Only after the woman had her own child, how difficult it was to be a mother.
A did she realize
B realized she
C does she realize
D she realized
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解析：考查倒装句式。only+时间状语从句放句首时，用部分倒装。句意“只有在那个妇女有了孩子之后，她才意识到做妈妈是多么不容易。”部分倒装就是把do/ does/ did/can/will等提到句首，排除B、D；因为时态是一般过去时，排除C。故选A。