The 4th Trimester

The Fourth Trimester

The fourth trimester is considered the 12-week period immediately after you have had your baby. Not everyone has heard of it, but every mother and their newborn baby will go through it. It is a time of great physical and emotional change as your baby adjusts to being outside the womb, and you adjust to your life as a new mum.

The aim of these postnatal guidelines is to provide some guidance about how to navigate that early postnatal phase from a movement perspective and ensure you build back to exercise minimising risk of injury. These guidelines have been developed by physiotherapists based on the most current research available, so we hope this saves you time from sifting through the many and often confusing information that is out there. This should be able to answer most of the common questions around returning to exercise postnatally. What things can you do safely and when? What can you do at home to help optimise my recovery and return to the activities I enjoy?

Regular exercise has numerous health benefits, all of which apply equally to the new mother as at any other stage of life. These benefits include building general strength, recovery of abdominal separation, stress relief and confidence returning to running/ sports.

It is important to note that no two women are the same, just as no two births are the same, so when you’re getting into postnatal exercise, it’s important you acknowledge where your body is post birth and seek advice from your health professional. New mums heal and recover at different rates, which depends on a numbers of factors including:

  • Fitness levels prior to and during pregnancy.
  • The type of birth (vaginal/ c-section)
  •  Whether a mother chooses to breast or bottle feed.
  •  Mother’s mental health.
  •  Level of family support.
  •  Amount of sleep mother is receiving.
  •  Abdominal Separation.
  •  Potential uterus prolapse.

For some, it won’t take long before they’re able to do what they were doing pre-pregnancy, but for others – it will take time. Remembering that it takes 9 months to grow Bub, it can take 9-12 months to recover and regain strength. Listen to what your body is telling you and try to enjoy gentle postnatal exercise. Embrace working out at a lesser intensity (it’s not for long).Sometimes in life, it really does pay to be the tortoise and not the hare!

Relative Rest

There are a few simple things you can do during the fourth trimester to protect your body and provide the best environment for healing.

Sleep is vital for healing on a cellular level. While your sleep patterns will be disrupted, allowing yourself to rest when you can is important.

Taking the load off the pelvic floor by sitting in a more reclined position or lying flat can give the pelvic floor the rest
needed to aid recovery. This applies for both vaginal deliveries and caesarean sections.

Ice can be helpful for pain relief and inflammation associated with both perineum and caesarean wound pain. Use
an ice pack or bag of frozen peas wrapped Aim for 20-30 minutes of horizontal rest 2-3x per day


Try feeding your baby ins a side-lying position for incidental rest.

If you’ve had a c-section, use a rolled towel/ cushion to apply pressure to your wound when coughing or sneezing. This makes it much more comfortable and helps to protect the abdominal muscles from injury.

Supportive Garments

Supportive/ compression garments after delivery are strongly encouraged following both vaginal and caesarean deliveries. They can be helpful to reduce ongoing pain and functional issues such as low back pain, pelvic girdle pain, varicose veins (vulval, legs), urinary incontinence and abdominal separation.

There are a number of options available – tubigrip, belts and compression tights (e.g SRC, Lenny Rose). Belts and tights
provide much more support than tubigrip. Choosing the right option can come down to cost and comfort.

The first 6-12 weeks postpartum is the key window where these have the most effect, so choosing something that you will actually wear is key. Stockists of the SRC tights are listed online. If you need any assistance with sizing, we are here to help.

Postpartum Exercise Guidelines

“T’ve had my 6-week OB/ GP check, I’ve been cleared to exercise”

Hold up! While the 6-week check is important and required before commencing classes at All for One. The doctors are the medical specialist and will assess both Mum and Bub to ensure both are recovering well. They may discuss things such as:

  • Scar healing (c-section/ peronium)
  • Review any pregnancy related medical conditions
  • Discuss birth control options
  • Ask about bleeding
  •  Address any other medical concerns.

However, it is also vital to be assessed by a physiotherapist who specialises in postnatal care to get a better understanding of where you are at in terms of your pelvic floor and abominable recovery. Physios are muscle and joint
specialist and will assess the following:

  • Abdominal separation
  • Review pelvic floor function
  • Address any musculoskeletal aches and pains
  • Provide guidance on return to exercise
  • Referral to specialists as required.

This diagram shows a typical progression of exercise throughout the fourth trimester.
Following a structured approach will help optimise recovery no matter the type of
delivery while reducing the risk of adverse outcomes.

Pelvic Floor Exercises

Walking and pelvic floor exercises can generally be started as soon as comfortable after giving birth (and the catheter has been removed). Start when you feel up to it.

The aim of the pelvic floor exercises is to help regain awareness of the pelvic floor and facilitate the activation and relaxation of these muscles. It is normal to have reduced sensation around this area, so it can take some time to build up.

Everyone will have different cues/ visualisations that work for them. Examples include:

  •  Draw your belly button towards your spine and pull your tummy away from your
  •  Lift through your front passage as if you are trying to stop the flow of urine, then
  •  Lift through your back passage as if you are trying to hold in wind, then relax
  • Lift up as though your pelvic floor is an elevator. Close the door and try to lift to
    level 1, then higher to level 2.
  •  Women who are familiar with using tampons can imagine squeezing in the vagina
    as if squeezing a tampon up higher in the vagina.

This movement is much more subtle than most people initially think. Less is often more! This is not an exercise that will give a strong “muscle burn”. You should be able to comfortably breath or talk throughout these movements. If you find yourself holding your breath, you are probably going 110%, which may in fact be doing the opposite of what we are trying to achieve and increasing pressure on the pelvic floor.
If you are having difficulty figuring out your technique, more information can be found at this website (, or get in touch with one of our physios who can help guide you.

Strength Training

Strength training and resistance training can commence from around 6 weeks postpartum (in the absence of any complications/contraindications). This should begin with body weight exercises first and progress to weights when ready. Your physio can guide you to ensure good technique that doesn’t place additional strain on abdominal separation.

The Mums and Bubs classes here at All for One are a great place to start to re-introduce some resistance training into your routine. Prior to commencing the Mums & Bubs classes, an assessment with one of our physiotherapists is required to chat about delivery, postpartum recovery and ensure the classes are safe and appropriate. These assessments can be done as early as 6 weeks (after your GP/OB check), but there is no such thing as too late!
You are of course more than welcome to bring Bub along with you to these appointments.

The classes are run as a reformer class where you bring along a bouncer/ mat/ capsule where Bub can stay next to you throughout the class or in the prams just outside. The physios taking the class are always up for a cuddle and have plan B if Bubs aren’t settling. We provide different options throughout the class so that everyone can be challenged regards
of where you are of your postnatal journey. The physio taking the class will also check in on form and provide
feedback to guide what level you should be working at.

Returning to Running

Runners just want to run! We understand that many new Mums want to get back out there and feel like themselves again. It’s efficient. It’s a great way to get some fresh air, have ‘me time’ and feel that runner’s high. We get it…

However, it is recommended that women do not return to running before 12 weeks. The 6-week milestone is one that serves as a tick box confirming readiness and suitability to return to an exercise class, sporting activity, or elite training. The healing process, however, extends well beyond this. Soft tissue is only about 75% healed at 6 weeks.

There are specific return to running guidelines that outline certain milestones (that focus on strength, endurance and
form) we want women to be able to achieve before commencing a gradual running program such as the couch to 5km app.

All the walking, pelvic floor exercises and strength work that can be done prior to that 12-week mark will be all beneficial in getting you back to pounding the pavement in no time.

The physios at All for One offer return to running assessments, where we can discuss the return to running guidelines,
screen for readiness and prescribe any additional exercises to help achieve your goal.

Perinatal Emotional and Mental Wellbeing

Pregnancy and the early postnatal period can be an exciting time, but we know it can also be tricky for lots of reasons. How are you doing? Is there anything troubling you?

Looking after yourself means looking after both physical and mental wellbeing. The perinatal period – conception to 12 months post-birth – is a time of increased risk for mental illness. Perinatal anxiety and depression affects up to 1
in 5 women and 1 in 10 men.

While this isn’t our area of expertise as physiotherapists, please know there are support services available. Perinatal Anxiety & Depression Australia National (PANDA) Helpline provides specialist perinatal emotional and mental health
support to anyone during pregnancy and early parenthood, including partners and family members. They provide judgement-free support by helping patients to make sense of their experiences, know what might lie ahead, seek help, and advocate for themselves or their partner.

1300 726 306
Helpline hours | Mon to Fri, 9am – 7.30pm AEST/AEDT |