Maternal Mental Health in the 4th Trimester: What No One Told You About the Emotional Whirlwind of New Motherhood

Co-authored by Keira Merkovsky, LCSW – Licensed Therapist, NMS Expert, and Founder of EvolvingMothers.com

The 4th trimester—those first three months after baby arrives—is a season of beautiful chaos. You’re healing, feeding on-demand, adjusting to a brand-new identity, and trying to sleep in 90-minute windows. All while managing hormones that have no chill.

So if you’re feeling anxious, irritable, weepy, overwhelmed, or just… not yourself—you’re not broken. And you’re definitely not alone. Many new moms experience what’s known as postpartum anxiety (PPA), and yet, it’s still one of the most misunderstood pieces of the postpartum puzzle that is not talked about enough.

What Is the 4th Trimester?

It’s the postpartum period where your body is recovering, your brain is rewiring for motherhood, and your emotions are on a rollercoaster. For many moms, it’s a time of joy and overwhelm. And despite what social media may suggest, it’s okay to feel both.

There’s no one right way to feel after birth—but if you’re experiencing racing or intrusive thoughts, an inability to relax, or a constant sense of fear that something bad might happen, those are signs worth paying attention to. Postpartum anxiety affects as many as 1 in 5 new moms—you’re not overreacting, it’s not your fault, and you don’t have to push through it alone (NIH 2019).

PPA vs. PPD: What’s the Difference and Which Might Be Affecting You?

Postpartum Depression (PPD) and Postpartum Anxiety (PPA) are both common—but often confused—mental health conditions that can arise after giving birth. It’s possible to experience one, the other, or both. Understanding their differences is key to getting the right support.

PPD Symptoms:

Persistent sadness or hopelessness (“Is it always going to be this hard?”)
Loss of interest in things you used to enjoy (“I know I should go for a walk or call a friend, but I just can’t find the motivation to do it.”)
Feelings of worthlessness or guilt (“I feel like I’m failing at the one thing I’m supposed to be good at.”)
Trouble bonding with your baby (“I love my baby, but sometimes it feels like I’m just going through the motions.”)
Changes in appetite or sleep not related to baby’s schedule (“I’m either too wired to sleep or too empty to eat — and it’s exhausting.”)
Thoughts of self-harm or feeling like your baby might be better off without you (“Sometimes I wonder if they’d all be better off if I just stayed in bed and didn’t get up.”)

PPA Symptoms:

Constant worry or dread, especially about your baby’s health or safety (“What if my baby stops breathing?”)
Racing thoughts or feeling like your mind won’t shut off (“It’s like there are a thousand tabs open in my brain and I can’t close any of them.”)
Physical symptoms like a racing heart, nausea, or dizziness (“My heart races, my jaw is always clenched, and I feel like my body just can’t calm down.”)
Irritability or restlessness (“I get mad at my partner for not doing things the way they are supposed to be done, even though I know he’s trying to help.”)
Difficulty sleeping—even when the baby is asleep (“As soon as I lay down, my brain starts racing and worrying about everything.”)
Intrusive thoughts or fears that feel hard to control (“Terrible thoughts come into my mind and I don’t know why, or how to stop them.”)

“Many women with postpartum anxiety do not report sadness—they feel on edge, fearful, or trapped in worst-case scenarios. And because it doesn’t always match the narrative of postpartum depression, it often goes unrecognized.” – ScienceDirect, 2020

5 Ways to Care for Your Mental Health in the 4th Trimester

1. Know what’s normal (and what’s not). Mood swings? Yes. Crying randomly? Totally. But if your anxiety is taking over—maybe you can’t sleep even when the baby’s sleeping, you are constantly wondering if you are doing something wrong, or you’re obsessively checking if your baby is breathing—that’s not just “new mom nerves.” That’s a sign to reach out. And there is help.

2. Say it out loud. “I’m struggling.” “I feel off.” “I can’t stop worrying.”
Naming your experience is powerful—and often the first step toward feeling more like you again. Connect with other moms to share these thoughts and you will quickly realize how common these experiences are. Knowing you are not the only one going through this really helps to normalize it, and that makes it easier to take steps to get the help and support that will work for you.

3. Find support that actually helps.
Whether that’s your OB, a licensed therapist, a postpartum group, or simply a trusted friend—find someone who can hear you without judgment. Anxiety thrives in silence. Connection helps calm it.

4. Protect your peace.
Say no to visitors who don’t feel helpful. Mute the mom groups if they’re stressing you out. Skip the dishes – or better yet, ask a friend or family member you feel comfortable with to come over and do them for you (people generally love knowing ways they can help that actually feel helpful!). Give yourself permission to do what feels good for your nervous system. This season isn’t about “bouncing back”—it’s about hanging in.

5. Move when it helps, not when it pressures.
Forget the pressure to “get your body back.” Instead, experiment with ways to help soothe yourself as you adjust to this huge life transition. A short walk, some breathwork, or a few stretches can work wonders at calming the nervous system when anxiety spikes. The goal is to feel better, not look different. After each thing you try, check in with yourself and ask yourself if it helped calm the anxiety, even ten percent. Find, and do, what works for you.

FAQs About Postpartum Mental Health

Q: What’s the difference between postpartum depression and anxiety?
A: Depression may show up as sadness, numbness, or withdrawal. Anxiety feels more like racing thoughts, constant worry, or panic. Many moms experience a mix of both.

Q: When can symptoms start?
A: Symptoms can show up within days, weeks, or even months after birth. Anytime in the first year is still considered postpartum.

Q: Is “mom rage” a real thing?
A: Absolutely. It’s often rooted in hormone shifts, sleep deprivation, and sensory overload. You’re not a bad mom for feeling it. It’s your brain and body’s way of letting you know you need more help or support.

Q: How do I bring this up with my partner or provider?
A: You don’t need perfect words. Just honesty. “I haven’t been feeling like myself.” Or, “I think I might need help.” That’s more than enough.

U.S. Statistics You Should Know

Postpartum anxiety affects 20% of new mothers in the first year postpartum, with peak onset in the 4th trimester (NIH, 2019).
Postpartum depression impacts 13% to 19% of new moms, often beginning 2–8 weeks after delivery (ScienceDirect, 2020).
About 35% of women with postpartum anxiety also experience symptoms of depression, making it extremely common to experience both (CDC, 2020).
Despite these numbers, only 15% of women with a postpartum mood or anxiety disorder receive professional help (MMHLA, 2023).

If you’re unsure what you’re feeling, that’s okay too. You don’t need a label to reach out. Feeling “off” is reason enough to ask for help.

Final Reminder: You’re Not Alone

Whether you cried over a spilled bottle, panicked when the baby slept “too long,” or are running on fumes—this season is hard. But anxiety doesn’t have to define your motherhood.

You’re doing an incredible job. And you don’t have to navigate this alone.

We’re here to walk alongside you—and so is Keira Merkovsky, LCSW, one of our trusted New Mom School experts. As a licensed therapist who specializes in all things postpartum, Keira offers support designed to help moms feel seen, understood, and never judged. You can connect with her by visiting EvolvingMothers.com

If you’re navigating the identity shifts of early motherhood and need a little extra support—especially around anxiety—her work might be just what you need right now.

💛 With love,
The New Mom School Team + Keira Merkovsky, LCSW