The Fourth Trimester and Postpartum Depression


Many women focus their attention on the first three trimesters of pregnancy. In the past, not much attention was given to the fourth trimester beyond breastfeeding and healthy sleep habits for your baby. However, so much more takes place during the fourth trimester. It is a time for bonding with your new baby, getting used to the routine of caring for a newborn and creating your unique family unit.

It is quite a surprise then for many new mothers who find themselves overwhelmed, fatigued, and anxious once they have birthed their babies. The “baby blues” affect 50-80% of women. This condition is often short-lived and is characterized by mood swings, anxiety, irritability, crying spells, sleep problems and feelings of hopeless-ness and loneliness. The baby blues usually go away after 7-10 days on their own. Symptoms are not usually severe and treatment isn’t needed. Although, there are things you can do to feel better. Nap when the baby does. Ask for help from your spouse, family members, and friends. Join a support group of new moms or talk with other moms.

For some women, these uncomfortable feelings persist and become what is commonly referred to as postpartum depression. Postpartum depression affects 10-15% of women any time from a month to a year after childbirth. The difference between postpartum depression and the baby blues is that postpartum depression often affects a woman’s well-being and keeps her from functioning well for a longer period of time. Postpartum depression needs to be treated by a doctor or other healthcare provider. Counseling, support groups, and medicines are things that can help. The factors that may contribute to postpartum depression include:

  • Feeling tired after delivery, broken sleep patterns, and not enough rest often keeps a new mother from regaining her full strength for weeks.
  • Feeling overwhelmed with a new, or another, baby to take care of and doubting your ability to be a good mother.
  • Feeling stress from changes in work and home routines. Sometimes women think they have to be “super mom” or perfect, which is not realistic and lead to added stress.
  • Having feelings of loss — loss of identity of who you are, or were, before having the baby, loss of control, loss of your pre-pregnancy figure, and feeling less attractive.           
  • Having less free time and less control over time. Having to stay home indoors for longer periods of time and having less time to spend with your partner and loved ones.

Any of these symptoms during and after pregnancy that last longer than two weeks are signs of depression:

  • Feeling restless or irritable
  • Feeling sad, hopeless, and overwhelmed
  • Crying a lot
  • Having no energy or motivation
  • Eating too little or too much
  • Sleeping too little or too much
  • Trouble focusing, remembering, or making decisions
  • Feeling worthless and guilty
  • Loss of interest or pleasure in activities
  • Withdrawal from friends and family
  • Having headaches, chest pains, heart palpitations (the heart beating fast and feeling like it is skipping beats), or hyperventilation (fast and shallow breathing.)
  • After pregnancy, signs of depression may also include being afraid of hurting the baby or oneself and not having any interest in the baby. In extremely rare cases—less than 1% of new mothers—women may develop something called postpartum psychosis. It usually occurs within the first few weeks after delivery. Symptoms may include refusing to eat, frantic energy, sleep disturbance, paranoia and irrational thoughts. Women with postpartum psychosis usually need to be hospitalized.

Researchers aren’t sure what causes postpartum depression, but think that the dramatic shifts in hormone levels during pregnancy and immediately afterward may result in chemical changes in the brain leading to the condition. The most important thing to do if you suspect you have symptoms of postpartum depression is to talk to your healthcare provider. This type of depression is an illness just like any other and there are treatment options. Some women opt for a course of antidepressants and talk therapy or group therapy. The use of acupuncture and herbs may be beneficial. Joining a support group such as PEPS (visit their website at is also extremely helpful. PEPS places you in a group with other mothers of newborns in your neighborhood. You meet weekly for four months with a group leader and discuss many of the topics that face new mothers during the fourth trimester. It gives you an opportunity to connect with other moms, get out of the house and get support.

It is important to talk about how you are feeling. There are many new moms who are feeling depressed, judge themselves, and feel guilty for not being “supermom”. They

are often embarrassed to admit to their partners, friends and family members how they are feeling. Recently, with celebrities like Brooke Shields opening up to the public about her struggles with postpartum depression, the topic is receiving more attention. Hopefully, more new moms are being educated and can feel assured that they are not alone and that there is help for this condition.

Here are some tips that can help prevent, or help you cope with postpartum depression:

  • Be realistic about your expectations for yourself and your baby
  • Limit visitors when you first go home
  • Ask for help — let others know how they can help you
  • Sleep or rest when your baby sleeps!
  • Exercise; take a walk and get out of the house for a break
  • Screen your phone calls
  • Follow a sensible diet; avoid alcohol and caffeine
  • Keep in touch with your family and friends — do not isolate yourself
  • Foster your relationship with your partner — make time for each other
  • Expect some good days and some bad days

Written by Diana Soto, former Licensed Marriage and Family Therapist at Acupuncture NW & Associates

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