Out of the hospital in two days, overwhelmed by relatives for the next three, new mom Denise Smith was exhausted when her husband left for a business trip. From her window in Glen Arm, she couldn't even see another house. There she was, all by herself, 24 hours a day, with a fussy new baby who refused to go to sleep.

"I laid her in her crib, went to the guest room and cried, and ## came back and said, 'OK, let's try that again,' " she says. The next morning, she gathered her strength to sign up for a new mothers support group at St. Joseph Medical Center. When she arrived, Mrs. Smith was in tears. "If not for this group, I would be in Shephard Pratt (the psychiatric hospital)," she says.

Exhausted, isolated and desperate for the companionship of others who understand their experience, new mothers call hotlines, sign up for groups at hospitals, or walk the malls in search of other mothers. For some, a special mother's lounge at Nordstrom's is the closest thing they've got to a support system to guide them through the difficult physical and emotional changes that accompany birth.

Across the country, the rituals of welcoming the next generation are caving in. Neighbors who once stopped over with a tray of lasagna and a sympathetic ear are working; parents and in-laws who once lavished attention on their new grandchildren live in other states; and friends who once filled hospital rooms with flowers don't order them anymore because the stays are so short.

The lack of organized support makes the 1990s a terrible time to have a baby, says Marian Malinski, a veteran labor and delivery nurse and educator of new moms at St. Joseph Hospital.

"Emotional support for the mother is not there," she says.

The societal changes come at the worst time for new mothers, who are being pushed out of hospitals in a day or less and forced to return to work in six to 12 weeks.

"There really is no post-partum care in the United States" once new mothers leave the hospital, says Dyanne Affonso, dean of the school of nursing at Emory University in Atlanta. In other cultures, new mothers are aided in their healing and recovery process by being relieved of all responsibilities except caring for the baby.

"In the U.S., we see childbearing as a product. Once the baby is done, it is done," she says. Yet, she says, "reproduction is a social event. You are reproducing for the next generation. With 12- and 24-hours stays, society is saying to women, 'You will do your healing on your own.' "

Perhaps in response, the number of women experiencing post-partum depression is on the rise, affecting between 12 percent and 20 percent of new mothers. Dr. Affonso calls it a cry for help.

"We are pleading for help. No one is hearing. Women are silent sufferers," she says.

Full recovery takes a year, says Dr. Affonso, and "the people who know that best are fathers -- in the U.S. fathers are overwhelmed by the needs of women."

Dr. Affonso has charted the state of childbirthing by talking to new mothers and fathers for five years in a project for the National Institutes of Health. Her conclusion: "We need to redesign the whole system. If we can't deliver care at the hospital, we have to deliver it at home."

Back to work

For most of this century, giving birth was considered a major event that took months to recover from. Members of the extended family tended to the new mom for weeks after the birth, often taking charge of cooking, cleaning and caring for other children. Through the 1940s, most women stayed in the hospital a week and those who could afford it often hired private nurses to stay with them another week or two at home, says Regina Cusson, associate professor of nursing at the University of Maryland.

In the 1960s and 1970s, a routine birth was still a three- to four-day hospitalization and a C-section was a week. And even in the 1980s, when parents began shortening hospital stays on their own, women didn't return to work as often and as soon they do now.

In the 1990s, 53 percent of women return to the workforce after childbirth, according to the U.S. Census Bureau. Many of them are older, college-educated and have moved away from home and family to establish their careers. Their mothers and grandmothers, sisters and brothers who would be aunts and uncles, either don't live nearby or are themselves working. Their husbands work, too.

Pushing women out of the hospital in 24 hours for a routine birth or 48 hours for a C-section is the latest blow to an already frail post-partum system.

Yet the stress of labor and the needs of women who go through it are unchanged.

In those first 24 hours, a new mother nurses eight or more times, tries to eat and get major bodily functions working again. She is bleeding, cramping and sore from nursing.

Typical is Audra Gallogly, 28, a social worker, who moved to Baltimore from Florida two months before her baby was born and found herself without friends. Her husband had only few days off when she delivered. She arrived home with new baby Dylan after two nights without sleep: she labored hard one night, and after delivery, stayed up feeding the baby all night. "There's no way I could go back to work," she told her husband.

She copes now by meeting other new mothers at St. Joseph, taking rides in the car with Dylan and talking with her sister on the phone.

Holly Schmidt, 34, a Perry Hall mother of three who hires herself out to new mothers to help with everything from grocery shopping to breast feeding, says most new mothers "are so tired and in pain that they can't even concentrate on what they need to do."

She is swamped with calls for her $15-an-hour "doula" service -- that's a Greek term for mothering the new mother. A key part of her job is to reassure them.

"With breast feeding, first-time moms have no idea what they are doing. Even if they have read books and books and books, when once they are actually doing it, they are still unprepared," she says. "Many have natural instincts, but they question themselves, they don't follow their instincts."

Because they are sleep-deprived and often socially isolated, new mothers are very vulnerable, says Mrs. Malinski, the labor nurse. As a result, a new mom needs "reassurance she's doing OK, education about herself and her baby -- even if she got it prenatally she didn't give it much credibility -- and she needs somebody to love and care for her," the nurse says. "And her husband is just as exhausted."

In short, for many new moms and dads, there's nobody to help.

Partly in response, hospitals have revamped their childbirth classes to include post-partum information and advice. But first-time parents can't take it all in, they are so focused on the delivery.

"They say we should do more education before the baby comes," says Kim Miller, co-founder of Family Affairs Inc. in Crofton, a maternal-child home health care company that follows up on new mothers at home. "But this is like learning to drive by reading a book."

Sleep deprivation

Lori Schramek, 27, says she was naive about breast feeding. "Everybody says it's the most natural thing in the world," she says, "but I had to learn it."

Her experience is common. In the past, much education and support for nursing and child care came from experienced family members and relatives. Today, even if mothers live nearby, it is hard for them to be supportive of breast feeding because they didn't do it, says Eileen Ryan, who counsels new moms about nursing by phone.

Four months after she delivered, teacher Monica O'Grady still can't get more than four hours sleep at night. Besides nursing son Andrew, she tends to 9-year-old Erin, whose badly broken leg keeps her up at night in pain or with nightmares. "I really feel overwhelmed," she says.

Mrs. O'Grady, 38, tried but failed to get an extra night in the hospital. "From Day 1 you are tired because you have been in labor all night, worked before that, and nursed the baby in the hospital," she says. "Probably the most wonderful experience of my life has been giving birth to my children. But at the same time you just don't feel well after you give birth."

The changes in her body are physiological and hormonal. "I had shakes, bleeding, cramps, headache, stitches," she says. When Andrew was 8 weeks old and her daughter broke her leg, Mrs. O'Grady's fatigue began to affect her milk supply.

Her husband and mother both are very involved in child care. And friends have brought over food. But in her Lutherville neighborhood, most people work full time or part time, she notes. "Most of us are having our babies in the 30s."

Even now she can only sleep from 1 a.m to 5 a.m. "The full picture is one of great sleep deprivation," she says, "The person who suffers is the baby."

Many women prefer to recover at home, and doctors and other experts believe it is the best place as long as there is a support system. But physicians worry that there is too little individual assessment of new mothers before they leave the hospital and many of them, while medically stable, need more time to recover from sleep deprivation.

"To treat someone who has 14 hours of difficult labor with a first-time baby the same as someone with two hours is not realistic," says Towson obstetrician Alan J. Tapper.

The first week at home can make or break a family, says Dee Dee Franke, a nurse-educator at Greater Baltimore Medical Center.

Everybody has different needs, Mrs. Franke says. "What's optimal is for parents to realize how to bring together their support systems way before having the baby -- even getting meals into the freezer."

But many women have a hard time asking for help, particularly older mothers who have established careers and are used to being in control.

"Women need to prepare for birthing with the knowledge that they are entitled to some kind of support system," says Sally Placksin, author of "Mothering the New Mother, A Post-Partum Resource Guide." Women are very active in decisions involving childbirth, she says, and should be just as involved about what they want to happen post-partum.

B6 "The hard part is, no one thinks of it," she says.

Circle of friends

Once they decide they need support, new mothers go to great lengths to find it.

With their neighbors at work and their streets eerily quiet, new moms like Janet Tomasic of New Freedom, Pa., are driving as much as 45 minutes to meet other moms. "It's been wonderful," she says of her friends in one of the few hospital support groups in Baltimore. "A lot of women work and there's nobody home in my neighborhood," she says.

Dawn Carey, 30, got the support she needed when she joined La Leche League in Salisbury and met other stay-at-home moms. She also met new friends in an exercise class for pregnant women given by Peninsula General Hospital. "We just started a playgroup -- another means of support," she says.

Volunteers, including cooks whose offerings help a new mother eat well and recover faster, are springing up in neighborhoods, churches and hospitals. A group at Faith Christian Fellowship in Baltimore makes two weeks of dinners for the new moms among them. Union Memorial and Sinai hospitals have volunteers who serve as coaches and guides for new mothers from birth through the first year.

And there's the lounge in the women's bathrooms at Nordstrom's. The Towson store has become a mecca for breast-feeding mothers who fear going out because they don't want to be stuck when finicky and unpredictable newborns demand to be fed.

"It's my favorite place in the mall," says Laura Clark, 29, who eats her lunch while she nurses her son several times a week. Before she delivered, she says, all of her friends told her, " 'You've got to check out Nordstrom's mothers' room.' "

For Denise Smith, life is easier now. Husband Bob, an engineer, missed out on bonding with their new daughter, Miranda, early on because of his business trips, Mrs. Smith says, but is making up for it now: Dad makes a bee-line for Miranda each evening when he gets home.

"I have my evenings free," she says.

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