Honoring the fourth trimester

Often, it starts with a little white stick. Hands shakily open the thick foil wrapper; a woman—too anxious to consider dignity—aims, as best she can, for the small, dense receptor.

It is a messy, memorable right of passage followed by a glacially paced three minutes. In those three minutes, she might bounce back and forth—several times—between excitement and trepidation.    

Then, as the second pink line appears, she commits. Yes. I want this.

This moment quickly leads to stacks of books, lessons in crochet, prenatal yoga, and lists of names neatly printed on lined paper. There are gift registries, baby showers, maternity clothes, and the Bradley method. Birth plans, savings accounts, and late night meals of peanut butter and banana sandwiches.

By the end of her pregnancy, she has learned “what to expect” and feels adequately prepared for labor. As for what comes after, she hasn’t a clue.

She imagines that it will be challenging at times, but she also imagines her grandmother’s copper hair with his blue eyes. She imagines Christmas mornings and summer swim lessons; pink, fluffy clouds and everything she’s ever wanted.

Fast forward to reality.

Contrary to the radiant and voluptuous nature of pregnancy, postpartum is a bit messy.

Our new mother compares herself to ShrekWith leaky breasts and broken blood vessels, she painfully straddles a maxi-pad the size of a saddle. She is worried, feels incompetent, and is silently pressuring herself to hit the after-holiday sales.

She is also so overwhelmingly in love with her child, and fears she will never be good enough. She wonders if her mate—the one who just months ago stroked her growing belly and came up with the name Charlie—might be from a different planet.


Yay, pregnancy

In America, we celebrate pregnancy. We prepare for childbirth. We purchase sweet stacks of little pastel “necessities” which we fold and organize weeks before the baby’s arrival.

We do not—by any stretch of the imagination—sufficiently prepare for and respect the fourth trimester.

Through prenatal appointments and self-education, a woman will become familiar with the developmental stages of a fetus, as well as the ins and outs of her own evolving pregnancy.

Profound transformation takes place in the three months following childbirth as well, yet women are often unprepared for the changes experienced by both her and her baby.

Says Tory-Kielas Jensen, postpartum doula and director at Welcome Baby Care in Edina, “You could write a book about all of the changes that take place just during the first week. Significant developments for Mom include loss of fluid, hormonal peaks and valleys, the production of breast milk, and unparalleled sleep deprivation; not to mention involution, or the return of the uterus to pre-pregnancy size.”

Many women are actually surprised and frightened by the cramping associated with the shrinking uterus. They are shocked at the six weeks of bleeding and discharge that accompany the healing of the placental wound.

Why is this? How is it that we know everything about fitted crib sheets, but we don’t know that hormonal shifts sometimes make hair fall out? Is it lack of education or is it a chronic societal inability to look at anything that might be deemed unpleasant?

In less developed areas, where true villages still exist, women grow up watching their mothers, aunts, and neighbors give birth. They watch women breastfeed, bond, recover, weep, and bleed.       

Most Korean families, as well as those of several other cultures, practice a significant lying-in period lasting anywhere from six weeks to three months. In Hispanic countries it is called La Cuarantena,and it lasts exactly 40 days. In India, Greece, and China, similar practices are considered sacred and unquestionable. Women, after giving birth, stay in bed. Period.

These women do not stay home alone, however. They suffer no feelings of despair or isolation. Instead, they are massaged, worshipped, taught, encouraged, and fed. A female caregiver is always in attendance, protecting the secondary womb—the one that facilitates the birth of a mother.


The American standard

As for the American standard in postpartum recovery? Well, it looks something like this: after an emphasis on “happily-ever-after” women experience a bit of a bubble burst when confronted with reality. We are lucky if we can afford six weeks of maternity leave. We are lucky if a neighbor swings by with a casserole.

We have constant media onslaught, which applauds a CEO for getting back in the office three weeks postpartum and a fashion model for getting right back on the runway.

The result is horrifying. As a woman sees the glorification of “bouncing back,” she forces herself to entertain the neighbors who stop by. She answers emails, goes grocery shopping, and attends her nephew’s baptism. Anything else is unacceptable.

Krista Post, a St. Louis Park psychologist who specializes in postpartum mental health explains that, “new moms in America have very high, and I think, unrealistic expectations of themselves. We think we have to do it all, and we feel guilty and inadequate when we can’t.”

Sad but true: the experience for most American women is about as far from la cuarantena as you can get.

It would be great if our country could change on a grand scale, insisting that both our public and private socio-economic policies prioritize motherhood; however, revamping the entire system is a daunting task to begin with.

Instead, start within.

Spark a shift in your own personal mindset, and watch it gently influence those around you. Honor the postpartum experience. That means devouring information about newborns, perineum care, and hormonal fluctuation with the same fervor usually reserved for pregnancy books and the baby registry.

Choose postpartum caregivers—including helpful friends—with the same scrutiny reserved for your OB or midwife.

If you can, hire a postpartum doula. Hire—at least temporarily—a gardener and a housekeeper. Save up for these expenses as you do the stroller, the car seat, and the diaper genie. Support is just as important, if not more so. Register not just for layette; request services, meals, and professional care.

Talk to your mother. Be firm if you find her advice to be pointed. Express gratitude in the ways that she helps you productively.

Focus on nutrition after birth as you did while pregnant. Eat your veggies; eat all the time. Take your vitamins.

Plan ahead for food, be it a stack of take-out menus or frozen soups prepared in advance.

Ask your employer for more time if you need it. Ask your employer to pitch in for the doula. Calmly explain the benefit to the company in having you return strong, healthy, and securely bonded with your child.

Fiercely protect your period of lying-in. If you must go back to work, take it slow. Recover. Demand that the world allows you to do so. These days happen but once, and you have a right to be healthy.

Most important, as that second pink line appears on the little white stick, rethink the length of pregnancy. Allow it to include the better part of a year, to include what many cultures would argue is the most important trimester: the fourth. 

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