Medical Director, The Women's Place

Texas Children's Pavilion for Women   


Editor's Note: Straight from the Source is a series. These Question and Answer sessions allow readers access to the thoughts of Houston's top experts.  


ParentsPost: Describe the psychological transitions happening around a baby's birth.


DR. PURYEAR: There is an enormous psychological shift the moment someone finds out they are to be a mother or father.  Before the baby comes one imagines what it's going to be like to hold their baby in their arms, who will the baby look like, who will the baby act like, what kind of parent will I be?  It is a time when a person reflects on their own childhood and their own parents and starts to think about how they want to do some things the exact same way and there are some things they will never, ever repeat.  Most people begin to imagine themselves as a better parent than theirs were—this is a good thing as each generation tends to do a better and better job of parenting.  When the baby arrives it's often a shock. 


ParentsPost: Why do expecting and new parents sometimes feel overwhelmed?


DR. PURYEAR: People describe how surreal it feels to be handed a baby and be told that it's going home with you!  There is a sense of overwhelming responsibility that you have been given another human being to care for that is totally dependent on you for its every need.  That can be terrifying!  Sometimes it can be so anxiety provoking that you wonder what you've done and wonder if you have any business at all being a parent, but for most people they grow into the job and feel more competent over time.  Realizing that you now are the parent and not just an independent autonomous human being is a huge role transition that most people negotiate over time but can still feel daunting and frightening. 


ParentsPost: Describe the impact of sleep deprivation during the newborn months on parents. 


DR. PURYEAR: Sleep deprivation may be a trigger for postpartum depression in both the mother and father.  It is important for parents to realize that protecting their sleep goes a long way towards maintaining mental health and a positive parenting experience.  There are many ways that new parents can make sure that both partners are getting adequate sleep, even if the mother is breastfeeding.  Sleep deprivation can make couples irritable and resentful of each other and small slights can become huge.  Losing sleep is inevitable in the early months of parenthood but paying careful attention to getting good sleep when you have the opportunity is important.


ParentsPost: What are some common anxieties expressed by brand new parents?

How do you advise them to address the issues?


DR. PURYEAR: The most common anxiety I hear is, "What if I do something wrong?"  Parents can become obsessed with the "right way," as if there is only one way of being a parent.  They often read too many books, get advice from too many people, and end up confused and anxious, which often makes for a confused and anxious baby.  My best advice is to use your common sense and pick one persons advice you trust.  For most people that is their pediatrician.  Hopefully your pediatrician is someone you chose because you have faith in their ability to give good care to your child and you feel understood and connected with them.  They make you feel confident in their and your ability to care for your child.  It's also okay to pick one book on childrearing that seems to make sense to you and to use it to guide you at 3 in the morning and your baby is crying and you're not quite sure what to do.  All of us need help at times, and a trusted "instructional manual" can be a big relief when you need to be pointed in the right direction.  And even though they're tiny, babies are very resilient.  It's really very hard to do serious harm to a child unless you're frustrated and angry with them.  I usually tell the story of pinning the cloth diaper to my baby's leg, and she turned out just fine.


ParentsPost: What issues are encountered by new parents in the First 100 days?


DR. PURYEAR: Division of labor is a big one.  Often if the mother is breastfeeding she feels overwhelmed with all of the childcare duties and that there's nothing her husband can do.  For breastfeeding moms it is helpful if the dad gets the baby ready for nursing, and then puts it back to sleep once baby is finished.  That way mom doesn't lose as much sleep and both parents are a little sleep deprived, versus the mother being totally overwhelmed and exhausted.  Sometimes I have mother's tell me that they are the one who always gets up at night because their husband has to work the next day.  Last time I checked, taking care of a baby 24 hours a day, 7 days a week was an exhausting, and demanding job.  Not one without pleasure, but a job none the less! 


ParentsPost: What are some issues that are potential sources of conflict?


DR. PURYEAR: Sleep deprivation can be a huge instigator of conflict between couples. There are also issues related to parenting choices:  to breastfeed or bottle feed, pacifier or no pacifier, let the baby cry or pick it up the middle it fusses?  Parents often disagree about the best way to raise a child and are often based on the way their parents did it or their sister, or the latest expert baby book.  There is no right or wrong way and this is the beginning of learning to work together as a team in raising your child.  It only gets harder, the older they get, and the stakes are higher.  The new family needs to create a united front to both sets of in-laws.  It is your child and while you appreciate their help and guidance what the two of you decide is the best way, is the way.  Each adult child needs to be responsible for letting their own parents know what the "rules" are.  Don't expect your partner to tell your mother to back off.  There are so many issues:  when to leave the baby with a sitter, going out alone without the baby, when to travel, how do we get our sex life back, where dose the baby sleep,  etc. etc.


ParentsPost: What is post partum depression and what are symptoms?


DR. PURYEAR: Depression is a disorder of mood, that has many symptoms beside depressed mood, including sleep disturbance, irritability, fatigue, and lack of interest or pleasure in usual activities.  One of the most difficult symptoms for new mom's is the feeling that they aren't enjoying the baby the way they should, that there is something wrong with them that they don't feel the joy everyone else seems to be feeling towards the baby, and that they must be or will be a terrible mother.  There is an enormous feeling of guilt related to this.  At its worst women can feel that the baby might be better off without them and they have thoughts of wanting to run away or even thoughts of hurting themselves.


ParentsPost: Are there any other post partum conditions? 


DR. PURYEAR: There are other postpartum symptoms besides depression.  These include postpartum anxiety, obsessive-compulsive disorder, and psychosis.  Postpartum psychosis is a psychiatric emergency where a mother loses touch with reality and may hear voices or have disturbing thoughts.  Sometimes the thoughts are about the baby being possessed or needing to be saved from evil.  These are the mother's we hear about who have injured their babies.  Fortunately this is a rare condition, happening in only one out of 1000 deliveries.  This is a treatable illness but needs to be diagnosed and treated as soon as possible.


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