THE 4th TRIMESTER:

Time to Take Care of Mom

ABOUT THIS BOOK

This book was produced by Allegheny Health Network (AHN), a non-profit medical system with eight hospitals and more than 50 women’s health offices in Western Pennsylvania. At AHN, we understand each woman has her own individual health care needs. That’s why we treat each woman throughout all of her life, from prevention and wellness, to state-of-the-art labor and delivery services, to advanced gynecologic surgery capabilities, to midlife care, mental health, and beyond!

With nearly 8,000 babies born at AHN hospitals each year and growing, we care for a lot of women as they make their journey through pregnancy, delivery, and adjusting to having a new little one in their lives. Those first few months after delivery offer their own unique set of joys and challenges.

That’s why we put together this brief guide to share about some of the things new moms might be experiencing in their own, unique ways – but not alone.

From our family to yours, congratulations – and take care!

About This BookPostpartum Doctor VisitsEmotional HealthSelf-CareResources

We believe so strongly in the emotional health of moms that we built a facility dedicated solely to it – the Alexis Joy D’Achille Center for Perinatal Mental Health at AHN’s West Penn Hospital.

This center, the first of its kind in the Western Pennsylvania region and one of few in the country, was built to provide research, information, and specialized treatment surrounding perinatal depression, anxiety, bipolar disorder, and infant loss.

The center has transformed women’s behavioral health treatment experiences, focusing on keeping mothers physically and emotionally connected to their children throughout the healing process. Our goal is to make Pittsburgh the safest place for moms and their new babies.

You prepared. You researched. You delivered. And now you're officially a mom.

Pregnancy is normally measured in the three trimesters that lead up to birth. But in many ways, the months following birth are just as important in making sure you and your baby are healthy – that’s why it’s called the 4th trimester. During these next few months, your health deserves as much attention as you gave it during the last nine months.

THE 4TH

TRIMESTER

We're Here for You

Whether this is your first pregnancy or your second or third, this guide is designed to help answer some of your questions. You will be going through some changes during the next several months – both physically and emotionally. Sometimes you may wonder, “Is this normal?”

While your most important source of information and guidance will come directly from your physician, we believe the information contained in this guide can be a helpful reference, providing an overall picture of what you might experience as you transition into your time with a new baby at home.

RESOURCE

AHN Women's Behavioral Health

AHN.org/hope866-951-6390

A note to moms

The reality is that many women begin a pregnancy, go to the hospital — and don’t come home with their baby.

For some, it means their baby needs extra special care in the NICU after he or she is born. This can be an emotional and exhausting time for moms, and it’s normal to feel anxious and a little helpless as you travel back and forth to the hospital and wait for news from the dedicated nurses and doctors caring for your little one. As they help your baby get strong enough to join you at home, please take some time to rest and take care of yourself, too.

Sadly, some moms experience complications with their pregnancy, and the baby doesn’t survive. The loss of a pregnancy, at any stage of pregnancy, can be a devastating experience like no other. Feelings of grief, sadness, anxiety, and sometimes guilt can persist long after you are physically healed. It’s important to find help.

whose babies don't come home:

Ask your doctor if they can recommend a bereavement counselor who specializes in helping families who have lost a pregnancy to guide them on their grief journey and prepare for their new normal.

For moms who are going through loss, the 4th trimester is different in all ways — but still a time to take care of yourself as much as possible. Families may find comfort in commemorating their baby through ultrasound pictures, photography, a special necklace, a ceremony with loved ones, a charitable donation in their baby’s name, or some other special observation or activity. We extend our most heartfelt condolences on your loss, and wish you peace and healing.

POSTPARTUM DOCTOR VISITS

After you’ve given birth, most hospitals will have a nurse call you a few weeks after delivery just to see how things are going, how you’re feeling, and if you have any questions. As always, don’t hesitate to pick up the phone and call your doctor if you’re not feeling well.

Your OB-GYN will want to see you 6-8 weeks after you give birth, unless there is concern to be seen sooner. Some of the things they’ll cover during that visit include:

  • An evaluation for postpartum depression and anxiety
  • A physical exam
  • Contraception options
  • Breastfeeding comfort and concerns
  • Anything else you’d like to discuss including pelvic pain, pain with intercourse, incontinence, or if your body doesn’t seem to be returning to its pre-baby state

Your pediatrician may also ask about your emotional health when you bring baby in for his or her first visit a few weeks before your OB-GYN appointment.

These are good times to ask about the little things that have been bugging you, even if they seem insignificant. Be open and honest! You know yourself the best, so if your body, mood, energy, appetite, or anything else seems “off,” please share those things with your OB-GYN or pediatrician so they can help.

EMOTIONAL HEALTH

There’s a preconceived idea that the weeks and months after giving birth are supposed to be the happiest time for a woman. And that makes it extra hard to admit to yourself or tell someone if you’re actually struggling and feeling sad during your pregnancy or after you give birth. You may have heard about the “baby blues,” or feeling a little down after you deliver. But postpartum depression, anxiety, and bipolar disorder are something more.

Your Emotional Health

Postpartum Depression

Postpartum depression, or PPD, is more persistent and lasts longer than the “baby blues,” and it’s a lot more common than people think. One in every seven moms will experience postpartum depression (PPD) each year – that’s over 500,000. It’s so common that it’s considered the number one complication of pregnancy, and affects more women than breast cancer.

Postpartum depression isn’t just about the situation. It’s a mix of significant changes in your body, with the added pressure of becoming responsible for a baby. Giving birth creates waves of rapidly changing hormones, sometimes giving way to sad and hopeless thoughts.

For many, this period of “baby blues” doesn’t last long. For others, these feelings just won’t stop. It can affect anyone, even if you don’t have a history of depression. And it absolutely does not mean you’re a bad mom.

What are some of the signs of postpartum depression?

  • Loss of pleasure or interest in activities you once enjoyed
  • Feeling sadness most of the time
  • Change in appetite
  • Feeling guilty about not being a good enough mother
  • Feeling irritable or having a low frustration tolerance
  • Feeling indecisive or angry
  • Lack of focus or having feelings that you don’t care about anything
  • Struggling to interact or connect with your baby
  • Withdrawal from family and friends
  • Feeling like a whole different person
  • Thoughts of self-harm or harm to your baby

SOURCE:  CDC, American Cancer Society

BY THE NUMBERS

Only 15% of women with perinatal mood disorders, including postpartum depression, receive treatment

1 in every 7 moms will experience postpartum depression

Postpartum depression is the #1 complication of pregnancy

More than 500,000 moms are affected by PPD each year

SOURCES: CDC, American Cancer Society, American Psychological Association

POSTPARTUM DEPRESSION SURVIVOR – BRIANNE

“I noticed I wasn’t connecting with my daughter as much. And I didn’t really know what to do. How do you solve this? I was off the charts for both postpartum depression and anxiety. And I didn’t want people to judge me for this. It wasn’t something that I had asked for.”

Postpartum Anxiety

Most new moms feel stress and worry, but sometimes it can be worse than that. Postpartum anxiety is a lesser-known but still serious medical condition that affects about 15% of moms. If you feel these things more often than not, please call your doctor:

  • Constantly feeling on edge
  • Racing or irrational thoughts
  • Sleeplessness
  • Rapid heartbeat
  • Irritability
  • Nausea
  • Lack of focus

POSTPARTUM DEPRESSION SURVIVOR – ERIN

“It can be hard to differentiate between being overwhelmed and exhausted from having a newborn and being something more than overwhelmed. Having a newborn is hard enough, let alone your hormones wreaking havoc on your body – there’s no reason not to get the help that’s available.”

Postpartum Bipolar Disorder

If postpartum bipolar disorder isn’t something you’ve ever heard of, you’re not alone. It's one of the most undiagnosed mental health conditions women face post-delivery, and can even be made worse by some medications used to treat postpartum depression and anxiety. If you or a family member have a history of bipolar disorders, it’s important to tell your doctor, especially if you experience emotional highs and lows that include the following symptoms:

  • Alternation between feelings of elation and depression or irritability
  • Decreased need for sleep
  • Rapid speech
  • Racing thoughts
  • Impulsiveness
  • Poor judgment
  • Distractibility

SOURCE: NATIONAL INSTITUTE OF MENTAL HEALTH

POSTPARTUM BIPOLAR DISORDER SURVIVOR – PATRICIA

“There’s this feeling around being pregnant that it’s supposed to be so joyful, and you’re supposed to focus just on the baby and not yourself. There’s nothing wrong with getting help. That’s the healthiest thing, asking for help. It saved my life and I’m proud of myself for doing that.”

What To Do

Fortunately, postpartum behavioral health issues are treatable medical conditions, but they are urgent and it’s necessary to get help right away. A qualified mental health professional can build a personalized plan based on your specific experience and help get you on the path to feeling better. We stress the importance of early detection and emphasize the need to watch for warning signs – not only by yourself, but by your loved ones, family, and friends.

Postpartum mental health concerns are real and it’s not your fault. Please reach out to your obstetrician, baby’s pediatrician, midwife, or primary care physician and share your concerns. If you feel that those already helping are not doing so urgently enough, please reach out to a therapist or psychiatrist.

Getting It Out There

It can be really hard to put into words what you’re feeling sometimes, especially if your feelings are new and strange to you. But it’s important to try so you can start to feel better.

Here are a few approaches that might help you bring up what’s on your mind:

Ask other moms. “When you had your baby, did you ever feel [something you’re worried about] or [something else that doesn’t feel right]? Because I’m starting to wonder if I should be worried about how I’m feeling…”

Be open and honest with your partner, sibling, or best friend. “I know you already think I’m weird sometimes, but in all honesty, have I been doing anything lately that stands out as totally not me?”

Write it down. “There are a few things that have felt off about me lately, and it was easier for me to write them down [or text] to share.”

If you feel that you’re in deep depression and you fear that there is immediate danger, such as self-harm or harm to your baby, please call 911 or 1-800-SUICIDE for help.

SELF-CARE

In the 4th trimester, self-care is more important than ever. True, carving out time to make sure mom is feeling good might seem like a daunting task. But whenever you’re able, try to check in with yourself for a minute and see what you can do to make sure you’re taking care of your own body and mind, as well as your family.

Take care of yourself, too.

The Importance of Sleep

Sleep is an essential part of our physical and mental health – it allows the body to heal itself and function on a day-to-day basis. But many new moms don’t get enough sleep as babies may wake frequently during the night for feeding, changing, and fussing. Sleep deprivation can take a toll over time and can lead to irritability, illness, stress, and forgetfulness. But hang in there – it does get better!

While some days will be easier than others to get the rest you need, it’s important to try to sleep whenever you can. Here are some helpful tips to sneak in periods of rest:

Sleep when your baby sleeps. Silence your phone, hide the laundry basket, and ignore the dishes in the kitchen sink. Calls and chores can wait.

Set aside social graces. When friends and loved ones visit, don’t offer to be the host. Instead, ask if they could watch your baby while you take a nap.

Don’t “bed share” during sleep. It’s okay to bring your baby into your bed for nursing or comforting – but return your baby to the crib or bassinet when you’re ready to go back to sleep.

Split duties. If possible, work out a schedule with your partner that allows each of you alternately to rest and care for your baby.

Give watchful waiting a try. Sometimes, you might need to let your baby cry himself or herself to sleep. Unless you suspect that your baby is hungry or uncomfortable, it’s okay to encourage self-soothing. If the crying doesn’t stop, check on your baby, offer comforting words, and leave the room. Your reassuring presence might be all your baby needs to fall asleep.

SOURCE: MAYO CLINIC

While it might be challenging to shop for and prepare healthy food while caring for a newborn, there are tips and tricks to make good nutrition possible:

Eat when baby eats. Sneak in small bites of fruit, yogurt, low-fat cheese, or whole-grain bread or muffins whenever you feed your baby. Stash healthy snacks within arm’s reach of your go-to nursing spots.

Welcome help. When friends offer to help, ask them to bring versatile, prepared foods like a rotisserie chicken, prewashed bags of salad greens, fruit salad, veggies and dip, or whole-wheat bagels.

Don't forget the freezer. Now’s the time to defrost any homemade goodies you premade or had friends bring and enjoy them. Also, stock up on frozen dinners and snacks (look for healthy ones).

Food as Fuel: Good Nutrition

ADAPTED FROM WWW.WHATTOEXPECT.COM

Have meals delivered. You’ve earned a break – don’t be shy about opting for deliveries from grocery stores and restaurants. Consider ordering ahead a few meals to reheat later.

Make leftovers. If you’re cooking, make extra for later. Boil six eggs instead of one, make the whole box of brown rice, bake a few potatoes, and cut up extra veggies.

Hydrate. Keep bottles of water in every room of the house, so no matter where you and baby are, you can grab a quick drink. To keep yourself hydrated (dehydration can lead to fatigue), make sure you have a drink every time baby does.

Eating a healthy, balanced diet is always important. But in the months following pregnancy, your body really needs that fuel to recover from pregnancy and delivery, boost energy, fight fatigue, and maintain a healthy weight. If you’re breastfeeding, eating well enables your body to produce wholesome milk for your baby.

Some of the nutrients that are especially important in the 4th trimester are:

Protein: Foods like beans, seafood, lean meats, eggs, and soy products are rich in protein, which help your body recover from childbirth. Aim for five servings each day, or seven if you’re breastfeeding.

Calcium: You’ll need 1,000 milligrams – about three servings of low-fat dairy – each day.

Iron: This nutrient helps your body make new blood cells, which is especially important if you lost a lot of blood during your delivery. Red meat and poultry are high in iron. So are tofu and beans. Whether you eat meat or go vegetarian, 15 milligrams daily should be your goal.

SOURCE: WEBMD

Exercise to Keep You Going

The idea of physical activity probably sounds overwhelming when you’re coping with the added responsibilities of a new baby, but it’s important to be active when you can. Even just a little bit of light exercise each day is helpful in reducing stress, improving self-esteem, increasing energy, regulating moods, getting your body back to its pre-baby shape, and sleeping more soundly when you do have the chance to rest.

If you had a healthy pregnancy and a vaginal delivery, you should be able to start exercising again soon after the baby is born. If you had a C-section or other complications, ask your health care provider when it is safe to begin exercising again. The best exercise is the one you can do safely and regularly. You know your body better than anyone – listen to it!

When you are ready to start exercising, here are some ideas for getting the recommended 20-30 minutes of movement each day:

Walking is a great way to get back in shape. Walking outside has an added bonus because you can push your baby in a stroller and get a little fresh air.

Check out fitness DVDs and online exercise programs you can do right at home. Many are designed for women who have just had a baby. Some even show you how to involve your baby in the exercise routines.

ADAPTED FROM THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS

Check with your local fitness clubs or community centers for classes that interest you, such as yoga, Pilates, spinning, and dance. Some gyms even offer special postpartum exercise classes and classes you can take with your baby and may offer childcare. You get the added benefit of social time, and workout buddies that keep you motivated!

However, if you are not sure how to start an exercise program or are having any pain issues, please discuss with your physician the option of attending women’s pelvic health therapy services.

RESOURCE

AHN Women's Pelvic Health Therapy Services

412-854-7010Learn More

Starting Motherhood with Less Stress

Having a baby is a big life change, and stress is to be expected. There are so many new responsibilities, an unpredictable schedule, less sleep, hormonal changes, wondering if you’re doing it right – it’s enough to make even the coolest cucumber sweat sometimes!

Self-care and stress management are important parts of adjusting to motherhood, and each day offers a new opportunity for renewal and moments of calm.

Here are some ways to reframe stressful situations and restore a little peace to these next few months:

Identify what’s causing the stress. Then determine what might be done to minimize that stressor – or how you react to it. Give yourself permission to adjust your standards and accept that it’s okay if things aren’t as they’ve always been.

Recognize what you can control, and what you can’t. Newborns have their own quirks, schedules, preferences, and agendas – and that unpredictability is part of what makes them cute!

Take care of your body. Good sleep, nutrition, and exercise are essential parts of coping with stress and anxiety.

Make time for daily relaxation. Even if it’s just a few minutes while baby is sleeping or with another caregiver, treat yourself to gentle music, focused breathing, reflection, yoga, or meditation.

Give yourself a pep talk. Positive self-talk may feel silly, but putting a positive spin on things can make them seem less daunting.

Accept help from your partner, friends, and family. They’re eager to lend a hand with things like running errands, dropping off meals, watching an older child, keeping you company, holding the baby while you take some time for yourself, and so on.

Know there will be setbacks. Be kind to yourself when they happen.

RESOURCES

There are many resources available in the community for you and your family. A resource guide detailing local and national information for children birth to age 21 can be found by visiting familyresourceguide.org.

The United Way offers additional resource support ‑ dial 2-1-1 or 888-553-5778 or 7-1-1 if hearing impaired.

AHN Women’s Behavioral Health

AHN Women’s Pelvic Health Therapy Services

Learn More412-854-7010Learn More866-951-6390

Postpartum Support Intl.

1-800-944-4773

PSI’s website receives more than 100,000 visitors a year who seek PSI for support, education and local resource information.

To obtain supplemental foods, nutrition education, and breastfeeding information.

For information on finding a doctor, getting health care coverage, immunizations, and tests for baby.

Apply for health insurance assistance for children.

After-hours non-emergency drug and alcohol questions

SafeLink Wireless

SafeLink Wireless Cell Phone (free cell phone and service up to 250 minutes per month, income guidelines apply)

Learn More

24-hour crisis hotline to offer support, information, and referrals on coping with a crying baby and preventing child abuse.

If you fear that there is immediate danger, please call 911 or 1-800-SUICIDE for help.

Caring for moms and babies in every trimester, even the 4th trimester, is #LivingProof.

Join AHN Women in our initiative with Chrissy Teigen to reduce the stigma of postpartum depression and anxiety by visiting MyWishForMoms.org.

1-800-977-3768Learn More

You have prepared for this special time. 

You are ready.

And we’re right here with you!

OUR PARTNER

The ‘4th Trimester’ of your pregnancy will bring new challenges, milestones, and learning curves. It’s okay to lean on family and friends, to raise your hand when you need help, and to depend on resources to make your life a little easier.

With so many changes happening at once, the last thing you need is to feel like you can’t put your baby down. With that in mind, one of the main reasons 4moms created the mamaRoo was to give parents an extra set of arms to help rock and soothe their babies. The unique bouncing and swaying motions of the mamaRoo mimic the movements you make to help calm your little ones. It’s been so helpful that mamaRoo is even used in over 375 NICUs across the country. Doctors and nurses have found it transformational in caring for preemies, and babies with severe conditions.

Together, we want you to be the happiest, healthiest mama that you can be.

For information on a wide range of breast-feeding topics/concerns.

To see upcoming exclusive content with Chrissy Teigen, or to find out more information about how AHN Women is innovating the treatment of postpartum depression and anxiety, follow AHN on Instagram, Twitter and Facebook.

If you feel that you’re in deep depression and you fear that there is immediate danger, such as self-harm or harm to your baby, please call 911 or 1-800-SUICIDE (1-800-784-2433) for help.

Entire contents © 2019 Allegheny Health Network (AHN). All Rights Reserved. All of her. All of her life.® is a registered trademark of Allegheny Health Network.

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To find support and resources outside of Western PA, contact Postpartum Support International at postpartum.net or call 1-800-944-4773.