How to Survive the ‘Fourth Trimester’

When I was pregnant for the first time I was overwhelmed by all the advice. The books, the momfluencers, the family/friends/strangers telling me when I should eat, what I should wear, how I should manage my symptoms. But the well of unsolicited insight seemed to dry up when it came to everything that happened right after. When I gave birth, the tearing, the hemorrhoids, the rock-hard boobs that were making breast milk for the first time, all of that was as shocking and scary as being told, “Here’s your baby, now take care of it forever.”

The only heads-up I got was “it’ll be hard” but hard how? I wanted to know but couldn’t really comprehend until I was in it, soaked in milk and spit-up and what may have been pee, I’m still not sure. Meanwhile, the moms on Instagram wore silk dresses, not a drop of breast milk to be seen. They were fine, seemingly unaffected by this massive change the way I was. I was drowning; they were thriving. None of the pregnancy books covered this part.

That first month, also known as the fourth trimester, can feel like a black hole of information, a missing chapter between pregnancy and parenting that’s been torn out of the book of motherhood. Baby showers, prep lists that tell you what to buy, and pregnancy apps all focus on what the baby will need, but, in my experience, brand-new babies don’t actually need much. Birthing parents, on the other hand, need a lot.

Going into the last stretch of that first pregnancy, I felt really good. I had all the baby gear — tons of little onesies and booties and a bag full of mitts or socks or mitten-socks. I’d gassed myself up, I was ready to take on motherhood. After a 24-hour labor and one night of horrible sleep at the hospital, my husband and I came home with a newborn, giddy with sleep deprivation, in a haze of love. In that delirious and delusional state, we immediately took the baby for a walk. I’d seen other new moms on social media up and about right after having their babies, so I assumed I was good to go, too. Instead we turned around after five minutes when I tore the stitches from my vaginal delivery and the pain was too excruciating to keep going, a pain that continued for the next several weeks. Ice packs became my saviors and an inflatable doughnut was my constant companion. And just as I was figuring out managing that pain, my milk came in and my breasts were like cement blocks, so engorged the baby struggled to latch. My nipples cracked and bled and every single piece of clothing was covered in the musky, sweet scent of breast milk.

I felt like I’d been left out at sea, drowning. All that advice about pregnancy or older babies did not prepare me for the shock of matrescence, of becoming both physically and mentally, a mother. I look back at all the selfies I took in that first month with my first born and I see a woman struggling, desperate for help, but since everything I’d read and heard focused on what my baby needed, I didn’t feel I deserved or could ask for it. It was isolating, depressing, and made my transition into motherhood difficult and fraught. How much better could it have been if I knew how to take care of myself and what to really expect?

Six years since those first few months with my first, I’m here again, for the third time now, drenched in bodily fluids, only some of which are mine. And while the physical and mental changes aren’t any less extreme, prioritizing myself and my care has made it a hell of a lot easier and more enjoyable.

To do that, I spent the last month of pregnancy putting together a kit for myself, not the baby. It included everything I’d need to take care of myself physically and mentally when the baby was here. I got together Peri bottles and Tucks pads for the bathroom, a couple of bottles of Dermoplast for vaginal pain, and a lot of ice packs. I got a sitz bath; giant, soft underwear; a blow-up doughnut to sit on; a quality perineal healing spray; and a good breastfeeding pillow and lanolin cream for chafing nipples, too.

Once the baby was born, my husband took over all the day-to-day care of our older two kids, handling the school runs and bath and bed times, while I focused on just the newborn. I even took over a separate room so I could do all that comfortably and he could get some sleep to take care of the other kids.

Food, I’ve found, is everything in the first month. My friends put together a meal train — two weeks’ worth of meals taken care of by my community — so we wouldn’t have to worry about food in the very beginning, and my mom made bone broth for me weekly and dropped it off. These were all, lovingly, dropped off and that’s it — we purposely didn’t have visitors at all for the first two weeks so everyone in the house could ease into this transition without having to entertain or even get out of our pajamas.

And this time around, I have way fewer sock-mittens and more stuff that’s actually useful like a Snoo, an expensive but very worth it bassinet that rocks and soothes the baby to sleep. Whatever fractured sleep I am finally getting is infinitely better because of it.

Most importantly, I had the knowledge of what I would feel physically. That, in the beginning, breastfeeding would trigger uterine contractions as my uterus started to return to its prepregnancy size and that those would hurt like a motherfucker. (A pain, I now know, is worse with each subsequent baby.) That the first frightening postpartum poo would feel like giving birth again, without the pain relief on standby. And that any vaginal tearing, even the smallest stitch, could feel like you’d been ripped in half and might come apart any second if you moved the wrong way or coughed too hard.

Two babies later, I was acutely aware of all the ways I would be healing and recovering and would need extra time and care for and I knew to ask for help doing it. And I focused my energy not on what I thought I could or should be doing — our first walk with this newborn didn’t happen until a couple of weeks after delivery — but on taking care of myself in that first month so that I could be present for the new baby.

How much more enjoyable would new motherhood be if new moms knew what to prepare for, not with the newborn but for themselves? If all those baby showers and pregnancy apps focused on making the actual transition to motherhood, even the second or third time around, that much easier for the birthing parent? If at our most raw and vulnerable we were encouraged to do nothing else but heal and recover, how much more joyous would that transition be?