Emotional transition

Sleep

Adequate sleep is fundamental to good health, and both pregnancy and the puerperium are times when women are especially vulnerable to sleep disturbance. Babies waking and requiring settling, and noc­turnal feeding contribute to disturbed sleep and poor sleep quality for many women.

Mood

The arrival of a new baby can be a stressful life event, especially when the expectations set for new mothers regarding their ‘role' and ‘feel­ings' do not align with their actual experiences. The transition to motherhood is made more challenging by sleep deprivation and the time-consuming activity required to care for a newborn. Many women who previously participated in the workforce identify a sense of social and professional isolation, and some may view the disrup­tions attendant in having a baby in their home from a perspective of ‘failure' as a parent (16). Additional financial stresses can make these feelings more acute, and contribute to a sense of guilt and shame. Changes in the nature of relationships with intimate partner will also affect a woman's mood and sense of well-being.

All of these changes are a normal part of the transition to parent­hood, and in most cases will be resolved as women and their part­ners adjust to their new circumstances. However, in a proportion of cases more serious disorders of mood will arise, and the mental health of the mother has the potential to affect not only her own well-being but also the health of the baby, other siblings, and her partner.

Relationships and sexuality

Having a baby is one of the most challenging events in an intimate relationship, and a newborn can also affect important interactions with other family and friends. Mothers are usually sleep deprived and there is reduced time available for other domestic tasks, for tending friendships and socializing, and simply taking time to rest and recover. In many settings women who have a new baby and who previously participated in the workforce may find there are financial stresses. All couples welcoming a first baby will be affected by the dramatic change from a time of relative freedom to one of attention to a baby's needs that can seem almost oppressive (16). Attention taken away from a partner to attend the baby's needs and conflict over parenting styles and roles can place stress on the most com­mitted relationship.

One of the major adjustments women and couples face is a po­tential for changes in sexual intimacy. Postpartum sexuality encom­passes a range of issues but perhaps most importantly is about a woman's self-perception as a ‘sexual being'. Unfortunately, in many settings the paradigm in which postpartum sexuality is viewed, particularly by well-meaning maternity carers, is that of dysfunc­tion rather than function (18). A broad approach to sexuality in the postpartum period should take into account issues such as body image, changes in lifestyle, fears and concerns about discomforts with sexual activity, and the partner's perceptions of, and interest in, sexuality.

Although there is a wide range of normal, many studies report that women's desire for sexual intimacy tends to reduce during preg­nancy, and this trend continues after birth (20). Reduced sexual desire is associated with less sexual activity and satisfaction, but en­joyment of sexual activity usually returns in the months after birth. For example, studies suggest that few women find intercourse en­joyable shortly after birth but by about 12 weeks the majority report that sex is ‘mostly enjoyable' (21). Fatigue is commonly reported as one of the main factors contributing to a loss of sexual interest, and is clearly related to a reduction in coital frequency. However, peri­neal pain following vaginal birth and transient atrophy of the vaginal skin with reduced lubrication can make intercourse unpleasant for many women. One of the important ways of helping women navi­gate these difficulties in the transition to parenthood is by being pro­active, since there are high levels of under-reporting. Fortunately women can be reassured that these changes are usually transient. Persistent reduction in sexual desire and frequency of sexual activity has been associated with perinatal mood disorders so careful in­quiry is warranted.