Why is Nobody Talking About the Fourth Trimester? - Bergen Moms Network

You’ve been preparing for months for the arrival of your new bundle of joy – you took birthing classes, bought the essentials, and carefully curated that registry…but what about what you need after the baby arrives? The overwhelming majority of moms report a surge in emotions, hormones, and feeling overwhelmed in the first two weeks postpartum – a whopping 80% – and this is fairly normal (we call it the baby blues). Staggeringly, however, 20% of all new moms will also go on to experience a PMAD (perinatal mood or anxiety disorder) and the majority of new moms’ report having “no idea” the things their bodies would experience after birth. Yet, most birthing classes will not cover this, and your friends may not warn you. So, why is nobody talking about this?

Postpartum – also known as the fourth trimester – is not discussed nearly enough but should be. Many women never know what it is going to be like until they are in the thick of it. As a perinatal mental health certified (PMH-C) therapist, I am always disheartened that so many mothers are left feeling alone, isolated or ashamed of themselves when really they’re going through a hard transformation. This transformation, which often feels like a rollercoaster for first time moms, is called “matrescence”, which means the physical, emotional, hormonal and social transition to becoming a mother. It's likely it isn’t discussed because while it's beautiful, it’s also overwhelming and downright hard and, at times, not very “instagram worthy.”

But there are lots of things we can do to make the fourth trimester much less overwhelming for moms and families! Recognizing all of that and planning for it not only alleviates some of the struggle new moms experience – it can actually empower them to respond from a place of awareness as their identity and world shifts.

So how do we do this? Here are four tips on how to actually prepare for a more successful fourth trimester:

1. Find your village or hire folks to form one before you need them. Figure out who your support system is and identify things they can actually help you with. Do you trust your mom or sister the most? Let them hold the baby while you nap or shower those first few weeks. Is your mother-in-law an amazing cook? Ask if she can make you some meals for your fridge/freezer. Family and friends not available? Hire a postpartum doula, a night nurse or housekeeping services who can help reduce your mental load. This is also a season of receiving for you, mama!

2. Discuss expectations with your partner/support people and be prepared to pivot if needed. This is critical rather than assuming you or your partner will change the diapers, or you will strictly breastfeed; have direct, clear communication about what you want and need, and vice versa, with room to make changes. This is much like writing a birth plan and is arguably just as important since you will be caring for a newborn and need postpartum care yourself for much longer than the birthing process.

3. Learn about what happens to your body after delivery, regardless of how you give birth. So many mothers are overwhelmed by the bleeding, hormonal fluctuations and mood swings which makes them feel a wide range of emotions. About a third of new moms also have c-sections and didn’t expect this or learn much about them which can lead to a higher risk of perceiving birth as traumatic and feeling overwhelmed by aftercare. Between classes at your hospital, you OB/midwife, and mom friends/family, ask about what you will need for aftercare. You will be surprised how quickly women will jump to share what helped them from perineum spray to adult diapers. There is no shame in the after-care prep game!

4. Understand that 80% of women experience the baby blues (sadness/low mood 2 weeks after birth) but if significant anxiety or mood changes last longer than 2 weeks, you may have a perinatal mood or anxiety disorder (PMAD) like postpartum depression or anxiety disorder. You are not alone! At least 1 in 5 women experience a PMAD in their first year postpartum and help is out there! Talking to a perinatal therapist who is certified and trained to support you (like some of us at A Work of Heart) can help you feel well again. There are also lots of peer support groups available to you as well, such as ones through Postpartum Support International, local playgroups/mom groups and at hospitals. Studies show that women who receive a combination of support and outlets such as therapy, peer support, movement/exercise and effective nutrition have more successful outcomes in the first year postpartum.

Learning about postpartum not only can help you have a better experience but can also help the next mom in line. Speak the secret – postpartum is a journey, and the more we help other moms out by normalizing their experiences, the better off we all will be, including the baby! As we often say, healthy mom, healthy baby.



Kara Kushnir, LCSW is a psychotherapist and owner of A Work of Heart Counseling in Allendale; she is certified in perinatal mental health through Postpartum Support International, providing therapy to mothers, children and adolescents. 

To learn more about A Work of Heart Counseling, visit the website or follow them on Instagram

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