The study also finds that moms often overlook their postpartum care. Doctors explain how to care for your health during the fourth trimester.

Postpartum Depression Stressed Mother Holding Crying Baby
Credit: Daisy-Daisy/Getty Images

May 9, 2019

Those first three months with a new baby aren't easy—even if you aren't a first-time parent. This is again confirmed by a new survey by Orlando Health, which finds that 40 percent of women feel depressed, anxious, and overwhelmed in the weeks following Baby's delivery.

The survey, which featured information from 1,229 women, also finds that 63 percent of new moms are concerned about their own health just as much as they are with their baby's health, but 37 percent of moms ages 18-34 say they don't have a good plan for managing their own healthcare. And many are likely not seeking medical advice because they're embarrassed—more than 1/3 of these women say they feel embarrassed by what their bodies are going through after birth. 

"I wish more women knew how challenging the fourth trimester can be—even more so than the first three—and that it's okay to ask for help," says Megan Gray, M.D., an OB/GYN at Orlando Health Winnie Palmer Hospital for Women & Babies. "Those first few months after you deliver are a learning experience, and if you're feeling overwhelmed, you're not alone."

Dr. Gray says women need to focus on their own health after delivery though it may feel impossible when caring for an infant and she calls on more health care providers to include this fourth trimester as a standard part of prenatal education.

Why the Fourth Trimester Can Be Hard on Moms

Entering into motherhood is a time of change and transition and sometimes it comes with mental health challenges, explains Katayune Kaeni, Psy.D., a California-based psychologist certified in perinatal mental health.

"The fourth trimester is a new phase of life that is unique and different from other changes they may have experienced. They have a new job, a new title, and often very little training or preparation for their new role as mother," Dr. Kaeni says.

"What we know is that depression and anxiety can start in pregnancy and if it does and it goes untreated, it can worsen in the postpartum period," she says. "What is really important to note is that a perinatal mental health condition can start anytime in the year following delivery."

Self-care is critical during this time, but it doesn't mean all moms should take a spa day. "Some moms need a break from their baby, some moms don't want to be away from their baby. All of that is okay," she says.

Dr. Kaeni adds that there are several forms of self-care, and it can be as simple as asking for help—having someone come over to help with child care or housework—and alleviating self-imposed pressure to complete a to-do list. New moms might also find relief in listening to music, watching a sitcom, or doing anything that helps them feel less overwhelmed.

"We need to stop telling moms what to do and we need to be asking them what they actually need," Dr. Kaeni explains.

How to Prepare for the Fourth Trimester

Educating women on what they may face in the fourth trimester can help them put systems in place to help, says Dr. Kaeni, who says she suffered from postpartum depression, postpartum anxiety, and postpartum OCD. Women shouldn't fear the fourth trimester; they should know it exists and that there's help if it becomes too much.

Women can proactively line up services such as lactation care and emotional support as well as communicate preferences to family and friends before birth, says Kristin Tully, Ph.D. a researcher at the University of North Carolina at Chapel Hill School of Medicine Center for Maternal and Fetal Health. They can revisit and revise their postpartum plan after delivery so it meets their needs as time goes on.

More health care providers are learning about caring for women in the fourth trimester, but more needs to be done, Dr. Kaeni adds.

"We do not yet have a consistent plan of care that is universally practiced for the mental and emotional state of women in the postpartum period," Dr. Kaeni says. "We need more screening, more follow up from health care providers, more adequately trained professionals, and to boost up accessible resources for mothers everywhere."