Pregnancy Essentials: Postpartum – The Fourth Trimester

Congratulations! You and your team have a new a player! What an incredible feeling to have! A ten month journey, a courageous experience through labor and delivery, and now you have this little one.

Maybe you are ready for this:

Or this

Or simply this:

In my years of practice, I have found that the most critical, and often overlooked period in pregnancy is the “after delivery” portion, also known as postpartum.

This now dubbed “fourth trimester” are the minutes, hours, days and weeks after delivery. While the preceding 10 months were a marathon and is filled with physical and emotional changes, it is the moments after pregnancy that shape the following years of a woman’s care, as well as her team members’.

Here I will discuss some of the critical highlights in postpartum care:

Postpartum care starts immediately after delivery. Granted there are no complications with delivery, the interaction between mother, family and baby are important.

Highlight: Skin-to-skin Contact

Research has shown that “skin to skin” contact benefits both moms and babies. This is when the newborn is placed immediately in contact with the mother and her bare skin. According to UNICEF:

“it helps the baby adjust to life outside the womb and is highly important for supporting mothers to initiate breastfeeding and to develop a close, loving relationship with their baby.”

Other added benefits include:

  • Calms and relaxes both mother and baby
  • Regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb
  • Stimulates digestion and an interest in feeding
  • Regulates temperature
  • Enables colonization of the baby’s skin with the mother’s friendly bacteria, thus protecting against infection
  • Stimulates the release of hormones to support breastfeeding and mothering.

After delivery, I usually advise my patients to take some intimate time for their new family. Before letting guests and family members join in the celebration, take time to form a strong bond with your new baby.

Highlight #2: The days after delivery
Once delivered, you are transferred to a postpartum floor, where you spend time recovering. The length of stay depends on the type of delivery; if you have a:

Vaginal delivery: 1-2 days

Cesarean Delivery: 3-4 days

During this time, your baby is observed by the pediatrics team, and you are observed by your doctor and the hospital team, ensuring that you are pain is well controlled, you are learning about breastfeeding, and there are no underlying post-delivery issues such as heavy vaginal bleeding, high blood pressure, or uncontrolled blood sugar.

Dr. Niku, what about after the hospital? When do I or my partner visit my doctor? How often?

In a recent effort to increase postpartum engagement, the American College of Obstetrics and Gynecology recommends a follow up within the first 3 weeks after delivery.

Studies have shown that symptoms of depression decreased, and there is also an increase in breast feeding with more frequent visits.

For an uncomplicated vaginal delivery, it is recommended to follow up at least three times:

At 1–14 days – you will be checked for

  • Recovery from any vaginal tears during delivery
  • Depression screening
  • Blood pressure check – especially if you have high blood pressure throughout pregnancy or required medication
  • Blood sugar check – especially if you had diabetes of pregnancy
  • Review of pregnancy or labor complications, lactation support

Dr.Niku’s TIP:

  • Know your baby’s weight, height!
  • How many weeks were you when you delivered?
  • Did you get an epidural?
  • Any complications with the delivery? Vaginal tear? Fever? Bleeding?

At 15–60 days

  • Discuss with your doctor your options for birth control
  • Depression screening

At 60–90 days

  • A Full examination and preventive screenings similar to anannual examination because this will be 1 year after the initial prenatal visit
  • A Pap smear may be needed

Here’s something new and innovative!

Visits aren’t necessarily limited to visiting your doctor in the office. Some practitioners and institutions are experimenting with telemedicine and remote visits, allowing patients to be quickly and efficiently assessed through technology. This is a growing field and we are learning about the risks and benefits for this method of practice.

Now some FAQ:

What are some common symptoms a patient may experience after delivery?

Heavy bleeding


Physical exhaustion

Urinary incontinence

Postpartum blues – usually resolve in 10-14 days after delivery

When can I have sex again?

It is recommended not to put anything inside the vagina for up to 6 weeks after delivery. You can be sexually active after, but it is ideal to use some birth control to avoid having another pregnancy too close to the previous one.

When Will my period come back?

Usually 6-8 weeks, often times longer if you are effectively breastfeeding. If not, it may return sooner.

When can I go back to work?

While I have my opinions about postpartum paid leave in US (I believe women should be given longer than the granted 6 weeks of postpartum coverage), most women in the US tend to go back to work within 6-8 weeks.

I will have a special discussion on postpartum depression in a separate post. This is a critical topic to be discussed. We need to continue to educate our patients, friends and family members about the signs and symptoms of depression in the postpartum period.

Get In Touch

Daniel Niku, MD, MS

Call Us: (310) 652-9347

Visit Us: 150 North Robertson Boulevard Suite 200
Beverly Hills, CA 90211

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Wednesday: By Appointment Only
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