The Later Postpartum

CW: Mental health, Suicide

Mental Health resources at the bottom of the blog. 

Can we get rid of the term 4th trimester? Or at very least go beyond it?! The concept of “the fourth trimester” has dominated the postpartum conversation for the past several years when in fact it is as limiting and problematic as a 6 week check up marker. The only science based reason to label a time period of 12 weeks, that we can think of, is that babies tend to make melatonin independently around 12 weeks, which can coincide, not always, with neurological developments that can support babies ability to regulate somewhat better independently. 

What about the postpartum person? They too exist.

Healing is long. Bodies need time. How can we redefine postpartum healing timelines to truly be trauma informed and person centered in our models of care? As people who work closely, in home with postpartum people long after 12 weeks, we can say that most people are still unravelling their birth story, finding their parenting sea legs, healing their pelvic floors, repleting nutrient stores and figuring out who the hell they are now throughout the 1st year and beyond. If this trend is so apparent, it must be normal. Another trend that is common is that postpartum people feel pressure to acclimate and “get back” to some physical, emotional, logistical, relational and personal state of being on an imaginary time line imposed by the medical industrial complex (money and time management based, not evidence based) and the parenting product and services industrial complex (money and popularity based, not trauma informed or educationally based). Imposing a timeline increases stigmas that block care and harm postpartum people. 

Our first postpartum doula training and certification process was through a very popular training body in North America. While we loved our trainer/mentor we did not jive with the certification standards and protocols. One of the clients who was part of my certification experience needed care beyond 12 weeks. She was suffering from a complex perinatal mood and anxiety disorder that even with a team of professionals and financial resources to access care was very difficult to come out of. She says to this day that adding postpartum doula care to the team (I joined her at 6 weeks postpartum when she was in the deepest suffering) was what galvanized the rings of support enabling healing to happen. And yet, according to my certifying body my person centered trauma informed care was potentially invalidating my certification? I was actively being told that I should drop this person at the curb if I wanted to “count” this service experience in certification. This is systemic harm within the birth work world. 

Postpartum doula care at 15 weeks postpartum is valid. 

Postpartum doula care at 15 months postpartum is valid. 

A postpartum doula can turn up to my house any day any time for the rest of my life, thank you very much. 

Postpartum is a continuum.

The maternal mortality index includes 365 days postpartum. We are not talking about that. People are dying in their home from preventable, treatable complications following birth. People are dying because we stop checking in, we assume okayness based off of a cute IG post or just straight up forget or minimize what they are going through. We need to be accountable to postpartum people in our communities beyond newborn snuggles, a onesie or a casserole. We need to be accountable to postpartum people within medical care’s perinatal services beyond a convenience based timeline, care behind a paywall, or a branded package that cuts off care and drops folks at the curb. 

Suicide accounts for 20% of postpartum deaths and latest numbers show that the highest risk for postpartum suicide is between 9-12 months postpartum. This is completely unsurprising to us from our personal lived experiences and from our professional gathered experiences observing and supporting hundreds of postpartum families over the last 8 years. Who is regularly checking on parents 9-12 months postpartum? No one. Which postpartum person feels totally empowered to seek perinatal mental health support if a postpartum mood disorder strikes or suddenly escalates at 9-12 months postpartum? Very very few people. 

Bounce back culture goes beyond pilates pressure and trendy breastfeeding clothing. It cuts to the core of all of our greatest insecurities as people and parents “I should have it together by now” and for some, fear of systemic discrimination and involving social services if they even seek supports at all. You are not wrong to feel this, why wouldn’t you when the messaging is everywhere, from your care provider to your Great Aunt Susan, to the stranger at the grocery store - the vibe is “stay hidden til you can need less”. 

Fuck that. 

If you need a permission slip to start healing your prolapse, your emotional landscape, your birth story trauma, your sleep cycles, your relationship, your sense of self, your iron stores, ANYTHING that connects to your transition to parenthood - consider it granted! Whether you had a baby 3 weeks, 3 months, 3 years or 3 decades ago you are in fact… still postpartum. Post means after and partum means delivery… your Mom is still postpartum. Your Grandma is still postpartum. And they could probably use some broth, a foot rub and some deep reflective listening space to be witnessed and uplifted too.

Where are you in your postpartum healing continuum? 

If you are struggling with your mental health here are some resources for you here.