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New Mom Care

When I was pregnant with my first child, I knew that many new moms arranged for people to come and help them after the baby was born, but I couldn't really imagine why, or what kind of help it was that I'd really need. After all, from what I knew of newborns (which, granted, wasn't a whole lot), it seemed to me that they slept all the time. And since I'd be nursing, there would be no one else who could really help with feeding. As I imagined it, anyone besides my husband and me around the house would just be someone else to entertain and worry about -- more intrusive than helpful. Couldn't my husband and I just do this by ourselves?

Luckily for me, two good friends with baby experience answered -- actually, insisted -- that no, we could not. And so, I relented -- assuring myself that even though I didn't really need them, it would still be fun -- and they flew out, timing it so one would arrive immediately after the other left. For one week they cooked, cleaned, reassured, listened, and made sure I rested as much as possible. As the second friend departed, I cried at the door. How would my husband and I ever do this by ourselves?

Like many women, my transformation from a confident, I-can-do-it-myself pregnant woman to a scared, overwhelmed new mom happened in about the same amount of time it took to deliver my baby. Despite all my reading and preparation, the physical and emotional demands of new motherhood took me by surprise -- an extremely common experience. "Women have stars-in-their-eyes expectations about what they are going to be capable of after the baby," says St. Louis psychologist Diane Sanford, Ph.D., who specializes in women's health. "I think we focus so much on pregnancy and delivery that we minimize the postpartum adjustment period. I've had women who think they'll finish their scrapbooks and reorganize their closets after the baby's born." Then, when these women end up having to count taking a daily shower as a postpartum accomplishment, they are naturally disappointed with themselves.

A better approach, says Sanford, is to recognize that the first several months after birth -- in particular, the first few weeks -- are going to be challenging physically and emotionally, and to prepare for this reality, rather than some romanticized ideal. "People are scared to talk about how hard this time can be because they think if you give women negative ideas, then it is going to be worse," says Sanford, "but, actually, if you help women prepare, it can be so much better. It takes so much pressure off."

Planning Ahead

One of the first notions that needs to go, according to Sanford, is the idea that you, or you and your partner, can handle everything yourselves. The fact is, a new baby and a new mom outnumber a single caregiver two to one, with separate needs that continue around the clock for at least the first month after birth. For the new mother, this includes a physical healing period of at least three to four weeks, if not more, says Linda Nicol, R.N., patient education coordinator at Loyola University Medical Center, in Maywood, Illinois, regardless of how "normal" she looks on the outside after birth.

"Your body is using your energy to heal on the inside, and if you're breastfeeding, you're also using at least 500 calories more than normal," explains Nicol. As a result, a new mom needs sleep, rest, nutrition, and as much stress relief as possible -- things she typically won't get on her own. "A new mom finds out it can take an hour to feed a baby, then she cooks or cleans or does laundry, and then an hour later the baby is hungry again," explains Nicol. "There isn't time for her to do anything else."

Because of all of these factors, Nicol and Sanford both always recommend that all women plan for a minimum of two weeks of daily help at home after childbirth, from both their partner and someone else, if possible. To get this, you'll need to line up family or friends or even pay for assistance. "Four weeks of help in the home from your partner and someone else is the optimum," says Nicol, but she admits that a month isn't usually realistic. Still, extensive aid -- of a month or more -- may be something you'll have no choice about needing if there are complications with your health or the baby's.

A woman who gives birth to a premature baby who can't come home right away, for example, doesn't need help with her newborn, but she may need more emotional support and at-home assistance. "I was pumping breast milk every three hours and then jumping in the car to go to the hospital the moment I woke up," says Debby Greene, a Big Sky, Montana, mom of three, including premature twins. Even though it would seem that it was easier to have her babies cared for in a hospital, Greene says the emotional and physical challenges of being separated from them meant she needed different kinds of help from her family and friends. She especially valued delivered hot meals, rides to the hospital, care for her older child, and lots of hand-holding.

Women who have had a cesarean also need very specific practical assistance. Since they cannot drive (for four to six weeks), vacuum, or lift a baby carrier or a heavy laundry basket, and they need to limit stair climbing for several weeks because of the risk of hemorrhage after surgery, friends and family willing to drive and lend a hand with housekeeping, as well as with baby and mom, are particularly valuable. And while women who have already had a baby may be confident about caring for a newborn, they almost always need help getting rest, which often requires one person to care for the older child and another to take care of the baby for the first several weeks.

Finding Help

If arranging for all this kind of relief still seems like something for other people, keep in mind that you can always send the people you've scheduled away if it turns out you don't need them, advises Nicole Zickler, a Seattle mom. "You don't know what will happen in delivery," says Zickler. "We prepared as if we would need a lot of help, telling the people we asked to come that we might end up sending them home."

Her daughter's birth went smoothly, but Zickler says she was glad to have her mom and dad with her, regardless. "During the first week, my mom would ask, 'Are you ready for me to go?,' and I'd say, 'No, please don't ever leave me!'" Zickler admits she was especially lucky when it came to her parents being there: Her mother had had four children and is a nurse, and her dad is an emergency-room physician. Perhaps more important, she says, both of her parents are instinctive caregivers, nurturing but not overprotective, and intuitive about what needs to be done. "She would make the beds and do the laundry and answer the phone without my even being aware of it," says Zickler.

In fact, the intensity of household needs during the first few weeks can often turn family and friends -- even ones who may drive you a little crazy ordinarily -- into tremendous helpers. Moms and mothers-in-law have been through childbirth, and they automatically love the baby, often making them ideal choices. But if that isn't the case or they aren't available, Nicol says it is important for you to to look for caregivers who will keep your interests top of mind. Be certain not to make the easy mistake of allowing people into your home whom you typically have to care for or entertain.

Friends with whom you are especially close may be the best choice, even if they have little baby experience, since you'll feel more comfortable telling them how you feel, and they'll instinctively know more of what you need without your asking. Besides, from walking the now-ignored dog to putting a meal on the table or picking up duplicate photos, there is definitely more than enough non-baby-related work to be done.

If there is no one near you or available whom you feel comfortable asking for in-home postpartum help, be aggressive about hiring the assistance you think you'll need. Many birthing centers, nursing agencies, and hospitals can now refer women to baby nurses or postpartum doulas. Baby nurses (who are not usually medical nurses) can live in and are available, in shifts, up to 24 hours a day. They specialize in newborn care and allow a new mother to sleep.

Postpartum doulas focus on making sure a new mom is comfortable caring for her baby, all the while emphasizing mother care. Both are expensive -- nurses from $20 to $30 an hour and postpartum doulas from $10 to $40 an hour -- but are worth saving up for if this is the type of help you'll need. Leah McNeill, a new mom, midwife, and part owner of the Puget Sound Midwives and Birth Center, in Kirkland, Washington, opted for doula help after the birth of her son, Eric, to cover the times when her mother couldn't be there. McNeill says she used her doula nearly every day in the beginning, then three times a week for a few hours in the afternoon and evening. "I'm a single mom," explains McNeill, "and having her around let me take a nap or a shower."

Making Lists

When planning for postpartum help or directing it after birth, you should be clear about just how often you need help, what kind of help you need, and exactly how you want it delivered. Before her son, Lance, was born, Seattle mom Molly Haugen says she prepared as if she were going out of town and someone would be house-sitting. She made maps for her visiting mother -- marking where the pharmacy and grocery store were located -- pre-paid her bills, made notes of when the garbage would be collected, wrote directions on how to check the answering-machine messages, and made a list of people to call after the birth. Her prep work kept her from having to direct her mother and husband.

This kind of list and direction making can also save you from the ever-present temptation to just do it yourself, or redo it yourself. If you have to have softener in the laundry or glasses on the top rack of the dishwasher, go ahead and spell this out on your lists or put appropriate notes on appliances. Not only will you save yourself hassles and irritation during your postpartum period, but you'll be better prepared for the years to come, when you have to tell babysitters the same things. Once you are home from the hospital, start a running list of things you need done. This way you or your caregivers will be able to easily delegate tasks when people call to ask if they can help.

And people will call. Like most new parents, my husband and I were amazed at how much help was offered upon the birth of a new baby -- some from people we knew only in passing -- and how surprisingly natural it felt to accept it. Although not particularly private people, we certainly never envisioned having friends come into our bedroom in the morning and take our baby, letting us fall back to sleep while they watched her and made breakfast. And yet the memories of this kind of help -- as well as the meals on the doorstep and the neighbor whose gift was to come once a week for a month to let me take a walk -- are some of our most precious, not just for the genuine assistance that it provided but for making us feel so welcome in the new community of parenthood.

Barbara Rowley, who lives in Big Sky, Montana, is a mother and freelance writer.

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