In this issue:
- A Mother is Born
- Creative Ways to Play with Your Baby
- Preparing Nutritionally for the Fourth Trimester: It’s all about you, Mom
- A Postpartum Story: Falling in Love after Postpartum Depression
BirthWays Newsletter
Postpartum: The Fourth Trimester
October 14, 2011
A Mother is Born
By Gina Hassan, Ph.D.
The human infant is born less developed than any other infant in the mammalian kingdom. In fact, the human baby is entirely dependent on its mother for its very survival. When a fetus is in its mother’s womb there is a complex system of support wherein the mother’s body provides the environment, the nutrition, and the hormones that move the baby’s growth forward. Once the infant has arrived in the world, however, the concept of unity and separateness evolves.
When a mother is pregnant, we are sometimes uncertain whether to think about mother and baby as two separate people or one complex organism. But once the baby is born, how do we think about baby and mother during this early phase when fetus and mother go from sharing a body to inhabiting two clearly separate bodies? Over the past several years the concept of the fourth trimester has emerged as a useful way of thinking about the continuum of dependency of the human baby on its mother and the complex nature of what unfolds during the early postpartum period.
Our culture does not tend to acknowledge this transition. Once the baby is born there is a definite expectation that the event has occurred and all should return to normal. As such, we do not routinely see the support in place for early motherhood that we see focused on pregnancy. Given this sharp reduction in support postpartum an important question to consider is whether a mother is born as quickly as a baby. Or might the birth of a mother take time as well, perhaps several months of gestation, so to speak, before she can really know and feel herself a mother?
The fact is, in Western culture we are generally isolated from extended family. Most of us do not grow up in households where our cousins and aunties are going through early motherhood before our eyes. We often enter this role with little inside knowledge of, or exposure to, what is called for and what early motherhood may look like. In some cultures there is a formalized lying-in period, usually lasting four to six weeks, where a new mother is taken care of by a community of women such that all the mother is required to do during this time is get to know her baby and ease into the experience of mothering. In our culture the new mother is generally doing this on her own, sometimes with the help of a partner.
Expecting to live life as normal once a new baby arrives is not a healthy or realistic expectation. The fourth trimester can be a magical time of deep intimacy, discovery, and bonding. However, if we allow the tasks of life (i.e. cooking, laundry, returning email, and socializing) to prevent us from being with the emotional aspects of early motherhood, it can become an experience filled with anxiety/depression and self-doubt. Many mothers end up feeling there is something wrong with them for struggling during this transition. This is a sad state of affairs. When mothers are provided with the space to ease into motherhood, when the enormity of the transition is honored and supported, rates of postpartum depression and anxiety are greatly reduced.
So what is a healthy recipe for the postpartum transition? Some of the ingredients include: plenty of space and time to grow into your role as a new parent; having realistic expectations about what this period should be like and how long it may take to feel comfortable in this role; ample support from family, friends and community; surrounding yourself with other new parents who can understand and are open to talking about the joys and challenges of this period; and allowing yourself to seek professional help when these supports are not enough.
Many women struggle during this period and our culture of shame — a culture that doesn’t allow for darker feelings to be acknowledged and expressed — may well cause more suffering. Open up space to feel hope by letting people in so you don’t feel so entirely on your own. Isolation is not good for new parents and certainly increases our risk of suffering. Connection and community are paramount, so reach out, ask for help, and accept help when it is offered.
Parenting can be joyful and stressful and will at various times be both. Having realistic expectations of ourselves as well as compassion and patience are important ingredients in making early motherhood a more joyful experience.
Gina Hassan, Ph.D. is a perinatal psychologist specializing in maternal mental health. She offers individual and couples therapy, consultation, and Mindful Mothering and New Moms’ Support Groups. For more information and/or to read other articles please visit her website at www.ginahassan.com.
Creative Ways to Play with Your Baby
By Kim Lyons
Now that your baby has arrived, what do you do to entertain and play with her? Forget about the advertisements plastering the parenting magazines or the aisles full of toys at the big warehouse shops; what I’m referring to doesn’t require anything more than being present and using items you find around your house or in the local park. Let’s call it back to basics: non-stressful ways to spend time with your baby.
This may mean changing modes, moving at a slower pace. For example, take your time getting out of bed, explore with massage, sing a lullaby, stare into baby’s eyes, and take those moments to be together. Give yourself permission to have a pajama day from time to time. Since babies can pick up on emotions such as stress and anger as early as 6 months, teach them how to take care of themselves by taking care of you. Find ways to create quiet periods throughout the day. The email, laundry, and dishes can wait.
As you lay in bed together, gently massage your baby’s toes one by one; use the opportunity to burst into “This Little Piggy” or begin introducing numbers by counting them. Not only does massaging his toes provide an opportunity for play and early number introduction, stimulating this area of the body boosts the immune system warding off colds and flu viruses. Other prime times to offer a gentle massage are during diaper changes and after baths. Administering long, slow strokes from head to toe is calming and relaxing not only for baby, but for you as well. If you want to dive deeper into massage, attend an infant massage class or check the library for books or DVDs on how to massage your baby.
How might you make use of other times together, such as when you are standing in a long grocery line? Start to move together by swaying back and forth; bend your knees and move up and down, turn around if there is room, and sing about your movement while you dance. No matter how small the movement, it will improve both of your attitudes about being stuck in line. Imagine the smiles from people around you as they vicariously release their own unspoken frustration. You can explore these dance moves with music while at home. Play a variety of music (classical, jazz, drumming, rock, etc.) and find a rhythm as you partner with your baby to tango, salsa or slow dance around your home. See what appeals to you and your baby.
You can also tone down the moves and introduce gentle passive movements, also known as baby yoga. Leg movements, where you move baby’s legs like they 
are riding on a bicycle, can offer gas and constipation relief. Simply hold her legs on the lower leg/calf and rotate them gently in a circular motion. Remember: If you meet with resistance, stop. Never force the baby to do any movements they are not ready for. You can clap baby’s hands at mid-line while singing “Patty Cake”, then take his arms out to the sides or up over her head for an easy stretch. Describe how you are opening and closing or moving up and down. See how many ways you can engage your baby’s hands and feet. You can gently clap them, roll them, tap them, push them, shake them, etc.
Many of us are very self-conscious about singing in our society, but babies don’t care what your voice sounds like. You can make up songs about anything such as: leaving the swings or washing your hands for lunch. Sing in a whisper, a big voice, or somewhere in between. Clap your baby’s hands together or offer him a wooden spoon to drum along. Try to remember old favorites from your childhood, check out the library or check out Internet resources for a new repertoire. For example, YouTube.com has an array of tunes sung by all types of people.
Finally, gather things from around the house or outdoors to play with. Look for items that will fit into one or more of the senses: touch, taste, sound, smell and sight. Remember you can explore items safely together, for example, sand at the park or beach may be a tempting thing to put in her mouth, but what about just sitting baby on your lap, scooping a fistful of sand and pouring it over her legs or toes. Or how about standing your baby up so just his feet are standing on the sand all the while describing the experience? You might say one or all of the following based on what is going on: “the sand feels warm because of the sun,” “the sand may tickle as it runs through your toes,” and/or “does the sand feel rough against your skin?” You are beginning to introduce descriptors that the baby uses as it learns to categorize while experimenting with all the different textures.
In addition, explore with more than just the hands and feet. Rub the silky scarf on her cheek or roll the smooth rock down his forearm. Take time to engage in play together and other times sit back and watch as your little scientist performs experiments with the toys you offer. Often grandmothers like to say, “All we had were pots and pans to play with and we turned out just fine!” I find this to be more and more true as I watch my 6 year old find 101 things to do with a toilet paper roll. Sometimes, it’s about adjusting our own perceptions and merely looking around with new eyes. Babies do get tired of playing with the same items though, so change things around by rotating items every week or two.
Keep things simple, it’s more about the quality than the quantity that you give your baby. Our time with our babies passes by far too quickly. What better gift is it to slow down and be less absorbed by the latest gadget and explore who is right in front of you? These and many more ideas can be found in my infant massage class at BirthWays or in my Tum e Time: Creative Ways To Play With Your Baby classes in Oakland, Berkeley and San Francisco, visit www.tumetime.com.
Preparing Nutritionally for the Fourth Trimester: It’s all about you, Mom
By Sarah Brick
The first 3 months after the baby is born is referred to as the fourth trimester, a time where we are adjusting emotionally and physically. The emphasis is often on the baby, but we need to take care of ourselves to enable us to have the energy necessary to take care of our little one. While everyone tells us how important it is to eat healthfully during pregnancy, this important postpartum period is often overlooked.
Nutrition is crucial during this time and can help us balance emotions, hormones, and replenish iron and minerals lost during the birth. Good nutrition will ensure a good milk supply and help us maintain the energy we need.
When your baby arrives it can be difficult to think about preparing healthy meals and snacks for yourself, so it is wise to prepare in advance. Good ways to ensure you are well nourished include: having a well-stocked pantry, keeping a few easy recipes on hand, and cooking a few meals ahead and storing them in the freezer. Completing a full pantry clear out and restock is a great way to ensure you have a full supply of healthy, nutrient dense foods to get you through the long days. It is important to remove any processed and refined foods from your diet, as these foods will hinder your recovery. As always, ensuring a balanced diet using whole foods is the way to go.
Here are a few healing essentials to help with an optimal recovery:
Seaweed – In Korea, women who have given birth are fed a seaweed soup called miyeok guk one or more times each day for a minimum of two weeks following delivery. Sea vegetables have the broadest range of minerals of any food. They are an excellent source of iron, which is important, as there is usually significant blood loss during birth. Add seaweed to soups and broths or toast nori in a pan for 5 minutes for a healthy snack. Crumble seaweed in with some raw nuts to munch on while nursing.
Herbal Teas – Loose-leaf herbs are a wonderful addition to your pantry, so stock-up on nettle, raspberry leaf, peppermint and chamomile. You will benefit from the vitamins and minerals present in the herbs. Nettle, raspberry leaf, fennel, and fenugreek are said to help milk supply; while peppermint and chamomile will calm the system. It’s easy to make up your own blends according to your preference. I like to blend peppermint, raspberry leaf, and nettle in a jar and let it steep in the sun.
Soups & Broths – Soups are amazingly versatile and healing. Preparing a nourishing bone broth* in advance, then simmering vegetables for a soup, will help sustain your energy to ensure you are getting a wide range of nutrients. You can make a big batch and put in the freezer for later use: Ziplocs work well. Soup is an excellent first meal after birth. Parsley is a particularly good addition to soups as it helps reduce inflammation and adds a good amount of iron and vitamin C to your diet and both are needed for your recovery. Preparing a mineral rich vegetable broth with a variety of vegetables and sipping throughout the day will help facilitate healing.
Nuts & Seeds – Having a supply of raw nuts and seeds will ensure you always have a ready to go snack. You can mix and match them as you want. Make sure you have a variety using walnuts, almonds, hazelnuts, pecans, as well as sunflower, pumpkin, and sesame seeds. Roasting nuts and seeds destroys much of their nutritional content, so they are best consumed raw.
Nutritional Yeast – Available at most health stores, nutritional yeast has a cheesy/nutty flavor and is packed with B vitamins. It is so easy to sprinkle on popcorn for a snack, or even to blend into milk as a drink. Vitamin B6 is critical in maintaining hormone balance and proper immune function. Due to the rapid readjustment of hormones in the mother’s body after birth, it is essential to eat vitamin B rich foods. Other sources include organ meats, raw milk, and organic free-range eggs.
Eggs – Touted by some as the perfect food. They are a great source of protein and B vitamins. In traditional Chinese medicine, eggs are recommended to strengthen one’s blood and energy by enhancing digestive and kidney function. Hard-boiled eggs are an excellent snack; you can pre-boil a few at a time and keep them in the fridge.
Healthy Fats – Whole fats are essential for maintaining hormone balance; they nourish us and satiate us. They should not be restricted in a mothers diet! Some experts believe that postpartum depression can be attributed to the depletion of omega-3 fatty acids in the diet. Use real butter, drink whole milk, and eat plenty of wild fish and even sardines. Try to use coconut oil for cooking. Olive oil, sesame oil, and walnut oil are best used cold over salads and vegetables. You will need fat in your diet to help with healing and recovery; it is critical you have enough.
Probiotics – Lactobacillus acidophilus and bifidobacteria not only help regulate bowel movements; they increase the absorption of minerals that require acid for absorption such as calcium, copper, iron, magnesium and manganese. You can take good quality probiotics in capsule form as well as eating plenty of cultured foods such as: raw sauerkraut, yogurt, and kefir.
Multivitamins – It is wise to continue with a good multivitamin during the fourth trimester. It should not be used instead of but rather as an insurance policy to compliment your whole foods diet.
Caring for a newborn baby and becoming a mother for the first, second, or even third time is truly a special experience. Providing ourselves with healthy ingredients to nourish our strong bodies will enable us to relish in the delights of motherhood.
*For more information on making nourishing bone broth, see my article on www.livingnutrition.net.
References
Murray, Michael. The Encyclopedia of Healing Foods. New York: Atria Books, 2005.
Lipski, Elizabeth. Digestive Wellness. New York: McGraw-Hill, 2004.
Enig, Mary G. Know Your Fats. Silver Spring, MD: Bethesda Press, 2000.
Fallon, Sally. Nourishing Traditions. Washington D.C.: New trends Publishing, 2001.
Weed, Susun S. Wise Woman Herbal for the Childbearing Year. Woodstock, NY: Ash Tree Publishing, 1986.
Sarah Brick studied holistic nutrition at Bauman College and founded LivingNutrition.net at the beginning of 2011. She specializes in nutritional support for pregnant women, postpartum recovery, and families. Services Sarah provides for families around the Bay Area include: cultivating healthy mealtimes through cooking classes in your own home, introducing solid food to babies, market shopping trips, and pantry restocks. She is a member of the NANP – National Association Of Nutrition Professionals.
You can contact her by phone (415-309-4179) or email (sarahbricksf@gmail.com), or visit her website at www.livingnutrition.net.
A Postpartum Story: Falling in Love after Postpartum Depression
By Jenny Summerlin
When my first son was born I knew I would have more children. I couldn’t get enough of him. There were moments when I wished he were a twin, so that when I laid him down I could hold another baby. I was obsessed with him and loved him more than I ever thought imaginable. When he was 8 months old we found out we were expecting again. I was thrilled, but a little shocked it had happened so soon.
My second pregnancy flowed much the same as my first with a bit more morning sickness in the beginning. To be perfectly honest, I didn’t read much during this time since I felt like the two pregnancies were so close together, surely I remembered everything. My first labor was not perfect, but I knew I could give birth. Around 35 weeks I started experiencing severe pain that only got worse. On the day of my 37-week appointment I could barely walk. The doctor measured my uterus and said even though I was 37 weeks pregnant; I was measuring at 40 weeks. That didn’t surprise me, as my first baby was also large. He then examined me for a second time during the appointment, telling me he wanted to check something. It felt like he trying to pull the baby out right then and there! I even said, “Wow, that was invasive.” But he said nothing in return.
I went into labor that night at 1 AM. When I arrived at the hospital I was in shock – they were letting me stay. Was I really about to have this baby at 37 weeks? I gave birth at 10 AM. They immediately put him on my chest and it was incredible. After that it was downhill. They said he was cold and kept him across the room in a warmer where I could not see him for 45 minutes. Then they said he had low blood sugar and needed formula. When I asked to breastfeed again I was told that I couldn’t because I had “already tried.” When I told the nurse that I wanted to be the one to give him the bottle she said, “I would be more comfortable if I did it.” I told the nurse and my husband I was going over to the warmer to feed my son. I felt like a mother bear: growling and doing whatever I needed to in order to get to and care for my son. I got up and another nurse and my husband helped me to walk across the room; I had just had an epidural. The adrenaline was pumping so hard I didn’t know I couldn’t walk. I sat in the chair and fed him the bottle and tried not to cry. He was sleepy and didn’t want the bottle. I begged him to eat so he could come back to bed with me where he belonged. I was allowed to go back to bed to feed him and that’s when I noticed all of the blood on the floor and in the chair. I ignored it. I had my baby.
They took him for 3 hours to be in the transition nursery. On our way to the recovery room, without my son, I told my husband I had just gone from being a mom of two boys, to a mom of none. I needed my boys by my side, where they belonged. My husband and I spent the next 3 hours walking back and forth from our room to the nursery every 10 minutes. I cried the majority of the time he was gone. The next morning the doctor I had seen at my weekly visit came to check on me and asked when I went into labor. He said he wondered how long it would take and that he had “felt sorry” for me. It hit me like a ton of bricks; he had stripped my membranes. I didn’t know it at the time of the exam. I was anxious the rest of the hospital stay and couldn’t wait to leave. I just knew they were going to take him from me again.
The next two months are a blur to me. I don’t remember much. I have so many memories of my first son and 1500 pictures to prove it. With my second I remember his jaundice was really bad, I remember crying in the bathroom a lot, and I remember nursing him and staring into space. I don’t remember much about him. At my 6-week postpartum checkup I left Jared at home with my husband. The nurse and doctor were very surprised I didn’t bring him with me, but I was so detached from him that I couldn’t understand why I would bring him. I wondered from the beginning if I had postpartum depression, but never said anything. I figured I felt like this because I was a failure; I didn’t protect my son.
Then the breakdown came. I sat on the bathroom floor one morning when Jared was about 2 months old and just sobbed. I cried for myself, for my children who deserved a better mom than me, and for everything that shouldn’t have happened but did. I cried because I was crying. Here I had two healthy sons and I was walking around feeling sorry for myself. I knew I should feel happy. I felt awful that I didn’t love my second son the same way as I had loved my first. I told my husband I had to call the doctor; that something wasn’t right. I made an appointment with a different Ob/Gyn at the practice to talk about postpartum and they got me in right away. I explained my hospital experience to the doctor and he asked me about my personal life history. I explained: My dad raised me and my mom is an alcoholic and drug addict. He stopped me and said that the way I was feeling regarding my need to be so physically close to my children combined with the need to be a perfect mom were classic of the experience of the child of an alcoholic parent. This clicked for me. Of course I never wanted to leave my children and of course I felt like I didn’t protect my baby in the hospital; I was carrying abandonment issues from my 3-year-old self when my own mother left me.
Although things were better when I walked out of the office that day, it wasn’t until a year later that I was fully back to myself. I loved my son dearly, but still felt disconnected from him in a way that I never was with my first. My sister has two sons as well that are only 18 months apart, so she was a huge support for me that first year. I’ll never forget when she told me she had to work harder to create a relationship with her second because you just don’t have the time to devote like you do with your first. That was incredible for me to hear; I always felt like she had an amazing bond with her second son. It also made me realize I wasn’t alone.
It didn’t take me long to realize you can’t be quiet about PPD (postpartum depression). The quieter you are, the stronger it becomes: like a deep dark secret that festers and eats at you. By opening up, I found out a coworker who had a son a few weeks after me was also suffering from PPD. Just by stopping in the hallway and saying, “How are you today?” provided incredible mutual support. It was a reminder to both of us that PPD is something that exists, but it doesn’t have to consume you. We were able to hug each other and remind one another that it’s going to be okay.
I also found ways and times to be alone with Jared for bonding. I made myself read to him and hold him. Even though it felt forced at first, and that made me feel terrible, I knew I needed to do it to create a bond with him. I had to tell myself, “take pictures everyday” because I knew I would do so naturally with first son Isaac. I made sure that I was never quiet. On days when my husband was working and I was sad, I would call my parents and ask if we could hang out when I just didn’t think I should be alone. It’s important to recognize those times and be honest about them. Feeling sad doesn’t make you a bad mom; it makes you a woman with natural ups and downs. You have to be responsible and know that people love you, even if you don’t love yourself at the moment.
I think PPD is very difficult to understand because, as with any depression, you believe you are the only one affected. You enter a deep dark part of yourself and don’t see anyone else around you. I never realized the true impact of my depression on others until I heard my husband tell the birth stories of our two sons. I had been feeling like a failure because I knew my son didn’t need to be taken from me and I felt I hadn’t done my job as a mom to protect him. Meanwhile, my husband was dealing with his own failures. He saw me drowning and didn’t know what to do. He felt like a failure because he couldn’t do his job as my husband to protect our son or me.
The biggest lesson for me from my experience was to understand knowledge is power and prevention is key. We all need to be informed. I am sure that if we had a doula with us after Jared was born, the nurse would not have treated me that way. If I had known about low blood sugar, the causes and cures, I could have been a better advocate for my son. However, at some point, you have to let go of what you should have done, or what you think you should have known. We all do the best we can with the knowledge with which we are equipped. I did the best thing I could by reaching out once I realized I was not getting better on my own. And now that I have been through it, I understand how important it is to be proactive and preventative; so does my family.
When Isaac was 2 and Jared was a little over 1, we found out that we were expecting our third. We knew we had to do something different, but we didn’t know what. So we started reading. I’ve been reading every birthing and pregnancy book I can get my hands on. I’ve learned so much about PPD as well as birth in general. Once I learned that the chances of having PPD are higher if you’ve had it before, I immediately told my husband. We made the choice not to use birth control when we got married, and we revisit that decision often. I remember the day I said to him, “If I continue to have postpartum depression with each child, we cannot continue to have children. It’s not fair to our family.” The thought makes my heart ache because we love having children and can’t imagine that we could be finished already. So now, it’s time be preventative. It’s all in the little things- like adding a couple of pregnancy apps to my phone where I get a daily reminder of what is happening with my baby and my body. It keeps the pregnancy real and it helps me to see that something amazing and wonderful is happening. We have a doula who has encouraged me to continue to examine my past birth experience so that I can forgive myself, the doctor, and the nurse in order to truly move on. If the prevention isn’t enough, we know we have support. My husband knows that if he sees any signs, even if he’s not sure, he has to contact the doula immediately so she can step in to find out how I am doing. I know now that there are plenty of support groups out there for women with PPD. I can’t know right now if I will suffer from PPD again, but what I do know is that I have the support to make sure that I get help immediately.
This may be my third son, but because of all the research we’ve been doing and all the ways I’ve been preparing for the birth, I feel like it’s my first. I think my Dad said it best when he called me recently and said, “You know, I’ve never seen you so excited about giving birth.” And he’s right. I am excited. I know that I won’t be alone. I know that I am doing the best I can to be the best mom I can be. I am taking my experiences, forgiving myself, forgiving the doctor, forgiving the nurse, and moving on into this next blissful journey of becoming a mom of three boys!
Jenny Summerlin is a wife, mom of 3 boys, and a first grade teacher. Her husband teaches percussion and stays home during the day with their adventurous boys. Since submitting her story to BirthWays, Jenny had a wonderful experience giving birth to their third son at home. Baby Grayson was born on October 12th weighing 10 lbs 8 oz. See Grayson pictured below.
About Postpartum Mood Disorders. One in five women will experience a postpartum mood disorder (PPMD) following the birth of their baby. Men also experience postpartum mood disorders. In sharing her courageous story, Jenny illustrated a number of common themes, particularly: self-blame, feeling disconnected from ones baby, shame, and isolation. Fortunately, Jenny was able to find her way through PPMD by making use of her community of friends and family. Seeking help from a trained professional is an important step in reducing the duration and severity of PPMD for most women. Unfortunately, many women do not get the help they and their families deserve because their PPMD goes unrecognized and shame and misunderstanding cause them to suffer in silence. If you believe you may be suffering from a postpartum mood disorder, reach out for help.
The following resources may be helpful:
Baby Center - www.babycenter.com/0_postpartum-depression-and-anxiety_227.bc
Postpartum Support International – www.postpartum.net
Perinatal Psychotherapy Services – www.perinatalpsychotherapy.com. Offering individual and couples therapy, New Moms’ Groups, and groups for Postpartum Depression and Anxiety.
Integrative Psychological Services - www.meghanlewisphd.com. Offering counseling and support for individuals, groups, and couples on the topics of preconception, pregnancy, postpartum, parenting, and much more. See website for a further description of services and contact info.
