The Fourth Trimester  

Jill Heath, PT, DPT

The fourth trimester has been receiving a lot of attention lately - and rightfully so. This period of time is technically the three months following delivery and unofficially extends into the full time that a mama is recovering from pregnancy and childbirth. There is so much going on during these months! We are adapting to physical, social, and psychological changes, recovering from childbirth, dealing with fluctuating hormones, and suddenly a tiny human is depending on us for everything. It’s a lot to deal with!  

As a physical therapist who cares for women during and after pregnancy, I am especially interested in what is happening with the pelvic floor, pelvis, and abdomen during the fourth trimester. The pelvic floor is a group of muscles inside the pelvis that has many important jobs:

1. Support pelvic organs (in other words, keep them inside the body)

2. Control the output of urine and feces (keep our pants dry)

3. Provide sexual support

4. Assist with posture and breathing

5. Stabilize the pelvis and trunk

When you consider how this group of muscles has been on a prolonged stretch for 9 months (holding up the baby, and still supporting all the other pelvic organs), endured further strain during the pushing phase of labor, and possibly tearing during vaginal delivery, it makes sense that it will need time to recover and get back to its important roles. The same goes for the abdominal wall - it has also been on a prolonged stretch, and in the case of cesarean, needs even more time to heal. The abdominals and pelvic floor work together as a team to provide stability to the body. Without them, our body tries to compensate by overusing the lower back muscles, holding our breath, and adopting poor postures.

During the early weeks postpartum, rest and recovery is essential. It allows the body to carry out the natural healing process. Furthermore, it prevents any additional strain on the muscles that are trying to recover. Considerations such as using support to get out of a chair or bed as well as keeping constipation at bay can avoid repetitive reinjury to healing muscles. A determined body and mind will often figure out a way to move even when the pelvic floor and abdominals aren’t helping, resulting in compensation patterns by overusing other muscles. Reteaching the pelvic floor muscles how to contract and relax during this time prepares them for more activity.  

Gradually returning to gentle exercise and progressively increasing activity is essential to regaining the muscle control. You wouldn’t consider going straight from a casted foot to running the next day, so the pelvic floor should be given the same respect. This is the time to take it slow, listen to your body, and modify if needed. Walking and gentle yoga are great to start with. If your goal is to return to higher impact exercises such as running and jumping, those should be considered only in the absence of pelvic floor issues after three months postpartum, and progressed gradually.  

Keep in mind that by the end of the three months postpartum, any urine or feces leakage, prolapse (bulging or heaviness in the pelvis), pain in the perineum or pelvis, is a sign that the muscles have not recovered and warrants an assessment by a physical therapist who treats the pelvic floor.  

Take advantage of this phase of pregnancy to allow your body to heal, get reconnected with your pelvic floor and abdominals, and regain a strong posture so your body is at its best for motherhood.

If you would like some guidance on how to navigate your recovery during the fourth trimester, visit me during an Open House at Blooma Minneapolis on Tuesday, October 8, anytime from 5:30-7:30. I would love to answer your questions about postpartum recovery, troubleshoot any concerns you may have, and provide basic exercise suggestions.



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