The Fourth Trimester Guidebook: Your Postpartum Mental Health Matters

postpartum mental health, PPD postpartum depression, postpartum anxiety, postpartum psychosis

This article marks the third installment in our series on the “fourth trimester,” otherwise known as the first 12 weeks postpartum. We’ve previously addressed what you need to know about good postpartum nutrition and safe postpartum exercise. In this article, we will discuss a third crucial element of postpartum wellness: mental health. We’ll cover three keys to promoting and protecting your mental health in the fourth trimester especially, including: adjusting your expectations of your baby and of yourself, creating a postpartum plan to proactively identify your support system, and being aware of the signs and symptoms (as well as treatment options) for postpartum depression. 

New motherhood: beautiful and challenging

If you’re like me, you too may have basked in the glow of that first day or two in the hospital, where the four walls of your room seemed to contain your whole world, and where meal preparation and dishes and laundry were the farthest things from your mind. But then you went home, where household chores and maybe older children clamored for your attention. And while your beautiful new bundle might have snoozed away the first twenty four hours of life, maybe you experienced a rude awakening, or many awakenings, as he woke every two hours like clockwork to eat during his first night at home. By your third day in, you feel exhausted and your nerves are frayed.

Or perhaps you’re a mom of a NICU baby, shuttling back and forth between home and the hospital after discharge. Along with all the usual challenges of new motherhood like breast engorgement and healing from any physical trauma sustained during delivery, you may also be navigating the NICU hallways and trying to keep your kiddo’s many medical teams straight. You may find the tears flowing easily and endlessly these days. 

Women have brought babies into the world since time immemorial, so you know that this can be done. But few may realize just how challenging it can be until it’s happening to them. Fortunately, there are a few things you can do to try to make the transition easier. It will still be difficult (as all change is)–but it doesn’t have to feel impossible.  

Are your postpartum expectations of motherhood realistic?

First off: manage your expectations of the postpartum time period, particularly during the fourth trimester. Especially with your first child, it can be jarring how much your day no longer revolves around you, but around feeding, burping, bathing, diapering, calming, and rocking to sleep another very tiny, very demanding person. According to postpartum doula Cassie Moriarty, a smooth transition for mom and baby starts during pregnancy. She says,

“I always encourage expecting moms to attend new mom groups before having the baby. It’s so helpful to see moms in this transition before they themselves get there. Seeing newborns in action beats any class you can take or book you can read!” 

According to pediatrician and author Dr. Harvey Karp of Happiest Baby on the Block fame, babies are actually born ‘too early’ in the sense that, unlike other animals, they are born completely dependent on their mothers for every aspect of their care. Of course, the alternative (i.e., staying in the womb until they’re more self-sufficient) would not allow babies to fit through the birth canal! I found this review of the abilities babies are born with (for instance, how frequent crying is to be expected as the baby’s primary means of communication, not an indicator of my poor parenting!) to be a helpful emotional reset for my own expectations of how things should go in the baby’s first few months. 

And when it comes to managing expectations, infant sleep is an area of particular concern. Like many new moms, I initially struggled with my son’s habit of nursing to sleep, and then waking up as soon as I put him in his napper a minute later! I was reassured when I learned that babies generally eat, have a brief period of alertness or wakefulness, and then fall asleep. So, my son was indeed acting like a baby when he ate, stayed awake for a while, and then slept.

According to Moriarty, I’m not alone in my concerns about baby sleeping patterns. She says,

“Infant sleep (or rather lack thereof) is a huge piece of what makes postpartum so hard. We’re told that baby must sleep alone, on his back, in a crib, and so few babies take to this easily. Moms feel like a failure when in reality, their baby is likely totally, perfectly normal. Modern infant standards clash with the biological norm, so there’s quite a chasm in expectations vs. reality.” 

Moriarty recommends this resource about biological norms for infant sleep and this resource for a research-based perspective on normal baby sleep. 

You need a plan to protect your postpartum mental health

In addition to managing your expectations for your baby, take stock of your expectations of yourself during the fourth trimester by listing out all your usual responsibilities within the family, such as laundry, bill-paying, cooking, etc. Since you cannot possibly juggle all of these responsibilities and care for a newborn, develop a postpartum plan to get down on paper the things that you will need help with, especially in the first few weeks. (Ideally, you’d put pen to paper while still pregnant.) 

While most women are familiar with creating a birth plan for their preferences or desires during the labor and delivery process, many have never heard of creating a postpartum plan (samples are here (brief) and here (comprehensive)). At a minimum, a postpartum plan identifies supportive individuals, be they family, friends, or a hired postpartum doula who can assist mom as well as people who can support dad, other children, etc. in the first weeks after the new baby’s arrival. Moriarty’s experience as a postpartum doula affirms the necessity of enlisting your “village” when you welcome a new baby:

“When you look at registries, there are a million gadgets and gizmos that claim to be essential ‘must-haves’ for new moms. But you know what is missing from this list? Hands-on help from family, neighbors, and community. This is the irreplaceable, and essential ‘must-have’ when it comes to supporting moms in the postpartum period.” 

Far from being a sign of weakness, being honest about what you are able to reasonably do is a mark of mature self-awareness, setting you up for success rather than for feelings of inadequacy and “failure” when you are, of course, unable to do the impossible. I’ve been humbled by how easily I get overwhelmed in the first few weeks with a new baby. But self-awareness led me to respond to my tendency towards overwhelm by keeping my focus narrow, centering primarily on my son rather than worrying about a million other tasks and people’s needs. And doing that led to better bonding with my little guy. I’ve also found that allowing other people to help you is a gift to them as well as to yourself–we all need to be needed.

When it’s more than just the “baby blues,” it could be postpartum depression

Whether this was your first or fifth baby, you’ve likely heard about (or maybe personally experienced) postpartum depression (PPD). But simply receiving appropriate and effective treatment for postpartum depression is a pretty low bar to set in terms of our societal expectations for postpartum women’s mental health. Do we really have to wait until new moms are clinically depressed to promote and protect their mental health in the tremendously vulnerable time after the birth of a new baby?

You (and hopefully your partner) may have to stand up for your postpartum mental health—even before you have your baby. With the many demands of modern life, be it work, school carpool, housework, volunteering and more, you may have to be the one to say “enough” when you feel your mental health is taking a beating. Having realistic expectations for both your baby and yourself, as well as a strong support system in place during the fourth trimester, decreases the likelihood that you’ll experience postpartum depression. Still, all the preparation in the world might not protect you from PPD, and you should know that there are treatment options if you do find yourself struggling more than is normal.

Natural Womanhood has previously taken a deep dive into this important topic, including clarifying how PPD differs from the baby blues, which are feelings of sadness and anxiety that approximately 70% of women experience after giving birth. While the baby blues last a few days after childbirth, the symptoms of sadness and anxiety associated with postpartum depression are much more severe and last for two or more weeks. Thankfully there are effective treatment options, ranging from antidepressants, to psychotherapy, to bioidentical hormone therapy. If you’re unfamiliar with the use of bioidentical progesterone to treat postpartum depression, a brief Natural Womanhood primer on why some women may benefit from supplemental progesterone is here. A bit more on the science behind the most commonly used progesterone protocol is here. An in-depth look at one woman’s transformative experience receiving bioidentical progesterone for postpartum depression is here. And, several suggestions of other hormonal imbalances to ask your healthcare provider about if you’re struggling emotionally during the postpartum period are here

Bringing a new baby into the world can be simultaneously the most beautiful and the most challenging thing you may experience in your lifetime. This fourth trimester series aims to serve as a jumping-off point for you to pursue healing and wholeness nutritionally, physically, and mentally so that you and your baby can thrive during this precious, fleeting time. 

Additional Reading:

The Fourth Trimester Guidebook: Postpartum Nutrition

The Fourth Trimester Guidebook: Postpartum Healing and Exercise

Concerned about postpartum mental health and milk supply? Think twice about your birth control choice (especially LARCs)

Sex after Birth: How to Know if (and When) You’re Ready

Everything You Need to Know about Postpartum Bleeding, aka Lochia

12 Relatable Instagram Accounts for New Moms to Follow

What’s the Best Postpartum Fertility Awareness-Based Method?

Three Science-backed, Natural Ways to Ease Childbirth and the Postpartum Period


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