top of page

DBT Skills for the Fourth Trimester

Updated August, 2021

DBT for Managing Emotions for New Moms

Taking care of a newborn is all encompassing. It is exhausting. And it’s natural to want to give our all to our baby.

How can a new mom maintain emotional balance? It would be insulting to give a simple answer to this complicated and nuanced question.

The Fourth Trimester: Awareness is the first step

First, the way to prevent postpartum emotional exhaustion is to become aware of the fourth trimester as part of family life, just as pregnancy and birth are part of family life. The fourth trimester should be part of the lexicon of motherhood on an individual level and a society level.

The fourth trimester is all about the postpartum period being a sensitive and significant time for both mom and baby.

Did you know it takes at least 3 months to physically recover from birth?

Did you know that 6 months of mom-baby time together is protective of maternal depression?

In 2018, thankfully, the fourth trimester was been included in the official lexicon of motherhood. In May of 2018, after much advocacy and research to support this position, the American College of Obstetrics and Gynecology (ACOG) recognized the fourth trimester as a sensitive, significant time for both mother and baby and their families.

The fourth trimester concept is new in the dominant American culture, which has been rather unconcerned with providing support to families after birth. The family leave policy of the United States is desultory. The think tank, Pew Research, finds that of 41 countries analyzed, only the United States lacks paid parental leave. A comprehensive article from the Washington Post can be found here about how the The U.S. Ranks Last in Every Measure When it Comes to Family Policy.

Thankfully, US society is moving forward with this social construct. ACOG has taken a research based position and polling indicates that 93% of Americans believe there should be paid family leave when babies are born.

You, as an informed individual, can take simple steps during pregnancy to plan for you and your baby’s postpartum needs. Don’t stop at your birth plan, also plan for the fourth trimester. Include proactive, protective care for both the mom and baby. Protective care for the mom buffers mom’s emotional and physical health, which, in turn, influences healthy attachment. And healthy attachment, in turn, promotes healthy physical and emotional growth in the baby. A healthy emotional and physical growth in the baby is, in turn, good for society.

Postpartum DBT PLEASE Skill

The PLEASE skill is part of the Emotional Regulation skillset of DBT. The DBT Emotional Regulation skillset is focused on helping individuals find ways to manage difficult, painful and strong emotions. One must be skilled at being aware of and mindful about being observant in a dispassionate way and being non-judgmental regarding one’s emotions as well.

PL: Treat PhysicaL Illness

Do not procrastinate on caring for yourself.

Physical pain – If you have an aching back or bad wrist, see a doctor, call in a massage therapist, do yoga. Whatever it is you need to do for yourself, find a way to get some help at the level you need. If you let it go, you know your physical pain will affect your emotional state. And that’s not good for you or your baby or you family. Ask for help, ask for someone to watch the baby, or just make the appointment and take your new little one along!

Emotional pain – The perinatal period is a high-risk period for perinatal mood disorders. In fact, perinatal mood disorders are the most common complication of childbirth. If, after 8 weeks postpartum, you find you are unusually sad, crying alot, feeling hopeless and have a low opinion of yourself as a mother and a person, please see your medical doctor or a therapist. If you need to cry on a friend’s shoulder, please do so. Don’t wait until you are desperate. Your emotional health is worth your time. Pay attention. If you are well, baby thrives as well.

If you need immediate help, call your doctor’s office. If it feels like an emergency, please go to the Emergency Room.


And you can get a list of perinatal mood disorder providers in your area.

Medication – If you need medication, but are concerned about the effects of the medication on a nursing baby, talk to your doctor about this. You can do research on your own as well. There are numerous online resources about medication and mothers milk. Some are listed below.

E: Eat well

Do not diet excessively postpartum.

Choose to nourish your mental and physical health by eating nourishing, protein rich foods. You need the lean protein in order to rebuild your hormonal and neurotransmitter balance. Eggs, chicken, turkey, warming spices such as black pepper and ginger are all healthy, warming foods that nourish the mom postpartum. Tryptophan rich protein is the building block of serotonin, the mood stabilizer.

Nourishment in the form of warming herbs help replenish the body on an energetic level. Tea preparations of the herbs chaste berry, chamomile, raspberry leaf and lemon balm are supportive of the female reproductive system. Other herbs traditionally used to support the postpartum woman are dong quai and goji berry.

A: Avoid Mood Altering Substances

Watch your intake of alcohol and any other substances that can interfere with your parenting abilities and with your mood. It is important to preserve your mood. If you need support for this, please reach out for help.

S: Sleep Hygiene

Dr. Samantha Meltzer-Brody is Distunguished Professor of Mood and Anxiety Disorders and Director of the Perinatal Psychiatry Program at the University of North Carolina at Chapel Hill.

One of Dr. Meltzer-Brody’s strong advice to postpartum mothers is to Preserve your SLEEP. Dr. Meltzer-Brody says that women with histories of a mood disorder must watch their sleep and plan to preserve blocks of sleep. Sleep preservation must be part of her treatment plan. Her support system, her spouse and family and other supports must be enlisted as part of her postpartum plan in order to preserve her emotional and mental health (Meltzer-Brody & Jones, 2015).

Waking up at night to care for an a baby can affect the mom’s sleep drive and It’s a balance between sleep when the baby sleeps and also be aware this could change your sleep drive a bit, so be aware of that

Dr. Michael Perlis’ and Dr. Colleen Carney’s work indicates that depression and insomnia are the closest of friends. It used to be thought that depression preceded insomnia. But now research has revealed a more compels relationship between insomnia and depression and there are indications that insomnia actually precedes depression. Sleep is very important!

E: Exercise

Exercise is an antidepressant when done consistently. Exercise will help regulate the sleep cycle as well. Generally, you need to wait until your 6 week check up to be cleared for exercise. When you doctor clears you for exercise, start slowly. Don’t exhaust yourself and don’t chase after the perfect body. After your doctor clears you for some physical exercise, start slowly. Give you body time to heal and adjust.

Have realistic expectations about yourself and your body. There are plenty of pictures of celebrity moms getting right back to work a few months after giving birth and looking fabulous with flat tummies! Of course, remember they have chefs, nannies, personal trainers and beauticians focused on them! They are far from average moms. They have lots of back up they can pay for!

Every woman is different and every brith is different, so the amount of time you need to work up to a strenuous work out will vary. Meanwhile, there are alot of Mommy & Me classes available now for moms and their infants.

Mommy and Me yoga is very popular as are Mommy and Me easy fitness classes. Below is an example of a fun follow along You Tube Mommy and Me fitness class!

And of course, there is always the wonderful exercise of walking. Taking the stroller out to the mall to mall walk if it’s too cold and snowy out or going to a nearby park and walking or just walking around the block.


Meltzer-Brody, S., & Jones, I. (2015). Optimizing the treatment of mood disorders in the perinatal period. Dialogues in clinical neuroscience, 17(2), 207-18.


bottom of page