You’re proactive about planning for your pregnancy and birth! You devoured the latest information and research in book and around the web about healthy birth options! You attended birth preparation classes of your choice. You found a birth professional(s) with whom you are comfortable. And you’re thoroughly anticipating the blessingway your friends and family are planning for you and your baby!
Have you given some thought to the quality of your fourth trimester?
And what is the fourth trimester, anyway? Dr. Harvey Karp defines it as the first three months after birth. He says the baby should actually still be in the womb for this time period because her brain and nervous system is still immature. But human physiology being what it is, the baby is born earlier with a smaller, less mature brain!
Think about it this way. Baby horses, on their first day earthside, walk and even run! But human babies, on their first day earthside, are still kinda sleepy, like a big fetus! Their brains and bodies need time to develop. So they need lots of care in the “outside womb,” especially in the first three months.
From the mom’s perspective, the fourth trimester is a time of recovery and big changes on physical, emotional and psychological levels as she transitions into motherhood after pregnancy and childbirth.
Now think about the American culture’s high expectations of women and their families. In the United States, the new postpartum mom is expected to recover quickly, become mobile and get back to “normal” life. Many women only have three months leave from their work. Three months is barely enough time for a woman’s body to regain its nutritional, hormonal and emotional balance. Expectations are high and it’s now the norm of our culture around birth and motherhood. Social mores and policies change slowly. With this in mind, you can be cognizant of it and readjust your personal expectations and be gentle with yourself. Make plans for your own postpartum physical and emotional transition a priority.
Hormonal rebalancing on the physical level can take at least three months, but maybe even longer, depending on individual differences and individual breastfeeding patterns. And the personal growth that goes along with the emotional transition to parenthood is ongoing. So it’s no wonder that many traditional cultures formally designate postpartum as a time of rest and recovery for the mother and baby and even have specific rituals for this transition.
Can we borrow some postpartum rituals from other cultures and give them a modern flavor?
In China, the ancient formalized postpartum ritual is called “doing the month.” In this ritual, postpartum women severely limit their physical activity, eat specific warming foods to heal the yin/yang imbalance created by childbirth, restrict bathing and delay assuming their mothering duties. This period of rest and traditional foods is meant to help postpartum women recover and thought to prevent their current and future illness.
Intuitively, it feels like this type of support for new moms should prevent postpartum depression. Let’s take a look at what research with actual women reveals about this practice. Interestingly, research shows an increase in postpartum depression in women who adhere strictly to the restrictive “doing the month” practices. Plus, women who adhere strictly to staying in bed for 30 days also experience significant physical deconditioning, sleep disturbances and body pains.
It seems that participating in a very restrictive postpartum experience is not exactly what is needed. While caring practical support after baby is welcomed, support that is too restrictive can be distressing on both emotional and physical levels.
So, how can you create a modern take on postpartum care? Extended families are scattered and there could be dwindling support for you postpartum.
Let’s think about some steps you and your family can take to suit your needs.
Add a section to your Birth Plan for the Fourth Trimester support!
If you don’t know where to begin, ask yourself some short self-exploratory journaling questions to help you formulate your Fourth Trimester Plan:
What is your personal style when it comes to asking for support?
Are you able to ask for and receive help? Many people are very independent and like to do for themselves. Think about if you’ve ever needed to let someone else do for you for a while. How did this feel? Can you take away some lessons from a past experience?
Being on the same page as your partner
John Gottman, PhD has positive suggestions for keeping a relationship healthy over the long term. Dr. Gottman has gleaned six positive social skills from studying real people that more harmonious couples use to maintain a positive atmosphere in f the relationship. These skills include being able to see the truth on both sides and also learning to bring up touchy topics in a respectful, non-threatening manner. Karen Kleiman says that allowing emotional residue to collect can harm a relationship and recognizing these tensions in yourself and your partner is helpful to maintain intimacy.
According to Judith Wallerstein, Ph.D., building an alliance as a couple is a crucial task of marriage. This process factors in quite strongly during the transition to parenthood. She says that developing an alliance as a couple is a deeply personal life-long psychological process of individuation and separation from your family of origin. Discussing your needs with your partner will help form your bond as a couple postpartum. Enlist your partner’s support.
What types of things do you need on a practical level to support your emotional style?
Are you a private person?
Do you need emotional space or do you tend to need to be social? What helps you in this respect? Napping alone? Watching TV alone? Taking a walk?
Where are some parks nearby? Where are there places to go if the weather is bad?
Sleep Prescription: Dr. Samantha Meltzer-Brody of the University of North Carolina at Chapel Hill is a big proponent of a postpartum prescription for sleep, especially those women who know they have pre-existing mood disorders. And, of course, we all suffer without a good stretch of sleep. How can the night shifts be dealt with? Can you hire someone such as a postpartum doula or a nurse to help with the night shifts? Is there family who can help?
Baby feeding method: How do you think you’d like to approach feeding your baby? Is your heart set on breastfeeding? Is your partner and family supportive of your intentions? Can you imagine your life breastfeeding, bottle-feeding or a doing combination of both? Try to think about how you can use your personal communication style to convey your wishes, maybe using humor and assertiveness to convey your wishes?
A high protein diet helps feed the hormonal system in the body, as protein is a precursor to estrogen production, which precedes serotonin production. So planning for practical help with this should be one of your priorities.
You might want to request frozen meals or food gift certificates as gifts for your baby shower or blessingway, in lieu of other gifts. Check it out: sometimes a local deli has a special, less expensive menu available for people in medical recovery and you can arrange to order from there. And take advantage of online grocery store shopping! It’s prefect for those who need extra help. Another idea would be to ask a family members to take a week in each month to shop for food and cook. And there is always the option to hire a postpartum doula. A gift of a postpartum doula from your family is a great contribution to your wellness!
Do you have a comfortable guest room for people to use?
Take a look around and pre-plan out the house and where guests can stay.
Don’t be shy about saying that you don’t want five people sleeping your house. You can say this in a non-confrontational manner, in your own way. Just say it, most people will understand, others won’t. But you need to be take care of yourself. This is your time, you need to quietly speak up.
Once you decide on the components of your Fourth Trimester Plan, how can you diplomatically communicate to your family what you need and when they are welcome to come? Your partner and you need to come together on this. Some ways to communicate are making phone calls before the birth or composing an email to individuals with the proposed schedule.
Signing up on a group website is also an option. LotsaHelpingHands is one such website that allows you to set up tasks for people to sign up for at their convenience. You can include this in your email.
What can you do if it is not going the way you need it to after the birth?
Keep in mind that the research with actual moms shows that support is helpful, but only if it’s given in the way that helps her as an individual. For your emotional health, it’s important to politely speak up. Enlist your partner’s support. Use your social and communication skills to ask for what you need. Just as the couple bond is enhanced by positive social skills, such as bringing up touchy topics in a respectful, non-threatening manner and also being able to see the truth on both sides of the topic are skills that will help you in parenting and getting along with your extended family.
It’s funny, postpartum is a joyful time yet also lots of work! Like many events in life, it may not always go the way you think it might. Ana Clare Rouds in her book, Dancing on the Edge of Sanity, describes how she was concerned about how it would be to have her in-laws stay with her and help her out postpartum. For her, it turned out that her mother and father in-law were respectful company and provided loving practical and emotional support for her, while her mother, though her biggest fan, was kinda stressful to have around. So, you can receive support from places you may not expect!
In general, research with real women shows that postpartum, moms appreciate support, but in the way she feels is helpful. Positive effects of support are weakened by stress caused by conflict with extended family.
The research with real women indicates that postpartum moms need personalized, non-judgmental support and to be seen as individuals. So let this inform your postpartum planning to include self-care and baby care!
Gottman, J. & Gottman, J (2011). Bridging the Couple Chasm. Seattle: Gottman Institute.
Grigoriadis, S., Robinson, G., Fung, K., Ross, L. E., Chee, C., Dennis, C., & Romans, S. (2009). Traditional Postpartum Practices and Rituals: Clinical Implications. Canadian Journal of Psychiatry, 54(12), 834-840.
Liu, Y., Maloni, J. A., & Petrini, M. A. (2014). Effect of Postpartum Practices of Doing the Month on Chinese Women’s Physical and Psychological Health. Biological Research for Nursing, 16(1), 55. doi:10.1177/1099800412465107
Rouds, Ana C. (2014). Dancing on the Edge of Sanity. Available on Amazon in May 2014.
Wallerstein, J. (1995). The good marriage: How and why love lasts. New York: Houghton Mifflin.