Beyond the Baby Year: Rethinking the Length of Postpartum Care
Reflections on the Hidden Longevity of Maternal Mental Health
There’s a study from Australia that I keep returning to—one that quietly, but powerfully, reshapes how we need to think about postpartum care.
Published in BJOG: An International Journal of Obstetrics & Gynaecology, this peer-reviewed study followed over 1,500 women from pregnancy to four years postpartum. Its findings? One in three women reported depressive symptoms during the first four years after giving birth, and 14.5% of mothers experienced clinical levels of depression at the four-year mark—many for the first time.
This research felt like a revelation and a validation all at once. And I haven’t been able to stop thinking about what it means for the way we care for mothers—not just in the immediate weeks after birth, but for the long, winding, years that follow.
The Myth of the “First Year” as a Finish Line
In many ways, our cultural understanding of postpartum ends abruptly— sometimes after six weeks, or maybe six months. We use terms like “bounced back,” when someone is “back to normal,” and healthcare workers, friends and family heavily front-load our support around birth and infancy.
But what happens after that first birthday candle is blown out? When toddlers begin to test boundaries, sleep becomes inconsistent again, identities shift even further, and relationships stretch under the pressure?
This Australian study shines a light on the reality: the emotional and psychological load of mothering doesn’t stop at one year—it often grows.
Depression Four Years Later—Why It Matters
For some mothers, the initial postpartum period might feel manageable. But stressors accumulate: returning to work, caring for multiple children, relationship changes, financial pressures, lack of sleep, and sheer isolation.
Many mothers aren’t sick enough to reach out for help, but not well enough to thrive. This middle place can last months—or years.
What if we stopped assuming things get easier after the first birthday?
What if postpartum depression screening was just as routine at four years as it is at six weeks?
What Would Change If We Extended the Postpartum Timeline?
At Nurture North, this research reinforces everything I feel in my massage therapy practice: the need to honour postpartum as a multi-year journey, not a brief recovery window.
If we recognized postpartum as a four-year period, how might that change things?
Would employers offer longer, staggered return-to-work transitions?
Would care providers continue regular check-ins well beyond infancy?
Would friends and family show up with the same tenderness and meals at year three as they did in month three?
Would we finally stop expecting mothers to hold it all together alone?
From Reflection to Reimagining
To every mother navigating these long, often invisible years: I see you.
And I want to ask you something—gently, with no judgment, only curiosity:
Would you have felt more supported if the postpartum period was culturally recognized to be four years long?
Would it have given you permission to soften, to ask for help, to still be in process?
You Deserve Longer Care
We can no longer afford to limit our care models to 6-week checkups or 1-year milestones. We must expand our definitions, build systems of support that last, and advocate for policies and practices that reflect the real timelines of motherhood.
And maybe—just maybe—start treating the fourth year with the same reverence we give to the fourth trimester.
Key Resources:
Woolhouse, H., Gartland, D., Mensah, F., & Brown, S. J. (2015). Maternal depression from early pregnancy to four years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG: An International Journal of Obstetrics & Gynaecology, 122(3), 312–321. https://doi.org/10.1111/1471-0528.12837
