The dreaming starts the moment your pregnancy is confirmed: you'll enjoy nine months of carefree eating and your libido will go into overdrive; your birth will come off exactly as you outlined in your birth plan, right down to your partner in tears as he cuts the cord; you will bond with your newborn instantly, the very moment she arrives; breastfeeding will feel completely natural and comfortable and result in a cherubic and healthy baby; and finally, the relationship between you and your partner will rise to new heights as you work together to raise a happy, healthy child.
With a lot of luck, all of these dreams may come true. But, for many of us, our hopes of a perfect pregnancy and easy early parenting hit a wall called "reality check" at one point or another.
Mom is nauseated for most of her pregnancy and would rather die than have sex, for example, or her blood pressure spikes and she finds herself on bed rest for the last two months. Or, that long-planned natural birth suddenly and frighteningly turns into a Cesarean section. It could be the baby has trouble latching on, turning breastfeeding into a painful and frustrating experience for the new mother. And that new bloom you expected to grow on your relationship? It dries up quickly as lack of sleep and fatigue take their physical and emotional toll on both partners.
What's a parent to do when ideal meets reality? Below are some insights and resources to make the decisions and transitions of parenting a little easier – or at the very least assure you that you are not alone and not going crazy as you navigate the joys and challenges of a new baby.
Ideal: Your family practice doctor, who has cared for you since you were born will deliver your baby.
Reality: Your family practice doctor may not do obstetrics due to the high cost of malpractice insurance these days or you may find you want to explore all of your options from delivery at home to a hospital birth. Family practice doctors, obstetricians and certified nurse midwives all deliver babies in hospitals in Washington, and licensed midwives, who deliver babies at home or at a freestanding birth center, abound in the region thanks to stellar midwifery training programs in King County.
- To find an obstetrician or family doctor, go to the Web sites of hospitals you are considering for your baby's birth and use the doctor search tools provided there. Or check out community reviews on Yelp.com.
- Certified Nurse Midwives (CNMs) deliver at Group Health Central, Swedish Ballard, University of Washington Medical Center, Evergreen Hospital, and Valley Medical Center. A handful provide both home and hospital care. To find a certified nurse midwife for a hospital delivery, go to the Washington Midwives Association at www.washingtonmidwives.org.
- To find a licensed midwife (LM) for a home or freestanding birth center birth, go to the Midwives Association of Washing-ton State at www.washingtonmidwives.org.
- Book: Great Starts Guide to Hospitals, Birth Centers and Home Birth Midwives in King County, produced by Great Starts, a program of Parent Trust. Download the guide using this URL: www.parenttrust.org/uploads/pdf/Web- store/GreatStarts%20Guide.pdf.
Ideal: You draw up your perfect birth plan with your partner and it works out just the way you planned it from the first contraction to the last.
Reality: Very few births go exactly as planned. Even the most ardent hope of birthing at home can turn quite unexpectedly into a hospital birth. Suddenly the dream of a vaginal birth must give way a necessary C-section.
Writing a birth plan—a one- to two-page document outlining for your providers how you want things to go from the first stages of labor to after baby is born—is an important way make sure you and your providers are on the same page and to make you an active partner in your care. Writing down the things you feel strongly about and the things you are more flexible on will help you and your providers achieve as close to the birth experience you wanted as possible. So, explore your options, write your plan, believe in it, make sure your provider supports it and then leave some wiggle room for both you and your provider if there is a medical or other need for changes in your plan.
You will increase your chances of the birth experience you want by working with a provider you trust to support your ideal, whether you dream of going completely natural or want an epidural once labor starts. Consider hiring a birth doula to provide sup- port and advocacy during your birth. Doulas work in all birth settings, using hands-on comfort measures, nurturing assurance and clarifying information to help you make informed decisions. Fees range between $500 and $1,500 depending on a doula's experience, and many provide pro bono care for those in need.
Resources: To use new interactive birth plan tools and find a doula for your family, check out:
- Interactive Birth Plans are available online. Just go to the site, fill in what you'd like in your plan and print:
- Pregnancy Today: www.birthplan.com/ birthplanner.php
- Childbirth.org: www.childbirth.org/inter- active/ibirthplan.html
- PALS Doulas: To find a certified doula in the region, call PALS at 206-325-1419 or go online to www.pals-doulas.org.
- DoulaMatch.net: Go online to find and compare local doulas available for your due date at www.doulamatch.net.
- Book: The Birth Partner, by Penny Sim- kin, PT, CD, $16.95. This book is intended to help the partner of the woman giving birth (baby's father, doula or loved one) prepare to support the woman. It may be purchased on Amazon or at Simkin's site: www.pennysim- kin.com/products.htm.
Ideal: Your birth will be an amazing and joyous experience from start to finish.
Reality: Unfortunately, births can sometimes be upsetting. While you hope this won't happen to you, it's good to know about resources to help you deal with a traumatic labor and delivery experience.
What is a traumatic birth? Well, it's different for every woman depending on what happened during her pregnancy, labor and delivery. Multiple factors include loss of control, loss of dignity, hostile medical providers, stress caused by family and others in the birthing suite, surgery, or unexpected and unwanted interventions. And when a woman feels she is not being heard or is not given the opportunity to give truly informed consent for medical procedures, she can feel traumatized. Additionally, for victims of sexual or emotional abuse, birth can be either liberating or traumatic. According to research done by local birth expert Penny Simkin, and others, few women ever forget their birth experience. A traumatic past experience or a traumatic birth can lead to long-term distress and anxiety.
Several therapists in the region now specialize in counseling women and partners through pregnancy and birth-related issues.
- To locate a therapist who specializes in birth trauma, miscarriage, neonatal loss, infertility, postpartum mental disorders, or preparing abuse survivors for birth go to Transitions to Parenthood at: www.transitiontoparenthood.com/ttp/resources/ Therapists.htm.
- Book: When Survivors Give Birth: Under- standing and Healing the Effects of Early Sexual Abuse on the Childbearing Woman by Penny Simkin, PT, CD, $32.95. It may be purchased on Amazon or at Simkin's site: www.pennysimkin.com/products.htm.
Ideal: Breastfeeding comes naturally.
Reality: Breastfeeding is a learning process for both mom and baby, and it takes time and patience to get it just right. A bad habit, like a poor latch, is very hard to break, causing pain for mom and frustration for both mom and baby. For breastfeeding success, get adequate support from day one. Attend breastfeeding classes before baby arrives and take the time now to check out the number and whereabouts of your local La Leche League breastfeeding support group. Make an appointment with a lactation consultant within the first few days of nursing. If you are in the hospital, get a lactation consultation – if they don't offer one, ask for one. If you are at home, you can get support from a private practice consultant (average cost between $50 and $80 per visit.) Some pediatric clinics in the area also offer breastfeeding support.
- To find a lactation consultant go to the directory at Breastfeeding.com, www. breastfeeding.com/directory/states/washington.html.
- Le Leche League Support Groups meet in King County. To find one near you, go to www.lllusa.org/WA/default.html or call 206-949-3076.
- Birth and Beyond: Call the breastfeeding hotline for support on the phone or set up a clinic or home visit with a lactation consultant. Birth and Beyond also offers a breastfeeding drop-in group help on Fridays from 11 a.m. to 12:30 p.m. and a Breastfeeding and Back to Work class. Go to www.birthandbeyond.com or call 206- 324-4831.
- Public Health-Seattle & King County offers a useful list of breastfeeding sup- port resources and contacts. Go to www.kingcounty.gov/healthservices/health/personal/breastfeeding/resources.aspx
- Your hospital also is likely to have a breastfeeding hotline, so be sure you get the number before you are discharged.
- Book: The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-Solution Guide to Breastfeeding from the Foremost Expert in North America by Jack Newman, M.D. and Teresa Pitman, $15. www.randomhouse.com/catalog/display.pperl?isbn=9780307345585.
Ideal: Your relationship with your partner will stay exactly as it was before baby.
Reality: That's possible. But the truth is a new baby puts pressure on even the best relationship. Pure exhaustion and constant worry about all the responsibilities of parenting take their toll – in fact, according to researcher Dr. John Gottman, 70 percent of couples experience profound stress, conflict and a decline in marital satisfaction during the first years of parenting.
What's the best thing you can do to buck the trend? First, be ready to cut your co-parent a lot of slack and remember that you are the best parents your baby ever had. Second, prepare yourself. You and your partner (and your baby) need each other to get through this early parenting phase with your sanity intact. Well before baby comes, read books that offer a realistic look at the impacts of new parenting on a couple. Sign up to attend local workshops focused on nurturing your relationship through what can be a very trying time. Make a plan with your partner about how you will deal with common concerns and pitfalls when they occur, write it down and refer to it when things come up.
- Bringing Baby Home is a workshop that walks expectant parents through the many challenges of new parenting while providing useful constructs for understanding your partner's experience. It also offers tools for mitigating the hard spots and keeping intimacy and romance alive. For a class near you, go to www.bbhonline.org.
- Book: And Baby Makes Three, by John Gottman, Ph.D. and Julie Schwartz Gottman, Ph.D., $9.93. www.gottman.com/51165/558683/Bringing-Baby-Home/ And-Baby-Makes-Three.html.
Ideal: Your mother in Missouri and your FWCs (friends without children) will provide all the support you need as a new parent.
Reality: The truth is some friends without kids will fall out of your life completely, and distant family won't be able to provide you the regular assurance you need that your baby is developing just fine and that what you are experiencing – the tiredness, the lack of sex, the body changes and the change in identity from working woman to leaking mom – is absolutely normal. So, no better time than a new baby to start creating community for your new family – new friends, seasoned parents and child development experts – who support your parenting journey, give you ideas and help you flesh out your own. A support group for new parents is a great place to start. Groups are available for just moms, just dads or for couples.
- Becoming Parents – This program for couples having a first child offers 21 hours of classes during pregnancy, with three-hour "booster sessions" when the baby is 3 to 6 weeks old and 6 months old. For more information: 206-427-7848; firstname.lastname@example.org. www.becomingparents.com.
- Community colleges offer group activities, playtimes and parent education programs for those with children from birth through age 5. Contact your local college to find out what is available in your area.
- Conscious Fathering – Offered at various locations in King County, this popular program provides basic infant-care skills and encouragement to men on the eve of fatherhood. For further information, locations and times, contact Bernie Dorsey, founder and program coordinator, Conscious Fathering Program, Parent Trust for Washington Children. 206-233-0156, ext. 227; email@example.com. www.consciousfathering.org.
- Eastside Mothers of Multiples – This support group for parents of twins and other multiples on the Eastside offers monthly meetings, playgroups and family events, and a special monthly meeting for expecting and first-year parents. 425-825-8139; firstname.lastname@example.org. www.emoms.org/default.aspx.
- First Weeks class is held twice a week for new parents and their babies. It provides opportunities to discuss breastfeeding, sleeping patterns, and other issues with Ann Keppler, RN, MN and co-author of Pregnancy, Childbirth, and the Newborn. At this class you will get a chance to share your joys and concerns with other parents of young babies. Drop-in groups are held Tuesdays and Wednesdays, noon to 2:00 p.m. at Birth and Beyond for parents and their babies under 12 weeks of age. The cost is $10 per meeting. Go to www.birthandbeyond.com/ firstweeks.html.
- Listening Mothers offers support groups to new parents, led by professional therapists with a focus on the emotional experience of the early parent-child relationship. Go to www.mindfulparentscommunity.com/ calendar/listeningmothers/.
- Mom2Mom – New moms are matched with a volunteer peer mentor, and meet one-on-one about four to six times over the first few months after their baby is born. It's best to sign up in third trimester of pregnancy. The program is free and open to all. It is sponsored by Jewish Family Services and the Jewish Community Center. For information, contact Margie Schnyder at 206-861- 3146 or email@example.com. www.jfsseattle.org.
- North Seattle Families of Multiples – This group meets the second Tuesday of the month at 7:30 p.m. at Olympic View Elementary, 504 N.E. 95th St., Seattle. 206-781-1552.
- Postpartum Support International of Washington offers various free support groups throughout the area. www.ppmdsupport.com.
- Program for Early Parent Support (PEPS) brings together "Newborn Groups" of 10 to 12 parents and their babies. The groups begin when babies are under 4 months and meet once a week for three months with a volunteer leader. PEPS also offers Baby Peppers for parents of babies 5 to 12 months old, and Little Peppers for families with two children under age 3. Go to www.pepsgroup.org.
Ideal: You're a happy person, and you will be so thrilled with the new baby in your life there is no way you are going to be depressed after baby arrives.
Reality: One in 10 moms and 10 percent of all dads and partners experience postpartum depression (PPD) or the more dangerous form of this, postpartum psychosis. PPD is more than just the "baby blues," the common episodes of sadness or anxiety in the first two weeks after birth, that about 14 percent of moms experience as hormones return to normal levels and breastfeeding is established.
Know the signs of PPD. If any of these symptoms during and after pregnancy last longer than two weeks, they are signs of depression and you should speak to your provider: feeling restless or irritable; feeling sad, hopeless and overwhelmed; crying a lot; having no energy or motivation; eating too little or too much; sleeping too little or too much; trouble focusing, remembering or making decisions; feeling worthlessness and guilt; loss of interest or pleasure in activities; withdrawal from friends and family; having headaches, chest pains, palpitations or fast and shallow breathing.
- For support call Postpartum Support International at 1-888-404-7763.
- Book: Beyond The Birth: What No One Ever Talks About is a short booklet that describes the emotional transitions to motherhood, and the difference between "baby blues" and more serious Postpartum Mood Disorders. It discusses causes, risk factors and treatment options in easy-to-understand terms, and features a list of resources and further reading; $6.50. To order go to www.ppmdsupport.com/publications.html.
Cheryl Murfin is a Seattle freelance writer, a certified doula and owner of NestingInstincts.com doula services.