My patient's baby was five weeks old. Happily, this new mom could once again expect a little sleep and there was a good chance that sanity would prevail as a result.
Such is the power of a new baby to destroy repose, disrupt peace of mind and fracture any sense of confidence.
I have a theory about motherhood wrung out of 30 years of being a midwife to women as they birth their babies and a physician to the new creation that is a family.
My theory concerns the time it takes from giving birth until moms are truly moms. I equate it to a crash course in compressing the tasks that took the previous nine months to accomplish into an intense and fast-forward nine weeks to mom-dom.
I believe there are three phases to master that will create the metamorphosis of the new mother.
The first has to do with sleep -- the new reality; the second concerns the body that isn't quite the same any more; and the last has to do with the new bundle that, yes, has a personality evident from the get-go.
It isn't a given that the mere act of laying the newborn on mom's bosom ensures a smooth passage from womb to room. This becomes glaringly true when the baby doesn't sleep and, by default, neither does mom.
"My God, we haven't had her for 24 hours yet and I'm giving her away already. It just took me three hours to ask them to take her to the nursing station."
The labour for this mom had been a long, tough ordeal full of worry and things going wrong -- fever in the mom and fetal distress in the baby. But blessedly and finally, out squeezed a healthy daughter to everyone's relief.
Yet that daughter demands attention without mercy and at 3 in the morning; there was no rest, no break, and no respite for the exhausted parents.
At home two days later, dads are pretty good at getting up with the baby, I note. But then in short order two things happen to them.
First, they go back to work and moms feel they mustn't expect them to get up in the night. After all, moms are the ones who are home now, not working -- at least not at their day jobs.
Second, dads stop hearing the baby cry. They seem able to slumber on through the howling coming from the cleared space in the family bed, where the baby is now ensconced because moms, now wired to rise with the first whimper, can nurse the babe while staying almost asleep.
The second big change that new moms have to acknowledge is the irrevocable changes in their bodies. "They lied," one patient said. "They didn't tell me it was going to be different down there and it is. It doesn't look the same. When will it go back to normal?"
There was the faintest hint of reproach in her tone as she waited for my response. Was I really going to discount the effect that passing that baby out of such a small space had had on that small space?
My response is always that it will be okay. Not the same as before, but okay. "The changes over the first nine months creep up on you," I say. "You don't react with shock as your belly enlarges and your feet swell, because you don't spend a lot of time looking at yourself. And there is still only you to deal with. Now, the change is sudden. You have no time and the functions you never had to pay heed to don't feel right. Even peeing may be a big deal and then there is that gape."
Remarkably, the fretting fades as the mother's body restores and heals to her new normal. Occasionally, and much later, there will be a reference to a certain looseness down there, and even an appeal by dads to "tighten" things up. But it will never be tight again.
The other change from sex object to baby-feeder has to do with breasts and, as one of my patients said, "when the milk came in, I felt I was being led by bowling balls."
By nine weeks, as most moms sit with babes in arms, their smiles are different. Most confess that until they knew the baby and how to "read" what was troubling their infant, they could be reduced to tears and catapulted into helplessness and frustration in an instant.
Even the most tranquil baby will have her moments of thunder, and "Call mom" becomes the response for many a stricken neophyte mother. Sometimes it's even a mother-in-law or a stepmom who can restore a sense of order.
All the while, whole days and nights are saturated with baby-tending -- a massive conversion of attention and energy by two, sometimes three adults spinning around this tiny bit of humanity. In a short space of time, all this work, all this intensity, moulds a new family unit.
The new dad who brought his wife and baby daughter into my office stood as I came in and wrapped his arms around me. "I want to give you a hug," he said. "Thank you for my two girls." He was back at work and missing every minute he was away from these loves of his life.
They were still shy of the nine-week mark by a full month, according to my system. Yes, for the charmed, it is an easy passage. The rest will need every moment of the nine weeks and maybe a little more. Mom will return to paid work at some point and begin another kind of separation from her baby, but nothing that will ever equal this first one.