The Fourth Trimester: No Need to be "Wonder Woman"

The "Fourth Trimester” discussed here includes the weeks, months, and years after pregnancy, between pregnancies or following a woman's last pregnancy. Referred to elsewhere as “postnatal depletion”, this is not an illness or disease that requires treatment in most cases. Instead, it falls into a nebulous category with other periods of normal hormonal flux women experience throughout their lives, including PMS, pregnancy, & menopause. And, like these issues, a given woman may experience a range of symptoms on a continuum, similar to a bell-shaped curve, with some women experiencing little to no distress, most women experiencing moderate distress, and some women significant amounts of distress. Similar to the aforementioned hormonal issues, the severity of symptoms may meet clinical diagnostic criteria and even still women may feel like they have to "white-knuckle it" through this stage, not wanting to ask for help for fear of being discounted.

"Is ours not a strange culture that focuses so much attention on childbirth--

virtually all of it based on anxiety and fear--

and so little on the crucial time after birth, when patterns are established that will

affect the individual and the family for decades?"

~Suzanne Arms

It is important to acknowledge that in the US we often put more kind focus on pregnant women and then switch this focus to the baby immediately after delivery when mother-focused support is virtually non-existent. We as a culture ignore the needs of new mothers and make many demands on them that are prevented in other cultures out of respect for the postpartum period, a time recognized & honored as distinct from other times in a woman's life. Curiously, these other cultures, which also incorporate social supports for menstruating and menopausal women, have virtually no post-partum disorders compared to 50-85% of new mothers in industrialized nations like the US. During this time, protective measures, so-called "mothering the mother", help support and care for new mothers.  Specifically, the practice of "lying in" relieves women of their normal workload and the implied duty to entertain visitors, allowing time for recuperation, rest, and family bonding.  Not only does our culture minimize the significance of this change & the support necessary to healthfully assimilate this change into the family's life, but there is often an unspoken belief that any woman who needs post-partum support has somehow failed when in reality we as a culture have failed her.

Of course, having a child & parenting is physically, emotionally, and mentally demanding and these effects are compounded with subsequent pregnancies & deliveries. Most women survive the transition relatively unscathed, but at what cost?  Few can honestly say they did not experience any of the symptoms listed below and, sadly, most did not seek any assistance either because they did not want to "bother" others or because they were simply too exhausted to focus on anything but mothering. However, by drawing attention to these issues, we can address these concerns sooner, rather than later, thereby avoiding a crisis. By caring for and prioritizing oneself, you can be healthier as an individual, mother, partner, colleague, & friend.

Symptoms may include, but are not limited to:

  • Fatigue
  • Sleep dysfunction
  • Poor motivation, concentration, memory
  • Mood swings
  • Menstrual irregularities
  • Inability to lose weight
  • Urinary & vaginal issues
  • Low libido & sexual dysfunction
  • Hot flashes/night sweats

By assessing a woman's medical & reproductive history, diet, lifestyle and relevant test results, we can often identify the underlying contributing factors to the symptoms she is experiencing.  Special attention should focus on follow-up on any issues encountered in previous pregnancies, such as prenatal/post-partum mood issues, blood sugar & blood pressure abnormalities, and nutritional & thyroid deficiencies.  These problems can negatively impact a woman's health and well-being long after the pregnancy & post-partum stages and make these already challenging stages more so.

A holistic approach focusing on the mind & body by integrating Eastern & Western medical therapies can be selected based on the severity of symptoms, individual risk-factors, and patient preference and may include recommendations for the following:

  • Social engagement & support
  • Counseling
  • Meditation & quiet time
  • Acupuncture
  • Aerobic exercise & yoga
  • Hormone replacement
  • Pharmacological & non-pharmacological treatment options

Unfortunately, one of the hardest things for any mom to do is find time for herself for self-care, but you may be surprised by the number of resources available to you: friends, family, neighbors, and daycares at gyms/studios are resources that are available to most. Having in-home help for a couple hours per week may seem like a luxury, but if it provides you with the support needed to get out for a massage, a run, therapy, acupuncture, lunch with a friend or a yoga class, it is money well-spent.

For more information, if you have any questions, or to schedule an appointment, please feel free to contact us today.