A Survival Guide for the Fourth Trimester

I'm so glad that physical therapy is finally getting attention! I'd never even heard of it as a possibility, and I gave birth at the purported best hospital for women and babies in the US. PT, or at least a check-up of your pelvic floor, needs to be mandatory for all women who've given birth vaginally. Your body changes and suffers damage to accommodate the birth and you're just not the same after. It's ridiculous that women have to wait 6 weeks for a general check up, and even then are not told about PT as an option, so they suffer the consequences for the rest of their lives. Scar tissue, muscle tightness and "knots" can cause pain that never goes away, and women suck it up and deal with it, with their partners and society unaware that there's a problem at all. My gynecologist happens to be the head of the department at said top hospital. And yet, he said that he'd never heard of such a thing as painful postpartum intercourse. He said I'd just "heal and be fine". But my two "normal" vaginal deliveries with two "normal" second-degree tears left me in so much pain that I was willing to give up sex for the rest of my life. I had to seek out a female gynecologist to ask for help. She was the one who sent me to PT and changed my life. With massage and exercises, the pain gradually went away completely. My therapist (also a woman!) is trying to raise awareness and help the countless women who suffer silently. We need to speak up and educate doctors, especially the male ones!

I had two babies completely unmedicated. I had none of these horrible ailments post partum. I think many women like to exaggerate. It really isn’t that bad.

Since about 1/3 of women end up with a c-section delivery, the "4th trimester" needs to have some serious focus on doing all the other things while recovering from major abdominal surgery, and all the baggage baggage which might accompany having had to have the surgical delivery.

The fourth trimester will continue for 18 years.

At 68 with a 42 year old son, I can tell you stories. I hope this helps new moms. In 1976, the 'smart wisdom' at the time said that newborns slept for about 18-19 hours per day. Our infant, born in 1976 had no clue that was his obligation. Our almost 9 pound wonder was awake about 14-16 hours per day and was as nosy. In the hospital the breast feeding nurse, a childless female instructed me in how to nurse. I couldn't get him to latch on. Fortunately, I was in a room with another mother who had previously breast fed. She told me to stand in the shower for about 5 to 10 minutes before feeding him. She sat with me, took her pointer finger, poked my nipple into his mouth, stroked my forehead, and his cheek. He let go of the breast 100% about 18 months later. She gave me the # for the La Leche League for further questions. When it was dinner time, he wanted to be nursed as we tried to eat. I learned how to be able to eat with the opposite hand. He refused rice cereal, rubber nipples, etc. Within 4 weeks, he developed a distress call which consisted of the sound 'ma'. I was amazed & when my husband heard it, he was shocked. He used it when hungry. At 6 weeks, we placed him in a walker a few minutes per day until he complained if we took him out of the walker. By the time he was 4 months, he would spend hours in the walker going backwards. He even developed his own sign language to communicate. Moral to the story, babies will amaze you! They are here to take over.

The original tribal culture of humans involved everyone helping new mothers. Our pioneer tradition evolving into many women closed away in individual homes, often isolating new mothers, has always struck me as a cruel fate for those engage in the most important duty of humans. Having a family must include lots of help from family and friends, or it is imperative to make new friends and join groups; perhaps more than you are used to or comfortable with in our individualist worker-bee society.

A lot of these "4th trimester" surprises should be broached in (ideally FREE and widely available) L&D/baby readiness courses. We would also do well to follow the UK's NHS model of sending around specialized nurses to women's homes to check on both mother and baby, and they do it within days of birth, not weeks. It's the most stress-free way to monitor infant growth, breastfeeding technique, and ensure that mother is healing up properly and not bleeding too heavily. They could also be trained to look for signs of PPD, domestic violence or other circumstances that might prove unsafe for mother and/or baby (e.g. overstuffed cribs) and provide basic instruction on pelvic floor rehab, while they're at it. Sleep deprived, bleeding women with immunologically vulnerable newborns shouldn't be traveling all over town to access these basic postpartum health care services.

The thing that helped me heal was my husband being home from his job at Walmart for a month, because he was full time it was open to him. And also I used formula from the start so we could both feed her. Having family nearby was also helpful because they babysat and babysit her now on occasion. Try not to be hard on yourself and give everything a try within reason regarding feeding and diaper methods. And the baby will sleep eventually!

I'd go one further on the breastfeeding and visit a lactation counselor in your third trimester. They can evaluate your breast tissue and nipples and prepare you for any challenges specific to your breasts such as an inverted nipple. Then if you do have that challenge, you are not there in the hospital with a sore body and hungry baby. Some visits may be covered by the ACA--I had my babies 15 years ago and paid about 50 bucks out of pocket. Well worth it to help ensure breastfeeding success!

The missing piece in the USA, what European countries have for new parents is a Postpartum Doula, we are trained to help new families during the 4th Trimester and the transition to parenthood, having the training to assist with breastfeeding, and newborn care give a hand around the house, and an empathic ear while helping the new family does make a difference. DONA.org is the leading non-profit that has been training and certifying postpartum doulas in the USA since the 1990’s. Here is the research and studies to back up the idea that with support from a postpartum doula the outcomes are better during the transition parenthood for new mother. https://www.dona.org/wp-content/uploads/2018/03/DONA-Postpartum-Position... I’m a DONA certified postpartum doula /doula agency owner placing other doulas with families in NYC for 20 years, there is a tremendous difference for the mothers and families who used a postpartum doula helping during the fourth trimester. Ruth Callahan, CLC, PCD (DONA) DoulaCare.com

The one product that helped me survive the 4th trimester was a couple of good soaks in a warm bath with Aveeno Active Naturals Oatmeal Bath Packets. The product is normally used for skin rashes but it works wonders on your post birth tenderness and pain. The other product I recommend for the months and years post birth is the Kegal Toner 8 (kegal.co.uk ) from England. They have a wonderful website with a variety of helpful products and a helpful customer line. This line of products addresses the prolapse and stress issues mothers experience post birth and during menopause. After using this product one hour daily you will back to new in 2-3 months. One essential recommendation is to continue taking your prenatal vitamins post birth especially vitamin D. You will be tested as a new mother in many ways it it important to stay healthy, fit and maintain your energy levels. Vitamin D keeps your muscles strong and therefore helps you with post birth recovery.

There absolutely should be more comprehensive support for post-partum mothers. The lack of advice and follow-up care really shocked me after the I had my daughter. One of the things I found most helpful was taking steps to help to recover my core strength - doing that made me feel much more like my old self. There are amazing providers of online postnatal exercise like Mutu and Mumhood (UK based but I think available in the US) which you can follow in your own time. I cannot recommend this enough if you're dealing with instability, loss of bladder control, pain or the persistent pregnant belly. And it's not about appearance - it's about repairing your body. And if you can't afford those, the Internet is a good source of advice here. Don't presume your gym or even yoga instructor knows what exercises will help you to heal, as some will actively make the situation worse (again, showing how little understanding of female health issues there is). Everyone deserves the time and space to heal, so do whatever you can to make a bit of time to look after yourself instead of focusing on your family. Screw the housework! :)

When I became pregnant with my first son, two of my coworkers separately told me about the hell that is the first 8 weeks after delivery.... including how everything hurts, breastfeeding is a nightmare and you feel like you are going crazy with the sleep deprivation at times. They also both told me that they were telling me this because no one told them, and it was incredibly depressing to feel like they were failing at “the most natural thing” a woman can experience. I was extremely grateful that they shared their real experiences with me, because lo and behold, the first 8 weeks after delivery were far from smooth. Knowing that I was normal instead of a failure was priceless and I am still grateful to them for their honest advice.

"Do what is best for your family, and don’t put unnecessary pressure on yourself to exclusively breast-feed. Consider supplementing with formula or donated breast milk." Thank you for saying this aloud. My Ivy-educated wife read all of the books during pregnancy, and was dead-set on breastfeeding for as long as possible with our daughter. Alas, irregularly shaped nipples, lack of milk, and a newborn who bit like a shark meant it did not go well. The lactation consultants at the hospital were crazy to the point of cruelty. They put so much pressure on her to keep trying, and (gasp!) not even think about formula for the baby who hadn't eaten anything since birth. My extremely educated wife did not need to be (what's the female equivalent of mansplaining?) a list of facts of which she was fully aware. Lots of tears followed, especially as the first formula bottle was handed to us. My wife rented a breast pump and did that for six months. Her production never provided more than half of our daughter's nutritional requirements. No one had the right to treat her so badly. In retrospect, it was really shameful what those women did to her. They presented themselves as advocates for the new moms, when they were anything but.

Things I wish I had known: 1. Prepare by having formula in your house, even if you plan to exclusively breast feed. A plan may not be reality. I almost hurt my baby by not producing enough milk, and nobody told me, until the situation was dire. I was so traumatized by that, I will never ever breastfeed again. Don't be like me; have a good experience. 2. Babies of European ancestry tend to be born around 40 weeks. Babies of Asian an African ancestry tend to be born early. Plan accordingly. 3. Everyone told me postpartum would be hard and awful. Except my mom. She said, "[compared to your miserable pregnancy] It will be easy, and come naturally, and you will love it." She was right. Genetics play a huge role in pregnancy and postpartum experiences. Listen to your mom. 4. The steps you go through are: the first day, the first week, the first month, and the first year. Each step gets easier. 5. Accept help. Ask for help. Be specific in what your needs are. Don't try to do it alone. People like being helpful. 6. If you take them to daycare, they will get sick (everybody knows this). You will also get sick (not as well advertised). You will be so sick, so many times. 7. You made a tiny human being from two cells, and grew it nourished it, and gave it life. You will secretly know you are a superhero for the rest of your life.

This is excellent! We don’t just pop out a baby and pop back to work. Every girl should read this.

It makes me angry that the reality of childbirth has always been hidden from women, denying so many the right to make an informed choice on whether or not to have children. As a child, I was a voracious reader. One day I picked up a copy of ‘What to Expect When You’re Expecting’. A couple of chapters was all I needed to decide that childbirth was not for me. Almost 50 now and don’t regret it, especially after talking to those of my friends who went through it. The most eye-opening thing, though, is how many of them had had no clue prior to becoming pregnant the damage that would be inflicted on their bodies. Personally, I think the gory details should be part of the 6th-grade sex ed curriculum. Would certainly cut down on teen pregnancies.

Post-partum depression risk is higher after a C-section than natural birth, as women lose less blood than with natural birth. Women who lose less blood end up.with a higher level.of carbon monoxide in their tissues, which can cause depression. The CO is easily messured in their exhaled breath. Donating blood to Red Cross after giving birth can help reduce the risk

I am so glad this article has been published in the New York Times and given a wide audience. I had a completely normal pregnancy, but my stitches completely opened a few days after giving birth. I only found out because the pain was so excruciating that my husband called the Maternity Ward where I delivered, asking where he could buy heavy-duty perineal ice packs ASAP, while I sobbed in the background. Seeing the OB-GYN 6 weeks after childbirth? Ha! I saw my OB-GYN at least a dozen times before the 6 weeks were up, and I am quite familiar with the silver nitrate chemical treatment described by the author. No one told me was a "normal" amount of pain was, and a nurse never came to my home to examine me. Moreover, my baby was latching incorrectly, causing a severely cracked nipple that developed into mastitis. Again.... no one to tell me the baby was latching wrong. I was on my own. And I am a middle-class, married, woman with a Master's degree living in a major metropolitan area. Please keep publishing articles like these.. they are so important and help pregnant women prepare (however they can) for the biggest change to ever happen in their lives.

Post-partum depression is much less about hormones, and much more about the struggles new moms face with so little support in our culture. You bring that baby home and quickly discover that only your life has changed drastically...you're stuck worrying about how you're ever going to get some sleep, what's the daycare plan, will you lose your job or be mommy-tracked, why do you feel so awful, why won't the baby stop crying, how come nobody is really helping me... It's a difficult time for sure. And why does every discussion about post-partum life have to turn into an argument about breast feeding vs. formula??? Cripe, everybody is so defensive!

I’m so glad that these kinds of articles are being published. Postpartum I expected soreness and sleep deprivation, not bleeding for 6 months, feeling like my internal organs were falling out, and a physical malaise and tiredness that made me feel like I was going to hit the floor all the time. Not to mention trouble with breastfeeding for 3 months and a baby with allergies that kept me from eating most anything but salads and fruit for 14 months. Not a common postpartum experience, but still I was not even somewhat prepared to meet even one of these challenges by my health care providers or other moms. In my midwife practice a postpartum checkup for PPD involved asking patients if they felt like killing themselves or their babies—an insane screening device. All moms should get pelvic floor therapy and all should get group or individual counseling to help deal with the huge changes parenthood brings. The biggest thing is setting moms up to have expectations that might match reality, and pre-scheduling PT and therapy for these moms as if it’s a normal part of ones health care rather than an anathema. I think a postpartum plan is a wonderful start.

Yes, the 4th and 5th pregnancy trimester are crucial. But what is even more crucial in my opinion is the pre-pregnancy trimester, the "Pre-Trimester". The pre-trimester is an essential time to save women's lives, to improve their chances getting pregnant, having a healthy baby, and surviving pregnancy intact. Once you are pregnant, it's often too late to improve certain parts of the pregnancy. Too few women understand that the pre-trimester is the essential time to improve a woman's health during and after pregnancy by starting healthy habits, exercising, being at the optimal weight for the pregnancy, and finding the right hospital and doctor. All necessary choices to improve the remaining 5 trimesters. https://www.babymed.com/prepregnancy-trimester-preconception-and-pericon...

Giving birth and the period after are such individual experiences. When I gave birth to two babies and had a miscarriage I was upset by how little anyone talked about what they had gone through and how isolated I felt. Luckily that is changing. I was lucky that I breast fed easily and I didn't have surgical interventions. But this article is alarmist and doesn't take into account the different conditions that women face, or their cultural understandings of normal ways to treat birth. It ends up advertising companies and flippantly pretending that all women are the same. We deserve better than this.

One of my granddaughters and her wife just gave birth. They are very fortunate to live and work in Portland, OR and each of their employers has a parental leave plan, so they are both able to stay home with the new baby for 16-18 weeks. So much for the "good old days" back in the '50's when I gave birth to my two, 16 months apart, and after the first child I returned to work in 2 weeks (husband in college) and had the luxury of staying home for 3 months with my 2nd child, but I had to quit my job to do so.

I wonder why our employers are perpetually surprised when women have babies. It's as if they're totally caught off guard - as if this isn't a completely natural process that has been happening for millions of years. Get with the program. Women have babies (and have been doing so . . . forever). The babies will take care of us in the future. Figure it out.

( The caveat to this advice is: breast feeding is actually a luxury of time that many women can't afford. There needs to be publicly mandated paid time off and in-home support for new moms Period. Its just too hard as it is.) I had the same initial problem with breast feeding and wasn't really comfortable until my baby was 6 weeks old. Besides calls and visits with a lactation consultant, my insurance paid for a pump and that really helped give me raw nips a break while storing extra milk for later. Also, having formula on hand to "cluster feed" the baby at night before bed really helped her stay asleep a little longer in the middle of the night. I did this for about the first 2 months. Its a pain but with a little help, it worked for me. Also, eat lots of healthy fiber (prunes, oatmeal, soup!) have a squirt bottle of water and numbing spray for your bum. I didn't have a BM for 2 weeks thanks to my sister's huge pot of post-partum mac and cheese and then hemorrhoids for 2 months.

Love all the awareness that is being brought to this. Mom to an eight-month-old. One thing I have noticed is that in this era of egalitarian parenting there is so much being placed on the spouse/husband to be the entire support system. Everyone needs to be taken care of. Accept all help from grandmas and other women. And hold a new mom's baby while she eats a meal:)

The very best thing that can be done to allow both mothers and babies to recover after birth is allow them the time to do so, without pressure to return to work so soon. Every other developed country other than the US (and quite a few of the developing ones) have national parental leave policies, and their economies haven't nose dived. Here in Canada, we give mothers a year off, paid for by their own employment insurance contributions, usually at about half of what they'd be earning in their jobs (80% for low-income earners), and that year can help others get a foothold in careers through mat leave covering. I wouldn't have given up that time with my son for anything, and considering I had an emergency C-section following a very serious birth complication, we both needed the time.

This is great, and I'm so glad that these things are being more written about in public. However, I would love to see a little bit more about perinatal mood and anxiety disorders, how to recognize them, and when to get help. As well as some recognition that many folks don't have access to some of the resources suggested in this article, for example, single parents, low-income, etc.

I HIGHLY recommend Kimberly Johnson's book The Fourth Trimester to anyone who is about to have or just recently had a baby. It makes a great gift too. Full of practical wisdom about how to regain vitality after birth through seeking proper support, nourishment and self-inquiry.

So much good advice that was not available in the 80's when I had my kids. No one ever talked to me about my pelvic floor! I didn't even know I was going to bleed for weeks after the baby was born. However, life went on and all turned out well. My tip for sleep: my first child napped one hour in the morning, and one hour in the afternoon. The morning was for chores, showers, etc. The afternoon was for sleep. When my 2nd came along, late afternoon was for Sesame Street or the like. I snoozed as I nursed the infant or she slept, and my 2-yr old would watch videos for an hour. Luckily she stayed put. Don't forget to ask for help. My husband was a saint and especially great at cleaning up a dirty infant while I cried.

Thank you for touching upon post-partum depression - a common, but stigmatised condition that is grossly under-diagnosed. Post-partum depression has nothing to do with your character, how good of a mother you are or how much you love your baby. It’s a health problem that needs medical care. If you’re feeling severely sad and anxious -please talk to your gynocologist or pediatrician and get help.

Eat, sleep, feed and diaper the baby, AND take a shower. (You can't hear the baby crying in there! It's OK For a few minutes.)

Please, can someone consider single mothers or those with limited financial resources and limited access to healthcare when these articles are written? What practical advice can you give a woman who must return to work within weeks of giving birth, or who does not have a partner to share the burden of childcare? What are the signs of postpartum depression, and where do you go to get help if you don't have regular access to medical care? Yes, childbirth and motherhood are difficult even for those with means, but the obstacles are monumental to those without money or family support. Perhaps the Times needs to diversify its writing and editorial staff to reduce this kind of socioeconomic blindness in their publications.

Ah, yes, witch hazel pads and numbing spray. Those were my indispensable best friends for a while.

I was one of the unfortunate mothers who had a horrible experience with breastfeeding; milk which didn't come in until around 5 days post-delivery (which led to excruciating sores/scabs) followed by insufficient supply despite nursing on demand, consultation with an IBLCE, etc. None of the measures I employed to increase milk production helped. Since my experience, I have been very curious about the actual number of women who "simply cannot produce sufficient breast milk." It's very common in articles about breastfeeding to read statements such as the one in this story that vaguely quantify the number as "some." My hunch is that we don't really know the actual number and that estimates are too low. If we don't have an accurate understanding of breastfeeding failure rates, how are we supposed to help and counsel new mothers? My theory is that the women who go to work as breastfeeding consultants had an easy time with nursing and therefore think it's going to be great for everyone...they can't grasp how it can be so difficult for some mothers.

The only thing a partner can't do is breast-feed. Anything else, the partner can do from day one, and that includes swaddling the baby and getting her back to sleep once mom has breast-fed--so mom can go right back to sleep.

I know this is not the most socially accepted thing to do, but I didn't even try to breast feed--we went right to formula mixed with bottled water. It helped with getting sleep and letting my husband participate in feedings and generally feeling like I had more control over my life. I don't regret it for a second.

An article on the postpartum period that makes no specific mention of engorgement? Unacceptable! Additionally, if your Nurse arrived "24 hours after delivery" with your first ice pack, it was much too late. Might have felt good, but to help prevent edema the cold pack needs to be applied soon after delivery. Finally, a significant percentage of the difficult & painful issues of the postpartum period are caused by poor birth practices currently in use in hospitals. Those birthing practices are also without any evidence for their use. Yes, we've come a long way since routine episiotomies, but we still have much to review.

The list of things I would have done differently is a mile long, but getting a night nurse is number one. I balked at the cost but truly feel that I would have been saved from the most awful, lowest weeks of my life and bonded with my child earlier and faster.

"Mothers should speak with a lactation consultant if after two or three days they are in a lot of pain or if the baby isn’t gaining weight, she added." After the first week, my daughter had lost weight, causing us to worry about the breast-feeding. The pediatrician told us that losing weight is quite normal for the first week or so and to carry on. It was a huge help, and we continued to breast-feed exclusively to 4 1/2 months.