Fourth Trimester Checklist: Moms Are Still in a Vulnerable State After Childbirth

A pregnant woman’s goals are staying healthy for the three trimesters to give her unborn baby the right start. They do everything to cope with pregnancy symptoms and prepare for delivery day. But preggos need to remember medical care should not stop at childbirth. There is still a critical period: the fourth trimester.

What is the fourth trimester?

The fourth trimester is the period between birth and 12 weeks postpartum. During this time, a woman’s body is still recovering (physically and emotionally) while she is also adjusting to her role as a parent. It is a particularly vulnerable time for new moms, which can have a big impact on their mental health.

“Having a baby is a complete life overhaul. A person’s life can become almost unrecognizable. Mental health issues are so very common during this life stage,” Laura Jordan, a therapist specializing in reproductive mental health, tells Romper.

She adds, “In fact, perinatal mood and anxiety disorder is the number one complication of childbirth. Drastic hormonal changes in conjunction with environment risk factor can instigate mental health issues such as increased anxiety over responsibility for another life, depressed feelings and grieving the loss of a life before baby came, and more recently, anger and rage are being recognized as common in postpartum.”

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How to take care of yourself in the fourth trimester

In the U.S., the American College of Obstetrics and Gynecology (ACOG), which governs standards of care and guides practice, now recommends that medical professionals view postpartum care through the lens of maternal health. Their new guidelines contain calls for a closer follow-up of women after birth, specific recommendations for doctors, and a need to support individualized, continuous postpartum care for each woman. The ACOG also urges women to see their doctor three weeks after delivery — even sooner if their pregnancy experienced complications.

“Women with high blood pressure, for example, are often seen within the first five to seven days after the delivery,” explains Dr. Lisa Hollier, president of the ACOG, in an interview with NPR. “We really believe that to best optimize the health of women, postpartum care should really be a process — not a visit.”

Apart from seeking help from doctors and medical professionals, moms can also take care of their mental health by reaching out for help and being open about their feelings and state of mind to friends and family.

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“When a new mother lets others in to her emotional experience explicitly, it can cut through the feelings of isolation,” explains Nicole Makowka, a psychologist and director of parenting education for LOOM (a company that holds parenting classes and coaching in Los Angeles, California), to Romper. “The other person now has an opportunity to be an advocate for the new mother, which means they can encourage her to sleep, eat, rest, and get professional help if needed.”

It is also crucial for new moms to build their “village” during pregnancy apart from friends and family, so they can have a steady support group after birth. (If you are looking for a supportive online community, check out our Facebook group Smart Parenting Village.)

Makowka also recommends talking to your child’s pediatrician about your experiences during checkups. “They will likely normalize the experience, provide insight, and share suggestions or referrals,” she tells Romper. “Other ways that women can cope with the emotional changes are to focus on rest, sleep, nourishment, asking and accepting help, and eliminating the expectation that healing and caregiving should be done in isolation.”

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Be clear to your partner about your needs — create a postpartum plan if you need to. This can help you anticipate the difficulties of taking care of a newborn, and for you to be prepared to get the types of support you need.

Lastly, take time to do things that bring you joy as a person, and not just as a mom. Self-care is important especially in the fourth trimester.

When to seek professional help postpartum

Experiencing “baby blues” for up to two weeks after birth might be typical, but if you have feelings of hopelessness, sadness, anxiety, or isolation after those two weeks are up, it is important to consult with a medical professional.

“Rage, intrusive thoughts, suicidal ideation, and not bonding with your baby are also red flags that professionals recommend women be on the lookout for in the fourth trimester that signals a need for help beyond the support of friends and family,” according to Romper.

The scariest symptom of postpartum depression is anger that cannot be explained. Learn how to identify it here.

Don't be afraid to reach out if you are feeling anxious, helpless, or depressed. If you need someone to talk to: 

• Crisis Line +63 (2) 893-7603 / +63 (917) 800-1123 / +63 (922) 893-8944
• Manila Lifeline Center at +63 (2) 896-9191 or +63 (917) 854-9191
• Department of Health's 24-hour suicide prevention hotline Hopeline +63 (2) 804-4637 / +63 (917) 558-4673 and 2919 for Globe and TM subscribers
• You can also join SOS Philippines on Facebook, a support group founded for survivors of suicide loss and Filipinos undergoing mental health ailments like depression and bipolar disorder.

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