The Fourth Trimester & Beyond

It's been a while since I've blogged. I've been a little busy... ya know... taking care of a baby while trying to take care of and heal myself. The fourth trimester is known as the 12 weeks following the birth of baby. I'm in my 20th week postpartum, so technically after the 4th trimester, I guess I must magically be back to normal because that's where society (at least in the US) stops counting and everything resumes. Life keeps spinning on. I guess you could say I'm in the 5th trimester... but everything beyond the "4th" trimester is just my life now. So although I haven't been updating the blog, a lot has happened and I'm hoping to start blogging more, and sharing more of my experience postpartum and the status of my PAES without botox. I also have mostly stopped dumping my feelings on instagram… so they gotta go somewhere!

Summer

Iris was born right at the end of June exactly one year since my first positive test: what a wild ride. July was amazing and by every account I was healing super well. It went by really slow since Matt was tapering for the Ironman and we mostly just watched the Tour de France everyday. I had developed a good routine with him home and could embrace summer at last. It felt so good after teaching pregnant everyday and not knowing if I would finish the school year with a baby in my "belly" or in my arms, to finally be across that finish line. I also really enjoyed that no one was at school and July tends to be quiet for teachers, so there were no work emails to get caught up in. Truly just relaxing!

​But then the Ironman came and went and August, a month of Sunday Scaries for teachers, just flew by. I technically only was allowed to take 8 weeks between the birth of Iris to recover before returning to work... But that meant my entire summer vacation was my "maternity leave" no vacation at all. Technically it’s against the law in Massachusetts for vacation days to be used as leave (because maternity leave is not a vacation!!) but a common misconception is that teachers get summer vacation when in reality they are just days we aren’t contracted to work. calling the summer vacations would be the equivalent of calling weekends part of vacation. They are simply days outside my contractual obligations. So since the previous summer was pregnancy and loss… and the summer before that was my second Botox injection (which more or less seemed like it failed), and the summer before that I spent teaching remote summer school and trying to learn every possible tool i could use to teach online, I haven’t had a break in a while… and now I’m not really getting this break, either. I was feeling so fried and as school approached my anxiety was in my throat. My therapy increased and rehashing all the past between covid and shut downs, threats of losing my legs, the pain and loss of a core part of my identity, having a surprise pregnancy followed by two miscarriages and now a healthy baby girl... I don't know. Whiplash isn't a bold enough description of what I had yet to process.

I wasn't sleeping, Iris initially showed promos. But she started vomiting almost every time she ate and was congested so badly! So I often watched her breathe at night. We didn't know if it was the bottle, how fast my milk was coming, or reflux. There were times in the middle of the night I swore she turned purple from not breathing but Matt assured me I was imagining it and it was shadows great m the dimmed nightlight (which I’m still sleeping with!). Anytime I fell asleep I was waking up panicking and throwing blankets off the bed because I was experiencing intrusive thoughts that she was in the bed suffocating (which she wasn't)... The miscarriages forever changed me. The worry didn't stop at Iris. I started having intrusive thoughts about myself crossing the street, or cars accidentally driving into our yard and hitting the big girls, or smashing through the bay window whike Iris slept on the floor. There was a bear in our yard once, so fear of letting the kids outside was intense… worse, I started googling; Do bears open doors? It wasn't just thoughts it was visions of these graphic things happening. During the day I could mostly forget about it or distract myself and take comfort in people around me acting like everything was fine (so it must be?) but when I closed my eyes I could see vivid and scary images and because I was so sleep deprived it started getting hard to tell what was me asleep and what was me awake. Physically, I was healing great, reminded how good I looked often… but below the surface the pressure of work pressing on my chest made it harder and harder to breathe.

Back to School... or Not.

Some of the fears were maybe normal "maternal instincts"... but they grew into what was clearly unhealthy and the idea of going back to work was looming and felt like a boulder on my chest causing panic attacks. If I couldn't have eyes on Iris making sure nothing was happening, I defaulted to the worst. Because the thoughts were occurring so frequently and involuntarily, when presented with real scenarios where I had to make decisions I had these patterns of negativity and worry I couldn’t over ride. Finally, after a tearful therapy session, it was decided that I needed more time off. As I've shared a little here, I have been a risk to myself in the past, especially when I'm still missing my core coping mechanism. I was exercising daily but not significantly and from past experience, I know that even the slightest pain in my legs triggers such a massive spiral... that on top of postpartum disorders and sleep deprivation? I just couldn't take that chance. I can't have my legs treated until after I’m done breastfeeding which the WHO recommends two years now....( I am hoping for at least 1 year like my other two kids)… so given my leg condition and history with prolonged PPA and PPD, to preserve my mental wellbeing, I'm taking the year off from teaching unless going back to work proves to be better for my mental health... until then I'm a temporary SAHM. The Friday before school started I got an approval notice from HR.
It took a while to get into a groove. The girls go to the school I teach at and it's 40 minutes from our house so initially between Matt and I it was 3 hours in the car driving to and from and to and from… but each of us took a shift which made it manageable… but once his travel started I was doing it all by myself. Planning breastfeeding around car naps and pimp sessions, and hoping she doesn’t throw up or choke over her gag reflex in the car. It was just way too much of my day! So one of my coworkers lives nearby and we were able to get her to drive the girls to school in the morning so poor little Iris wasn't living in her carseat. She developed Plagiocephaly (flat head) that just finally has started to work itself out now that she's not in the carseat so much and can move around. This was a pretty big step because the car seats of all three kids have been an area of obsession. We of course installed car seats in the car they go to school in, but relinquishing a little control was a big step, as my therapist reminded me. It's mid November and I'm just now feeling like I can breathe a little better (still not sleeping, but maybe someday!)
​

Health and Fitness

My primary fitness goal has been to lose weight. Prior to getting pregnant I was able to run 10 miles at a decent pace with the Lever System taking 45lbs off. I gained about 45lbs when I was misdiagnosed during Covid before I even got pregnant... So if I could get back to my "pre-pandemic" weight theoretically I could run on my own two feet again someday. I have never been successful at changing my diet. I guess I don't have much discipline, but this was my number one goal so I was on the lookout for a way I could be accountable with that goal. I want to write a more detailed post on this once I do this “summary” /recap, but a lot of the emotional weight I carried felt intertwined with the physical weight so losing weight feels like a good path to healing most of what I'm consistently struggling with.

Diet

I enrolled in a breastfeeding study and was selected to be in the intervention group. The intervention group has to eat 8-10 servings of fruits and vegetables a day. The study delivers a bag of vegetables to my doorstep every week and I have a check in with a nutritionist every week. All I have to do to stay in the study and get these perks is eat fruits and veggies, keep a food log, provide 4 milk and baby stool samples a year, and keep breastfeeding. It seemed easy enough, but sometime in October, Iris was falling of her growth curve for weight and approaching that “failure to thrive” diagnosis. She was happy all the time, but spitting up often and a couple times a week projectile vomiting. I questioned my weight loss goal, questioned eat by so many fruits and veggies, felt like I caused this! But then we had her stool examined and she was diagnosed with a cows milk protein allergy. So after having a little pity party thinking I was going to have to stop breastfeeding (which is something I truly love and don't want to stop prematurely and for sure would have caused a spiral), and lose the perks and accountability of being in this study... I started reading and researching and decided to go all in and give up dairy, soy, beef and whey protein. The funny part is it always amazes me how quick i could give up Reece’s PB cups once I was allergic. Cheese was one of the more calorically dense foods I consumed… goodbye cheese. It hasn’t been as hard as I thought. It lines up well with the breastfeeding study, but it’s a lot of label reading! It took a few weeks but little by little Iris stopped spitting up and as she started gaining weight more appropriately... I've continued to lose it. I've been really thankful to be home during this time because I spend so much of my day learning how to prepare different foods and figuring out what I can eat and what will work for the whole family. The difference it's made in Iris has me feeling so proud of myself, I’ve made steady (not drastic) weight loss and weigh the least I've weighed since 2021.

Workouts

During pregnancy I had a peloton streak going. I kept up with it for a while missing only 1 day (the Boston Marathon) since January 1st but my streak ended just shy of 100 straight days again. Sometime around Matts Ironman I just forgot one day... and one day quickly spiraled… but I started it back up again and was doing hard bike rides (power zones) on a regular basis once cleared to do so... I was lifting 4 x a week…and I’ll admit, initially it was the first time in my life I looked at what I was burning as a way to eat more food later (cheese cheese cheese!)... but then the week Iris was diagnosed with CMPA (Cows milk protein allergy) I took off from exercise completely and I think have since found a bit more balance between the calorie counting and corresponding food and exercise. It’s almost impossible to go too far over calories for the day with 8-10 servings of fruits and veggies and no dairy, beef of soy. So I needed the week to process and make sure I was eating enough to still produce milk for Iris and have energy to exercise. I had to find supplements for calcium and vit D and just find stability again! Now that I’m exercising again, it’s proven to be a bit harder because she’s learned to roll all over the floor, so it’s not as simple as when she’s just kickin’ around. I've kept myself in a slight calorie deficit everyday but it feels really sustainable and none of my exercise is determined by calories. At this point I don’t feel the need to calculate in as much detail. I have recently started walking and think that will be my main form of exercise with strength training built in. Iris is getting heavier, and I’m definitely feeling it in my shoulders and back… my initial pelvic floor healing was great, but as I’ve added impact from walking and I’m finding more gaps to fill in or figuring out where I fatigue and how to address the issue. It seems like the healing will ebb and flow a bit. I can’t believe at 6 weeks postpartum I used to just start training. No wonder I’ve been so effed up!

Chiropractor and PT

After Iris was born I went to the chiropractor weekly and gradually reduced it to monthly. Once I hit the 6 week Postpartum mark, I went to my pelvic floor PT and have been going weekly until just last week I was switched to twice a month. So much of my groin pain from when I had Maebel is being resolved this time around. It's a lot of micro-movements, but my body really hasn't been right for 6 years. The original theory on my legs was that it was related to this groin issue. I'm sure it's not *the* issue since the scans were so clearly PAES, but now I am wondering if it was made worse by the fact that my pelvis was so unbalanced? I'm not running anytime soon but really curious to see how it goes when I get there since the stability of my pelvis has been so atrocious for the better part of the last decade. It’s getting better. I have so much hope it will be better than ever! I've never worked so hard at something in my life! But I took the year off from work to "heal myself" and I’m just now realizing how many layers there are to be to that process. It's all connected. The PT's both talk a lot about the nervous system, and the more I learn the more I realize that some of my pain is maintained by old memories and habits. It's *not* in my head, but it might be exaggerated by old patterns. I'm working on interrupting signals and not giving them as much response as I typically would. I also learned that even generalized stress sends signals to the calves or the groin since that is where it's so used to going. So that's why even when I'm not running and I've had a particularly stressful day, my calves and body feels so fragile. I'm working on interrupting and rerouting those signals, but spending time lowering my cortisol will be important. Sleep someday will also be nice!

Psychotherapy

I was doing therapy weekly initially, but the amount of appointments for all of the above was adding stress so I now have PT and Therapy on alternating weeks so that I can manage it better. Self care is a lot of commitment and a big investment, but I feel like I'm slowly becoming myself again. I feel excited for things and motivated without caffeine abuse, and I can get through a day without needing to pop 4 advils (It’s a good thing no one ever gave me something stronger). And as of now I’m not taking any medication. Exercise actually has good research with depression and anxiety, and right now I’m stable enough and excited about my progress enough that i don’t want to introduce any other factor. I’m not against it by any means… but don’t feel it’s the best path for me, right now.

what I’ve learned is each individual experience I’ve gone through put in isolation, is not so bad… but therapy is helping me stop gaslighting myself into believing I’m just being a wuss about it all. Just like training for a marathon: cumulative fatigue. It’s never one workout that will tip you over the edge to “overtraining” or injury… its stress over time. And when I look at the last 6 years, I have yet to stop treading water and recover. I’m just now starting to.

TLDR: 

• I'm staying home for the year
• I'm eating 8-10 servings of fruits and vegetables
• I can't eat dairy, soy, whey, beef or nuts (my own allergy)
• Weight loss is my main goal, I've lost 23lbs since 6 weeks postpartum
• I have a nutrition call every week. 
• I'm going to PT every 2 weeks
• I'm going to Therapy every week
• I'm going to the Chiropractor monthly
• I still don't sleep

I'm hoping to blog more often so that I can write with better quality and no just do quick summaries... but just to catch things up I had to do this post. To anyone with PAES, the Botox is mostly maintaining it's effectiveness for normal day-to-day. For anyone postpartum... Take the time off you can! Don't gaslight yourself into thinking your worries and fears and anxieties are "normal" and shouldn't be met with compassion and understanding (from both society and yourself) To anyone with CMPA, follow me on instagram- I've been saving things I'm eating in my story highlights!