Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

CHAPTER 19. Managing as parents

You’ve made it home from the hospital. The car seat probably seemed enormous, but you got your little one tucked in and buckled up. The drive home was slow and careful, savoring your baby’s first entrance into the new and big outside world. You’ve arrived in your own home and the waiting is finally over. Your baby is here. So now what?

For some new parents, along with the joy and elation of bringing home a first baby, comes the further realization that this baby is solely in your care. This may come as a bit of a shock, but rest assured that feeling anxious or nervous about your new responsibilities is completely normal. Unless you’ve taken care of an infant in the past, being around a young child so reliant on you may be a new experience. Truly, you wonder, how do I go about this business of parenting?

The transition to parenthood, as experts like to call it, is one of the biggest changes to take place in a person’s life cycle. Bringing a newborn into the family has a way of producing profound alterations in the way you live, the way you look at the world and in how you relate to others. Becoming a parent is a transition so profound, in fact, that it often requires you to develop new dimensions to your identity to accommodate the transition.

EARLY SURVIVAL TIPS

Don’t be surprised if the first few weeks, or even months, with your newborn are full of chaos. During pregnancy, and even in the hospital, it’s easy to imagine your blissfully content family sitting down for a wonderful home-prepared meal while everyone laughs and coos at the baby. Unfortunately, reality more frequently plays out to the tune of bags of fast food wolfed down while you and your partner take turns trying to figure out why your baby is unhappy at the moment, amid a clutter of diapers and wipes and blankets and burp cloths. Add a big dose of sleep deprivation to the situation, and it’s quickly apparent that all may not go as you may have planned. And by the way, why didn’t anyone tell you it would be this hard?

Tackling transitional stress Now that you’ve been warned — transitioning to parenthood is stressful — consider these suggestions for easing the transition and making life a little simpler for all parties involved, including baby:

 Reach out to friends and family. OK, so you don’t necessarily want your mother-in-law to move in and set up shop, but it does help to remain open-minded to accepting help from others. Family members and friends can perform important household functions — such as cooking a meal, loading the dishwasher, doing laundry, taking the dog for a walk — that may allow you and your partner to get some rest, spend time with the baby or with each other. It’s OK to set limits on outer sources of help, but it’s OK to accept help, too.

 Keep your strength up. You’re less help to your baby and the rest of your family if you’re not good to yourself. That means eating right, exercising regularly and taking time to relax. Make sleep a priority. Lack of sleep is cumulative, and constant fatigue can be a trigger for depression.

 Protect your time. If you feel overwhelmed, eliminate activities that aren’t absolutely necessary. Just because the gutters don’t get cleaned or the lawn mowed right now doesn’t mean you won’t ever do it again. Your days will eventually fall into a more routine schedule. But for the first few weeks or months after the baby is born, you can reserve the right to say no to certain tasks or events.

 Get back to basics. It may be more difficult to cope with everyday demands while you’re adjusting to a life change, such as parenting a newborn. Keep things simple by working on one task at a time. Make bathing the baby the main event for the afternoon and proclaim the day a productive one.

 Practice forgiveness. No parent is perfect, and no new parent is going to get everything right on day one. Try to be more tolerant of yourself and of your partner. Successful parenting takes practice, which means making mistakes and moving on to the next strategy. Be realistic with your expectations of how you should feel or not feel. It’s normal to feel uncomfortable or disoriented during a transition period. Some days will always be better than others.

 Accept change as a constant. Certainly this is true when it comes to newborns. If a pacifier works today, it may not work tomorrow. And the swaddling technique you’ve worked so hard to master may become completely unnecessary the moment you’ve finally perfected it. Resiliency, the ability to adapt to changes and overcome obstacles, is key here. In general, people who can roll with the punches generally come out of transitions more successfully than those who refuse to be flexible.

 Maintain a sense of humor. Babies can make you do things you’ve never dreamed of before, like cleaning poop off of your hands or walking around smelling like spit-up. The ability to find humor in yourself and your circumstances can play a key role in helping you adapt to your new role. Laughter in itself relieves tension and relaxes your muscles as well as your mind.

Getting enough sleep The premium placed on sleep generally skyrockets in every newborn’s household. While newborns can sleep up to 16 or 17 hours a day, they usually do it in spurts of a few hours at a time. And sometimes it may feel as if all the baby’s sleep is taking place during the day and none of it at night. And where does that leave you? Exhausted. But take hope. Babies’ sleep patterns evolve rapidly during the first few months, and eventually your baby will consistently sleep for longer stretches at night, allowing you to get more sleep, too.

Volumes have been written on how to get infants to sleep at night, and many experts have important and helpful advice to share. But your baby is unique, and so are you as parents. So try different strategies, but don’t be too disappointed if a particular method doesn’t work out exactly as planned. Eventually, you will find a schedule that works for you and your baby. In the meantime, some of these suggestions may help:

 Sleep (or just relax) when you can. Turn off the ringer on the phone, hide the laundry basket and ignore the dishes in the kitchen sink. Your chores can wait. But try to make sure it’s quality sleep — in other words, don’t sleep on the couch in the midst of household traffic. Aim for a dark, quiet spot with a comfortable surface to stretch out on.

 Don’t nap if it makes you feel worse. Some evidence indicates that daytime napping or dozing is less likely to relieve fatigue, a more severe form of tiredness experienced by many new parents, than is getting a few hours of solid, undisturbed sleep. If you prefer not to nap while your baby naps, it may be more helpful to catch up on some must-do items, so you can use nighttime hours for sleep rather than other tasks.

 Set aside your social graces. When friends and loved ones visit, don’t offer to be the host. Let them care for the baby while you excuse yourself for some much needed rest or personal time (even if it’s just to take a shower).

 Don’t share a bed during sleep. It’s OK to bring your baby into your bed for nursing or comforting — but return your baby to the crib or bassinet when you’re ready to go back to sleep.

 Share nighttime duties. Work out a schedule with your partner that allows both of you to rest and care for the baby. If you’re breast-feeding, perhaps your partner can bring you the baby and handle nighttime diaper changes. If you’re using a bottle, take turns feeding the baby.

 Postpone the inevitable. Sometimes, middle-of-the-night fussing or crying is simply a sign that your baby is settling down. Unless you suspect that your baby is hungry or uncomfortable, it’s OK to wait a few minutes to see what happens.

WHEN SLEEP BECOMES A STRUGGLE

Sometimes, you may feel so weary that sleep eludes you, and you’re unable to relax. If you have trouble falling asleep, make sure your environment is suited for sleep. Turn off the TV and keep the room cool and dark. Avoid sleep-killers such as nicotine, caffeine and alcohol because they can disturb your sleep cycle, making your rest incomplete. Don’t agonize over falling asleep, though. If you don’t nod off within 30 minutes, get up and do something else that you know will help you relax, such as read a book, sip a cup of decaf tea or listen to soft music.

Negotiating household chores By now, you’ve probably gotten the message that once your baby arrives, attending to household chores may need to give way to more important matters such as tending to your baby’s needs and getting some sleep.

It’s not always easy to let these things go, however. Closing your eyes to your surroundings offers temporary relief but doesn’t solve the problem. In addition, maintaining some control over your environment can be helpful when you don’t necessarily feel a comfortable grasp on other aspects of your life, such as breastfeeding or managing a colicky baby. To help you cope with basic household tasks, think about these tips:

 Embrace the chaos. Often, part of becoming a parent means more stuff, more clutter, more chaos around the house. And while there are a variety of ways of sorting, storing and organizing the paraphernalia that accompany children, it’s usually going to be more in quantity and messier in quality than what you’ve had prior to becoming a parent.

 Refresh your household organizational chart. Divisions of labor between you and your partner that may have worked before may need to be revisited as a result of new responsibilities. For example, if one partner is taking on more infant care duties, the other can step in to fill any gaps, such as making dinner or doing the laundry. If you and your partner are able to establish clear expectations and a goal of working as a team, there’s likely to be less resentment on either side about who does what when it comes to household chores.

 Get help. If friends or loved ones offer to help with household chores, accept it. It leaves you with a few less tasks to accomplish. If this type of help isn’t available and you’re overwhelmed by other duties, you might consider hiring a cleaning company or a handyman to help you. Many parents attest that this is money well spent.

Paying for baby Raising a child can be one of the biggest financial investments you’ll ever make. The U.S. Department of Agriculture (USDA) estimates that the cost of raising a child from birth through the age of 17 in a middle-income husband-and-wife family with two children is close to a quarter of a million dollars, or $222,360. And this doesn’t even include college.

Still, you don’t have to be a millionaire to raise a family. There are ways to trim this number and get around assumptions made by the USDA. Following are the main spending categories measured by the USDA and tips for saving in each.

Housing Housing accounts for the biggest expense in raising a child, about 30 percent. The USDA includes in its estimate the average cost of an additional bedroom for each additional child, either by moving to a bigger house or renovating. For some families, additional space is a necessity, but you can also get around this cost if you’re able to maximize the space you already have.

Child care and education This is the next biggest cost, but not every family carries this expense. If one parent stays at home to care for the kids, there are no child-care expenses (except for the income that parent may lose to stay at home, but this isn’t counted in the USDA estimate). Also, education in public schools is less expensive than is private tuition.

Food Food costs are the third largest expenditure. If you’re not breast-feeding, food costs can begin to accumulate early. However, it’s only a matter of months before your baby needs more than just breast milk to thrive. One way to cut costs on formula, baby food, cereals and other bulk items is to join a warehouse club such as Costco, Sam’s Club or BJ’s. And if you can’t use up all the items yourself, or you don’t have the storage space, consider starting a co-op with friends to divide up the goods. Shopping online for bargains may be another way to trim your food expenses.

Transportation Transportation comes next in the lineup of expenses, and it includes monthly car payments and down payments, car insurance, fuel, repairs and public transportation. This expense is on a lot of new parents’ minds as they consider the kind of vehicle they want for transporting their new little one. Keep in mind that while new cars are great, their value drops considerably once you drive them off the sales lot. To save money, consider buying a gently used car, maybe one that’s just been returned from a lease and still has some of its warranty left. Also, shop around for an auto insurance policy to find the best rate.

Health care This cost includes medical and dental expenses not covered by insurance, and health insurance premiums not paid by an employer. If you purchase your own health insurance, covering your family’s premiums can be a substantial cost. Shop around to compare different plans and to find a reasonable rate. You might consider finding an insurance agent who can help you find the best plan for your budget and circumstances. Health insurance premiums that you pay for yourself are also tax-deductible.

Clothing When you have your first baby, it can be hard to resist all those cute baby clothes in the shopping malls. But this budget item represents another opportunity for savings. Many parents are happy to give away clothing that their children have outgrown, and with any luck, your baby will be six to 12 months behind the fashionable toddler next door. Consignment shops, outlet stores and end-of-season sales offer additional ways to cut clothing costs. Warehouse clubs and online grocery stores frequently offer discount prices on items such as diapers and wipes.

Miscellaneous This category includes personal care items, such as toothbrushes and haircuts, and toys and entertainment. As your little one grows, this category will consume a greater share of your income.

PARENTING AS A TEAM

What sort of impact does a baby have on a couple? A pretty big one, as it turns out. Up until your baby’s birth, you and your partner may have enjoyed a very equitable relationship, perhaps with dual careers, a healthy work and home-life balance, and a relationship of sexual equals. If you’re not consciously prepared for your new roles as parents (and who is, really?), you may be surprised when a new baby upsets the harmonious precedent you’ve set.

Marital relationships often suffer following the arrival of a newborn, in part because roles are suddenly unclear and work and home life expectations become unbalanced. Frequently, couples will revert, even if unintentionally, to more traditional divisions of labor, with the wife taking on most of the household maintenance and child care and the husband becoming a more distant caregiver.

In essence, new parents tend to emulate their own parents because their parents are their role models, and this is what they know. But in an era of modern expectations, resentment and conflict can quickly brew, spilling over into all areas of the marriage.

In addition, disagreements that may have lived primarily in the background — about life goals, for example, or how to handle finances and other family affairs — may now be brought to the forefront. Couples also tend to spend less time together after the baby arrives, and both are likely to be sleep-deprived, setting frayed nerves even further on edge.

Still, the arrival of your newborn doesn’t have to be followed by lasting marital conflict. Keeping a clear-eyed view of the challenges that lie ahead can help you stay alert to negative attitudes that can corrode a relationship, yet optimistic about developing complementary new roles together as parents. In the end, you may be surprised at the strengths you and your partner uncover.

Common feelings after childbirth An extensive review of parenthood experiences during the child’s first year by two Swedish authors revealed an overarching theme for both mothers and fathers of “living in a new and overwhelming world.” Efforts to reorganize the family structure and adapt each person’s role to new needs constituted a significant, often stressful challenge.

Both mothers and fathers expressed a range of emotions, some similar to each other and some different.

Common feelings expressed by mothers include:

 Amazement and enjoyment

 Complete love for the child

 Unpreparedness

 Powerlessness and inadequacy as a mother

 Constraint because of the needs of the infant

 Loss of a previous lifestyle

 Disappointment

 Frustration with lack of personal time

 Resentment of their partners who don’t seem as tied down by the baby as they are

 Loss of identity, confidence and self-esteem

 Fatigue and being drained of energy

Common feelings expressed by fathers include:

 Increased responsibility for child care

 Deep engagement and attachment to the child

 Sense of closeness as a family

 Strain due to new demands

 Confusion resulting from lack of guidelines or role models

 Fear of being isolated or left out

 Wanting to help but not always feeling welcome

 A strong need to protect and provide

 Fatigue

 Frustration with lack of personal time

The importance of support As you can see, it’s not unusual to have mixed feelings while adapting to your new role as a parent. But when a parent perceives a high level of support for his or her role, it tends to have a positive influence on the parent’s feelings. For example, in the Swedish review, parents who reported satisfaction and confidence in their roles also reported feelings of mutual solidarity with their partners.

Another study sought to identify factors that might predict how well a couple could weather the stress of first-time parenthood. Couples who did well and were supportive of each other as parents had realistic expectations of both marriage and parenthood. In other words, they knew that marriage could be difficult and required maintenance — especially in times of transition — and they also didn’t expect the birth of a child to significantly improve their own personal well-being.

Knowing that the road ahead might be a bit bumpy seemed to better prepare them for the transition to parenthood. Partners who had unrealistic expectations after the baby’s arrival tended to be less supportive of the other’s parenting style, perhaps because they unwittingly blamed their spouses for their unfulfilled hopes.

Setting the tone Parents’ marital satisfaction is closely linked to the parenting experience. For example, a new mother who is overloaded with the new responsibilities and tasks of caring for a baby is likely to filter that stress down to her marriage. If she invests herself in the baby at the expense of her husband, he may begin to feel left out and less satisfied with the marriage. Interestingly, some research suggests that fathers who are dissatisfied with their marriages show less affection to their daughters (although not to their sons) than fathers who are satisfied with their marriages.

On the other hand, the more a father is involved in caring for the baby, the more marital satisfaction the mother feels. Husbands, in turn, are more involved in infant care when wives feel more autonomous and allow their husbands to share in child-care duties — even if a husband’s methods differ from his wife’s. Also, the more mothers and fathers are able to control their impulses and channel and release frustrations appropriately, the more playful and connected they feel toward their child.

A marriage also sets the tone for the rest of the family. When parents engage each other with respect and mutual appreciation, are attentive to their marriage and are sensitive to sharing the tasks of parenthood, they create an optimal environment for a child to grow up into a mature, confident and responsible adult.

In general, a couple who was satisfied with their marriage before the baby’s birth is more likely to have a higher level of marital satisfaction after the baby’s arrival than a couple who wasn’t satisfied prior to baby’s birth.

WHAT MAKES A STRONG, HEALTHY FAMILY?

In a comprehensive report on the family, the American Academy of Pediatrics identified several characteristics shared by successful families, regardless of their structure. According to the report, successful families are:

 Enduring

 Cohesive

 Affectionate

 Mutually appreciative

 Committed to each other

 Communicative

 Resilient

 Committed to a common faith

FINDING TIME FOR YOURSELF AND EACH OTHER

Part of the stress involved in early parenting comes from the nearly constant demand placed on your energy and resources. Burning yourself out, however, is no way to be a good parent or a good partner. It’s important to regularly take time to recharge your personal batteries and to invest in your relationship with your partner.

Getting away on your own It’s not always easy to get away from your new parent duties, but one way to do this is to swap brief interludes of personal time with your partner. Allowing your partner some time off, even if begrudgingly at first, can help your partner refresh his or her reserves and come back feeling renewed and ready to get back in the fray. Getaways don’t have to be long; in fact, you may not even need to leave the house. Here are some suggestions to get you inspired:

 Get dressed and go out for a cup of coffee or tea. It’ll make you feel like a regular adult again.

 Take a walk at a nearby park. Nature has a way of soothing away stress.

 Ask your partner to take the baby out so you can have the house to yourself.

 Make a quick trip to your local driving range or gym. If it’s something you enjoy, it might help release some stress.

 If you like to cook and it relaxes you, ask your partner to watch the baby while you prepare a favorite meal.

 Stake out a remote corner of the house and do some stretches or deep breathing.

The important thing is to have a few minutes all to yourself so you can relax and regroup.

Getting away together It takes time and effort to invest in your marriage, but it’s worth it, both for you and your child. You don’t have to book a trip to Tahiti to renew your relationship, but find something to do together that you enjoyed previously and that you share a common bond over, something you can both laugh or talk about easily.

This can be as simple as recording your favorite TV show and watching it together at an opportune moment. Or sitting outside together for a few moments after the baby’s been fed and put down to sleep, even if it is late at night. If you do want to get out of the house, most grandparents are more than willing to watch their new grandchild for a few hours. If grandparents aren’t available, ask a family member or friend, who most likely will be glad to help out.

Sex after pregnancy Sex does occur after pregnancy. While sex may not be foremost on your mind at the present time, in time it will become important again.

For one thing, it takes time for a woman’s body to heal after giving birth, whether your baby was delivered vaginally or by C-section. Many care providers recommend waiting four to six weeks before having sex. This allows time for the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal.

The other important timeline is your own. Some women feel ready to resume sex within a few weeks of giving birth, while others need a few months — or even longer. Factors such as fatigue, postpartum blues and changes in body image all can take a toll on a woman’s sex drive.

Caring for a newborn is exhausting. If you’re too tired to have sex at bedtime, say so. This doesn’t mean your sex life has to end, however. Consider making love early in the morning or while your baby naps.

And don’t forget there’s more to an intimate relationship than sex, especially when you’re adjusting to life with a new baby. If you’re not feeling sexy or you’re afraid sex will hurt, share your concerns with your partner. Until you’re ready, you can maintain intimacy in other ways. Most couples are ready to resume sexual intercourse six months after childbirth.

When you are ready to have sex again, take it slow. Due to hormonal changes, the woman’s vagina may be dry and tender, especially if she’s breast-feeding. Start with cuddling, kissing or massaging. Gradually build the intensity of stimulation. If vaginal dryness is a problem, use a lubricating cream or gel. Try different positions to take pressure off any sore areas and control penetration. Tell your partner what feels good — and what doesn’t.

If sex continues to be painful, talk to your care provider. Low doses of estrogen cream applied to the vagina can help, but the estrogen could possibly decrease your milk production if you’re breast-feeding. Ask your care provider to help you weigh the pros and cons.

SINGLE PARENTHOOD

If you’re a single parent, you’re likely to face many of the same challenges as any other new parent, married or otherwise. In fact, many of the sections discussed earlier in the chapter may apply just as well to single parents as to married ones. But parenting a newborn on your own presents its own set of challenges, not the least of which is the fact that nearly all parenting responsibilities rest ultimately on the physical, mental, emotional and financial resources of one person, you.

The literature is often unclear when it comes to the odds of successfully parenting a child on your own. But this may have more to do with the circumstances that often, but not always, surround a single parent — such as poverty, divorce, a mistimed pregnancy — rather than the parent himself or herself. Many children, both young and old, can attest to the monumental love and support provided to them by a parent who happened to be single. If circumstances are difficult and a parent succeeds in creating a positive family experience, it only attests to the incredible resilience of the parent in the face of intense obstacles.

To cope with some of the particular challenges of single parenthood, consider the following suggestions:

 Gather support. Support for your role as a parent is critical as you navigate the ups and downs of learning how to be a parent. This may mean cultivating and drawing on sources of support such as the baby’s grandparents, aunts and uncles, friends, a religious or spiritual community, or a network of other parents in a similar situation.

 Seek out good child care. Most single parents are also working parents, so finding child care that promotes your child’s well-being and accommodates your schedule is critical. Get recommendations from family, friends and other parents. Visit the location and talk to the person who will supervise your child’s care before committing.

 Provide worthy role models. As your child grows, it’s helpful to have role models of both sexes for your child to learn from. Incorporate activities with adults you trust and admire into your child’s life. You are an important role model for your child, as your child sees you succeed both in the workplace and at home.

 Make time for your child. Single parents are often busy managing the demands of work and baby care, and time with your child may not be as much as you’d like. Still, take the opportunity to interact with your baby whenever possible: sing in the car on the way to day care, spend a lazy Saturday morning together perusing (or trying to eat) the newspaper, or take a long walk around a park.

 Make time for yourself. Single parents need breaks, too — perhaps even more so than do couples. Plan dinner and a movie for yourself after the baby has gone to sleep. Find a fitness center that offers baby-sitting services while you work out. Gather the phone numbers of prized baby sitters from your parent friends or take up your mom’s offer to watch the baby while you dine out with a friend or see a movie on your own.

 Be part of a community. Feeling connected to the world around you is important for anyone, but can be especially helpful for a single parent. Get to know your neighbors, join a church or religious community, or connect with groups dedicated to single parents. Being connected to a larger community can also be beneficial if a crisis arises.

HANG IN THERE

Becoming a parent, no matter what your situation, is an intense and life-changing experience. Those first few weeks can be confusing, exhilarating, exhausting and amazing. Learning the ins and outs of successful parenting is an ongoing challenge, even for experienced parents. But as you begin your parenting journey, remember that it’s also likely to be one of the most rewarding aspects of your life.

For all the challenges raising a child brings, it can also bring unimaginable love, raucous fun and deep satisfaction. It’s also very doable, and has been done by millions of others around the world. So read as much as you can, learn as you go and listen to others. Doing these things will help you understand what’s normal and what’s not and when to get help. But most of all, listen to yourself and your child. Taking the time to get to know your baby over the next few months will set the stage for a lifelong relationship of the most intimate sort, a parent-child one.