The “fourth trimester,” or the first three months postpartum, is a critical yet often overlooked period for the psychological and emotional well-being of gestational carriers. While surrogacy primarily focuses on the pregnancy and the transfer of the child to the intended parents, the emotional and mental health needs of gestational carriers during the postpartum phase often go unrecognized. This blog post explores the challenges gestational carriers face in the fourth trimester and emphasizes the importance of comprehensive care.
The Fourth Trimester: A Time of Emotional Transition
While much of the focus in surrogacy revolves around legal, medical, and ethical issues, the fourth trimester presents unique emotional and psychological challenges for gestational carriers. Despite not assuming caregiving responsibilities after birth, gestational carriers undergo significant hormonal changes and emotional shifts. Often, the healthcare system neglects their mental health, concentrating instead on the well-being of the newborn. However, gestational carriers deserve the same postpartum care as all women who give birth, including psychological support to help them transition out of their caregiving role.
As Dr. Ilona Goldfarb’s research highlights, all postpartum women, including gestational carriers, face physical and emotional challenges that are often not adequately addressed by healthcare systems. This gap in care can leave gestational carriers vulnerable to postpartum depression (PPD) and anxiety.
Understanding Emotional Adjustment Through the “Head, Heart, Hormones” Model
A useful framework for understanding the emotional adjustment of gestational carriers is the “Head, Heart, Hormones” model developed by Katrina Hale. This model addresses three dimensions of postpartum experience:
- Head: Gestational carriers intellectually understand that the child belongs to the intended parents, which helps shape their expectations post-birth. Despite this, emotional complexities can arise.
- Heart: Emotionally, gestational carriers may feel attached to the child they carried, leading to feelings of loss or sadness after the birth. The emotional detachment required can be challenging and requires mental health support.
- Hormones: Like biological mothers, gestational carriers experience hormonal fluctuations after giving birth, which can exacerbate feelings of vulnerability. These hormonal changes can contribute to postpartum emotional challenges, including anxiety and depression.
By addressing all three aspects—intellectual, emotional, and hormonal—mental health professionals can provide targeted support that helps gestational carriers manage their postpartum experience.
Hormonal Changes and Their Impact on Mental Health
The hormonal shifts that occur after childbirth can significantly impact a gestational carrier’s mental health. The sharp decline in estrogen and progesterone can lead to mood swings, anxiety, and depressive symptoms. In addition, the hormone oxytocin, released during labor and childbirth, fosters emotional bonding, which can cause a gestational carrier to feel an unexpected attachment to the child.
These hormonal fluctuations, combined with the physical recovery from childbirth, can create a perfect storm for mental health challenges. Gestational carriers, who do not assume ongoing caregiving roles for the newborn, may feel an emotional conflict that needs to be carefully managed by mental health professionals to prevent long-term psychological effects.
Gaps in Postpartum Care for Gestational Carriers
One of the most pressing issues in the fourth trimester for gestational carriers is the lack of continuous postpartum care. Unlike biological mothers who may receive at least a few postpartum checkups, gestational carriers often have no structured follow-up care. This absence of medical and psychological support can leave gestational carriers to navigate emotional and physical recovery alone, increasing the risk of PPD and anxiety.
To address this gap, healthcare providers must develop comprehensive postpartum care plans for gestational carriers, including regular mental health check-ins during the first three months postpartum.
Emotional Complexity of Relinquishing the Child
While gestational carriers understand the nature of their role in the surrogacy process, the emotional complexity of letting go of the child they carried can still be profound. The release of oxytocin, often called the “bonding hormone”, during labor and childbirth can create an emotional connection between the gestational carrier and the baby, leading to feelings of loss or grief, despite the gestational carrier’s initial intellectual understanding of her role.
Without proper psychological support, these emotions can become overwhelming. Counseling and therapeutic support can help gestational carriers process their feelings and adjust emotionally after birth.
Cultural and Social Stigma
In some cultural contexts, surrogacy carries social stigma, which can add another layer of emotional complexity for gestational carriers. Depending on their community, gestational carriers may face judgment or ostracism, intensifying feelings of isolation and emotional distress. Mental health professionals must take these cultural factors into account, offering culturally sensitive counseling that respects the gestational carrier’s unique context.
Postpartum Depression and Anxiety in Gestational Carriers
Another frequently overlooked risk is that of postpartum depression and anxiety in gestational carriers. Traditionally, research on PPD has focused on biological mothers, but gestational carriers experience similar hormonal shifts and emotional challenges that can trigger these conditions. The societal assumption that gestational carriers are less emotionally affected because they don’t care for the child is misguided. In fact, the emotional weight of carrying a child for someone else can increase the risk of mental health issues.
Mental health professionals must be vigilant in recognizing the early signs of PPD and anxiety in gestational carriers, offering necessary interventions to support their emotional well-being.
The Role of Mental Health Professionals
Mental health professionals play a critical role in supporting gestational carriers during the fourth trimester. They can offer pre-birth counseling to emotionally prepare gestational carriers for the challenges ahead and provide ongoing postpartum support through counseling or therapy. Cognitive-behavioral therapy (CBT) and emotion-focused therapy (EFT) are particularly effective in helping gestational carriers process their emotions and prevent long-term psychological distress.
In addition, mental health professionals can extend support to the families of gestational carriers. Partners and children may also experience emotional challenges during the surrogacy process, and family therapy can help alleviate confusion and emotional strain.
Long-Term Psychological Adjustment
The emotional and psychological needs of gestational carriers do not disappear after the fourth trimester. Long-term support is crucial to ensure their emotional well-being. A collaborative approach, involving healthcare providers, intended parents, and mental health professionals, is essential for promoting long-term psychological health.
By providing continuous care, mental health professionals can help gestational carriers navigate the emotional complexities of surrogacy, ensuring that they receive the support they need during this vulnerable time.
Contact PECNA for Support
If you or someone you know is a gestational carrier in need of mental health support during the postpartum period, PECNA is here to help. Our specialized team of mental health professionals understands the unique challenges gestational carriers face during the fourth trimester. Contact PECNA today to learn more about how we can support you in maintaining your emotional well-being.
