The Efficient Minimalist Pregnancy: 4th Trimester

What is the fourth trimester?

Besides the obvious issue that this phrase is mathematically inaccurate…this is an important part of pregnancy that really should be focused on. It’s the 12 weeks after baby arrives and it requires just as much–even more–preparation and care than the other three trimesters. You’re getting used to baby- baby is getting used to being not in a dark warm space. Oh and by the way you’re recovering from serious physical trauma and no doctor checks on you for 6 weeks as part of standard care. There is so much that changes mentally and physically it felt irresponsible to not include content from this time to our pregnancy series.

I have to include the caveats that all pregnancies and postpartum situations are different. Always talk with your healthcare team and what’s right for you in terms of timing, care, etc. Do your own research and digging. This is just what has worked for me, my body, and my timing.

Read the minimalist essential first and second-trimester post, the third-trimester post, and the baby registry guide to catch up on all the baby content.

How did you recover from delivery in terms of bleeding/tears?

Let’s just jump right in with vaginal care, shall we? If you’re new to this like I was- you need to know a few things right off the bat. Be prepared for about a month of bleeding on top of any pain you personally experience. You probably won’t be able to walk normally for several days. But it does get better.

I had second-degree tears but was lucky enough with my recovery to be cleared at 4 weeks to resume physical activity (As a reminder, my OBGYN was so sure I was going to deliver at around 38 weeks we went ahead and scheduled my postpartum 6 week visit…except I had to be induced at 41 weeks so that’s why this appointment was early). I like to think I did a pretty good job with my research into recovery, especially since a big percentage of what I bought for my at-home postpartum kit contained what the hospital taught me to use while I was there. Here’s what I found helpful:

1. Get this washable surgical underwear: They actually had a version of these at the hospital but I’m so glad I had bought more. This is all you should wear the first two weeks. They’re stretchy and can hold all of the pads/icepacks depending on your bleeding. And then you can just throw them away and it’s not a big deal.

2. Buy these disposable pad/icepacks: My hospital also gave me several similar ones, but they are incredibly useful in the first few days to reduce swelling. I know there are lots of online hacks to make your own ‘freezer pad-sicles’ but seriously eff that…I did not have the mental capacity to do that (or anything beyond keep a small human alive and sleep). I bought one pack, had extras and the fact I could just use them immediately without making them/going to my freezer was what I needed.

3. Buy varying degrees of pads to have on hand: Get maxi-overnight pads and work your way down to panty liners as your bleeding lessens.

4. Dermaplast: They also had this at the hospital and I’m so glad I bought it to have on hand ahead of time. This is important if you had stitches since it reduces itching and pain.

5. Tucks: Not for what you think actually- while many people end up having hemorrhoids due to the pressure placed on this area, I used them for the stitches.

6. Peribottle: I actually preferred the one from the hospital, so I’m not linking the one I initally bought. But essentially, this is going to be very important until your bleeding stops/you heal. The day peeing stops feeling like such a production is a great day.

rehabbing your pelvic floor

I hate to break it to you, because this often isn’t mentioned in pregnancy-related articles, but the chances are pretty good your pelvic floor is going to be seriously messed up after birth. You’ll likely have stress incontinence (aka you leak urine on occasion) and that’s normal (WHAT) for several months. There’s also the chance your internal organs will fall into your pelvic floor (EXCUSE ME?) which is known as prolapse. But you can work to rehab this rather than just deal with it.

In France it’s standard practice to work with a pelvic floor specialist after birth and they often use a product like Perifit. Let’s not mince words: it’s an intervaginal joystick that integrates with phone games to trick you into strengthening your pelvic floor. If you’re a data nerd, you’ll love this. It gives actual data feedback, graphs and tests as proof. It has multiple types of programs that work to fix specific pelvic floor issues.

Breastfeeding

This is total “you do you” territory and there’s a lot of guilt associated with breastfeeding vs formula. As a dietitian, I knew I wanted to breastfeed since there are a lot of good studies that show major benefits for Mom and baby. But the bottom line is “fed is best”. If for some reason breastfeeding isn’t working out, stop beating yourself up over it.

Our kid came out and immediately was ready to eat (truly), which started two days of constant lactation consultant appointments which were frustrating. He had a tongue tie, a high palate, flow sensitivity (ahem-lack of patience) and breastfeeding was not working out despite the fact that we tried and tried (I had a heaving, sobbing, breakdown the second night in the hospital at 2 AM involving a crying baby, not latching, being exhausted and full of hormones- trust me, I’ve been there and I never cry).

What we landed on was exclusively pumping and that has been fantastic. To me, it’s the best of both worlds: breast milk for baby, not being “attached” for 45 minutes, and Chris being able to feed him- especially at night. It cuts night time feeding time in half since he can feed, I can pump, and we can both be back in bed in 20 minutes.

If you are breastfeeding, one of the best pieces of advice a friend of mine gave was to use nipple cream immediately and continue as needed over the first few weeks. I also highly recommend these nursing bras. I did not buy specific nursing apparel beyond this since anything with a low neckline or a button-up basically IS nursing apparel. What I will say is be prepared for some of your tops not to fit with the bigger boob situation. You may not have a bump anymore, but you do get two enormous ones up top (yes, even bigger than before).

Dealing with your mental health and comfort the first few weeks:

The first two weeks are survival, pure and simple. Have zero expectations. Your goal is to get from day one to day two. Things will get better.

You may be lucky enough to have someone who can come help you during this time, but we were on our own and have been on our own the entire time. It can be done. My mother-in-law who lives in the Caribbean just flew up at the end of the second month to spend a few days with us (she quarantined and had COVID tests done). We actually loved this timing since two months on our own gave us a solid amount of time to just be a family together, figure out a routine, and have the baby be more interactive when she came.

Here’s what was helpful the first two weeks:

1. Buy a robe: Don’t even attempt clothes. Just have a robe that’s cozy, washable, and you won’t cry over if it gets stained.

2. Have a ‘minimum must have’ list daily: I’m a to-do list lover and what we found helpful was to have a minimum list daily. For the first two weeks it was seriously making sure we both had a chance to nap and shower, feed the cats, and get the mail.

3. Say yes to everyone who wants to drop off food: I’m so glad we pre-stocked our freezer with meals. This, in addition to the SAINTS who ordered us food or dropped off food made me want to cry tears of joy. A good friend of ours was brilliant and made several meals that were freezable or usable immediately. This was so, so wonderful.

how did you get your baby to sleep? Is the Snoo bassinet worth it?

You won’t realize the value of a continuous night’s sleep until you can’t get one. I haven’t had that since maybe the second trimester of pregnancy but each week I get closer to a full night sleep, I have a deep sigh of relief.

Let me start by saying don’t expect to sleep more than a few hours at a time for the first few weeks. That is utter fantasy and is not going to happen. Your goal for the first few weeks is to learn to simulate a womb. Become a womb whisperer. We went into “figuring out the sleep thing” by understanding the baby gets upset because it’s not like it was “inside”, they’re hungry, or they need to be changed. That’s basically it.

At 8 weeks old, he’s sleeping 8+ hours at a time at night. It can be done.

Step one is learning how to swaddle. Ask the nurses to teach you while you’re at the hospital because they make it look like you’re simply wrapping a burrito, not a small squirmy creature. And while the swaddle from a blanket is great, there are also products that are going to save you so much hassle. Buy a Halo sleep swaddle. Buy two actually. They make the swaddle super simple with the help of zippers and velcro. We actually basically left our baby in a Halo the first two weeks. To this day, he naps with them and sleeps with them and they make him SO cozy. The other reason I love the Halo is it has dual-direction zippers, so in the middle of the night for diaper changes, you don’t have to fully undress.

Step two is the white noise machine. Get one on your phone as an app (I used oscillating fan on Calm) to carry with you during those first few weeks when you’re trying to soothe. Buy one to keep in the nursery. If you’re using a Snoo, you’ll have one automatically.

Step three is a schedule. Your goal is to teach routine. During the first two weeks, there is no schedule or routine. You have to feed every two hours period (seriously, this is the current advice–don’t let your parents tell you about how you slept all the time–that’s not good. That typically means you’re actually underfed. You’re supposed to wake and feed the kid at first).

We are using the Moms on Call method and schedule which changes based on age. Creating a routine is really helpful and your goal is to facilitate helping the baby learning to string together sleep cycles. You do that through the 5 S’s for soothing which was created by Dr. Harvey Karp… who later invented the Snoo (ah-ha moment).

Some people really don’t like this method and to be clear this is NOT a cry it out method. We have never let him ‘cry it out’, but as other cultures do, we pause–we give it five minutes–and oftentimes he would go back to sleep. You’ll be surprised to realize a cry is not a cry every time. Babies are seriously just noisy.

Now, he doesn’t do that at all and we have a solid idea of when he’ll wake up and need to be fed (right now he sleeps 8 hour stretches at night at 8 weeks old and then goes back to sleep after feeding and changing for another 3+).

Or you could just buy or rent or borrow the Snoo. Okay, hear me out. It’s worth it. I knew about the Snoo but didn’t really think of renting it. But a friend asked if we wanted to borrow hers and we said OF COURSE and Chris said had he known about it we 100% would have gotten one anyway (Chris sidenote: Carlene needs her sleep. I’m not stupid.). The Snoo is a bassinet that moves and has white noise and adjusts the intensity based on baby stirring. It automates the 5 S’s process and then will stop after a few minutes if it doesn’t seem to be working, alerting you it’s time to step in and attend to the baby. The Snoo works with an app on your phone where you can see what ‘level’ of soothing is happening, adjust it manually, and see sleep data to see patterns. I HIGHLY RECOMMEND the Snoo.

At first, baby HATED the Snoo. We actually used it as a stand-still bassinet for the first few days because we thought he would never get on board with it. But keep trying because all of a sudden, I promise it clicks. Snoo also has a customer support team where they’ll help you troubleshoot why baby might not like it. You can make lots of adjustments like the motion limiter setting, or adjusting the parameters of what level it starts soothing, how loud, etc.

The most valuable advice we got about the Snoo is to double swaddle. That means you use the Halo swaddle INSIDE the Snoo sack. This changed the Snoo game from us (thank you so much to the person who recommended this on Instagram).

BTW You apparently don’t need a nursery at first

This was a surprise to me. As in, it never came up ever in my research during 10 months of pregnancy (honestly nurseries are a lucrative affiliate link content hive for websites, so I’m not really that surprised…). It’s the current American Academy of Pediatrics recommendation to have the baby’s bassinet in your room for a year. This means you don’t actually need a nursery technically. It is, essentially, a room to put all the stuff you won’t be using yet. It’s an expensive storage room.

And while I hear that, I’ll be completely honest with you, we are not following that advice. Baby sleeps in his nursery and has since he was 1 month old. We have the Snoo app which tells us how much he’s stirring, as well as an audio and visual monitor. The nursery is also right next to our bedroom, so we can hear him and get to him within about ten seconds.

We decided to move him into the nursery because the boy was LOUD when he slept. We weren’t getting any sleep because of his sleep noises (not crying- just the noises he made while simply existing). For us to be getting terrible sleep when we actually could sleep wasn’t good for any of us.

So depending on your house layout (I probably wouldn’t feel comfortable doing this if the nursery was on a different floor or end of the house), I think you can use your best judgment here. I talked to friends and family who were on both ends of the spectrum. Some friends moved baby to the nursery by day three, others slept with baby in the room for 6+ months.

What about weight loss?

This is an incredibly touchy subject as a whole for so many people, so if you feel triggered by this, please skip it. But for those of you who are interested, I want to provide a safe resource for you.

This should absolutely not be on your radar until you feel mentally and physically prepared. It’s far more important you have basic sleep and feeding yourself covered before thinking of adjusting your nutrition or movement postpartum.

I also want to say, my starting point was maybe different than others. I did not take pregnancy as a free pass to eat anything. I basically ate exactly what I typically was eating. I didn’t do more than I would have over an average holiday season (well, drinking excluded).

Since I was cleared for activity by week 4 (including using my Peloton bike as long as I was comfortable), I started with 15 minute rides the first week and was back up to 30-minute sessions by week 7. At my baseline, I feel better with some kind of movement every day. We try to do a family walk daily, and some days that’s enough for me, but the majority of days I like to do a spin class.

From a nutrition/calorie perspective, breastfeeding/pumping burns several hundred calories a day (although it also requires calories, so to be too far in a deficit is detrimental to that process).

My goal was balancing time in the kitchen with healthy eating, so I started with convenience foods that were healthy (Daily Harvest, bagged salads-the kale one from Costco is a favorite), and am back to cooking more from scratch. I am in no way counting calories (and never have), but looking at it from a 30,000 ft perspective of balance.

Postnatal vitamins and supplements

Because I left the hospital with low iron on my blood tests, this was especially important for me. Breastfeeding, and postpartum recovery have their own nutrition needs, and to not address them feels a little irresponsible as a dietitian.

There are thousands of dangerous supplements on the market. I continued to use Ritual brand’s postpartum supplement after using their prenatal vitamin since they are very transparent with their sourcing data and bioavailability. (You can get $15 off your first order with this link- full disclosure this also gives me a referral bonus).

Midsection postpartum wrap

Another flag for people who may be triggered by weight loss or appearance discussions to skip this section.

This is not a harsh waist training non-pregnancy- kind of thing. This is taking advantage of the remaining circulating relaxin in your body from delivery that lasts for three months, paired with improving your core support and shoving your organs back where they should be.

I have found this really helpful for core support since it provides structure and compression. I used a three-part mid-section postpartum wrap that allowed me to add different support sections at different week marks. I did not start this process until a week postpartum and only wore them for a few hours at a time when needed.

There are obvious things I hate about this particular product’s marketing (like the model has obviously never had a baby or has been years postpartum….) and the type of reviews left (definitely not supportive of a more health-promoting usage, more of a vanity, unrealistic type). But do I like this product? Yes.

Covid, the vaccine, and visits

With COVID, we’ve been very cautious throughout pregnancy. We don’t have to go out and interact with others, or travel, so we don’t. We chose to do this because we simply don’t know the long-term effects COVID could have on women who are pregnant or their babies. So why would we risk it? Honestly, COVID life for us wasn’t much different than our typical day-to-day (minus grocery shopping).

With the baby in the picture, we are continuing to be cautious. Babies have zero immune system, so to put him at risk for something like COVID is irresponsible in my opinion. We haven’t interacted with anyone except my brother and sister in law who graciously jumped at the chance to quarantine and come to visit him masked and my mother in law who quarantined and had a COVID test done when she came to visit for a few days from out of town.

Both our general practitioner and our pediatrician agreed that the safest option is to only allow visitors who have been fully vaccinated and have waited two weeks after the second dose for maximum efficacy PLUS being masked on top of that.

Does it suck not being able to have people meet the baby without these barriers? Yes. Some people are willing to do these things to come visit, others aren’t. It is what it is. But thankfully with technology and Facetime and shared photo albums, it’s not like we’re raising this kid in the dark.

In terms of the vaccine, we’re low on the priority list. We work from home and we have no prior illnesses that put us higher up on the risk list. So we’ll patiently wait, and know that eventually, we’ll be able to have playdates and visits. Talk about the most “better safe than sorry” scenario ever.

If you were to ask me my opinion as a health professional on the vaccine and breastfeeding, which vaccine I would prefer, etc…the data changes day by day. What we do know is many people do not have a choice of one vaccine over the other and any vaccine that’s safe is good. That includes for pregnant women and those who are breastfeeding (multiple professional bodies related to pregnancy and breastfeeding have stated this). There’s a great video series from Vox you can find online that talks about what efficacy numbers actually are with each vaccine as well as explaining mRNA vaccines.

On being purposeful with time

One of the most difficult things I’ve run into was the inability to be efficient. At first, it was impossible to get anything done. You feel like you can’t set the baby down. But you can. And you’ll learn how to maximize time even more (or if you’re not, you’ll feel the brunt of feeling like nothing is getting done and hate it).

Now that we’re actually on a schedule, I know I can have 1-1/2 to 2 hours of super-effective time when he’s napping, or I can have a good block of time when Chris is feeding him. Don’t half-ass working or relaxing. Just pick one and use that time you have to either recharge or get something done.

It won’t be perfect. There will be days when you really can’t do anything because the baby really just needs to be held. Accept it. Know what you want to do on days when that happens. I feel thankful we both work from home and can take these hurdles as they come.