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Want to help new moms? Consider the fourth trimester

Dec 15, 2022

Americans love to define things. We have terms like toddlers – for babies that are starting to walk, tweens—for children transitioning into adolescence, and another—young adults—for those teetering on the cusp of adulthood. These are monumental changes in everyone’s life. But the biggest one of all, perhaps, is strangely ignored: the transition into motherhood.

As women go through what is arguably the most awe-inspiring change they will ever experience, the medical establishment takes little to no care considering their emotional well-being. Expectant mothers are seemingly told everything about what happens to their fetuses at every stage of their pregnancy’s three trimesters. Then, they’re asked to put together a birth plan, as if giving birth to a baby is a dinner party that could be anticipated and organized to perfection. And if that wasn’t scarring enough, no sooner have new mothers recovered from childbirth than they’re presented with a new list of to-dos focused on their babies. These are often delivered in the form of mantras like “Breast is Best,” which makes women having trouble breastfeeding feel a range of negative emotions; from guilt, to shame, to panic.

It’s time to end all of that.

For the joyful, demanding, difficult, magical, and life-affirming task of bringing a new life into this world, we owe women much more. It’s time to start thinking of the Fourth Trimester. It should be a three-month period, and maybe even beyond 12 weeks, in which women can take the time they need to transition into motherhood, and a term known as matrescence. It would be a time to give women permission to make mistakes and figure it out. It’s ok to not know exactly how to “be” in this new role. And we are starting to do just that. My colleagues and I even highlighted our own personal struggles during those months in this video series as a way to normalize the hard times.

What should it look like? First, we must spend a lot more time thinking about physical recovery. And this includes how women recover from vaginal and cesarean sections. According to the American College of Obstetricians and Gynecologists (ACOG), anywhere between 53 and 79 percent of vaginal deliveries will include some type of laceration. And even though most lacerations do not have what the ACOG defines as “adverse functional outcomes,” OB-GYNs should take more time to review what happened during the delivery – a “Time Out” so to speak.

With more information about what happened, and moreover how to care for their bodies, women may be more empowered to talk about what happened and feel that their symptoms and concerns are real. We also need to talk more to women about the physical healing after a c-section. A c-section is major abdominal surgery – there is no such thing as a laparoscopic (small incisions on your abdomen) section. Women need time to physically recover as their bodies need to heal.

It is also important to discuss back pain, leg swelling, pelvic pressure, urinary leakage, and skin stretching. Pregnancy changes your body. This is normal, and women need time to transition to the changes. Physicians should help new mothers focus on internalizing one key concept: almost everything that’s happening to a woman after birth is perfectly normal. Did you pee yourself just a little bit? Sure, it may be embarrassing, but bladder issues are very common, and there’s no reason to feel embarrassed in the least. We should help women know what to expect not only when they’re expecting, but also after they’ve delivered and find themselves living in a body that feels a bit different than it did before motherhood. We should talk about it more.

Then there's the emotional component.

A new mother’s emotional state, however, is not limited only to the occasional discomfort about bodily functions. One in eight women suffer from the condition we currently call postpartum depression (PPD). There are women that have anxiety and mood disorders or suffer from trauma and stress from their birth experiences. Newer screening modalities guide medical professionals to do just that – we should screen women for postpartum mood and anxiety disorder (PMAD). By expanding our screening processes, we can help identify more women who have emotional changes that need additional support. To put it in context, a stunning 30 percent of all deaths within the first year of motherhood are caused by suicide. We need to do much more to help women handle the emotional toll of new motherhood.

A big first step is easing up on the lactation pressure. Rather than vigorously advocating for breastfeeding, which can and does cause stress for new mothers, especially those having trouble with the practice, we should adopt a new mantra: Sane is best. There are benefits to breastfeeding. I am not advocating to not breastfeed or pump, I advocate for women to make their own choices. New mothers should do whatever helps them and their babies maintain a good emotional and physical balance. This connection is more important than what the baby eats. It is how this baby connects with its family. In part, this has to do with remembering that no one solution is always applicable to everyone: just like diners at a restaurant don’t always get the same dish, so should mothers enjoy a variety of options, choosing whatever makes sense to them at the moment.

Finally, we should realize that the sort of shift new mothers so desperately need to help them more successfully cope with the physical and emotional challenges of this awesome transition won’t happen in a vacuum. It’s not merely up to physicians to create better protocols, or to families to change their outlook, or to culture to catch up to the science. It’s up to all of us to rethink how we help new mothers adjust. Responsibilities for mothers don’t just end after we purchase something from the baby registry or joyfully attend the baby shower; we must give new mothers the time they need—months, not days—to adjust. The health of our families depends on it.

So let me remind you of the definition – matrescence is the transition to motherhood. Let’s allow mothers the time and room to do just that.

This article originally appeared in Northwell Health's Newsroom

Stephanie Trentacoste McNally, MD, is the Director of OB-GYN Services at the Katz Institute for Women’s Health at Northwell Health.