Thursday, January 31, 2013

What should we say to other women?

Lately I've been pondering what to say to the women in my life who I'll call "waiters."  I'm not talking about women who are single, or may never want children.  I'm talking about the ones who are in relationships, happy and stable ones that have lasted several years (sometimes more than 5), actively talk about wanting children, and aren't having any because they are "waiting."  I'm not alone in this pondering either.  Here's an article about how older parents are changing everything we know about society.  Worth the read, I'd say.

On the one hand, from the outside, I'm a weirdo.  Got married very young for this day and age, had first child just after finishing undergrad 1.0, so she can look like a surprise rather than very carefully planned.  If you look at the (absurdly vast and torturous) amount of school I've attended since, it makes a lot of sense that we wouldn't have had another child in that time because nobody has children while in school (ahahahahahah... how wrong our perceptions of college students today are...).  Aside from the Grand Faceb.ook Pregnancy Announcement, I have not really talked about our lousy fertility with anyone aside from a friend who also has PCOS.

I'm not sure how to put it delicately to friends/family either, or if it ought to be delicate at all.  Infertility stinks and you are increasing your odds by waiting to even try.  Yes, if you aren't "ready" for a real reason (we have no jobs or healthcare, we are about to lose our house/housing, we are seriously ill), wait by all means.  But I really worry that with all the stories of successful ART in older couples, folks in their 20s have zero sense of declining fertility and increasing risk of birth defects and other ickiness like developmental delays and all that jazz.

I sort of feel like I have the responsibility to share my story so the myth of awesome fertility into your 40s goes away, and to go with it, the myth that infertility only happens to women 35+.  But then I think, "But is it worth it? What if I'd just make people annoyed with me?"  I hate the mommy wars with a passion, and I'm all about making the right choices for you and your family.  My worry is that so many people are making choices without understanding the consequences that they'll kick themselves later.

And of course, I'm shy.  It hurts a lot to talk about waiting a year to get pregnant and have it end in miscarriage twice including a d&c just before finals (super stress! Terribly healthy).  But then I consider that PCOS is hereditary and I have female relatives in exactly this "waiting" zone who may have no idea they have it because of taking oral contraceptives for years (probably almost 20 for one of my cousins with zero children).

So I never know what to say and I haven't said anything yet, but I feel like I shouldn't wait either.  On the one side, I hate squashing the fun of being young with "you won't be young forever and you may not magically be fertile so don't wait forever!" doom and gloom.  On the other hand, I hate the idea that someone who has a choice to wait or not is waiting and winds up with an infertility heart break.

Tuesday, January 29, 2013


At present, there are a few quandries running around in my head, so yall out there reading this (the 5 of you), suggestions welcome.  My brain is very heavily into school and school alone at this point (and yes, I can tell you the starting replacement dose for almost any electrolyte you'd like to have, thanks very much), which makes this burning desire to nest really challenging.

1. First to second floor communication with sleeping baby/kid: We have this lovely 2 story house that's pushing a century old.  Much of it gets awful cell phone reception, and we only have one anyway, meaning we could call from the cell upstairs to the land line downstairs, but the land line resides far from the living room/future baby territory.  Do we get another phone so the land line is upstairs as well and could be called from gchat in case of emergency or do we try walkie talkies?  Or does the sleeping parent get the couch and the infant care parent get another room on the same floor?  Previously with the kid, we took 3 hour shifts for rocking/diapering/whatever while the other person slept, and in case of actual kid sleep, we could call in early to get help moving the babe without waking.  I imagine some of this is in our future, so I'm hoping to develop a plan.

2. Split level baby accommodations: the spouse thinks one Little Monster bed is adequate, I think that perhaps we should have a downstairs bed as well.  We have one fancy changing pad and it will be upstairs in the kid room, and we'll have somewhere downstairs to change Little Monster too, but then there's the consideration of where the primary dirty diaper storage will happen (or if two small storage receptacles are better).  We've never had two real floors before (plus a basement) so no idea how this might work.  Help?

3. How long do you do "rooming in" anyway?  The kid slept in our room until she was 6 months, and the first 3 or so was on purpose with the next 3 happening because we had one room.

4. Cat troubles: Currently the adult bedroom has a door (read: is cat-free at night because zie is a bed hog) and the child bedroom does not, so the cat sleeps on the recliner in the kid's room (likes people I guess).  In the mornings, if nobody is awake at Cat Feeding O'Clock (time varies, but is usually about 5:45am), the knocking of all the things onto the floor commences, and then the meowing at our door if nobody is awoken by the ruckus.  Do we need to prevent the cat from terrorizing Little Monster as a way to wake everyone, or do we wait to see if Fluffinella realizes this is an option first, and should we be keeping the cat out of the crib even before it's occupied regularly (aside from the pirate octopus festive bedding, that is)?

5. Is there an app that does all the things that the Itzbeen timer times, and can I make it sync across iDevices and/or the internet itself (a web interface too)?

6. The life raft maternity pillow: should it come to the hospital too or do I beg for adequate alternative hospital-issued pillows? It is a bit big and hard to wash, but sooooo comfy...

Sunday, January 27, 2013


I'm super duper sick. Still.  It's been a week of occasional fevers and mostly hacking and feeling awful.  I had no idea my face could be this puffy (and seeing myself clearly was a mistake. No more peeking.).

On the upside, the new OB in the practice is great.  Yay!  It's pretty exciting, I think.  It's a shame she didn't start sooner. During my check-up, she did the quick "and what general thing is wrong with you?" questioning, and I got a lovely decongestant that makes my heart race so I'm taking it sparingly and an antibiotic for the clearly bacterial part of this illness (let's just not mention it specifically as it's gross).

I suspect that I've gotten the flu, based on the minor illnesses of the spouse and kid (they were both sick for 2-4 days, maybe 24 hours of a fever) and me being very sick.  Yes, that's right.  Get yer flu shot, because 2 of 3 people here had them and were very minimally sick... and me, since I got 3 hives after my last flu shot, I didn't get one this year.  I'm pretty excited about the egg-free vaccine that's coming out soon, probably in time for the fall flu shot season.  Now flu shots for very nearly everyone!

One of the highlights of being sick has been dreaming of the desert.  I've been up every couple of hours, sleeping about 10 hours a day total but with good sized gaps.  How on earth my shivering, drenched self winds up dreaming of Arizona and cacti and sand twisters I have no idea.  At least it's consistent. 

Lab this week was about dehydration and fluid overload, so maybe that's contributing to the lovely painted desert dreams.  Thrilling experience, finding a corner to sit with my box of tissue, pile of snacks, and 3 drinks for... I'm actually not sure how long lab is. Very long with no breaks.

The spouse is convinced it's because I'm pondering with much more seriousness Indian Health Service and the cool locations I've heard about are in the desert out west.  Also possible.  I'm not sure though if I could live in a place where it never snows, if I could live with myself raising Little Monster in a place with no skiing or sledding or snow days (because if we do this, we'd move in the summer of 2015 and I imagine Little Monster wouldn't remember snow at all).

We got our first new computer since we got married on Friday, and it's a desktop.  We realized that the kid had no concept of a desktop, since we've just had laptops (for work or school) since she's been around.  She will need her own chair for it pretty soon with the amount she wants to use it or "help" with using it.  Note to self: establish computer limits now that there's a computer cool enough for the kid to want to use it.  I would have thought that with the cool new TV (can you tell we don't expect to buy a new thing again after Little Monster gets here and are stocking up now) the kid would be watching movies on that, but noooo... movies on new computer!

I think it's time for another foray into the desert.  Maybe there will be Gila monsters this time.

Saturday, January 26, 2013

Curiouser and curiouser

Here's a couple of things I've been thinking about lately:

1. "I don't know where that is, I'm not from here."
We're setting up interviews with folks for Little Monster care, and since these are with people we randomly connected with on the internet, I'm of a mind that they should be somewhere public for everyone's comfort.  I also happen to know a friend of a gal who was killed after responding to a craigs.list childcare job posting, so I get being cautious.  In this light, I figured that a coffee shop would be appropriate.  There are a few around town, so I started off suggesting the one that's in an old fast food place because it is relatively large and has a big old former fast-food sign.  It's also across the street from the college and a half mile from the big box shopping area, so I presume most people have seen it, no matter how long you've lived here.

The response from one person was "I have no idea where that is, I'm not from here originally."  Newsflash: me neither!  We've actually lived here the same amount of time!  I suppose that if this is the first new place you've ever been, it might be hard to get out, or if you never drink coffee, you'd have no idea about the coffee places... but there is the go.ogle, and I picked places with websites.

My strategy when we are in a place even for a week is to know where the important stuff is: gas station, grocery store, restaurant or two, and then possibly the hospital.  When we move somewhere, I expand to figure out where there's big box type store(s) or a general store,  the library (and a vague sense of "open often" or "open rarely"), and a coffee shop or similar cafe.  I just see it as part of moving that you hunt down these places and figure out how to get to and from them, so it's a mystery to me that "but I've only lived here for 6 months!" is a reason not to know or figure out where a common public place is.  I'll grant you, the coffee shop downtown that's on a weird diagonal street between major streets is hard to find even with an address, but if not a coffee shop, is there a better public meeting place?  The community center we don't have (or if there is one, I haven't found it yet since we have a fancy gym/community gathering space instead)? Hmm.

2. Father-daughter dance events
The local gym/community center-ish place is having a father-daughter ball sometime soon in celebration of possibly Valentine's day.  I admit to being a wee bit weirded out by this event.  Yes, it's a nice idea to have daddy-daughter things, but the related Purity Ball things? Whoa weird.  (I should say that as a resident of a place it snows for most of my life, debutante balls are not a thing that's typical around here so this is a bit culture shock, a bit personal preference for less glorifying stuff).  I see no reason for girls to promise that when Daddy gives them away on their wedding day, they're still virgins, let alone in public at some strange group ritual.  Very odd.  This particular event is just supposed to be a dance, an occasion for little girls to dress up, play princess, and have Daddy (or Grandpa) take them to a fancy dinner and dance.

I guess I object to such deals further on the idea that little girls need to be taken care of more than little boys.  There aren't mother-son Purity Ball equivalents where sons promise to stay virgins until marriage.  There's no occasion where little boys are expected to dress up and pretend to be royalty while being doted on by moms.  I'm not a fan of the double standards we build for boys and girls.  My kid is just starting to get the very distinct line between "girls can do anything" and "boys can't do girl things" that's so much a part of growing up today.  As much as I tell her this is untrue, that boys can wear dresses if they want, and they can like pink if they want, my opinion isn't the one that matters.  Her peers' opinions are what matter and besides choosing them carefully for her, there's not much I can do.

Some of it I get, that women are stuck with the physical evidence of pregnancy, and there's no avoiding that, while the man involved can deny involvement convincingly until there's a DNA test to prove otherwise (and the damage is so much less severe to a man than a woman).  But how should that change how I parent my kids?  I think I should be having the same talk with girls and boys about sex and how risky it is without marriage or a relationship like it, how sex and love are physiologically intertwined so it's worth waiting to have sex until you've got emotions to go with it.

3. The ever-shifting technology line
When I got a cell phone, I was 17 and I could use it sometimes.  It was the family cell phone.  I took it with to school so I could call home (because it was long-distance, I couldn't just use the phone at school).  It was not for texting, it was only for calling friends after 9pm and on weekends (again with the long-distance problem), or for emergencies like the time I put the car into a 7 foot snowbank.

When the kid first used a touch screen device, she was about 30 months old.  Now she can navigate it herself for hours if there's enough battery.  There are apps on it that are just for her, some that are also for adults, and lots that are "boring grown up things."

The first time I touched a computer, I was probably about 18 months old and I had my own program on it when I was 4 or 5.  It took 15 minutes to turn on and start my program.

Now that we know the technology better, as its use matures, I think the line between using technology and withholding it has to change too.  The trouble is that it's hard to know where the line ought to be.  We went to the Giant Store of Swedish Furniture (i.kea) the other week and I was shocked at the number of children under 3 who were intently watching an iDevice or smart phone while in strollers.  I think I'll probably try to keep screen devices away from Little Monster until zie is at least 3 unless it's viewed only (like a tike movie in the car on a long trip).  But how long can I keep a personal electronic device away from the kid? At what age can she have an iPod of her own? Or an iPad?  We actually have more small digital music players than house residents right now, so she could have one of her own now if we weren't opposed to it.  IT'S SO COMPLICATED.  My brain may explode, so I give up for now and will think about it again some time.

Friday, January 25, 2013

Tweet tweet!

Tonight's Family Movie was the one about circus bugs and the saving the ants from the grasshoppers. I was so inspired by the little non-English speaking bugs that I joined Twitter. I'm @MomPharmD and I'll be following you all soon. Tweet tweet!

Family size

I've been contemplating family size lately, since we're getting close to being a family with more than one child.  (Holy moley whoa. WHOA. I'm slightly less in shock now than I was before but still.)

Here's where my original thoughts come from: watching my parents and their siblings.  My mom is the middle of three and my dad is the oldest of 5.  On the spouse's side, my MIL is one of just two and my FIL is one of...6 plus some given up for adoption they've since met (oh the complexities and how the world has changed in 50-60 years).  Because my parents are on the older side and one set of my grandparents were also "very old" parents, I've gotten to see much more how end of life stuff goes down in a family than most people my age.

My observations have really shaped how I see family size and what's desirable as far as siblings.  When my dad's parents started to decline and need lots of care, there were 5 siblings and 2 of their spouses to share the burden.  When my MIL's parents had the same sort of decline, there were only the two of them and one spouse, so the burden was so much greater and it was more of a struggle to decide what to do.  You'd think that with 6 sources of ideas, it would be harder to decide on a course of action, but because there were so many more folks giving input it was easier to see the clear choice to make.  With only two people making hard choices, it took much longer to reach a conclusion about continuing care.

Maybe it's selfish of me to think about the day soon when I'll be the person deciding what's the next step for my parents, and how there's only the four of us (the sibling, spouse, and sibling's attachment plus me) to handle all of the mess my parents have gotten into (and believe me, I am thrilled to let them take care of themselves as long as possible, but it isn't going to last as at least one memory vanishes and health declines).  It hurts my head to realize that we (me and the spouse) will wind up with the responsibility for my parents as their health declines because my sibling just isn't there in life yet.  It is reality that smaller families mean increased elder care burdens when the time comes.  There won't be a way that we can split up care with everyone getting one day a week like my dad's family did.  We'd get well more than that.

All my life, my mom has gone on about how awful it is to be the middle child of three, and I can see that too.  It's been challenging for them because you wind up with three ideas, or just two and someone has to pick a side, and having to pick a side your whole life is no fun.  Someone is always losing and feeling like everyone else has sided against them.

So if I have my say, I think that 4 children makes for a great family size.  There's enough folks that you can have two versus two in family feud scenarios, nobody is the middle child alone, nobody is the odd one out, and you aren't only two where you get the terrible dichotomy of someone being right and someone being wrong.

The spouse hasn't seen so acutely how hard it is to be just two siblings, but has over time been convinced that a third child wouldn't be so bad and would probably be a fine idea.  But then, there's the consideration that we had a surprise 3 year gap with those three very sad losses mixed in.  Are we willing to have 8 years from child one to child three or longer, if it means we have to wait to retire?  Are we willing to suffer more losses?  Can we manage if I have to be on bed rest again at some point while pregnant and couldn't work for weeks?  What will it do to us to go through more losses?  What sort of fortune would it cost to get all the testing to know we've ruled out any reason for those losses?  How much are we willing to spend on a dream of the right family size (and knowing we won't have the money to spend on it for two years, does that change things, and what would we go through in the meantime)?

At the moment, our thought is that we'd like to adopt at least one more child and maintain birth order, because there are children out there who need stable families and we'd like to expand ours.  But then it gets complicated and expensive and there are other things to consider, like do we want to match skin tone or do we work at being a multicultural family, and how ready are we to have an open adoption, and how does that work with presumably two biological kids hanging around the place too?  Knowing that adoption costs at least twice what a healthy pregnancy costs (domestic, from foster care, in our area, as well as I can make out from a bit of research), money is again a thing to consider unfortunately.  Not a big fan of money and how much it influences our family building choices, but life is what it is.  We'd be less broke if I hadn't been in school forever or if we'd waited longer to acquire the kid so we had some solid income under our belts before her arrival.  Then again, there's no sense looking back and wishing away how you got to wherever you are now.

Life happens and sometimes it's surprising.  I suppose that for all this consideration and planning, there's another surprise again just around the corner.  It's just strange to me to realize this is very possibly the last weeks I'll ever be pregnant.  I didn't think about it until now and it's almost as surprising as it is that this is 33 weeks.  Whoa.

Thursday, January 24, 2013

Hypnobabies part 1: unboxing

I thought I would write a series of posts about my experience with the hypnobabies home study course.  I ordered the thing last week some time and it turned up eventually.  The spouse did the actual box opening since I was typing up a case report (that's a practice patient report, more specifically).

In case you're unfamiliar with the "unboxing" video meme, here's one of my very favorites. There exist unboxing videos for almost anything in existence these days.

First impressions: it rained pamphlets and packing peanuts when the box finally came open.  The cover letter that goes with it was fairly comical, as performed as a dramatic reading by the spouse with louder parts indicating RANDOM CAPITAL LETTERS, as-written pauses (or run-on sentences actually), and some eyebrow waggling for underlining.

Second impressions (or, when I had the course itself in my hands): I am unconvinced that doing only this childbirth preparation method is necessary or a good idea.  It also entertains me a great deal how many places on this thing it has a blank for Baby's Name.  Since we don't know if Little Monster will be a lady or gentleman baby, we don't know a name.  We've only recently narrowed down the lady baby names to probably one or two choices.

I laughed really hard at the 12 pt, dense text page for my healthcare provider to read.  As if I could convince my OB to read that!  I don't think I could even manage to read the thing fast enough to him for him to listen to it.  It has a vaguely cult-ish tone that I suspect would further suggest to my OB that I'm some crazy hippie who is to be patronized into shutting up and not taken seriously, and that's not going to get me good care.  That will make me a joke among the docs (and yes, the docs should be more sensitive and open to different things, but I am not an optimist when it comes to healthcare provider's time and willingness to try new things AT ALL).  If I were to write something for that purpose, it would be not more than a half page of text, and in bullet points.  I am going to bring it up at a visit, mention that I'm doing it and that it's typical for labor to look different for someone using self-hypnosis (and hey, the book mentions that, and it's exactly the slightly weird labor pattern I had with the kid, so that's something interesting), and that I do intend to try really hard to avoid any meds during labor and INCLUDING pitocin after delivery.

Third impression: The "brief guide" that's bound with the Partner Guide is 20-some pages long, so not all that brief if you ask me.  The Partner Guide is shorter yet. Hmm.

Overall: I'm excited about the course but unsurprised that it's a bit far out into right field for my personal tastes.  I prefer organic food when I can get it, but I recognize that sticking to a food budget is more important to survival.  This course feels like it is the ultra-free range, super duper organic, fair trade, here's-the-life-history-of-your-chicken crunchy childbirth option, so anything less than absolute adherence is made out to be just AWFUL... so I guess I will continue to be a terrible, irreverent person.

Wednesday, January 23, 2013

The awesome stuff

In the spirit of being fair about life with the 4 year old, here's a series of awesome things that have gone down this weekend.

1. The kid opened a board game that she got for the Festive Winter Holidays.  It's a game about ladybugs and most of it is counting.  When I first heard the spouse and kid playing it, I thought they were playing Candyland only it sounded really fun.  Then eventually I was done with my lecture review and I got to come play, and it's a great game.  I was trounced by the 4 year old and it was fun anyway.  Highly recommend this game for ages 3+ and especially if you've read the Eric Carle book about ladybugs (warning: very long book).  After we played, it was time for the adults to cook dinner, so the kid set about creating her own game using the pieces, feeding ladybugs aphids and some kind of adventure avoiding the aphid-stealing ants.  Best. Game. Ever.

2. A couple of weeks ago, the kid discovered Pokem.on videos at the local video rental place.  We rented a second disc of episodes this week, and she is hooked.  So of course, what does the spouse do?  Goes and finds a giant pile of cards for the card game.  Now they have created two decks and are attempting to learn all the rules (wow is it complicated).  I believe this is about turn 5 and it's taken 1.5 hours to get to this point with the explaining and whatnot.  BUT she is still entertained!  The kid is having a great time playing with these cards, even though she can't read, because there's symbols for just about every little element to the game on the cards.

3. I washed all of the currently found baby clothes in the newborn to 3 month sizes the other day.  Then I cried because EMOTIONS.  I remember the kid being tiny and wearing some of this stuff, and the time she stole my chemistry flashcards and ate ethanol (that's the good part of beer, for those of you not intimately familiar with chemistry) before I realized what she was up to, and I laughed for a good 15 minutes because MY BABY has been "drinking" while I wasn't looking that closely.  I am still mostly in shock that Little Monster will be here, eventually, in the relatively near future.  Holy wow that's amazing.  I also spend lots of time crying and hoping for everyone still awaiting the next part of the family's arrival.  It's so hard.  I'm not one to apologize for feeling what I do, but I am with you all who are waiting, so don't take me for insensitive.  I figure you are totally free not to read, and that's cool by me.  I understand how much it hurts.  Sheesh, honestly waiting around in the OB waiting area and seeing the ladies with the oldest younger than the kid and two more children and a giant belly just hurts my heart, and I think it always will.  It's hard to let go of the vision of your life you had before infertility hijacked it.  I do intend to continue to scoff at anyone who tells me "next summer when I'm pregnant" or anything like it, because you just never know.

Tuesday, January 22, 2013

Faces of ALI: The Unique Hell of Secondary Infertility

If you haven't yet, go read this lovely portrait of Esperanza over at Faces of ALI.  Jjiraffe has the words for this experience so much better laid out than anything I could say.  I'll wait.


In that first paragraph, she points to the VERY popular myth that infertility is because ladies are waiting around for ages before having babies.  In addition to Esperanza's story of young motherhood doesn't magically equal super fertility, I'll chip in mine.  I still have over a year until I'm 30 and we got our most official diagnosis with secondary infertility in the fall of 2010 (the Generic Infertility diagnosis was in the fall of 2008).  Yep, we did exactly what all the "you're infertile because you're so OLD" naysayers recommended and it didn't prevent infertility.  If anything it gave us more years of heartbreak because we believed the lie that because we were young, things would just work out eventually.

Yep, we got super lucky and I'm magically pregnant, but how long would we wait from here to a next child? Secondary infertility is really ugly.

We went to this parenting class last night, and everyone is introducing themselves, and how many children and what ages are they.  We're the only ones with just one (actually there were two other very pregnant ladies, one with an almost 2 year old, one expecting her first) and nobody else had over 4 years between children.  Mostly it was neatly lined up "mine are 6, 4, and 2" and "4 and 1" and all these shiny, happy, outwardly simple to achieve families (and while one family has triplets, I didn't get to ask the ART question, and I'm not sure I would have anyway).

It stings. I was glad to hear that it's unpleasant for the spouse too, and I don't think I'd have cried (gah twice) unless I were under the influence of lots of hormones, but it will always hurt some.  It hurts to have your reality assaulted and completely altered by circumstances beyond your control.

Here's the other stuff I've written about secondary infertility, just for reference (and my reference!).  I'll seriously consider those tag deals some day (labels here in blogger-land?).

Monday, January 21, 2013

PAIL Theme post: Where do babies come from?

So it's clear that this is a question that we've answered, on account of having a 4 year old who will be a big sister soon.

The short answer came from living on a farm.  The daddy and the mommy get together, and then the baby grows in mommy's tummy.  The kid has seen this process from conception to birth, although I'm not sure it sunk in very much.  I imagine that it will similarly be something she sees again, so that's the mechanics explanation taken care of.

In the people edition, we talked about how when a mommy and daddy love each other very much, sometimes they decide to have a baby, and the baby can grow inside the mommy.  

I think that we'll probably talk about the additional complexities that go with this in a year or two, especially since adoption is potentially on the horizon.  I think the best way for us to explain it is that sometimes mommies and daddies need help getting the baby to grow and sometimes that means some doctors need to help out.  Sometimes other people help too by growing the baby in their tummy or helping in other ways that involve complicated science (and you can ask more about it when you are older, Kid). 

In answer to the "how did the baby get in your tummy?" question, I'm at a loss.  Go ask your other parent.  We need to get to a sex ed class sometime soon so I feel more confident about how to have these conversations.  Our faith community puts on a workshop series for parents and kids based on the Our Whole Lives curriculum so we'll have to find one to go to soon.  Maybe I'll order the parent guide that goes with it now.

I think that I have no idea how to talk about adoption with the kid though, so I need to put that on my research radar for sooner rather than later, especially since we know some families with adopted children.

This is part of the PAIL monthly theme post series! Go check out what everyone else has to say!

Sunday, January 20, 2013

Rare benefit to being crazy and having children while in school

It's pretty typical for people to be all "whoa. You're in pharmacy school and have an almost 5 year old? I don't know how you do it!" when I mention that I do not stay home with the kid and cannot come for mommy and me or whatever it is during the day (why are all child-parent things in this town during the weekdays only? UGH).  I'd say it's pretty typical for people in any professional program to hear that.  The culture suggests the following are a good idea (and in order): go to college, get advanced degree, then get married, start career, have children.  If you aren't doing things in exactly that order, WHOA! People can't handle the dissonance.

I'd say that yes, if you are fortunate to be fertile enough to wait the possibly 10+ years getting an advanced degree (say MD or PhD) takes, that's a nice trajectory.  The trouble is that not everyone has that kind of time to wait or patience to wait (and of course, not everyone is in a serious and committed relationship sooner than that 10+ years anyhow, but since I know a great glut of people who have been together as long as the spouse and me but are only recently/not yet seriously attached and have zero children, I associate choice with waiting to have children until somewhere after the late 20s).  In our case, because we knew we were looking at lower than expected fertility, plus familial autism on both our sides where the only known/proven risk factor is parental age, we figured that we would make children work as younger people.  We decided that the spouse would do the first advanced degree and mine would be second because I'm younger and had more undergrad left when we got hitched.

The whole school/young family balance is not easy or fun.  It just isn't.  It's challenging to have school demanding 15 hours a day, 7 days a week (in a normal semester) and to add a relationship to the mix is hard, let alone adding small people to the mix.  But apparently being a mom in a relationship is hard on your career too (well, duh).  Today I read two very interesting articles about momming and work. 

One was about how long it took women history professors to get tenure and it found that single women got tenure faster than married ones, BUT also that married MEN got tenure faster than everyone (single men and any group of women).  This makes overt sense, even if I don't like it, because men who focus on a career or have the chance to have a spouse stay home and support them have an advantage.  I presume that if a woman has a spouse stay home and support her career, she'd get ahead too but there aren't a lot of chances to see this in action. 

Furthermore, if you have one career among two people, you move when a big opening in that career comes up.  If you have two careers, you have to consider how moving for an awesome opportunity impacts both and if you can have both careers in the new area.  If you add children to the mix, it's even harder to move if something amazing comes up for one career only.

The other article I read was about pregnancy discrimination and how much it winds up costing women to be visibly pregnant.  I'm not talking about the thing that happens where suddenly your every conversation with a new person is exclusively about your impending offspring, but actual dollars and cents in addition to being perceived as less competant, less committed to their jobs, less dependable, and less authoritative.  (Note: I get that if you hated your job pre-children, at the very least being pregnant makes you realize you are not all that committed to your job, so maybe people see that... but I think it's a prejudice for the most part.)  In dollars and cents, the article points to research showing that the pay gap between mothers and non-mothers is BIGGER than between women and men (more than the extra 28 cents per dollar men earn, meaning women earn $0.72 to a man's $1.00).

So how is this beneficial if you're a student parent?  Easy.  Nobody can discriminate against me for being a pregnant student.  Nobody can pay me less or skip me for a raise for being a parent.  If I'm done being pregnant by the time I graduate (and that's out there as a possibility) then I get to start my career without ever having to go through the "oh yeah, I'm pregnant" discussion with my boss.  Yep, I'll have to navigate the balance between parenting and working, and how much to mention or not about my private life, but it's a lot easier to do that with no visible, on my person signs of my family changing.

How sad is it that it's advantageous to torment myself by doing school and having a young family at once to avoid the struggle with discrimination against moms?    How horrible is it that marriage isn't an equally beneficial institution?  On the one hand, I am proud of how far we've come since my grandmother was encouraged to become a secretary and she became a professor instead.  On the other hand, I got the very same talk from a (woman) guidance counselor in high school.

I do, however, someday get to be the boss.  It's in my plan to be the boss, whether that's owning my own pharmacy or managing a hospital pharmacy.  When I'm the boss, everyone gets paid parental leave and is expected to take it.  I will ASK parents if they are interested in a more time-consuming or travel-involving promotion before skipping them.  I will do my best to never talk about my children (whoa. plural children is something that is very likely to be real soon...) more with female than male coworkers.  I won't assume that a pregnant person suddenly wants to talk about family and not work while at work, or that priorities have necessarily shifted toward home and away from work (because I am the boss in this imagined scenario, I expect my employees to TELL ME if their priorities have shifted and they want a different position or responsibilities to match).  I get to pay everyone equally based on experience and whatever salary scheme I come up with around qualifications.  I get to be sure that time off for medical appointments is allowed for everyone in case someone (when perhaps) needs to make lots of trips to the RE in search of a baby.

And as a woman, I have every intention of piping up for other women around me who are new (rookie? prospective?) parents so they don't have to carry the burden alone.  I'll keep conversations with pregnant ladies professional unless they bring up children first.  I'll do my part to keep my family out of the workplace as a bargaining tool ("I need this week off because my kid has a field trip" type deals).  I will demand fair pay and rationale if I don't get an expected raise for something like "lack of commitment to the company."  It looks like we'll be in the unusual spot where my career may be the only career for a year or two, so I intend to work like crazy to get ahead because it makes our lives so much more stable.  Maybe my little family can help pave the way for better gender equity in the professional realm.

(disclaimer: yep, I am not talking at all about the inequity that women choose by choosing lower paid jobs or not working full time or as many hours like a lawyer "only" working 50 hours a week. That's another issue than discrimination against women who are/about to be parents, and warrants its own discussion.)

Friday, January 18, 2013

Things nobody tells you about nursing: oversupply

Trigger warning!  This is about that whole breastfeeding thing, and it's mostly about mechanics.  I should write another post about emotions that went with it sometime, because it was an emotional experience for all 13 months we did it (note: not mostly happy, cheery, oh how wonderful is this! emotions that you hear so much about).  But that will come at some point.

Obligatory silly picture, this time of a guinea pig in a bonnet!

You will find lots and lots of information all over the internet about what to do if you really want to breastfeed and don't have enough milk (or someone has told you that you don't have enough milk, which many times is untrue).  However, there's a lot less around about what to do if you have way too much milk (and there was hardly any 5 years ago when we dealt with it).  But for the curious, here's an article by an expert that links to some other articles too!  Here's my experience with it with the kid.  I'm not a lactation consultant or trained in any way, so if you've got this problem too, check with someone who is trained for their specific advice for you and your small person.

I started off with a vast supply of milk.  When my milk came in, it didn't stop at "in" but moved right on into leaking.  Lots.  And this was at 18 hours post-delivery, so the kid wasn't really interested in much milk just yet as a snoozing brand new baby.

The first time I talked with the lactation consultant (about 2 hours postpartum) I felt pretty confident about the whole thing.  My mom was a La Leche League leader or whatever it's called and nursed the sibling for 3.5 or 4.5 years (me more than a year but well less than 2), my MIL nursed both her kids for at least 6 months exclusively and in part for a few months after that.  Heck, my grandma nursed all three of her kids too.  I felt like I had a supportive environment and some experienced ladies around to support me (when they were around, which wasn't that much).

The second time I talked with the lactation consultant was a few hours after my milk came in, when she told me "your supply should regulate itself in a few weeks, so if it hasn't, come back in a couple and we'll talk."

So we nursed on demand, as long as the kid wanted, and it went fairly well latch-wise.  I started pumping before the occasional feeding (on the same side of course) and would feed the kid after I'd pumped 2-4 ounces at about 3 weeks old, but I was hesitant because I didn't want to suggest my body make any more milk.  I spent my time wearing a bath towel with my robe and changing towels every few hours when they were totally soaked through.

My doctor said the same thing, that it would be better in a few weeks (at the kid's 2 week visit, where I had to change nursing pads after the 25 minute appointment because they were soaked).  Then I got a depo.provera shot at the 6 week postpartum visit, and heard again that "this will help regulate your supply" and that having my period back should also help (yes, period at 6 weeks postpartum, silly overachieving body must have been proud about getting the pregnancy thing right).  It didn't.

So what's so bad about oversupply aside from being sopping all the time?  The balance of foremilk (mostly water) and hindmilk (much higher in fat) is totally off.  The kid would nurse for 15-20 minutes, burp, spit up most of what she'd eaten (or at least a whole lot, but being pretty happy), wait a few minutes, then act hungry again and eat another 10 minutes, then repeat for about half the feeds of the day.  Yep, the kid was gaining weight all along, but she wasn't a happy kid.  She spent several hours after her evening cluster-feeding suffering from colic.  Nobody knows what causes colic, it just happens.  However, since she got better at the same time I quit oozing milk constantly, I figure the two were related.

The thing that did help was nursing on one side only in blocks of several hours, but we didn't figure this out until maybe 10 weeks along.  First we tried 2 hour blocks for 3 days with no change, then 4 hour blocks, then 6 hour blocks (which hurt the other side a great deal).  That finally helped settle things down.

I also think that me going back to school when the kid was 12 weeks old helped too.  As much as "nurse on demand" is generally a great idea, when she could, the kid was snacking every hour during her "day" and this encouraged my body to produce too much.  When I wasn't right there for snacks, she suddenly decided to eat half as often but would nurse longer (and I presume took more by bottle, but since she'd had two bottles ever prior to that, there's no way to compare).  With pumping, I found that if I pumped at about the same time as her regular meals (but for much longer because I apparently don't do super well at pumping) I had no trouble keeping up the daytime schedule.  We did have some trouble when I didn't pump enough during 2 days we were mostly apart (I didn't pump during her night feeds) but it was just a hitch and my supply stayed right on track with her demands until I broke my ankle when she was 11 months old.

Short version of what helped with oversupply: pumping first, then nursing made for a happier baby, block nursing only on one side for several hours in a row rather than switching every feed helped, and some separation helped prevent snacking that my body was over-responding to.  Also lots of towels in the beginning.

General nursing things nobody tells you: the first 6 weeks are horrific, and the next 6 are often also not fun, but after that, it gets better and it's so much simpler to grab a diaper or two and a baby than to fuss about with bottles and formula.  I think the reduced time burden of not having to fuss with bottles really kept us sane when the spouse got a job and I was in school full-time, so I'm doing it again, despite being fairly ambivalent about how "wonderful" nursing was.  Let's face it, I'm lazy.  It's so much easier to yank my shirt around than to measure formula and water and mix it, and there's less fussing from the baby if the food is available faster.

Wednesday, January 16, 2013

Birth story 1.0 version 2.0 aka EMOTIONS

So I had an excellent time reading about birthing times from SRB over at Little Chicken Nuggets, A at Mellow in the Midwest, and at The Wild Rumpus this past week.  Big conversations about it all, because let's face it, it's a complicated and emotional deal this "giving birth" thing.  It inspired me to re-read what I wrote before about when the kid was born, and I realized that it was her story for the most part.

So here's my half of things. It's long... also note, I am writing about MY experience and MY preference to have any future children in a hospital because it's what works for ME.  There is no judgement intended and if you're reading that, then my bad.  Me, way too chicken to have a home birth.  You?  That's your deal and I am happy if you are happy and have a certified midwife (aka a med student with zero experience in labor and delivery in the woods somewhere is not a good idea, so just say no and go to the ER... not that I know someone who thought it WAS a good idea and needed a vast quantity of stitches when she did get to the hospital... ahem...).

At my "and now you are 40 weeks and still pregnant with nearly too high blood pressure" visit on my due date, my doc scheduled a non stress test for 4 days later, saying, "But I'll probably see you in delivery before then."  After the NST was normal and I was still pregnant (effaced but no change in dilation in weeks), I was scheduled to come back in another 4 days to decide how soon to induce because my blood pressure was staying right there at the line of scary and normal.  I was a little tiny bit worried by the blood pressure, but mostly just really exhausted.  I had contractions starting at 35 weeks that would last for almost a minute, sometimes up to 5 an hour, and then they'd quit, so I figured there was no hurrying things along.  Kid had her very own schedule to keep all along.

I have to say that I was thrilled with my doctor, a family practice doc.  She figured out what was wrong when I was bleeding at 13 weeks that 2 previous docs had missed, she understood my weird food allergy/sensitivities (that never happens, sometimes not even with docs who specialize in allergies...), and was all-around awesome.  She even came in early one day to visit me when I had my appendix out (which I think was optional as the hospital doc was officially in charge of me).  I didn't feel pushed at all into plotting an induction because I had researched the pants off of hypertension in pregnancy and I knew the stats got icky after a while... and I was soooo tired and ready to be done gestating.  I'd also spent about 10 days only leaving the 2nd floor apartment to go to the doctor so I was stir-crazy.

So when the actual, official, for keeps contractions started (on day 3 since prior appointment), I was fairly unimpressed for the first 3 hours.  I charted them and figured that either this would be it or not, but whatever.  I fought with my math homework and lost, so I watched terrible broadcast TV (we got 3 channels, two of them FOX, arg).  When the contractions got to be more like every 9 minutes I was more interested in them, possibly even excited that this might be it.  No pain yet really, just crampiness and "oh that again" sorts of things.

At about 8 minutes apart for 30-40 minutes we called our doula to join us milling around.  In the hour from our call to her arrival (more than an hour? no real concept) I'd say that it felt "real" to me.  We were really going to have a baby and soon.  This was probably 10pm or so, and nobody was tired, so there was more bemoaning the awful TV choices, chatting, I glared at my math textbook some, and mostly things were comfortable.  Since we weren't tired until about 2am and by then my contractions were getting hard to talk through, there was no sleeping.  At 3am-ish, I couldn't talk through them anymore and decided it was time to go to the hospital, since the contractions had been 4 minutes apart for an hour.  I remember feeling really focused and confident that I could do it, that this whole birth thing was no huge obstacle.  I'd started on some self-hypnosis to manage pain and it was working pretty well, because I wasn't really in much pain, just I had to only focus during contractions rather than doing anything else.

We got to the hospital, got checked in, and verified that nobody was making me get an IV port since I really didn't want any pain meds.  This was probably helped along because the nurse who spent an hour trying to get an IV set up when I had my appendix out just 21 weeks earlier was my nurse.  I think she was thrilled to not have to repeat the process.  At home I'd been snacking and drinking as much as I could to stay hydrated and avoid the horrid IV.  The snacking turned out to be a bad idea...

Sidenote: you'll note that "the nurse" doesn't have a name, and that's because I'm pretty sure I never saw the same nurse more than twice while I was in labor.  It was a new person every hour or so.

Eventually in the next couple of hours, my water broke and I started throwing up with each contraction.  Right then, the pain was very disruptive and I probably panicked a tiny bit, but the nurse was in and declared me "in transition" and once I heard that, it clicked.  I knew that this was the most pain and that if I could get through it, I was home free for the rest of the birth (not sure how I knew that but I felt sure of it, so that's what counts, eh?).  After maybe 4 or 5 contractions, I was so tired that I slept between contractions (and maybe during some too?).  Lots of pain but after the first few throwing up, I figured it couldn't get any worse.

I am pretty sure that with the sleeping and the hypnosis, I was in and out of being aware of anything for a few hours here.  I vaguely remember a nurse coming in and being concerned that I wasn't dilating fast enough and she "was going to talk to the doctor" but I don't remember a doctor coming in before mine turned up at 9am or so (can you tell I focused on the clock when conscious enough to do so?).  As it turns out, every room in L&D was full and they'd claimed an additional room for a woman in early labor from recovery, so I imagine the doctor on call was busy with someone else.  I remember the girl down the hall screaming a lot and the nurse commenting that the 16 year olds always screamed so much, and the woman next door swearing a lot.  Mostly I just focused and tried to breathe.

At some point the kid moved so nobody could get a heart rate on her externally, even with the handheld doppler.  Apparently her heart rate had been doing something funny before they couldn't track it, and my amniotic fluid was yellow, so there was some cause for concern.  I came to enough to realize we were talking about internal monitoring and that meant I'd have to stay in bed, but since I'd been laboring laying on my side anyway, I wasn't fussed, so we went with it.  It did mean itchy tape, but eventually I quit letting it distract me and got focused on the clock again.

Eventually I felt like pushing, so my doula or the spouse fetched a nurse and I was at 10 cm on my side but not quite 10 when I rolled over (maybe onto my back, maybe the other side).  This part I was not a fan of, the having to wait.  It wasn't more than a few contractions before the army showed up and I was warned they were turning on the blinding lights, but my doctor was there, so I was very comfortable, even with the light.

I was just whispering at this point, and I was really glad that the nurses and my doctor followed my lead and were also very quiet (or at least not loud).  After maybe 20 minutes or so of pushing, the kid's heart rate quit doing what it was supposed to during a contraction and it wasn't coming back up fast enough afterward, so my doctor explained the options quickly: we could try another push or two but with what her heart rate was doing, it was getting dangerous, and since she was so close to crowning, we probably needed to do an assisted delivery if she wasn't born right away.  I said OK to one more push, and made zero progress (for the 4th or 5th contraction in a row, and I was getting frustrated), so that was it.  Another army of people turned up, the giant tray of implements of destruction was opened and things were handed over, and just before the next contraction I got some novo.caine and an episiotomy.  With the contraction, I pushed and using the fancy vacuum-extraction deal, the doctor pulled, and there was a very blue baby.  I think a nurse cut her cord as soon as her head was out since it was very much around her neck.  She got some chest compressions with face suction from what I could see, I rested and held the spouse and my doula's hands, and then there was wailing.  Then there are pictures of me and the spouse crying together, because sheesh! It was scary at the end there.  Everyone not talking really fast over by the warmer let out a breath all at once, and they bundled the kid off to the nursery after a few seconds by the bed so I could see her.  Someone realized she didn't have an ID bracelet yet, so her foot got uncovered quickly to put it on, and the spouse went with her to the nursery (carrying an ID bracelet that I presume got put on when they arrived).  It was a bit scary but I was in a good place and I figured there was no need to panic.  She was in good hands.

After the placenta business, I got a bunch of stitches for the 3rd degree episiotomy and another 2nd degree tear.  Then the army of people was suddenly all gone and the L&D nurse was insisting I drink something, at least two glasses, or I'd have to have an IV.  I had some tea and some apple juice, then sent my doula down to the nursery with the camera to take some pictures of the wee tike for me since I had to hang around for a bit longer in bed.  About the time she came back, I was inspected again and cleared to get up and be about (so it had been an hour or two somehow magically since the army left me mostly alone).  When I got to the nursery, the kid was un-blue enough to be allowed out of the oxygen hood (no cool nasal prongs for babies at this hospital) and the nurses had me get settled to try nursing in a rocking chair.  No dice, so since her something level was too low, she had a tiny cup of formula (drank 5 mL as I recall, and that was it until she got cow's milk at 12 months).  Eventually the spouse and I decided we were hungry and the kid was dozing in her hood, so we left to get food and move to a regular room.  I think because we had a complicated delivery we got a few extra hours to hang around in the delivery room, and it was nice.

In a few hours the pediatrician cleared her to come room in with us and we had a lovely time figuring out how this "nursing" thing was supposed to work (which is to say, not doing spectacularly but muddling along).  The next day I woke up soaked because my milk came in while I was asleep (from say 2am to 7am, sleepy kid).  I'd sort of felt like a failure for getting the kid stuck right at the end there, but mostly I was at peace with it as really necessary. 

From here, it's a story of milk oversupply and the challenges that go with that (the choking, the reflux, the eating all the time because there's never any hindmilk) and me whining about my hatred of smelling like milk all the time. I suppose I should write about oversupply some time because it's a scary and challenging thing to deal with too, not just some kind of gift horse.  Trojan horse I say!

In the immediate aftermath, I was scared but grateful.  This tiny person that I was mostly the boss of had come quite close to dying, had an x-ray to rule out a heart defect, and now spent hours nursing and then spitting up most of what she ate (and she nursed 12-14 times a day, at about even intervals in that first two weeks, then cut back to just 10 times a day with a cluster in the evening before the colic howling).

I'm really glad that I had a doctor, that I had a doctor I trusted, that we knew enough about what bad things might happen and when they were needed so we could make a quick decision without the doctor rushing us, and that I had a doula to run interference with the nurses so they weren't bugging me too much.  We saw the free hospital lactation consultant at least twice in the hospital and 2 or 3 times postpartum, and I went on my way disliking nursing but being all right with the birth experience.  Sometimes  I feel like a failure for needing help at the end of delivery but not usually.  Mostly, I just hope that this time, with a set of doctors I'm not wild about and who tend to see me as a baby factory rather than a person, things will come close to going as smoothly (pre-delivery at least, that last 10 minutes could be smoother).  With these docs though, I'll push hard if they want to induce for anything but pre-eclampsia or 42 weeks even because I'm not sure how far I trust them to know what's best and I'll demand a second opinion.

I will say that I don't talk about my birth experience at all, ever.  It's my deal and I don't like talking about it in person.  Possibly it's a reflection of the fact that zero of my age-mate friends and relatives are having children (and they are not, or not on purpose), possibly it's that it was scarier and more traumatic than I usually think about it being, but I think fortunately the trauma was circumstantial and not created by anyone.  It's a lot easier to live with, knowing that scary things happen, and sometimes it's totally all right.  I'm sticking with that thought and assuming that Little Monster will wait to turn up until after my spring break just for fun or spite or being on hir own schedule.

Tuesday, January 15, 2013

The dessert saga

I've concluded that the kid will never have dessert again.

In the last week, she's quit eating and started demanding sugary drinks and desserts.  By "quit eating," I mean that she eats less than half of her normal meal, declares herself full, and then whines for a cookie, or some candy, or the graham crackers, or whatever.  Sometimes there's even zero wait time from "I'm SO FULL I just don't have room in my tummy for any more food" to "Can I have a cookie? You promised I could have a cookie!"  The trouble is that it's technically accurate, we did say at the start of the day that IF she behaved, she could have a cookie.  Eating three bites of dinner doesn't qualify as full, nor does it qualify as well behaved when she screams for 20 minutes about her cookie demands.

My thought on the "no more desserts ever" line is that there will be no negotiations.  None.  All desserts are verboten and it is simple: no, not today, not tomorrow, never.  The adults will have to be sneakier about desserts, but we can be sneaky and have our tiny amounts of sweets too.

While I'm taking away things that are making my life a fiasco, I think I'll rule out week night TV as well.  We currently have a TV black-out time of 6pm, so in theory we get 2 good hours of wind-down before bed, but it gets fudged.  Maybe she starts some episode at 5:45, so it runs over a bit.  Maybe she doesn't get home until 6pm and we are tired and she won't play alone so we put on something to enjoy some scream-free time.

I am fed up with the saucy demands for "couldn't you just spoil me, just this once?"  Perhaps, if it were only ever actually once.  Once becomes "but the last time, you said I could..." and from there, we move into the land of Only Eats Graham Crackers and Marshmallows.

As much as it is helpful to understand that this is a phase, and an awkward one where the kid is starting to understand a tiny bit of what "we can't play with you right now, go play by yourself" means, it still irritates me.  If you listen to her caregivers (besides at daycare), this kid is a saint compared to other kids.  I expect decompression when we get her home, but to have only decompression and no even moderately well-behaved kid moments is hard.  Gah.  At daycare, occasionally a saint and occasionally trouble, so a pretty normal kid.

It's a lot for me to expect some of that normal to happen at home.  I think it's time to try even harder to get her to bed earlier because we are all happier if she sleeps properly.  If she wails herself to sleep over the cookie in 5 minutes, she is clearly overly tired.

In the realm of the dessert saga and not sleeping, I am considering giving up on the idea of sleep entirely  I mean, insomnia is one thing but pregnancy-augmented insomnia is just astounding.  I get tired enough to fall asleep only to wake moments later in agonizing pain from staying put too long... amazing!  Then I'm wide awake when the spouse's 5:30am alarm goes off, sure as shootin.  I stay vaguely exhausted all day and never tired enough to nap.  Sigh.  Terrible rom coms and looking like a raccoon for me.  The spouse turns up sometimes and asks what I'm watching, and I have no idea.  None at all.  It's all some peculiar series of convoluted twists until the destined couple gets together.  I admit to choosing them mostly based on if I like the the lead actress or not (Kelly MacDonald yes, some blond whose name I can't think of, no).  I should probably lay off the desserts too.

Monday, January 14, 2013

Life with one car

One of the things we changed when we moved was we ditched a car since we'd be in town and wouldn't need the second car. 

There's been a lot of adjustments as a result, although a good chunk of those are because we ditched the station wagon and kept the hatchback.

The big thing that's different is that our schedules either need to coordinate or I need to take the bus (and the bus stop is 3 blocks away, across a busy street, and kinda spendy, so I would rather drive the short distances around).  This means that I need to also be up and functional at 7am to drop the kid at daycare so I can then drop the spouse at work if I need the car during the day.

Otherwise, mostly having a small car limits how much we can buy on one trip or how many people can go with.  Example: we recently bought a double stroller, and in the box, it took up our entire hatch space (haven't tried it out of the box yet).  We also had 4 bags of groceries, so they got squished into the seat next to the kid.  This isn't going to work with carseat 2, so it means more frequent shopping trips or not everyone goes shopping.  Notable also is that we can't just buy stuff at i.kea and assume we can fit it in our car, no matter how few people we put in it.  It's pretty comical though to have me driving, the spouse behind me, and the passenger side of the car totally loaded with stuff along with the cargo space behind the rear seat. Clown car!

If I were working, would we need a second car? Probably not.  We have two bikes and town is only 4 miles or so across so at least one of us could bike (probably the cold-indestructible one so I could be lazy and drive. Who wears sandals in up to 3 inches of snow...). 

Life with one car is so much less of a headache.  It's nice to keep track of only one maintenance schedule, have lots of room for junk important stuff in the double garage (I adore the garage by the way, super luxurious), and to have a much lower insurance payment.  Since we sold the older car, we didn't change the car payment at all, but we aren't paying for all that extra fuel or oil.  I imagine that next year I'll make more of an effort to take the bus and be on top of its weird little schedule.

Currently, after 8ish months of practice at life with one car, we're thinking we'd like to stick with one car, maybe for the foreseeable future.  I'd never imagined that was possible, but here we are, making it work in a place with only nominal public transit.  The trick is having daycare within bike trailer distance of at least home and preferably one job (and a bike trailer big enough for offspring and stuff or at least copious bike bags for the stuff).  Right now we're close to this ideal but not quite close enough for it to work really well, but who knows what will happen.

I keep imagining next year and what will happen and I'm letting it go. Really. Mostly. I'm trying.  Somehow the job will work out (did I mention that the job we moved for won't last beyond August? Arg.), we'll be able to stay here at least until rotations, and I will either get amazing rotations magically all in one place or get to do my plethora (ok, so 5 that need to be in at least 3 places) of out of town rotations in cool places and somehow we can magically all go and it will just work out... hmm...

It is kind of funny though to watch the faces of the minivan owning, zero current offspring couples after our childbirth class admiring us and our tiny car (well, looking askance and astounded actually).  Oh suburbia, you are so wrong.  A minivan is not necessary.  It would be cool to have the space but we'd probably fill it with stuff or enlist the kid in hockey or playing the harp or something if we had one.

Sunday, January 13, 2013

What do you get out of taking a childbirth class a second time?

Here's what I've learned so far now that I've survived half of our hospital's childbirth class:

1. I must demand the spouse practice labor massage techniques a lot more because back massages are great.

2. Sitting on classroom chairs felt a lot like back labor, it made my back hurt so much.  Whew only one class this semester!

3. While the videos we are watching show all sorts of fancy, non-traditional labor positions (aka not laying on your back and not pushing lying down), this hospital doesn't have the stuff to support them (bar for bed squatting deliveries, yoga ball for labor, birthing chair, none of that).  How was I supposed to know the little rural hospital where I had the kid was so progressive to have all that stuff?

4. Hypnobirth is a novelty to labor & delivery nurses.  Decidedly going to have to be sure the spouse and doula are on top of explaining it so nobody is bugging me.  The concept of a doula was foreign to almost our entire class too (but at least not the nurses teaching it, so that's nice).  Hmm.

5. We are still among the youngest in the class.  I'd say that about 2 couples are younger than us (but not by much more than the 5 years since we had the kid), 2 about our age, and the other 3 are older (probably at least 5 if not more years older).  Moving to a less rural area makes at least that much of a difference.  Last time our class was about half early 20s, half early/mid 30s (so below national/state averages for having kids).

6. IV access is required.  Boo.  I'll be laboring at home as long as humanly possible since this is the case.  Tape gives me crazy hives so I want as little as possible.  PLUS I have to keep the IV access for 24 hours after delivery (seriously? ugh).  I get that getting an IV set in an emergency isn't fun, but a week of hives isn't either, and the odds of me needing an IV are very likely low (and get lower because I HATE having an IV and will work really hard to avoid it).

7. To add to the reasons I don't want an epidural, they do straight caths for women with one (that means that instead of leaving a catheter in, they just insert one every hour or two).  Too much risk of infection for me if I can help it at all.

8. I wrote a birth plan last night, and it can be summed up as the following:
  • I want a live, healthy, mom and baby at the end of this.  
  • While getting there, don't bug me.  
There are details to "don't bug me" like "don't tell me how dilated or whatever I am, don't offer pain meds because I'll ask if I want them, pretty please don't tell me about contractions, and no constant monitoring unless medically necessary."  Mostly, though, I'll stick with "don't bug me."  When it's prettified, I'll post it here probably.

9. About a third of deliveries are c-sections.  Joy.  On the upside, I have a good chance of being transferred to the next bigger hospital 45 minutes away if I need one.  Actually, that's not so much an upside as irritating. Maybe the docs there are less... whatever it is that makes me not the most thrilled with this practice.  It's not just a bigger hospital, it's a HUGE hospital complete with something approaching a hospital industrial complex around it (including 3 more big hospitals right nearby).  Very scary level of big and complicated.

10. Baby-friendly hospitals don't give out pacifiers (probably good) and 80% of women leave this hospital breastfeeding (probably also good).  I'm of course curious about how many are still nursing at 12 weeks and 6 months.  At least the class covers breastfeeding and there will be a lactation consultant around. (Did I mention that I'm now on the "oh fine, nursing it is" side of the decision to breastfeed because the spouse pointed out that if I'm not nursing, I have to return to cat box duty?  After almost 4 years of being excused from this, I'll stay away a bit longer.)

11. I am certainly getting myself the hypnobabies self-study course.  It worked before, and even if it doesn't work smoothly this time, it's better than nothing.  Novelty or not, it will help me be more present during labor (and I probably won't change all the language like it suggests because it's too ingrained in my life).

PAIL-related anecdote: At the start of the class, the teacher has us introduce ourselves and say what our favorite OR least favorite thing about this pregnancy has been (exact words).  The spouse went first, then me, and so I said that my least favorite part was being nauseous up to 24 weeks (actually it was more like 27).  My favorite part that I didn't say: I'm still pregnant!  It's miraculous to realize that every day.  Whoa.  Everyone else's favorites/least favorites (and they went with both after me, interestingly enough) were the usual sort - feeling him move, bonding, stretch marks, easy pregnancy, la la la.  I figured that I shouldn't put the fear of loss into the rookies.

Friday, January 11, 2013

When doctors aren't needed

One of the cool things wandering around the spheres of thought about health care is that pharmacists should do more disease management, since we have a super shortage of primary healthcare providers.  Last spring the US Public Health Service released a report about all the "trial projects" and demonstration sites they've had where after a patient gets a diagnosis, they see a pharmacist for follow-up.  It works really well, better than when patients see a doctor for that follow-up.

Relatively recently the NY times wrote an article mentioning this, and it makes me happy that we're getting that level of recognition. 

Why should we send people to see a pharmacist after getting a diagnosis from their doctor, aside from pharmacists being awesome and available?

Availability is a great reason to see a pharmacist.  Work weird hours?  There's probably a pharmacy open even weirder hours than you, and you can get in to see a pharmacist at some strange time.  Depending on how the pharmacy is set up, you might be able to drop in, wait a while, and get a short visit in.

Better outcomes is a good deal too.  Not surprisingly, when you get the medication expert on the healthcare team to talk to people about the medications they take, you get better adjusting of the meds than when the diagnosing expert chats with the patient about it.  This is not to say that doctors do a bad job! I think they do amazing things, but enabling doctors to focus on treating/diagnosing rather than having to also focus on the nuances of which medication is best in which set of complex circumstances would probably benefit them. 

Example in current system: Patient with high blood pressure develops a cough after taking lisino.pril, so we're going to switch to the next choice of an ARB (another similar medicine for high blood pressure), which while discovered by the pharmacist when Patient was picking up a refill, so refers Patient to doctor to get a prescription for the new drug.  Doc picks one based on what absolutely works best.  Patient goes back to pharmacy to get the new med, and it costs $125 a month because it's a brand name only product.  There's a generic ARB that works almost as well as that brand name drug and Patient's insurance has it for a low copay.  So the pharmacist calls the doc, and within a day or two, that change gets made.

Example in new system where pharmacists can prescribe for continuing care: Patient with high blood pressure getting a refill of lisin.opril has a cough but no cold, so Pharmacist switches to an ARB after checking Patient's insurance to see which one is covered.  A copy of the progress note gets sent to the doctor(s) involved.

Look at that! It took a lot less time for everyone for the pharmacist to just make the change based on an adverse reaction rather than seeing the doctor and then having to have a second change made because the doctor doesn't know prescription insurance like the pharmacist.

It goes beyond the simple "you're having a bad reaction to medication x, so now we try y instead" sort of change, of course.  There's increasing or decreasing doses based on simple lab parameters or something like blood pressure that we can measure.  There's changing medication based on more complex lab results we get from a bigger "real lab" like elderly people with low kidney function needing some slightly different medication.  Pharmacists are already trained to make these changes, and in many settings are already doing so.  Patients benefit.  It saves money.

How do we make it happen?  First we need to give pharmacists status to bill as healthcare providers according to Medicare (and the rest of insurers will follow along).  It makes me giggle a lot that a PA, with 2 years postgraduate educations, is allowed to prescribe but a pharmacist with 4 or 5 years postgraduate education isn't.  Make sense? Nope.

Second, doctors need to realize that pharmacists aren't trying to take over their jobs.  I never want to diagnose.  It isn't my job, I'm not trained to do it, and I don't want to.  I just want to work at the top of my license and save everyone some time by using my skills to their fullest.  In several states, doctors' organizations are very busy stopping pharmacists from legally expanding into areas like giving shots (let alone into prescribing for patients with a diagnosis).  Nurses get worried about pharmacists taking their jobs too, to which I say, again, no.  I don't want your job, I want to do my job better so everyone avoids headaches and wasted time.

To the nurses and doctors who are all "MY TURF!" I say: didn't you read that article in the NYT or the report from the Public Health service?  There's a shortage of doctors and primary care providers (advance practice nurses with prescribing rights and physicians' assistants).  Pharmacists can help fill that gap, especially in rural areas where there's a bigger shortage of primary care providers.  Where I live, it takes at least 6 weeks to see a primary care person outside of urgent care (and urgent care isn't the same thing as seeing a primary doc at all).  It's more like 10 weeks if you want a longer visit like a new patient or well-child visit.  It isn't very rural here, which means that in more rural areas, the shortage is worse.  Couldn't we play nice and let the pharmacists save doctors time with those continuing medications folks who need a tweak?  We can't be a healthcare team if doctors and nurses want their own private teams.  Patients lose in that system.

Saturday, January 5, 2013

A moment of grumpiness

In November, the clinic handed me a whole slew of "and now you're going to have a baby, here's stuff you should know" papers.  It included one about what newborn screening is, circumcision options and how much it costs, and a two-page deal on the prenatal education classes (maybe other stuff about carseats?).  I looked at the dates, saw that 1. they don't want you until 6 months along and 2. the last one of the year was the next day, so I requested the 2013 calendar of classes.  There wasn't one yet.  I ask again in early December and "no dates for sure yet."

They offer the class 6 times a year, half of those set up to be a long Saturday and a Friday night and half meeting 4 times for a few hours, but no classes for non-first time parents so no childcare available and no shorter version (breathing techniques can bite me, for example, and I have no desire to watch a video about labor ever again).

I was just realizing that we still hadn't gotten any dates since my last OB visit was almost 4 weeks ago, so I went and looked at the website today.  The January class starts next Monday!  Thanks for the advance notice of that!  And there's no class in February, so we will suffer and go to the 4 meeting class because I really want to be familiar with L&D ahead of time.  With a March due date, no class in December or February, that gives us a single class option to be in their 6+ months window. This happens to plenty of people, but it frustrates me doubly because the annual schedule wasn't done by the first of December.  Ugh.

UGH.  Big downside to living in the boonies with a single area hospital.

Friday, January 4, 2013

No more rose-colored glasses

Warning: I'm gonna talk about postpartum depression and life with a colicky baby.  Feel free not to read if it's not something you're comfortable with.

Also a cat picture, because they make everyone happy amiright? Cat in a window!

About this time 5 years ago, I was sitting down and figuring out exactly how things would go once the kid arrived.  We were budgeting for childcare and figuring out where to advertise and planning interviews and such.  Now, we're doing all those things again, only with a potentially lower stress semester about to start than the one 5 years ago (what idiot thought a full load including a math class was a good choice? It was me, wasn't it? I was very wrong).

I imagined the following: the spouse would be home for a few days after the kid was born but I'd figure things out enough to punt within that time, delivery would have been uncomplicated for all involved so we'd be home and healthy in rapid succession, nursing wouldn't be fun but would be doable, and the kid would sleep for at least 12 hours a day with no major sleep impediments in the way.

What we got: complicated delivery and a day in the hospital after an ambulance trip at age 7 days, only one day home for the spouse, super duper oversupply of milk (like whoa), mastitis at 3 weeks and again at 8 weeks, and colic starting at 10 days.  Whoa not anything imagined.  I wound up giving up the semester as a lost cause and being home starting at 7 weeks postpartum.

The other part that I hadn't considered was postpartum depression.  I'd say that anything that was wrong with me was that I was numb.  I quit caring, especially about myself.  Eating? I'll get to it, maybe.  Sleeping? Oh ha.  Bathing? Maybe tomorrow, the kid is howling. Still. After 5 hours straight.  I was numb for about 3 months, and then the colic went away and we all slept and I got better (phew).

For us, the real kicker was the spouse's postpartum depression.  It may have been that a family member died just before the kid was born (so we couldn't travel to the funeral and it was a surprise loss), or that the seasonal job's season got cut short with a scary auto accident, or that we were about to be homeless until the spouse's new job started a few months later, or just the hormonal overflow of the whole thing.  It was serious and scary for months until the spouse finally could afford some healthcare and see someone about it.

This time, we're trying to plan better and be prepared for the worst, if that's what we get.  Here's the specifics.

1. Have mental health well in hand before Little Monster arrives.  If I'm honest, things weren't so rosy last time even pre-baby.  We're getting check-ups and med adjustments dealt with ASAP so there are no existing problems to make worse.

2. Preparations for meals: we're buying a big ole freezer and I'm going to be loading it with food so we have things to defrost so meals are less trouble.

3. Support system: we didn't have one at all last time, so this time, I'm going to make a list of folk who have said or hinted that they'd like to help and put it next to the phone so when we need help, we know who to call.  We're scheduling infant childcare to include running the dishwasher and doing laundry, and to start before our due date (and we have a proper budget to pay for it so we won't have to cut hours to afford food either).  I'm also going to try to schedule a friend to come by for a few hours a week on the weekend so everyone can have a nap while someone else monitors the wee ones.

4. Lighter class load.  No math classes this time.  I'm just slow at math, so it takes twice as long as any other class.  Just the one class, and it's one I took before and did quite well in (although I missed the pass mark on the final by a single question).

5. Auto-pay for the bills.  Almost all bills will be set up to auto-pay on their scheduled due dates so we don't have to fret about it.  If we could arrange for grocery delivery, I'd do that too.  Similarly I'm going to switch all our prescriptions to auto-refill and delivery so when we are due to be out of something, it just magically shows up at the door (and yay for free prescription delivery).

6. Generate a "usual groceries" list so other people can do the shopping for us.  We also recently bought a pad of paper with a list of grocery items on it labeled "All Out Of" and little boxes to check, so when we run out of something, we have a record of what we need to buy.  Now I just need to get a pencil/pen on a string to go with it, because with no marking device, it just looks cool on the fridge.

7. In case of oversupply of milk, I'll pump before every baby feeding.  I think a good chunk of the Kid's terrible reflux was overeating to try to get to some hind milk last time around, so maybe we can fix that.  Before I was afraid pumping would keep my supply up too high, but since it regulated itself at about 14 weeks anyway, I think that so long as I didn't pump/nurse to empty with every feeding, it probably wouldn't do that.  At the least it would mean I'd have lots of frozen milk stored.

8. Plan for time out of the house with zero children or at least zero baby: The spouse is doing some kind of fancy fitness challenge at the gym (oh man, we have a gym membership! How luxurious!) so that will require a few hours a week.  I get the same number of hours (probably something like two) a week out of the house to have "me time" too.  Mental health breaks are really important and must remain a priority.

Most of this stuff is about streamlining our lives so we can focus on surviving rather than everything else that takes away from valuable sleeping time.  It's also about asking for help when we need it, knowing that we will need lots of help, and finding that help ahead of time so when/if things go badly, we're supported and they don't go as badly as before.

There's another emergency plan too: ask my mother to come help out.  She's mostly retired at this point, so she could come stay for a while and would if we ask.  The problem is that she and I tend not to see eye to eye about much and criticizing my every move (while providing no helpful/feasible alternatives) is one of her hobbies (and when I point out how hurtful it is, she proclaims that she wasn't criticizing anything at all! She was just making a suggestion!).  This is the emergency plan though because I'd rather not have to deal with the commentary on everything I'm doing wrong.  As helpful as another set of hands could be, I'm not sure it's worth the mental stress.  Mental health is priority one, so we're going to stick with that as long as possible.

I also think that splitting up the wailing colic time worked out fairly all right for us.  I fed the kid before her "bedtime" when she was so tired and so unable to sleep, then I'd go sleep for 3 hours while the spouse walked with the kid and sang to her so she'd stop howling and just look sad and wide awake, then we'd trade for 2-3 hours until the kid approached sleepy and could be put into bed to sleep (and she'd sleep for 3-6 hours in a row after the scream-fest most days).

Thursday, January 3, 2013

Media literacy and child rearing

In my "I'm going to teach English and stuff!" days, my specialty wasn't speech or reading or writing.  It was media literacy.  I'm not persuaded that media literacy belongs in a classroom with understanding literature and basic reading/writing, but it might.  It's certainly one of the more crucial literacies in the world today since there's lots to know and only so much time to understand everything.  I'll make the case that health/science literacy is also absolutely crucial.

Anyway, I read a very lovely post about our role in media literacy for young people, and how damaging kids' stuff that has bad role modeling in it really is.  A very short summary of the post: feminism is a big deal, and explaining the anti-woman stuff going on in the media (notably kids' movies) to kids in particular is important.  I'm going to try hard to keep the kid away from the specific movie mentioned (Beauty and the Beast) but it's more complicated than just explaining it.

I grew up with a something-or-other wave feminist-trained mother who'd given up all the trappings of her wave to stay home and raise children aside from the lectures on various things.  Scary movies were a very popular subject, but I've realized it's because my mother is terrified of them and actually doesn't concern the movies themselves.  The anti-woman stuff though, those lectures were notorious and repetitive.

I'm not convinced that it was effective to lecture 5 year old me about how terrible the relationship between Belle and the Beast was.  It was a nice idea but mostly I hated her ruining a nice movie by dissecting it and being mean about it (and sometimes trying to keep me from seeing things without explaining what was so awful about it).

So I get that we can't explain the controlling relationships of movies to 5 year olds without wringing all the fun out of being 5.  What do we do instead?  I've been considering that.  Here's my idea.

I think we do talk about the terrible media depictions of women and relationships as they come up, but we need to show a good example at the same time.  We need to limit the length of lectures because of short attention spans among little ones.  My kid doesn't need to know why it's bad that the Beast shouts at Belle, she just needs to know that it's never OK for a person to yell at someone they care about (and then I need to do that because "but everyone else [or Mommy] is doing thing x you just said I shouldn't do! Why can't I do it?" is very powerful in the 3-10 year old set). 

I also refuse to prohibit movies because they have awful depictions of women and women's roles, because that punishes the kid unnecessarily and we skip those chances for conversation.  I will however try really hard to find good example movies and show those too, then discuss the difference between the two.

We need to keep having the dialogue and doing the critical thinking as adults so we're ready to have the conversations with kids.  My part is to know what's wrong in media my kid(s) consume and to point it out in succinct ways when there's the opportunity without being judgy and dream-quashing.  It's a fine line and I need to keep my personal feelings out of it when explaining the facts about media she's consuming.  Example: it makes me mad that Gaston is so mean to Belle and stages a riot trying to imprison the Beast when she continues to ignore him.  The facts don't involve my anger.  Objectively, it's just wrong that a man won't accept "no" from a woman, so I can point that out.

I'm very fortunate to have a spouse who's also game to point out the awful things in the media the kid consumes, so it's a team effort.  I think one of the things that frustrated me so much about my parents' relationship was how one-sided it was - lectures from mom, silence from dad.  It was clear there was no unification of child-rearing goals, and as the child in the crossfire, I was very prone to avoid the whole thing and ignore it as an attempt at brainwashing.

I'll continue to struggle with a kid who just figured out she should do and like what all the other girls do and like, and that includes getting into trouble together (on purpose) and doing bad stuff together.  Explaining why she should stick up for what she knows is right (and to trust us about what is, in fact, right) will stay a struggle, but we'll stick with it.  Did I mention I hate girl drama, and what if we have another one? Girl drama for the next 18+ years... oh my.