Meet Jasmine. She’s a first-time mom in The Bronx, three weeks out from having delivered a healthy baby girl. Everyone wants to know how the baby is doing. “Who does she look like? How much is she eating?” they ask. Jasmine smiles, answers every question, and listens to advice.

 

What she doesn’t say is that she hasn’t showered in four days, she cried for two hours last night for no obvious reason, and she feels guilty for not being as happy as she envisioned.

 

Jasmine is living through “the fourth trimester,” a period that can be especially challenging for many new parents. You’ve heard of the first, second, and third trimesters of pregnancy, but the 12 weeks after a baby is born (known as the fourth trimester) can be just as demanding for a mother, as pregnancy itself. Yet, after delivery, medical attention often shifts primarily to the baby, leaving many mothers with limited support for their own recovery and well-being.

 

Those first 12 weeks are filled with physical and emotional changes that we don’t talk about nearly enough. While bodies heal, hormones that surged during pregnancy drop dramatically, sleep becomes a memory, and for many women, feelings of sadness and worry creep in. About 80% of new moms experience “baby blues” in the first weeks after baby is born.

 

This can include mood swings, tearfulness, and irritability. For most, these feelings fade, but for roughly one in five women, they deepen into postpartum depression or anxiety, conditions that are real, common, and very treatable.

 

Postpartum depression can show up in new moms as feeling numb or emotionally disconnected, not enjoying things they once loved, or having persistent thoughts that they’re doing everything wrong. Postpartum anxiety can look like constant worrying that is hard to shut off, as well as experiencing physical symptoms like a racing heart, difficulty sleeping, and a persistent sense that something bad is about to happen.

 

In The Bronx, the stakes are especially high. Studies show that some women in the borough are almost twice as likely to screen positive for depression as other women across the country. Financial stress and feeling isolated can worsen symptoms. But asking for help isn’t always easy. Focusing on the baby, worries about judgment or not knowing where to find mental health support can keep many women from reaching out.

 

If any of this sounds familiar to you, or to a loved one, please know that this is not a character flaw. These are medical conditions, and help is available.

 

At Montefiore, we developed the Prenatal Healthy Steps Program to address this need. Healthy Steps is an online prenatal support group where pregnant women like Jasmine can prepare for the emotional road ahead. We talk openly about baby blues and postpartum depression, and practice stress management exercises together.

 

We help women think about what kind of parent they want to be and what social and community support they need to get there. We encourage every parent to think carefully about their “village.” Who can they call when they’re feeling overwhelmed? Who will help with the baby at 2 a.m.? Having a plan before the baby arrives can make a real difference.

 

One stress management exercise we teach is reframing. Reframing is a technique used to shift your mindset, so you’re able to look at a situation, person, or relationship from a slightly different perspective. During the fourth trimester, Jasmine experiences many judgmental and pessimistic thoughts about her ability to be a parent.

 

For example, she said, “I always wanted to be a mom, but I’m failing at this,” or “I love my baby, but I don’t know how to care for her when she cries.” The word “but” can erase the first part of the sentence and magnify negative thoughts. Replacing “but” with “and” makes room for two things to be true at once. It can help quiet a racing mind and allow space for hope.

 

Once the baby is born, we connect families to Montefiore’s Healthy Steps Program (https://www.cham.org/programs-centers/healthy-steps), which provides support and guidance to families of children from birth to age 5 who are seen at Montefiore pediatric practices (https://montefioreeinstein.org/patient-care/services/primary-care/locations).

 

Parents can meet with a behavior and development specialist who attends to both the baby’s and parents’ needs, as part of the baby’s well child visits. If you are a Montefiore patient and pregnant or recently postpartum, and feeling overwhelmed, sad, or anxious, reach out to your or your child’s medical provider, and ask to be connected to Healthy Steps.

 

Some other helpful resources available to families include Just Birth Space (https://www.justbirthspace.org/en/communityconnect) online postpartum and parenting support groups, Expectful’s health and news hub (https://expectful.com/), breastfeeding resources (https://montefioreeinstein.org/patient-care/breastfeeding-support), and stress management apps such as CALM and Insight Timer. For immediate mental health support, call or text 988 any time, day or night.

 

Polina Umylny, Ph.D., is director of Montefiore’s HealthySteps Program, assistant director of Montefiore’s Behavioral Health Integration Program (BHIP) and assistant professor of pediatrics at Albert Einstein College of Medicine. Natasha T. Kostek, Psy.D., is currently completing a pediatric psychology postdoctoral fellowship through BHIP and HealthySteps at Montefiore’s Comprehensive Family Care Center. They would like to thank David and Miriam Phalen for their support of the HS: BRIDGE Project.