Moms Get on-the-Job Training From Experts : Parenting: After the Stork, a postpartum care service in San Juan Capistrano, is helping women make a smooth transition into motherhood.

Like many new expectant mothers, Barbara Poliquin had carefully planned for the big day when she and her husband, Mark, would bring their first baby home from the hospital.

But all the classes and books in the world couldn’t have prepared the Laguna Niguel woman for the reality of childbirth and motherhood.

“I’ll never forget the day I came home from the hospital. I walked through the door and started crying,” said Poliquin. “I was tired. I was very nervous. I just didn’t know what to do. I had just spent six days in the hospital after developing an infection from my Cesarean section. I knew I needed help, but I couldn’t burden my family members.”

To her rescue came Mary Davis from After the Stork, a postpartum care service in San Juan Capistrano that employs health care professionals, childbirth educators, mothers and others to go into the home and help women make a smooth transition into motherhood.

“She helped me the way only another mother could,” said Poliquin. “It was like having a nurse in my home. She helped me with the baby and gave me advice on breast-feeding. Plus, she did the laundry and made casseroles.”

Most important, said Poliquin, she allowed her to get what most new parents crave most those first few weeks -- sleep. Davis slept in baby Aimee’s room at night and brought the infant in to Poliquin every three hours for feedings.

So pleased with Davis’ help, the Poliquins relied on her again when their second child, Benjamin, was born two months ago.

With hospitals discharging women quicker after giving birth and many new parents today finding themselves without families who are able to lend support, postpartum care companies such as Davis’ are growing in popularity around the country.

In 1988, there were only 14 services nationwide, said Debra Pascali of the National Assn. of Postpartum Care Service. Now, there are more than 100, she said, with 15 to 20 of them in California.

Often called “Doula” services--from the Greek term meaning “to mother the mother”--such private care firms are filling a void left by changes in an increasingly mobile society and shifting health care system, say advocates, mothers and some health care professionals.

Because some hospitals are discharging women as early as six to 12 hours after giving birth, postpartum help for new mothers “is a necessity, not a luxury right now,” insists Chris Morely of Tender Care, a Doula company that serves clients in Los Angeles, San Bernardino and Orange County.

But the high cost of such private care does make it a luxury. With prices ranging from $17 to $24 per hour, depending on the service and location, critics say it’s a service for the privileged. Most clients are upper-income, professional women and couples.

Pascali and others say they hope postpartum care service will become more affordable for middle- and low-income families through cooperation from hospitals, third-party reimbursements from insurance companies, and government support.

“It should be available for everyone,” said Pascali, who operates MotherLove Inc. in New Jersey.

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While low-income and very young mothers have stresses in their lives that may make coming home from the hospital difficult, Davis notes that in her experience, career women also have a uniquely tough time making that transition from the board room to motherhood.

“For someone who is successful and in control of her career, it is difficult when all of a sudden the baby is in control. It can be awfully scary,” said Davis. “I’ve seen a high-powered career woman left a quivering wreck by a seven-pound baby,” said Morely.

Davis says her company is not a nanny service. She and most of the members of her staff are mothers and have received training to help the new moms with infant care. They will work day or night to help make the new mom more comfortable.

Some family clients received the service as a baby shower gift, said Davis. Sometimes grandparents who can’t be there to help hire the service for their daughter or daughter-in-law.

Whether mothers are poor or affluent, lack of support, sleep deprivation and dramatic hormonal changes after the birth of a baby can leave them feeling overwhelmed and anxious, said Lois Gobrecht, a Yorba Linda psychologist.

That’s why it’s imperative for them to have support that will allow them to adequately bond with their babies and care for other children as well as themselves, said Gobrecht, who specializes in treating women with postpartum depression.

“When women don’t bond well with their babies, it can have long-lasting ramifications, including an increased risk for child abuse,” she said.

Such situations can also put “babies at a higher risk for being neglected,” according to Karen McCurdy, senior analyst with the National Committee for the Prevention of Child Abuse in Chicago.

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There’s further evidence of a growing sensitivity to the problem.

Harvard Community Health Plan, a major HMO in New England, is already offering postpartum care service to women who leave the hospital within 24 hours after giving birth, according to Joan Singer, head of Mother Care, whose company serves private and Harvard Community HMO clients in the Boston area. Some California services are also proposing such a plan to health care facilities here.

The National Committee for the Prevention of Child Abuse is so concerned about assisting and educating new mothers whose families may be at risk for child abuse or neglect that it is in the planning stages of a nationwide project that would send nurses or para-professionals into the homes of needy parents on a limited basis to teach them about child rearing, nutrition and development.

The project, modeled after a government program in Hawaii, would be funded by private and public money, according to Glenn Goldberg of the committee’s California office.

At the UCI Birthing Center, which handles only low-risk births, mothers are generally sent home within 24 hours but return to the center when the infant is 2 days old, according to B.J. Snell, director of nurse midwifery. At that time, the center staff helps the mothers with breast-feeding or any other problems or questions they may have related to caring for themselves or the baby.

Long Beach Memorial Hospital’s Home Health Care department has launched a program that sends nurses to the homes of new mothers to medically examine them and their babies and assist with any problems, according to Lucy Baker, director of nursing services.

The program was launched in response to concerns that mothers are being released so soon from the hospital that many of them--especially younger women or first-time mothers--were insecure over their abilities to care for themselves or their infants, said Baker.

To qualify for the program, women must be referred by their doctors. Some insurance companies pay for the service; otherwise, families pay $127 per visit from the nurse.

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There have been tremendous changes in birthing policies at hospitals over the years. Twenty years ago, women stayed in the hospital about four days for a vaginal birth and about seven days for a Cesarean section, according to Dr. Padraig Carney, president of the staff at the Women’s Hospital at Long Beach Memorial Hospital, where about 5,000 babies are born each year.

Back then, many of the new moms would be welcomed home by mothers or mothers-in-law who would help run the household and care for other children, impart motherly advice, give the mother emotional support, time to bond with the baby, and the needed rest to recover.

Today, some of the major insurance companies in California pay for a maximum 24-hour hospital stay for a normal, vaginal delivery and no more than three days in the hospital for an uncomplicated Cesarean section, said Carney.

Views vary on whether earlier release from the hospital can have a detrimental affect on the new mother’s emotional or physical well-being.

Long Beach Memorial’s Carney and UCI’s contend that if the mother is doing well and there are no complications or medical reason for keeping her hospitalized, it’s better for her to go home.

Although some women may complain they were exhausted and felt overwhelmed by the prospect of having to go home and take care of a baby and older children within 24 hours of having a baby, others actually want to leave early, according to some health care workers.

Nevertheless, when today’s mothers arrive home, their parents and relatives may often live too far away or are too busy to advise them on things like breast-feeding or help her with the house and other children.

While Snell agrees it is important for new mothers to have loving support and help of the husband, family or friends, she says tired mothers who plan to breast-feed shouldn’t relinquish all night-time feedings.

If someone else is giving the baby bottles all night while the mother sleeps, the infant will get confused and it will become detrimental to successful nursing, said Snell, who is a lactation specialist.

Claire Carlyle, 35, of Huntington Beach, who left her position as a high school principal to raise her twins, said After the Stork provided her with the help she desperately needed after she arrived home from the hospital and her mother and mother-in-law had to leave.

The fact that the in-home care provider had children of her own and was well trained, made her feel comfortable. “After all, they are taking care of the most precious things in your life,” said Carlyle.