Blog
May 04
Guest Blog: The Fourth Trimester — What It Is and How to Navigate It

Sarah Bunzey, RNC-OB and Janice Prichett, LCSW-R wrote the following piece published in the spring/summer edition of Saratoga Family.

The birth of a child is an exciting, happy time—but it can also be overwhelming. Approximately 10% of mothers experience persisting feelings of anxiety, despair, and sadness in the postpartum period.

Although you've likely heard references to the "baby blues," these more severe, lingering feelings may indicate perinatal mood disorder, which includes postpartum depression and postpartum anxiety.

Perinatal mood disorders are not a sign of weakness. A woman experiences significant changes from pregnancy through childbirth, and in the weeks and months after. Those changes—physical, mental, emotional, financial, environmental—can take a toll, and it is something we as a society do not talk enough about.

Transition to Motherhood

A vast majority of expectant couples enroll in childbirth preparation or infant care courses, but there are few—if any—options to educate pregnant women and their partners/families on the realities of life with a newborn. The time between birth and the baby's first birthday, called the fourth trimester, is often characterized by lots of attention on the newest member of the family.

But what about Mom?

Sarah BunzeyThe transition to motherhood, or to mothering multiple children, is far from seamless. Physically, in the postpartum period, the focus shifts to the health of your baby, which is a marked change from the regular appointments and check-ups you had while pregnant. Emotionally, you'll be tasked with handling a variety of sometimes-conflicting feelings that might not make sense to you. You will have to manage your expectations, maybe ask for more help or set stricter boundaries for your family and friends, and that can be very hard to do.

Such stress can manifest into postpartum depression or postpartum anxiety. Symptoms may include:

  • Feeling irritable or angry with those around you
  • Difficulty bonding with your baby
  • Sadness or depression
  • Feeling out of control, or "crazy"
  • Problems eating or sleeping
  • Upsetting thoughts that you cannot get out of your mind
  • Anxiousness or panic
  • Worry that you'll hurt your baby, or yourself
  • Feeling you should never have become a mother

It is important to understand you are not alone. Perinatal mood disorders are the number one complication of pregnancy and childbirth. They do not discriminate. Counseling and treatment are available, both online and closer to home at Saratoga Hospital.

The Edinburgh Postnatal Depression Scale

Over the last year, the behavioral health team has worked closely with specially trained nurses in our Mother/Baby Unit to screen for and address perinatal mood disorders. Postpartum women answer a series of questions prior to discharge from the hospital, and the staff provides a list of community resources should they need additional support.

Implementation of the Edinburgh Postnatal Depression Scale allows us to quantify what postpartum women are feeling. It is a screening tool, and women answer a series of scored questions. Based on the score, women are offered the opportunity for an evaluation by a social worker. When necessary, they may be referred for counseling with Concert Health, the hospital's partner in remote behavioral health services.

The results of the Edinburgh Postnatal Depression Scale, as well as any meetings with social workers or Concert Health, are documented in each woman's electronic health record so her providers—primary care, OB/GYN—are able to monitor her progress.

We're here to help.

And there will be progress. With professional care and support, recovery is entirely possible. That's why honest communication between you and your healthcare team is so important. You are not alone in feeling this way, and our team is ready to help.

If you or your loved one could benefit from extra support, Saratoga Hospital hosts a bimonthly support group led by a Licensed Social Worker and a Registered Nurse who have completed specialized training specific to postpartum mental health.

The Maternal Mental Health Support Group meets via Zoom on the first and third Thursday of each month from 7 PM - 8:30 PM. For more information, please call 518-580-2871, or visit SaratogaHospital.org.

Sarah Bunzey is the nursing director of women's health services at Saratoga Hospital. Janice Prichett is the executive director of behavioral health services at the hospital.


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