General Health & Wellness • Jul 27, 2023

The Fourth Trimester: Postpartum Mental Health

Postpartum is not something that new moms always prepare for. Four days after we welcomed our healthy rainbow baby to the world, I found myself shocked by the overflow of tears falling into my spaghetti while eating dinner with my husband. Why was I crying? Our baby boy finally made it here! I had the most supportive husband and extended family. We were home recovering nicely with our two fluffy Siberian huskies. What could be wrong? I was struggling with what is commonly referred to as postpartum baby blues.

Most people are aware of the 1st, 2nd, and 3rd trimesters of pregnancy, but a 4th trimester surprises some people. The fourth trimester is 12 weeks after the baby is born. This period usually involves a bundle of joy and a bundle of emotions! It is physically and emotionally challenging for everyone involved, especially the recovering mother. Mom is adapting to a newborn while also trying to heal herself, and sometimes from a major abdominal surgery, all while fluid is leaking from multiple orifices.

Even as a healthcare professional, I found myself struggling with the adjustment. I was surprised by breastfeeding challenges, sleep cycles (or lack thereof), acne, night sweats, and hair loss. Postpartum challenges and mood changes do not discriminate!

After giving birth, there is a sudden drop of two hormones; estrogen and progesterone. This results in postpartum baby blues for 80% of moms and up to 10% of non-birthing partners. Let’s take a second to recognize the significance that most women experience uncontrolled mood changes after giving birth.

Baby Blues Quick Facts:

  • Timing: weeks 0-2 of the 4th trimester
  • Symptoms: mood swings, crying, and irritability
  • Treatment: not usually required, but please let your doctor know you are experiencing these symptoms.
    • Symptoms usually subside when hormones level out around week two postpartum

What if symptoms worsen or persist, though? This is when you should contact your healthcare provider immediately to discuss your symptoms and options.

Postpartum depression, anxiety, and psychosis are entirely different beasts and are very serious issues. The CDC reports 1 in 8 women struggle with postpartum depression. Postpartum depression differs from baby blues based on the timing and severity of mental illness symptoms.

Postpartum Depression (PPD) Quick Facts:

  • Timing: persists after two weeks postpartum but can begin anytime within the first year of the baby’s life
  • Symptoms:
    • Lack of sleep
    • Withdrawing from baby or loved ones
    • Feelings of guilt or hopelessness
    • Low energy and concentration
    • Changes in appetite
    • Irritability
    • Thoughts of self-harm or harming others

Postpartum Anxiety Quick Facts

  • Timing: persists after two weeks postpartum but can begin anytime within the first year of the baby’s life
  • Symptoms:
    • An overwhelming feeling of worry, sometimes revolving around controlling the things around her or about the baby’s routine and safety
    • This can result in strained relationships or even loss of sleep

Postpartum Psychosis Quick Facts

  • Timing: very rare
  • Symptoms:
    • Paranoia
    • Hallucinations and/or delusions
    • Mania: risky behavior, lack of sleep without fatigue, impulsivity, rapid speech, and more

Risk Factors for postpartum mood and anxiety disorders consist of:

  • Previous history of mood disorders
  • Being a teen mom
  • Fertility, pregnancy, or birth complications
  • Preterm labor and delivery (before 37 weeks)
  • Being a mom to multiples
  • Lack of strong social support

I strongly believe our society puts very unhealthy pressure on being the best mom and a happy mom. There is pressure to breastfeed, to have extended family meet your new baby while you are still bleeding, and to sleep when the baby is sleeping.

Thankfully, postpartum mood and anxiety changes can be treated. Typically, moms fill out the depression screening before discharge from the hospital and at the postpartum visit; however, sometimes, that postpartum visit is not for six weeks! Many providers, including me, now screen for mood changes before delivery. This makes initiating treatment or establishing care with a therapist easier if needed. If medication is needed, know that these medications can be very safe for pregnant or lactating moms. There are also free online support groups at

If you have any concerns about your mood, do not hesitate to contact your Ob/Gyn. Please know you are not alone, and having mood changes after giving birth does not make you a bad or ungrateful mom. If you’re like me, you might have a hard time asking for or accepting help. I now realize that asking for help is a sign of strength, not weakness.

Additional Resources for Support and Help

  • National Maternal Health Hotline: call or text 1-833-852-6262
  • Postpartum Support International: visit; call or text 1-800-944-4773
  • WashU Perinatal and Behavioral Health Service: 314-454-5052
  • If you are in an immediate emergency, please call 911