With the arrival of a baby, women often are faced with difficult and heart-wrenching decisions. Should I stay home or continue with my career? How will I feel about myself if I work part-time or quit my job entirely? What do I want for my child? If I choose substitute child care, how will my child adjust?

Economic pressures and a desire for career-related challenges lead some women to return to the work force. Those choosing to be at home often struggle with a variety of issues -- isolation, financial limitations, self-doubt about their decision, feelings of inadequacy, and a new baby in constant need of attention. No matter what their choice, many women experience ambivalence long after making a "final" decision.

Physicians, nurses, and other medical professionals are often prime sources of support for expectant and new mothers wrestling with these issues. Pregnant women often build strong bonds with their obstetricians and nursing staffs and feel comfortable sharing concerns about how their life will change after delivery. Frequent well-baby visits provide a terrific opportunity for pediatricians, family physicians, and medical staff to offer comfort, help new mothers decide what's best for them and their families, and aid them with any necessary transitions. Nearly all health care professionals who come in contact with women "in the trenches" of child-rearing day in and day out can provide support to at-home mothers.

Unfortunately, many medical professionals may not know how to help women who are considering or have chosen to be at home. Yet, it needn't be that way. By expressing interest and offering pragmatic suggestions, medical professionals can help mothers who are struggling with work options, women who have made a commitment to be at home, and women who are considering some combination of the two. Suggestions include:

• Ask a mother how she's doing with the transitions associated with a new baby, whether it be her first, second, or even third child. With the anticipation and arrival of a baby, women often experience a traumatic shift in their identity. One day they are a member of the paid work force with well-defined responsibilities, a planned schedule, a paycheck. The next, they are at the whim of a baby demanding constant attention. Hormonal changes and the need for recuperation also can leave some women longing for what they may remember as carefree work days. For others, what initially seemed like an easy decision -- returning to work or choosing a new life at home -- becomes highly emotional and complicated. By asking how the mother is doing in her new role, health professionals give her the chance to share her feelings, to learn that negative feelings are probably normal, and to receive helpful advice. Medical professionals also can create opportunities for discussion with at-home mothers "in the trenches" by expressing interest in the personal challenges they face while at home.
• Let women who express frustration with work-related decisions know that self-doubt is normal. Millions of women today struggle with the commonly accepted view that they can "have it all." This frustration may manifest itself when a woman contemplates all of the adjustments associated with her new role as a mother and with a change in her work status. Our society provides little acknowledgment of this struggle and sparse validation of the choice to be at home.
• Where appropriate, remind women that the decision to be at home or return to work need not be an "all or nothing" one. Today's mother can preserve a home-centered environment for her child through pursuing creative employment opportunities such as job-sharing, flex- and part-time employment, "tag team" parenting, telecommuting, home-based business, and motherhood sabbaticals. Indeed, 1997 Census Bureau data reveal that 46.3% of all married couple families with children below age 18 with both parents employed have a mother who is considered a part-time employee, and therefore is not on the job full-time, year-round.1 Women who are concerned about losing valuable skills while at home should be encouraged to examine the skills they will use/develop while at home (e.g., leadership, planning, education). Volunteering also can provide opportunities for at-home mothers to use/develop marketable skills.
• If any mother fears she is (or would be) the only one staying home, let her know this simply isn't the case. The March 1996 Census Bureau report, "Who's Minding Our Preschoolers?", shows that 49.9%--of 10.2 million--of all children below the age of five are cared for exclusively by a non-employed mother.  This figure rises to 62.2%--or 12.7 million--when adding children whose parents care for them in tag team arrangements (7.8%), children whose mothers care for them while on the job (e.g., home-based businesses) (3.0%), and children who are cared for by their fathers (1.5%).  Indeed, only 25.5% of young children are cared for by a non-relative with 15.1% in center-based care (e.g., day care centers, preschools, kindergarten programs), 8.0% in home-based day care, and 2.4% in nanny care.  (Relatives care for the remaining 12.3% of all children.)  It is indisputable that care by parents is the #1 choice in the United States for young children.  At-home parents abound.  The challenge is finding them.
• For mothers struggling with loneliness and isolation, give specific suggestions for building new social contacts. Parenting and/or recreational classes can help foster needed friendships and help new mothers find mothering mentors. Volunteering and joining (or starting) play groups in a neighborhood or place of worship can bring women with common interests or cultural backgrounds together. The national organization, Family and Home Network, 800-783-4666 (www.familyandhome.org), connects at-home mothers through its monthly publication, Welcome Home, and its three books, Discovering Motherhood, What's A Smart Woman Like You Doing At Home? and Motherhood: Journey Into Love. Other national organizations providing assistance in identifying existing or starting new play groups include: MOPS International (Mothers of Preschoolers), 303-733-5353; FEMALE (Formerly Employed Mothers at the Leading Edge), 800-223-9399; the National Association of Mothers Centers, 800-645-3828; La Leche League International, 847-519-7730, and Attachment Parenting International, 615-298-4334 (click here for more information on these organizations)
• Offer encouragement to women who find that the life of an at-home mother isn't what they expected.
• Let a new at-home mother know that happiness may not be instantaneous. Like any new job, she must build a new life -- establish new skills, a new network of friends, and a new routine. This can take months, a full year, or more!
• Reassure a new mother who is disappointed by the lack of personal time that such frustration is typical and her time management will be easier when her baby's routine becomes more predictable. Encourage her to re-examine her expectations, set realistic goals and choose priorities carefully. At-home mothers can create personal time through mothers-day-out programs, co-operative babysitting, hiring babysitters, and asking mates to watch the children.
• Where appropriate, remind at-home mothers that the grass isn't always greener on the other side: returning to the paid work force would have, like being at home, advantages and disadvantages. By encouraging mothers to think through the pros and cons of alternative approaches to issues, health professionals can help empower at-home mothers, leading to greater confidence in their decisions.
• As the opportunity arises, encourage fathers/mates to support at-home mothers through words and deeds. Many people simply do not realize how physically and emotionally challenging life is for at-home mothers. Supportive mates can make difficult times pass more easily and bring couples closer together.
• Give at-home mothers a pat on the back. The voice of a trusted physician and nurse in praising the work of women choosing a home-centered life is essential. It is often in moments of great frustration that mothers remember words of kindness and encouragement from others who understand their daily joys and frustrations. After all, guiding children into adulthood is delicate work -- an art worthy of much time and devotion. The medical professional's support and affirming voice to this truth can transform many lives.

To receive free brochures for patients, send an email to fahn@familyandhome.org or write to: Family and Home Network, 9493-C Silver King Court, Fairfax, VA 22031. Please specify the quantity of brochures you would like to receive.

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Footnotes:
1Data in this reprint are periodically updated to provide the most pertinent information to readers.