Thoughts on the Fourth Trimester

Here we are at 11 weeks postpartum and almost at the end of the fourth trimester. What happened to time?!

The postpartum period following Teddy’s birth has been quite different than the postpartum following my firstborn, Caleb. I am really thankful for Teddy’s birth – it truly was just as I had hoped and an answer to many, many prayers. In fact, it was so smooth it felt too good to be true. I knew there had to be some bumps in my future – that’s not how birth and life work, but birth and life also are not a bump-less ride.

Overall, I’m really satisfied (if that’s the right word?) with how I navigated this postpartum experience and actually rested and unplugged from the outside world. I really wanted to be able to slow down, accept help and detach from technology. In essence, to cocoon myself with just my family, our close community here and this sweet, tiny baby who just entered the world.

I wasn’t perfect and there were a few times where I downloaded the IG app again and then after mindlessly scrolling while nursing for a day or two, I realized, “yea, I don’t want to be doing this…” and would delete it again. And there was that one time where Nick came downstairs and I was vacuuming during nap time and he was like, “umm, what are you doing?” and then my pelvic floor was sore for the next 3 days. I didn’t get back into cooking & house stuff until almost 6 weeks postpartum. But that was only possible because of Nick being so supportive, our amazing friends here, my selfless mama and Nick’s wonderful parents. I know not every mama has access to these resources and support and that leaves me feeling both really thankful for what I do have and sad for what other mamas lack. Postpartum support is a whole other conversation for another day.

Physically

Since I was lucky enough to not tear this time around (I had a second degree tear with my first birth that required stitches) my bleeding stopped after a few weeks and as a whole, my vagina/perineal area healed up quickly and well. Cheers. The better indicator for me of if I was pushing too hard and needed to slow down (ex: stop picking up Cal as often, dial back on the walking, take a break from babywearing etc) was how my pelvic floor was feeling. I could easily tell when it was feeling tired and needed a break. I 10000% attribute not having long term pelvic floor issues following Cal’s birth with pelvic floor PT so I have already began that this time around with the hope of healing well and avoiding long term problems following this birth. Between PT and doing the Momma Strong postpartum videos, I’m feeling like I have some direction and intention this time around vs feeling like I’m guessing on how to care for myself best and that feels good – because most of my days as a mom of two feel like I’m winging it. 

Emotionally 

Woah. This is an area where I had unmet expectations. I’ve mulled around with whether or not to share publicly my experience because 1) it’s vulnerable and 2) the experience doesn’t just involve me – it involves my family and my babies. But, I hadn’t really heard moms in my life share thoughts/feelings that were similar to what I felt postpartum and once I started sharing (the more I shared my honest thoughts, the more free I felt with accepting them) so many moms would say, me too. So my hope in sharing is that if you’ve had a similar experience, you know you’re not alone.

Following Cal’s birth, I cried off and on that first week. But it wasn’t because I was sad or grieving our old life – it was like the love and joy I had for him was so insanely intense I didn’t know how else to release those feelings except to cry. They were so strong it almost physically hurt my heart to feel that deeply. With Teddy, I had that post-birth euphoria right after he was born, but I didn’t feel the same magnetic, intense, instant bond that I did with Cal and that felt scary for me. Having Cal meet Teddy for the first time didn’t bring me to tears because I was so happy and full of joy. Instead, I was brought to tears as I hugged Cal and looked at Teddy because I was so concerned with how Cal was feeling. Did he think I had replaced him? Did he feel less loved? How did he feel about this big change that just happened? Was he going to be okay?

A close mama friend of mine (who I know always understands me) sent me this quote after I called her crying that first day about of how I was feeling. This is exactly how I felt.

I knew I loved Teddy, there was no doubt there. But this love was different. And realizing that I no longer could devote all my attention and care to one child had me feeling all kinds of conflicting emotions I hadn’t yet experienced in motherhood. I can, for better or worse, become very hyperfocused on Cal’s (and soon to be Teddy’s I’m sure) emotional health. The idea that he could feel anything less than deep, unconditional love – that he could for one second feel like he lost any part of my love by having another baby join our family absolutely crushed me.

With Cal, loving & bonding with him felt like ripping three shots in a row at a frat house. Drunk, immediately. With Teddy, it has been like opening a bottle of red wine and really enjoying it. Drinking a sip or two and then letting it breathe for a bit in between sips. And then after a few glasses of a thick, juicy red you realize, yep….feeling drunk. I love them both, but the way I love them is different. What was fear in that first week of not loving and bonding with Teddy like I did Cal, is now so far gone. As I sit here editing this post from my phone with a sleeping 10 week old on my chest, I feel so bonded and in love with this sweet baby it brings me to tears. We just needed some time.

I now realize that I will never love Teddy like I love Cal. And I will never love Cal like I love Teddy. I don’t love one more than the other and I don’t love them the same, but I do love each of them uniquely. They each hold a special, separate place in my heart.

After the rollercoaster of that first week, I really started to level off and I stopped crying several times a day. I had many moments during that first week where I grieved our old life as a family of three – but in retrospect, I’m realizing that it wasn’t our life per say I was grieving, but rather not having to feel the harsh reality of my human limitations. With one kid, I could meet all his needs (within reason) and give him my full attention. With two though, I cannot. I cannot be all the things all the time. Motherhood feels 4x harder. That has been really humbling. 

And my placenta pills came on day six so there’s that. There is pretty much no solid evidence on encapsulating your placenta so I don’t have data for you, but with my n=2 I swear by it. Throw in some placebo effect with those placenta pills and I was feeling so much more leveled out by week two.

Breastfeeding 

I was really thankful for an overall, rather seamless breastfeeding journey with Cal. When my supply dropped mid pregnancy he kept on nursing up until the third trimester when my colostrum came in and he didn’t like that and self weaned. I felt at peace about it, it felt natural. And while I would have loved to tandem feed, when Teddy was born and Cal saw him nursing that did the opposite of making him want to nurse again haha. So up until the end of pregnancy he drank a combination of Ripple milk, then A2 cow’s milk when we trialed him back onto dairy (he’s now totally over his dairy allergy thank God!) and the frozen breastmilk I still had in our freezer. Once my milk came in after Teddy was born, I starting catching milk in the haakaa and down the road started pumping in the morning after Teddy ate so Cal could drink that breast milk out of a cup. Some people think that’s weird, but I’m all about him drinking breastmilk in any form until he’s at least two.

Teddy got thrush within the first week or so of his life. I’m not sure what tipped it off because I’ve been GBS negative with both pregnancies and thankfully haven’t had a reason to take antibiotics in what must be 10+ years. So who knows, be he had it. A mild case, but still…thrush. And if you’ve had to deal with thrush before, you know it doesn’t go down without a fight. Thankfully, I wasn’t symptomatic and Teddy didn’t feel irritated by it. He latched well from the beginning and loved the boob. But because of the thrush, I didn’t want to give him a pacifier until it cleared because then I’d have to be constantly sterilizing pacifiers and I didn’t have time or energy for that. So my boob was his pacifier.

Between catching milk (and then eventually pumping) for Cal plus Teddy constantly sucking (and just my own body/genetics/hormones) I ended up with a mega oversupply. Which sounds like a great problem to have, but in reality is not at all. Milk was everywhere. My boobs were always full and uncomfortable. And Teddy was being pummeled with milk, guzzling to where he was then having huge, waterfall like spit ups and was fussy all the time until he was upright in a wrap or carrier and attached to me. He was also gaining weight at RAPID speed. At his one month appointment (at 5 weeks old) he was up from 7 lbs 5 oz at birth (he initially dropped down to 6 lbs 14 oz) to 11 lbs 10 oz – almost a pound a week! If he was gaining like that and happy I wouldn’t have thought anything about it, but he was not happy. Throw in a few frothy green poops and I knew this wasn’t normal. After hours of research and consulting an IBCLC friend, we started block feeding, I quit the haakaa and pump altogether and within a few days he was SO much happier, my boobs were so much more comfy and his weight gained leveled off closer to average. Now, weeks later, I have just begun to add in a morning pump again if my boobs are full, but have stopped using the haakaa altogether and seems to be keeping my supply manageable. **It goes without saying, but this is just what worked for me. Please consult an IBCLC if you’re having breastfeeding issues so you can figure out what will work for you and your baby.

Along with the oversupply & thrush, Teddy also had a yeast diaper rash which was a whole other animal to deal with. Because I researched for hours on how to deal with the thrush and yeast diaper rash, I’ll share what worked for us here, although this is not medical advice. And full disclosure, I did not scour PubMed for journal articles. This was mom-googling because I was tired and desperate and did not have the time or mental capacity to read research. I didn’t pick up the nystatin prescription for Teddy because I knew from my nursing practice it wasn’t that effective and can have nasty GI side effects. I know it works well for some babies, but I wanted to hold off for a bit. So I gave other things a try first. When it comes to alternative therapies, I do think that even if something doesn’t have robust research behind it, in many cases if the chance of harm is super low or pretty much non-existent I think it never hurts to try. So here’s what we did:

For the thrush I started taking a probiotic with acidophilus in it and gave Teddy these infant probiotics. Then after each nursing session, I swabbed his mouth with coconut oil using a q-tip and then after letting my nipples air dry, wiped them with apple cider vinegar diluted in water (1 tbsp in 8 oz water) followed by coconut oil. I also just walked around topless a lot because yeast thrive in dark, warm environments so sunlight and airflow are key. Nick was constantly pulling the blinds down in our house and on our porch lol.

For his diaper rash, I started with changing his diaper as often as I could (which was almost hourly if he wasn’t sleeping) and let his bum air dry or I used a blow dryer on the cool setting during the nighttime. Yes I was blow drying his bum several times a night. It was as exhausting as it sounds. After it air dried I wiped it with the apple cider vinegar dilution followed by lathering his whole bum in coconut oil. After a week or so it was kind of working, but not like I hoped. So I did some more mom-googling and came across amazing reviews for this diaper balm. I already was using the same brand of nipple cream so trusted this brand. WOW. This diaper cream really nipped it right in the bud. Within 48 hours it was significantly better and within a week totally clear. I have continued to use it as our everyday cream. It’s pricey, but worth every penny to not have to deal with the yeasty beasties.

Dealing with the thrush and diaper rash felt like a part-time job because it added so many steps to an already time intensive process of feeding and diapering a newborn – and preventing Cal from jumping off every piece of furniture while I did that was a job in and of itself. Thank goodness for a fenced in backyard. 

Newborn Metabolic Screen

Teddy’s metabolic screen had a positive screen for MSP-1. Every baby gets a newborn metabolic screen unless you opt out, but most of the time it’s negative. But sometimes, you get a positive. The thing is, there is such a high false positive rate and the more I’ve researched the more I’m finding that this is actually a huge conundrum with the screen because it adds a lot of parental distress during the vulnerable postpartum period when you could have a perfectly healthy baby because it’s just that, a screen, not a diagnostic test. But on the flip side, they would never want to not catch one of these metabolic diseases in a baby because most of them, if not caught early, can lead to devastating effects, including death. So the screen can be incredibly life saving.

Nick and I found a 2020 well designed research paper on screening for MSP-1 and learned it has one of the highest false positive rates. Only 0.5% to 1% of babies who screen positive actually have MSP-1. While that was and is reassuring, you still don’t want your baby to be in that 1%. MSP-1 is not a genetic disease you’d ever want your child to have. It has certainly been a test of faith for me and us. A journey I’m so grateful we have had because it has grown me in ways I needed. We are in the second stage of the testing process and so far it is looking like he is likely a carrier and does not actually have the disease. The people at UVA Genetics have been amazing and we are thankful that so far, things are looking positive and hopeful.

So between the thrush, yeast rash, oversupply issue, metabolic screen and my grandma passing away when Teddy was six weeks old it was an up and down postpartum. But I’m coming out of the fourth trimester feeling really grateful, happy, only semi-exhausted and humbled, yet (mostly) confident in my ability to manage the insanely sanctifying chaos that is mothering two under two.