The Fourth Trimester : Think it takes only six weeks to bounce back from childbirth? Wrong. Research shows new moms need <i> months </i> to recover.

As a nurse, Carol Ann Friedman thought she knew what to expect during her own postpartum recovery:

If she had a Cesarean section, she would need eight weeks to heal.

If she had a vaginal birth, six weeks.

By then, she figured, her life would be back to normal. She would be rested, ready to return to work, adjusted to her baby, with the household running smoothly.

Right?

Wrong.

“It took me much longer than eight weeks,” she recalls. “I felt better about the eighth month. “

Having spent her career nurturing others back to health, the irony of the situation didn’t escape Friedman, a certified lactation consultant in Pasadena.

The vast majority of women would categorize having a baby as a joyous event, full of rewards and moments of sheer delight. But when the tears flow, it’s often because society’s benchmark for when new mothers should be recovered--six weeks to eight weeks--is unrealistic for many.

“A joke,” says one woman, aptly.

“Ridiculous,” says another.

“It’s almost brutal,” says Friedman.

Scientific studies--and new mothers themselves--attest to a much longer adjustment period, something akin to a fourth trimester.

In a study published last year, researchers found that most women need months--maybe as much as a year--to fully recover from childbirth.

One month after delivery, women still complained of breast problems, fatigue, hemorrhoids, poor appetite, constipation, increased sweating, acne, hand numbness or tingling, dizziness and hot flashes.

Three months after delivery, many of these symptoms continue, the study reported, while 40% of mothers also reported pain during sexual intercourse, as well as respiratory infections and hair loss at three to six months.

Even at nine months postpartum, many women said they experienced vaginal discomfort and constipation.

And 20% reported problems related to sexual function one year after childbirth, says researcher Dwenda K. Gjeringen of the University of Minnesota.

Moreover, as many as 10% of women suffer postpartum depression in the months following childbirth, other research has shown. Postpartum depression is a severe mood disorder linked to changing hormones in which stress and fatigue can play a major role.

Even without experiencing such a serious postpartum illness, “Recovery from childbirth often requires more than the six weeks traditionally allotted,” Gjeringen says.

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Baby is now 2 months old and signs are everywhere that Mother should be up to speed.

At six or eight weeks, disability payments usually stop--a not-so-subtle hint that a woman should now be ready to return to work.

Yet, according to Gjeringen’s study, the postpartum adjustment period is especially hard for women who return to the work force--about half of all new mothers--soon after childbirth. The average working woman takes eight weeks off for childbirth, according to 9 to 5, National Assn. of Working Women.

At six weeks, the last visit with the obstetrician takes place. That is when, according to medical textbooks, the uterus has returned to its non-reproductive state.

Using that as the benchmark of recovery, physicians pronounce most of their patients fit and ready to resume sexual relations. Never mind that the typical patient is still 20 pounds overweight, exhausted and sore.

There is also a tacit assumption in many quarters that the mother should have her baby on some kind of schedule at six weeks. After all, when are the in-laws ever wrong?

In truth, the postpartum adjustment period differs greatly among women, and recovery simply cannot be predicted or planned, experts say.

“A lot of it depends on whether the baby is an easy baby or not,” says Sandy Hill, the owner of an Orange County parent-care service called After the Stork. For example, some babies have health problems, develop colic, are hard to feed, sleep fitfully or are ill-tempered.

“Women often say, ‘What’s wrong with me? I’m not adjusting. Why is this so hard?’ But it’s usually because the baby is a difficult baby,” she says.

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Physically, too, recovery varies widely.

“The physical recovery is usually much slower than what people expect,” says psychologist Georgiana G. Rodiger, a mother of five and founder of the Rodiger Center in Pasadena. “Childbirth is a much more traumatic--especially for a first birth--than most people care to describe. And one of the worst parts is you don’t get sleep. That goes on for months.”

Some new mothers also feel pressure to lose all their added weight a couple months after childbirth. If a woman is returning to work at six weeks, she’s lucky if her regular clothes even fit, Friedman says.

“Most of us have body-image issues at that time,” she says. “But it’s very natural not to have lost the weight at that point.”

Postpartum recovery is clearly on the fast track these days, beginning from the moment of birth.

It is common now for women who have an uncomplicated vaginal birth to be discharged in one day and women who undergo C-sections in three days.

And, under some insurance policies, childbirth is just a pit stop: Women with vaginal births go home in eight to 12 hours. “These mothers are still in a fog,” Friedman says. “I’m trying to tell them how to change a diaper and they’re saying ‘What? ‘ “

The early discharge trend can throw the entire postpartum period out of kilter by placing too much on a new mother too soon.

For example, Friedman says, breast-feeding rates in the United States declined in the 1980s (they have since stabilized), possibly because a new mother may have little help during the difficult first few days.

“The critical period in breast-feeding is the first three days, and these women are already home,” she says. “They need someone to nurture them. That’s what nurses used to do. But they are not around anymore.”

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The trend in early discharge and a light-speed postpartum recovery sometimes seems like a backlash to the days a generation ago when new mothers spent five to seven days in the hospital and came home to a supportive extended family and a neighborhood full of casserole-bearing, stay-at-home moms.

“In the old days, the mother was in bed and everyone said, ‘Oh, that’s ridiculous--this isn’t an illness,’ ” notes Susan, a Los Angeles woman who asked that her full name not be used. “Then it became a thing of who can get out the door the quickest.”

But those women racing out the door, new baby in tow, may find the world an inhospitable place.

“Women who have babies don’t get a lot of support from society or their families,” says Lola Clark Tirre, a herbalist and mother of three who lives in San Clemente. “I think women are expected to be back to normal in less than six weeks. If they have other children, they are expected to hold down the fort, to car pool, to get everyone to their activities. You see a lot of women out with newborn babies. You never used to see that. It’s shocking.”

New mothers who refuse to get with the program are subject to ridicule, Tirre adds.

“I don’t think it’s respected if a woman says she is going to stay home and bond with her baby for several weeks. People think you are kind of kooky.”

Not many women have the luxury of staying home and cocooning, says Linda Juergens, director of the New York-based National Assn. of Mothers’ Centers, a network of nonprofit discussion groups.

“Certain societies have ways of relieving new mothers of duties as she recovers and having a mentoring period with other mothers. In our society, we have nothing built in to support a new mother. The extended family is gone.”

Coinciding with this decline of a support system, she notes, is an increase in expectations.

“It has gotten to a point where people think the mothers can do everything,” Juergens says. “They can take care of the newborn. They can physically recuperate and can get back to all the things they did before the baby. But no one is asking, ‘Are you ready for this?’ ”

Least of all employers, say new mothers.

Although the Family Leave Act provides for four months of maternity leave while guaranteeing job security, few employers provide paid maternity leave to supplement disability payment. And most women can’t afford to stay home without a regular paycheck.

Hill, who runs a parent-care service, recalls one mother, six-weeks postpartum, crying when Hill left at the end of her shift.

“Part of it was that I was leaving and she had no more help. And part of it was that she had to start thinking about getting back to work,” Hill says. “She was forced to bring her adjustment to an end.”

Susan recalls bringing her first child home after having a C-section. A co-worker called her and mentioned that Susan’s boss was wondering when she would be returning to work.

“I heard that and I started to cry,” she says. “I thought, ‘I just had surgery!’ But I guess he felt it was different than another kind of surgery.”

Part of the solution to the cultural crisis facing today’s new moms may be a return to old customs.

For example, new moms are increasingly joining breast-feeding or parenting organizations, says Friedman, the owner of two stores that carry lactation equipment and clothing. At her Mothers with Style store in Glendale, women meet weekly for support.

Women are not only helped individually, but a forum is created for them to air their concerns, says Juergens, of the National Assn. of Mothers’ Centers.

“As a national organization, our hope is to raise the consciousness among people about these issues,” she says. “We want to expand the maternal voice and get women to feel entitled to make their needs and wants known.”

Another trend reflecting the needs of new mothers is the surge in for-profit postpartum care services--organizations that dispatch trained workers to do light housekeeping, cooking, baby care, grocery shopping and answering the telephone.

About 90 such businesses operate nationwide, charging from $15 to $25 per hour, according to the National Assn. of Postpartum Care Services. Insurance providers rarely cover these services, and only a fraction of women can afford it, Juergens says.

But, she adds: “The recognition that that is valuable and needed is a step toward saying that everyone needs it.”

Postpartum experts are also pressing for friendlier workplaces that feature flexible working hours and a private, comfortable place to pump breast milk.

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Old hands at motherhood say the best advice for new parents is to relax their own expectations about what their lives should be like after having a baby and focus on enjoying the baby.

Friedman says that when she imparts this wisdom, new mothers often burst into tears--of relief.

“I think the best advice to moms is to take it day by day--to be realistic about what you can do, and that you can’t be an incredible mother, lose all this weight and be perky and happy. What your baby needs the most is your love, not your being thin or organized.”