Most people know that a normal full-term pregnancy is divided into three trimesters that help define the changes that happen during the pregnancy. But the fourth trimester — the six to 12 weeks after the baby is born — can be a particularly vulnerable time for new mothers and their mental health.
The First Three Trimesters
The fourth trimester—the first weeks and months after delivery — is just as important for new mothers and should be viewed as a continuation of prenatal care. “The fourth trimester is a time of great adjustment for new mothers, so it can be incredibly stressful,” says Priya Gopalan, MD, chief of psychiatry at UPMC Magee-Womens Hospital. “That is the period when the risk of postpartum mood and anxiety disorders is highest, which coincides with moms going back to work and caring for a newborn and older children. In all the excitement about the birth and focus on the new baby, the new mom often puts her own needs aside to care for her infant, which can have a negative impact on her mental health.”
According to the American Psychological Association, roughly 14 percent of new mothers develop postpartum depression (PPD). Postpartum Support International reports that approximately 13 percent develop postpartum post-traumatic stress disorder (PTSD).
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Why is The Fourth Trimester Important?
The fourth trimester, which begins virtually the minute your baby arrives, brings a massive amount of physical and emotional change. “For a first-time mom, there’s often an intense moment of realization when she considers the magnitude of the responsibility of caring for another life,” says Dr. Gopalan. “Her body goes through significant changes too, so she needs to tend not only to her newborn, but to her own personal care and recovery from the birth.”
Tremendous hormonal and physical changes occur during the fourth trimester — your body is trying to get back to its pre-pregnancy state and healing from the delivery. Almost all moms have some degree of pain after giving birth. Mothers who deliver vaginally may have to deal with perineal issues, which can include an episiotomy, vaginal tearing, and/or hemorrhoids. Mothers who give birth by C-section will need to monitor the incision and follow lifting/moving limitations.
Other physical issues associated with the fourth trimester include breast changes — nipple pain from adjusting to breastfeeding, and breast engorgement (if not nursing) — as well as postpartum blood loss, which can cause low blood pressure and exhaustion. Almost all new mothers report fatigue due to sleep deprivation and shortened sleep cycles as the result of night-time feedings.
“All of these changes and stressors can make new moms susceptible to behavioral health issues,” says Dr. Gopalan. “These issues can range from the baby blues to postpartum mood and anxiety disorders, such as PPD and postpartum PTSD.”
Postpartum Depression (PPD) and PTSD
Postpartum depression is characterized by persistent and often disabling symptoms of depression or anxiety in the first weeks or months after childbirth. Postpartum post-traumatic stress disorder (PTSD) is caused by a real or perceived trauma during delivery or after the baby is born. It has the same symptoms as PPD plus others, including flashbacks, avoidance, hyperstimulation, and functional impairment.
Obstetricians and pediatricians have begun routinely screening for signs of PPD at the baby’s first wellness visit and the mother’s postpartum checkup, usually about four to six weeks after delivery. That’s just one reason why it’s so important for new moms not to skip their postpartum appointment. Another reason: Skipping that appointment could lead to serious physical complications, such as an infection or incomplete healing.
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Screening for PPD
At UPMC Magee-Womens Hospital, doctors use the Edinburgh Postnatal Depression Scale, a standardized screening tool that asks patients to rate their feelings of sadness or anxiety within the last seven days. Based on the responses, doctors can recommend the appropriate resources.
Magee Behavioral Health Services offers therapist appointments at the hospital during pregnancy and after delivery, especially for women who have a history of depression. Outpatient therapy is available at our locations in Wexford and Bethel Park for women who are identified as having PPD symptoms.
For those women whose depression would qualify them for intensive outpatient treatment, UPMC Magee offers the New and Expectant Mothers Specialized Treatment (NEST) program in conjunction with UPMC Western Psychiatric Hospital. NEST is available at the UPMC Magee provider offices in Wexford three days a week for three hours per day. Services include individual and group therapy with a psychologist or therapist. NEST, which is available for women who are pregnant and up to one year postpartum, accommodates both mother and infant by:
- Promoting healthy adjustment to pregnancy and motherhood
- Stabilizing depression, anxiety, and other symptoms
- Offering specialized group and individual psychotherapy
- Helping with medicine management
- Providing a supportive environment that promotes mother/infant bonding
Signs and Symptoms of PPD
All new moms and their family members should be aware of the common signs of PPD, which include persistent feelings of:
- Not being engaged with the baby
- Not taking care of herself, dressing, showering, etc.
- Something that seems “off”
If you notice signs of PPD or postpartum PTSD in yourself or a new mom you’re close to, don’t ignore or brush them off, says Dr. Gopalan. “These are very treatable conditions. The sooner your doctors knows about your symptoms, the sooner they can help get you on your way to feeling better.”
For more information about Magee Behavioral Health Services, visit UPMC Magee-Womens Hospital or call 1-866-MyMagee (696-2433).
For more than a century, UPMC Magee-Womens Hospital has provided high-quality medical care to women at all stages of life. UPMC Magee is long renowned for its services to women and babies, but also offers a wide range of care to men as well. Nearly 10,000 babies are born each year at Magee, and the hospital’s NICU is one of the largest in the country. The U.S. Department of Health and Human Services recognizes Magee as a National Center of Excellence in Women’s Health, and the Magee-Womens Research Institute is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology.