancy to postpartum life. Your uterus, which stretched to accommodate your baby, starts to contract and shrink back to its pre-pregnancy size, which can cause some cramping and discharge. Hormone levels also undergo a major shift, dropping from their pregnancy highs to a new balance, affecting your mood, milk production, and energy levels. Your breasts will feel full and may be sore as they adjust to breastfeeding. 

What is lochia? 

Lochia is the vaginal discharge that occurs after childbirth as your body sheds the uterine lining that built up during pregnancy. It’s a normal part of postpartum recovery and can vary in color and consistency over time. In the initial days, lochia is typically bright red and may contain small clots; this is called lochia rubra. As the weeks progress, the discharge transitions to a pinkish or brownish color, known as lochia serosa, and finally to a yellowish or white discharge called lochia alba. Lochia gradually decreases in amount and eventually stops altogether, usually within four to six weeks after delivery. As your Naturopathic Doctor during the fourth trimester, lochia is something we’ll monitor to help track recovery. 

What are normal postpartum symptoms, and when should I be concerned?

As a Naturopathic Doctor, I want to reassure you that experiencing a variety of postpartum symptoms is normal. It’s common to feel fatigued as your body adjusts to a new sleep pattern with a newborn. Mood swings are also typical due to hormonal fluctuations, which can lead to feelings of sadness or irritability. Postpartum bleeding and discharge are expected, though they should gradually decrease in flow and change in color over time. However, there are specific signs that warrant closer attention. If you experience severe abdominal pain, it might indicate complications such as an infection or retained placenta. Heavy bleeding, defined as soaking through more than one pad per hour or passing large clots, should also be monitored closely. If you experience symptoms like fever, chills, or noticeable redness and swelling at the site of a cesarean section or any other wound, it’s a sign to call your primary healthcare provider to address potential infection. 

What are effective ways to alleviate postpartum cramping of soreness? 

First and foremost, give yourself plenty of rest—your body is working hard to recover and needs time to heal. Drinking herbal teas like red clover or nettle can be really soothing and help with cramping and uterine health. A warm compress on your lower abdomen can also make a big difference in easing discomfort. Don’t forget the importance of staying hydrated and eating a balanced diet to support your recovery and keep inflammation at bay.

When it comes to getting back into the swing of things, gentle exercises can be beneficial. Try pelvic floor exercises, like Kegels, to strengthen your core and help with any incontinence. Simple postpartum abdominal exercises can help tone your muscles, and incorporating some gentle yoga or stretching can improve flexibility and ease muscle tension. Prior to starting physical activity it is important to get the go ahead from your care provider at your 6 week postpartum visit. 

What should I know about my menstrual cycle and contraception in the fourth trimester?

I’ve had several patients ask about the return of menstruation during the postpartum phase, particularly while breastfeeding. There is considerable variation in how long it takes for a woman’s period to return and regulate, largely due to the hormone prolactin, which is responsible for milk production and works to prevent ovulation when elevated. Typically, if you’re not breastfeeding, your period and potential ovulation will return much sooner than if you are breastfeeding. For those who are not breastfeeding, menstruation often returns within 6-8 weeks, though it might be irregular at first. For breastfeeding mothers, it may take several months for your cycle to restart due to the hormonal changes associated with lactation, which can suppress ovulation. 

The return and regulation of menstruation during breastfeeding depend on factors such as the frequency of nursing, pumping, supplemental feeding, and how long the baby sleeps at night. More breast stimulation results in higher prolactin levels and a lower likelihood of menstruation, whereas less stimulation increases the likelihood. The Lactational Amenorrhea Method utilizes breastfeeding as a birth control method, with night nursing being particularly effective in preventing ovulation. Additionally, prolactin levels can be influenced by stress, hypoglycemia, sexual activity, exercise, pituitary tumors, Cushing’s syndrome, thyroid dysfunction, and certain medications.

When your cycle does return, it may be different from what you were used to, with variations in flow and duration. It’s normal for your cycle to take some time to stabilize, and together, we’ll monitor any significant irregularities that may signal that a deeper look into your reproductive health may be needed. 

Once your period returns, you should assume fertility and use protection if you prefer not to become pregnant again, as ovulation can occur before the first postpartum period. If you’re considering hormonal contraception options, such as birth control pills or implants, keep in mind some can influence your milk supply and may need to be timed appropriately with your body’s recovery. Together, we’ll have an open discussion about the various options so you can select a method that supports your postpartum health and aligns with your family planning goals.

How can I support hormonal health in the fourth trimester?

Supporting your hormonal health during the fourth trimester can make a difference in how you feel and recover—and it doesn’t have to be complicated. Assessing hormone and nutrient status with lab testing will be the initial step. We will also start by focusing on a balanced diet filled with fresh fruits, veggies, lean proteins, and healthy fats—these nutrients help your hormones find their new balance. Drinking plenty of water throughout the day is also important. To keep stress in check (as a twin mom, I understand this is easier said than done), try incorporating some gentle yoga, meditation, or deep breathing into your routine. And don’t forget the importance of good sleep; quality rest is key to keeping your hormones in harmony. These simple, natural approaches can help you feel more balanced and supported during the fourth trimester.

Naturopathic Support for Your Fourth Trimester in BC

The fourth trimester is a key period for recovering physically, balancing hormonally, adjusting emotionally, and getting used to life with your newborn.  It’s important to address this time to ensure you receive the support you need.

 As a Naturopathic Doctor specializing in fertility in BC, I’m here to provide gentle, personalized care to help make this transition easier and more positive, focusing on your overall health with a holistic approach. Contact me today to discuss how I can support you during every stage of your fertility, pregnancy and postpartum journey.