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When it comes to planning for the 4th trimester, or the first 12 weeks after birth, the focus is often on the baby. But what about the mother? In the 4th trimester the mother will be healing from delivery all while trying to take care of a newborn. Many women experience not just feelings of overwhelm as a result, but potentially serious psychological distress. In fact, psychological difficulties are the number one postpartum complication.

There are a number of perinatal mood and anxiety disorders (PMADs) including postpartum depression along with postpartum anxiety, postpartum OCD, postpartum panic attacks, postpartum bipolar disorder, and postpartum psychosis. Symptoms, which can emerge during pregnancy or up to a year after delivery, can include feelings of sadness, anger, irritability, anxiety, intrusive thoughts, and so on.

Women who have a personal or familial history of psychological disorders are at risk for PMADs as are women who have a history of abuse, women who experienced pregnancy complications or a traumatic delivery, and women who have experienced pregnancy or infant loss. Other stressors, such as relationship difficulties and financial struggles, are also risk factors.

Particularly if you are at risk of developing a PMAD, but even if you do not have any risk factors, it is a good idea to consider ways that you can support yourself through yourself through the 4th trimester.

1.    Practice self-care and self-compassion. Have a plan for sleeping and eating. And no I don’t mean for the baby, I mean for the mother. Sleep is arguably the foundation of self-care and while it will inevitably be compromised during the 4th trimester, make sleep a top priority. Identify ways you can get as much uninterrupted sleep as possible; for example, if or when you bottle feed have someone else do a nighttime feeding so you can get a longer stretch of sleep. It can also be difficult to feed yourself while taking care of a newborn. Some parents organize meal trains, other prep and freeze meals in advance, others order take out. Do what works for you. Knowing that sleep and other self-care practices like exercise will be disrupted during this time, it is important to identify ways that you can practice self-care in the 4th trimester. You might consider going for daily walks before you have the clearance from your doctor to engage in more formal exercise like postnatal yoga, and meditating through an app like Expectful and/or writing in a postpartum journal. Also, be gentle with yourself emotionally during this time of transition, sometimes referred to as matresnecne.


2.    Consider who in your support system you can ask for help. Enlist as much support as possible. The more help you have with tasks such as cooking, cleaning, laundry, and other tasks, the more you can focus on resting and taking care of your newborn. Consider not just practical support, but emotional support as well. If you have a partner, know that your relationship will likely be strained under the pressure of the transition into parenthood. Approaching parenting together as you each learn how to care for your newborn, giving each other grace, and expressing appreciation for each other may help.


3.    Seek additional supports. You may benefit from attending a mommy and me group or a support group such as the perinatal (pregnancy & postpartum) mood support for moms offered by Postpartum Support International (PSI). Particularly if you are at risk of experiencing a PMAD you should consider establishing care with a therapist prior to the postpartum period. You can find a therapist who is perinatal mental health certified in your area through PSI’s online directory, which you can at the PSI website.


      PSI has a helpline available at 1-800-944-4773 (4PPD).


The National Maternal Mental Health Hotline is available 24/7 at 1-833-852-6262.


If you are experiencing thoughts of suicide the Lifeline can be reached 24/7 via text or phone at 988. In the event of a mental health emergency call 911 or go to the nearest ER. Please note that this information is intended for informational purposes only. It should not be used as a substitute for psychological or medical care.


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