While the first nine months of pregnancy are focused on fetal growth and birth preparation, the vital 12-week window afterwards—the fourth trimester—remains largely undiscussed. It's rather an 'invisible' stage of motherhood; despite the constant medical scrutiny of the infant, the mother’s own struggle with hormonal crashes, physical recovery, and brain changes is often ignored.
It is a period typically characterised by intense emotional swings. Ranging from intense protectiveness towards the baby to an identity crisis to an unexpected sadness, a new mother navigates through a cycle of mental health challenges.
"Every mother experiences the invisible fourth trimester. Every new mother would go through a learning curve fatigue as she navigates feeding, sleep routines, her changing body, and adjusting to a new life being so dependent on her. All these are very natural experiences. However, these lead to a lot of mental health challenges, which are often exacerbated due to familial and societal pressures," said Dr Janhavi Nilekani, Founder and Chairperson, Aastrika Foundation & Aastrika Midwifery Centre.
Nilekani will be taking part in the panel discussion on 'Women as mothers and Pre-natal health' at Mpowering Minds Women’s Mental Health Summit to be held in Bengaluru on February 27.
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Normally, once the little one arrives, the whole world around you is after the baby. This shift in focus, 'ignoring' the mother, is not a healthy practice. "The transition into motherhood is often accompanied by a shift in focus to the baby. While the baby’s health is paramount, the woman who is transitioning into motherhood is not focused on or supported. Being repeatedly told that her primary—or only—focus must be the baby creates a dangerous narrative: that her own mental, physical, and emotional needs are now secondary. In addition, the expectation that the mother should immediately connect to the baby creates increased pressure on the woman," she said.
During the postpartum period, when the mother struggles to even make simple decisions in her life, it is important to make her feel empowered or guide her through the phase. In many cases, empowerment is often stripped away under the guise of "tradition" or "inexperience".
"In the postpartum period, a woman often loses the right to make simple decisions about her body, her schedule, and her parenting style. When a mother feels she has lost the agency to govern her own life, it creates a sense of helplessness. She isn't just a mother; she is an individual
who has suddenly lost her sense of self," said Nilekani. She also added that, in her experience, this is mainly seen among the urban, working women, who had made decisions on their life choices, including career, life partner and so on.
The arrival of a newborn demands an 'all hands on deck' approach, but too often, the mother remains the primary navigator. When every decision—from feeding to sleep cycles—rests on her shoulders, the risk of depletion is high. True support isn't just 'helping out'; it’s about intentionally shifting these responsibilities away from the mother to ensure her well-being isn't sacrificed.
"Having physical help (nannies, family, or partners) does not automatically equate to a lighter mental burden, as there are other things that fall exclusively on the mother. It is usually the mother who takes the onus of researching and learning about breastfeeding techniques, sleep training, and how to hold the baby, etc. This cognitive labour of having to independently figure out these things can lead to mental exhaustion," said Dr Nilekani.
While postpartum rituals, including dietary restrictions, are designed with the intent to support the mother, they can become frequently isolating as well.
"Strict confinement, diet restrictions, or traditional observances can cut a woman off from her support system and the outside world. Instead of feeling nurtured, she may feel trapped within a set of expectations that don't align with her actual needs, turning what should be a period of healing into a lonely endurance test," added Dr Nilekani.