Your Fourth Trimester – going gently as you heal after childbirth

By Julie Bell, Doula © 2008

In our culture, new mothers are often expected to bounce back after giving birth and carry on as normal. We can have a competitive or impatient drive to do this ourselves. But your ‘fourth trimester” is an important and precious part of your birthing journey. This is your “Babymoon” time – a time for milky snuggles with this soft-skinned little person who will never be so little again, a time of healing and rest for your body, and a time for nurturing your breast-feeding relationship with your little boob-mate. It’s a time to for going gently.

So often we can be rushed and driven in life, by external and even internal pressures, but if we can pace ourselves according to the natural seasons of life, we can better avoid burn-out and exhaustion.

Take this time to rest and heal and bond, allow yourself this precious “Babymoon” that only comes once and is gone so fast. Motherhood is a long journey, full of peaks and valleys, joys and tears. As with any effort requiring endurance, pacing is critical to staying the course.

What is your body doing?
Just as during your first three trimesters, your body is doing important work. May this work be honored by those about you – and by you yourself!

Your Uterus
* Your uterus is involuting to its original size. This may be accompanied by after-pains as the baby’s suckling triggers the release of oxytocin which causes your womb to contract. These after-pains can range from mild cramping to being extremely painful for some women. As with labour pain, although it’s no fun, it signals that your body is working efficiently and well. Try to relax and breathe with the cramps as you did during labour, and give your womb a little pat for being such a good uterus! These after-pains recede after a few days.

Your Placental Site
* The site where your placenta attached to the wall of your womb is healing. If such a large raw area was visible on the outside of your body, it would likely alert yourself and the people around you to be caring and gentle with you until visible healing took place. The healing taking place is invisible, but nevertheless deserving of recognition and care.

Lochia
* You continue to lose lochia (blood and mucous discharge) for around 6 weeks after birth as your uterus and cervix heal and revert to the non-pregnant state. Most women would consider a 6-week menstrual period a challenge, and would rest and take nourishing food and supplements to support their body. In the same way, the lochia is a hint to you from your body, “You are still healing. Take it easy.”

Your Perineum
* Your vagina and perineum may swollen and tender, and this may take time to heal, particularly if there are any tears, bruises, grazes or stitches.
* Some women get hemorrhoids after birth. They may feel huge and very sore right afterwards – but take heart – now that the weight of the baby is gone, they will heal quickly. Witchhazel can be helpful, or try an over-the-counter preparation from the Chemist.

Your Abdomen
* If you had a caesarean, 6 weeks is the usual time recommended for recovery after major abdominal surgery.

Your Fluid and Electrolyte Balance
* A re-adjustment of your fluid and electrolyte balance is taking place after the loss of sweat, blood and amniotic fluid, and as your breasts produce milk. The puffiness you may have noticed during the third trimester, as your body stored extra fluid to guard you against de-hydration, is now lost through your pores. You may notice extra sweating for the first week or so. This re-balancing act is likely to go more smoothly if you remained well-hydrated during labour (gotta love that ‘labour-ade’) and kept passing urine regularly. Continue to keep up a steady intake of fluids through this post-natal time.

Your Hormones
* A round of applause for your amazing hormonal system, please. We know that the hormones of birth and breastfeeding are produced in the pituitary gland of the hypothalamus, which is in the part of the brain that is sensitive to emotion and instinct. Therefore it makes sense that loving tender care, respect and support would make a positive and significant difference to the functioning of these amazing hormones.

After giving birth, your hormones are doing a phenomenal job as they promote the involuting of your womb, produce milk, trigger the let-down reflex, and cause loving feelings and attachment behaviour to promote optimum bonding. Oxytocin is the “hormone of love” – and of birthing and breast-feeding. Oxytocin may also cause you to feel sleepy, just as it does following sexual intercourse. Along with the natural exhaustion that comes with an arduous labor and nights of broken sleep, you may feel quite ‘wiped out’. Don’t worry – and don’t fight it. It’s your hormones protecting your rest. Go with the tide, it will turn at the proper time. You can see how nature has orchestrated this on purpose to assign rest to the mothers, so that their journey to motherhood and their newborn’s journey into the world, might be as gentle as possible. Take the hormonal hint!

Your Breasts
Your breasts are doing the most visible work at this point. From producing the liquid gold of colostrum to establishing your milk supply, your breasts are doing a magnificent job, and need rest, nurture and nourishing fuel. Many women experience tender nipples – even very sore nipples – in the early weeks until the tender tissues adjust and the mother-baby team become pros at the attachment thing. Breastfeeding is a skill that does not always come so naturally. So be patient with yourself and your baby. Doing too much too soon can cause blocked ducts which can lead to painful mastitis without treatment. In this way, your breasts absolutely insist that you rest and do not get out there and rush around too soon. What’s the cure for blocked ducts to prevent ensuing mastitis? Go back to bed. Take your baby to bed with you and stay there for a day or two. Nothing but sleep, skin-to-skin cuddles, breast-feeding and lots of nourishing food and drinks.

Your Emotions
Body, mind and spirit are all involved and impacted during such a momentous event in our life-cycle. This is a time of huge adjustment. Don’t be scared of the less-than-positive feelings that may surface, particularly if there was stress or trauma surrounding any aspect of your birth or personal life. It is better to let your feelings ‘breathe’ than to suppress them out of a sense of having to act the role of the blissful new mother. It’s normal to feel less than blissed out after a few nights of little sleep, sore bum and sore nipples. You may ride the waves from baby blues to baby glees. You may notice that your heart has turned to marshmallow and even a strain of gentle music will cause a lump in your throat and start the tears. Don’t worry – you’re not losing the plot! It’s all normal – and part of the way nature has designed us to be intuitive and tender-hearted as we care for our newborns. If your emotions are alerting you that you are feeling troubled because of events that were traumatic, be sure to reach out for help. You are not expected to struggle alone, and validation for your experiences and your emotions is an important step to healing.

Some Practical Tips for Self Care after Birth:
* Soak your healing tissues in a herbal bath with plenty of sea salt and perhaps a drop of tea tree oil. You can make up a herbal bouquet yourself and place them in a little muslin bag, like an over-sized tea-bag to put in your bath. Herbs such as lavender, chamomile, rosemary, uva ursi, lady’s mantle, sage, comfrey and calendula are ideal.

* Tip for a bath in ultimate comfort – try taking a water-proof baby’s changing pad and placing it behind your bath in the bath. Lean back …. Aahhhh!

* Have plenty of maternity pads at hand.

* Use a ‘peri-squeeze’ bottle to squirt a gentle stream of warm water or herbal liquid over your perineum during toileting. These are also available from Blissful Herbs.

* Try prune juice, Metamucil or psyllium to make sure your first bowel motions are soft and easy to pass.

* Try witchhazel or a cream like Proctosedyl if you have hemorrhoids.

* Try freezing a face cloth or soft muslin cloth, soaked in water or your herbal liquid, in the freezer to lay on your perineum while you rest on your side.

* Have a long drink with every breastfeed.

* Eat plenty of nourishing food.

* Enjoy a massage.

* Wear your baby. There are a number of excellent slings of various styles available. The time will soon come when your baby is too heavy for this luxury. Enjoy!

* Air and sun your breasts. Go topless occasionally, especially if your nipples are tender.

* Massage your breasts to break up blockages, lumps or tension. This will encourage your let-down and increase your confidence to hand-express.

* Soothe and tend to your breasts with organic oil, healing ointments like calendula if your nipples are sore, cabbage leaves or cold cloths if you are engorged.

* Sleep – or at least rest – when your baby does. You can catch up on housework next year. Or the year after that. ‘Power naps’ save the day! An afternoon nap can do wonders with replenishing milk supply and general well-being.

* Consider sleeping baby beside you in the bed, sleep topless if you wish (not practical if you’re leaking liters all over the bedclothes) for easy night time breastfeeding.

* Stock up on lovely skin-to-skin contact by taking a bath together and sleeping topless together.

* Accept help. You’ll be dying for your independence, too – but accept help and nurture if it’s offered. You can assert your independence and capabilities after your post-natal recovery time is over!

* Hire household help if you can afford it.

* Accept offers of meals

* Accept offers to mind older children or take them for an outing.

* Rest and heal. You may feel desperate to get out of the house, so treat yourself to a walk along the beach or in the park, a swim, a spa, a picnic – anything relaxing, but postpone strenuous or lively social events for now.

* Keep up the gentle stretches and relaxation session you did during pregnancy.

* “The more lovingly a mother is mothered, the more lovingly she can mother her children.”