Postpartum Care Planning

as a crucial part of pregnancy and parenting

The “fourth trimester,” or the first weeks of postpartum, is arguably the most tender and vulnerable time in a woman’s life. She has emerged an entirely new person from pregnancy into constant caregiver; it is a sacred time of transition and renewal. Yet, she cannot help but recognize her own intense needs as she simultaneously tries to focus on the rhythms of motherhood and the unique patterns of behavior her child exhibits.

In most cultures, the first 40 days of postpartum are considered a crucial part of the healing experience.

During this time, a woman’s body is recovering from an experience like no other. Her uterine lining is continuing to bleed, and she constantly wonders if it is doing so in a normal or life-threatening manner—because no one really told her what to look for. There may be stitches somewhere; maybe she is holding a pillow over her abdomen to cough or sneeze. Her breasts suddenly feel like someone else’s; they don’t quite seem to fit. Regardless of her decision to breastfeed or not, they are engorged, maybe chapped, and leaking. Always leaking.

Moods change with the moments: the highest highs and maybe the lowest lows.

Shes frantically google things the in the night about her baby. The intense feelings of fear and love, mixed with uncertainty of her own abilities, come in waves.

She wonders about the thresholds of normalcy for some of the things she and her baby are experiencing.

She may feel untethered, lonely, or altogether inadequate for this new role.

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But it doesn’t have to all be this way. Most of us simply do not know what kind of support to ask for—and when it comes our way, how to receive it.

In a country with endless focus on birth planning and preparation, very little postpartum planning is discussed with pregnant women in the United States [5].

But many professionals are recognizing the need for this conversation and are creating better standards of care a little at a time [1, 5, 14].

With hopefulness, I watch these cultural tides slowly turn, and urge my clients to prepare not only the baby’s room and an adorable collection of outfits, but their personal maternal support system that will exist directly following birth.

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Many cultures have built-in practices to support a new mother for at least the first 4-6 weeks of postpartum. These usually involve communal support from women who have witnessed the postpartum period countless times before. These women may answer questions about uterine linings and colic and aching breasts. Their real-world experience can recognize reasons for concern at a moment’s notice, providing layers of wisdom for new mothers who are unsure if their experiences are typical or not. Meanwhile, our new mama focuses on rest, rejuvenation, and attachment with her child. Her community feeds her family, assumes her household chores, and gathers around her as she heals.

A mama in Mexico might practice a 30-day time of rest with her family called the cuarentena while her support system cares for her basic needs [6].

A mama in an Eastern country such as China or Japan might be “doing the month,” being nurtured by her family and community as she adjusts to motherhood. She hides out, per say, in the restful arms of the people who recognize how much she needs space to adjust before re-assuming her other roles and responsibilities [2,3,6,7].

Korean mothers not only rest for 21 days, but are fed mostly-warm foods such as the traditional seaweed soup, and are encouraged to take herbal steam baths and receive massages to assist in healing the body [6].

This kind of nurturing postpartum care is often called “mothering the mother,” a practice culturally unheard-of in the United States, save for the occasional church-sponsored meal. Women can, of course, choose to pay out-of-pocket for a postpartum doula, and many may have a mother or other maternal figure come stay for a brief time. But the rallying of family and community to support the new mother is not necessarily commonplace.

This is not to say that family and community supports do not exist at all for women in the United States, just that we are not accustomed to providing the supports in the same holistic way that other cultures do. We drop off our casseroles and we go on our merry way. We do not uphold postpartum as a sacred time of healing and bonding, but as something to rush through to the next phase. And this leaves our mothers who are entering postpartum largely unprepared for what to expect.

As Western women we tend to enter postpartum with unrealistic expectations of “bouncing back” and Wonder Woman-ing the whole she-bang. Then, when reality strikes, we may feel shameful for asking for the support someone should have told us all along that we would absolutely need. And, of course, asking for help is something that we are not historically fantastic at doing.

So when postpartum proves to be trickier than expected, our mamas are left frantically trying to piece together support for themselves in-the-moment.

But what if we skipped the shame cycle and prepared ourselves to accept specific kinds of support before the fourth trimester even arrives? What if, culturally, we marked it as normal to need others in postpartum, so that mothers do not feel as if asking for help is an imposition—but rather, a completely normal part of new parenthood?

Postpartum planning can not only prepare a mother for the realities of the fourth trimester, but assist her in rallying these supports prior to baby’s arrival so that she can ease into her new role more readily.

Statistically, we know that taking the time to create a postpartum care plan can decrease medical, emotional, and mental risks to both mother and child [1, 2, 6,13].

A mother owes it to herself and her growing family take into account the weeks following birth; and to allow herself permission to rest, rejuvenate, and heal.

But what if I don’t have any supports?

If you are someone who feels as though your social, familial, and/or community supports are lacking, maybe preparation prior to the fourth trimester is even more crucial. We must gather the supports you do have to ensure you are able to heal well, and in turn provide adequate attention to learning your newborn.

Usually, however, when I work through postpartum planning with a mother-to-be who has limited resources, she often realizes that she is more readily equipped than she thinks. Often, the barriers lie within our own struggles to

1. Know where to turn for help and
2. Ask for and allow yourself to receive such help

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Author and postpartum expert Kimberly Ann Johnson succinctly shares that “everything a new baby needs, a mother needs” [6]. Think,

Rest.

Nourishment.

Bathtime.

The constant support of another human who has walked this road before.

To imagine we do not need those things in postpartum is fooling ourselves. They are all vital aspects of this season of motherhood and transformation.

In our next installment, you will find practical tips for rallying your own support system prior to the entrance of the fourth trimester.

May we mother each other well.

References:

1. Barimani, M., & Vikström, A. (2015). Successful early postpartum support linked to management, informational, and relational continuity. Midwifery, 31(8), 811–817. https://doi.org/10.1016/j.midw.2015.04.009
2. Chien, L.-Y., Tai, C.-J., Ko, Y.-L., Huang, C.-H., & Sheu, S.-J. (2006). Adherence to “doing-the-month” practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan. Research in Nursing & Health, 29(5), 374–383. https://doi.org/10.1002/nur.20154
3. Eberhard-Gran, M., Garthus-Niegel, S., Garthus-Niegel, K., & Eskild, A. (2010). Postnatal care: A cross-cultural and historical perspective. Archives of Women’s Mental Health, 13(6), 459–466. https://doi.org/10.1007/s00737-010-0175-1
4. Entsieh, A. A., & Hallström, I. K. (2016). First-time parents’ prenatal needs for early parenthood preparation-A systematic review and meta-synthesis of qualitative literature. Midwifery, 39, 1–11. https://doi.org/10.1016/j.midw.2016.04.006
5. Fahey, J. O., & Shenassa, E. (2013). Understanding and meeting the needs of women in the postpartum period: The Perinatal Maternal Health Promotion Model. Journal of Midwifery & Women’s Health, 58(6), 613–621. https://doi.org/10.1111/jmwh.12139
6. Johnson, K. A. (2021). The fourth trimester: A postpartum guide to healing your body, balancing your emotions, and restoring your vitality. Shambhala Publications, Inc.
7. Liu, Y. Q., Maloni, J. A., & Petrini, M. A. (2012). Effect of postpartum practices of doing the month on Chinese women’s physical and psychological health. Biological Research For Nursing, 16(1), 55–63. https://doi.org/10.1177/1099800412465107
8. Mott, S. L., Schiller, C. E., Richards, J. G., O’Hara, M. W., & Stuart, S. (2011). Depression and anxiety among postpartum and adoptive mothers. Archives of Women’s Mental Health, 14(4), 335–343. https://doi.org/10.1007/s00737-011-0227-1
9. Postpartum plan for new parents. 4th Trimester Project. (2023, August 14). https://newmomhealth.com/toolkit/postpartum-plan-for-new-parents-toolkit-old-version/
10. Postpartum plan. (n.d.). https://www.postpartum.net/wp-content/uploads/2023/04/PP-Plan-Updated.pdf
11. Postpartum planning for expectant parents. Postpartum Support International (PSI). (2024, January 15). https://www.postpartum.net/postpartum-planning-for-expectant-parents/
12. Razurel, C., Kaiser, B., Sellenet, C., & Epiney, M. (2013). Relation between perceived stress, social support, and coping strategies and maternal well-being: A review of the literature. Women & Health, 53(1), 74–99. https://doi.org/10.1080/03630242.2012.732681
13. Savage, J. S. (2020). A fourth trimester action plan for wellness. The Journal of Perinatal Education, 29(2), 103–112. https://doi.org/10.1891/j-pe-d-18-00034
14. Stuebe, A. M., Kendig, S., Suplee, P. D., & D’Oria, R. (2020). Consensus bundle on Postpartum Care Basics. Obstetrics & Gynecology, 137(1), 33–40. https://doi.org/10.1097/aog.0000000000004206