Es un tema que me gusta mucho, porque como médico, Pediatra y Doula tengo diferentes definiciones y visiones, pero como mujer y madre, te das cuenta que aunque se ha avanzado mucho, la salud mental de la mujer que se convierte en madre es poco tratado más allá de el criterio médico de depresión postparto. Pero que además como yo, que tuve que incorporarme a clases a los 10 días, trabajar al mes con turnos nocturnos, la realidad y la historia es otra. Y sé que así como yo, hay muchas mujeres que a los 7 días del postparto se quedan solas porque no tienen red de apoyo y el esposo empieza a trabajar, las que están solas en otra ciudad o país, sin esposo siquiera, las que trabajan independientes y tienen cosas que resolver, y las que aún estando acompañadas se sienten abrumadas con esto de ser madre. Así que para todas nosotras este artículo, basado desde lo científico y la experiencia no solo profesional, sino como madre y puerpera.
Al parecer, según las definiciones más actualizadas, el postparto de la mujer acaba cuando termina la cuarentena, su cuerpo vuelve al estado ordinario anterior a la gestación.
(RAE, 2019).
El puerperio es el periodo desde el final del parto hasta la aparición de la primera menstruación, en este tiempo se desarrollan simultáneamente multitud de cambios fisiológicos en la mujer con la finalidad de retornar gradualmente al estado pregravídico y establecer la lactancia. Las posibles patologías acontecidas en este periodo son un motivo frecuente de consulta. (Sesmero, 2002).
Como médico conseguí muchos artículos donde explican las etapas, los cambios en los loquios, las patologías frecuentes (mastitis,hemorragias, infección, entre otras), pero lo común es que en cada artículo, al final mencionaban someramente la patología psiquiátrica del puerperio, como si eso fuese lo único que viven las mujeres luego de parir; citando:
“ Uno de los trastornos mentales más frecuente en el puerperio es la tristeza o «maternity blues». Lo presentan el 40-80% de las puérperas, con síntomas depresivos que desaparecen en 7-10 días. No se considera una patología y no requiere tratamiento farmacológico, sólo tranquilizar y apoyar a la paciente y realizar un seguimiento para evitar que progrese. La depresión puerperal no parece ser un cuadro diferente al de la depresión mayor. Aparece en el 10-15% de las puerperas. Se manifiesta después de la segunda semana postparto. Se manifiesta en cansancio físico y psíquico excesivo, alteraciones del sueño, pérdida de interés y autoestima, anorexia, llanto, sensación de culpa. El tratamiento debe ser de inicio precoz e indicado por el psiquiatra.” B. Bezares, O. Sanz, I. Jiménez, Patologia puerperal 2009.
Volver al estado anterior suena sencillo, sin embargo, es contradictorio con la realidad de las mujeres que atraviesan un embarazo y un parto, las cuales difícilmente pueden ser las mismas y estar como antes, y mucho menos a los 40 días después de parir.
A nivel fisiológico sus cuerpos han atravesado un sinfín de transformaciones, algunas más evidentes que otras, y muchas se instalan en su ser para quedarse. Se sabe por ejemplo que el cuerpo de la madre alberga en su interior células del bebé que gestó y que son el resultado de la intercomunicación que se estableció entre ella y su criatura durante el embarazo. Este fenómeno es conocido como microquimerismos (Quirós y Arce, 2010) y da buena cuenta de cómo la transformación fisiológica en la madre es duradera.
Por otro lado, no podemos obviar que en el posparto o puerperio existe una realidad emocional cambiante en la mujer que ha gestado y parido de la que es necesario hablar por el protagonismo que tiene en ella durante este período. Y es que a nivel psíquico la mujer se transforma de una manera complicada de explicar con palabras (lo hemos vivido), muchas madres hablan de la experiencia transcendental que es para ellas el haber creado vida y haberla parido, ahí es nada (Olza, 2018). Y después de ese huracán que todo lo cambia, cuando supuestamente estamos de vuelta a la «normalidad» tras esos 40 días, el mundo emocional se nos antoja más caótico que nunca, así pues aunque en esta cultura los medios de comunicación nos muestran mujeres impolutas y casi inmaculadas con sus hijos dormidos en brazos, la realidad que vivimos no corresponde con esta escena plastificada.
No es extraño por ejemplo que la mujer puérpera sienta su alma distinta, quizá fragmentada en pedazos por lo que sucedió durante el parto, puede que empoderada por lo que fué capaz de hacer, pero en cualquier caso diferente a antes de atravesar esta experiencia de gran trascendencia en su vida.
Ahora más que nunca se hace real esa mezcla de energías, esa extraña conexión a través de la cual la madre sabe lo que siente su bebé y éste a su vez es la persona que más la conoce precisamente porque nota en sí mismo lo que le está pasando a ella. Este fenómeno denominado fusión emocional es único y especial, sumerge a ambos en una burbuja de intensa conexión muy práctica para la supervivencia de la criatura y también la de la madre, pues cuanto más conectada esté a su bebé más sencillo se le tornará sobrevivir en la selva del puerperio. (Leer el artículo de emociones entre madre y bebé).
Por lo tanto, y teniendo en cuenta lo anteriormente descrito, la definición de posparto actual resulta en cierto modo reduccionista y creemos que es importante reivindicar que el puerperio o posparto es una etapa que va más allá de los cuarenta días. Además, es un período no solamente caracterizado por lo fisiológico, sino por todo el movimiento emocional que supone convertirse en madre.
Con esta mirada ampliada desde lo perinatal se hace necesaria una nueva definición de puerperio. Así podemos afirmar que se trata de una etapa en la vida de la mujer madre que va desde que ésta pare a su criatura y afianza la fusión emocional con ella, hasta que su bebé sale de su esfera emocional comenzando una experiencia vivencial más autónoma.
Así pues, ya que existe esta unión indisoluble durante más tiempo que lo que tarda en curarse la herida uterina responsable del sangrado tras el parto, las mujeres seguimos en posparto más allá de la cuarentena. Y es que nuestra criatura es una parte de nosotras aún, aunque haya terminado la unión física ya que perdura la energética, siendo uno a la vez que dos. Esta ampliación de la maravillosa y caótica etapa del posparto es sin duda predominantemente emocional, de ahí la nomenglatura que proponemos de puerperio emocional, para abarcar el período desde el fin de la cuarentena hasta la terminación de la fusión emocional, aproximadamente a los tres años, cuando las madres sienten realmente que sus hijos dejaron de ser los bebés que sostenían.
Puerperio Emocional. Esther Ramírez Matos es psicóloga perinatal y terapeuta sistémica. Instituto Europeo de Salud Mental. Agosto 2019
Amé cada palabra que describe la psicologa Esther, porque siendo madres sabemos que ese ciclón de emociones es así, además agrego que entramos en la etapa de cuestionamientos (creánme, aún siendo pediatra), es que las mujeres nos damos duro a nosotras mismas: será qué si soy buena madre, si el bebé llora, uno cree no lo hace bien, si cuando vamos a consulta nos dicen que algo no se estaba haciendo como era; nos lapidamos y pensamos no estoy hecha para esto; si el bebé rechaza el seno o la comida, sentimos que nos rechazan a nosotras, y en esta lista inserte cualquier cosa que haya pasado por su cabeza y que la pone en el puesto de la mala mamá.
Por eso comparto el concepto, que en Canadá ya se considera el puerperio como los primeros doce meses tras el parto, que tiene que ver con los cambios emocionales y a nivel cerebral, planteando que incluso podría durar entre uno y dos años. Este puerperio alejado es un concepto todavía abstracto, que muchos profesionales de la salud no admiten, sobre todo por su imprecisión y subjetividad, pero que evidentemente existe, y las mujeres somos testigos de ello.
Para cerrar, aclaro que aunque las etapas están muy bien definidas por los expertos no siempre es fácil afrontar la cascada de sentimientos que se suceden durante el postparto, por lo que es importante que el papá asuma también su nuevo papel y que entienda los cambios que va a sufrir su pareja. Preparándose
para esta etapa durante el embarazo, cuyo objetivo final no sea el parto, sino el crecimiento tanto individual como de pareja y la transformación de la familia.
¡Ánimo! Es sólo una etapa.
Hay que cambiar el ritmo de vida para adaptarlo a las necesidades actuales de la familia. No te presiones ni exijas demasiado. Hay que darse un tiempo para que todo encaje. Poco a poco las cosas vuelven a la tranquilidad. Con paciencia, amor y compasión hacia nosotras mismas todo vuelve a la normalidad y a la vuelta de la esquina quieres volver a ser mamá.
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