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The Fourth Trimester

Guest Blog by Jen Wilson.

You can read her original blog post here.


You don’t really hear anyone mention the Fourth Trimester and it’s a pretty big deal so that’s why I wanted to write about it!

There are many milestones during pregnancy, from your first appointment with your GP and midwife, your 12 and 20 week scans. The three trimesters which are all milestones in themselves. Each trimester comes with lots of information about what to expect.

During the birth you have support from your Midwife, followed by home visits from the Midwife and the Health Visitor. But what happens after those early few weeks when suddenly we are on our own? We are not feeling ourselves physically and/or mentally and we don’t know if how we feel is normal or not! Welcome to the Fourth Trimester!

What is the Fourth Trimester?

The fourth Trimester is the three months following the birth of your baby. If you search online for ‘The Fourth Trimester’ you will find it being referred to as the ‘three month period of adjustment for babies to life outside the womb’.


Not only do you suddenly have a little human being that depends on you 24/7 but you have a lot of other stuff to deal with too! The stuff that no one tells you about! I’ll get to that later.

In the early days of motherhood, you are muddling your way through how to look after a baby. This can be challenging in itself. Your hormones are all over the place, your mood is up and down and you are not getting much sleep.

As the weeks progress, and you start to settle into some kind of routine (hopefully!) you may become more aware of how your body is feeling. Mainly that it doesn’t feel like it used to! We brush it under the carpet and say to ourselves ‘My body just feels like that because I’ve had a baby’

Your body probably DOES feel like that because you’ve had a baby but that doesn’t mean that it SHOULD feel like that or that the way it feels is normal!

The 6 Week Check

Another milestone  – The 6 Week Check, the moment we meet with our GP and they tell us that all is good and we can resume normal activities.

But hang on a minute, what did your GP ask you? Did they ask you how you were feeling, if you had any problems? Was there a hands on assessment for Diastasis Recti? Did they assess your Pelvic Floor Function or even ask any questions about issues such as Urinary Stress Incontinence?

It is all very well telling someone they can ‘resume normal activities’ but what concerns me is that it depends what your ‘normal’ is!

If your normal is exercising and being active, and you haven’t been assessed for Diastasis Recti or Pelvic Floor Weakness, then we have a problem.

The problem is that we should not be returning to exercise (the wrong type) too soon when our body is not ready. This will only make conditions such as Diastasis Recti and Pelvic Floor Weakness worse.

Factors to Consider

Women aren’t really told about the changes that occur to their bodies during pregnancy and birth (i’m talking about the stuff on the inside that we can’t see) and how these changes can affect you in the short and long term.

Did you know: It can take up to 2 years for your body to fully heal following pregnancy and childbirth. It doesn’t matter what type of delivery you had, whether the labour was straightforward or not, the fact is, tissues, tendons, deep core muscles and the pelvic floor have all been through some degree of trauma and need time to heal!

Because of this, there are many factors to consider before returning to exercise. Even if you don’t exercise you should still read on as you may still be affected by some of these issues.

And by the way – BEING A MUM IS A PHYSICALLY DEMANDING JOB! So exercise or no exercise this stuff is still important!

The purpose of this Blog is to raise awareness of the issues you may face or indeed are already facing, so that you can take the necessary steps in getting any help you may need.

Nobody told me that would happen when I had a baby!

When I was working through my Advanced Post Natal Training Course, I joked that the long list of possible Post Natal ailments should be given out as a form of contraception!  Joking aside, these many ailments can cause misery. Some women have none, some have a few and some have many!

I’m not going to discuss all of them here as that would take too long! I am however, going to discuss Hormones, Energy, Aches and Pains, Diastasis Recti, Pelvic Floor Weakness and Pelvic Organ Prolapse. This, is the ‘stuff that no one tells you about’!


During those early days of motherhood our hormones are all over the place – I know mine were! From being fine one minute to crying uncontrollably the next! Personally, it took me a few weeks for these extreme feelings to settle down. Speaking to other mums it is reassuring to know that this can be quite common.

However, it is so important that you ask for help or seek advice if you feel particularly low or detached from your baby or if these feelings last a long time.

You can read more about Maternal Mental Health at


Energy, what energy! Lack of energy is totally normal and will probably last for quite a long time!

Labour and birth is absolutely exhausting with little time to recover as you now have a little human being relying on you 24 /7. It is only natural not to have much energy. During those early days and weeks, take the opportunity to nap and rest when you can. Don’t be afraid to accept and / or ask for help if you need it.

Increasing your energy

Unfortunately, the sleep deprivation may continue for many months if not years (in my case!). One of the best ways to boost your energy is to exercise! So get outdoors for a walk or join a post natal exercise class.

Although you may not feel like it at the time, I can guarantee if you arrive at a class sleep deprived and exhausted you will leave feeling energised. I’m yet to meet a mum who doesn’t say at the end of class ‘I feel so much better for that!’ even if she hardly slept the night before!


Have you noticed that you have lots of aches and pains that you didn’t have before pregnancy? Upper back, middle of you back, lower back and hips to name a few!

What Causes these aches and pains?

Post natal aches and pains are very common but it is important to establish the cause of these aches and pains. Nine times out of ten this can be put down to the changes that occur to our posture during pregnancy. The good news is that these changes can be corrected by embarking on an exercise programme that specifically addresses Post Natal issues. If however, the pain is severe you really should make an appointment with your GP.


Diastasis Recti is the stretching, lengthening and weakening of the entire abdominal wall that occurs during pregnancy and remains into the postnatal period. This is very common and the majority of women will have this post birth.  For some women, the separation will heal of its own accord, but for many women this is not the case.

Why does it matter if you have a Diastasis?

A Diastasis leads to chronic dysfunction throughout the body resulting in pain and discomfort. This can affect everyone regardless of whether you take part in any form of exercise or not. Being a mum is physically demanding, we push, we pull, we lift, we bend, we carry, we twist and turn.  Doing all of these movements on weak foundations will only lead us to long term problems and pain.

Common signs of a Diastasis

  • A mummy tummy,

  • Protruding belly button,

  • Back and hip pain,

  • Leaking issues (sudden urinary incontinence),

  • Abdominal protrusion when you do crunches or lift heavy weights for example,

  • Stubborn pregnancy pooch

There’s lots more information and a guide on how to check if you have a Diastasis at ‘DIASTASIS RECTI – WHAT YOU NEED TO KNOW’


‘But I only leak when I sneeze’

Leaking is COMMON after childbirth but it certainly ISN’T NORMAL even if it is only just a little bit when you sneeze!

Please don’t  accept this as being part of having a baby, this is something that can be fixed through a corrective exercise programme.

If, however, your incontinence is much more severe (I.e you are having to wear pads and change them regularly throughout the day) then please seek some medical advice with your GP or a Women’s Health Physio as you may need some specialist help.

Signs of a Weak Pelvic Floor

  • Any leakage of urine (no matter how small) when coughing, sneezing, bending, laughing, lifting weights, squatting, pushing trolleys/prams, jumping, jogging, blowing your nose, vomiting, straining your bowels.

  • Leakage of urine when hurrying to the toilet

  • Leakage of urine when hearing running water

  • Increased frequency of urination

  • Dragging, aching or feeling of heaviness down below

  • Problems in controlling wind or bowel contents

  • Lower Back pain

  • Abdominal separation (Diastasis Recti)

  • Prolapse


What is a Prolapse?

A prolapse occurs when the Pelvic Floor Muscles are weak and unable to do their job of holding the Pelvic Organs (bladder, bowel and uterus) in place. The result being that these organs fall out of place.

There is a risk of prolapse after you’ve had your baby. Assisted births (forceps/vacuum) can increase your chance of a prolapse by 50%!

If your Pelvic Floor Muscles are already weak (which they will be following pregnancy and childbirth, even if you had C section) anything that places pressure on the Pelvic Floor increases the risk of Prolapse when the muscles are weak. This includes straining to go to the toilet, coughing, sneezing, lifting, running, jumping, the list goes on!

Signs of a prolapse

  • Heaviness or dragging sensation down below,

  • Lower back pain,

  • Difficulty inserting or keeping a tampon in place,

  • A bearing down inside the pelvis,

  • Difficulty with sex (laxity or difficult penetration),

  • Difficulty emptying the bowels,

  • Anything that just doesn’t feel right down below


If you are affected by any of the above then I can assure you that you are not alone!

The good news is that all the above can be fixed by embarking on an exercise programme that is designed specifically to address post natal issues.

However, depending on the severity of your symptoms, you may need to be referred to a medical professional for further assessment and help.

If there is one message I would like to get across to you today: IF SOMETHING DOESN’T FEEL RIGHT THEN IT PROBABLY ISN’T!

Please don’t be afraid to ASK and please don’t just ACCEPT feeling a certain way because you have been pregnant and given birth. It’s always best to visit your GP or a Women’s Health Physio for their help and advice.

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