Fourth Trimester: A Holistic Approach at Preparation
Hey there, sister! Welcome back! Today we’re going to cover the topic of the sacred postpartum time or what I refer to as the Fourth Trimester. I’m really excited about this topic because there really is quite an educational gap when it comes to learning about and preparing for the postpartum time. It’s arguably one of the most important seasons of a woman’s life but seems to be the season most forgotten about.
In our culture here in the United States, the village is not really something most of us experience. In other cultures, our wise elders “Mother the Mother” throughout the postpartum season. In today’s society, here in America, the postpartum is a neglected and overlooked part of the childbearing year. In our society, so many mother’s head back to work within weeks of giving birth, spouses head back within days, maybe a week or two if you’re fortunate. Many well-meaning family members and friends give clothes as the perfect gift when one might really need help with their other children, maybe some household help and maybe a few meals made for them in the postpartum season.
Did you know that how you experience your Postpartum Season will greatly affect how you experience menopause?! The Fourth Trimester seems to be the “forgotten frontier” for many women. Our American culture does not place importance on a woman’s postpartum healing, but the way a woman experiences being held, loved and fully supported during her postpartum season will affect society as a whole.
The idea that rest, support and care after birthing a baby are very basic human rights, but it does not often fit the economic and social realities here in America. But, I want to challenge that societal norm to change and the change, for your lineage, can very well start with YOU! A cultural shift needs to happen and you can be the one in your family lineage who changes the narrative around the postpartum season.
It’ll take a shift in yourself, first. You may be feeling pressure to prove yourself as a “super mom!” You may be feeling like you don’t want to burden others with your very real and very important needs. Or, maybe you’re feeling that because you wanted this baby so badly that you shouldn’t express your need for help when you’re having a hard time. But, again, I want to challenge those concepts!
Before we dig really deep into the meat of this workshop, I want to ask you a couple of questions for you to reflect upon, perhaps journal them out and see what comes up for you.
-What has been the most challenging part of your past postpartum experience(s)?
-Have you felt supported in your postpartum?
-Why do you think the postpartum is so challenging in our culture?
So, let’s start with the basics!
What IS the Fourth Trimester?
To simply put it, it’s the 3 months (or more!) AFTER your baby is born. It’s the transition from womb to world, for both baby and mama. This is not the time to encourage productivity. This is also called a “lying-in” period. In different cultures, there are different definitions of how many weeks are “acceptable” to be in the postpartum season and to take it slow. Especially for women here in America, where the most that many women get to stay home with their newborn is 6 weeks postpartum. In other cultures, a woman is not to resume her normal duties until MUCH later in her postpartum season. Some cultures it’s 12 weeks, other cultures it’s the first forty days, and in some cultures, a WHOLE year!
The birth is the passage and the postpartum time is the reintegration season. Though, here in America, it seems very prevalent that the postpartum season is associated with Postpartum Depression. And, again, I want to challenge that concept!
Why Is This Postpartum Time SO Important?
Postpartum is so very important for so many reasons! For one, did you know that how you are supported and recover during the postpartum season will affect how you experience menopause?! The postpartum season is met with major physical, emotional, social and spiritual happenings. This time is important because it will influence the health and wellbeing of mom, baby and the family as a unit; forever!
This is the baby's transition period “earthside!” The baby ONLY knows you, mama! Your blood rushing through your veins, your emotions, your heart tones, your movement, your voice. Your baby only knows warmth, comfort, being held snuggly and never experiences hunger pains. You and the baby are one unit. Coming out into the world, your baby is suddenly experiencing noises louder than they’ve ever heard before. Bright lights, cold air, suddenly your baby is experiencing hunger pains. But, your baby does not realize that you and him or her are two separate humans! Your baby still recognizes the unity of one unit. The mother-baby dyad.
This Fourth Trimester time is a time to be together, skin-to-skin; preferably. This is a time to establish breastfeeding, learn all about each other and create that strong bond that will last a lifetime. This is a very fragile and tender time that needs to be undisturbed and unhindered, just like the birth. This time is a time of creating a whole new family unit and family dynamic.
Physical Realities for Mom
So, let’s talk about the physical changes that happen with mama! If you are a first time mom, your body will never be “pre-pregnant” again! Your body is either “non-pregnant” or “pregnant” from here on out. There is a HUGE amount of physical changes happening and they’re happening very, very quickly. This will invite challenges on every level, especially if you’ve had a difficult birth or you find yourself in the postpartum unprepared.
Physically, your uterus is shrinking back down to its non-pregnant size. Your cervix which was opened up to 10 centimeters to allow your baby's passage is now going back down to size but remaining slightly open in order to allow lochia to flow as normal. There’s changes to your vagina, your breasts’ change, you’re experiencing sleep disturbances, your hormones are shifting. Your abdominals feel different, your pelvis and especially your tailbone is sore from moving and flexing to allow your baby to pass through. Even your organs have to begin their descent back down to their non-pregnant positions.
I want to note here, also, that Days 2-5 can really be “wet” days! You’re bleeding, you’re leaking milk, your hormones are shifting so you may be sweating a lot, crying and just generally emotional. You’ll also experience uterine “afterpains.” Typically these afterpains aren’t terrible in first time moms, but in subsequent moms, the pains can get worse after each baby.
Emotional Realities for Mom
The immediate postpartum can be a really challenging time for many. It’s really hard to quantify the emotional changes and the possible stress because they really do differ from person to person. How someone feels at 2 hours after the birth is usually a lot different than at 3 days after the birth. I want to stress that there is no right way to go about this. It can be hard and much of that hard IS hormonal and it WILL pass. Planning for your postpartum season can ease the stress and set you up with enough support for a much more stable postpartum season when we’re talking about the emotional factors.
This time can be challenging because you’re no longer pregnant; and if you’re anything like me, maybe you weren’t ready to birth your baby. Perhaps you wanted a little more time. With my most recent pregnancy, I wanted my baby to be born at 40 weeks and 1 day. I have never made it to my “due date” and my pregnancy was so enjoyable that I just was not ready to not be pregnant anymore. So, when my first contraction hit around noon on January 25, 2022 at just 39 weeks pregnant, I prayed that it was just a Braxton-Hicks contraction or a little bit of prodromal labor since the contraction was more like a period cramp. I had very intermittent contractions about every 20 minutes for a few hours and after that every so often. It gave me hope that it would either stop or I was just experiencing prodromal labor (even though I have never experienced that in any of my other pregnancies.)
Anyways. Not many experience that not-so-ready-to-birth feeling, so maybe that’s not you. But, for me, it definitely played a role in my immediate postpartum days with some sadness and needing to process that he was here, even though I wasn’t ready.
Roughly 80% of women will experience the “baby blues” in the first 2-3 weeks postpartum. About 10-20% of women will experience postpartum depression up to a year after birth. About 1 in 5-6 women will experience postpartum anxiety. Postpartum psychosis happens in .1-.2% of births and is very serious. This is usually very sudden and in the first two weeks of birth.
Regardless of the severity, please ask for help if you are struggling at all! Encourage your spouse to ask on your behalf if they notice something is off.
For me personally, I have had varying degrees of postpartum depression. I had the worst experience after my first. I had a very medicalized birth with an unnecessary induction at 39 weeks. My body and my baby were NOT ready for birth and it turned sour pretty fast. I ended up with a c-section after 13 hours and never progressing past 3 centimeters. I was so elated that my baby was here, but I was wholly unprepared for the emotions and I was very uneducated about physiological birth or postpartum. It wasn’t until my baby was 6 months old that I recognized that I had severe postpartum depression. Some days were very scary.
After my second baby was born, I had a pretty easy going postpartum. I remember being so excited to get out into the world with my sweet baby girl! Her birth was very undisturbed. I went into labor at 39 weeks and called the shots during my labor. She was born without any drugs and my husband and I worked as a team to advocate for me and our baby. My husband stopped the doctor from performing an unnecessary (and not consented for) episiotomy but, there was still obstetric violence and rape in that birth. I had a lot of pregnancy anxiety that flowed over into my postpartum time as well. My sweet girl was our Rainbow Baby after a 7 week miscarriage the year prior. So anxiety over losing her was my biggest ailment.
My postpartum after my third baby was by-far my best experience. We had a hands-off, unhindered, undisturbed home birth. The midwives arrived about 10 minutes before his birth. I was already in the birth tub and feeling the Fetal Ejection Reflex as they arrived. It was April when he was born and the spring weather here in Michigan was really setting in. So we got outside a lot within the first days of his birth and that all helped so much. The kicker here though… My husband's sudden death sent me spiraling into a deep depression and anxiety-stricken state when our baby was just 5 months old.
The birth of my fifth baby (my fourth is adopted out of foster care, so that’s a whole other topic on a “postpartum” depression, of sorts, after bringing home an abused baby and going through the foster care system and into adoption. So I won’t touch on that here. But, it IS a thing experienced by many foster care and adoptive moms.) So, the birth of my fifth baby was so beautiful. There were some anxieties throughout my pregnancy and some fears I had to work really hard through, some in direct relation to being mismatched with a birth team member, which is why I’m really big on women carefully choosing their birth team, praying over it and aligning really well with whomever they’re inviting into their birth space. But, again, I digress, as that is a topic for a completely different workshop.
With the birth of my fifth baby, we had some physiological jaundice to work through for the first few weeks. The general atmosphere of our medically minded culture tends to throw fear your way. There were many times throughout my pregnancy and immediate postpartum that required me to get really quiet with God and really ask if I should be concerned about what we were working through or if all was well, all was normal. All of that brought anxiety. But, this time around, I was much more educated on nutrition, rest and calling in prayer warriors.
What Is Happening for the Baby?
Ok, so I went a little deeper on the postpartum depression and anxiety stuff than I intended, but I feel it’s important and needed. So, this time for the baby is very transformational as well.
Respiratory: In-utero, the lungs are filled with amniotic fluid and the baby is simply “practicing” breathing movements. The placenta and umbilical cord provides all the oxygen baby needs. But, the oxygen saturation in-utero is actually lower than we get “on the outside.” So, when a baby is born, the fluid is pushed out of the lungs and replaced with oxygen. Baby’s can take up to three minutes to begin breathing on their own. As long as the baby is still connected to the placenta, the baby is still receiving oxygen.
Circulatory: While in-utero, all of the baby’s needs are met by the placenta and the cord. Once a baby is born there are shunts that must close and blood begins to circulate. There are areas within a baby's body that don’t receive much blood flow while in the womb, so after birth, the baby’s body perfuses these areas with blood which is another reason why delayed cord clamping is so incredibly important! Cutting off the baby from his or her FULL blood supply can have lifelong, detrimental health effects from a lack of blood supply. There’s also veins and arteries in the umbilical system that must close off because they’re no longer needed after the baby is born.
Digestive: The amniotic fluid, placenta and umbilical cord provide all of the baby’s digestion while in-utero. Once a baby is born, there will be absent bowel sounds for as much as 15 minutes before the digestive system gets revving up. The passing of meconium and urine is a great sign that the digestive system is beginning to work!
Temperature: While in-utero, the temperature is perfect! Around 98.6. Once a baby is born, the baby cannot regulate his or her own temperature, so it’s very important to keep the room warm. Between 77-82 is a really good temperature. Stay skin-to-skin, either with mom or dad.
Senses: While in-utero, the baby’s senses are pretty muffled and limited. The environment is warm but dark. Sounds are muffled through layers of mama’s body and uterus as well as the amniotic fluid. Once a baby is born, there are lights! So many scents! Loud, unmuffled voices! New flavors! Movement! New sensations on the skin! It’s a sensory overload.
There’s constant learning and the brain waves are in delta most of the time, which is subconscious imprinting for the baby. This is why it’s important to have a slow, quiet, peaceful transition period without a lot of voices, no bright lights, no hands other than the hands of the mother and immediate family. Allow this new little one the space to transition.
Traditions Around the World
Did you know that in other cultures and countries, the time after a baby is born is treated much differently than it is here in America. Here’s a few examples of postpartum traditions from around the world.
The Island of Palau: New mothers are honored in a celebration called “Ngasech.” After 4 to 10 days of ritual cleansing, the “Ngasech” ritual elevates the postpartum woman to her exalted role of mother with chanting, feasting and flowers.
These rituals may be really foreign to us, but they can help us remember that our own 10 days of “cleansing” could really just be staying home with our baby, nursing and bonding.
Indonesia: Most Indonesian women do not go out of the family compound or resume their regular responsibilities until the baby is 42 days old. On the 42nd day, the baby is named, the village participates in the beautiful ritual and a feast is held.
In America, this is not usually possible because we don’t live with our extended families. So, perhaps it’s not possible to not leave your house for an entire month, but could you arrange to stay home for at least a week or two weeks after your baby comes?
India: In India, Ayurvedic tradition encourages a new mother to stay home and be pampered for the first 22 days postpartum. Her role as an exalted one is honored. This time of rest helps strengthen the infant-mother bond. In this precious lying-in time, breastfeeding becomes smooth. Rest and protection of both mother and baby’s delicate nervous systems are priorities and very few visitors are allowed.
Latin America: Some women engage in La Cuarentena, a custom that translates to “quarantine.” During these six weeks, the new mothers abstain from sex, certain foods and strenuous activity. Their focus is to dedicate themselves to breastfeeding and taking care of the baby. Other family members pitch in with cooking, cleaning and childcare for older children.
Japan: For three weeks after birth, it is tradition for the new mother to recover in her parents’ home. She stays in bed while other family members help out with chores.
Pretty interesting, huh? I think so anyway! It’s fun to see how our traditions (or lack there-of) differ from other countries and cultures. One thing that everyone can agree upon, in the postpartum season, all mother’s need warmth and warm nourishing foods, deep rest, social and emotional support, bodywork and ceremony. Which leads me into my next section!
Pillars of a Healthy Postpartum
These are certainly not new ideas but they are ancient ideas that many cultures have discovered and practiced for hundreds of years.
Nourishment: In the postpartum, you want to focus on warmth. Warm, easy to digest, nourishing whole foods and teas. We also want to focus on warming the body. So warming foods and teas, soups. You NEED calories in the postpartum season. Not only are you healing from birth but you’re breastfeeding! The caloric needs are higher in postpartum than they are during pregnancy. Make sure you’re focusing on gentle proteins, getting Vitamin A with orange foods, getting B Vitamins and fiber with green foods and getting in healthy fats. Some things to consider preparing ahead of time and having on hand would be crockpot meals, putting gift cards for restaurants on your baby registry. Stock up on non-perishable quick eats. Prepare ingredients for Mother’s Bowls (this comes from the book, The First Forty Days). Consider keeping smoothie ingredients on hand such as spinach, protein powder, yogurt, berries, etc. Broth and soups are some of the most nourishing things to keep on hand. It’s also important to consider rebuilding your blood with things like collagen or gelatin, mineral repletion, and beef liver capsules. All of this will also support tissue repair.
Deep Rest: Birth is a very intense process and the way we heal in the postpartum season will represent our future health and how we experience menopause. Our culture does a terrible job of resting… We live in a toxic culture of “hustle” and always doing and going. Something that helped me a lot as I was creating my own postpartum plan was the 5-5-5 “rule.” This is simply 5 days IN the bed. 5 days AROUND the bed. 5 days around the house. Focus on warmth while resting, have family members or friends bring you food and drinks to your bedside. Give yourself this space to rest, pamper, reflect on the birth, write your birth story, process anything needing processed. This is a time to take a mental, emotional and physical break from the world with no expectations.
Social and Emotional Support: It truly takes a village! And, most of us in America don’t have a naturally built-in village. So it can take planning and implementation to have a really restful postpartum time. Most depression and anxiety issues are due to a lack of community support and involvement from the family. Plan your maternity and paternity leave. Have a list of supportive family members and friends who can do tasks for you during this lying-in time. Activate your social support systems through church, schools or other organizations. You could even barter with friends, a give and receive system with other expecting mamas. Prepare freezer meals and stock up on things like bone broth. Maybe in lieu of a baby shower, perhaps consider a “nesting” day or meal prepping day. Have a close family member or friend organize a meal train for you. This is a really great way to sort of control the flow of visitors as well. Ask people to sign up to bring a meal and if you’re feeling up to it, you can invite them inside for a short visit or you can just ask them to leave the meal in the cooler on the front porch. Consider hiring paid support. Some examples would be a postpartum doula, bodyworkers, massage, acupuncturist, cleaning services, lactation consultants (not tied to a hospital), childcare for older children, pelvic floor therapist, etc. But, most importantly, I want to encourage you to lower the bar. Things WILL eventually get accomplished.
Bodywork, Ceremony and Ritual: Healing and honoring the body, naming and honoring the baby. Some examples for this category can be; sharing your birth story with a trusted friend or family member. Taking an herbal bath. Researching the benefits of Vaginal Steaming. Researching the benefits of Bengkung Belly Wrapping. You can even consider a Sealing Ceremony such as a Closing of the Bones Ceremony, a Tea Ceremony. A dedication ceremony at your church. There are so many beautiful ways of honoring this new chapter!
Creating Your Postpartum Plan
Ideally, you want to create your postpartum plan earlier in your pregnancy and not wait until the last minute. The end result is much different when you’ve spent intentional time curating this plan and organizing your resources. I encourage you to learn more about the Fourth Trimester so that you can educate your family and friends. You can never get this time back. It is worth every ounce of effort to prepare well for it. As you learn about the postpartum traditions in other cultures, be open and curious about what resonates with you and consider implementing it for yourself. Visualize what you want for yourself during this time. What parts of your plan are absolutely non-negotiable? What parts of your plan are flexible? Prepare to make things easy on yourself.
Make a list: delegate what has to be done, write down things that can be delayed for a few weeks, erase what can be put off for a while.
Postpartum Plan Journaling
How long I will stay in bed:
How long I will stay in my room:
How long I will stay at home:
This is my “WHY” for resting:
Things I will have on hand to stay comfy:
Examples: nursing bras/tanks, legging, comfy underwear, nursing pads, water bottle
Things I will have on hand to do:
Examples: Books/Magazines, Journals/Babybook, Shows/Movies, Crafts, Podcasts
Contacts of those who can help:
Examples: OB/Midwife, Lactation Consultant/Support Group, Online Support, Doula
Meals I will prepare ahead of time:
Who I will delegate to organize a meal train:
Who will the meal train link be sent to:
Favorite snacks and drinks to keep on hand:
Someone to be with me:
Write down three willing friends or family members who will come be with you
These are where I will create “postpartum stations” around my home:
Books About Postpartum:
By Kimberly Ann Johnson
The First Forty Days: The Essential Art of Nourishing the New Mother
By Heng Ou, Amely Greeven and Marisa Belger
Build Your Nest: A Postpartum Planning Workbook
By Kestrel Gates
A Sacred Beginning: Nurturing Your Body, Mind, and Soul during Baby's First Forty Days
By Sarah Brangwynne and Sasha Rose Oxnard
Important Decisions to Research
I’m listing these here because many things in your pregnancy and birth can disrupt the flow of hormones and disrupt your postpartum season. This is not an exhaustive list and is mostly topics to research after the birth of the baby. Each topic has a direct impact on you, your baby and your postpartum time. I encourage you to be open-minded, curious and willing to listen when there is a pause in your spirit.
Who Catches Baby?
Rubbing Baby and Removing Vernix
Cord Clamping and Cutting (Immediate, Delayed or Physiological)
Suctioning Baby
Skin-to-Skin
Hat and Blanket vs. Naked
Active Management of the Third Stage
The Newborn Exam
Weighing and Measuring
Antibiotic Eye Ointment
Hep B Vaccine
Vitamin K (Shot, Oral or None At All)
Baby’s First Bath
Circumcision
Diapers and Clothing
Swaddling
Tongue and Lip Tie Assessment/Revision
Breastfeeding Guidance and Support
Favorite Postpartum Items to Support You
As a mama 5 times over, I’ve gathered different items over my years of preparing for my postpartum seasons. Here’s a short list of some of the items I find as must-haves when I’m preparing for a postpartum season.
Here’s a Bublup I made full of pregnancy, birth and postpartum supplies if you’d like to check it out!
https://rolls.bublup.com/view/cdb1ed37-ffd6-4aa6-81ad-1bbafa743291
After Ease Tincture: to ease the afterpains
Period Underwear: an alternative to pads and depends
Boppy Pillow: helpful for a sore tailbone
Peri-Bottle: for warm water or warm herbal sitz baths
Postpartum Herbal Bath Blend: for healing herbal baths with baby
Washable Chux Pads: for blood, milk and sweat to save your sheets
Ease the Ache: for postpartum hormone rebalancing and period cramps
Water Bottle with Straw: hydration is so important
Milk Flowin’ Salve: for clogged ducts
Breast Balm: relieve sore nipples
Resources
It’s better to do your research during your pregnancy and curate a resource list with names and phone numbers of people you can call. Even if you don’t need to call them, knowing that you have a network of trusted, researched resources will help bring you peace in the postpartum should concerns or questions arise.
Support Groups
Education
Breastfeeding Education
Prenatal Yoga
Postpartum Doula
Lactation Consultant
Chiropractor
Craniosacral Therapist
Pelvic Floor Therapist
House Cleaning
Trauma-Informed Counselor
So, that’s it! That was A LOT of information and I hope you were able to take notes, jot down the journaling prompts and overall, just learn a lot! I hope you walk away from this feeling more guidance along your journey of preparing for your postpartum season. I can’t wait to see you in this space again, sister! Until next time, God Bless!
Comments
Post a Comment