Why is Postpartum Support So Important in the Fourth Trimester?

During pregnancy, so much emphasis is placed on labor and delivery. And rightly so—it’s an important event. But the fourth trimester (that postpartum period spanning the three months after you give birth) comes with plenty of adjustments and lasts longer—and we are often left without a road map for how to seek out and accept postpartum support. Classes like birth prep courses, lactation consults, and infant CPR classes can certainly help you feel more prepared. But hands-on and mental health postpartum support is essential for new parents.

Why is postpartum support important?

That old adage—”it takes a village to raise a baby”—may be true, but a chief complaint among new parents is often that the proverbial village is nowhere to be found. Still, doing everything all on your own often isn’t sustainable—and, even if we can do it alone, it doesn’t mean we should. The result is an increase in Perinatal Mood and Anxiety Disorders (PMADs). In fact, there is a correlation between social support (or lack thereof), and PMADs. 

What are PMADs?

Perinatal Mood and Anxiety Disorders (PMADs) refer to mental health disorders that typically develop during pregnancy and up to a year postpartum. It’s an umbrella term that includes postpartum depression (PPD), postpartum anxiety (PPA), postpartum obsessive-compulsive disorder, and postpartum psychosis. Crucially, they can and should be treated by a mental health professional. And if you’re able to set up a good postpartum support system, you’re less likely to develop the more serious side effects of these disorders.

Postpartum support if you’re pregnant

About half of PMADs start in pregnancy and continue into postpartum. There are certain risk factors that may put a birthing person at a higher likelihood of developing a PMAD, but it’s possible to experience one with or without those risk factors, which is why it’s important to know the risks and assess if they apply to you. These include:

• A personal or family history of depression, anxiety or other mental illnesses 

• A history of infertility treatment and/or pregnancy losses

• Severe mood changes around the time of your menstrual period, or a Premenstrual Dysphoric Disorder diagnosis

• Medical complications during pregnancy 

• Financial or relationship stressors

• Limited emotional support

Do I Need a Postpartum Supplement? →

How to set up your postpartum support system while pregnant:

Even though there is no way to fully prepare for the drastic transformation of becoming a parent, here are some suggestions that may bolster your transition, especially if you are worried about PMADs postpartum: 

• Develop a postpartum plan. This can include things like discussing the details of maternity and/or paternity leave with your partner if you have one; deciding who is doing the night and early morning feedings; what are the boundaries around the birth and visitors thereafter; and who is helping with housekeeping and day-to-day childcare. Meeting with a couples therapist who works with parents can be helpful for working through conflicts.

• Build your village. While the village may be hard to find, it can be hired (if funds allow) or supplemented with social programs and professionals. Seeking out a lactation consultant, perinatal psychotherapist, physical therapist, and a sleep consultant can all be extremely helpful in the postpartum period.

• Fill your Rx. If you are on medication, check with your doctor or psychiatrist to learn what medications are safe for pregnancy and breastfeeding and chat about any alternatives or supplementary help you may need if you are unable to take medication during this time. 

• Do your homework. Familiarize yourself (and have your loved ones familiarize themselves) with the signs of PMADs and the treatment options. The Postpartum Husband is a helpful book for those whose partner is at risk for mental health issues in the perinatal period. It's an easy read and offers specific things to say (and not say). Research has shown that supportive relationships during postpartum depression treatment are associated with a reduction in depressive symptoms.

Postpartum support if you’re in the fourth trimester

Most new mothers (up to 80%) feel the baby blues after giving birth. It’s caused by the sudden change in hormone levels (the drop in estrogen and progesterone) after delivery, combined with stress and lack of sleep. You might be tearful, overwhelmed, emotionally fragile, and experience mood swings—and this is completely normal. The baby blues begin within the first couple of days after delivery, peak around one week, and resolve by the end of the second week postpartum without any intervention. While the baby blues and PPD have some overlapping symptoms, if they don’t go away after a few weeks, they worsen, or the onset is after the first two weeks, then you may be suffering from a PMAD and should seek out additional help. 

What Is Postpartum Fatigue and How Can I Cope? →

Symptoms of PPD and postpartum anxiety can appear any time during pregnancy and generally develop within the first year after childbirth. Some experience anxiety alone while others experience it in combination with depression. If you’re experiencing any of the following symptoms, it may be out of the range of what is normally expected in the fourth trimester and it’s time to seek out an assessment. If you don’t have an established relationship with a psychotherapist or psychiatrist, start with your OB/GYN, midwife or even your child’s pediatrician. 

Some of the signs of PMADs include:

• Low mood, feelings of sadness or crying

• Feelings of irritability, anger or rage

• Decreased or increased appetite (more than expected with breastfeeding)

• Sleep disturbances (more than expected with new baby); sometimes manifesting as insomnia even when baby sleeps

• Feelings of guilt, shame or hopelessness

• Loss of interest, joy or pleasure in things you used to enjoy

• Lack of interest or difficulty connecting with your newborn baby

• Possible thoughts of harming yourself or the baby  

• Afraid of being alone with baby

• Constant worry

• Overwhelm

• Indecisiveness

• Physical symptoms such as dizziness

• Inability to sit still

• Racing thoughts

• Feeling of impending doom

• Flashbacks of birth 

Postpartum support to seek out in the fourth trimester

Emotional support is vital for the first 40 days after birth (but is beneficial for much longer than that). The main issues faced in the fourth trimester tend to be sleep (or lack thereof—both your own and baby’s), feeding challenges, and partner resentment. Here are some things that can help:

• Hands-on support. A family member or, if resources allow, hiring a postpartum doula or night nurse, is ideal to support the recovering birthing person and allow new parents to get sleep. If having family support and/or hiring your village is not an option, then it's important to make a postpartum plan with your partner in order to negotiate the schedules for day- and night-time feeding and parenting.

• Feeding support. Consider supplementing with a breastmilk alternative (i.e. formula) for some of the feedings in order to prioritize sleep, which can affect mood. Consult with a lactation consultant for any feeding support, including weaning, if you choose to make the switch to formula.

• Sleep support. There are lots of free resources (and plenty of paid courses) to help you help your baby to sleep. Find a method that aligns with your preferences, and keep at it. Remember that getting sleep is extremely important and should be prioritized—and you should not feel guilty for doing so. 

• Medication, if necessary. While medication doesn’t necessarily need to be part of your plan, there are some instances in which it can make a massive difference in your quality of life postpartum. Many medications have a lot of research supporting their safety in pregnancy and while breastfeeding (like Zoloft, considered the gold standard for SSRIs in the perinatal period). 

• Social support. Connecting with other new moms to commiserate and celebrate is crucial. “Mommy-and-me” groups are a great way to meet other parents with babies around the same age, can be educational about the baby's development and sleep schedule, and can provide some much-needed social stimulation at a time when you may be feeling increasingly isolated.

• Emotional support. Emotionally focused support circles like Life After Birth are more parent-centered and tend to your transformation. Additionally, if you experienced a traumatic birth or have an issue that warrants more privacy, then meeting with a perinatal psychotherapist one on one can be beneficial.

Postpartum support beyond the fourth trimester

PMADs can be temporary and are treatable, but if left untreated, then they will stick around. Twenty percent of perinatal mental health complications occur from pregnancy to two years postpartum and 13% of parents are still experiencing mental health conditions at four years postpartum. Year one of a baby’s life is magical and acute. If you’re beyond the fourth trimester or even past the first year and still not finding your footing, then it's not too late to reach out for postpartum support. 

Seeking out postpartum support beyond the first year

Think Maslow’s hierarchy of needs when it comes to life with a baby. Ensuring your basic needs are met (sleeping, eating, showering, socialization, fresh air, and sunlight) can be the key to a more comfortable postpartum experience. If you are having trouble getting those needs met, then develop a plan with your partner to seek out hands-on help. Depending on what challenges you are facing, one-on-one, couples, or group therapy can help work through your relationship or mental health concerns; a lactation consultant can guide you on your feeding or weaning journey; a sleep consultant can address any lingering (or never-went-away) regressions; and a pelvic floor physical therapist can help with post-labor discomfort or physical health concerns. Sometimes trying to find the answer on your own isn’t an option, and asking for help from the pros can help you get to the other side of a PMAD.

If you or someone you love is suffering from any of these aforementioned mental health issues, know that it is not your fault and you are not to blame. Postpartum Support International has a warm line and will call you back within 24 hours to help connect you with resources in your area. In addition, there is a National Suicide Prevention Lifeline: 1-800-273-8255, or you can call 911 if it is a true life-threatening emergency. The more we can let go of the stigma associated with mental health issues in the perinatal period, then the more they become normalized.