The Fourth Trimester
When you are pregnant there are a few hushed whispers from mostly new mom friends about the realities of the postpartum period and the first 12 weeks of a babies’ life known as the fourth trimester. They may say it is tough, some may even say it was one of the hardest seasons of their life. But at that stage you are likely too wrapped up in the anticipation, the joy and the excitement of your new baby-to-be to really let it sink in. As you should be.
And then suddenly you are home with a days old baby, no instruction manual, no return policy and a heart full of love, wonder and likely some terror.
What follows is part a reflection of my own experiences during the fourth trimester, which will be so very different from anyone else’s but there will likely be common threads, and my advice to other new moms, moms-to-be, partners and anyone looking to support a friend through this transition.
And what a transition it is. My heart truly goes out to anyone going through this experience during COVID as the isolation is magnified beyond belief. I certainly never expected not to have my mom nearby when I had a child, nor did I expect that my child wouldn't meet their grandparents until nearly three months, but such are the realities of the world right now. That said, I don’t know that anyone ever has a truly easy fourth trimester, and despite some minor bumps along the way I consider our experience to be relatively straight forward.
All of my reflections and thoughts here certainly aren’t to say that there are not moments of incredible purity and beauty and utter joy in those early days. There most certainly are. And at the end of it these are the memories to cherish and savor as you let all of the anxieties and uncertainties and frustrations and tears fade away. However you get through this time it will be enough and just right. Whether you love it or wish it away or land someplace in the middle please try not to judge yourself. Be kind to yourself and give yourself and those around you as much grace and patience and forgiveness as you can.
My story certainly didn’t begin the way I expected it to. At 38 weeks, my doctor, whom I hadn't seen in-person for several weeks due to COVID-19 mandated video visits and rotating visits with other doctors in the practice, commented that I was measuring very small and that she wanted another growth scan to verify the baby’s size. (I had to wait a week as the scans have to be two weeks apart and my last one had been the week before and had indicated normal growth.) She gently warned me that if things were as she suspected they would need to induce me at 39 weeks following the ultrasound. I didn’t ask her how likely this was but in my head I somehow came to the 20-30% range which felt safe enough that I didn't really need to be concerned. Fast forward a week and I finished up a conference call, grabbed my mask and purse and hopped in a car with my husband to go to the hospital for the scan. I left my work computer on, half drafted emails in my saved items folder and with a looming presentation the next morning at 8am. (Spoiler: I didn’t make it and left my co-presenter high and dry!)
At the hospital, the ultrasound tech took us back and introduced herself as Viola. In a passing thought I registered that her name might be a strange sign of sorts as one of the middle names we had picked out if the baby was a girl was Violet after my grandmother. She did the measurements once, and soberly told us that growth had stalled and the baby had fallen below normal ranges. She then did the measurements again to verify and pulled up the heart beat while she went to go get the doctor. The doctor came in and asked if I knew what this meant, I nodded in a sort of stunned way while she went over the risks of the situation and the benefits of delivering at 39 weeks when IUGR is diagnosed. We were then escorted upstairs where I was admitted and taken to a room and my husband was sent home for my things. One COVID test, lots of medication and and about 26 hours later Ellison Violet Grey joined us. Truly nothing can prepare you for the moment they place your child on your chest and they give their first cry. Shock, wonder, joy and so much responsibility in one little bundle.
Despite what anyone tells you there is nothing that can prepare you for the blur that is the early days of trying to figure out life with a newborn. They are fragile and precious and entirely dependent on you. Many have early health issues, from weight gain and feeding challenges (check), to jaundice (check), to skin conditions (check), to reflux (check)... not to mention the babies that are so tragically born with far more serious conditions. The early days can feel like a roller coaster ride colored with a fatigue so intense you’re barely managing to hang on. But there is also extreme joy, sweetness and moments that are so precious that you will cry happy tears instead of tears of frustration and exhaustion in those blurry, early days. Hang on to those moments. Savor them. Remember them. Though it can be so hard to see it at the time, this stage is fleeting and they truly are only so small and new for a very short time.
There is no way around it but feeding your baby is one of the most time consuming, exhausting and important things you will be doing in the early weeks and months. I won’t go too much into breastfeeding here despite having A LOT of thoughts on the subject, but whatever your personal opinions or preferences are, try and remove the pressure and guilt and anything else that comes along with feeding your baby in a certain way. FED IS BEST. Hands down. You may want one thing and your baby or body may want another. You have to come to a compromise about what is best for you and your baby and be at peace with it. (Also, as a side note, you truly haven't lived until you’ve had a virtual appointment with a lactation consultant via FaceTime with your husband holding the phone over your head and you less-than-half-dressed clutching a screaming infant. Just trust me on this one. I’ve filed it deep in the mental folder of things I’d like to forget.)
These are bits of my story but everyone has their own experiences and they are all different and valid and worthy of being told and shared and supported. As a woman this is probably the biggest transformation you will go through in your life and it deserves to be acknowledged. It is also a huge transformation in your relationship with your partner. Try to take time for one another. Talk and most of all listen. No matter how involved your partner, mom or closest friends are, this is also something that you will in large part have to find your way through alone. No one else will be in your head with you at 2am, but I promise it does get incrementally easier and all parents have been there. You’ve got this.
My unsolicited advice for the Fourth Trimester:
1. Cliche but true: It takes a village
Find your mom tribe. In person is best but if you have the good fortune (KIDDING) to give birth during a pandemic, virtual will absolutely do. I can't tell you how much comfort and connection I have found in late night or early morning text or Instagram DM conversations with other moms. Some are women I have known for years, others were virtual strangers but have become some of my closest companions during this period. It sounds scary to reach out and initiate a conversation but I promise there is a very high likelihood that the other person will be more than happy to chat, share advice or commiserate. We’ve all been there.
2. Ask for help and outsource
This could mean a range of things from in-home help if you can swing it - postpartum doula, night nurse, your mom, your mother-in-law, aunt, sister, friends you name it. Or it could mean outsourcing things that just aren’t priorities, your laundry, your grocery shopping, cleaning etc. I made the huge mistake of trying to do it all. I don’t say this with any bit of pride, rather with an admission of my own stubbornness, but I only took one nap in the postpartum period and that was the day I came home from the hospital. Don’t be me. Don’t bother cleaning your bathroom and take the damn nap.
3. Take time for you
At least once a week my husband politely but firmly shoves me out the door for a bit of me time. I resist, but go, even if for a few minutes. Take a walk alone, get your nails done (they won't last but you will feel SO much better for a day), sit outside and call your mom, get something to eat that you didn’t have to scrounge together for yourself and sit on the curb in the sunshine to enjoy it in silence (been there). Just take a few minutes for you. You’ll be a better mom for it and your baby will not remember that you stepped away for a bit.
4. Read and educate yourself. But then stop
There are absolutely diminishing returns to trying desperately to figure out what might be going on with your baby. Everyone is an expert and everyone has an opinion. Read, talk to your network and your pediatrician and then stop and trust your intuition. It doesn't have to be perfect or even look like it does for anyone else. It just needs to work for you, your baby and your nuclear family. Take the pressure off of yourself to match your routine or practice to exactly what that uber-popular baby book or mommy guru says. Babies are humans too and some days are great days and some days they just get up on the wrong side of the proverbial bed. Just go with it as best you can and know that tomorrow will always be a new day and a new chance to find your groove.
5. Get outside and move
Obviously this depends on where you live and the time of year, but fresh air, open spaces and movement were critical for me. When the baby is fussy put them in the stroller or carrier, put in your AirPods and go walk. Usually before you hit a half mile they will have calmed and so will you. Music, podcasts, audio books, phone calls are all great distractions.
As soon as you are able I highly recommend easing back into movement. Even just some breathing exercises will help your physical recovery so much and help clear the mental cobwebs. I started some gentle breathing and stretching about a week after delivery and slowly increased from there until getting cleared for full activity by my doctor. There are tons of great postpartum recovery resources online that should help provide a place to start (@thebellemethod and @melissawoodhealth are two that I used).
6. Remember you have interests and talents outside of being a great mom
Try to nurture them without guilt. I have struggled with this one BIG time. I knew I would need to work on a few hobbies during the postpartum period to keep myself mentally engaged but I was not prepared for the guilt that came with that. Let.it.go. Just throw it away. The guilt will always be there in some way, shape or form no matter if you are taking a yoga class today or reading the FT tomorrow. Just pick a few things that you really love and try to make space and time for them even if you have to let other things go and/or ask your partner or support network for help to make it happen.
And if you decide you want to go back to work earlier than planned (raises hand) that is OK too. And if you decide staying home is best for your and your family, DO IT. Just because you’ve become a mom overnight doesn’t mean that who we were/are before just disappeared. Things in your life will obviously need to shift and expand and rearrange themselves but they don’t need to vanish.
7. Get help if you even remotely think you need it
Because you don't see your OBGYN until six weeks (yes, you read that correctly) after you deliver (for a normal birth), many pediatricians will do scans for Postpartum Depression (PPD). I vividly remember sobbing through one online questionnaire maybe ten days or two weeks after delivery and thinking, “Well, I can’t be that depressed, at least I know what the ‘right’ answers are even if I am completely lying as I fill this out.” Wrong.
You can be the mentally and emotionally strongest person and still struggle through this time. It is unfamiliar, scary, isolating and a huge shift in who you are as a person and a transformation of your identity. Plus your hormones and physical body have gone through so much and you truly just don’t feel like yourself. I frankly find it hard to believe that anyone gets through this period without experiencing SOME form of mental or emotional difficulty. That isn’t to scare anyone, just some reality. Please, please, please get help even if you think you might need it.
8. Change the conversation
This stuff is HARD. Talk about it. Talk about it with your partner, your mom, your friends, your doctor. Few bring it up unprompted, but if you initiate the conversation everyone has a story (or ten). Shared experiences bring learning and comfort. They help this from feeling SO overwhelming and daunting. Scary as it is, talk about it.
9. Give yourself grace
This is one of the hardest things to go through. Hands down, no shame in admitting it. It does get easier and it will get better but please try and give yourself the grace and space you need to get through it. It doesn't have to be perfect or look like it does for anyone else. Try not to compare and when you need to just put the baby down, walk into the other room or outside and take ten slow deep breaths and start again. You are doing a wonderful job for your baby and you are truly all that they need.