Ever Heard of the “Fourth Trimester”?

By Allison Chapple, MS/EdS, LPC, NCC

Pregnancy is a time of nervous, but exciting, anticipation of a brand new life. Many women experience morning sickness and fatigue in the first trimester, unexpected body changes in the second and physical discomfort in the third, but they know all of these symptoms will all come to end once the baby is born. But what most women aren’t prepared for is the “Fourth Trimester,” otherwise known as postpartum. Women especially might not be prepared for the negative feelings that often arise with the addition of a new family member.

The term postpartum depression (PPD) often brings to mind people like Andrea Yates, the Texas mother who killed her five children by drowning them in the bathtub while in a cloud of postpartum psychosis. While tragic events like these do occur, PPD does not typically present in such a severe way. More commonly, new mothers experience the “baby blues,” a term for the short-lived mood swings and weepiness that occur in the first few weeks after birth in one-half to three-quarters of new mothers. By contrast, PPD is a more long-lasting, severe mood state which affects general functioning. The symptoms of PPD, which can emerge anytime from the first few days following birth up until a year post-delivery, include:

– Feeling sad, irritable, or angry
– Insomnia
– Lack of interest in activities of daily living
– Lack interest in the baby or other children
– Lack of pleasure in the baby and other family members
– Feelings of guilt, hopelessness, helplessness, worthlessness
– “Mood swings,” which sometimes include bouts of uncontrollable crying
– Constant exhaustion
– Changes in appetite
– Inability to concentrate or think clearly
– Excessive worrying
– Feelings of being a bad mother
– Decreased libido after the 6-week postpartum check up

Who is at risk of PPD? Research shows a higher incidence of PPD in: (a) women who have experienced depression during their pregnancy, (b) mothers who have had episodes of PPD historically or have been diagnosed with psychiatric conditions prior to their pregnancy (depression, Bipolar Disorder, psychotic disorders), and (c) teenage mothers, single mothers, women in lower socioeconomic classes, and women in tumultuous marriages. But, PPD can potentially affect ANY woman. This includes women who haven’t had PPD with previous children, women in stable relationships, women with no history of mental illness, and women who have waited their whole life to be a mommy!

With the new responsibilities of taking care of a new baby, many women ignore or minimize symptoms like those listed above. With pressure to appear like a “magazine-perfect” new mother, it is difficult for most women to admit to their partners, friends, and families that they are actually struggling. Many times it requires a loved one gently (or not so gently!) urging the mom to talk to her doctor about the way she is feeling. Many OB-GYNs have begun to use a PPD screening tool at the 6-week postpartum check-up as a way of catching symptoms that a new mother might be too ashamed to confess or can’t clearly articulate. Pediatricians also often catch new mothers’ silent struggling through a paper test or oral interview.

If you think that you might possibly be struggling with PPD, there are a number of things that can help. First, professional counseling can help you learn how to combat false beliefs associated with PPD (i.e., “I am a bad mother,” “I am useless to everyone in my life,” etc.), learn strategies to deal with negative emotions, and provide you with support and encouragement. Second, your OBGYN or internist might suggest an antidepressant to help you deal with your symptoms. He or she can talk to you about side effects and which medications are indicated for breastfeeding. Social support, though, can often be the most effective aid for helping new mothers “get over the hump,” especially from other new moms who might be coping with the same feelings. Many hospitals offer new parent support groups where a trained counselor, lactation consultant, or registered nurse can answer questions about all things baby.

If you feel as though you are struggling with the “baby blues” or PPD, don’t feel ashamed to seek help. You do not have to suffer silently!