Deborah D. Gordon has spent her career trying to level the playing field for healthcare consumers. She is co-founder of Umbra Health Advocacy, a marketplace for patient advocacy services, and co-director of the Alliance of Professional Health Advocates, the premiere membership organization for independent advocates. She is the author of "The Health Care Consumer's Manifesto: How to Get the Most for Your Money," based on consumer research she conducted as a senior fellow in the Harvard Kennedy School's Mossavar-Rahmani Center for Business and Government. Deb previously spent more than two decades in healthcare leadership roles, including chief marketing officer for a Massachusetts health plan and CEO of a health technology company. Deb is an Aspen Institute Health Innovators Fellow, an Eisenhower Fellow and a Boston Business Journal 40-under-40 honoree. Her contributions have appeared in JAMA Network Open, the Harvard Business Review blog, USA Today, RealClear Politics, The Hill and Managed Care Magazine. She earned a BA in bioethics from Brown University and an MBA with distinction from Harvard Business School.Full Bio
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A lot of time and effort goes into preparing for the birth of a baby — but the plan for what happens when the baby comes home doesn't get nearly as much attention. Life changes instantly with the arrival of a new baby and a new mom's mental health is not always prioritized during that time (the 12 weeks after the baby is born known as the "fourth trimester") or beyond.
Having a baby is supposed to be the happiest time of a mom's life. But in reality, some moms may experience the "baby blues."
The baby blues can be a common occurrence after giving birth and may include symptoms like mood changes, feelings of worry, tearfulness, irritability and sleep difficulties, which typically go away on their own within two weeks and don't impact a mom's ability to care for herself or her family. Postpartum depression (PPD), on the other hand, is associated with symptoms that are much more severe and longer lasting than the baby blues.
Research shows that women are more likely to experience PPD if they receive no support or minimal support from family, friends or community members after the birth than women who receive appropriate support.* With approximately one in eight mothers in the United States reporting that they experience symptoms of PPD each year, it's critical to have a support system in place.
A 2021 HealthyWomen online survey of more than 1,000 adults+, sponsored by Sage Therapeutics, Inc., revealed the pressures and stigmas facing expectant and new moms, education gaps that still exist around PPD and "baby blues" as well as the importance of planning for the fourth trimester and helping moms set up a support network.
Planning for the fourth trimester
Between hormonal changes, loss of sleep and adjusting to the needs of a new baby, the fourth trimester can be a difficult time for moms.
Dr. Anjali Kaimal, chief of the Division of Maternal-Fetal Medicine at Massachusetts General Hospital and associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, who was not involved in the survey and is not affiliated with Sage Therapeutics, said it's a good idea to plan ahead for this time. "The fourth trimester — or the 12 weeks after delivery — [is] a time of incredible emotional and physical [change] for a parent and their infant. A plan can mean so many things, but I think recognizing and validating all that is happening during that period and supporting people through those changes makes a lot of sense."
According to our survey, while a majority of pregnant women (76%) created a birth plan leading up to their baby's arrival, only 21% created a plan that focused on their own maternal mental health after the baby was born. Eighty-four percent of those who support new moms said it would have been helpful to have a maternal mental wellness plan that prioritized mom's mental health in the fourth trimester.
Steven D'Achille understands the importance of planning for potential maternal mental health challenges firsthand after losing his wife, Alexis, just six weeks after the birth of their daughter, Adriana.
According to D'Achille, Alexis had trouble breastfeeding, would hear phantom baby cries in the night and was in tears every morning after long sleepless weeks. Alexis was convinced that Adriana was bonding with other people but not with her. It turns out that Alexis was experiencing some of the symptoms of PPD* and, heartbreakingly, she eventually took her own life as a result.
"I can't emphasize enough how critical it is to put a plan in place well before baby is born and start having conversations with healthcare providers about what to do if you start to see signs of PPD. You have to be proactive, not reactive," D'Achille said. "PPD is not a women's health issue, it's a family health issue, which is why it's important that the entire family is educated about the signs and symptoms of PPD and be there to support the new moms in their lives."
Recognizing the signs and symptoms of PPD
One of the hardest aspects of managing PPD is that many people don't know how to recognize the condition in the first place. Oursurvey found that one in four pregnant women, moms and their loved ones didn't know the difference between baby blues and PPD, making it difficult for them to ask for help. And even when they recognize there is an issue, those conversations are still difficult for some moms.
A variety of reasons explain why new moms of children under 2 did not or would not discuss their PPD symptoms++: not wanting to bother anyone (36%), feeling guilty (27%), feeling like the symptoms were a normal part of having a baby (20%) or feeling embarrassed (19%). Another 17% said they didn't think anything would help them.
Despite how difficult these conversations may feel, it's important to seek help for PPD.
Like all medical conditions, it's important that any maternal mental health concerns be addressed, according to Kaimal. "If left untreated, they put both the pregnant person and the baby at risk for complications."
Taking the initiative to support pregnant women and new mothers
Our survey results showed the majority of pregnant women and new moms (91%) felt pressure to "do it all" on their own after the baby was born with 44% of those saying the pressure they felt was "extreme." One in five new moms said anxiety was the most challenging mental health component of being a new parent.
"It's incredibly important for a husband or partner to be on the front line and support new moms in not only identifying PPD but seeking out and advocating for care," D'Achille said. "The same is true for friends and family."
Most new moms reported that it was important to have a group of friends and family to take initiative to help support her. To support their mental health postpartum, new moms overwhelmingly believe it is important to arrange for help to take care of the baby (87%) and to designate a group of people to check in on them (73%). This would help them have time for self-care, which many respondents felt would help support their mental health and well-being, along with having help in chores like meal preparation and cleaning and — not surprisingly — having time to sleep.
Having a new baby around is exciting, but it's important for friends and family to remember that the moms have needs too. Kaimal added, "The best way to have a healthy baby is to have a healthy mom."
Check on Mom (a Sage Therapeutics program) – Provides resources to help women prepare for and get the support they may need during the fourth trimester and beyond, including a tool to help create a maternal mental wellness plan, an opportunity to designate a mom team and access to helpful information about PPD. The Check on Mom program doesn't replace a woman's healthcare provider, who is the best resource for individual medical advice.
If you or your loved one are in distress or going through a difficult time, please find resources below:
- Call 911
- Call your healthcare provider
- Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
- Text the Crisis Text Line at 741741
*Some of the risk factors of PPD include family history of depression, increased stressors, and hormone changes related to pregnancy. Women with PPD may experience a mix of emotional, physical and/or behavioral symptoms. Symptoms to be mindful of include persistent sadness, anxiousness, or "empty" mood; loss of interest or pleasure in hobbies and activities; difficulty sleeping; appetite or weight changes,; irritability; feelings of guilt or worthlessness; difficulty concentrating; remembering or making decisions; persistent doubts about the ability to care for the new baby; thoughts about death, suicide, or harming oneself or the baby. These are not all the symptoms of PPD, and it's important to reach out to your healthcare provider if you're concerned about PPD.
+In August 2021, HealthyWomen conducted an online survey in the United States of more than 1,000 adults, including new moms of children under 2 (510 respondents), pregnant women over the age of 18 (261 respondents), and care partners (260 respondents).
++Of all respondents, 59 new moms said they did not or would not discuss their PPD symptoms.
This resource was created with support from Sage Therapeutics, Inc.
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