The Fourth Trimester
A pregnant woman is eagerly tracking her pregnancy. She is excited when she is out of the first trimester and can now share the news on social media. She is exhausted but excited to enter the third trimester as she can now count down the weeks and start preparing her hospital bag and the nursery. She also is looking forward to her baby shower. Everyone is excited to meet the baby.
And the day is here. The baby is born. All tracking stops. The pregnancy tracking phone apps are forgotten and the journey to motherhood begins. The mother is prepared (or at least tried to prepare as much as possible) with knowledge and tools to care for the newborn baby.
But what about the mother herself? What about that healing and shrinking uterus? What about the whirlwind of hormonal changes? Or the healing painful scar?
This is the Fourth Trimester.
The 3 months following the birth of the baby is the fourth trimester. Or what I like to call the 'forgotten trimester in the west'.
In this blog post I will share my personal postpartum journey as I followed a specific Ayurvedic (traditional India medicine) practice 6 weeks following the delivery of my 2 children. We will also look at different postpartum traditions around the world and how they are similar. Sadly, postpartum care is really lacking in the West.
My Story
It all started at the hospital. My son was born during the cold month of November. Snow had not started but both my moms were prepared for the winter ahead. You see they had knitted sweater, hats scarfs for me and the baby months ahead. "I will be wearing a hat and scarf indoors", I asked my mother-in-law. "Yes, for at least 2 months", was her reply in a matter of factly way. We live in a house that has central heating. I did not see the point.
2 weeks before the due date of my first child I was eagerly packing my hospital bag. My mother-in-law sneaked in her newly knitted clothes into the bag. "Um the hospital has blankets and is heated mom". I tried to remind her that we live in Canada where they have central heat. I assumed she wasn't aware because she delivered her child in Northern India where the winters although not as cold as Canada can get chilly indoors due to lack of a heat source. And she just reassured me that it was necessary.
The same week she went to the Indian Grocery store and went on a shopping spree. She was frantically calling people from back home and making notes of strange herbs I never heard of. She and my husband went to the store and an hour later came with 2 bags full of weird herbs. Some I had seen before but some were new to me. She was upset because the grocery store did not have 2 things. I believe one of them was a dried up coconut. So she called my mom who lives in another city in Southern Ontario. Luckily that city is Brampton where you will find Indian stores in almost every corner of the block.
All the ingredients were ready. But she did nothing to them. They just sat in the bottom spice drawer for 2 weeks.
November 3rd and I was in labour. My mom (who lives an hour away) was called and my mother-in-law (who lives with us) came to the hospital with me. I had a good delivery but ended up with Grade 3 tearing. This was when I had very limited knowledge about the pelvic floor.
I remembered the nurse would come in every so often to encourage skin to skin contact with me and my baby boy. Both my moms were irritated by that because they just wanted to cover me and the baby up. You see they wanted to keep our bodies warm. When the nurse would leave my mother-in-law would place a blanket on me and my baby. I don't think skin-to-skin contact is a big thing in India because both my moms hated it! They thought me and the baby would get sick.
Anyways exit the hospital and I was not allowed to carry anything. Not even my bags and my baby. Even in the car they tried to bundle me and the baby up with blankets but luckily my husband took my side on this one.
Once home I was told to sit down for a bit before I was taken upstairs. We live in a two story house. I sat for a few minutes but I really wanted to move around. My stitches were hurting (from the perineal tearing) and standing helped alleviate the pain. But I was encouraged to sit and rest. Once me and the baby were taken upstairs, I did not realize we would be stuck there for 6 weeks! "You can't climb stairs", my mother-in-law mentioned.
I sat in my room with the baby. I had visitors. Sometimes they would take the baby for a bit so I could sleep and rest. I ended up dozing off for 20 minutes and was gently woken up to a heavy smell. It smelled like burning ghee. As much as I love my ghee treats this smelled like it was going to clog up my arteries. I could hear my mom and mother-in-law having a conversation on how much to add the ingredients.
Another 20 minutes later I was presented with a crumble mixture of herbs and flour and ghee. I wasn't sure if it would be sweet or blah. I saw raisins and I love raisins. I could finally eat raisins (I couldn't have raisins during my pregnancies)! My mother-in-law assured me I would love it because she loved it. So I took a spoonful. It was ...ok. I could taste the crunchy herbs. Some bitter. Some sweet. Some weird. I would describe it as a mixture of weird textures and flavours all combined in wheat flour and ghee. Needless to say I was expected to eat this twice a day for 6 weeks. Now you would believe me when I say I gained 10 pounds 6 weeks postpartum.
Traditionally the baby and the mother goes back to her parent's house for 6-8 weeks (or more). But we had doctors appointment so we decided I would stay put as driving in the winter for an hour with a new born was not favourable. I am kind of sad I missed out on this tradition for both my kids.
So here I am all cozied up inside with a thick sweat and hat on and watching Netflix. Oh did I tell you I was also told not to watch too much T.V. or read. My eyes and brain needed to rest. My mom told me that if I was watching something intense or upsetting it can effect my mental wellbeing and recovery. We are really emotionally sensitive at this time because of surge and decline of certain hormones.
I was also encouraged to rest and dismissed from my household duties.
Baby #2
2 years later I delivered my second child. Rinse and Repeat. At least now I knew what to expect.
Some traditions that I did not follow...
I was given the option to tie a cloth around my waist after I delivered my baby. It was suppose to act as a make-shift belly binder. I was however not pressured to do so. With other more important things to worry about (like sleep!) I did not follow through with it.
Yoni Steaming: This is something I wish I had tried as it would have helped with my grade 3 tear. And it sounded so rejuvenating (for my vagina!). Basically Yoni steaming is vaginal steaming with herbs. It helps with increased circulation, reduce postpartum cramps, increase healing and helps with perineal and pelvic floor discomfort. With the combination of different herbs, I am sure there are other benefits as well outside my scope of understanding.
Other postpartum traditions around the world
Let's look at some postpartum experiences around the world.
In China there is a period of 30-40 days called 'zuo yuezi' where the mother is expected to stay inside, given herbal tonics and massages and exempts from any household duties.
In Mexico this period of rest is called 'Cuarentena' which literally translates to Quarantine.
In Japan this 'confinement' period is acutely 100 days where the women rests at her parent's house. This tradition is called 'Satogaeri shussan'.
In Korea this period of care is called 'Sanhujori'.
In Nigeria this period of rest is called Omugwo. A belly massage is given to help reduce the belly and flush out the blood to allow for quick recovery.
In Turkey the mother is given a drink called 'lohusa serbeti' which is made of cloves, cinnamon, nutmeg and red sugar. All of these ingredients have a beneficial effect on the recovering mother.
You may have noticed a common theme here. The purpose of these traditions are to promote healing and reduce stress on the mother. She usually stays the month (or more) at her parents house where she is free from any household duties like cooking and cleaning. All focus is on resting and recovering. No lifting or carrying or any exercising is allowed. During this resting period, the postpartum women is discouraged from watching T.V. or reading. During the first few weeks, all meals are brought to her in bed. Special medicinal herbs and recipes (that are passed down generations) are prepared and given to the mother. There is tremendous social support surrounding the 6-8 weeks postpartum period.
Postpartum care in the west
The postpartum care received differs from country to country. Some of the care is centered at a hospital or facility. But in most countries the care is received at home in the company of family and wise people.
Unfortunately in the west the level of postpartum care one receives is heavily insurance dependent. In Canada, I was discharged in 24 hours. The next time I heard from my OBGYN was 6 weeks after delivery. If it wasn’t for my family and traditions I would not have known the importance of the time in-between.
Some European countries like France already understand the importance of postpartum care. These countries offer anywhere from 4 to 6 weeks of postpartum care in the form of regular weekly check ups and rehabilitation. However, in Canada I was offered just one quick visit for my 6 week follow up. And the visit was barely 5 minutes long. Because I had no private insurance, I had to pay for pelvic floor therapy out of pocket.
Conclusion
I believe that seeking postpartum care immediately after deliver will help with better quality of life. We looked at how different cultures incorporate varies traditions to help the mother rest, recover and feel supported. I understand it may be difficult to follow most of these traditions in countries like Canada and United States mostly due to lack of family support and guidance from elderly. However, it will be of tremendous benefit for the state/provincial health care system to provide 6 weeks of continuous postpartum care for mothers. We already see the positive benefit such programs have in France.
References:
1. Song, JE., Chae, HJ., Ko, J.M. et al. Effects of a maternal role adjustment program for first time mothers who use postpartum care centers (Sanhujoriwon) in South Korea: a quasi-experimental study. BMC Pregnancy Childbirth20, 227 (2020). https://doi.org/10.1186/s12884-020-02923-x
2. Dennis C-L, Fung K, Grigoriadis S, Robinson GE, Romans S, Ross L. Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review. Women’s Health. 2007;3(4):487-502. doi:10.2217/17455057.3.4.487
3. Celia Shatzman. 2017. Pregnancy and Birth Traditions Around the World. The Bump.
4. Mukherjee H. (2022) Concept of Satogaeri Shussan in Japanese Childbirth Rituals: From the Perspective of Contemporary Japanese Women ISSN: 2436-0503 – The Kyoto Conference on Arts, Media & Culture 2021: Official Conference Proceedings https://doi.org/10.22492/issn.2436-0503.2022-1.6