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  • Kristen Drozda

The “fourth trimester” and postpartum mental health

Just when you think you’ve made it through the three trimesters of pregnancy and giving birth, you’re faced with the onset of the "fourth trimester"! This “fourth trimester” defines the postpartum period from the time after your baby born to the time, he or she turns 3 months old. During this time, you and your baby will experience a lot of physical, mental and emotional changes as you bond and settle into your new life as a family. Your hormones will be in flux, your organs will be moving back into their pre-pregnancy position to and your breast milk will come in. A mother’s brain also undergoes changes as there is growth in the brain regions that are involved in emotion regulation, empathy-related regions, which all affect maternal motivation and instinct.


After a mother has given birth, she will tend to focus on the care of the newborn baby, as will other family, friends and even health care professionals. But new moms need special care too and not just at the six-week postpartum medical checkup! Did you know that an estimated one in six women experiences postpartum depression? Although the numbers may actually be higher due to underreporting, misdiagnosis, as well as a lack of awareness. While most healthcare professionals will screen new moms for postpartum depression, it is often underdiagnosed. This is because some mothers are more private and don’t want to admit that they’re struggling, especially at a doctor’s office. They may not feel comfortable sharing negative feelings about their experiences or about their babies, and the stigma about a possible underlying mental health issue becomes a reinforcer for their silence. Some moms try not to think about how badly they feel or they may think that it is just a normal part of the postpartum period and silently hope that the bad feelings will eventually go away on their own. Moms may feel unsure if seeking help will make actually things better or worse. Unfortunately, the misconception that mothers should endlessly radiate joy and happiness actually result in women holding back in getting help and as a result they tend to struggle on a longer-term basis.


Postpartum or perinatal mood disorders can affect a new mother in the weeks and months after the birth of her baby. “Normal” baby blues are due to a hormonal shift after birth and can trigger symptoms of anxiety, guilt, negative maternal attitudes, as well as difficulty with coping with life events and parenting responsibilities. These symptoms usually diminish within a few weeks. However, if these symptoms last or get worse can indicate that a mother may be experiencing postpartum depression, anxiety, obsessive compulsive disorder (OCD), or another perinatal mood disorder. These perinatal mood and anxiety disorders can last up to 14 months after birth or sometimes even longer! These mood disorders can cause a mother to become withdrawn, disengaged or experience feelings of hostility towards her baby. This is why early detection and treatment are key for prevention of these risks.

It’s actually a misconception that postpartum depression just affects women, did you know that it can impact fathers too? Fathers show similar brain changes as mothers when they're deeply involved in caregiving. It is more common in mothers, but can affect any new parents even those who adopt!


Some moms may be more prone to postpartum mood disorders such as women who have a past history of depression, who experience significant life stressors or those that report having a lack of social support. However, these general risk factors actually only account for 30 per cent of the risk for developing a postpartum mood disorder. The two biggest factors that are directly associated with postpartum mood disorders are the amount of stress that a women experiences during pregnancy as well as the lack of support after the birth of the baby.


The great news is that there are various treatment options for postpartum mood disorders, such individual psychotherapy, group therapy and medication. Some moms may be hesitant about taking medication due to concerns about the side-effects if they are breastfeeding. Unfortunately, not enough moms seek help. This could be due to the stigma surrounding mental health issues, or time demands and concerns about securing child care if the mother wants to go to individual therapy.


Group therapy can be very helpful for new moms as it offers the benefit of emotional support and decreases the social isolation that many new moms feel. It also gives moms an opportunity to meet other moms with whom to share similar experiences, to learn new coping, problem-solving strategies and parenting strategies.


If you’re a new mom, contact us about our upcoming Perinatal Mental Health Therapy group.


-Sabine Kussmann


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