African American mother and newborn baby

The Fourth Trimester

The 12 weeks after you give birth are a special time. Babies are adjusting to life outside the womb. For moms, it’s also a time of great emotional and physical changes as you recover from childbirth and your hormones continue to shift. While you focus on the joys and challenges baby brings, it’s important not to overlook your own health and wellness. Important aspects of self-care include:

  • Eating good, nutritious food
  • Sleeping when you can
  • Asking for and accepting help
  • Seeing your doctor for follow-up appointments

It’s essential to watch for post-birth complications and contact your provider if you have any concerns.


Even if you had normal blood pressures throughout your pregnancy, you should still notify your obstetrician if you develop headaches, vision changes or pain in the right upper portion of your abdomen — especially in the first two weeks after you deliver.


This usually occurs in in first 24 hours but in some instances there can be a delayed hemorrhage. This is defined as excessive bleeding greater than 24 hours after delivery and occurs in about 1% of pregnancies. If you are soaking through entire pads in less than an hour, you need to contact your physician.


It’s possible to develop an infection inside your uterus after delivery. If you experience fever (greater than 100.4 degrees F), chills or foul smelling vaginal discharge, you should notify your obstetric provider.
If you had a cesarean section, fever (greater than 100.4 degrees F), chills or discharge/redness around your incision could be a sign of a skin infection. You will want to notify your doctor about these symptoms right away.

Mood Changes

Up to 70% of women will experience some sort of mood disturbance within first several months of having child. Is it baby blues, anxiety or postpartum depression?

Baby blues are considered any mood disturbance in first four weeks after baby is born. It’s quite common to feel weepy and cry for no reason, feel impatient, sad, restless or have difficulty concentrating. Hormonal change plus the sleep disturbance that comes with baby can trigger these emotions which usually lessen with time – usually within the first 10 days.

Postpartum anxiety is extremely common but oftentimes unnoticed because many think anxiety simply comes with motherhood. But extreme anxiety, difficulty controlling worry, difficulty concentrating, irritability and sleep disturbance signal something more serious.

Postpartum depression is considered when a mom has more than four weeks of depressive symptoms that severely impact her daily functioning, including loss of interest in activities, decreased motivation, sleep disturbances, appetite problems, fatigue and thoughts of harming self/others.

Changes you might notice include:

  • Insomnia or sleeping too much
  • Unwilling or unable to care for newborn
  • Not taking care of self
  • Decreased appetite/li>
  • Anxiety or irritability

Women at increased risk for postpartum depression include those with:

  • Personal or family history of anxiety
  • Premenstrual dysphoric disorder
  • Obsessive compulsive disorder

Moms with babies in NICU also have an increased risk of postpartum depression, anxiety, PTSD, traumatic birth experience. In fact, up to 15% of women with baby in NICU meet diagnostic criteria for post-traumatic stress disorder.

It’s important to get evaluated by a professional as soon as possible for mood disturbances. It’s been shown that maternal mental health impacts bonding, maternal confidence and infant development.