The Fourth Trimester: Postpartum Mental Health and Treatment Options
The “fourth trimester” is a term used in reference to the three months immediately following baby’s birth. Like the time spent in the womb, this is a pivotal period for baby’s growth and development.
But those changes aren’t exclusive to your baby – the fourth trimester may impact you as a new mom, too, albeit in different ways. It's no secret that the postpartum period ushers in an intense life change. Especially for first-time mothers, the new transition can bring unexpected physical and mental challenges.
Taking care of yourself is crucial in these months.The transition to your “new normal” can be a bumpy one
Moms often talk about the "new normal" that develops in the months after their babies are born. And this new normal isn’t always an easy adjustment, thanks to personal and external pressure, physical changes, and a (sometimes unwelcome) spotlight from friends and family.
New moms often experience fatigue and sleep deprivation, a perceived loss of freedom, control, and self-esteem. They may experience a difference between the fantasy and reality of motherhood, all while needing to learn new skills and manage the new demanding role.
Unsurprisingly, your body is undergoing another transition (the post-pregnancy stages), at the same time you’re learning how to be fully responsible for a tiny, wonderful, wholly new life.
Mental health concerns, including depression and anxiety, are relatively common
Every new mom’s experience is unique experience. However, if you’re feeling inexplicably anxious or depressed, it may help to keep these three common postpartum concerns in mind:
Baby Blues:
- Affect approximately 60-80% of new moms in the postpartum stage
- Last between 2 days and 2 weeks
- Often peak 3-5 days after delivery
- Affects approximately 12% of new moms in the postpartum stage
- Recovery time depends on a number of factors, ranging from personal history of depression to severity of symptoms and what type of support you have at home
- Postpartum depression can begin days, or even months, after childbirth. The peak of risk for developing is three months after birth.
- Affects 10% of women during their first few months postpartum
- Often starts in pregnancy and worsens after birth, but can start up to one year after birth
- Recovery time ranges, depending on treatment, personal history, and severity of symptoms
Having a baby can also re-trigger or exacerbate other anxiety-related mental health conditions, too. Women sometimes experience newly-onset Obsessive Compulsive Disorder (OCD) after the birth of their child, or find that their previous OCD symptoms reemerge.
If you have a postpartum mental health concern, know that it’s likely highly treatable
New moms tend to overlook their needs as soon as their baby arrives, but supporting yourself in all stages of pregnancy is crucial to maintaining a healthy mental state.
Here are a few things you can do for yourself:
- Be educated about postpartum mood disorders! For example, learn more about the symptoms of postpartum anxiety or the difference between postpartum depression and baby blues, so that if you or someone you love is affected, you can work towards treatment.
- Attend a new mom’s group – even if you think you won’t enjoy it, this is a great way to connect with other moms, and learn useful tools to overcome your concerns, worries, and fears.
- Start planning your fourth trimester early. Figure out who your support system is early on. This includes babysitters, and friends and family who can help with certain needs.
- Consider starting, re-starting, or continuing therapy. Work with a clinician who specializes in cognitive behavioral therapy or interpersonal psychotherapy.
Postpartum therapy is helpful for mental health concerns – and beyond
If you’re experiencing symptoms of postpartum depression or anxiety, or another perinatal mental health condition, therapy can help! A panel of experts recently reported that cognitive behavioral therapy (CBT) and interpersonal therapy may be the most effective treatments for most women with postpartum depression.
It is also extremely helpful to explore your own beliefs about motherhood, and to look at what may be impacting your ability to bond. This can be achieved in individual therapy or in a group setting.
If you’re considering therapy for postpartum mental health concerns, Postpartum Support International is a great place to start. They provide many of the trainings for professionals specializing in perinatal mental health and have a plethora of information.
And if you’re ready to find a therapist for postpartum depression, anxiety, or the transition to motherhood, visit Zencare.co to browse a vetted network of perinatal specialists in NYC, Boston, and Rhode Island.
Finally, know that you are not alone in your struggles. Entering motherhood marks a significant life change for any woman, and the right support system can make a world of difference.
This is a guest post from Zencare, a website that helps people find their ideal talk therapists. Visit Zencare to browse their vetted network of top therapists, including perinatal therapists, using criteria like insurance, sliding scale, location, and specialties. You can also directly book a free assessment call from the Zencare site.
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The sound of cheery calls of “MAAAAMAAAAA” from the next room may be lovely at 7am. At 4am, or 5 am, not so much. Your baby may be up and ready to start the day, but you probably aren’t.
Answering the questions below may help you get there.
- Is your nap schedule mucking up your baby’s overnight sleep?
This might seem like an obvious question, but your baby’s sleep needs will change fast in the first few years of their lives. A quick look at the average nap number and duration might give you an idea:
- For babies from 3-6 months old, it’s normal to take 3-4 hour-long naps per day.
- For babies 6-15 months old, expect 2 naps with 3-3.5 hours of total sleep.
- For one and two-year-olds, you should expect a single 2-hour nap.
Part of the reason you might be seeing earlier wakeups is that your baby has graduated from one nap cycle to the next.
- Does your baby have enough time between their last nap and their bedtime?
We call this an “awake window,” and it can make a big difference. It might seem strange that your baby went to bed fine the night before, and you’re seeing a response to nap scheduling in the pre-dawn hours, but if your kiddo’s sleep is disrupted at night, it will impact the morning.
- 3-6 months, at least 1.5-2 hours between final nap wakeup and bedtime.
- 6-12 months, at least 2.5-3.5 hours between final nap wakeup and bed.
- 12-18+ months, 3.5-4.5 hours between final nap wakeup and bed.
- Is the room staying dark after the sun comes up?
Black 0ut curtains can make a big difference here. Remember that our brains signal wakeup when the light changes. So if dawn is at 430am, and even a little bit of light comes into your baby’s room, their little brains will PING with wake up juice.
- Is your baby going to sleep too early or too late?
It might seem counter-intuitive, but a late bedtime can actually backfire on you. Overtired kids don’t sleep as well. If you made their bedtime later and it didn’t fix the problem, try an earlier bedtime and see if that helps. You might be surprised.
- How do you make it better?
Try to make one change at a time; just one. Stick with that change for 3-5 days to see if it impacts things. (One night is usually not enough to see substantial change.) Be as consistent as you can with the change you made. For instance, if you decide to increase the space between bedtime and final nap wakeup, make sure to stick to the wakeup time you planned.
If your baby is waking up and chirping happily to themselves, feel free to leave them there for a little while. Let them get used to being alone in the crib. If you can, try to delay the start of the day by 5-10 minutes each day. This can make a big impact.
Everything else aside, remember that this is a short time in your kid’s life; as they get older, their sleep will become more regular, and so will yours. Don’t let yourself get too discouraged. Things are hard now, and you’re doing a great job.