The 4th Trimester...why Americans suck at it.

I have given birth nine different times, and I never understood the importance of the time known as the "4th Trimester". The 4th trimester is the time from birth to around 12 weeks. This period is when your baby is learning about the world, and you are learning how to survive the hours of no sleep and cannot drink enough cups of coffee. There are traditions to protect the precious early weeks in the postpartum time in many other countries and cultures.

In China, they have a tradition known as zuo yuezi or "the Gateway." The gateway is the place between one way of being (life before baby) and a completely new existence (life with your baby). Much care is taken to protect the mother from anything that would cause her chi to from being disrupted.


In Latin America, women are placed in a la cuarentena, translated quarantine. Mothers stay home for 40 days to ward off chances of becoming overly exhausted or ill. They are wrapped in a faja, which is a long piece of fabric to keep their belly warm.


In Indonesia, a bright light burns in the home for 40 days postpartum to show honor to the new life brought earthside.

In all of these examples and many more that are not mentioned here, there are two consistent pieces to the whole puzzle—the family support and the midwives' support to the family.


In the American health care system, women leave the hospital after giving birth and do not see their care provider for weeks. No one to check in on them, no one to ask them how they are doing, no one to make sure they are taking care of themselves. While many of these new families have supportive partners and friends, it is not the same as having someone who knows and understands the postpartum period's ups and downs.


In other cultures similar to those listed above, we see midwives who frequently visit the new mother, as often as every few days for a few weeks. In some cultures, the midwife makes warm soups to feed the mother. In others, the midwives wrap the mother or give them healing abdominal massages.







As a new mom, many times over, I always felt that I had to be back up and doing my daily routine as quickly as possible. I mean, I had a bunch of kids that needed their momma to take care of them. I had a house that needed to be cleaned. Food that needed to be cooked. Kids that needed to be schooled. I was a stay at home mom, and I cannot even begin to imagine the difficult decision to go back to work at six weeks, as is the norm in America.


While each of those things is honorable, the result of not taking the time to heal physically and emotionally is why we see such a larger number of women dealing with PPD and PPA than in other countries. One study I found showed statistics of over 70% of postpartum women in the US experience at minimum the "baby blues," while in other countries, it can be between 5-23% depending on the country studied. That is a HUGE difference and is shameful when considering the science, medical, and economic advantages we have in America.

As I spent years as a doula and then midwifery student, I started to see the need to remind new families of the importance of the 4th trimester. To slow down. To listen to their bodies. To eat nutrient-dense foods. To take in the sights, sounds, and smells of the postpartum period.


I like to use a leg injury analogy to help me explain to families why it is crucial to take the time needed to heal and be restored. I ask the partner and other family members what they would do if the mother had a plate-sized bleeding wound on her leg. They always respond by taking care of her, doing the chores for her, not allowing her to move around too much, increasing the bleeding and healing time for the wound. I then tell them that is precisely what is going on in her uterus. That she now has a plate-sized open wound in her uterus, and just because you cannot see it does not mean it is not there. The more work she does (especially dishes and laundry), the longer it will take for her to heal and stop bleeding.



I then see a lightbulb turn on. You can tell that they never thought of it that way, and once having that visual, they can have more compassion for all that the new mom is going through. I have seen partners step up and take on work that they had never done before and do it joyfully, knowing that they are serving their partners and allowing them the time they need to heal fully; body, heart, and soul. There are not much sweeter things to watch than seeing a partner take care of the new mother, knowing that their work helps provide a safe space for the new mom and baby to bond and get breastfeeding off to the very best start possible.

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