Experts Recommend “Fourth Trimester” Care for Mothers-to-be to Help with Post-Partum Issues {Guest Post}

Experts Recommend “Fourth Trimester” Care for Mothers-to-be to Help with Post-Partum Issues {Guest Post}


Guest Post ByCarrie Krawiec, LMFT of the Birmingham Maple Clinic

In a recent update, the American College of Obstetricians and Gynecologists released a revised opinion to propose a new paradigm for postpartum care. The new recommendation replaced the former model where the first postpartum visit takes place six weeks after birth. The new advice suggests women should have their first encounter with their OB/GYN within three weeks after delivery and care should be followed up as long as needed but particularly focused on the 12 weeks following delivery, thus dubbing this comprehensive care as the “fourth trimester.”

The initial weeks after delivery can be a whirlwind of confusion. Hormones, sleep deprivation, change in routine and more – those demands contribute to a variety of physical, social and psychological changes. At the same time the weeks following birth are a critical period for a woman and her new infant, setting the foundation for long-term health and healthy relationships. The new recommendations help to provide touch-points so obstetric care providers can assess how a mom is navigating the new challenges of motherhood and help tailor support to each woman’s and child’s unique needs.

In the weeks following pregnancy, many mothers feel unlike themselves and find it hard to determine what is contributing to their emotional distress and the severity of the experience. Conventional wisdom states that a mother’s postpartum depression is largely triggered by hormone fluctuations. Interestingly, men can also be at risk for postpartum depression. And, postpartum in men may also be caused by a man’s shift in hormones even though they were not pregnant and did not give birth. In fact, as many as 1 in 4 fathers become depressed after the birth of a child, half of all men with depressed partners are likely to be depressed, and depression among men increases 68% during the first five years of the baby’s life.

If you are concerned that you or your partner could be suffering from a postpartum mental health issue like depression or anxiety, it is imperative to talk about it to your doctor at a follow up appointment. The new recommendations for earlier and more frequent follow up care help the doctor track changes in mood or anxiety. While women often have a broader social network to talk about issues and problems, men may often keep feelings to themselves. Sharing your feelings does not mean you are complaining or burdening your spouse or other supports. In fact, it means you are acknowledging a problem and taking steps to fix it.

Here are some other solutions to help reduce the risk of worsening mental health conditions after a child is born:

  • Take Care of Yourself
    • Both mom and dads can value from carving out time individually and together. Exercise, eating well, journaling, yoga, napping—anything that reduces stress should have a spot on each parent’s to-do list. Plus, while you are getting rejuvenated, you give your child the opportunity to connect and attach to other special caregivers like the other parent or grandparents.
  • Set Boundaries and Expectations
    • Another form of self-care is setting boundaries with others and internally with yourself. If you are tired from too many visitors, too much advice or some other inconvenience, get comfortable saying “Thank you, but no thank you.” Asserting boundaries for yourself and others will help you to take care of yourself and your child.
  • Be Flexible
    • Before you have a child you many have preconceived expectations and fantasies of what you want your life to be like with a baby. You may say things like “I will definitely breast feed” or “I definitely will not co-sleep” or “I will get back to working out in two weeks.” The truth is, when babies come into your life, some of our most rigid thoughts need adjusting. Some parents feel like failures if their perceived post-baby life does not work out as planned. Each parent and baby needs time to work out what works specifically in their household. Allow your baby to be a part of the unique process of becoming a member of your family instead of trying to crunch yourself, your partner, and your baby into some unattainable goals.
  • Be Open to Speaking to Others
    • Use your doctor and/or your baby’s doctors as an opportunity to talk about how you are doing and what questions you have.
    • Find new parent groups or reach out to friends, family or other supportive parents to get advice (while maintaining flexible expectations and boundaries, since what works for one family may not be the same for yours).
    • Consider counseling or medication. Professional help like talk therapy, antidepressants or anti-anxiety medication may be helpful, per your doctor’s recommendation, especially in the first few months following a new baby.

More About the Author:

Carrie Krawiec, LMFT of the Birmingham Maple Clinic is licensed and trained to provide individual, couple, and family therapy. Areas of interest include a variety of relationship issues including adult family conflict, family conflicts between parents and teens, relationship and marriage counseling, co-parenting following divorce, step-parenting, peer relationships, emotional regulation, anxiety, and depression. Specific training in Parent Management Training-Oregon (PMT-O Specialist); a behavior management technique for parents to utilize with children to prevent and reduce behavior issues in children age 7 to 17.

Carrie Krawiec Headshot


*Photos courtesy of Birmingham Maple Clinic


Cynthia Tait

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