The 'Fourth Trimester', as it is often referred to, is the theory that babies are born ‘too early’ and they need this first 3 months to transition from the inside to the outside. And it’s not just our newborns that need a period of adjustment. We think mamas need a fourth trimester as well! There is often this assumption that mama is going to just jump right back into life full steam ahead as soon as baby is here...and that just isn’t always doable. Those early months are often spent trying to find a new “normal” and mothers are often healing physically while dealing with a major shift in responsibilities and identity. We’re pleased to welcome our panelists this morning, Laura Cox, Debbie Perdew, Lucy Bautista and Candy Beers-Kim.
Ladies, will you please tell us your name, how many children you have and why you’ve agreed to join us today?
Laura - 6 children…first 2 children while a working mom, now a SAHM, oldest is 10, homeschooled…4 boys, 2 girls. Helped found TMC, moved away and is glad to be back today!
Debbie – DONA doula, 8 living children 37-17, plus one stillborn baby that she grieved alone. She has also experienced a prolapsed uterus and difficult c-section recovery, and wanted to help other moms through this.
Candy – pediatric sleep consultant from Richmond, mom of a 2 year old. Had postpartum anxiety, even though she teaches yoga and has advanced degrees…didn’t realize she could have anxiety; felt like she or her daughter was going to die, and it was horrible. Having a child was the best thing that ever happened, but she also wanted to run away…doesn’t feel like there’s a lot of honesty surrounding this, and wants to share with other moms that it’s normal. Also, there’s a lot of myths about SLEEP; hard to decipher what is healthy/what is reality.
Lucy Bautista – 5 children, 22-36, 2 grandchildren. Midwife at CMG Women’s Center.
Okay, so we’ve given birth to our precious child and now what?! Obviously we must recover physically from birth. Could each of you briefly share some of your personal recovery stories? Were you surprised by anything (pain, amount of bleeding, unexpected tenderness, trauma from birth)?
Laura: First was very different from others. More traumatic to my body, took a couple of weeks of just laying down around the house to feel recovered. Subsequent children were a lot easier. Breastfeeding with first was 3-4 months with pain; still has sensitivity/soreness for the first month with each child.
Debbie: First was hardest too. Felt like I was breastfeeding all day long for what I thought would be the rest of my life; I would cry when she cried while feeding. After my c-section I felt like I was failing my baby; he was in the NICU, I had 2 children at home…I also had one colicky baby that I just walked for miles daily to get him to be quiet. That was quite traumatic as I had other children; my oldest daughter still remembers just hearing crying all through the night. My C-section was the most difficult physical recovery.
Cindy: my daughter was breech; went from an OBGYN to a midwife; most of my friends have homebirths, so I assumed I would have this wonderful, lovely birth…I got to labor fully up to 10 cm, but she had a 90th percentile head, so they rushed me to the OR and I had a c-section. We did get skin to skin; but afterward I felt ‘less than’ compared to my friends. The hype around natural birth is awesome, but not so awesome if it doesn’t go as planned. We have lots of great options for healthy births!
Lucy: first child was hardest. I worked full-time up until I had her. I had high expectations for cooking/cleaning/being at home/visiting friends. About 2 weeks later I crashed and burned HARD. Also had a colicky baby who had breastfeeding problems and wouldn’t sleep. One child didn’t sleep through the night til 6 years old. I had a lot of expectations of what life would be once I was home….so I try to encourage people to go home and plan to be ‘the queen’ for 2 weeks after you have a baby. We need to provide the support for them to be the queen, to not have to do anything other than be with baby…then gradually build up. Your maternity leave is time to learn your new role. With the first, you think ‘oh my gosh is this my forever life?’ but subsequent babies you have better perspective.
Debbie/Laura : You’ve both had multiple births. Do you find that you had more or less pain after subsequent babies?
Less for both….except c-section recovery for Debbie, which was harder.
Birth can leave our vagina, vulva and perineum extremely tender. When did soreness subside for you? What type of clothing was most comfortable during your fourth trimester? Was there anything that was particularly helpful in your healing? (Witch hazel, sitz baths, spray, ointments, etc.)
Debbie: can not emphasize enough: Take the time that you need to recover!! I had a prolapsed uterus (pelvic floor is loose and felt like a tampon slipping out…led to other problems later). I was wearing him (the 7th child), vacuuming and pushing a piece of furniture – not a good idea!
Laura: Stay in your pajamas until you get those 8 hours of sleep, no matter how long it takes to get those 8 hours throughout the day! (2 hours here, 2 hours there) Don’t just jump back into exercise or keeping house; you may have to get over that and your spouse may have to as well! Even if you don’t have complications, they can come from over-doing it.
Harvey Karp, M.D., assistant professor of pediatrics at UCLA and author of The Happiest Baby on the Block began studying colic and newborn crying in the early 1980s. He’s also popularized the term “The Fourth Trimester”. In his research, he discovered that colic is basically nonexistent in several cultures around the world due to their soothing methods. He developed what he calls “The Calming Reflex”: behaviors that mimic the conditions within the womb. Dr. Karp calls these conditions the five “S”s. The five “S”s are: swaddling, side/stomach lying (but not for all night sleep), a loud SHUUSSHHIINNGG sound, swinging and sucking. Karp studied the Kung San tribe of South Africa and discovered that their babies very rarely cry. “Mothers soothe and calm their babies very quickly. They carry them all day long while walking miles a day," says Karp. "They also nurse their babies 50 to 100 times a day, and sleep with their baby on top of them." Karp says the American approach of having a newborn sleep separately from his parents, who then tiptoe around trying not to disturb him, does not work well for babies. "All infants are born with an 'off' switch for crying," Karp explains. "Inside the uterus they get constant holding and rocking, and the noise in there actually is louder than a vacuum cleaner. Then suddenly they are born and it's quiet and still. So the best way to activate a baby's calming reflex is to emulate the movements and noises that babies experience inside the uterus. But you have to do it exactly right."
Ladies, what do you think of this slide?
Debbie: I did some of these things naturally. I love wearing my babies, sometimes it was for protection from their siblings, (ha!) or I could breastfeed and get something done.
Candy: I read some of Dr. Karp’s book for graduate school prior to having a child. Letting go…attuning into what your child needs. If baby is fussy, we need to match that energy. Sometimes we want to ‘fix it’ right away, just as if a friend came to us to vent, we need to acknowledge that what they are feeling is valid…move in rhythm with your baby, slowly bring them down.
Example of a swaddle
Using the 5 S's by baby wearing
Lucy: we, as women, are wired differently, and take it personally when we have a hard baby, ‘why can’t I fix it? What am I doing wrong?’ Our babies are people, with their own personalities and opinions. Some people are fussy, some people are sensitive, some are shy…we need to love and celebrate them, and not take it on ourselves to feel badly if they’re not what they expected.
Candy: My pediatrician said ‘Evelyn (my daughter) is very passionate’. I like that term! Also, babies do great moving around freely…they do best on a clean floor, don’t need all the fancy stuff, but having them in the bathroom or kitchen so you can get some things done – or shower!! – is a good idea.
Laura: some moms I know never baby-wear, and make it through just fine. Some people love it, some people don’t.
Erica: with my third, I use baby-wearing for naps, which I had never done before. I would sit in the recliner, then cinch him to me so I didn’t worry about him falling out of my arms, because I was so tired!
Comment: Just as babywearing isn’t for all adults, and also isn’t for all children. Some babies hate babywearing and will fight it! Again, personalities.
s our bodies are recovering physically, our hormones are doing a crazy job of adjusting at the same time. Did any of you notice hormonal highs and lows? Did any of you experience postpartum depression or any postpartum mood disorders? How long did it last? How did you cope?
ALL : We’ve had other café topics dedicated to postpartum and body image, but quickly, ladies what
surprised you most about your body in those first three months?
Are you familiar with Tracy Hogg, aka The Baby Whisperer? She recommends the following type of routine/rhthym (Eat, Activity, Sleep, Your time). Did you follow anything similar? Do you have any favorite authors or resources for the fourth trimester? Did any of you successfully follow a stricter schedule?
Candy: I have this book but haven’t read it! But I like this idea. As a mom and sleep consultant, I recognize that there is a wide range of advice. From literally scheduling when mom eats to doing completely baby-led. I personally let her (baby) lead then set healthy boundaries around that to develop a ‘routine’ kind of like this. Any book you read, take what resonates with you, and throw out the rest. Most books, even from a PhD or MD, are opinion-based books.
Laura: I read a book ‘Night-time Parenting’ by Dr. Sears, prior to having children. For me, I have co-slept with all my infants, as I seem to get more sleep. Also, establishing a night-time routine. I am really big on sleep, especially nighttime sleep, and I start right away when we get home – lights go off, this is when we sleep. Even if they don’t get it right away, we’re establishing a routine. Otherwise, they seem to fall into their own routine…
Candy, you help many families with sleep issues. What are your thoughts on “newborn sleep patterns”? When you work with families, what is your goal length of sleep, quality of life, something else? Is there anything in particular you want to share with our mamas on the topic of newborn sleep?
Candy: I’m sure you all have friends whose babies slept through the night right away, and we always hear about those. Truly, before 6 months, ‘through the night’ means 5-7 hour chunks. FULL nights (12 hours) is very rare…rejoice if you have them and don’t tell anyone. ;) We always hear ‘is the baby sleeping?’ and then panic if they’re not. Before 4 months of age…do whatever you need to to get through the night. You won’t do anything to develop bad sleep habits during those times. Their circadian rhythm isn’t set. One of the best ways to help set that, is to get baby outside to know the difference between day vs. night. You don’t need to follow a routine unless it helps you.
You can lie them down with weighted hands on them, then slowly take hands off. If they start crying, put them back on. Do this every day slowly so they learn to fall asleep on their own…it may take until they are four months old. Pediatricians only have 2-5 hours of expertise in their residency about sleep, so they aren’t really experienced in that. 4-6 months is when you start working on that, but no pediatric sleep consultant is going to tell you to let your baby cry it out.
So here we are trying so hard to meet the needs of our babies, but as we discussed earlier, we too, are adjusting. What would be some “cues” that we as mamas should be looking for in ourselves that we are not doing well?
How much did/does lack of sleep play into your ability to cope?
Laura: I try to go to bed early (9/10 pm) but this baby won’t go to sleep until 11 or 12. So I adjust and go to bed earlier because I know I won’t be getting it later in the night. If I don’t get sleep, I get angry, so that’s how I know if I’m getting enough sleep. I am testy/yelling at the kids or my spouse. I try to make sure to get enough sleep for that reason. Also, crying or feeling overwhelmed. Don’t be afraid to ask for help…if you are even far removed from postpartum but still feeling overwhelmed…ask for help! I had to ask for extra help this time, even though it was my sixth baby. Don’t feel like a failure, because it has nothing to do with it.
Lucy: Can I say too, if you’ve had a couple of bad nights, be SAFE. If you have something scheduled but are too tired to drive, cancel it. Once knew a man who was a teacher, and he scheduled with other teachers/friends so that everyday for a month he would come home with dinner already prepared for them!
Candy: we really need a tribe. I had friends bring me dinner, but also come over just so I could nap. Accept that help! Try to be intentional about creating/finding that tribe. Sleep deprivation is huge, and you may need to have someone help you take care of baby so you can sleep.
NOTE: We have a Postpartum Support Team!! If you are expecting a baby, even if you're just recently expecting, please sign up here, so we can be ready to support you!
In a handout created by the organization, Postpartum VA, they state, “The most successful treatment for perinatal mood and anxiety disorders is a combination of selfcare, social support, talk therapy and medication if necessary." Do you agree? What were some forms of selfcare you took?
Debbie: I found it to be essential. I met with a friend everyday to walk. We would talk through what the day would look like, I would let my husband watch the children or the older children. It’s something that I still do…also, new babies can be hard on a marriage. When my husband came home, he and I would have time just for us. The children could be around but not talk.
Laura: Yes, showing your children that the spousal relationship is very important and showing the children that he is important. Don’t feel guilty asking for help from your husband, even if they’re not that ‘into it’. You NEED to take care of yourself. Exercise also is very important, but slowly and don’t overdo it.
Candy: recovering from a c-section, I couldn’t apply my coping skills, which are dancing and yoga, usually. I had to go to friends. I posted something on Facebook about having insomnia, and a friend messaged me about maybe having postpartum anxiety. Peer-to-peer counseling was a huge help. If you have a PMAD, you haven’t failed! I’m someone who is more natural…essential oils, meditation, etc. Everyone told me ‘Zoloft is fine’ and I said NO! But a friend called me and said ‘I missed out on the first year of my child’s life, don’t do the same thing.’ So I got on Zoloft, and it was awesome. I knew the adverse effects a mood disorder could have on my child, but was still so resistant, until that friend said that to me. Also, I had another friend with a baby around the same age, so we would message each other in the middle of the night/early morning if we were up! If you’re breastfeeding, try to pump right before you go to bed, and have husband take the first feeding, so you get a good chunk, and baby may learn to take a bottle. This was so helpful for me personally.
hew! What a great amount of fabulous information. Thank you to our panelists for sharing the beautiful, raw truth about your postpartum experiences!