Nutrition in Pregnancy + Beyond: The Fourth Trimester

The Fourth Trimester (also known as: wait, I thought pregnancy ended after the third trimester)

The term "fourth trimester" was coined to describe the first few months of the baby's life outside the womb.  It's that time when your baby is no longer physically attached to you, but basically still attached to you.  While I haven't hit that point in my second pregnancy, I feel like it's the time I remember most vividly from my first.  

So here's a quick story of the birth + following weeks with my first child:  41.5 weeks + still pregnant, induction, lost baby's heartbeat, emergency c-section, baby arrives (joy!), why can't I breastfeed (tears), all the lactation consultants, mastitis, oh so tired, but oh so in love!  Needless to say, it was a whirlwind of emotions (as I imagine most, if not all, birth experiences are!).  Here's where I struggled along with strategies for a happy + healthy fourth trimester.   

THE ISSUES*

1. "Where's my milk?" [waits a few days] "Alert! Milk overload!"  I went from being told at the hospital that I'd likely need to supplement with formula because I simply wasn't producing enough milk to a few days later producing so much (and encountering a few other breastfeeding issues) that I ended up with mastitis.  Yes, breastfeeding is natural, but that doesn't mean that it comes naturally for you or the baby.  I relied heavily on lactation consultants, experienced mamas, and a few extra doctor's visits to find a way forward that worked best for me and the baby.  The most important takeaway:  your worth, value, and competency as a mother are not defined by your ability to or the ease with which you breastfeed!     

2. "In the battle of sleep versus food, sleep wins."  With the baby's arrival, the idea of mindful eating switched from being present and focused on hunger cues during meals to merely being mindful that I actually ate.  Many days food wouldn't even cross my mind until lunchtime (and for a person who can tell the time of day by hunger cues, this was a big shift!).  I'd end up ravenous, reaching for the quickest "meal" I could make (does a handful of nuts + a scoop of ice cream count as a meal?).  

3. "So, do I just eat with one hand for the rest of my life, or how does this work?" Yup, and good luck (just kidding!).  Two-handed meals return rather quickly (although I still deal with the occasional one-handed meal along with the more common try-to-eat-while-entertaining-a-toddler meal).  But for the first few months, meal prep + meal devouring often occurred with baby in hand, carrier, or at least nearby.  And nothing wakes a sleeping baby like the blender blasting on high! 

4. "I'm going to teach you to get out of the house."  The most valuable sentence I heard post-pregnancy.  Seriously.  Packing the bag, safely wearing/walking/driving with the baby, breastfeeding on the go...it all felt overwhelming to the point that it was just easier to stay home.  Cue serious isolation.  Learning a few tricks proved helpful in easing my mind, simplifying the process, and providing much-needed fresh air + activity.  

THE STRATEGIES  

At a recent seminar on the 4th trimester, the speaker jokingly proposed the development of a postpartum eden for mama + baby - with access to nutritious one-handed meals, all the baby gear you could get your hands on, relaxing massages, exercise classes, sleep specialists - the works!  I could definitely get on board with that, but in the meantime, here are a few strategies I plan to use in the upcoming months to improve postpartum self-care.**

On breastfeeding:  While I studied breastfeeding (the science, the techniques, the challenges) in both the community health and clinical setting, I felt defeated when attempting with my own child.  With a c-section, latch issues, and trouble regulating milk production, I struggled physically and emotionally during those first few weeks. Here are a few strategies to ease the transition and to assist in milk production.

  1. Ask for help! Call the nurses into your room, schedule appointments with lactation consultants, and reach out to friends and family who will be open + honest about their breastfeeding experiences.  Push that ego aside (I had to!) and take all the tips you can get (especially from the experts!) - you never know which ones will stick.  
  2. Try to relax and remain flexible.  Remember there are safe ways to feed your baby that don't require breastfeeding.  Putting pressure on yourself to "succeed" at breastfeeding can add extra stress that you definitely don't need with a newborn.  Sure, take steps to reach your goals, but try not to let the outcome define your worth.
  3. If you do breastfeed, recognize that your energy needs will remain elevated from pre-pregnancy needs (by roughly 400-500 calories per day).  As you begin to focus on postpartum weight loss, maintain a caloric intake of at least 1500-1800 calories per day to help keep the milk flowing (and to lose those lbs at a safe + maintainable rate).  Try to incorporate lactation promoting foods such as oats and flaxseeds while following a healthy diet (fruits, veggies, seafood, lean meats, nuts, whole grains) and staying hydrated.  Speaking of hydration, you can reintroduce alcohol and caffeine as a nursing mother, but be wary of timing and amounts as both can enter your milk.  Enjoying an alcoholic drink immediately after nursing usually allows enough time to safely feed again with the next 1.5-2 hours.  If you want to indulge in beer, wine, or a cocktail but are worried about alcohol within your breastmilk, purchase a few alcohol test strips to provide confirmation that your milk is safe for the baby to consume.  

On eating:  As the mother of a newborn, you have lots on your mind, and eating doesn't always take priority.  Simplify the process by stocking your fridge with fruits, vegetables, yogurt, eggs, milk (or a milk alternative) and other healthy yet minimal-to-no prep options.  Keep the pantry loaded with oats, nut butter, nuts, seeds, high fiber cereal + crackers, sprouted whole grain bread, and legume-based pasta.  If you're on top of your game (go mama!), spend time in your third trimester making freezer meals that you can later reheat.  If not (full disclosure: I was/am in this category), take advantage of a slow cooker, especially when trying to incorporate more protein in your diet.  A quick breakfast can include eggs with fruit + veggies, a fruit + yogurt parfait made with high fiber cereal, or a protein-packed smoothie (which may require moving the blender to a far corner of your house to avoid waking the baby!).  I like to toss protein powder into my smoothies, but Greek yogurt + peanut butter work well too to get that extra protein boost.  Breakfast foods work well for lunch and dinner too, or you can make a hearty sandwich, toss shredded chicken (from your slow cooker!) on top of a salad, or throw on a pot of legume-based pasta (which is high in both fiber and protein).     

On mobilizing:  In the first couple weeks postpartum, I lacked the confidence that I could soothe a crying baby in public or breastfeed in public or basically do anything baby-related in public.  Thankfully, an experienced mother (my sister!) showed me the ropes, and helped me avoid spending months as a hermit.  Step 1 involved streamlining the diaper bag to only include a couple diapers, wipes, a blanket, and a change of clothes for most ventures out of the house (thus significantly reducing the weight of the bag!).  Step 2 included a lesson in the many uses of swaddle blankets (shield the sun, use as a nursing cover, clean up unexpected spit up!).  And step 3 was to JUST DO IT!  Worst case, you cut your outing short and head back home.  Two of my favorite ways to get out of the house included going for daily walks and beating the crowds with an early dinner out.  Both provided ways to nourish my body and needs through exercise and healthy eats without requiring too much commitment or pressure.  Initially, I timed outings around feedings, but eventually grew more comfortable doing it all in public.  Progress at your own pace, but try to schedule at least one daily outing with you and the baby.  Engaging in (light) exercise, treating yourself to a meal (without prep or cleanup!), or window shopping can all be relaxing + low-key options for getting out of the house.    

To those in the fourth trimester, congratulations, mama!  Your life has forever changed, but you will eventually sleep, eat, and exercise on a more regular basis.  Enjoy the precious time with your little one(s) and remember to take care of yourself too! 

Side notes:

*I recognize how blessed I am to experience two healthy pregnancies. While pregnancy comes with challenges in many forms, those that I faced were absolutely minor and pale in comparison to the joys associated with becoming a mother.  

**As a dietitian, I work to employ evidence-based nutrition practices while recognizing and understanding the unique circumstances of the individual.  If you're interested in personalized prenatal or postpartum nutrition services, please contact me