Postpartum Symptoms: Understanding the “Fourth Trimester”

What is the definition of postpartum?

Typically, pregnancy, labor, and birth get the most attention when one is speaking about the journey to parenthood. However, the postpartum period (or season) is the fourth crucial piece of this journey - one that cannot be overlooked or ignored. The “postpartum” season, also referred to as the puerperium or the “fourth trimester,” is the time after delivery of an infant until the maternal body returns to its “normal” physiological non-pregnant state, and there are a lot of symptoms.

How long is the postpartum period?

There is little consensus about the true end of this fourth trimester; some suggest this season to last up to 12 months post-delivery. The American College of Obstetricians and Gynecologists (ACOG), a well-respected obstetric governing body, considers the postpartum season to extend up to 12 weeks after birth.

It is important to note that all of a woman’s organ systems do not return to their true normal in these timeframes and that the return-to-normal process is not linear or the same for everyone. These differences have likely led to the continued lack of consensus on the exact timeframe of the postpartum season. Everyone experiences postpartum symptoms in their own way.

What is the cause of postpartum?

After delivery of the infant and the placenta, there are a variety of resets that need to happen in a woman’s body. Some of these take place in response to hormonal changes. Other aspects of postpartum are part of the body’s physical recovery and healing response. 

Here are some common areas of change, healing, and recovery after delivery:

• Swelling: this usually resolves within a week or so
• Vaginal Soreness/Trauma & Bleeding: healing and recovery here can take up to 6 weeks (or longer)
• Swollen Breasts: breast changes are related to the hormones of milk production; they should settle out after about a week
• Bladder Dysfunction: though these often resolve in about 8 weeks, issues can be lifelong or need surgical repair
• Hair Loss: hair changes are related to hormonal changes; usually resolves within a year

How long do postpartum hormones last?

There are four hormones commonly discussed related to pregnancy and postpartum. They are estrogen, progesterone, oxytocin, and prolactin. After birth, estrogen and progesterone immediately plummet. Oxytocin and prolactin immediately begin to rise. Around 2 or 3 months postpartum, a woman’s hormones should all begin to reset to non-pregnant levels (except for prolactin, which remains for the breastfeeding mother), with true “normal” being reached by about 6 months.

Potential complications and challenges of postpartum

How long does anxiety last after having a baby?

Though most women begin to feel postpartum anxiety (PPA) shortly after birth, it can also begin before birth (approximately 25% of cases). It is difficult to say how long it may last. While many cases may be related to hormonal changes (and resolve when hormones settle around 6 months), many women need professional help to treat and/or manage their anxiety and its effects. If untreated, moderate to severe PPA can last indefinitely.

Can you prevent postpartum depression (PPD)?

Typically, postpartum depression cannot be prevented. However, there are some common risk factors. When these are known, a woman and her family can do preemptive work to circumnavigate these factors or alleviate their effects. 

These include:

- History of depression or postpartum depression

- Family history of depression or mental illness

- Drug or alcohol abuse

- Traumatic life event during pregnancy

- Difficult pregnancy or difficulties related to baby's health

- Lack of support system

Women who face some of these challenges and symptoms need to speak with their care provider early. With or without symptoms, there are treatments, counseling, and therapies that may prove effective in preventing or lessening PPD and its effects.

What are symptoms of prolapse during postpartum?

Pelvic organ prolapse can occur when one or more of the organs in the pelvis slip down into the vagina. Common organs to do this post-delivery are the uterus, the bowel, or the bladder. Though this isn’t life-threatening, the condition can cause many uncomfortable symptoms, including pain, a feeling of heaviness, dragging discomfort in the vagina, issues voiding, feeling/seeing a bulge in the vagina, and discomfort with intercourse. Prolapse treatment will depend on the severity of the issue.

How do you treat postpartum preeclampsia?

Postpartum preeclampsia is a rare condition that occurs after childbirth. It is characterized by high blood pressure and protein in the urine. Common symptoms are severe headaches and changes in vision. If left untreated, it can lead to seizures and/or be deadly. Do not ignore these symptoms! Let your provider decide if you need treatment or not. Depending on the severity of the condition, treatment may include medication(s) for blood pressure management and seizure management. 

How can you prevent postpartum challenges?

There are many postpartum challenges that are outside of a woman’s control. However, there are always things a woman can do to ensure her mind and her body are at their best for both pregnancy and postpartum. 

This includes:

• A healthy diet; make sure your body is getting the vitamins and nutrients it needs
• Exercise; be safe in pregnancy and resume at the right time postpartum
• Rest and ask for help
• Talk about your mental health; include your partner and your provider
• Trust your intuition and listen to your body