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Plan Ahead for Your Fourth Trimester During Your First Three!

Monique LaRon transferred into my practice during her second trimester.

During the course of my 25 plus years midwifing pregnant women, I have placed a high priority on women getting their emotional needs met. When they feel their concerns are alleviated and voices heard during their first, second, and third trimesters, it paves the way for a calmer and more empowering Fourth Trimester.

While pediatrician Harvey Karp, MD coined the memorable and now popular phrase, ‘The Fourth Trimester,’which spans the first three months after delivery, cultures worldwide have historically celebrated this period with many traditions to insulate mom and newborn for months from outside influences. Women were given meticulous care, kept protected in their homes, and fed well to create ample breastmilk. Applying abdominal heat wraps, massage, and baby wearing were also customary.

New York City's Katherine Casey LCSW-R, has seen links between difficult post partum adjustments and birth care provider, "More research is showing that if women have a hard time during postpartum, they probably struggled during pregnancy as well. One thing I like to focus on in working with pregnant women is assertiveness - the ability to know what they want and ask for it.” Katherine considers one of the most common fourth trimester problems that women come to her for counseling is, “Isolation. It presents in a lot of different ways - difficulty connecting with a partner, uncertainty about caring for baby, strong feelings/urges that are alarming, or just plain feeling overwhelmed!”

I believe a woman’s adjustment during her Fourth Trimester is a labor of love and experientially like labor - with emotional peaks and valleys to move through. Just as labor requires endurance, stamina, perseverance, strength, and patience, so does the fourth trimester. This concept also applies to woman who had a cesarean section. Regardless of where or how the baby was born, all women experience changes immediately post partum due to the hormonal shifts impacting physical, mental and emotional responsiveness or reactivity. These changes, combined with sleep deprivation, make the reality of caring for a tiny human who is learning to adjust to extrauterine life and completely dependent on his or her parents, nothing short of an extraordinary feat. New moms need to take care of themselves and their babies simultaneously, which makes the Fourth Trimester a sacred, life giving time. And yet new parents need support to continue gestating their newborn on the outside. The placenta nourished the baby inside the uterus for nine months, and it follows that post partum should be a continuation of emotional and physical nourishment.

A new mom is less apt to experience isolation and more likely to have a smoother Fourth Trimester and closer connection with her baby, whether it is her first or fifth baby - if she has gathered birth care professionals to be her guiding lights. Neelu Shruti, Founder and Owner of Love Child, a support space for expecting and new parents says, “The biggest challenges in the fourth trimester are sleep, breastfeeding and physical recovery from birth. No new parent is exempt from dealing with these changes. Those who are able to create a postpartum plan in advance, have support to help them execute their plan and who have an understanding community to talk and share with others going through variations of the same challenges, tend to feel more empowered in their fourth trimester.”

As Casey describes, “A lot of times women are going to a provider because they are familiar ("they've been my gynecologist for years!") or because they have a specific specialty ("I was classified high risk") without knowing all the options.” The support team starts with the right provider, and can include: birth and post partum doulas, lactation counselor, certified massage therapist, acupuncturist, chiropractor, physical therapist, pelvic floor specialist, or pre and post natal exercise/yoga/pilates classes. Finding childcare/nanny services should also be planned prior to delivery. If you are on a budget, create an ‘Availability Schedule’ before birth to coordinate family and friends (especially those who have given birth), for comfort and help with breastfeeding, cooking, cleaning, and running errands. Finding a neighborhood parents' community like Love Child that offers plentiful wellness services and resources are hidden gems for parents being ushered into new parenthood. They help ensure that no woman is left behind during any trimester.

A woman’s mindset during the first three trimesters, coupled with her perception of her birth experience, creates her self image, which continues immediately into her fourth trimester. Unconscious choices and habits could influence her perspective in whether she considers her birth a triumph or a setback. Birth counseling and review of the medical records can help women to make sense and reframe what happened and to heal any trauma. Unresolved feelings may continue through the fourth trimester, and into the next pregnancy, with some women choosing to forgo another pregnancy due to unaddressed trauma that occurred in or out of the birth room. If ill feelings about a birth experience linger and women simmer in low self worth, it can lead to post partum depression and anxiety. When a new mother finds herself harboring feelings of isolation, unworthiness, anxiety, depression, or is unable to take care of her baby or herself, or has thoughts of hurting herself or her baby - she should immediately contact her health care provider or be taken to the nearest hospital emergency department for evaluation and treatment.

I asked Monique LaRon about her fourth trimester: “I am very fortunate to not have experienced postpartum depression during my fourth trimester, and in big part I attribute it to the type of care Risa provided me on the theoretical and practical level. Finding the right provider, who always explained the exact what and why of each exam I needed to complete and exactly how to interpret the results, provided me with an agency of my own body and health that I had never had before. The empowerment that I gained and the relationship we built during my prenatal visits, carried into the actual delivery process – everything went smoothly and just as I had planned – and ultimately into my fourth trimester."

I hope you found this useful.

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