Fourth Trimester: Your Needs, Your Extended Family and Research on "Doing the Month"
- Kathy Morelli
- Jul 28, 2014
- 7 min read
Updated: Feb 24
Different cultures acknowledge the postpartum period in different ways.
In the United States, postpartum is viewed as a time when the new mom is expected to quickly recover and become mobile and get back to “normal” life. The focus is on healthy pregnancy and birth and how to care for a newborn. However, the mother's physical and emotional transition receives less attention as part of the postpartum conversation in the US.
Think about it, you’ve taken your childbirth classes and gone through the fun and deliberate process of completing your birth plan.
You carefully researched and chose your healthcare provider and where you want to give birth. You gave thought to whom you’d like to have with you as your support person in the birthing room. But did you plan your support during the postpartum period?
The Fourth Trimester Is a Major Transition
For the new mom and her family, the first few weeks postpartum is a time of adjustment on many levels: physical, emotional and spiritual. Pregnancy, birth and postpartum are times of great hormonal changes. Rest and good solid nutrition will help your body recover your pre-pregnancy hormone levels.
Re-balancing on the physical level can take at least three months, but maybe even longer, depending on individual differences and breastfeeding patterns. And the personal growth that goes along with the emotional transition to parenthood is ongoing.
Many traditional cultures formally designate postpartum as a time of rest and recovery for the mother and baby and even have specific rituals for this transition.
Perhaps we can borrow some ideas for postpartum planning from other cultures and give them an American flavor?
If you’d like a broader overview of this developmental window, you may also want to read American College of Obstetricians and Gynecologists Recognizes the Fourth Trimester, which explores how postpartum care is evolving in the United States.
“Doing the Month” in Chinese Tradition
In China, the formalized postpartum ritual is called “doing the month.” In this ritual, postpartum women severely limit physical activity, eat specific warming foods to heal the yin/yang imbalance created by childbirth, restrict bathing and delay assuming mothering duties. The intention is to help postpartum women recover and prevent current and future illness.
Intuitively, it feels like this type of support for new moms should prevent postpartum depression. However, research on this practice (and other culture’s similar postpartum practices) shows a nuanced conclusion.
Interestingly, some research shows an increase in postpartum depression in women who adhere strictly to the “doing the month” practices. In addition, women who ad-here strictly to “doing the month” also experience significant physical de-conditioning, sleep disturbances and body pains.
It’s Not Just Support — It’s the Right Support
In a country such as the US, where extended families are scattered and there is dwindling support for postpartum women, we wonder why this research regarding women who are getting lots of postpartum support actually become depressed and physically ill?
The research indicates that whether or not a postpartum woman thrives depends on what type of support she receives.
Generally, a postpartum woman’s psychological wellness is positively correlated with social support, but the positive effects are weakened by conflict with in-laws and parents and also by feelings of stress associated with inflexible rituals.
The research indicates that postpartum women need personalized, non-judgmental support that meets their needs on an individualized level.
This nuance — that support must be individualized — is central to my article on Postpartum Depression & Marital Challenges, where I explore how relational dynamics deeply influence maternal mental health.
Borrowing Wisdom — Without Rigidity
While few modern day American women want to participate in a restrictive, ritualized experience similar to “doing the month,” caring practical support after baby is welcomed.
So, how can you care for your needs during your postpartum experience?
Under the BirthTouch® model, I encourage women to include a Fourth Trimester Plan alongside their birth plan — a thoughtful design for recovery, connection, and protection of the maternal nervous system.
Designing Your Postpartum Plan
You carefully considered your choice of birth place and the support people in the birthing room to suit your needs, and you can proactively think about your postpartum planning in the same way.
Here are some short self-exploratory journaling questions to help you formulate your postpartum plan:
Draw on previous experiences
Think back to a time in your life when you needed help.
How did this feel?
What was good about the help you received?
What felt not so good about the help you received?
How can you apply what you learned from that previous experience to designing your postpartum experience?
Being on the same page as a couple
According to Judith Wallerstein, Ph.D., one of the tasks of marriage is to build a strong alliance as a couple. This is a gradual, deeply personal life-long psychological process of individuation and separation from your family of origin. This process factors in quite strongly during the transition to parenthood.
Discussing your needs with your partner will help form your bond as a couple postpartum. Enlist your partner’s support. John Gottman, PhD has positive suggestions for enriching communication between spouses, and this is usually a long term endeavor.
Dr. Gottman’s research shows that developing six positive social skills help create a a stable relationship. improves the atmosphere of the relationship. Such skills as:
learning to bring up touchy topics in a respectful, non-threatening manner
being able to see the truth on both sides of the topic
are skills that Dr. Gottman found couples who were married for the long-term possessed.
If you’re navigating identity shifts as well as relationship shifts, you may find support in Matrescence: Identity Transformation in Motherhood, where I discuss the psychological reorganization that often accompanies this life stage.
Emotional support
Are you a private person?
Do you need emotional space? How can you set this up? (Maybe plan to take a nap or watch TV alone in your room upstairs?)
Or take a walk alone?
Do you get lonely?
Are you more gregarious?
Do you need to get out in order to quell boredom and anxiety?
There is no right answer...only your answer.
Practical Support
Sleep Prescription:
Dr. Samantha Meltzer-Brody of the University of North Carolina at Chapel Hill says that a new mom always needs a prescription for sleep, especially those with pre-existing mood disorders. Of course, we all suffer without good sleep. Think about the night shifts and how you can cope. Can you hire someone? Is there family who can help?
Baby feeding method:
How do you envision yourself feeding the baby? Who’s supportive of your intentions, whether they be to breastfeed, bottle-feed or do a combination of both? Can you be kind and assertive, perhaps use humor, to convey your wishes?
Meal Planning:
Practical help with this is a great idea for postpartum recovery, as a high protein diet helps feed the hormonal system in the body.
Some suggestions:
request frozen meals at your baby shower or blessingway.
food from a deli in your town has a special menu for people who are doing a medical recovery
ordering from the grocery store online is now possible.
having family to shop for food and cook for the first few weeks after you give birth is a great help.
Visitor Plan:
Do you have space for visitors to use comfortably?
Pre-plan out the house and where guests can stay.
You can set boundaries.
Don’t be shy about saying that you don’t want five people sleeping your house. Just say it, most people will understand, others won’t. But you need to be true to yourself. This is your time, you need to quietly speak up.
Communication:
Once you decide on aspects of your Postpartum Plan, how can you diplomatically communicate to your family what you need and when they are welcome to come?
Consider sending an email before birth outlining:
When visitors are welcome
Length of stay
What kind of help would be most useful
Your partner and you need to come together on this.
For more on nervous system protection in early motherhood, see Bonding Through Mindfulness: Connecting With Your Baby, which includes simple practices for regulating both mother and infant.
If It’s Not Going Well
Remember, research shows that support is helpful for a new mom, but only if it’s given in the way that helps her as an individual.
For your emotional health, it’s important to politely speak up. Enlist your partner’s support. Use your social and communication skills to ask for what you need.
Dr. Gottman found couples who were married for the long-term possessed:
the ability to see both sides
learn to bring up touchy topics in a respectful, non-threatening manner
.It’s funny, postpartum is a joyful time yet also lots of work! Like many events in life, it may not always go the way you think it might.
Ana Clare Rouds in her book, Dancing on the Edge of Sanity, describes how she was concerned about how it would be to have her in-laws stay with her and help her out postpartum.
For her, it turned out that her mother and father in-law were respectful company and provided loving practical and emotional support for her. While her mother, though her biggest fan, was kinda stressful to have around. So, you can receive support from places you may not expect!
A Gentle Reframe
The fourth trimester is not a time to perform.
It is a developmental window — physically, hormonally, relationally, psychologically.
In my work in perinatal mental health, I see repeatedly that what protects mothers is not perfection, nor tradition, nor total independence.
It is attuned support.
Support that says:
“What do you need?”
“How can we make this easier?”
"We will adjust as you adjust.”
You planned for birth.
You deserve to plan for yourself afterward.
Related Reading
Bibliography
Gottman, J. & Gottman, J (2011). Seven Principles for Making Marriage Work. Seattle: Gottman Institute.
Grigoriadis, S., Robinson, G., Fung, K., Ross, L. E., Chee, C., Dennis, C., & Romans, S. (2009). Traditional Postpartum Practices and Rituals: Clinical Implications. Canadian Journal of Psychiatry, 54(12), 834-840.
Liu, Y., Maloni, J. A., & Petrini, M. A. (2014). Effect of Postpartum Practices of Doing the Month on Chinese Women’s Physical and Psychological Health. Biological Research for Nursing, 16(1), 55. doi:10.1177/1099800412465107
Rouds, Ana C. (2014). Dancing on the Edge of Sanity. Available on Amazon in May 2014.
Wallerstein, J. (1995). The good marriage: How and why love lasts. New York: Houghton Mifflin.
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