Author offers plain talk
on postpartum problems

October 25, 2002

PROVIDENCE, R.I. - Depression. Incontinence. Guilt. Stretch marks on your breasts.

Mama never said there would days like these - nor worries like these - after giving birth.

''No one told me to feel depressed is normal; to have aches and pains is normal,'' says Lisa McLeod, 39, a new mother from Providence, R.I. ''It's not all sunshine and roses, being pregnant.''

That's why Sylvia Brown, a descendant of the Browns of Brown University fame who's now living in England, worked with Mary Dowd Struck, vice president for patient care at Women & Infants Hospital, to produce ''The Post-Pregnancy Handbook.'' The authors claim it is ''the only book that tells you what the first year after childbirth is really all about - physically, emotionally and sexually.''

''It's the best-kept secret,'' Brown said in a recent telephone interview from her London home. ''We're just not prepared in any way - in terms of organizing our lives, or in terms of the physical consequences or the emotional consequences.''

Even here in the States, Struck said, ''There's a lot of information out there, but there isn't a book that sort of pulls it all together ... that really connects the emotional and physical together in one place.''

The book is designed as a reference guide, outlining a host of problems and concerns women may face after giving birth and offering potential solutions, including traditional and alternative or complementary treatments. Brown admits it's not light or cheerful reading, and it could add an entire new list of worries for nervous moms-to-be.

''I tell first-time pregnant women not to read it until one or two weeks before the birth because they'll get a little bit rattled,'' she said.

But on the other hand, Brown said, it's better to be prepared rather than to feel like you're all alone in dealing with the issues that many women face after giving birth.

''The point of my book,'' she said, ''is to give a new mother the tools she needs so she can get over these problems and get on with her new baby.''

McLeod is among the new mothers interviewed for this story who said they wish people had given them more information about what to expect.

McLeod thought she was going to love being pregnant. She envisioned it as a happy time, when she'd be pampered by everyone. No one told her she might be horribly depressed instead. But for much of her pregnancy, she said, ''I was very moody. I would cry at the drop of a hat.''

It was so bad, she worried about taking her son, Quenten, now four months old, home from the hospital because she figured she was at risk for severe postpartum depression. Thankfully, she said, that didn't happen.

But looking back, she was surprised no one warned her how much it would hurt when the baby kicked while in her belly, or that she'd need so many tests because hers was considered a ''high-risk pregnancy,'' or that breast feeding isn't nearly as easy as it looks.

''I wish more people would actually tell you the truth (up front),'' McLeod said. ''They don't want to upset you, because you're pregnant, but you're going to go through it anyway.''

Candy Hall, 31, of Providence, wishes someone had warned her that she'd have embarrassing episodes of incontinence, during and after pregnancy. ''That was a huge surprise. I kept thinking there was something wrong.''

And no one told her the back pain could get so bad she had to leave work two weeks before her son, Maison, was born on Sept. 6.

She also didn't expect that afterward she'd become so forgetful, or that she'd get varicose veins so young, or that she'd have stretch marks on her breasts - and not her stomach. ''That was a big surprise,'' she said.

Lisa Guarino, 36, another new mother from Pawtucket, R.I., said she was surprised it took so long to become pregnant in the first place. She also didn't expect morning sickness to last the whole nine months. ''It went from one thing to the next.''

Guarino said she was as prepared as she could be for the emergency C-section she had to undergo when her daughter, Emily, was born April 20. But she didn't realize the surgery could result in intestinal problems that caused her to be readmitted to the hospital the day after she came home.

Fortunately, she said, everything turned out fine. But, she recalled, ''When I went to one of my (postnatal) appointments, I was still feeling sick. ... I was still having gas and getting nauseous. And (the doctor) said, 'Well, I'm glad you're feeling better.' And I'm like, 'But I'm not feeling better.'''

''I knew in my mind everything was fine,'' she said. ''... But I guess I didn't expect to feel the way I felt. I felt sort of sick and just weird.''

Brown said she decided to write the book ''within hours'' of giving birth to her son Adrian, now 9.

She was living overseas at the time, with her former husband, a United Nations official stationed in the war zones of Croatia and Pakistan. She went to Paris to deliver the baby, and realized she had no network of family or friends there to turn to for help and advice.

It was tough, she recalled. ''I had a difficult birth ... and I was in such pain the day after his birth I took 17 showers to relieve the pain.''

She said she was angry at not getting help and information from the medical community and friends, and she was frustrated at not finding any books dedicated to what to expect after giving birth.

''I had read all the pregnancy and childbirth books and had a pretty good idea of what to expect with the baby. ... But no one told me you get hemorrhoids after you have a baby, and I didn't know what to do to make the stitches (from the episitomy) more comfortable.''

She didn't know which of her aches and pains were normal, or what to do about them.

But it wasn't until the birth of her second child, Laure, now 7, that she actually began work on her book - hoping it could provide other women with the type of information she wishes had been available to her.

She started by surveying more than 300 new mothers, and found that 64 percent had bad experiences after giving birth, including medical concerns ranging from back pain to migraines to incontinence.

She was surprised to find that 8 out of 10 women suffered some symptoms of ''the baby blues'' after giving birth. And, she also estimates that many women suffered from undiagnosed cases of postpartum depression that they or their doctors had dismissed as fatigue or feeling overwhelmed.

She also was amazed to see how little attention the medical establishment placed on the ''pelvic floor,'' a network of muscles that supports a woman's genital and digestive organs, which affects everything from incontinence to sexual satisfaction. Her book devotes an entire chapter to ''strengthening the pelvic floor'' through a variety of simple exercises.

The information and tips in the book ''come from all over the place,'' she said, noting that she interviewed nearly 60 medical specialists ''in all areas of maternal health,'' in addition to sorting through the information submitted by the new moms who'd responded to her questionnaire.

The advice ranges from common sense (make sure you rest as much as possible and make time for adult activities to stimulate your brain) to medical treatments, including traditional and alternative medicines, exercises and therapies for everything from stress to recovering from a C-section.

''In my book,'' she said, ''I try to define every possible problem and define what is serious and what you can take care of yourself.''

''It's not a book that's supposed to be read cover to cover,'' she noted. ''It's really a reference book. The idea is to look up whatever problem you might have in the index, and then find out why this is happening and what you can do about it.''

Some of these issues may be mentioned in other pregnancy books, Brown acknowledged. However, she said, while ''most pregnancy books warn you that this might happen, but they don't give you a lot of constructive advice and concrete suggestions. I do give a lot of tips and advice and suggestions.''

Brown initially published the book in France two years ago, and she later teamed with Struck, whom she met through a family friend, to review it for medical accuracy here in the United States before the book was published this past July (St. Martin's Press, $24.95).

''Naturally, women tend to be so focused on the birth itself that they really need extra prodding to think about the rest of their lives,'' Brown said. She said she hopes childbirth educators and medical professionals around the world will do more in the future to educate women about life after the baby is born. ''Women think they're just going to ride off into the sunset, and that's obviously not the case.''

As Struck noted, ''I think people are very surprised by the physical trauma that happens to them during delivery, and they are totally unprepared for it. ... It's all right to feel like you've been in a car accident after you've had a baby.

''You need to recuperate. You need to allow your body to return to normal. ... You need to concentrate on yourself and your baby for the first few months.''

In another new book, ''Becoming a Mother,'' author Gro Nylander noted that midwives and others who work with pregnant women say, ''It is almost impossible to get pregnant women to look beyond the birth. It's like a mountain on the horizon that blocks the view.''

''This is a shame,'' Nylander writes. ''... The postpartum period is a very special time, and it can be helpful to know a little bit about it.''

That's why she includes in her book a chapter called ''Postpartum: Blood, Sweat, Smiles and Tears,'' where she examines everything from incontinence to hemorrhoids to massive hair loss soon after giving birth because of hormonal changes.

But all the books and advice in the world can't prepare new moms for the feelings they'll experience when they hold their babies near.

As McLeod says of baby Quenten, as he nuzzles against her chest, ''He's, like, the most amazing thing.''

Guarino agrees. She says of Emily: ''Every morning, I just feel blessed.''

Knight Ridder Newspapers