The Fourth Trimester

As I await the arrival of my second baby, I’m doing what I can to prepare for the postpartum period. With our first baby, labor and birth itself occupied most of my thoughts. But this time, I am also thinking about how I can be supported in the days following birth.

One of the books I read on this topic is called “The Fourth Trimester,” by Kimberly Ann Johnson. In this book, Johnson writes about her own struggles postpartum, and her healing journey that took her from Brazil to Thailand and beyond to learn the ways that women are cared for in traditional cultures around the globe.

Though specific rituals and traditions differ, Johnson identified five universal postpartum needs. These are an extended period of rest, nourishing food, loving touch, the presence of women and spiritual companionship, and contact with nature.

I also read another book called “The First Forty Days,” by Heng Ou, who comes from a line of healers who practice traditional Chinese medicine, acupuncture and herbalism. She also defined five common themes amongst traditional postpartum care practices. Her list is, similarly, retreat, warmth, support, rest and ritual.

All around the world, new mothers are expected to rest for a period after giving birth. In most places, this ranges from twenty to sixty days. Both books write about the Chinese tradition called “zuo yuezi,” which is sometimes defined as “sitting the month” or “confinement.” Ou chooses the word “retreat” rather than “confinement,” but intends to encourage women to remain inside with their babies as long as they are able, keeping activity levels low rather than rushing out into the world with their babes. In both Chinese medicine and Ayurveda, the ancient medicine of India, the belief is that a mother resting postpartum leads to long-term health: Johnson writes, “Ayurveda says 42 days for 42 years. In other words, how you’re cared for in those 42 days can set you up for a lifetime of great health and you can even heal prior lifelong illnesses during that liminal space because it’s such a transparent window.”

Ou’s “warmth” and Johnson’s “nourishing food” go hand in hand. Both write of the importance of eating warm, nourishing meals after giving birth. Across the globe, women have traditionally been fed foods that are warm, easy to digest, mineral rich, and collagen dense. Ou has more of a food focus in her book and shares many recipes, including a simple rice porridge called congee, homemade fried rice — a traditional first postpartum food in Chinese families, and many warming soups ranging from sausage stew to more traditional egg-drop soup with liver and greens. Ou clearly specifies that the postpartum woman should eat soft foods and healthy fats, and avoid any cold foods and drinks, as this can lead to a slow digestive system as well as stagnating “the circulation of blood necessary for returning the womb and reproductive system to a healthy, nonpregnant state.”

Both agree that support from other women is critical. In times past, this was a given, as women in the community gathered around a postpartum woman to help with food, childcare, massage, cleaning, and anything else the new mother might need. Today, as so many of our lives feel busy and stretched too thin, this is less common. Johnson recommends building a “postpartum sanctuary plan” similarly to the way in which many women write a birth plan. Plan to need more help than you think you’ll need, and get creative about where you might find that help. Meal trains ( are a way that a simple schedule can be set up online to organize friends and family members who want to bring food to new parents. Ask for help from friends and family, and tell them what you want and need.

Ritual and loving touch both acknowledge the new mother in a period of time when most people want to hold and see the baby. In traditional cultures, the birth of a child was a rite of passage for the mother and was meant to be celebrated. Both authors encourage massage or foot rubs, or simply acknowledging the massive transition that a woman has undergone to become a mother, whether it is her first baby or her fifth.

Of course, this list of needs may seem luxurious to some people, especially in a country where there is no paid maternity leave. I was lucky to have my husband moving into his slower work season when I had my daughter, and he cooked, cleaned, worked and more as I struggled physically postpartum. This time, our baby is due as the farm work starts to build, and so, taking advice from these wise authors, I have enlisted friends and hired a postpartum doula to help care for me, so that I can care for my children. The collagen-rich chicken broth we recently canned and the soups I have frozen will be a start. But as much as I feel like a modern, independent woman, I’m delving deep into older times as I become a mother again, and I hope to encourage other women to do the same.

Lindsay Courcelle, CMT is a myofascial release therapist, part-time vegetable farmer, and natural-health advocate. Email her at


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