In my practice, I hear a lot of questions about the “fourth trimester.” I specialize in perinatal mental health and this subject is near and dear to my heart.
What does the fourth trimester refer to exactly?
Dr. Harvey Karp started referring to the “fourth trimester” as the first three months of a new baby’s life. This recognizes that human babies are more like marsupials than other mammals; they aren’t really able to survive without us. Think about how horses are born able to walk. Due the size of human brains and skulls, our babies are born relatively sooner, when their heads can still fit through the mother’s pelvis. Understanding how underdeveloped our babies truly are helps us to better care for them. By the way, this is one reason why babies love being worn snuggly close to their parents.
Thankfully, we have started paying more attention to parents and recognizing that this is a critical stage for OUR health, development and mental health, as well. Last May, the American College of Obstetricians and Gynecologists (ACOG) redefined the standards of postpartum care. When I had my first baby, I was shocked that my doctor, who had monitored me every week of the end of pregnancy, dropped all focus and said, “See ya in six weeks!”
It made me feel as though I was completely unimportant compared to the baby, who I promised to bring to the pediatrician in a few days and every two weeks after that. The ACOG finally recognizes that women who have given birth need comprehensive care in the fourth trimester. (And yes, they called it the fourth trimester!) Furthermore, they recommend looking at physical AND emotional well-being. You can read their statement here.
I’d like to also mention that the fourth trimester is a critical time for birth partners and adoptive parents as well. There are obviously huge physical changes after delivery, but non-birthing parents are going through massive life transitions, too. We also think there are (albeit more subtle) hormonal shifts happening for partners, as well as sleep deprivation. I will refer more to moms in this article, but please know that most of this applies broadly.
What types of things do moms come to you with in the fourth trimester?
Anthropologist, Dana Raphael, started using the term “matrescence” in the 1970s to mark the developmental stage of becoming a mother. She noticed the transition lasted from preconception to pregnancy and birth, whether through birth, adoption or surrogacy, and beyond. Matrescence recognizes that the birth of a child also marks the birth of a mother. Becoming a mother can be just as awkward, messy and vulnerable as adolescence.
In general, I find people come to therapy when they feel overwhelmed. Stress is when we feel the demands on us are greater than our perceived ability. Of course new parents feel overwhelmed! The stakes are incredibly high. We are responsible for keeping vulnerable, precious little creatures alive. It is a 24/7 job, with little prior training.
On top of that, many new moms add a layer of guilt. If they aren’t living up to their expectations, they may feel like they are failing as a mom. Many think that being a mom and breastfeeding should come naturally, and when they don’t, question their value and worth as a woman.
In therapy, we unpack the “reproductive story.” Almost all of us have had a story, a narrative we have imagined since our own childhood, of what it would be like to become a parent. I’m betting few have told themselves, “I’m going to have three miscarriages, two failed IVF rounds, anxiety during pregnancy, an extended NICU stay, birth trauma, mastitis, etc….”
Therapy is a place to grieve the loss of that story, and of the life and identities we have lost. We get to come to terms with our new, integrated persona, and start to love our new self.
What are some practical self-care tips for mamas in the fourth trimester?
As I mentioned, distress comes when your expectation of yourself and motherhood don’t match reality. Take some time to check your expectations. Did you imagine you would be instantly balancing baby, home, exercise, work and other responsibilities, and post the beautiful proof on Instagram daily?
So, I love self-care. I talk about it all the time. But I also fear that self-care today has become another burden on busy people. Do you picture spending half the day at the spa? Having childcare in place to drive to an hour-long yoga class and back? Fortunately, those are not the only options.
Sometimes the best we can do is find “micro-moments” of mindfulness. Here are some suggestions:
- Take one minute to focus on your breath, connecting with your body and feeling grounded in the “right here, right now.”
- If you work, take a minute in your car before rushing out and into the house. Just breathe and focus on you.
- If you are parenting full-time and have a partner or relative, ask for a few minutes to yourself when they come home. You could mindlessly scroll social media (no judgment here!) but you will get more benefit from doing a brief guided meditation or a few yoga stretches.
- If you get the opportunity to go to the bathroom by yourself, maximize the experience by using your favorite soap to wash your hands. Smell the scent and give yourself a pep talk in the mirror. You got this!
- Find some calm by practicing mindfulness during house chores. When washing the dishes, let your mind focus on the feel of the water and let other worries slip away.
When should you seek extra help in the fourth trimester?
You should seek extra help for the fourth trimester when you are pregnant. Seriously. The biggest mistake most people make with their mental health is waiting too long.
I saw recently that some women are planning a new mom shower vs. a baby shower. Rather than focus solely on the cutest gear and onesies, think about making your own meal train. Get friendly with your local grocery delivery app. Ask friends to sign up to clean your house or take older children. Start a registry for postpartum massages, acupuncture and therapy.
Sometimes I get asked the difference between Postpartum Depression and the “Baby Blues”. The baby blues refer to a hormone related mood drop, typically starting four days postpartum and lasting up to two weeks. Clinical depression lasts more than two weeks and can be more severe.
But frankly, you don’t need a clinical diagnosis to benefit from therapy! If you are going through a transition and would benefit from having a space outside your relationship or closest friends to process, then think about it.
You are doing a great job. You are doing enough.
Remember, there is no “perfect” in parenting. It is not possible to do it all. Fortunately, perfect shouldn’t even be our goal. Attachment theory teaches us that babies and children need “good enough” parents. Winnicott found that babies and children actually benefit when we fail them in manageable ways.
Are you “good enough”? Then you are already doing it! Give yourself a pat on the back, some credit, and a little bit of a break.You got this, mama.
If you take away anything from this post, remember that you matter. Yes, that baby may be cute and needy, but your needs matter, too. You deserve support, love and mothering. Go get it.