The Health Curve

The Fourth Trimester: Navigating Life After Birth - with Stacey Silverman Fine, MD at Maven Clinic

• Dr. Jason Arora • Season 1 • Episode 24

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The postpartum period - often called the fourth trimester - is one of the most raw, emotional, and transformative stages in a woman’s life. Yet postpartum health remains one of the most overlooked areas of modern healthcare. Hormones shift dramatically, physical recovery begins, sleep becomes fragmented, and parents navigate a deep identity transition.

In this episode of The Health Curve, host Dr. Jason Arora speaks with OBGYN Dr. Stacey Silverman Fine of Maven Clinic to demystify postpartum recovery and explain what truly happens after birth. They cover the physical and emotional changes of postpartum, breastfeeding challenges, pelvic floor healing, postpartum anxiety and depression, and why the traditional six-week checkup is far from sufficient.

You’ll also learn what real postpartum support should look like - from partners, families, workplaces, and the healthcare system.

If you want an honest, evidence-based conversation about life after birth, this episode is your postpartum guide.

Introduction to the Fourth Trimester

Speaker 1

Welcome to the Healthcare Podcast . I'm your host , jason Arora . As part of our Women's Health series , we're diving into one of the most overlooked chapters in all of healthcare the postpartum period , also known as the fourth trimester of pregnancy . It's raw , it's emotional and it's life-changing , but it's so often ignored . My guest again is the wonderful Dr Stacey Silverman-Fine of Maven Clinic . From recovery and hormones to identity shifts and gaps in care , we aim to explore what life really looks like after birth and why it deserves so much more attention . Stacey , it's great to have you back again . Looking forward to discussing postpartum with you in this episode .

Speaker 2

Thank you for having me back , Jason .

Speaker 1

Okay , so let's start with the basics . What exactly is the postpartum period after the birth of a child in this episode ? Thank you for having me back , Jason . Okay , so let's start with the basics . What exactly is the postpartum period after the birth of a child ?

Speaker 2

The postpartum period is really thought of as the fourth trimester . It is accompanied by market changes that are going on to the birthing parent as well as to the couple if we have a couple going on as well as accompanied by huge hormonal shifts and identity changes as well .

Speaker 1

And so this is not a footnote to . The pregnancy right Like this is its own biological phase , in which there are a lot of things going on environmentally as well .

Speaker 2

Absolutely . This is not a footnote . This is actually an extremely important time and often under-discussed and really can be a very tumultuous time for the new family .

Speaker 1

Absolutely . That's why we're talking about it . So can you start with the biology ? What's happening with the hormones ? There is milk production , all these sorts of things are going on . The body's

Biological Changes After Birth

Speaker 1

going to change again . What happens biologically to the birthing parent ?

Speaker 2

Yes , after birth , levels of estrogen and progesterone drop rapidly and it's this drop in these hormones that can affect the mood , can really affect a lot of the changes that we see going on within the birthing parent . The uterus is involuting and trying to shrink back to its normal size or pre-pregnancy size . We have hormones that are being released that are stimulating the breast to produce and release milk Really stimulating the breast to produce and release milk really quite an unbelievable time . And when we add to that what's going on biologically , we also have to remember that we're also having drastic changes in identity that are going on during this time .

Speaker 1

And so , if we take all those changes , what do you think ?

Speaker 2

people who are going to go through this period , or maybe going through it right now , need to know the most how can they help themselves with all of this context I think what's most important to know is that there are drastic changes going on in the body , both from a biologic standpoint , as well as changes that are going on socially . Often , when we're in this time period , we're not getting sleep , we're home , we're not out and about as much . We become sometimes a little more isolated

Supporting New Parents

Speaker 2

during this time , and I like to remind people that , while there is a lot of positivity and excitement around bringing home a new baby and potentially delivering a baby , this isn't always the case for everybody . This might be a very challenging time for people and again , this is one of those times when I say there isn't one right way to do this . The only one right way actually is your way , and so really important to emphasize that here .

Speaker 2

There's a lot of opinions that people have about how things should occur in this postpartum period . Everybody's going to have an opinion about how you should be feeding the baby , how often the baby should be waking up in the night , whether you should be putting cereal in the bottle or not in the bottle , because this was an old thing that used to occur here in the United States and oh , you should let the baby cry or no ? You shouldn't let the baby cry , or you should do that . You know everybody's going to have an opinion and ultimately it's going to be up to you to decide the way you want to have this process go .

Speaker 1

I'm getting flashbacks from post-birth of both of my children , and this definitely happened a lot . So , speaking from the perspective of the father or the partner , what advice would you give to partner or family members who are around someone who's just given birth ?

Speaker 2

I think what's really important is to keep an open line of communication , to let the person know who gave birth , that you understand that they're undergoing a lot of biological changes that you're here to support . But what's also important is the partner is also going through a lot of changes . They may view their role in society and in the household very differently than they did before , which might create some stresses for the partner as well . So I think what's really important here is keeping an open line of communication and really helping to support each other during this time as we develop new roles .

Speaker 1

So , moving on to some of the specific issues that arise in the postpartum period , what do you see most often ?

Postpartum Depression Explained

Speaker 2

I think most often we see a period of what can be termed the baby blues , where the hormones are really creating a lot of changes that are going on . We're also having some sleep deprivation , adjusting to a new identity and the demands of caring for a newborn . That can be really overwhelming . So I think that's one of them . I think number two we often will see issues around feeding and nursing , at least in my mind . When you look at it in the movies and things , it looks like it's so easy and in reality for some it is a natural and somewhat seamless process , but some people really struggle to get that milk established , the milk letdown process , to get that milk established , the milk letdown process , all of it , the milk supply established , really getting a baby to suckle and latch appropriately , and so we can see quite a bit of issues regarding that as well during this time .

Speaker 1

Tell us a bit more about postpartum depression and the baby blues , because this is something I think people are talking about a bit more . It's a lot more common than I think we all realized as a society not too long ago . Can you talk a bit more about ?

Speaker 2

postpartum depression . Really a lot of things changes in hormone levels . We've talked about this a bunch . Estrogen and progesterone levels are dropping dramatically after delivery and these hormones really do influence the neurotransmitters that are in our brain .

Speaker 2

And I always say this it is all in our heads , it's just not in our heads the way people have said it was in our heads . It's in our neurotransmitters , these signals that get secreted that really can involve mood , energy , motivation , sleep , and really disruption in these neurotransmitters can lead to depressive symptoms . There have been some imaging studies that have actually showed altered activity in the brain that control mood and emotion and regulation of that , and can even control things such as decision-making during this time period . And so really postpartum depression is not just postpartum blues . We need to remember that if it's going on longer than just a week or two , if it's really severe , if it's interfering with our activities of daily living , then we might have something else going on and really need to reach out and seek the support of not only providers but also our support systems as well that might be in place .

Speaker 1

And do we see other mood changes during this time , like aggression , anger , resentment , those sorts of things ?

Speaker 2

I think absolutely we can see all of those and I think some of that can come from both sides . This is a new environment , a new identity , not only for the birthing parent but the partner as well . For the families , the family structure may look very different . We may also have another little one at home , maybe we have a toddler at home and we've just brought home a new baby into that household . And I remember that was a really big deal for me when I brought home my second .

Speaker 2

I remember my first looking at me my first day home and saying go back to work and take him with you , and being absolutely devastated . That was the response that I got from the love of my life , right . And somebody at one point said to me remember that your first child she was 29 months at the time had 29 months of unprot individual time with you and your spouse , whereas this new baby isn't going to have that at all , although now he got it when his sister was away at college and of course now he's a teenager and really doesn't want that individual attention . But I think really we're having to adjust to everybody in that family taking on a new role and a new identity .

Speaker 1

Tell us a bit about postpartum bleeding .

Speaker 2

Postpartum time is really an interesting time in terms of bleeding as

Physical Recovery and Challenges

Speaker 2

well . We do know that bleeding can occur for four to six weeks postpartum . In general , it tends to lessen over time . But this is a time when we tell the birthing parent that they're not allowed to put anything in the vagina , so this includes tampons as well . So we're using pads and in general the bleeding at the beginning can be much heavier , but over time should get less and less and less .

Speaker 2

Bleeding will also correlate with activities . So many times I'll have a patient meet with me where they'll say their bleeding was much better . They were feeling really great , and so they were out and about and they were walking and they were carrying the baby and they were doing this and they were doing that and now all of a sudden , lo and behold , today their bleeding picked up . So sometimes that bleeding can be a gauge of whether we've overexerted or not . In addition , if that bleeding is going the wrong way , it's getting heavier with time or we're soaking through more than a pad an hour and that is going on for two to three hours important to reach out to a provider to make sure everything's okay .

Speaker 1

And how about urinary or fecal incontinence ?

Speaker 2

Unfortunately , both of these can occur as well as the pelvis is restoring itself to pre-pregnancy levels and may have had trauma with delivery . If we've had a vaginal delivery or even a C-section , we may have some urinary incontinence and fecal incontinence as well . I think that first bowel movement is a really anxiety-producing event for the birthing parent after a vaginal delivery and so many times we have birthing parents on stool softeners during this time as well and we really try and emphasize trying to empty your bladder regularly . Usually I'll tell somebody you know we really should be emptying that bladder every two to three hours during our waking time and when we go to the bathroom really sitting on that toilet for a full count of seven to making sure we're emptying regularly , and if we're having pain from stitches or a previous tear , we might need to be doing some soaks . Sometimes we'll even have patients urinate in a sitz bath if they're having a lot of discomfort . So really quite a bit is going on here .

Speaker 1

We'll get back to this conversation in just a moment , but if you're finding this episode helpful , here's a quick ask Take a second to follow or subscribe to the Healthcare Podcast wherever you're listening , and if someone else in your life would benefit from this episode or any of the others you've heard , please send it that way . All right , let's get back to it . All right . So let's move on to some of the community questions

Common Postpartum Questions Answered

Speaker 1

that we got . How much bleeding after birth is normal ?

Speaker 2

In general , bleeding after birth , as previously stated , can really vary At the beginning . Generally , we can expect to be changing a pad many times during the day , but when we're soaking through more than a pad an hour for two or three consecutive hours , that's something that's really important to reach out to our provider , for we also can see really small clots , maybe the size of a nickel or maybe a dime , but if we're starting to get clots that are the size of a small orange , that might be something where it's time to reach out to a provider .

Speaker 1

When can someone have sex again after giving birth ?

Speaker 2

General rule of thumb is that you can start having sex about six weeks after delivery . Usually recommend that you've had that visit with your provider to make sure that everything's healed appropriately .

Speaker 2

Another community question is why does the mother of a newborn feel so emotional ? The reason the mother of a newborn feels so emotional is really multiple reasons . Number one the hormonal shifts , that estrogen and progesterone levels are dropping dramatically and this is affecting our mood . In addition , sleep deprivation and adjusting to having a new identity and the demands of caring for a new baby . Also , if we have a history of depression or anxiety , this may be increased in that postpartum period as we're trying to reach and keep up with the demands of that newborn . Lack of support can also play a role here Limited help , either from a family or a partner , maybe financial strain . I think we mentioned social isolation previously . That can happen because we're not taking that newborn out , and then we may also have had a really traumatic birth experience or complications at delivery or with the baby . That can also be creating further strain .

Speaker 1

So after childbirth , when does someone need to start taking birth control again if that's what they want to do ?

Speaker 2

In general , since we recommend pelvic rest and nothing in the vagina for the first six weeks . Really we recommend contraception starting around four to six weeks postpartum . Occasionally , if somebody is looking for a long acting contraception like an intrauterine device , some of those will be placed immediately postpartum in the hospital before somebody goes home . The progesterone IUDs can actually decrease bleeding as well , and so sometimes people will have those placed immediately postpartum before heading home . But otherwise that follow-up at the provider's office is when contraception is usually discussed .

Speaker 1

When is it okay to start exercising again in the postpartum period ?

Speaker 2

Generally , exercise will be recommended to begin around six weeks postpartum . Again , we usually like to make sure that the patient is healed Now . That doesn't mean they can't do anything Taking walks in the neighborhood with the stroller , or slow walks with the stroller being outside , a little bit moving around so that we're really mobilizing a lot of the fluid that is changing and shifting as we're getting back to pre-pregnancy . Biology is something that goes on , so we don't really need to do nothing but really getting back to our regular vigorous exercise routines , generally six weeks postpartum .

Speaker 1

And is hair loss during the postpartum period a normal thing ?

Speaker 2

Hair loss during postpartum is extremely normal and very common . It is called telogen effluvium and the reason it happens is that the hormones in pregnancy sync up all the hair follicles , so normally we have hair follicles that are growing , we have some that are resting , we have some that are falling out , but they all sync up in pregnancy and then after pregnancy what happens is they all end up in the hair loss stage at the same time , and so really we can see a lot of hair loss during that postpartum period . We'll have signs that it's coming back . If women look around their hairline , they'll see small little hairs growing back in , and that's a sign that things are coming back the other way .

Speaker 1

Is it normal to have night sweats in the postpartum period ?

Speaker 2

Night sweats are extremely common in the postpartum period , and they're usually caused by those absolute rapid plummets in estrogen and progesterone levels that happen after delivery .

Speaker 1

Okay , let's look at another community question here . So can someone get pregnant if their period hasn't come back yet ?

Speaker 2

Absolutely , jason . Someone can get get pregnant if their period hasn't come back yet . Absolutely , jason , someone can get pregnant even if their period hasn't come back yet . In the postpartum period , we will see the release of an egg or eggs , as that body returns back to its pre-pregnancy state , and that return can happen at various stages , and really this can depend on whether somebody is bottle feeding or whether somebody is nursing . Even in nursing we can still

Resources and Support Systems

Speaker 2

release an egg , and so really important to keep that in mind .

Speaker 1

What resources are available during the postpartum period that you would recommend and you feel that people should be aware of ?

Speaker 2

I think what's important to think of here when we think about resources is really engaging support .

Speaker 2

In the US this looks very different than in the rest of the world .

Speaker 2

Many times in the rest of the world we have quite a bit of support around this new family and here in the US , really , most of the time these families are on their own . So I think it's important to make sure that we engage support from family and friends . Maybe we're looking into starting some meal trains , maybe some child care help , maybe even postpartum doulas and peer support groups . Making sure what's important here is that we're reaching out to providers and we really need to equip nurses and midwives and doctors and doulas to screen early for postpartum depression and to talk about mental health without stigma . We are now routinely using some postpartum screening tools , including the Edinburgh Postnatal Depression Scale . During postpartum visits we can really screen for mental health and then making sure that , if needed , that referral pathways are there to clear those who need therapy or need medication or need support groups . So I think , reaching out to providers , engaging friends and family , engaging our partners , making sure we're keeping that open line of communication so that the family can get the support that they need .

Speaker 1

Stacey , once again , thank you so much for joining us . This has been a lot of fun and I'm sure our listeners will get a lot out of it . Look forward to recording our next episode together .

Speaker 2

Thank you , Jason .