Be Prepared for the Reality of Postpartum

It happens this way: The 7-pound bundle with the soft, spiky hair and fingernails like tiny pearls lands in your arms--the greatest gift of your life.

Emotion No. 1: You will throw yourself in front of a train to spare this child a single moment of pain or despair.

Sleepers have to be changed after one spit-up; crib sheets laundered if a single drop of pee comes into contact with the 100% cotton. Babe has to be held if he so much as whimpers. Absolutely no one but Mom, Dad and maybe Grandma will be allowed to place their germy mitts on this perfect specimen.

Soon, according to a number of studies on the postpartum period, the health of many new mothers begins to erode. Dad’s health and mood can slip as well. And the marriage, studies find, isn’t as satisfactory as it once was.

At some point along this typical spectrum, new parents, particularly mothers, usually discover the downside of caring for an infant--the fatigue, the dilemmas, the quarrels, the shock that it can be so very hard, say experts on parenting and the postpartum period.

“The focus has been on the arrival of the baby. But we have not paid significant attention to the fact that the transition to motherhood is the single most important life transition that a woman can make,” says Sherman Oaks psychologist Evelyn G. Kohan. “You become responsible for another human life, and it’s an ongoing responsibility.”

According to Kohan, an expert in postpartum mood disorders, the major obstacle in adjusting to parenthood occurs when one’s expectations don’t match reality.

Experienced parents can attest to the challenges during baby’s first year. Jackie Miller can look back and laugh ruefully over how her preconceived notions of motherhood clashed with the real thing.

The Long Beach woman gave birth to son James five months ago.

“I was naive. I’m 34; I thought it would be a piece of cake. This is hilarious--I actually thought I might be able to study for a graduate exam!” Miller says.

Even being warned that parenthood was hard had not prepared her.

“I had feelings of being incompetent as a mother. And you feel like you’re the only one who is. It makes you feel that you’re no good at the one role that you’re really supposed to be playing,” says Miller, who adds that a very supportive relationship with her husband helped her adjust.

Studies confirm that many mothers find the postpartum months unexpectedly difficult.

The physical recovery from pregnancy and childbirth is also a more drawn-out process than women typically expect, researchers have found.

A 1993 study by a University of Minnesota rsearcher found that, three months after delivery, many women experience physical problems such as poor appetite, fatigue, hemorrhoids, constipation, hot flashes, pain during sexual intercourse, respiratory infections. Even at nine months postpartum, many women said they had vaginal discomfort and constipation.

“Mothers typically do not pay enough attention to themselves,” Kohan says. “They focus on the baby and don’t realize that the mother’s adjustment is the key element in caring for the baby. There is a new body of research showing that babies develop differently based on the mother’s adjustment.”

*

It is an all-too-typical morning at the Moms & Babies Support Group meeting at Long Beach Memorial Medical Center.

Chris Knight and her son, Dylan, 5 months, kick off the meeting.

“He’s waking up every morning around 4. I put in his pacifier, and he’ll go back to sleep. But I’m wondering why he does that,” she muses.

Liz MacDonald cradles 4-month-old Annabella.

“We’re starting a bedtime routine,” McDonald offers. “Hopefully, in a couple of weeks, we’ll have some results.”

About 10 minutes into the meeting, Lori Doty enters the room with a diaper bag and 6-day-old Tara. The pinkish, wrinkled newborn attracts the attention of all the new moms. One of them praises Lori for “getting out so soon.”

The meeting resumes, but within minutes, Lori is starting to sniffle. The group politely ignores her and continues to discuss baby-sitting issues, teething pain and the travails of traveling with baby.

Lori, however, advances to sobs. Pam Hastings, a nurse educator and facilitator of the group, walks over to her, hugs her and tells her that it’s normal to be teary in the first few weeks.

“I guess I wasn’t ready for this,” Lori says, smiling through her tears.

The other moms murmur words of encouragement. Lori nods but continues to cry. A couple of the other mothers start to sniffle. Three are crying, then four, five.

Hastings passes out tissues.

Eventually, Lori confides that everything is fine. But: “I wish I was back in the hospital,” she whispers. “You feel so safe there.”

For the most part, new mothers simply need support, says Hastings. The Moms & Babies Support Group is a free, weekly group.

“The purpose of the group is to make friends and build support systems within this group,” Hastings explains. “They become aware that they are not alone and other mothers are experiencing the same things.”

Support from other people, time to rest and good communication between spouses are elements that postpartum experts uniformly identify as crucial to healthy adjustment.

During that 15-year span when Kay Willis had 10 babies, she eventually discovered what she considers to be the secret of surviving the postpartum months. She learned how to take care of herself first.

According to Willis, the New Jersey-based coauthor of the book “Are We Having Fun Yet” (Warner, 1997) about the postpartum period, falling victim to fatigue, countless demands and perfectionism without ever stopping to “refuel” and ask for help is the single biggest mistake new parents make.

“My basic message is that mothers have to learn to take care of themselves so they can better take care of their children.”

Willis advises new mothers to rest--completely getting off their feet--for 15 minutes a day and schedule a two-hour period to do something for the mselves each week, such as taking a class, going to a movie or out to lunch with a friend.

“I take the guilt out of parenting,” says Willis, who adds that the two-hour-a-week breaks should begin by the third month postpartum.

Many new moms fail to communicate to their partners about the strain they are under, experts say.

“The birth of the baby is a huge transition for the couple,” Kohan says. “And if communication has been a difficult issue in the past for the couple, it will come to light in the crisis of the birth of the baby.”

*

While problems with fatigue and marital communication are common and are usually resolved within the first few months of childbirth, some women are at risk for more serious psychological disorders in the postpartum period. An estimated 10% of women become clinically depressed, and an additional small number of women develop panic disorder or obsessive-compulsive disorders, says Kogan.

Postpartum mood disorders that require treatment are different from the “baby blues,” the short-lived period in the few weeks after childbirth when many women find they cry easily.

“Many women can experience a range of emotions, feelings of anxiety, sadness, inadequacy, worthlessness,” says psychiatrist Lori Altshuler. “However, if such feelings interfere with her ability to enjoy her baby, function in the family or at work, she may be suffering from a treatable depression disorder and should consider an evaluation from a psychiatrist.”

Women, however, are very reluctant to seek help, says Cheryl Beck, a University of Connecticut nursing professor and expert on postpartum panic disorder.

“Our society doesn’t condone motherhood as a reason for depression. We put this pressure on mothers that they have this beautiful baby and there is no reason to be depressed, so snap out of it.”

All new parents should be told--either by the obstetrician or in childbirth education classes--that the possibility for a mental health disorder exists after childbirth, Beck says.

“They need to hear that there is this possibility,” she says. “They need to be told that it’s not the mother’s fault.”

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Dealing With Postpartum Blues

For more information, help or resources on postpartum depression:

* Postpartum Support International: (805) 967-7636. National resource organization, based in Santa Barbara, for families experiencing a postpartum mood disorder.

* Postpartum Health Alliance: (310) 915-7028. Los Angeles-area support group for families experiencing a postpartum mood disorder.

* UCLA Pregnancy and Postpartum Mood Disorders Research Group: (310) 842-6346. Offers information and free clinical services to women experiencing mood disorders.