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Preparation for postpartum life

I just finished reading Kimberly Ann Johnson's guide to the postpartum period, "The Fourth Trimester: a postpartum guide to healing your body, balancing your emotion, and restoring your vitality," which was published in December 2017.

The main focus of this book is that there is much more to the postpartum period than taking care of newborn babies and that there is an urgent need for us to reframe it as a period of great transition and healing for new mothers. We need to bring mothers back to the forefront of postpartum life.

Ms. Johnson emphasizes that our cultural norm to "bounce back" after pregnancy with goals to return to our pre-pregnancy lives (weight, work, sexual activities, etc) is unrealistic and may actually be harmful in the long-run.

She discusses that in many other parts of the world it is customary for extended family members to come into a new mother's home after labor and delivery to take care of her as she recovers from birth. They help by by preparing healthy meals, cleaning, and tending to all household tasks so that the new mother can rest, heal, breastfeed, and bond with her baby. In many of these cultures it is believed that if a mother does not have ample recovery and healing time after giving birth, she is at risk of poor health and functioning for the rest of her life. This is in marked contrast to the U.S, where, while it is normal for extended family members to visit after a new baby is born, the focus of their visits are often on seeing the newborn. The new mom is usually an afterthought, despite having recently gone through one of the most physically and emotionally challenging events of her entire life.

Thus, we start out our lives as new moms with unrealistic expectations of being able to "do it all" and are not conditioned to be able to ask for and seek the help that we need. In many cases, especially as we have our first babies, we don't have a clue that we might even need much help during the fourth trimester, or that life with a new baby might not go as planned.

Overall, I believe that this book is worth reading and sharing to provide a framework for women for preparation for the postpartum period, and I don't think that the author wants or expects women to follow her advice to a tee-for example, I can't see myself personally using vaginal jade eggs (or expecting the mothers I work with to do so!)

Some of the main take-aways from this book include the following:

1. When you are pregnant, make sure you plan for the "fourth trimester" as much as you do for your labor, delivery, and items you will need after the arrival of your baby. Make sure that you have plans for how you will take care of your needs (not just the needs of your newborn) and keep your expectations realistic. Do not expect yourself to be a "superwoman" and bounce back to your previous life, as this is not possible.

2. Figure out who can/will help you after you have your baby and do not be afraid to ask others for help. One recommendation is for pregnant women to put together their own "meal trains" for their friends and neighbors to participate in after they have their babies. Postpartum doulas are also a wonderful resource for postpartum support and care and are now available in most parts of the U.S.

3. It is important to gain an appreciation that both pregnancy and the postpartum period are a period of great physical, mental, emotional, and spiritual change, and that healing and recovery should not be rushed. I actually learned more about post-birth pelvic floor dysfunction from this book than I had learned during my entire medical training! The author recommends considering meeting with a pelvic floor physical therapist prior to birth so that you have someone to reach out after delivery if need be, which I think is great advice.

4. You need to do what works best for you and your baby and follow your intuition, even if it differs from the advice of your family, friends and/or the medical establishment. The author shares that she had anticipated exclusively breastfeeding but hit a point in which she required formula supplementation to be able to adequately nourish her daughter. Although she was disappointed she was able to use it as a learning experience that motherhood does not always go as planned, and supplementing actually helped her to relax a bit about breastfeeding and ultimately boost her own milk supply.