How to Prepare for the Fourth Trimester with Doula & Sexologist, Kimberly Johnson

preparing for postpartum

As I plan for the arrival of my baby girl, it’s hard not to get wrapped up in exactly that – planning for the arrival: eating the right foods (pizza is a vegetable, right?), putting together a birth plan, cobbling together a nursery (that will never look as good as Pinterest makes it look), figuring out what to put on the registry, and so much more. But what about after the baby arrives – then what? It’s not something most people think about or plan for and until I sat down with Kimberly Johnson, founder of integrative motherhood resource, it was not something I had thought about either.

But thankfully, with her new book – The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions, and Restoring Your Vitality – the realities of intimacy difficulties, potential physical traumas, and often overlooked support needs postpartum are brought to light, along with thoughtful and accessible approaches she’s developed from her life and career as a doula and sexologist for tackling these issues. After having read this insightful work cover to cover, I can say this is a book every mom to-be should read. Below – excerpts from my interview with Kimberly discussing her book, available now on Amazon.

The reason the three months after birth, or the fourth trimester, is so important is because it’s during this time that a woman is either set up for a lifetime of good health or poor health. It’s a vital time when women need to be supported because we are seeing right now in the US what happens when women aren’t supported, when our society doesn’t have adequate maternity and paternity leave and women are stressing to get back to work, when our birth practices leave women traumatized, or traumatic birth injuries go unattended to because no one is talking about them and women experience disinterest in sex or long-term low grade physical pains.

Right now our culture is showing us what happens when you don’t take care of women after they have babies – 67% experience marital decline, 86% have pelvic floor dysfunction, 1 in 7 have postpartum depression – and all of these things are not necessary if the right care is given to mothers. When women are cared for postpartum, it’s been found in studies that they don’t have anxiety and depression and the rate of postpartum depression is reduced to 1%.

My book is meant to help people understand the importance of supporting the mother during the fourth trimester, what conversations need to happen to adequately prepare for this period to make sure that the mother gets the emotional, physical, spiritual support she needs.

There definitely needs to be an extended rest period after giving birth for mothers of at least 30-40 days. Every culture has a practice that emphasizes this period of rest: in China it’s called “the golden month,” “sitting out the month” or the “confinement period”; in Vietnam it’s called “sitting in the nest”; and in Mexico it’s called “la cuarentena.”

Everywhere around the world there is a period of time where women are cared for by other women; they either are taken out of their home to a family members house or cared for in their own home. The essential part, and what really matters, is that mothers aren’t doing anything during this period except bonding with their baby and being taken care of so their body can recover. How their bodies recover is by eating collagen dense, mineral rich foods to help detoxify all of the placental blood so the uterus can clean itself out, then after that rebuild the tissues.

It doesn’t matter if it’s traditional Chinese medicine or Ayurvedic or the traditions in African cultures, they describe it all the same way: A woman’s body is emptying out when the baby is born, and because there is this empty space in the woman, ‘yin’ or wind can come into this space and when it does, it can cause problems. Which is why all of these cultures emphasis the importance of staying warm and being cared for while this space, that has been emptied in the body by the baby, can come back together and heal.

But beyond this period women need continued support ideally for the three months that make up the fourth trimester and even beyond that. Countries like Sweden and Denmark give a year of paid maternity and paternity leave to families.  Sometimes they are even able to stagger this so that one person will be home one year with the baby and then another will do the next year, or they’ll overlap. And these countries even have paid child care so that when women do go back to work there is someone to help them care for their children which can be another huge stress.

In the US, we need to have change at every level of the system. Families need to receive paid maternity and paternity leave so that women aren’t stressing out that they need to get back to work right away because anyone who has to go back to work 5-6 weeks after having a baby is of course going to be depressed. You cannot be normal at six weeks postpartum. At six weeks you just start to feel normal and say, okay, now I can kinda feel me, then at three months another window opens. Just like your baby, your baby will start to need you a little less, not a lot less, but a little, and then you can start to feel yourself a little more. But at 5-6 weeks postpartum, a baby cannot be separated from its mother all day long, so of course the baby and the mother are both going to feel that separation.

Thankfully we are seeing in the US companies like Facebook and Microsoft now offering four months of parental paid leave, replacing the six-week maternity leave policy for women and acknowledging partners. These companies are using it as an enticement for people which is amazing because research shows that retention is better when people are supported postpartum.

We did have it once; it was called “lying in” and it happened up until the turn of the last century, but things changed once midwives stopped overseeing births and the Industrial Age happened. After that we became a culture that worships productivity, and resting during the postpartum period is not productive. It is if you look at it in the long term, which is what Chinese medicine is so good about since they see the benefit of slowing down in the short-run to preserve life force and longevity down the line, but Western cultures only see the short-term productivity loss.

We love the terms – “badass,” “girlboss,” and “superwoman” – and these terms are associated with not resting. Women get a lot of attention and positive praise for not stopping. So when you go back to work ten days after having a baby, everyone is impressed and it’s like no, that’s neurosis. The postpartum period is a time that needs to be respected.

The midwives say “five days IN the bed, five days ON the bed and five days AROUND the bed,” which means there is a period of fifteen days at least of just being in your room postpartum that should be respected.

I recommend women start planning the type of support they want ahead of time.

When I was pregnant, I went to a prenatal yoga class not because I loved the yoga class necessarily but because that’s where I met other pregnant women. It’s really important that pregnant women be around other pregnant women so you can give each other emotional support. But since you’re all having babies around the same time, you can’t really give each other the raw support of cooking, cleaning, helping with chores for each other which is where you need family to come in.

Some people don’t want their mother or mother-in-law around and just want the support of their partner, but when I hear this it raises red flags because after giving birth the mother needs to be mothered during the postpartum period. If you don’t have anyone mothering you, you are going to become resentful of your own mother who’s not there, you’ll become resentful of your partner because that’s not his job to mother you; he’s not supposed to do that and he’s going through his own transition. This is why I feel it’s important for women to have postpartum support in the form of their mother, a postpartum doula, an aunt, or something because I know many women think they can do it all, but this isn’t the situation where you want to be a badass and carry it all on your own. This is a situation where you want people to take care of you, and that can be very hard for some people.

Women are incredible, we are badasses, but we shouldn’t have to prove that by doing everything on our own. Women need to chill with their babies for forty days and then they can start to slowly do the things they want to do. Yes, we want to get back to everything we used to do right away, but that can be shortsighted because sometimes if a mother overdoes it after birth and strains, her organs could prolapse, stitching could tear, or a strain could cause long-term back pain. It’s so important to be gentle with the body and give it time to properly heal, and this means taking it slow and letting other people support you.

Postpartum really is a time to feminize sex. It is a time for female pleasure to be at the center of intimacy and to take penetration off the table because no one wants hard and fast penetration after they have a baby.

You hear women all the time say after they have a baby – I’m touched out, my baby is breast feeding or touching me all of the time and I don’t want to be touched anymore or I’m just too exhausted – so it’s important to ask then – what is the sexual connection and intimacy that would be energizing for the woman and for the relationship?

In our culture we are very penis and vagina focused, but it’s important to broaden what sex is, what connection is and how to create connection and intimacy without defaulting to penetration. These are good things for couples to talk about and to practice before the postpartum period, so that after the baby comes they’re able to stay connected and stay intimate.

There is a big focus in the book on the medical realities of birth because that’s something that I couldn’t find myself after I had my daughter. Before experiencing my own birth injury, I had never even heard of a “birth injury” before. I had no idea I could get hurt and that there was something I could do about it afterwards, which is one reason why I now specialize in helping women recover and heal from birth traumas.

Physical birth traumas can be a variety of things: pelvic floor tears that have to get stitched back up; hemorrhoids; incontinence or being unable to control your bladder entirely; and then other women just have painful sex after they have a baby and they don’t know why, but it’s because the muscles in the vagina are strained  — Imagine the vagina as a loose knit sock, now when something big gets pulled through it some of the sock fibers are going to get pulled to one side and some are going to get stretched to the other side — this can happen to the vaginal muscles after birth.

There are also traumas that can happen that many women may not see as trauma. Like some of my patients will say, I just have no libido or I don’t want my husband to touch me, but it’s not that they have no libido or don’t want the intimate touch of their partner, it’s because their body has been traumatized from the emergency cesarean they had to have and their body just does not want anything to go into them. Or I have women telling me their tailbone has been hurting them for three years after they had their first baby, and I ask them if anyone has worked on it and they say no, then I work on their tailbone for forty minutes and all the pain from three years gets released.

It’s just insane to me that 70% of all women have babies and there is no care for women after they have babies. It’s a cultural blindspot. We need to tell women, hey, by the way there is some stuff that’s going to go down when you give birth and afterwards you’re going to need support – here’s how to plan for it so you’re ready.

Kimberly Johnson’s book, The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions, and Restoring Your Vitality, is now available on Amazon.

Photographed and edited for length by Amy Chang, founder + editor