Throughout pregnancy, clinicians carefully monitor a woman’s health. Vitals are obtained, laboratory testing is performed, growth is monitored, and complications are identified. Then, a new life is brought into the world, and medical attention dramatically shifts. The medical attention previously directed toward a mother abruptly ends, and the infamous “See you in six weeks” appointment is scheduled.

Unfortunately, childbirth is often considered a marker of the end of maternal medical risk instead of being identified as the beginning of another critical period of care: the fourth trimester. The American College of Obstetricians and Gynecologists (ACOG) recommends postpartum care be viewed as an ongoing process rather than a single six-week encounter. Initial contact should be made with the mother within the first three weeks of delivery, and a comprehensive postpartum visit should be performed no later than twelve weeks after birth. This is crucial, as the weeks and months following childbirth are filled with profound physiological, psychological, and emotional changes. ACOG recommends that comprehensive postpartum care address physical, social, and psychological well-being, including mood and emotional well-being, infant care and feeding, contraception, sleep and fatigue, physical recovery, chronic disease management, and overall health maintenance.

The Centers for Disease Control and Prevention (CDC) emphasize that urgent maternal warning signs can occur not only during pregnancy but throughout the year after delivery. These symptoms can be signs of serious or life-threatening complications and require prompt medical attention.

The fourth trimester also comes with significant mental health vulnerability. Perinatal depression and anxiety, while among the most common complications of the postpartum period, remain underdiagnosed and undertreated. Systematic reviews have estimated postpartum depression prevalence at approximately 14 percent to 18 percent, depending on the population and methodology used. Anxiety is also prevalent during the perinatal period, and depression and anxiety frequently coexist.

Screening tools are in place for timely assessment and follow-up for depression and anxiety. It is important to note that postpartum mental health does not only encompass anxiety and depression.

Postpartum patients may experience post-traumatic stress, obsessive-compulsive symptoms, bipolar disorder, and, rarely but importantly, postpartum psychosis. Postpartum psychosis is a psychiatric emergency characterized by symptoms such as delusions, paranoia, hallucinations, and impaired insight. Psychosis can involve a loss of contact with reality, unlike postpartum depression and anxiety. This requires immediate psychiatric intervention and hospitalization.

Postpartum diagnoses come with challenges because many symptoms are easy to normalize. “Give yourself time to adjust, all new moms are anxious, and it makes sense to be exhausted because you just had a baby.” These statements, while at times appropriate, can also delay recognition of a serious medical or psychiatric condition.

So where is the answer? A health care system must routinely ask women how they are doing and, more importantly, genuinely hear how they answer.

A postpartum assessment needs to extend well beyond physical recovery. It needs to address mood and emotional well-being, sleep, fatigue, chronic disease, contraception, infant feeding, physical complaints, and the patient’s overall social and psychological health.

Clinicians must rise to the occasion, asking questions beyond “How are you doing?” We need to be direct when asking about sleeping patterns, persistent anxiety, intrusive thoughts, safety, and physical concerns. We need to make sure our patients know when and how to seek help.

Modern-day health care has made enormous progress in caring for women throughout pregnancy and childbirth. Our next job is continuing to recognize that maternal care does not end in the delivery room.

The fourth trimester deserves treatment, too.

Allison P. Boyle is a professor and physician assistant.