HuffPost | Transitioning To Parenthood (Part 2 of 4): Planning and Setting Expectations

MD for Moms | Peri-Natal Psychiatry
Pregnant Woman Reading Children's Book in Bed

My column on HuffPost opens in a new window is the written counterpart to my weekly BBM Global Network and TuneIn radio show (Wednesdays 1pm) opens in a new window, with which it shares a title, MD for Moms.

This article was originally published on HuffPost on 3/11/2017.

This is the second of a series exploring the transition to parenthood and the realities of being a new mom.

As I’ve explored many times, most recently in the first article in this series, our identities as women change profoundly as we enter motherhood, altering priorities, interests and often personal and professional goals. The focus shift from self to baby begins after seeing a plus sign, being given a due date and appreciating that you now comprises more than just me.

Trimester 1: Walking on Eggshells

Pregnancy is a marathon. The first trimester is filled with anxiety about miscarriage along with nausea and fatigue. Some enter pregnancy with cautious optimism while others are more exuberant, their perspectives informed by experience, age, and the path taken to pregnancy.

I was particularly worried about miscarriage in my third pregnancy, in part due to having lost a wanted pregnancy shortly beforehand. Whenever these anxieties intruded, I would stealthily brush my arms across my chest checking for nipple soreness, my body’s tell-tale sign of pregnancy; if it was present, I knew I could relax. I remember engaging in this ritual as a woman passed me going in the opposite direction and looking up to catch her knowing smile, which seemed to be saying,‘I get it, we’ve all been there.’ I’ve imparted this same smile to other women, hoping to indicate that it will get easier.

Although even the most stoic woman is likely to experience profound anxiety during the early days of a wanted pregnancy, it should remain manageable and controlled. What if you can’t relax, can’t stop obsessing and ruminating? I remind my patients that no amount of consternation will change the health of a pregnancy – being more anxious and hyper-vigilant will function only to make the first trimester that much more painful. If your anxiety is negatively impacting your daily life, please consider finding an appropriately trained mental health provider to work with.

Despite each trimester occupying the same 12 week time period, the first weeks feel endless, like a childhood summer, a long wait for the stage where the pregnancy is less tenuous.

The first trimester often ends with a sigh of relief along with a much needed boost of energy and excitement as the second trimester – the honeymoon phase – starts.

Trimester 2: The Honeymoon Phase

The second trimester seems the shortest, possibly because while the nausea and morning sickness have faded, making this physically the easiest leg of the journey, the delivery date remains comfortably off in the distance.

Most women start showing early in second trimester, unveiling mom-to-be to the world. Once a pregnancy is public knowledge, it often becomes the focal point of discussion, with well-wishers rarely hesitant to offer advice. People espouse the pros and cons of everything from childbirth method (epidural, doula, midwife, OB/GYN alone, Caesarean section, Room-in or nursery) to which diaper pail deodorizers work best (hint: none – baby’s room will eventually need to be aired out!) to the optimal baby-feeding technique (exclusively breastfeed, breast plus bottle, or formula only).

Despite the well-intentioned impetus behind these anecdotes and personal opinions, the conflicting information often leaves parents-to-be feeling overwhelmed and confused. Many will obsess about finding the ‘right’ answer and the ‘perfect’ stroller or car seat and so forth. This distress is usually for naught, given that the answers will reveal themselves naturally after baby arrives; in any case, there is no perfect stroller or glider, so if you don’t like the one picked, exchange it!

Obsessing over the tangible can take the place of dwelling on the deeper issues that can be addressed during the second trimester. As delivery is (hopefully) not imminent, this is the ideal time to establish plans that can help make the postpartum months as uncomplicated as possible.

Trimester 3: The Long Haul

Third trimester often begins with a sense of urgency. Empty nurseries start to fill with furniture and clothes, teddy bears and lovey blankets. As the due date nears, energy starts to wane along with the ability to see your feet. Time stands still in anticipation. Two competing thoughts assume equal prominence : “I want this baby out now!” vies with “I need more time before baby arrives.”

Physically, the third trimester is trying – as baby gets bigger, reflux may worsen; kicks to the ribs are more painful and ankle swelling becomes the norm – making the drive to deliver understandable. Nothing says ‘ready to pop,’ like having wet spots on your shirt while standing in a subway car, eight months pregnant and lactating early. Exhaustion is no guarantee of sleep – it can become difficult to get comfortable enough. Baby’s head sits directly on the bladder, making nightly bathroom trips common and further disrupting rest.

Then there’s the competing thought: ‘Stay in longer, because I’m not sure I will ever be ready for this baby to come.’ This anxiety varies in degree depending on how many babies mom has borne. First-time mothers face the uncertainty of caring for a newborn. Many wonder how they will learn to care for their baby, how to decipher the hunger cry from the tired or wet cries (you just figure it out instinctively). These issues are intertwined with establishing one’s identity as a mother and learning to appreciate the intense responsibility that is part and parcel of parenthood.

Multiparous moms, or women who are not first-timers, often feel more confident about their ability to care for a newborn. They have been through the trenches and survived, and more importantly, so did their first born. However, they too experience anxieties of a different sort close to delivery: how they will juggle it all, how the older child/children will adjust, and how the new baby will change the family dynamic.

These ‘second-time-mom anxieties’ hit me particularly hard. I vividly recall sitting on my then nearly 2.5 year old son’s bed crying, wondering if the baby girl arriving two days later was a mistake. I wondered how I could ever split my time, my love, and myself enough for two. I questioned why my husband and I would make life harder for ourselves when we had finally figured out this parenting thing. It is not a secret that the heart has an incredible capacity to expand and love more children without reservation; however it takes delivering that subsequent baby to truly believe this statement to be true.

Postpartum Planning: The Earlier, The Better

The postpartum period can be made more straightforward if plans are made before baby is born. Let’s set up a framework for how this can be approached.

Divvying up the major activities of early parenthood is important and best engaged in before baby is born. Second trimester pre-planning allows parents more latitude and often more clarity rather than rushed decisions made in a state of panic after baby’s birth, when preventable issues have already surfaced.

Talk out the night plan, the day plan – map out how to ensure mom is sleeping enough and include dad early and often. The goal is to avoid complete exhaustion, since sleep deprivation leads to anxiety, powerlessness and loss of joy in the little things. Exhaustion leads to irritability and low frustration tolerance, and formerly minor annoyances can become catastrophic.

In the beginning we can all get by with less sleep, but the impact over time can have serious negative consequences. Similarly, it is crucial to establish a plan for how mom will continue to obtain sufficient nourishment in the weeks and months after baby arrives. Despite infants sleeping up to 18 hours a day, these hours inexplicably don’t feel adequate to allow time for a real meal much less a shower.

Obtaining enough calories and general nutrition postpartum is essential to making that period a healthy one. Precooking and freezing healthy meals, planning on a meal delivery service and/or having a weekly grocery delivery are some options to ensure there is adequate food available for mom.

More mundane issues such as who is going to be in charge of ordering diapers, bath supplies, and other necessities should also be decided in advance, which can relieve sources of potential conflict and resentment later on.

Establishing in advance how parents will nurture each others mental health and support one another is incredibly valuable for the entire family. Set up (at least) weekly date nights during pregnancy to establish the routine. Interview and hire a sitter or ask for scheduled weekly help from reliable, trusted family for date nights once baby arrives. Pre-planned date nights that are religiously observed are extremely beneficial in safeguarding the marriage and for both partner’s well-being.

Parents should also discuss how to comfortably talk about their emotional states and feelings. I will go into depth on this in Part 3 of this series on transitioning to parenthood.

You can only care for your family effectively and fully if you have taken care of yourself. If you are exhausted, undernourished, under-stimulated and so on, you are not at your best and cannot care for your family optimally. Taking time for yourself and prioritizing your needs in addition to taking care of your family translates to a happier, emotionally healthier pregnancy and postpartum period.

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