DBT Skills for the Fourth Trimester: Using the PLEASE Skill to Support Body and Mind
- Kathy Morelli
- Feb 4, 2019
- 6 min read
Updated: Jan 25
DBT for Managing Emotions for New Moms
The DBT PLEASE skill focuses on caring for the body as a foundation for emotional balance - an especially important practice for the fourth trimester.
Taking care of a newborn is all encompassing. It is exhausting. And it’s natural to want to give our all to our baby.
How can a new mom maintain emotional balance? It would be insulting to give a simple answer to this complicated and nuanced question. Brain biology, hormones and mood are so intertwined!
The Fourth Trimester: Awareness of the Importance of Postpartum Recovery is the First Step
To prevent postpartum emotional exhaustion, it's important to recognize the fourth trimester as an integral part of family life, just like pregnancy and childbirth. The concept of the fourth trimester should be included in the language of motherhood both personally and societally.
The fourth trimester is a crucial and delicate period for both the mother and the baby.
Are you aware that it takes a minimum of three months to physically recover from childbirth? Your hormones take time to rebalance after months of pregnancy and birth, You body needs time to physically recover. The initial six months after childbirth are regarded as a significant adjustment period, as parents navigate parenting, bonding and attachment with the baby, physical recovery, and emotional changes.
In May 2018, following extensive advocacy and research backing this perspective, the American College of Obstetrics and Gynecology (ACOG) acknowledged the fourth trimester as an important and sensitive period for mothers, babies, and their families.
The concept of the fourth trimester is relatively new in mainstream American culture, which has traditionally lacked concern for supporting families after childbirth. The United States has a lackluster family leave policy.The think tank, Pew Research, finds that of 41 countries analyzed, only the United States lacks paid parental leave. A comprehensive article from the Washington Post can be found here about how the The U.S. Ranks Last in Every Measure When it Comes to Family Policy.
Thankfully, US society is moving forward with this social construct. ACOG has taken a research based position and polling indicates that 93% of Americans believe there should be paid family leave when babies are born.
As an informed person, you can take straightforward actions during pregnancy to prepare for the postpartum needs of both you and your baby. Incorporate the Fourth Trimester into your Birth Plan, ensuring proactive, protective care for both mother and child. Protective care for the mother supports her emotional and physical well-being, which subsequently affects healthy attachment. This healthy attachment, in turn, fosters the baby's healthy physical and emotional development. Such development is ultimately beneficial for society.
Why the PLEASE Skill Matters in the Fourth Trimester
The DBT PLEASE skill is about taking care of your body's needs, which helps regulate your emotions. Paying attention to your body's needs gently down-regulates the nervous system so as to reduce emotional intensity. Mindfulness is another DBT skill that gently downregulates the nervous system.
PL: Treat PhysicaL Illness
PLEASE is all about consciously having a self-care mindset everyday. Small acts of self-care add up and support your emotional well being.
Physical pain –
If you have an aching back or bad wrist, see a doctor, call in a massage therapist, do yoga. Whatever it is you need to do for yourself, find a way to get some help at the level you need. If you let it go, you know your physical pain will affect your emotional state. And that’s not good for you or your baby or you family. Ask for help, ask for someone to watch the baby, or just make the appointment and take your new little one along!
Emotional pain –
The perinatal period is a high-risk period for perinatal mood disorders. In fact, perinatal mood disorders are the most common complication of childbirth. If, after 8 weeks postpartum, you find you are unusually sad, crying alot, feeling hopeless and have a low opinion of yourself as a mother and a person, please see your medical doctor or a therapist. If you need to cry on a friend’s shoulder, please do so. Don’t wait until you are desperate. Your emotional health is worth your time. Pay attention. If you are well, baby thrives as well.
If you need immediate help, call your doctor’s office. If it feels like an emergency, please go to the Emergency Room. For Warmline Support, call Postpartum Support International’s Warmline and you can get a list of perinatal mood disorder providers in your area.
Medication –
If you need medication, but are concerned about the effects of the medication on a nursing baby, talk to your doctor about this. You can do research on your own as well. There are numerous online resources about medication and mothers milk. Some are listed below.
E: Eat well
Postpartum is the time to keep yourself well nourished, with good food. Don't diet excessively postpartum.
Nourish your mental and physical health by eating protein rich foods. You need lean protein in order to rebuild your hormonal and neurotransmitter balance. Eggs, chicken, turkey, warming spices such as black pepper and ginger are all healthy, warming foods that nourish the mom postpartum. Tryptophan rich protein is the building block of serotonin, the mood stabilizer.
Warming herbs help replenish the body on an energetic level. Tea preparations of the herbs chaste berry, chamomile, raspberry leaf and lemon balm are supportive of the female reproductive system. Other herbs traditionally used to support the postpartum woman are dong quai and goji berry.
A: Avoid Mood Altering Substances
Watch your intake of alcohol and any other substances that can interfere with you nervous system balance. Staying balanced will enhance your mood which will enhance your parenting abilities. If you need support for this, please reach out for help.
S: Sleep Hygiene
Dr. Samantha Meltzer-Brody is Distinguished Professor of Mood and Anxiety Disorders and Director of the Perinatal Psychiatry Program at the University of North Carolina at Chapel Hill.
Dr. Meltzer-Brody’s strong advice to postpartum mothers is to Preserve Your SLEEP. Dr. Meltzer-Brody states that women with a history of a mood disorder must watch their sleep and plan to preserve blocks of sleep. Her postpartum treatment plan must include Sleep Preservation. Lining up a support system, including her partner and family and other supports, as part of her postpartum plan will help preserve her emotional and mental health (Meltzer-Brody & Jones, 2015).
Waking up at night to care for an a baby can affect the mom’s sleep. Napping when the baby sleeps can affect your sleep drive a bit, and cause insomnia.
Sleep experts Dr. Michael Perlis’ and Dr. Colleen Carney’s work indicates that depression and insomnia are the closest of friends. It used to be thought that depression preceded insomnia. But now research has revealed a more compeling relationship between insomnia and depression and there are indications that insomnia actually precedes depression.
Sleep is very important!
E: Exercise
Exercise is an antidepressant when done consistently. Exercise will help regulate the sleep cycle as well. Generally, you need to wait until your 6 week check up to be cleared for exercise. When you doctor clears you for exercise, start slowly. Don’t exhaust yourself and don’t chase after the perfect body. After your doctor clears you for some physical exercise, start slowly. Give you body time to heal and adjust.
Have realistic expectations about yourself and your body. There are plenty of pictures of celebrity moms getting right back to work a few months after giving birth and looking fabulous with flat tummies! Of course, remember they have chefs, nannies, personal trainers and beauticians focused on them! They are far from average moms. They have lots of back up they can pay for!
Every woman is different and every birth is different, so the amount of time you need to work up to a strenuous work out will vary. Meanwhile, there are alot of Mommy & Me classes available now for moms and their infants.
Mommy and Me yoga is very popular as are Mommy and Me easy fitness classes. Below is an example of a fun follow along You Tube Mommy and Me fitness class!
And of course, there is always the wonderful exercise of walking. Taking the stroller out to the mall to mall walk if it’s too cold and snowy out or going to a nearby park and walking or just walking around the block.
Caring for the body in the Fourth Trimester is not a luxury - it is the foundation for perinatal mental health and emotional well-being.
References
Meltzer-Brody, S., & Jones, I. (2015). Optimizing the treatment of mood disorders in the perinatal period. Dialogues in clinical neuroscience, 17(2), 207-18.
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