Huff Post | Transitioning To Parenthood: Mom Leaves The Nest (Part 4 of 4)

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

This article was originally published on HuffPost on 9/19/2017.

Finding yourself and enjoying your role as a parent are core issues explored via the articles on my Huff Post blog, MD for Moms. The first three installments of this series, Transitioning to Parenthood, delved into how the bond is forged between mom and baby and the planning required both during and after pregnancy to minimize stress and safeguard your marriage. This final article will consider the next phase, as baby grows out of infancy, maternity leave ends, and mom must re-establish her identity as a woman and a mother.

Postpartum Considerations

Labor is a huge physical endeavor – unlike anything else asked of our bodies. A woman with an uncomplicated delivery will burn roughly 2,500 calories, about the same as a well-trained runner giving it her all in a marathon. After crossing the finish line, marathoners are expected to relax, recuperate and allow their bodies time to heal, while mom barely gets a high five before being thrown into parenting full-force.

In the United States, while home births have increased in popularity over the last 10 years, over 98% of them still occur within a hospital setting. As such, hospital-based delivery will be my main focus, and it’s notable that women who deliver at home do not inherently have more time or support to recuperate than women who deliver in the hospital.

Increasingly, hospitals are eschewing traditional nurseries in favor of “rooming in.” Rather than de-facto taking baby to the nursery, these days new moms are encouraged to have baby stay with them . Requests by mom for baby to be taken to the nursery instead are often met with sidelong glances and questioning looks.

A patient of mine, exhausted beyond measure after laboring for over 24 hours, recounted the unspoken criticism she experienced in this same situation. She felt pressured to keep her baby nearby lest she be seen as a poor mother, even though a few hours sleep would have been physically and emotionally restorative.

After pregnancy and labor a woman’s body needs to heal. American culture does not provide mom with time, space or the resources to recover; we revere pregnancy yet do not respect the physical ordeal of labor and fail to support new moms during the first three months postpartum. New moms feel compelled to ‘bounce back’ within days while simultaneously taking care of their newborn. This translates to a culture of over-tired, foggy and often unfulfilled new moms with some of the highest levels of postpartum depression (PPD) and anxiety in the developed world.

Being the primary (and sometimes only) caregiver for a newborn (and any other children at home) is a huge undertaking that likely hinders the healing process. This postpartum experience leaves moms exhausted and worn out in short order, with no personal time with which to recover and truly connect with their new role.

The US clearly hasn’t gotten the message yet that mom matters – we have a lot to learn and many countries to learn from.

Many cultures outside of the US do value mom’s health, granting her the time to recover so that she can properly care for her baby. In the US, new moms are on average discharged from the hospital after a vaginal delivery in 1-2 nights and have no follow up for six weeks. Comparatively, moms in France, Germany and the UK on average remain in the hospital 3-4 days after a vaginal delivery and are visited within a week by nurses or midwives and/or are provided the equivalent of government-sponsored night nurses. Research shows that the European model, which provides recurrent midwife visits at 10 days and three weeks postpartum, has a better outcome for mom and baby. Women are more likely to successfully breastfeed for longer, to use contraception, to have immunized babies and are less likely to be depressed as compared to the meager US offering: an obstetrician (OB) visit at six weeks postpartum.

In France, beyond funding midwifery care, the government also pays for a type of pelvic floor physiotherapy that reduces pelvic pain postpartum and for all subsequent pregnancies, improves sexual satisfaction, and reduces urinary incontinence. French birth rates are low, so providing this for all new mothers helps encourage women to have additional children. Conversely, the US pays for no postpartum rehab and appropriately trained physiotherapists are hard to come by. As a result, over 30% of women in the US suffer from weak pelvic floor muscles and all associated pain and indignities.

Support for new moms isn’t limited to Europe. Many Asian cultures practice confinement, whereby a woman is cared for by friends and family for 30-40 days. In Chinese culture, women remain in their homes for thirty days; in Korea, women are cared for and remain indoors for at least 21 to 30 days and as many as one hundred; in Indonesian and Malaysia, the latter of which has the lowest rates of PPD among Asian countries, women are kept from cooking and cleaning and must remain home for the first 40 days postpartum. These cultures accept that such confinement is necessary to ensure the health of mom and baby and isn’t considered a weakness.

The six week time frame that many non-US cultures grant mom for childbirth recovery is not chosen randomly; the body requires approximately that much time for initial healing. This interval allows the uterus to return to its pre-pregnancy size and the vaginal discharge called lochia to diminish and eventually stop.

Moms Aren’t Rushed Back to Work Internationally

Motherhood in the US quickly becomes a blur of feeding, changing and burping the baby, leaving mom in an over-tired haze. By around 12 weeks baby starts to sleep more consistently, mom feels a bit more like herself and time with baby isn’t as stressful. The cruel irony is that this corresponds with the end of maternity leave – just as things seem more manageable and perhaps even fun, mom is forced back out the door.

The US ranks last of 41 developed countries as the only industrialized nation without mandated paid maternity and paternity leave. The Family and Medical Leave Act of 1993 (FMLA) throws parents a bone with 12 weeks of unpaid leave annually for new mothers; New Zealand, the second worst country, provides two months of paid leave.

Paid maternity leave translates to improved health for mom and baby, lower rates of postpartum depression, and increased rates of nursing. Studies have shown that women with fewer than 12 weeks of maternity leave are more likely to experience depression and to have poorer overall health status.

Swedish parents are entitled to at least a year of paid maternity leave that can be shared between both partners. Sweden consistently has the lowest rates of PPD in epidemiological studies. Coincidence? Not by a long shot. This low rate has been attributed to more inherent social and medical support for mom and the entire family both during and (most notably) after pregnancy along with a family-friendly maternity/paternity leave policy.

Finland began providing baby boxes at discharge from the hospital over 80 years ago. Baby goes home with a box of necessary items including the box itself that can be used as a bassinet, infant clothes, nursing pads, diapers, wipes and bathing essentials. Providing such items lessens anxieties about having everything ready for baby’s arrival and proves beneficial for new parents who may need extra guidance. Finland has the lowest rates of SIDS at 1.3 deaths per 1000 births compared to the United States’ 23rd place world ranking with 6.5 deaths per 1000 births. New Jersey, Alabama and Ohio employ similar programs — hopefully other US states will follow suit. Comparable boxes are available for purchase in other states but are not mandated by law.

If the US modeled its international counterparts, parents would have less stress and be afforded the time and space for mom to heal and for both to comfortably bond with baby in the postpartum period.

Until The US Steps Up, What Can Moms Do?

As the return-to-work date nears, many moms feel anxious, sad and overwhelmed. It seems inconceivable to leave baby after logging so much time together. Anticipatory anxiety can be profound and when severe can rob new moms of the joy they could be experiencing during those final weeks of maternity leave.

Some women become apprehensive about their ability to perform up to their former standards at work; others are riven with uncertainty about their baby’s safety and security. Several strategies can be employed to counter these common fears.

Ideally during pregnancy but at least a month or more before returning to work, sit down with your partner and address whether your family prefers daycare or a nanny. If day care, are there options through either of your jobs? If not, get recommendations from friends with children; visit a few and talk to the owners and other parents. If mom is nursing and plans to continue, does the facility support mom coming in for a session? Will baby’s nap schedule be followed? Are parents happy with how their babies are treated and cared for? Does it seem warm, inviting and clean? Trust your gut and find a place that you feel comfortable with.

If you opt for a nanny, figure out what qualities are important to your family – do you prefer a more mature woman with a long track record, perhaps kids of her own, or would you rather a younger, more energetic woman? How many hours a week do you need, is flexibility important or can you ensure the same daily hours? Decide how you want to pay, be it hourly or weekly and how you hope to find Mary Poppins. Will you search yourself or use an agency? The former is far more time consuming and labor intensive, but the latter is far more expensive and removes you from some part of the initial review of possible candidates.

A helpful tool is a shared online calendar (as discussed in Part 3 – I use Google) which ensures that baby is always covered without forfeiting either parent’s career in the process. For example, a morning drop-off or wait for nanny to arrive should be balanced with the freedom to come home later; your partner will handle that day’s pickup or be home in time for nanny to leave.

Establishing a plan that works with your schedules and jobs without either partner feeling spread too thin is critical for mom’s peace of mind and helps ease her transition back to work. Each partner’s career is important; if one person is expected to rush home from work by 6pm (for example) whereas the other walks in whenever their day ends, resentment will build. Keep lines of communication open and remember that your partner can only know what you tell them – don’t expect support when you are feeling overwhelmed or overburdened if you keep your misgivings to yourself.

Running Home Happily

After having a child, priorities drastically shift, from doing whatever it takes to succeed at work, to doing well enough and getting home early.

Many women agonize over this push-pull between professional and personal expectations. Rather than attempting to become a master of both domains, set realistic goals and plans for the transition back to work.

Yes, there will be days when you will need to stay late and ask your partner to handle pick up or let the nanny leave, but the bulk of the time you will feel a strong pull to get home and will do whatever is needed to accomplish this. Lunch at your desk holds more appeal when it gets you home an hour earlier for extended cuddle time.

Take time to establish a comfortable balance between your drive at work and the yearning to be with baby and how this jibes with your specific job. Give yourself the space to screw up, to be a bit tired and possibly slow when you return to work – it’s a big change – but you’ll find your footing and feel confident again while enjoying your time at home.

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