The 4th Trimester

Le 14 mars 2019

Postpartum, the “4th Trimester”

I couldn’t think of any better introduction to this note about the postpartum period than those words from Dr Christiane Northrup (an inspiring author on women’s health). This short paragraph perfectly encapsulates how our societies tend to sadly leave new mothers in a “gap” of care and support at a time when it is most needed:

If I were running the country, I’d make sure that every postpartum woman had full-time help for cooking and cleaning for at least two months after the baby is born and that she had time for one or two naps every single day. In some traditional cultures, women with newborn babies are often cared for by their midwives, mothers or other women for two to three months after the birth of the baby. During this time, their only duties are to breast-feed, rest and recover so that they can be fully present for their new babies”. Dr Christiane Northrup, Women’s Body Women’s Wisdom- The complete Guide to Women’s Health and Wellbeing.

A period of 30-40 days of confinement is common practice in a lot of traditional cultures around the world: the mother is offered to rest in her private space, while other close relatives or professional carers look after her through massage, offerings of warm and nourishing food, look after the household for her and the logistical aspects of running a family. Ayurveda, the sister science of Yoga, and Traditional Chinese Medicine have a lot to tell us on the needs of a new mother and the essential phase of postpartum recuperation and adjustment of the physical, physiological and emotional bodies (some book references at the end of this note refer to these ancient, time-tested wisdoms). Or maybe you have heard of the adage « 5-5-5 »? (5 first days in bed with your baby- 5 days mostly on the bed mostly resting- 5 days near the bed, still mostly resting on the bed but beginning to move about just a little).The common theme of all those ancestral traditions is for the mother to rest so she can focus on her own recovery, bond with her baby and establish breastfeeding. Remember: when a new baby is born, a new mother is also born and needs as much care as her new baby.

We however have to be realistic about the sort of postpartum care we’ll be able to organize, especially when we live somewhere far from family and friends or other support network. For a myriad of reasons, including financial ones, spending a long period of rest and receiving full time attention from carers for several weeks is simply not possible for most new mamas.  All sorts of other social pressures also often lead new mothers to feel they need to go back quickly to being the woman they were before pregnancy and birth and “get on with it”, ignoring the profound changes both experiences entail. The “super mama” stereotype is too often imposed on us, and we, as women and mothers, might also need to re-learn the art of receiving for ourself. Asking for help is not always a comfortable place to be, but ultimately a deeply nourishing and loving attitude towards ourselves which our families benefit from too…

This is why considering the various options which might be available to you both from a practical and financial side will give you the best chances of navigating the challenging first months after the birth, getting as close as you can get to create space, time and the right environment for you to recover from the high demands of pregnancy, birth and postpartum recovery . For most women, including the postpartum period in the birth preparation plans is the best way to ensure that they already have a good network of people to rely on for after the birth. Once the baby is born, the demands are high and chasing up the carers you need and add stress to an already demanding time is to be avoided.

The “4th Trimester”, what’s that?

The term “4th trimester” was coined in the 1970s to describe the fact that human babies are somehow born “too early”, and that certain aspects of their life support system are still immature and will need, roughly, an extra 3 months outside the womb to mature. This often translates into a baby needing lots of care, attention, holding, skin-to-skin, feeding, etc. On the mother’s side, the demands can be huge, while she is herself going through the process of physically, physiological and emotionally transitioning between pregnancy/birth and postpartum. Hence the need (NOT the luxury!) for the mother to be “mothered”, to be given as much time as possible to rest, recover, and be supported so that her energy can go to help her baby move through this “extra” trimester as smoothy as possible.

Postnatal Depletion, which is a more recent concept, has sadly become a reality for many women, which may only be acknowledged years after the birth of their first child (yes years- up to 10 according to some specialists!). So the idea of ensuring there is a proper period of rest and recovery after birth is to be taken very seriously. Pregnancy, birth and mothering can deplete women of key nutrients (pregnancy is when it all starts), but can also feel physically and emotionally exhausting. In Ayurveda, it is said “42 days for 42 years”, meaning that the way you look after yourself in the early postpartum weeks can set you up for years of good health. A “rushed” postpartum time can lead to years of ill health.

(For a sum up on Postnatal Depletion: )

Here is a list of support organizations operating in and around Brussels. They can help create a nurturing and nourishing postpartum environment. There is also a list of tips and ideas shared by some of you on what helped them most during that crucial time, as well a some books on the postpartum period.

Please note that this list is far from being comprehensive. I have noted the organizations and practitioners which many of you have mentioned and appreciated, and those most likely to offer English as a spoken language. Let me know if there are others you would recommend, so I can keep adding options to this list and future new mothers can benefit from your personal. Experience.

Please also note that I have focused this list to the immediate postpartum period. Some of the organizations listed also offer care or activities for when you are ready to “go out” again, socialize (mother and baby groups/mama cafés etc), exercise, etc. But no rush….!

Postnatal Home-visits

(Essential! Even if you have planned a hospital birth and have been promised postnatal home visits from midwives)

Zwanger in Brussel An amazing group of dedicated independent midwives offering postnatal homevisits, regardless of where you have given birth. They’ll check on you and your baby, help with breastfeeding. Elke is also a qualified IBCL lactation consultant. It is advised to make contact with them during your pregnancy.

Wheel of Care A group of midwives and nurses offering postnatal homevisits

Au fil de la Naissance Another group of independent midwives offering postnatal homevisits.

Naissentiel A house in Etterbeek gathering various practitioners around birth and postpartum. 3 of their midwives propose postnatal home visits

Many other support services offered. Check the website.

Amala Another group of independent midwives who offer postnatal homevisits.


Doulas are birth supporters, and some also offer postnatal support to the parents.

Francophone Association of Doulas: , where you can search for a doula in your area which offers postpartum services.

Breastfeeding support

Antenatal and Baby: Run by midwife and IBCL lactation consultant Jo Everatt. Breastfeeding support (some home visits, skype calls and breastfeeding clinic near Schuman). Also organised at by Antenatal and Baby: psychotherapy, counseling, Mum, Partner and baby groups (but only once you’re ready for the socialization part).

In addition to the organisations mentioned before: La Leche League the site you can access a telephone number which will tell who to call and in which language)(also regular meetings);

BCT Brussels Childbirth Trust Breastfeeding counsellors available over the phone.

Help with practical aspects (cleaning, shopping etc):

Familiehulp- A family-support organisation providing home help. Mostly dutch-speaking but you can also request helpers in French and English.


Massage offers many therapeutic benefits, often bringing an instant feeling of relaxation, and a long term effect on the muscular system, lymphatic system, para-sympathetic system, etc. Some massage therapists will offer home visits or welcome you with your baby. Please contact the therapists to discuss:

Sylvie Bianchi



Rebozo Massage/Ritual

The rebozo ritual comes from Mexico and is traditionally offered to women during the first week after birth and then again 2 or 3 times during the first 6 months postpartum (and indeed at different times of transition a woman goes through). The ritual usually lasts a minimum of 2h30 to 3 hours and involves warm oil massage, sudation, and binding the body, especially the pelvis and abdomen with the traditional rebozo, a long woven scarf (to “close” the body after pregnancy and birth). The ritual can be deeply healing both at the physical and emotional levels.


Pascale Barthes, Midwife


Nutrition is a very important part of looking after your recovery. Remember that pregnancy is often a time when your body looses some of its minerals and vitamin storage, and rebuilding strength through food should be a priority to avoid feeling depleted.

– Why not get yourself a book of simple, wholesome recipes?

On the nutrition part, I would also suggest to visit a herbalist at the end of pregnancy and get a bag of herbal infusion specific for the postpartum period. A good herbalist will be able to prepare an appropriate mix of herbs to support the huge physiological changes of the early weeks and help sustain nourishment. (while you’re there consider also getting a mix of herbs for a stitz bath to hep with the recovery of the perineum).

– Herboristerie Sanjivani offers both ayurvedic and western herb preparations

– Desmecht

Mothers Supporting Mothers

Isolation can be a real issue for new mothers, so once you feel ready to get out and about, reach out to others. There’s nothing like getting together with other women in a supportive spirit, sharing the same concerns. There are more and more opportunities to do this in Brussels:

Zwanger in Brussel organize the Baby Boost

 Antenatal and Baby


The Mamastés

Practical Tips:

– Prepare and freeze some nutritious meals for you (and family) during the last weeks of your pregnancy for you to enjoy after the birth.

– Grocery delivery.

– Healthy meal delivery.

– Plan a “food train” or ask your partner or a good friend to organize it for you (requesting from each visitor to bring a nutritious meal (flowers and chocolates are nice but not essential at this stage).

– Indicate the “visitors etiquette” in your birth announcement;

– Prepare a playlist of guided relaxations or relaxing music for you to listen to during those long hours of breastfeeding.


Check the Newborn Mothers website, and in particular the blog. Some useful tips, meal plans etc,:


« I loved the atmosphere in your classes, spending some quiet time to bond with my growing baby and getting in tune with the sensations in my body were great preparation for the birth »