Postpartum Recovery: The Elusive Fourth Trimester


Just recently, I was finally able to finish reading the book, The Red Tent after starting and stopping it several times. Must have had something to do with having a child and working full-time. Anyway, part of the book documents what life was like after women gave birth in ancient times. Apparently, they were waited on hand and foot by their sisters and mothers and their feet never touched the ground for one month. Two months if they gave birth to a girl. Say what? Man, I’m lucky if I got to shower or eat a warm meal after I had Mia. The closest I got to not having my feet touch the ground was when I was recovering from my c-section because I could not feel my legs. But I was back on my feet walking (or pacing) the hospital room as soon as I could because I was feeling a bit stir crazy and because I thought it was just expected of me to give birth, get out of bed, strap my baby in a sling, and live a normal life once again. I didn’t want to be viewed as the weak woman wallowing in postpartum recovery.

But life was never going to resume as usual and it took a while for me to fully comprehend that I needed to slow down and take care of myself and my newborn no matter what when I came down with a severe case of mastitis. And it never really occurred to me, until I recently came across this article that the postpartum period should be viewed as the fourth trimester – a time of unparalleled change in your body as it adjusts back to its non-pregnant state. It is a critical time that requires moms to relax, recover, and bond with baby. The piece also explores current postpartum cultures in other countries, many of them sounding like slightly revised versions of the ancient rituals described in The Red Tent. As I am nearing the end of my third trimester in this pregnancy, I became intrigued by this fourth trimester that is not really talked about in our culture, except maybe in terms of postpartum depression or anxiety. For me, it was probably the hardest (and my least favorite) part of the whole birth and child rearing process the first-time around.

The article outlines what other nations are doing in the realm of postpartum practices and I really want to share these with you all and get your thoughts:

In the Indian Ayurvedic tradition, new mothers stay at home and are pampered for 22 days after birth. This period of rest is considered vital to protect the delicate nervous systems of both mother and infant. Few visitors are allowed, and mother and child are protected from wind and bad weather.

Hey, I’m having a winter baby and it sure would be nice to stay warm and cozy until spring hits.

In Japan, a new mother is treated as if she were the baby—she’s put to bed for 30 days, waited on, and indulged while she recuperates from the birth.

Um…yes, please!

In parts of Southeast Asia, a father begins to collect wood during the pregnancy, stacking it in a special place, and reserving it for a practice called “mother-warming.” After the birth, the house is closed up and a sign on the front door announces the new arrival, letting the community know that the new family needs quiet time. The father lights a fire next to or beneath the mother’s bed, and she and the new baby are wrapped in warm blankets. Mother and baby are kept inside this womb-like environment, removed from the demands of daily life, and kept safe from wind and rain for several days or weeks, depending on the culture.

Sounds good to me, although I would not let my poor hubs go out and chop wood, our gas fireplace will do just fine. And can you imagine being wrapped up like in the womb removed from the demands of daily life? Hea-ven!

After reading all this, I started to feel a little gypped of postpartum pampering and began to think how tough modern women of America have it. We bear the children, and then get right back to work, and cook, and nurse, take care of our spouses, and rear our children as best we can, and worry our heads over getting back to our pre-baby weight ASAP. And many times we’re still judged for our choices. Let’s not even discuss our country’s abominable family and medical leave system. On the other hand, many new moms (myself included) have a hard time asking for help once the little one arrives. Katie addressed this beautifully in her recent post. It inspired me to ask a family member to help us out once this baby arrives by picking up our daughter from school for the first few weeks of my recovery. I was so afraid to ask such a giant favor, but not only did they happily agree, they went out and purchased and installed a car seat for their vehicle. This is modern American mother-warming in my eyes.

So I guess I am not feeling entirely defeated by the fact our country has not adopted a sensitive and supportive outlook on postpartum recovery. And even though the women in The Red Tent had awesome post-natal care, they did have it tougher than us after the first twelve weeks. After all, they were one of four wives and bore children in droves. They basically were servants to their husbands and were deemed marriage material based on dowries. When Matt and I moved in together, my dowry was clean 300 thread count cotton sheets and a spice rack. After Mia was born, I was lucky I had a good job to go back to and seeing my family on the weekends was enough to know the three of us were loved. And these long weeks of confinement spent with family members? I am not sure I could tolerate my mother-in-law for thirty minutes, much less thirty days.

I guess I am hoping to reach a happy medium as an American working mom about to give birth in a culture where women strive to have it all.  I just don’t believe I have to do it all at once, especially after bringing a new life into this world. I think I deserve a break.


21 thoughts on “Postpartum Recovery: The Elusive Fourth Trimester

  1. I love this truly! ! I’m a Doula and a mom of 2 little boys. I think the Red Tent resumes our work in a beautiful way…we women don’t know any more how is to get support from other women, to be loved..
    to accept that love and care without feeling guilty or offended.
    In the pursuit of freedom we forgot to be what we are, amazing souls, strong ones too but our biggest strength is be together and care for each other.

    I will recommend you to watch the doc of Helen Castor: medieval times: birth, married and death. Really inspiring and help to understand our cultural heritage and traditions about our lives in this Catholic society.

  2. Hiring a postpartum doula may seem expensive but mothers are more likely to breastfeed (saving up to $3000 in formula costs alone), the risk of postpartum depression decreases (money saved on medical bills), marriages are less likely to have issues (savings on marital counseling), unnecessary calls and visits to pediatricians are less likely, parents are less likely to spend money on unneeded baby gear since the doula can give advice regarding what is needed… The list goes on. Many doulas (like me) accept payments, will lower fees for families in need, and provide gift certificates from friends and family.

    Postpartum doulas are experts in doing exactly what you are describing-giving the mother the emotional and physical support she needs to relax heal and focus on her family and what is really important. We are worth every cent and I’ve never had a client who disagreed. 🙂

    1. Yes, you certainly are worth every penny as you are providing a most precious and life-saving service. It was not my intent to infer that the service was not worth it, because it really is! Sorry if it came across that way. To be honest, I was amazed (and happy) to learn that post partum doulas actually exist. I wish my OB, hospital, or everyone else I’ve encountered in the birthing community, spoke of you wonderful people more often. Thanks for all that you do to help all mamas in need 🙂

  3. I was JUST talking to someone yesterday about how the “fourth trimester” is the most important part for Mamas and babies!! I’m SURE if we, as a culture, were more cognizant and supportive of this there would be much less post-partum depression. For my 3rd pregnancy, I loudly voiced to my friends how much support I was going to need and want. And they totally stepped up for me. One of my friends organized a meal-train for me, and friends took turns dropping off meals every couple of days. One of my dear friends came over and cleaned my bathroom and vacuumed days after I gave birth. And everyone took turns taking my oldest two boys to their house so I could have uninterrupted rest with the baby. I also asked my Mother to come from Maine and help out. She stayed for 10 days and it was awesome. It was the only 4th trimester that I didn’t get mastitis. Mastitis, I’m SURE, is the sign that new mamas are doing far too much. We really do need to nurture new Mamas so much more than we do! Thank you for writing about it!

    p.s. I LOVED the Red Tent. Every single month I long for one! 😉

    1. Oh, this comment made me teary – I am so glad you have such an incredible community of support! Your friend that cleaned your bathroom? Awesome.

  4. I really, really enjoyed reading this, Mary Grace. How backwards our approach is now! When you put it out there like this, it truly does seem ridiculous. Thanks for this persepective.

    1. I am so glad this resonated with you because I really think we need to reexamine our system (or lack thereof) of postpartum recovery. I am SO glad that you will be entering the care community as a lactation consultant. Mamas need kind and compassionate care givers/educators like you. And please, please tell your future clients about the wonderful existence of postpartum doulas!

  5. We read the red tent with my bookclub and we were not fans – but now that I think of it I think that none of us had babies at that time. Perhaps we’ll need to revisit it. Great post.

  6. I wish we were better about this in our culture. I had family members willing to help, but there’s such a stigma about being “too dramatic” or “lazy” after giving birth (which is CRAZY…) especially after having a 2nd child. I really did feel like it was a badge of honor to return to life as usual immediately after, which is horrible!!

    1. I was the same way Sarah! With my first, I worked up until my contractions started and then was working from home high on pain meds right after I had my daughter. Some of my emails might have been a little incoherent 😉 But I just thought it was the right thing to do to keep from going stir crazy. This time around, I think the first few weeks will be filled with lots of guilt-free movie watching, chocolate eating (the antioxidants are healthy), and just trying to calm my raging hormones. At least during the day while my daughter is at school 🙂

  7. I too loved The Red Tent, which surprised me because I don’t like reading about ancient times. But it was GREAT. Isn’t the concept of a doula along these lines, where we hire someone to take care of us and the baby? I always wished I could afford one of them.

    I also think the baby needs the 4th trimester — all that disjointed wailing stops at around 3 months. I think they were meant to stay inside for a year! What a combination — jangled mom and disoriented baby. It’s amazing we can get through it intact.

    1. It is amazing how we get through it! And yes, I found that after my baby hit 3 months, it started getting much easier. That’s why I think it’s so important to be extra gentle on yourself during those critical early months of chaos. Thank you for bringing up the issue of postpartum doulas. I wanted to address it, but thought my post was already lengthy. I did some research and the going rate for PP doulas in CT is about $20-50/hour, so not entirely cost effective for many moms. I just think it sucks that we have to outsource help, but hey, whatever works. We don’t exactly live in small villages that make it conducive to have our neighbors, friends, and relatives pop over to help out.

  8. I loved the red tent and love this article! You know I believe we should be helping and asking for more help 🙂 so excited for you

  9. Wow this is fantastic. We really have the treatment of new moms backwards don’t we? How funny that we were just talking about this together!

    1. Yes, after living the difficulties of the postpartum period with my daughter and after doing some digging and finding out what other cultures are doing, I really do think we tend to neglect moms during the very critical fourth trimester. It’s like “You had a baby? That’s great, now carry on with your life would ya?!” In some of my reading, I came across stories of women who felt they had to wait until their 6 week follow-up appointment with their OB to have their physical and mental well-being addressed. For many moms, that is the time they have to go back to work. That is just too late IMO. So, it is my hope that women can feel confident to ask and receive the help and support they need.

  10. MG how i would love a little bit of that ancient motherhood hospitality over here! My mom always tells me that when they were in Italy, all of her aunts cared for each other and their babies and the new mom was literally taken care of like her kid was. Makes sense to me!

Share Some Comment Love

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s