If you are one of the lucky ones who can make choices, and you choose to stay home, you may find yourself having second thoughts about your decision after a few weeks of uninterrupted baby care. On the bad days when everything goes wrong, you may feel hemmed in, trapped, and angry. You may be jealous of your spouse who escapes every day to the adult world. And if you go back to work, either because you want to or because you must, you probably will not be entirely satisfied either. First, you will need to come to terms with the daily separation from your baby, then with the fact that you will almost surely miss some “firsts”-the first time she smiles, or turns over, or says “Mama.” In addition, you may be bothered by another problem common to working women. One who does not feel pressure and guilt as she tries to satisfy her responsibilities as a wife, mother, and worker is indeed a rarity, even if she is able to stay home for several months, or even years, after the baby’s birth. As some have put it, she takes on three full time jobs and tries to do all three part time. A fragmented feeling of being too much needed, of being pulled in several directions at once, seems to go with the territory of being a working mother.

Of course, many mothers go back to work very soon after their babies are born and neither they nor their babies suffer. Most are gone from home eight to ten hours a day. A few manage to work at home, to work part time, or to have the advantage of working under the flexible-hours provisions that some forward-looking companies now offer, but every arrangement has its disadvantages.

However, many of those mothers and most medical professionals recommend that you wait, until you can, until your baby is four to six months old before you return to work for several reasons. One, of course, is the matter of your health, both physical and mental. Your recovery will probably be complete by that time and your baby’s sleeping habits are likely to have become fairly well established. Proper rest, nutrition, and exercise remain essential for you, even though time for them becomes more scarce. And along with the roles of worker, spouse, and parent, you should devote at least some time and attention to your own needs.

Babies are individuals. Each will tell you in special ways what he needs from you. Many experienced mothers say they can tell the reasons for their babies crying, saying, for example, that the hunger cry is rhythmic and repetitive, the pain cry is loud and shrill, and the ill cry is continuous, whiny and nasal. As the baby grows, he will have more reasons to complain by means of crying; boredom, frustration, loneliness, fear, over- stimulation, and sometimes the overtiredness that prevents sleep. As you get to know your own child better, you will learn to interpret the reasons for crying.

Occasionally, a baby will cry because he is in pain. One traditional cry of pain is the prick of an open safety pin, largely avoided now by the use of specially designed diaper pins and eliminated completely by the use of disposable diapers that need no pins. Another cause for pain is a raveled thread from the baby’s clothes wrapped tightly enough around a finger or toe to cut off circulation. A baby crying because of sickness will usually have other symptoms of illness, such as a fever, diarrhea, or a runny nose. An earache is indicated by the baby’s pulling on, or attempting to pull on his ear. Generally, a healthy baby will have a strong loud cry. If your baby’s cry becomes abnormally weak, consult your doctor right away.

Sometimes, especially if postpartum depression has you in its grip, you and your baby can get into a joint crying cycle. When the baby cries, you get anxious and nervous. The more the baby cries, the worse you feel, and nothing you do seems to help quiet the baby. The baby senses your feelings; your anxiety in turn, makes the baby anxious and uncomfortable; and the child expresses these feelings by crying even more. You dissolve in tears yourself, and neither of you can seem to stop. One way to help both of you to calm down is to take a warm bath together. The skin contact and the warm liquid environment are soothing and may be all you need. However, if you find yourself getting into these cycles with any regularity, talk with an experienced parent or your doctor.

You’ll find some of the things you do to help your baby stop crying are the same as what you do to help him go to sleep. Most of these are warmth, rhythmic sound, and gentle repetitive motion. These three great comforts can be ideally combined when you cuddle your baby closely as you sing softly to him and you rock together in a cozy, padded rocking chair. This will also soothe and rest you, and you will probably find it a more reasonable solution then letting your baby “cry it out,” as some will likely advise you to do to teach him who is “in charge.” Picking up your infant when he cries does not spoil the baby, whatever you may hear from others. Remember, too, to let your baby know that crying is not the only way to get you to show your concern and love. Pick up and cuddle your baby when he is awake and not crying.

Having read the previous discussion of labor, you now have some sense of the physical and emotional events of normal spontaneous labor. It is concern about a tear or labor pain that influences many women to choose to use pain-relieving medication in labor.

The Use of Pain Medications or Anesthesia in Childbirth

Pain medication in childbirth has been used for centuries. Alcohol. Opium, and other drugs have been used, though how extensively is not known.

When using pain medications, you make a trade-off in return for relief of pain and tension and possible speeding up of labor, you accept the side effects on labor progress, your mental and physical well-being, or on your baby. You should balance the advantages and disadvantages as they apply in your situation before using or not using a particular medication.

What are the kinds of medications available, how do they work, and what are their risks and benefits? This section provides an overview that will assist you in discussing the subject with your doctor and making a decision on your preferences.

First of all, the choice of natural and medicated childbirth only exists as long as the labor remains normal. Some interventions are painful or stressful and increase the need for pain medications. If, however, you or your baby requires intervention [such as induction of labor, use of forceps, or cesarean section] for medical reasons, you will need pain medication.

Medication for Early Labor

Because the medications that provide the greatest pain relief also tend to interfere with early labor progress, they cannot be used too early, unless you want to stop labor. There are medications available if a very prolonged and exhausting pre-labor or early labor has caused excessive anxiety and worry. Sedatives or barbiturates [sleeping pills or medication] may help you rest. These are given in pill form or by injection, They may temporarily halt your labor while relaxing you or allowing you some sleep. These drugs reach your baby, who cannot easily excrete them, so it is important not to receive large doses. Because babies born with such drugs still in their bodies may have problems breathing or sucking, your doctor will probably only use small doses and will try to be sure that they have worn off before birth.

Tranquilizers are also used in long pre-labors to reduce muscle tension and anxiety. Some also help if you have severe nausea or vomiting. Depending on the drug chosen, you may feel dizzy and confused, your mouth could feel dry, and your blood pressure altered. These drugs also cross the placenta to the baby and may have effects on fetal heart rate, and newborn muscle tone, suckling and attentiveness.

Morphine, a narcotic, may be used in an attempt to stop a long, non-progressing labor. While it may cause you nausea, dizziness, and confusion, it may also do just what you need-put you to sleep and stop your labor temporarily. Narcotics can linger in the baby and can have some effects on behavior and breathing after birth. The greater the amount of the drug given the greater the effect on the baby.

Though you will find your child reacting to her father differently as the child grows-your eighteen month old, for example, will enjoy roughhousing with Daddy, but when in trouble will very likely turn only to Mommy-the effect of a close, nurturing relationship with a male figure is good for both boys and girls. The popularity of Fred Rogers for nearly twenty years on public television’s Mister Roger’s Neighborhood indicates how enthusiastically children react to caring presence of men in their lives.

Besides lending a hand around the house and accepting some of the responsibility for the care of his child, the new father often takes the traditionally male responsibilities very seriously. He may feel the financial burden of a third member of the family very strongly, especially if the mother’s income has been important and she does not plan to return to work in the near future. And he may envy his wife her opportunity to stay home with the baby as much as she envies his being able to get out every day.

Men who participate as fully as they can in the birth of their babies and who continue to share the responsibilities of home and children, find the rewards great. Their lives take on a new dimension; their marriages are strengthened and become more meaningful. Fathers can “mother” too, and those who choose to accept that responsibility, are today the norm, not the exception. Reports of surveys bulge with statistics. Here are just a few: Eighty-five percent of fathers are present during their wife’s labor; fifty percent during delivery. Ninety-six percent help with baby and child care; eighty percent do not refuse to change diapers.

It will be necessary to support your baby’s head with one hand foe about three months when you pick him up and to hold your baby against your shoulder so his head won’t fall backward when you carry him. It used to be common to swaddle babies loosely in receiving blankets, and some parents like to enclose their infant’s arms and legs this way until they are used to holding and carrying them. You’ll soon find yourself going smoothly through the tasks that involve moving and handling your baby subconsciously avoiding the sudden movements and loud noises that frighten or startle babies.

The Importance of Touching

This statement bears repeating: Picking up and holding your baby will not spoil him. The importance of touch to an infant cannot be stressed enough, a fact now recognized to be part of the bonding process encouraged by doctors, it is even said that mothers who are separated from their newborn infants during the first hour after birth are somewhat less confident about their intuitive mothering skills than those who go through the bonding process. Your baby’s skin in his or her most well developed sensory organ immediately after birth, and the largest organ of the body, its stimulation can have a profound effect on the baby’s behavior. Your gentle, confident, and firm touch, will calm your baby as well as assure him of your love.

Toxoplasmosis is another organism that causes only mild symptoms in an adult but that can injure the fetus, causing blindness or hydrocephalus, which can cause brain damage. Toxoplasmosis is found in some raw meat, unpasteurized goat’s milk or cheese, unwashed raw fruit and vegetables, and in anything contaminated by cat feces. Someone else will have to empty the cat’s litter box while you are pregnant. Also, keep the cat off all counters and tabletops. Wash them off frequently.

Since a pregnancy is not usually confirmed until six or eight weeks after conception, and it may take a little time for the body to build up depleted stores of vitamins and essential minerals, it is very important to adjust your diet before you become pregnant if at all possible. A good diet will also make you feel stronger and healthier and help you through the demanding months of pregnancy, through the birth itself and through the postnatal period. If you feel better, you will be more likely to enjoy your baby to the utmost.

Preconception Care

As we learn more about how diet, drugs and other substances in the environment might affect an unborn baby, more and more mothers are trying to prepare well in advance for the birth of their baby. Genetic counselors are available if you know of any genetic disorder in the family or if you are at greater risk of having a baby with disabilities. Advice on diet and general health care in pregnancy may be available at your prenatal clinic or your doctor’s office. Talk with your doctor about getting this extra attention if you would like it.

It is worth having your health checked before you conceive.

You might want a Pap smear. You can also have a swab done to check that there are no harmful micro-organisms in the vagina. Recent research shows that thrush and gardnerella, bacteria that causes bacterial vaginosis, may be linked to a difficulty to conceive, that an organism called mycoplasma may be linked to miscarriage, and gardnerella to premature deliveries. Not all such infections cause symptoms normally, but they may cause problems in pregnancy. Checking on them before you’re pregnant maybe wise.

It is also true that the majority of women do not want to wait months to conceive, and many conceive by accident, or experience problems in conceiving, and these mothers may feel guilty that they are not doing the right thing: “We started out with all the best intentions, stopping smoking and drinking, taking vitamin pills and eating only health-foody things without any additives. But it took me nearly two years to get pregnant. By the end I was fed up with the whole thing-we never enjoyed ourselves, we felt guilty about everything we ate or didn’t eat. In the end I just ate what I felt like and let it go at that.”

Genetic counseling is available at many hospitals for those who are worried that they may be at extra risk of having a baby with disabilities-this includes older mothers and those who have some hereditary illness or genetic defect in their family.

“We had genetic counseling at the hospital because I was 40 and my husband was too, and his child by his previous marriage had had problems. There was a blockage at the entrance to her stomach. She had to be operated on at birth, but she’s fine now. We were told doctors could pick up on this with an ultrasound scan, because the baby would not be able to swallow the amniotic fluid, which otherwise would show up in the stomach. The ultrasound was reassuring. By knowing of any problems in advance, our doctors would be set to do immediate surgery after the baby’s birth. I was also concerned about the extra risk of having a baby with Down syndrome-I was surprised at how greatly the risk went up between the ages of 40 and 41. We decided to have the amniocentesis and other tests done because we felt we couldn’t have coped with a baby with severe disabilities. I thought the counseling was very helpful and reassuring.”

Genetic counseling can be helpful. It enables the couple to talk through any worries they have and to put the risks they are facing into proportion. This is especially true for older mothers who may feel this pregnancy is their only chance to have a baby. It can also be helpful in establishing the reasons for any previous babies born with disabilities in the family, or for several miscarriages, and point toward ways of overcoming them. For example, it has been shown that mothers of babies with spina bifida had far fewer affected babies in subsequent pregnancies if they took supplements of vitamin B and folic acid. Some couples who have had several miscarriages have been told this was linked to a genetic problem but that if they kept going they had a chance of having a normal pregnancy, and this has encouraged them to continue trying to conceive.

A pacifier may help put your baby to sleep. The Leche League discourages the use of pacifiers on the grounds that they may diminish a baby’s need to suck and therefore make her a less efficient nurser.. Some parents disapprove of them, too, probably because they find distasteful the not uncommon sight of a toddler whose sucking needs have long since been outgrown walking around with a pacifier stuck in her mouth like a plug. In fact, some find the sucking that is one of a baby’s instinctual needs somewhat difficult to understand at all. They may feel that extra nutritional sucking indicates that something is lacking in the emotional development of their child, and that therefore they are “bad” parents.

Nothing could be further from the truth. Newborns need to suck; it is their most satisfying form of gratification. The benefits of a pacifier can be seen when a baby’s need to suck goes beyond her need to eat. Infants may awaken a short time after a feeding and indicate what seems to be hunger by trying to put their hands in their mouths or crying, when what they really need is to suck.. Thumb-sucking would be a good substitute if infants could find these natural flesh-and-blood pacifiers when they want them. Since a tiny baby rarely put thumb to mouth at will, a pacifier meets her need to suck and eliminates unnecessary feedings that inconvenience you and may upset the baby’s digestion.

Another possible benefit of pacifiers has been discovered in using them with premature babies. Those who were induced to accept pacifiers in the hospital were found to develop sucking muscles sooner than those who did not take them, and thus were able to be taken off intravenous feedings and fed by mouth sooner.

If you give your baby a pacifier in bed, do take it away when she is asleep, to avoid the baby’s becoming dependant upon it to stay asleep. And never tie it on a string around the baby’s neck. It could cause strangulation. After six months or so, the need foe extra sucking will disappear. If you dislike the pacifier you could probably arrange for it to disappear about the same time.

We know fear and tension can create additional pain in labor and make it intolerable. If you tense all your muscles and fight the contractions, you make it much more difficult for your body to do its job. You need to think, therefore, in terms of helping your body through the contractions. This thinking is behind the various breathing and preparation techniques that are taught to women in prenatal classes during pregnancy. By accepting the pain and dealing with it, many women find they do not need painkilling drugs, which might also interfere with their being in control. For others experiencing a long and difficult labor, painkilling drugs may provide much-needed relief.

Breathing Techniques

Slow, deep breathing will help you relax between, and at the beginning and end of, contractions. At the height of a contraction, it may help to breathe quickly and lightly, taking air into the top part of your lungs only. (Do that for just a short while.) During the transition between the first and second stages, when you may feel a desire to push out the baby, your doctor or midwife may ask you to wait till she is sure the cervix is fully dilated. At that point, short, rapid, panting breaths may help you overcome the desire to push.

Pain-Relieving Drugs

A number of pain-relieving drugs are available to women in labor. They are particularly useful if you are experiencing a very long labor, if the baby is presenting the wrong way (see below) or if you are becoming exhausted. These drugs, however, can pass into the baby’s bloodstream and affect the baby, or may affect the progress of the labor. Many women find it useful to wait a little between the moments they first feel that they may want pain relief and deciding to accept it. In the meantime, they may find labor is progressing so well that they are nearly ready for the baby to be born. If progress is slow, however, or there is some problem, they can always decide to accept some pain relief.

Meperidine Hydrochloride

This drug, most commonly known by its trade name Demerols’, provides pain relief. It reduces anxiety and thus pain; however, not all women find it is an effective form of pain relief. Some find it makes them feel heavy and out of control without helping the pain much. Demerol crosses the placenta and can affect the baby, making it drowsy at birth, especially if the drug is given close to delivery. (It should be given at least two hours before the baby is born; this means it cannot always be given at the point in the labor when the woman needs it most.) Some babies even need resuscitation after the birth. Many are sleepy and slow at breastfeeding. This medication can also make the mother feel sick.

Epidural Anesthesia

An epidural consists of a local anesthetic that completely numbs the abdomen and legs, thus removing all sensation of contractions. If an epidural is timed just right, it can be allowed to wear off for the second stage so that you can feel and push with each contraction, thus helping the baby out. It seems to have little or no effect on the baby. The main potential problem is that, because some women cannot feel anything, they cannot participate in the second stage of labor, which is likely to be prolonged. The baby is more likely to be delivered with forceps. However, the correlation may be due to the fact women who are having difficult labors anyway are likely to ask for epidural anesthesia.

An epidural is injected into the epidural space in the spine, between the vertebrae and the membrane enclosing the spinal cord. You will be asked to lie on your left side and to draw up your legs to make as tight a ball as possible. This position makes it easier for the anesthetist to put the needle into the epidural space. You will be given a local anesthetic so you do not feel the tube being inserted. After that, the anesthetic is put in. It feels like a cold fluid running down your legs. The catheter is left in your back so the epidural can be “refreshed;” you will also normally have a catheter put in to empty your bladder because you will not be able to control this yourself. An intravenous drip is usually set up too, in case your blood pressure falls suddenly, which can happen with an epidural.

For some women, an epidural is the answer to a difficult labor:

“1 had been in labor for hours, with strong contractions, but I wasn’t dilating much. I became exhausted and thought I couldn’t take any more. They offered me an epidural, and I accepted reluctantly. I have to say the effect was wonderful. Within a few minutes, I was sitting up and talking to the nurses and felt like I could cope again.”

Epidurals can cause problems. About 20% of the time, the epidural does not take and provides inadequate pain relief, sometimes along one side only. Occasionally-in about one in 100 cases-the needle punctures the membrane enclosing the spinal cord. This means you are more heavily anesthetized and may suffer headaches lasting up to a week after the birth. Very rarely, in about one in 100,000 cases, permanent damage can result.

“1 hated it. First the anesthetist had trouble getting it in. In fact, a little piece of plastic tubing broke off and is still floating around somewhere in my spine. Then I had all these tubes and drips set up, and I couldn’t get up and walk for hours after the birth. I didn’t feel or see the baby born at all because I could feel nothing. I had no idea it would be like that. And, because I couldn’t push, he was delivered by forceps-so now I have all the pain of an episiotomy, which I could have done without.”

Women having an epidural should be aware that they are often beginning a chain of medical intervention they might otherwise have done without. On the other hand, if the labor is likely to be difficult, it means you are spared a lot of pain and are already anesthetized if the baby has to be delivered by forceps. And if you should need an emergency Cesarean, the epidural will enable you to be awake and avoid a general anesthetic when your baby is born.

Pudendal Block

This painkilling injection can be made into the vaginal wall with a special needle. With it, you will feel no pain at all from the delivery, and is especially useful when forceps are used. It may be used in conjunction with Demerol.

Local anesthetics are also given if an episiotomy is necessary and for any stitching done on the perineum afterward.

Still, the traditional nuclear family survives, and in many homes the familiar structure of mother as full-time homemaker and the father as financial provider continues. It used to be customary for the at-home mother to be almost entirely in charge of the house and the children. Today, however, we find fathers taking more interest, helping more often with household chores, and involving themselves more fully in the lives of their children than their father did. They are no longer strict and unapproachable beings who are seen by the children only foe a few minutes a day and demand peace and quiet when they are home. Their relationship with their children is personal and openly loving; they talk about feelings, they show that they care.

There are also more public indications today that men no longer measure their worth only by their achievements outside their homes, as their fathers did before them. Both child care literature and advertising now direct information to “parents” instead of only to mothers; childbirth education classes require the participation of fathers. Parental leave of absence, extended to males in Sweden in 1979, is becoming more common among companies in this country, and federal legislation may soon guarantee men as well as women eighteen weeks of unpaid parental leave from their jobs in any two year period, offering protection for both the employees’ jobs and their benefits during their absences.

Men usually are not able to choose between their children and their work, as some women can, and many have not had the role model of a nurturing father to emulate. However, a father today is apt to involve himself as much as he possibly can from the very beginning of his wife’s pregnancy, sharing the important decisions about the doctor she will see, the birthing environment, and the hospital of which the baby will be born. He may accompany his wife on some of her visits to obstetrician. He participates in childbirth classes, in which he learns to coach his wife during the birth of their child, and then supports and aids her throughout her labor and delivery. Various studies have indicated that delivery times are shorter, anesthetics are used less frequently, mothers and babies are calmer, and infant’s feeding problems are less likely when fathers are present in delivery rooms. After their babies are born, fathers often accompany their wives on visits to the pediatrician, if their work hours allow, and some take their babies for checkups alone.

But before we get to that what are the signs and symptons the expecting couple can appreciate as the first indications that the birth of your child is near. These may be:

* Note that all women do not experience all of these signs; the most important ones are the last two. The others are more like warning signs that labor is coming soon.