Book Review – The Fourth Trimester

The Fourth Trimester is a book designed to fill the gap of limited information about the postpartum period after the multitude of books around pregnancy and birth. More than the cursory chapter at the end of these said books, The Fourth Trimester is a deep dive into the best practices to aid a holistic recovery for women to transition into their motherhood journey thriving. 


The book was born from Kimberly’s own experience of childbirth and feeling alone and unsupported, and her even more drastic postpartum recovery journey. Kimberly who was already well versed in the mind body connection and an experienced body worker, went on to research more and more to develop her understanding and knowledge in this area to help heal her own wounds.


Kimberly talks about the five universal postpartum needs; extended rest period, traditionally around 20-60 days, known in ayurveda as “the scared window”, in Traditional Chinese Medicine as “sitting the month”; nourishing food, the common theme across multiple cultures are to eat foods that are warming, easy to digest, mineral rich and collagen dense; loving touch, to include massage and traditional belly wrapping and ‘closing the bones’ ceremonies; presence of wise women and spiritual companionship, new motherhood is seen as territory for women, and new mothers need to be held in the presence of loving elders who can share their experiences and wisdom; and contact with nature, to connect to the beauty and slowness of this period.  Each of these areas need to be considered in the postpartum sanctuary plan.


The book is divided in to three parts; preparing for the fourth trimester, focused on how to prepare when still in the third trimester; savouring the fourth trimester, focusing on the five universal postpartum needs and actions to meet these needs; and beyond the fourth trimester, which addresses the journey of matrescence (without use of the term) and redefining oneself after having a baby.


The book overall feels very well researched and narrative based on Kimberly’s own experience as a yoga teacher and body worker and becoming a mother.


Each of the chapters ends with a summary, reflections and actions which helpfully consolidate all of the information in the chapter.  The reflection points really added value to unpick ingrained thought processes and really connect in with intuition and how the body feels.  I think these would be invaluable to go through antenatally.


Kimberly’s theme throughout the book is about getting to know your body and connecting with self. Neither of which we are typically taught as children or as adults.  There is a lot of shame around these discussions and confusion around our knowledge of body parts (I hold my hands up and say I only started using the word vulva since having my daughter, before then, I hadn’t heard of it and thought the correct term was vagina, as I think many people do, men and women). Kimberly focuses on slowing down and taking time to reflect on what we need in the moment, and allowing ourselves to ask for it from the support network around us.  Connecting with intuition and physical feeling are key messages that she drives throughout the book.


There is a strong focus on the parenting partnership, with multiple chapters giving tangible actions to ensure that the parental relationship thrives throughout and after this postpartum period.  Kimberly emphasises the importance of maintaining an emotional connection as well as a sexual relationship, although definitely not just focused on PIV (penis in vagina) intercourse.


There is a definite nod to the traditional ayurvedic and traditional Chinese medicine practices and how these can be incorporated within the postpartum period for all mothers by following simple guidelines i.e. warming foods, extended rest periods etc.


Due to Kimberly’s background and personal experience, there is a focus in the book around pelvic floor health, with infinitely more information than a standard advice of “do your pelvic floor exercise/Kegels”.  Kimberly goes on to explain that there are four domains of pelvic floor health: biomechanics, related to posture and flexibility; biochemistry  described as the internal environment of your body including hormones, influenced by diet and nutrition; emotions  typically from pre-existing trauma or birth trauma related; and scar tissue, which she describes as the physical artifacts of trauma.  Kimberly describes how identifying which area of the pelvic floor needs to be supported and healed, the treatment and care differs.


In Kimberly’s chapter around deepening intimacy she shines a light on the needs of the partner in the postpartum period.  A gentle nod to ensure that care all around is needed.  The key point she raises, from research done by relationship experts Drs John and Julie Gottman, is that men just need to feel seen and not invisible during this time when all maternal attention moves to the new baby.


The main challenge I felt with this book is the suggestions for a thriving postpartum versus typical western societal norms.  I don’t know many people who would actually feel comfortable to put a note on their door asking for people to do jobs when visiting mother and new baby. Or to set up a food train.  Whilst these are amazing ideas, and I think most new mums would want that, actually being able to ask and for the request to be accepted would challenge many norms we’re in.  Perhaps this is a space for a doula to support the new mother by actioning these requests on her behalf? 


Sadly, lots of the recommendations also require finances that not all new mothers have.  Pelvic floor specialists and physios are expensive and not often referred to on the NHS therefore often making them wholly unattainable for many.  I think reading this could make some mothers feel disheartened that these opportunities for recovery are not open to them.  There is also a gap in the availability of some of these services, a quick search for Rolfers in the UK shows there are only 41 trained specialists. 


This was the first book I read when pregnant for the second time with my daughter.  Knowing that I wanted to do things differently from when I had my twins I wanted to know more about how to look after myself once my daughter was born.  I think this book kickstarted my journey in to being a postnatal doula and now re-reading it for this book review and cemented my admiration for it.  The absolute need in my opinion for a postpartum sanctuary plan can make all the difference to a woman’s early experience of motherhood, and therefore her entire parenting journey.  I have based one of my services packages around what Kimberly describes as five days in the bed, five days on the bed, five days around the bed and really emphasising the need to slow down and allow our bodies to heal.  I have used this book as my template for best care postpartum and will continue to refer back to it as my services and business develop, alongside the many other wonderful books there are out there.


I have found the book quite moving in the reflections it asks the reader to complete. Quite possibly life changing.


Whole book has a huge emphasis on connecting back to yourself.  Taking time to listen to your instinct and body.  As Kimberly says, “radiant health is a birth right”.

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