New mom and baby

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, Psychiatry, 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, about 14% of new mothers develop postpartum depression (PPD). Postpartum Support International reports that approximately 13% 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,” Dr. Gopalan says. “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 like nipple pain from adjusting to breastfeeding and breast engorgement (if not nursing). Some people also experience 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,” Dr. Gopalan says. “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.

Screening for PPD

At UPMC Magee-Womens Hospital, doctors use the Edinburgh Postnatal Depression Scale. This standardized screening tool 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-Womens Behavioral Health Services offers therapist appointments at the hospital during pregnancy and after delivery, especially for women who have a history of depression.

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. 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:

  • Anxiety.
  • Hopelessness.
  • Sadness.
  • Not being engaged with the baby.
  • Not taking care of yourself (not 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.

“These are very treatable conditions,” Dr. Gopalan says. “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-Womens Behavioral Health Services, visit UPMC Magee-Womens Hospital or call 1-866-696-2433.

Editor's Note: This article was originally published on , and was last reviewed on .

About UPMC Magee-Womens

Built upon our flagship, UPMC Magee-Womens Hospital in Pittsburgh, and its century-plus history of providing high-quality medical care for people at all stages of life, UPMC Magee-Womens is nationally renowned for its outstanding care for women and their families.

Our Magee-Womens network – from women’s imaging centers and specialty care to outpatient and hospital-based services – provides care throughout Pennsylvania, so the help you need is always close to home. More than 25,000 babies are born at our network hospitals each year, with 10,000 of those babies born at UPMC Magee in Pittsburgh, home to one of the largest NICUs in the country. The Department of Health and Human Services recognizes Magee in Pittsburgh as a National Center of Excellence in Women’s Health; U.S. News & World Report ranks Magee nationally in gynecology. The Magee-Womens Research Institute was the first and is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology, with locations in Pittsburgh and Erie.