The shock of motherhood

Jillian Werb, mum of two, trained as a counsellor, her course included some research into the difficulties faced by new mothers, and the many things mothers feel guilty about. The result was this article, which she hopes encourages mothers to be 'good enough ' rather then 'perfect'.

Becoming a mother is a huge change in a woman's life - physically, socially and psychologically. While there are lots of pregnancy manuals, once your baby is born the focus switches almost exclusively to the baby. Very few books talk about what mothers might be going through. The pressures on women to become 'perfect mothers' creates an ever-increasing spiral of guilt and, often, depression. So, I chose to look at the transitions and struggles women go through before, during and after they become a parent to understand better why motherhood can make us feel guilty.

• Heard the joke about motherhood?
• The medicalisation of childbirth
• Adapting to motherhood
• Becoming a 'good enough' mother
• Letting go
• About the author

Heard the joke about motherhood?

That's just the physical aspect. Women can also be affected emotionally during pregnancy, as they lose control over their shape and take on sole responsibility for ensuring the health of a baby over which they only have limited control. They can eat well, exercise to some extent and give up smoking, but, in the end, the welfare of the baby is also affected by hereditary and environmental factors. And these are the side-effects of healthy, 'normal' pregnancies, with no mention made of the traumas suffered by women who cannot conceive, miscarry, suffer stillbirths or many other pregnancy-related disorders such as gestational diabetes, pre-eclampsia or placenta praevia, which can result in hospitalisation for weeks or months.

Before a baby is born, or even conceived, women are under a barrage of stress to be perfect - in diet, in activity and in behaviour.

The medicalisation of childbirth

Labour is impossible to predict, different for every woman, and can be terrifying. The medicalisation of childbirth can be alienating and frightening, including the simple fact that it usually takes place in hospital.

We now have methods of pain relief that should work but don't always. Each method of pain relief has its side effects, which can place pressure on women to attempt a 'natural' birth, then feel like a failure when they do need help with managing pain, or require some kind of intervention such as ventouse, forceps or Caesarean section. 'When the course of labour takes an unexpected turn, when women find it more painful than they anticipated, and when they feel out of control or encounter complications, they feel as if they have failed the first hurdle of "good" motherhood,' says Kate Figes, author of Life After Birth. Women who have had a C section may feel that they have let down their child in some way. The recovery period from such major abdominal surgery takes time, especially if it was an emergency, performed after a long and tiring labour.

Shock after the birth

Some women are left feeling shocked after childbirth. One woman interviewed by Kate Figes, who had an uncomplicated 12-hour labour, compared giving birth to: '… having a near-fatal car crash where you just manage to crawl out of the wreckage.'

Childbirth can cause post-traumatic stress disorder (PTSD), and it can also evoke earlier experiences of sexual abuse or rape. Feelings of powerlessness, of being out of control, of not being listened to, are common. Women who have not suffered PTSD but can't forget the experience can also find it helpful to talk to a counsellor. Other ways of tackling a traumatic birth experience include writing a story of what happened, or talking to those who helped you deliver, either in the days after the birth or later. Many hospitals run helpful Birth Afterthoughts sessions to help mothers come to terms with the medical side of their birthing experience. These can be taken at any stage after the birth - weeks, months or possibly years later.

The medical profession's current opinion of childbirth is that a new mother is not ill, but: 'a healthy, intelligent individual who has just achieved a memorable event,' Fundamentals of Obstetrics and Gynaecology. After being given a clean bill of health after their six-week postnatal check, 47% of new mothers still complained of at least one health problem like backache, frequent headaches, migraine or bladder problems, and at least two-thirds of those had problems 13 months to 9 years after giving birth. Often mothers are too tired to go to the doctor, especially as they are already taking their baby to medical appointments and health checks.

After birth, the body never regains its former shape, especially the breasts, stomach, nipples and vagina/perineum, not to mention stretch marks. Some mothers can view these changes as the badge of motherhood, as Kate Winslet famously remarked, while others, such as Liz Hurley work harder than ever before to get back to normal.

Adapting to motherhood

Bonding after birth
During pregnancy it's surprisingly easy to forget that at the end you'll have a baby to look after, 24/7. Almost every mother remembers arriving home with her tiny, precious bundle, realising that she is responsible for its well-being, and feeling terrified.

'No amount of warning can adequately prepare us for the sheer torture of night after night without deep prolonged sleep,' warns Figes. Newborns need feeding every few hours, depriving their parents of sleep, particularly deep REM sleep. This can lead to slower physical recovery from childbirth, postnatal depression, itching or burning eyes, blurred vision, hunger, lethargy, irritability, lack of sense of humour, inability to undertake simple tasks or absorb new information, increased anxiety, poor short-term memory, angry outbursts, paranoia or even visual hallucinations. Books say 'sleep when your baby does,' but if you have older children, or your baby doesn't sleep much during the day, or you have other things to be doing during that time, this isn't always possible.

Two-thirds of all babies aged 6-12 months, and 20-30% of all children aged 1-3, have trouble sleeping through the night. Modern childcare manuals tend to suggest that it is cruel to leave a child to cry itself to sleep, while a few argue that it is better in the long run for both parent and child if the child learns to resettle itself back to sleep without its parents' help. This can be one of the most difficult and guilt-inducing choices a parent has to make.

Postnatal depression

It's assumed that women immediately fall in love with their children at first sight, but more common feelings, according to Kate Figes, are: '… shock, grief, relief, disgust, amazement, joy and exhilaration'. Women often feel guilty if they don't instantly love their child. Yet it can be hard to love a baby who keeps you awake all night, cries all day, and makes your breasts hurt when they feed. It helps to know that love will grow, and that it's all right to not adore your child from the start.

Postnatal depression (PND) can affect any woman after the birth of any of her children. 'We need to get rid of this notion that postnatal depression is an illness that afflicts a small number of unfortunate women rather than every woman to a greater or lesser extent,' says Kate Figes. PND can range from puerperal psychosis (affecting 1 in 500 women) to mild 'baby blues' (thought to affect around 80% of mothers and often only lasting a few days). Although puerperal psychosis needs psychiatric treatment, milder depression is often mistaken for other aspects of new motherhood such as exhaustion or poor health. Counselling, hormonal treatment, tranquillisers or anti-depressants can help alleviate the symptoms, as can simpler measures such as getting out of the house every day and having people to talk to.

Becoming the 'good enough' mother

Contradictory advice
Babycare manuals place increasing demands on mothers, while contradicting each other. In The Continuum Concept, Jean Liedloff encourages mothers to carry their children everywhere, no matter how exhausting that might be. Deborah Jackson's Three in a Bed encourages parents to sleep with their children for as long as the children choose, no matter how badly that affects the parent's sleep patterns. Most modern babycare manuals tell mothers to feed their babies on demand and to pick them up as soon as they cry, while a few (e.g. Gina Ford's Contented Little Baby Book) suggest that the key to a happy child is feeding and sleeping to a strict routine. Parents, particularly mothers, have to work out which books to ignore, which to use, and how to use them, deciding their own balance between parents' and child's needs.

Children can bring out unknown depths of anger in parents, but expressing anger is not considered 'good mothering'. Yet not shouting might mean expressing anger in more subtle but damaging ways - scrubbing their child too hard in the bath, damning praise, sarcasm and 'forgetting' promises. Getting angry then apologising at least enables children to learn to see their parents as independent beings who get upset and angry just as they do, and to develop independence. Both mother and child learn that they can express hostility without losing love.

A balancing act

Balancing work and childcare issues is also an area laden with guilt for many women. Most women need to go back to work to provide much-needed income for the family. Many choose to go back either full or part time because they desire some mental stimulation and company that doesn't revolve around children. Yet many feel guilty about abandoning their child in nurseries, with childminders, or with family members while they pursue a career.

Research regularly shows that the children of working mothers do just as well as children of stay-at-home mums, as Kate Figes asserts: 'There is tremendous arrogance in the assumption that only the mother of a child can best look after that child. Child psychologists know that children thrive in the presence of other children and learn through play.' Research also shows that it's not working that damages children; it's the guilt that mothers feel about working. So instead of always reacting with guilt when faced with a dilemma in which you believe you are putting yourself first, why not heed Figes's advice: '"Good-enough" mothering is about finding a compromise between the needs of both mother and child as an integral unit rather than subservient pandering to the needs of little emperors. We can only raise confident, independent, socially responsible children if we have those attributes ourselves.'

Relations with the father

Having a child changes a woman's relationship with the child's father, for better… or for worse. A survey in America showed that relationships change in four basic ways after the birth of a baby:

1. 12-13% of couples found relations deteriorated to such an extent that they were in danger of separation.
2. 38% were unquestionably more distanced than pre-pregnancy.
3. 30% stabilised the situation so there was no deterioration but no new closeness.
4. 19% overcame their difficulties and found the relationship improved.

We now rely more on our partners than we ever have done before and we expect much more from our relationships, as Figes confirms: 'We search for complete personal, sexual, emotional and even intellectual fulfilment from our relationships and expect to be able to maintain that equilibrium through the impact of children'. It is important, but often difficult, for mothers to allow partners to father in their own way and to learn from their mistakes.

Letting go

During the first few months mothers have to react with split-second urgency, especially with their first baby. As babies reach 6 months, they become more rewarding, and you can '… relax in the knowledge that, in spite of earlier doubts, you are doing well as a mother, and you and your baby are in synchrony,' says Sheila Kitzinger in her book The Year After Childbirth.

Play to your strengths

In taking on the new role of mother it is tempting to be 'perfect' at everything. But motherhood involves never-ending tasks and a limited amount of time in which to do them, and it can feel like you never achieve anything. It helps to play to your strengths, to only attempt to achieve a few tasks at a time, and to accept the inevitable chaos and lack of control of your life that children bring. I found it useful to think of motherhood as a series of phases, each of which will come to an end. When you have a colicky baby who screams every evening, it is easier to bear if you can reassure yourself that it is only for a few months.

Pluses of motherhood include the joy we get from our children, increased confidence in ourselves and ability to cope with lack of control, a sense of identity, meaning, and of being integral to someone else's life, increased spontaneity, and a joy in the simpler things. Says one mother: 'I thought I knew myself before, but now I realise that I don't. It's such a life stage, a massive milestone.'

• Don't be a manic mum: 12 ways to juggle work and kids
• Find out everything you need to know about being a working parent
• Got a toddler issue you want to discuss? Talk to other working mums on our Toddler troubles discussion forum