fourth trimester

Interview with Kathleen Murphy from MamaCare

Kathleen Murphy is a Naturopath, Acupuncturist and mother based in Sydney. She runs the amazing MamaCare and we wanted to chat to her about all things the fourth trimester.

In traditional cultures the 4th trimester is a normal progression after a new baby is born. How important is this wonderful and special time for a new mother and her baby?

The fourth trimester is incredibly important! I cannot say it enough… and I say it a lot. I think it deserves just as much attention as preconception and pregnancy health, labour and birth preparation. The period after birth is hugely important and a significant transition for any new mother – physically, emotionally, spiritually – regardless of if it’s her first baby or she’s had many before. Whether that new mother is aware of it or not, she is mentally, physically and emotionally engaged in extremely important work during this period.

In many different traditions, around the world, the importance of the fourth trimester is understood and the period following pregnancy and birth is honoured as a special time for the mother herself: a transition. In many cultures, women are not expected to carry on their normal lives, there is no pressure to ‘snap back’ to where they were before. Instead, they are recognised and respected for the changes they’ve undergone and journey they are beginning.

Take physical healing, for example. A woman’s body goes through significant change over the course of pregnancy, a gradual process over the course of roughly 40 weeks. During and after birth, she again experiences a seismic physical shift, but in a much (much!) shorter space of time. Unsurprisingly, this new mother’s body needs to recover and there is a process of physical healing required, whether she has a smooth and relatively easy birth or high-level intervention.

Emotional wellbeing is another extremely important area to address. The emotions experienced following the birth of a child can be intense and overwhelming. There is also a huge fluctuation in hormone levels immediately following birth, with the onset of breastfeeding, and the weeks that follow which can leave new mothers feeling vulnerable, emotional and fatigued.

Understanding this transition, recognising the importance of the fourth trimester, and providing the right support during this time, allows a new mother to adapt and thrive. It facilitates strong bonding with her baby. It supports her other significant relationships, with her partner and family. Honouring the fourth trimester serves not only the new mother but also her baby and her community.

The 4th trimester is not very well known in our modern day society. Why or how do you think this happened?

Look, lots of reasons I think.

I think a big part of it is that, these days, most of us live outside of close-knit family or friendship communities and lack the ‘village’ support that is essential during major life events… including the weeks and months following the arrival of a newborn. And the many years beyond that, it must be said!

Also, many of us, particularly in the urban environment in which I live and work, are having fewer children and doing so later in life. So, we don’t regularly see close friends or family going through pregnancy and birth, having babies and raising children. For many people I speak to, one of the first babies they ever hold is their own. How incredible is that! As such, we have no model to follow when it comes to caring for ourselves and others during this huge life transition

There is also the issue around the medicalisation of pregnancy and birth; viewing them as a health conditions requiring treatment and management rather than natural life processes. But that’s a whole other conversation!

I am heartened, however, to observe and be part of a discussion that is getting larger and louder about the importance of postpartum care and the fourth trimester. Let’s bring it back!

Can you tell us a little about your personal experience in your 4th trimester?

I had a beautiful fourth trimester.

My husband and I live 1000s of kilometres from our family and closest friends, so I knew we’d need to call in help and support in the weeks after giving birth. Happily, my husband was able to take several weeks leave from the time I went into labour. We also arranged for our parents (first mine, then my mother-in-law) to stay and help during the first four weeks after my daughters’ birth. I understand this arrangement wouldn’t work for everyone, but we are lucky to have an excellent relationship with both sets of parents. We’d also talked to them about it in advance, our needs and expectations, so everyone was on the same page about the purpose of their visits i.e. to support me and my husband… rather than just drink cups of tea and hold the baby (though we did plenty of that too!) We also hired a doula for labour and birth support, and her follow up in the weeks afterward was a wonderful support.

I put an embargo on visitors, first to the hospital and then to home, for the first few weeks as I wanted to stay in the newborn bubble as long as I could… to let myself heal, bond with my new baby and find our rhythm as a family.

I had also stocked the freezer and pantry with my favourite nutrient-dense, yummy foods. I also requested meals from the few close friends and family who visited in the first month – something we could share together when they visited and, again, discussed in advance, so it didn’t feel like an imposition. As such, for the first month, we ate delicious healing mama-nurturing foods without doing much cooking or prep-work at all. It was awesome!

I took herbal medicines and some nutritional supplements to support my energy, balance hormones and promote healing. I ended up having an unexpectedly large amount of intervention in my daughter’s birth, so healing (physically and emotionally) was a big priority.

An unusual end to my fourth trimester culminated in us moving to the other side of the world for six months. We flew out of Sydney when my daughter was just two months old. At the time, I felt physically and emotionally strong, confident with my baby and undaunted by this big change, which I attribute to an extremely well-supported and nourished transition into motherhood. This is something I wish for all women, whether its their first or subsequent baby. And certainly, something I plan to replicate with our next child!

You are an accomplished Naturopath and Acupuncturist. Can you tell us about your role at Mamacare and how it started?

I’ve always worked with preconception and pregnancy care and understood the importance of good health and support after birth but didn’t really get the concept of a fourth trimester or how crucial this period can be for new mothers.

Quite self-centredly, it was my own pregnancy and the birth of my daughter that made apparent to me the importance of this transition. At this time, I was talking to a good friend of mine who was also expecting her first child and our conversation turned to what resources we had found, were using, recommended to others, etc. She mentioned that there was so much (an avalanche in fact) of information on how to take care of yourself during pregnancy and how to prepare for birthing, but very little (almost nothing) on what to do afterward. This was a real light-bulb moment for me! I consider that otherwise casual conversation the start of MamaCare.

From there, I started looking into services and resources, thinking about out how best to approach this, I spoke to practitioners and researchers in the field of maternal and integrative health… and eventually got a small business up and running, at the start of last year, alongside my clinical practice.

What is Mamacare? And what services do you offer?

MamaCare is an in-home health service that provides health checks, physical treatments, postpartum resource pack, tailored nutritional and herbal advice, a support email and phone line.

I visit women in their house before and after birth to check in and perform a regular health review. This includes a general health assessment and specific pre- or postpartum review, tailored health recommendations, discussion around a woman’s feelings about the birth and new motherhood, assessment of birth recovery, breastfeeding, newborn health, etc. I may also incorporate physical treatments such as acupuncture, massage and moxibustion (a Traditional Chinese Medicine warming treatment). When other family members are present (e.g. partner, parents, other children) they may be involved in the consultation and are encouraged to take an active role in supporting a new mother’s health and that of the newborn.

Depending on what we decide beforehand, I may visit just a couple of times or up to every week throughout the fourth trimester. Some women have me see them at home initially then move appointments over to the clinic as they start to feel stronger and ready to get out for longer periods of time.

I also work with other clinicians managing these women’s health before and after the birth – including obstetrician, midwife, doula, GP or lactation consultant – in order to make the experience as collaborative and beneficial as possible.

What positives have you seen since working with mothers in the important 4th trimester period? What feedback have you received?

One of the biggest positives to come out of this that I have experienced, is the value and appreciation mothers feel from having someone solely focused on their needs and wellbeing. I’ve heard this a few times now: how good it is to have someone focus on the new mother herself: to help her heal, ensuring she feels well and supported.

There are also the small but significant rewards of helping to relieve back pain or abdominal cramping, supporting breastfeeding or balancing mood. Seemingly ‘normal’ clinical stuff, but which is often overlooked or goes unchecked for new mothers who aren’t able to get into the clinic to have these things seen to. As such, I bring the clinic – and the support – to them!

Where can we find you?

I’m based in Sydney, with a clinic in Pyrmont and home visits are mostly around the Inner West and Eastern Suburbs. I have travelled further, including interstate, for some extra-special new mothers. But for the most part, I am in and around Sydney.

The website is: http://mamacarehealth.com.au/

Facebook page is: https://www.facebook.com/mamacarehealth/

Instagram is: https://www.instagram.com/mamacarehealth/

Kathleen Murphy from Mamacare. Image by Angelica Sotelo photography.

Kathleen Murphy from Mamacare. Image by Angelica Sotelo photography.

Post Natal Depletion Q&A with Dr Camilla White

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Q: Mother, Integrative Doctor, Health Coach......You’ve got some pretty impressive credentials, can you tell us a bit about yourself and what inspired you to get to where you are today?

A: I’m mother to Evie who is 4 and Banjo who is 2 and we moved to Byron a few years ago. It’s always been a dream of mine to live up here and we love the outdoor lifestyle and natural beauty as well as all the inspiring friends we’ve met. I have a background in emergency medicine but I’ve always been interested in nutrition, holistic health, yoga and meditation. After my second child was born and my marriage broke down, I suffered from severe hospital fatigue and burn out. That difficult time luckily led me to a wonderful job in Integrative medicine where I work with inspiring doctors alongside wonderful naturopaths, acupuncturists, traditional Chinese medicine practitioners and other skilled therapists. I have a special interest in women’s health and postnatal care and after reading about the work Dr Oscar Serrallach was doing, I was keen to get involved. 

Q: Since working at the Health Lodge in Byron Bay, you’ve become a pioneer in women’s health. Can you tell us a bit about post natal depletion and what you see in clinical practice?

A: Post natal depletion is very common in clinical practice but not normal and not widely recognized. There’s very few texts written about it. Post natal depletion is a very understandable outcome of a series of less than ideal events leading to depletion at multiple levels of a woman’s wellbeing. The postnatal depletion period can last up to 10 years after the baby is born. Postnatal depletion is a syndrome with a constellation of symptoms that arise from physiological issues, hormonal issues, and interruption of the circadian rhythm, layered with psychological, mental and emotional components. Some of the factors that contribute to postnatal depletion are that modern women are having children later in life and we go into motherhood already close to the maximum capacity of what our bodies can handle. Western society does a poor job of preparing modern women for motherhood, we are all stressed and overwhelmed with choices and multiple responsibilities in a fast paced society. Throw into the mix pregnancy, birth and breastfeeding and add a little sleep deprivation, nutritional insufficiencies, environmental toxins and lack of social support and you have a recipe for postnatal depletion. In clinic, I see Mothers who are exhausted, overwhelmed, stressed, anxious and having difficulty coping with something they’ve been led to believe would or should come naturally to them.

Q:What symptoms should women (and partners) be looking out for so Post Natal Depletion doesn’t go undiagnosed?

A: Some of the symptoms of postnatal depletion include baby brain, fatigue (often debilitating), insomnia or disturbed sleep, weight or hormonal issues, loss of skin elasticity, skin dryness, softer nails and thinning hair. Partners could look out for mothers who are seemingly constantly stressed or overwhelmed, sensitive to light and sound, overly emotional - I’m sure we can all relate! If you have most or all of these symptoms, you are not alone. If you are also able to experience joy and anticipation at times, then chances are you aren’t depressed - you’re just depleted.

Q: Working with lots of women have you seen an increase in Post Natal Depletion? Do you think there is a rise in incidence or is it a case of newly recognised rather than a new condition.

A: I think it is both a case of a newly recognized condition and a rise in the incidence of mothers with postnatal depletion due to the society we live in. Western society on the whole does not offer the community or familial support in the fourth trimester (40 days after birth) like other more traditional cultures do. Our society expects women to get back to work, get your pre-baby body back and generally just “get on with it” often without support. What these ancient cultural practices have in common is a protected time (referred to as confinement) with lots of social support for the mother to fully recover after she gives birth. She has an army of helpers to allow her to sleep and rest. Someone to do the shopping and cooking and someone showing her how to breast feed, change and bathe the baby. She can relax in the knowledge that she is in a safe and nurturing place with those who only want the best for her and her new baby. Doesn’t that sound great?

Q: Have you seen a link to Post Natal Depression?

A: There is a difference between postnatal depletion (very common) and postnatal depression (less common). Postnatal depletion is a syndrome with a spectrum of symptoms. PND is at the most severe end of the spectrum and certainly postnatal depletion can contribute to PND but not all women with depletion will become depressed. Within the first 12 months of birth, the PND rate in Australia is approximately 13%. Some women are genetically predisposed to depression and have a history of the same as well as anxiety. One of the cardinal symptoms that distinguishes depression from depletion is anhedonia - the inability to derive pleasure from things that previously did bring pleasure. In depression, there is no joy in the experience of motherhood and no enjoyment in activities or simple tasks that would have usually brought joy.

Q: How can we help to prevent women from getting post natal depletion? Do you think we need more support for new mums in the early days of motherhood? Is it time women started looking at self -care as a necessity rather than a luxury?

A: We can prevent postnatal depletion by giving new mums more support in the early days of motherhood. Bring back the fourth trimester. Organize a postpartum doula, meal drops and practical support for the new mother. Mothers need to make self care a priority. Ask for help and accept it with grace. Get good sleep. Take good supplements. Eat good food and drink lots of water. Have a good restorative therapy as often as you can (yin yoga, acupuncture, massage), do some gentle activity, be good to yourself and don’t entertain visitors (unless they are going to help!), limit social media, slow down and simplify your life - de clutter your home, be good to your soul - make time for some meditation, do mindful breathing exercises, gratitude mantras or visualization. Enjoy life. You are amazing! You made a baby! Be proud and thrilled with your body, even when you’re still depleted. Put on some music you love, dance and sing along with your baby. There can never be too much joy in the house. 

Q: Tell us a bit about the retreats you are planning this year. They sound like every mums dream!!!

A: Through @yourholdingspace I’m creating some delicious mothers retreats with Natalie Martinot and soon we will be launching @spacetoflow ~ a place where you can go to find a bit of peace, some space to flow with life and nurture yourself. Our retreats will focus on sacred self care practices and mothering the mother. They will be around 3 days and nights of delicious Ayurvedic food, nutritional advice and recipe sharing, yin yoga, Vedic meditation, massage and essential oils workshops held in the beautiful Byron hinterland. We’d love to incorporate a Sisters and the Sea Fourth Trimester pack and an opening Women’s circle. Watch this space xx

Q: Lastly, where can women find out more about post natal depletion?

A: Much of this information has come from what I’ve learnt from Dr Oscar Serrallach and his book that is to be released very soon - The Postnatal Depletion Cure. If you are in the Byron Shire, the naturopaths at the health lodge are a wealth of information and you will currently find me at Cape Byron Medical Centre.