The Fourth Trimester: A Doula's Survival Guide

Betsy Weber aka The Lake Bluff Doula has been working as a doula since 2009. She is sharing her essential guide to postpartum recovery and self-care for new moms.

The biggest surprise for me, in pregnancy, was the lack of dignity. Exams, shots in the bum, vomiting in public, incontinence, and enduring every stranger’s opinion of my body was a lot to take in. Under it all, though, was an important lesson in vulnerability: I was developing a new-found dependency on my midwives, my partner, my family, and my community. These feelings are hard for anyone, and I think pregnant people are eager to shrug them off once the baby is born.

But here lies the risk: If we bounce back immediately after birth, we may lose a powerful moment to build a solid foundation in our partnerships, families, and communities. Not to mention the opportunity to focus on getting to know our baby and their unique needs.

This is why I love the term “the fourth trimester” in reference to the first three months of a baby’s life. This time is seen as a continuation of the pregnancy for both the infant and parents. It suggests the caregiver and baby are living in symbiosis and the need for care and attention to them both - tending to the parents is tending to the baby. After all, for the first three months of an infant’s life, her caregivers are her environment.

Even though every family is different, everyone bringing home a baby needs to focus on resting and bonding. Be protective of your fourth trimester! Edit out or delegate any unnecessary tasks and emotional stressors. This is a time to tuck in and enjoy your baby.

Physical recovery and care during the fourth trimester

If you just gave birth, you are not only recovering from a long labor and possibly major abdominal surgery, you are also recovering from the pregnancy, that is, a large and adorable parasite living off you for nine months. If you are breastfeeding, you are using at least an extra 400 calories a day and your body is going through changes akin to puberty in a matter of days. Furthermore, your placenta left a wound the size of a salad plate in your uterus - anyone seeing something like this on the outside of your body would suggest you go home and lie down! Overdoing it risks hemorrhage and postpartum depression. Here are some tips to assure you are able to rest accordingly.

A Midwife's Postpartum Prescription:

• No cooking, no cleaning, no chores, no childcare of older children, and no errands other than doctor appointments for two weeks! (Or more - depending how you are feeling.)
• Leave Google out of it: Call your healthcare provider if you have any concerns about you or your baby. Get a second opinion if anything persists.
• Stay in bed for 24 hours: Skin to skin with your baby is a magic recipe for calm and centering. If you are feeling overwhelmed or are having breastfeeding problems. Do this at any point in your postpartum time, especially the first day you are home from the hospital.
• Focus on rest, not exercise: Anything more than gentle stretches and short walks can wait in the first six weeks.

Mental recovery and care

Even if this is not your first baby, the fourth trimester is a big transition. Be gentle with yourself. Try and prepare a few lists before baby comes to help you through some of the valleys in the rollercoaster of postpartum.

Before baby arrives:

Make a list of things to do when you are stressed. It’s hard to think of these things when you don’t feel well. For example, your list might read:

• Tell someone how I am feeling
• Make sure my basic needs are met (fresh air, water, food, personal hygiene, social interactions, movement)
• Sit or walk outside
• Watch the clouds
• Make eye contact with myself in the mirror or someone else
• Ask for a hug or shoulder and neck rub
• Take a shower with dimmed lights
• Use a mantra to refocus yourself (e.g. “I slow down to love my baby and body”, “Just because it is hard doesn’t mean I’m doing it wrong.” “I deserve to rest.” “I can’t make it perfect.”).
  Set up a relationship with a therapist you trust!

Once baby arrives: 

• Cuddle and kiss your baby and caregivers to ease frayed nerves and physical pain.
• Ask for words of encouragement from your caregivers.
• Share BOTH the enjoyable AND the difficult thoughts and feelings you are having and perhaps journal your most intense thoughts and feelings.
• Tell your birth story multiple times to trusted people! It is necessary and healing.

As new parents, we are confronted by the fact that we most definitely need help. Secure as much help as you can before your baby comes (more is better) even when you are uncomfortable being in a position of need. Don”t worry about asking for more once your baby is here too - your help is baby’s help!

Before baby arrives:

• Plan to have an adult in the house to care for ALL of you for the first two weeks. Longer is better if you have older children.
• Remember, it is a blessing to be a part of a new family in this way and friends are eager to help!
• Baby showers are a great place to have people sign up for meal trains or volunteer for tasks such as walking the dog, taking older children on play dates, or stopping by for light housekeeping like dishes and laundry.
• Connect with the many professionals who are available to help postpartum families: pediatricians, lactation consultants, postpartum doulas, night nurses, babysitters, housekeepers, landscapers, snow plowers.

After baby arrives:

• Be specific! Postpartum care is not innate in most families. Even if someone has offered to help, they may need a lot of direction. Write a list of what you’d like them to do.
• Insist all visitors wash their hands when they arrive. (Ask smokers to wear clothes they haven’t smoked in and wash their faces as well. It is important to keep the baby away from second- and third-hand smoke.)
• Have a table/basket near your bed with water, snacks, diapers, wipes, a trash bag, creams, and other essentials so you don't have to get up. Ask helpers to keep this stocked.

Bonding

This is the magic of the fourth trimester: Falling in love with your baby. Being on "baby time", days and nights running into each other, the new baby smell, and the pure deliciousness of a newborn are one of life’s greatest joys. Your baby’s physical, emotional and social well-being depends on a strong bond with you in these first few months. Physical closeness also relieves stress for both parents and babies. Come back to these practices anytime your family is dealing with sickness or stress.

• Plan on being skin to skin with, nuzzling, kissing and breathing in your baby as much as possible for at least the first week.
• Use a soft wrap carrier (like a K’Tan, Moby or Boba) to babywear whenever needed. You can even try it without a shirt for hands-free bonding around the house!
• Encourage caregivers to be skin to skin with the baby when they are holding them.
• Ask for lots of kisses, hugs, and massages from your partner and caregivers. These physical touches increase love hormones that promote bonding, healing, and breastfeeding. An added bonus: sharing germs with other people in your house will transfer antibodies to your baby through breastmilk.

Further Reading

The Fourth Trimester by Kimberly Ann Johnson
What No One Tells You by Alexandra Sacks, MD and Catherine Birndorf, MD
The First Forty Days by Heng Ou

Thanks to Betsy Weber, The Lake Bluff Doula, for this blog post. Betsy began her birth work as a DONA postpartum doula in 2009. The following year, she also trained as a birth doula and began work as a nurse-midwife assistant. In all, she has attended about 50 home, birth center, and hospital births. She also received training in Neonatal Resuscitation, as a Breastfeeding Counselor, Certified Nurse Assistant, placenta encapsulation specialist, and ICEA Childbirth Educator. She now works as a community doula on the North Shore of Chicago with her husband and two sons, Kimball and Linus.