http://mumpharmd.wordpress.com/2013/03/01/weekly-update-1/
Email for the password, which I'm happy to share:
mizfuturepharmd at gmail dot com
Thursday, February 28, 2013
Weekly update
I thought it would be nice to do a weekly update about Little Monster's growth, because I am sure to forget all of what happened, arguably so I have room in myhead to memorize important stuff about various medications.
They will be password protected so feel free to email me for the password. I'm happy to share but would like to limit readers to humans rather than spam-bots. I presume I'll post them between Thursday and Saturday.
EDITED to add: I may post them over at my intended new wordpress home, as an incentive to me to get this blog moved over there, with links here until that happens properly.
Email me at mizfuturepharmd at gmail dot com (and I'll figure out how to make that more prominent around here. Eventually.)
They will be password protected so feel free to email me for the password. I'm happy to share but would like to limit readers to humans rather than spam-bots. I presume I'll post them between Thursday and Saturday.
EDITED to add: I may post them over at my intended new wordpress home, as an incentive to me to get this blog moved over there, with links here until that happens properly.
Email me at mizfuturepharmd at gmail dot com (and I'll figure out how to make that more prominent around here. Eventually.)
Thursday, February 21, 2013
Considering the end of things
Very briefly I figured I'd mention the PAIL theme post for the month.
I'd wonder how I've missed it to this point, but man, did I ever. I blame school and the tiny human currently snoozing on me (again...).
We realized a few years ago that it was really time to get things in order, notably when my uncle was going through hospice at the end of his life and how nice it was for everyone to get things squared away. This was in stark contrast to the spouse's grandma who put off making a will for months after her diagnosis of terminal cancer and never did get to it, where her estate was in limbo for several YEARS and we have no idea what she intended to happen with her assets or even what they all were.
We've put it off since then.
It is high time to get to all the end of life planning stuff. We have put it off way too long. I've started the "in case of death" list of where our things are (money, life insurance that we should buy more of, debts, bills, things I don't want my parents to find that my sibling should remove before they do find them, all that jazz). It's in a document online that I'll share and update at least once a year. We've discussed who we want to have custody of the wee ones (squee! plural! yipes!) in the event we both die, but we need to touch base with the siblings to confirm our plans (and to tell the spiritual sponsors of the kid that we have moved them to second position because of the very minor role they've opted to play in her life). Tomorrow for pete's sakes I'm making an appointment to do our will and trust stuff with a local lawyer because IT IS TIME. We are not utterly broke and this is too important to put off.
Do we have the right sized stuff? Yes and no. We rent a house that's the perfect size for 2 kids but not for more or for 2 who cannot share a room. We have a tiny car that fits us snugly but exactly. If/when we add to our family, we'd have to change both of those, but the car is a couple of years and many thousands of miles old and the house is likely temporary along with the place (but maybe not).
On the whole it is high time to finish getting our ducks in a row so we can share that with our parents (and siblings) and be sure that they have done the same. I can guess that one set of parents can direct us to their lawyer who has a folder with all the details, and the other set of parents has been meaning to get to it one of these days. Of course the younger set will be right on top of things and the older set off in the woods expecting to live forever... Sigh...
I'd wonder how I've missed it to this point, but man, did I ever. I blame school and the tiny human currently snoozing on me (again...).
We realized a few years ago that it was really time to get things in order, notably when my uncle was going through hospice at the end of his life and how nice it was for everyone to get things squared away. This was in stark contrast to the spouse's grandma who put off making a will for months after her diagnosis of terminal cancer and never did get to it, where her estate was in limbo for several YEARS and we have no idea what she intended to happen with her assets or even what they all were.
We've put it off since then.
It is high time to get to all the end of life planning stuff. We have put it off way too long. I've started the "in case of death" list of where our things are (money, life insurance that we should buy more of, debts, bills, things I don't want my parents to find that my sibling should remove before they do find them, all that jazz). It's in a document online that I'll share and update at least once a year. We've discussed who we want to have custody of the wee ones (squee! plural! yipes!) in the event we both die, but we need to touch base with the siblings to confirm our plans (and to tell the spiritual sponsors of the kid that we have moved them to second position because of the very minor role they've opted to play in her life). Tomorrow for pete's sakes I'm making an appointment to do our will and trust stuff with a local lawyer because IT IS TIME. We are not utterly broke and this is too important to put off.
Do we have the right sized stuff? Yes and no. We rent a house that's the perfect size for 2 kids but not for more or for 2 who cannot share a room. We have a tiny car that fits us snugly but exactly. If/when we add to our family, we'd have to change both of those, but the car is a couple of years and many thousands of miles old and the house is likely temporary along with the place (but maybe not).
On the whole it is high time to finish getting our ducks in a row so we can share that with our parents (and siblings) and be sure that they have done the same. I can guess that one set of parents can direct us to their lawyer who has a folder with all the details, and the other set of parents has been meaning to get to it one of these days. Of course the younger set will be right on top of things and the older set off in the woods expecting to live forever... Sigh...
Tuesday, February 19, 2013
HA!
And now, a moment of laughter in the midst of homework and a sleepy haze. (Aside: my practice patients this week are very likely to die due to inattention... sorry imaginary people.)
I ordered replacement parts for my breast pump today since the originals have vanished into thin air. Some segment or other has shipped now, so I got the email notification, as follows:
Your Giant Dot Com Order of "Branded Custom Breast..." has shipped!
Nice. Way to go email generator. Now I'm ordering breasts in addition to many other strange things! HAH!
I ordered replacement parts for my breast pump today since the originals have vanished into thin air. Some segment or other has shipped now, so I got the email notification, as follows:
Your Giant Dot Com Order of "Branded Custom Breast..." has shipped!
Nice. Way to go email generator. Now I'm ordering breasts in addition to many other strange things! HAH!
Saturday, February 16, 2013
Luck favors the prepared
One of the most exciting things about a surprise 37ish week baby is just how unprepared it is possible to be. Carseat still in its box, no bed, cloth diapers unwashed, no groceries beyond the bulk stuff. We're getting caught up quickly but it's doubly tiring.
Aside from me feeling like a super grouch due to super engorgement today, and aside from that early labor online shopping spree being crucial, things are going well. A friend dropped by with a big sister present for the kid and some disposable diapers and onesies for Little Monster, so nobody has to go get them tomorrow. We've got a decent handle on nursing and sleeping, although having to roust Little Monster to eat is a bit strange, but still. Just amazing. Hopefully things keep ticking along and I get to keep hogging LM during her naps. There's something about a sleeping tiny person I find irresistible right now.
And that's my "go feed the baby" timer. Back to the land of spit-up and cuteness.
Aside from me feeling like a super grouch due to super engorgement today, and aside from that early labor online shopping spree being crucial, things are going well. A friend dropped by with a big sister present for the kid and some disposable diapers and onesies for Little Monster, so nobody has to go get them tomorrow. We've got a decent handle on nursing and sleeping, although having to roust Little Monster to eat is a bit strange, but still. Just amazing. Hopefully things keep ticking along and I get to keep hogging LM during her naps. There's something about a sleeping tiny person I find irresistible right now.
And that's my "go feed the baby" timer. Back to the land of spit-up and cuteness.
Wednesday, February 13, 2013
Well that was exciting
At just about 37 weeks, my water broke, and it was clearly go time for Little Monster's arrival. We're really excited that she is here! Everyone is doing well so far and the kid is a super excited big sister. Birth story to follow when I get to it.
For the moment, let's stick with what I said every few minutes for the first two hours after her arrival: wow. Just wow.
For the moment, let's stick with what I said every few minutes for the first two hours after her arrival: wow. Just wow.
Healthcare reform: birth control compromise?
One of the really snazzy features in the Affordable Care Act is the increase in no-cost-sharing preventative services for people with insurance. Sure, the subsidies and expanded (hopefully) government programs that increase access are awesome, but helping make sure that underinsured people get some value from their insurance is my personal favorite part.
One of the preventative services that has to be free is an annual wellness visit. Clearly, nothing but the visit itself counts as "no cost sharing" or otherwise known as "free." You'll pay through the nose for blood tests and any extra things your insurance company can manage to charge you for, but it's an improvement. With a free check-up annually, hopefully we catch more health problems sooner and avoid big illnesses.
Another one is birth control. It got deemed a preventative item just like vaccinations, so it has to be covered at no cost by insurers.
This one gets many up in arms though. Despite science saying that birth control pills suppress ovulation and have nothing to do with fertilized eggs as far as we can make out, some faiths have decided birth control is immoral because life begins at conception and there's an outside risk that these hormones might stop a fertilized egg from implanting. I can see how you can be of a mind to think life starts at conception, and it is America, so you are free to decide whatever you'd like.
My take: your beliefs apply to you yourself. Your faith says eating cows is immoral? Fine! Don't eat them. Just don't try to stop me (mmm... beef...).
The complexity: employers pay for health insurance, and individual business owners are those employers, and some of those people object to paying for healthcare they disapprove of. If we were a sensible country, we'd fix this by having everyone in a single healthcare pool so no single person would be paying for anyone else's healthcare choices. But we are not sensible. We are "free market" and how DARE we consider doing something that would save us all money and probably give us better care at the same time... hmm... but this is mostly a distinct issue.
This weird system has been supported for years, where we allow a few religious groups to get exempted from paying for very specific things they deem immoral. IVF is of course on this list. Hormonal contraceptives are on the list. Abortions are, sometimes also other pregnancy ending things like drugs to induce miscarriage (that are used for molar and ectopic pregnancies as well as elective terminations, but of course they don't make that distinction).
To me, this seems like a case of me choosing to make a moral decision for someone else based on my moral views for myself. It bothers me that someone can decide for me whether it's moral for me to use contraceptives or have IVF. It's my life, my body, I should get to be the boss of it without anyone intervening in the process.
The compromise that the White House has issued is that employers will pay for healthcare, and health insurers will pay for those "morally reprehensible" parts that are federally required (aka contraceptives). It's a shell game at best, but it's a compromise that keeps the technically fussy at bay.
So yay for a compromise that gets women better access to medical care, prevents abortions, and keeps everyone happy enough. I think it's best we let women be the boss of themselves, don't you?
One of the preventative services that has to be free is an annual wellness visit. Clearly, nothing but the visit itself counts as "no cost sharing" or otherwise known as "free." You'll pay through the nose for blood tests and any extra things your insurance company can manage to charge you for, but it's an improvement. With a free check-up annually, hopefully we catch more health problems sooner and avoid big illnesses.
Another one is birth control. It got deemed a preventative item just like vaccinations, so it has to be covered at no cost by insurers.
This one gets many up in arms though. Despite science saying that birth control pills suppress ovulation and have nothing to do with fertilized eggs as far as we can make out, some faiths have decided birth control is immoral because life begins at conception and there's an outside risk that these hormones might stop a fertilized egg from implanting. I can see how you can be of a mind to think life starts at conception, and it is America, so you are free to decide whatever you'd like.
My take: your beliefs apply to you yourself. Your faith says eating cows is immoral? Fine! Don't eat them. Just don't try to stop me (mmm... beef...).
The complexity: employers pay for health insurance, and individual business owners are those employers, and some of those people object to paying for healthcare they disapprove of. If we were a sensible country, we'd fix this by having everyone in a single healthcare pool so no single person would be paying for anyone else's healthcare choices. But we are not sensible. We are "free market" and how DARE we consider doing something that would save us all money and probably give us better care at the same time... hmm... but this is mostly a distinct issue.
This weird system has been supported for years, where we allow a few religious groups to get exempted from paying for very specific things they deem immoral. IVF is of course on this list. Hormonal contraceptives are on the list. Abortions are, sometimes also other pregnancy ending things like drugs to induce miscarriage (that are used for molar and ectopic pregnancies as well as elective terminations, but of course they don't make that distinction).
To me, this seems like a case of me choosing to make a moral decision for someone else based on my moral views for myself. It bothers me that someone can decide for me whether it's moral for me to use contraceptives or have IVF. It's my life, my body, I should get to be the boss of it without anyone intervening in the process.
The compromise that the White House has issued is that employers will pay for healthcare, and health insurers will pay for those "morally reprehensible" parts that are federally required (aka contraceptives). It's a shell game at best, but it's a compromise that keeps the technically fussy at bay.
So yay for a compromise that gets women better access to medical care, prevents abortions, and keeps everyone happy enough. I think it's best we let women be the boss of themselves, don't you?
Tuesday, February 12, 2013
Free range versus abundance of caution
I've been ignoring updating about the nuts and bolts of this pregnancy thing for a variety of reasons, most of them involving me finding it boring or slightly scary to consider. Mostly boring.
BUT. I'm getting ready to go to non-stress test #4, and it sounds like we're going to keep doing them twice a week until Little Monster arrives or fails one and then arrives very quickly. Why? Because on a day where I slept about 18 hours (and therefore didn't eat) when I was awake I noticed markedly decreased movement. Like we're talking going from 10 kicks in the first 5 minutes of an hour to just hitting 10 in 45-60 minutes (and 10 is the normal minimum that we're told to be looking for in an hour).
My doctor's argument is that it's good to be abundantly cautious. I figure that since the only cost to me at this point is my time, then I'll go along with it, because I'm a paranoid nervous pregnant person. On the cost front, I know this isn't costing me a thing because we have a high deductible for the year and we were going to hit it with this pregnancy thing anyway, so it's only costing my insurance company and the spouse's employer for me to have perhaps more tests than I really need.
I'm conflicted about it, but at least at the last NST not everything was perfect. The first part Little Monster had an elevated but only slightly heart rate, and then after that, there weren't quite enough changes in heart rate for everyone to be super happy with. I spent 2 hours with the monitor and then another half hour waiting for lab work to come back and my doctor to stop by to check in with me.
My goal in life is to be a free-range parent, to not intervene in things that are going just fine or not causing harm. It's hard for me to get used to all this monitoring and fretting when there aren't strong causes for doing it. One of the reasons I really like evidence-based medicine is that doctors are people and people get swayed by emotions. We like to know all the answers to questions we might not even have really asked. Like the liver function panel I had drawn. Were there any signs of dysfunction to indicate that test was needed? Nope. Is it nice anyway to know it's fine? Sure. Is there evidence that all this monitoring changes outcomes unless there's signs to indicate doing so? Not really...
In pharmacy school, we are often reminded that habit is a hard thing to break. There was a group of drugs back in the '80s that we were sure would lower blood pressure and reduce the number of heart attacks and strokes. It was totally true that they did lower blood pressure, but they increased the number of heart attacks in people taking them rather than reducing them. It was a big study, and then another study confirmed it, and the drug lost the indication to treat high blood pressure as a first line treatment (this class is still used but as the last string drug, when all the others are already being used). Doctors were told to get patients off of it.
Within 6 months, 70-some percent of patients taking the drugs were still doing so because the doctors were sure they were just fine. They'd used them for years without a problem! How could their personal experiences be wrong? (disclaimer: we all do this, not just doctors. It's a people thing that we do, but we need to be aware that we're doing it. I'm just acutely aware of doctors and healthcare because I'm spending so much time hanging around them these days...)
I get being cautious, I do. I'm happy with it, mostly. But I worry that doing things "that probably won't hurt but we don't know if they help" can get out of hand. I wonder if it's already out of hand here in my very own life. I'll particularly wonder it if my blood pressure stays down and I have to have another pre-ecclampsia panel on Thursday (with no other indications than that my blood pressure was almost in the danger zone once at one visit).
I keep thinking about how parents worry about increasing traffic near schools, which leads them to drive their kids to school, which means more kids who aren't good pedestrians and can't navigate heavy traffic near schools, and it's a vicious cycle of more cars and less pedestrians. Is everyone safer in cars? I'm not sure, I haven't seen the data, but I would suspect that as dying in a car crash is a leading cause of death in the US, car passengers are probably at a greater risk because they intervened in a "normal" process of kids walking to school...
BUT. I'm getting ready to go to non-stress test #4, and it sounds like we're going to keep doing them twice a week until Little Monster arrives or fails one and then arrives very quickly. Why? Because on a day where I slept about 18 hours (and therefore didn't eat) when I was awake I noticed markedly decreased movement. Like we're talking going from 10 kicks in the first 5 minutes of an hour to just hitting 10 in 45-60 minutes (and 10 is the normal minimum that we're told to be looking for in an hour).
My doctor's argument is that it's good to be abundantly cautious. I figure that since the only cost to me at this point is my time, then I'll go along with it, because I'm a paranoid nervous pregnant person. On the cost front, I know this isn't costing me a thing because we have a high deductible for the year and we were going to hit it with this pregnancy thing anyway, so it's only costing my insurance company and the spouse's employer for me to have perhaps more tests than I really need.
I'm conflicted about it, but at least at the last NST not everything was perfect. The first part Little Monster had an elevated but only slightly heart rate, and then after that, there weren't quite enough changes in heart rate for everyone to be super happy with. I spent 2 hours with the monitor and then another half hour waiting for lab work to come back and my doctor to stop by to check in with me.
My goal in life is to be a free-range parent, to not intervene in things that are going just fine or not causing harm. It's hard for me to get used to all this monitoring and fretting when there aren't strong causes for doing it. One of the reasons I really like evidence-based medicine is that doctors are people and people get swayed by emotions. We like to know all the answers to questions we might not even have really asked. Like the liver function panel I had drawn. Were there any signs of dysfunction to indicate that test was needed? Nope. Is it nice anyway to know it's fine? Sure. Is there evidence that all this monitoring changes outcomes unless there's signs to indicate doing so? Not really...
In pharmacy school, we are often reminded that habit is a hard thing to break. There was a group of drugs back in the '80s that we were sure would lower blood pressure and reduce the number of heart attacks and strokes. It was totally true that they did lower blood pressure, but they increased the number of heart attacks in people taking them rather than reducing them. It was a big study, and then another study confirmed it, and the drug lost the indication to treat high blood pressure as a first line treatment (this class is still used but as the last string drug, when all the others are already being used). Doctors were told to get patients off of it.
Within 6 months, 70-some percent of patients taking the drugs were still doing so because the doctors were sure they were just fine. They'd used them for years without a problem! How could their personal experiences be wrong? (disclaimer: we all do this, not just doctors. It's a people thing that we do, but we need to be aware that we're doing it. I'm just acutely aware of doctors and healthcare because I'm spending so much time hanging around them these days...)
I get being cautious, I do. I'm happy with it, mostly. But I worry that doing things "that probably won't hurt but we don't know if they help" can get out of hand. I wonder if it's already out of hand here in my very own life. I'll particularly wonder it if my blood pressure stays down and I have to have another pre-ecclampsia panel on Thursday (with no other indications than that my blood pressure was almost in the danger zone once at one visit).
I keep thinking about how parents worry about increasing traffic near schools, which leads them to drive their kids to school, which means more kids who aren't good pedestrians and can't navigate heavy traffic near schools, and it's a vicious cycle of more cars and less pedestrians. Is everyone safer in cars? I'm not sure, I haven't seen the data, but I would suspect that as dying in a car crash is a leading cause of death in the US, car passengers are probably at a greater risk because they intervened in a "normal" process of kids walking to school...
Monday, February 11, 2013
Some thoughts on daycare
This is a smidge convoluted, how I got to be thinking about daycare. I follow Shelley over at Tales from the Waiting Room and she had a thoughtful discussion on her choice to (probably) send her expected little guy to daycare. One of the posts she linked to as informing her thoughts on it is this one from a SAHM. We're also just about to hire a babysitter for Little Monster's pre-daycare opening (and daycare age) care 15 hours a week, so we've been interviewing people and hoping to find someone we like.
The reasons given in that post really struck a cord with me, although I think that all 4 reasons given are reasons that I really want my kid in daycare. Let me explain.
Disclaimer: I am not here to criticize your choices, but to explain mine. If you are happy and your family is happy with one parent staying home all or most of the time, more power to you. That's not me and it isn't us right now either. Do I hope that maybe the spouse can stay home with Little Monster at some point? Yes, because the spouse would be really good at that sort of thing (while I would clearly not be). Do I occasionally feel guilty that I send my kid to daycare? A tiny bit, but mostly, I am sure it's the right choice for our family and the kid.
Reason one from the Diapers & Daisies post for staying home: A mother has unconditional love, a teacher doesn't.
True. But I don't want my kid expecting unconditional love from every angle all of the time. The world isn't a nice place where everyone is loving and caring, and I want her to navigate the real world. If she spent all her time with me being loved unconditionally, even when she was being a brat or choosing to be badly behaved, she'd never learn that life won't accept that level of behavior. I want her to be prepared to have to take direction she doesn't like when it's important. I want her to understand that things can't always be her way, on her time table. I think it's fantastic that the kid gets to spend time with adults who care for and about her but don't love her unconditionally because they don't let her get away with stuff in the same way I do or Grandma surely would.
Reason two: Teachers don't love your kid as much as you think they do.
Also good, in my view. Loving my kid is my job. I wish the kid's teachers would be honest about whether my kid is the one they hope goes away early, because I might be able to help change her behavior such that she stops being that kid. If she's already having a hard time being a contributing member of a community, I want to know now. Again, I think that love shouldn't be the only thing kids experience. If we prolong the phase of life where kids aren't responsible for their actions, we are making it harder for them later in life to handle a world where they aren't at the center. Example: one of the girls at the kid's daycare has a teenage older sister and spends a lot of time acting just like this older sister, playing the "let's be best friends! Now I hate you! Now you must give me all your stuff/attention to be my friend again!" game that is so common among older girls. I don't like it one bit. It irks me. But I know that it was only a matter of time until the kid ran into this game, and it's one she will have to be able to play, at least a little bit, to survive in school. I am glad she gets to practice coping now when there's only one girl playing this game rather than 15 of them in her kindergarten class. I am glad that her teacher is there to provide feedback on the situation to her and help her along without the mama-bear instinct to try to help her "win." The kid shouldn't be winning at the expense of others, but as her mom, my gut says, "DEFEAT THAT MEAN KID! Put her in her place! Squash her!" It's good that someone else is also helping her manage, someone with more objective distance than me.
Reason three: Our children are special and perfect in our eyes only.
Perhaps it's because I am from a place where being out of the ordinary is stomped out of people, or perhaps it's because I am practical enough to recognize that my kid cannot be perfect (she's a person, and people are imperfect by definition), but I don't want my kid feeling extra special about herself. I want her to know herself, to understand her strengths and weaknesses, and to know how to cope with herself. I don't want her thinking she's perfect, not now, not ever. People who declare themselves perfect are either lying to themselves or trying really hard to convince the world they believe that lie about themselves. (By "perfect" I mean without anything to improve. I think we should all know our weaknesses and work to improve our weak areas as best we can.) I also find it very valuable for my kid to know that she is a kid, just like other kids, and that while some things about her are special, there are special things about everyone. Example: she's lucky to have a cat at home. Other kids might not have a cat, but they might be able to speak another language. She will be a big sister, and that's special. Other kids might be a little brother or sister, and that's special too.
Reason four: They are not always doing what you think they are doing.
I know that our daycare has a preschool program. I'm paying more than is typical around here for her to have that program. I know that they have a curriculum, and that it dictates some of what goes on each day. I also know that they do actually work on things from the curriculum. Do I care that the curriculum said they should spend 15 minutes writing the letter D and they only spent 7? No. Does it bother me broadly that for some reason, in pre-middle school settings, skipping part of the curriculum is "just fine because they were too squirrelly to learn anything anyway?" Yes. It sets up a very bad precedent for when kids are older and there is no skipping the boring/unfun/hard parts of the curriculum because of standardized tests. It sets kids behind because the curriculum (hopefully) builds and if you skip the early stuff, the later stuff falls flat and in middle/high school you wind up reteaching stuff that should have been mastered long before but got consistently "skipped." I think, at least in the pre-k setting, that equal parts of the important learning come from structured and unstructured time. Over the week I presume that it balances out. Today they spend less time with letters, tomorrow a little bit more. That's fine and part of the deal. If I think she's being consistently shorted on her structured time, I would be concerned and would think about making a different choice for her daycare/preschool because I would feel lied to about the whole thing. I don't think it's likely to be the case though. Most programs seem to do pretty well, in my experience.
This article that Shelley also references does a great job of talking about the mommy guilt that goes with choosing EITHER to work or stay home. Boo on being guilty. BOO. Life happens, and all we can do is make the best choice available to us at the moment, do our best, and be happy with what we get. Life is never ever perfect, no matter how much we try. Daycare is a choice, and it can be a good one. Being home with your own kids is a choice, and it can be a good one. Doing some fancy hybrid of other people watching your kids and parents watching the kids is a choice, and it can be a good one. Can we please not attack each other?
The reasons given in that post really struck a cord with me, although I think that all 4 reasons given are reasons that I really want my kid in daycare. Let me explain.
Disclaimer: I am not here to criticize your choices, but to explain mine. If you are happy and your family is happy with one parent staying home all or most of the time, more power to you. That's not me and it isn't us right now either. Do I hope that maybe the spouse can stay home with Little Monster at some point? Yes, because the spouse would be really good at that sort of thing (while I would clearly not be). Do I occasionally feel guilty that I send my kid to daycare? A tiny bit, but mostly, I am sure it's the right choice for our family and the kid.
Reason one from the Diapers & Daisies post for staying home: A mother has unconditional love, a teacher doesn't.
True. But I don't want my kid expecting unconditional love from every angle all of the time. The world isn't a nice place where everyone is loving and caring, and I want her to navigate the real world. If she spent all her time with me being loved unconditionally, even when she was being a brat or choosing to be badly behaved, she'd never learn that life won't accept that level of behavior. I want her to be prepared to have to take direction she doesn't like when it's important. I want her to understand that things can't always be her way, on her time table. I think it's fantastic that the kid gets to spend time with adults who care for and about her but don't love her unconditionally because they don't let her get away with stuff in the same way I do or Grandma surely would.
Reason two: Teachers don't love your kid as much as you think they do.
Also good, in my view. Loving my kid is my job. I wish the kid's teachers would be honest about whether my kid is the one they hope goes away early, because I might be able to help change her behavior such that she stops being that kid. If she's already having a hard time being a contributing member of a community, I want to know now. Again, I think that love shouldn't be the only thing kids experience. If we prolong the phase of life where kids aren't responsible for their actions, we are making it harder for them later in life to handle a world where they aren't at the center. Example: one of the girls at the kid's daycare has a teenage older sister and spends a lot of time acting just like this older sister, playing the "let's be best friends! Now I hate you! Now you must give me all your stuff/attention to be my friend again!" game that is so common among older girls. I don't like it one bit. It irks me. But I know that it was only a matter of time until the kid ran into this game, and it's one she will have to be able to play, at least a little bit, to survive in school. I am glad she gets to practice coping now when there's only one girl playing this game rather than 15 of them in her kindergarten class. I am glad that her teacher is there to provide feedback on the situation to her and help her along without the mama-bear instinct to try to help her "win." The kid shouldn't be winning at the expense of others, but as her mom, my gut says, "DEFEAT THAT MEAN KID! Put her in her place! Squash her!" It's good that someone else is also helping her manage, someone with more objective distance than me.
Reason three: Our children are special and perfect in our eyes only.
Perhaps it's because I am from a place where being out of the ordinary is stomped out of people, or perhaps it's because I am practical enough to recognize that my kid cannot be perfect (she's a person, and people are imperfect by definition), but I don't want my kid feeling extra special about herself. I want her to know herself, to understand her strengths and weaknesses, and to know how to cope with herself. I don't want her thinking she's perfect, not now, not ever. People who declare themselves perfect are either lying to themselves or trying really hard to convince the world they believe that lie about themselves. (By "perfect" I mean without anything to improve. I think we should all know our weaknesses and work to improve our weak areas as best we can.) I also find it very valuable for my kid to know that she is a kid, just like other kids, and that while some things about her are special, there are special things about everyone. Example: she's lucky to have a cat at home. Other kids might not have a cat, but they might be able to speak another language. She will be a big sister, and that's special. Other kids might be a little brother or sister, and that's special too.
Reason four: They are not always doing what you think they are doing.
I know that our daycare has a preschool program. I'm paying more than is typical around here for her to have that program. I know that they have a curriculum, and that it dictates some of what goes on each day. I also know that they do actually work on things from the curriculum. Do I care that the curriculum said they should spend 15 minutes writing the letter D and they only spent 7? No. Does it bother me broadly that for some reason, in pre-middle school settings, skipping part of the curriculum is "just fine because they were too squirrelly to learn anything anyway?" Yes. It sets up a very bad precedent for when kids are older and there is no skipping the boring/unfun/hard parts of the curriculum because of standardized tests. It sets kids behind because the curriculum (hopefully) builds and if you skip the early stuff, the later stuff falls flat and in middle/high school you wind up reteaching stuff that should have been mastered long before but got consistently "skipped." I think, at least in the pre-k setting, that equal parts of the important learning come from structured and unstructured time. Over the week I presume that it balances out. Today they spend less time with letters, tomorrow a little bit more. That's fine and part of the deal. If I think she's being consistently shorted on her structured time, I would be concerned and would think about making a different choice for her daycare/preschool because I would feel lied to about the whole thing. I don't think it's likely to be the case though. Most programs seem to do pretty well, in my experience.
This article that Shelley also references does a great job of talking about the mommy guilt that goes with choosing EITHER to work or stay home. Boo on being guilty. BOO. Life happens, and all we can do is make the best choice available to us at the moment, do our best, and be happy with what we get. Life is never ever perfect, no matter how much we try. Daycare is a choice, and it can be a good one. Being home with your own kids is a choice, and it can be a good one. Doing some fancy hybrid of other people watching your kids and parents watching the kids is a choice, and it can be a good one. Can we please not attack each other?
Friday, February 8, 2013
At least
I've been thinking a lot about "at least" lately.
For some context, there's the most recent round of the Pain Olympics going down. One of the major "events" that attempted Pain Olympians play is the "At Least" game, wherein whatever the Olympian went through is deemed much worse than whatever the blogger being criticized is perceived to have gone through, and "At Least" the blogger can/has/should appreciate something the Olympian lacks (like can get pregnant if not carry to term or has children or is happily married or has a nice job or A job).
It's also just about my grandpa's birthday. He'd be 91 this year. He was very fond of talking in terms of "at least" though. It didn't make a lot of sense to me, but I think it's a result of having been young during the depression (rather than a young adult like my other grandparents were). When you have seen just how desperate life can be for so many people, I think you realize how lucky you are, and that no matter how bad things are in your life right now, "at least" it isn't as bad as the depth of awfulness you've seen. I can't ask him, so I will never know for sure, but that's my suspicion.
Sample conversation:
Me: "It's awfully cold this week, isn't it?"
Him: "At least it isn't snowing! I remember once when we still had snow into June, but these days with the global warming, the snow melts by the end of May at the latest."
Me: "True."
I've been thinking about the "at least" part of my life too. A friend from undergrad just died of breast cancer (and she was diagnosed when we were students, although she was a student in her 50s). One of my pharmacy school classmates also died of cancer and two are living with it now (in remission but one is likely going to come back). When I consider how hard things are, I often think to myself "at least I don't have cancer and neither do the spouse or the kid. We are so lucky."
Then I consider how painful it is to have someone telling me "at least..." when it comes to, well, anything in my life. At least I have a house, and the internet, and enough food, and what have you. At least you have one child, isn't that enough? Yep, maybe infertility wouldn't seem like such a big deal if I didn't have my basic needs met. I suspect it still would bother me. At least you haven't gone into debt to have a child, at least you have a working car, at least you're in school and will have a good paying job when you finish...
I always have in my mind that there's a "yet" after any time someone says, "At least you haven't lost..." or "at least you haven't gone to jail" or whatever. I'm not sure if that's because I'm pessimistic or because I try to worry about just today or because I know how close I have come to losing everything. Repeatedly. I walked the line where on one side was isolation and jail and madness, and I lucked out to wind up on the side where things got better. I know that line is perilously close at all times and just because the really bad stuff hasn't hit me YET, it doesn't mean it never will. I make my choices and they keep me from those awful, maybe preventable, "yet" scenarios.
I'm not sure how I feel about even just thinking about "at least" in my head. It bothers me to some degree, that I have this need to compare my life to others' and to deem my experience easier or less painful than theirs. It's probably just human nature to compare me to everyone around me, so I have some sense of myself and my place in the world.
I just have to be sure to keep my big "at least" mouth shut if I have the urge to say it, because that comparison hurts so much when others make it about me, I can only assume it hurts others too if I do it.
For some context, there's the most recent round of the Pain Olympics going down. One of the major "events" that attempted Pain Olympians play is the "At Least" game, wherein whatever the Olympian went through is deemed much worse than whatever the blogger being criticized is perceived to have gone through, and "At Least" the blogger can/has/should appreciate something the Olympian lacks (like can get pregnant if not carry to term or has children or is happily married or has a nice job or A job).
It's also just about my grandpa's birthday. He'd be 91 this year. He was very fond of talking in terms of "at least" though. It didn't make a lot of sense to me, but I think it's a result of having been young during the depression (rather than a young adult like my other grandparents were). When you have seen just how desperate life can be for so many people, I think you realize how lucky you are, and that no matter how bad things are in your life right now, "at least" it isn't as bad as the depth of awfulness you've seen. I can't ask him, so I will never know for sure, but that's my suspicion.
Sample conversation:
Me: "It's awfully cold this week, isn't it?"
Him: "At least it isn't snowing! I remember once when we still had snow into June, but these days with the global warming, the snow melts by the end of May at the latest."
Me: "True."
I've been thinking about the "at least" part of my life too. A friend from undergrad just died of breast cancer (and she was diagnosed when we were students, although she was a student in her 50s). One of my pharmacy school classmates also died of cancer and two are living with it now (in remission but one is likely going to come back). When I consider how hard things are, I often think to myself "at least I don't have cancer and neither do the spouse or the kid. We are so lucky."
Then I consider how painful it is to have someone telling me "at least..." when it comes to, well, anything in my life. At least I have a house, and the internet, and enough food, and what have you. At least you have one child, isn't that enough? Yep, maybe infertility wouldn't seem like such a big deal if I didn't have my basic needs met. I suspect it still would bother me. At least you haven't gone into debt to have a child, at least you have a working car, at least you're in school and will have a good paying job when you finish...
I always have in my mind that there's a "yet" after any time someone says, "At least you haven't lost..." or "at least you haven't gone to jail" or whatever. I'm not sure if that's because I'm pessimistic or because I try to worry about just today or because I know how close I have come to losing everything. Repeatedly. I walked the line where on one side was isolation and jail and madness, and I lucked out to wind up on the side where things got better. I know that line is perilously close at all times and just because the really bad stuff hasn't hit me YET, it doesn't mean it never will. I make my choices and they keep me from those awful, maybe preventable, "yet" scenarios.
I'm not sure how I feel about even just thinking about "at least" in my head. It bothers me to some degree, that I have this need to compare my life to others' and to deem my experience easier or less painful than theirs. It's probably just human nature to compare me to everyone around me, so I have some sense of myself and my place in the world.
I just have to be sure to keep my big "at least" mouth shut if I have the urge to say it, because that comparison hurts so much when others make it about me, I can only assume it hurts others too if I do it.
Wednesday, February 6, 2013
Balancing parenting
I feel like there's a lot to say here, so I'll start with the thing at hand. Expect a series of posts on the struggles to co-parent rather than boss the other parent around because "I'm the mom!"
I've requested, and the spouse agreed to, the spouse get an annual physical early along with the kid's 5 year old check up. Since she had all her pre-kindergarden shots last year, there's not a huge rush for her to be there the moment she turns 5, so I suggested that both these appointments be scheduled for when my MIL will be here to help manage Little Monster. Since it takes 6-8 weeks to see a doctor (!!!) I've been suggesting that these appointments be scheduled for about a month now.
At first, the conversation went: "Can you schedule your physical early this year?" "Sure. When were you thinking?" "How about when your mom is here? You could take the kid for hers too." "OK. Do you care which doctor we see?" "A breathing one, preferably female." "OK. I'll call tomorrow and schedule them."
In a week or two, I inquired again and "I'll get to it tomorrow" came up. In 3-5 days, I asked again (and yes, I did put reminders into my calendar so as not to nag immediately). Still no appointments.
Now we're getting to not so many weeks from the end of March and the ideal time for these visits. I decided it isn't my thing to call and schedule because A) one appointment isn't mine to make and B) nobody asked me to.
The caveat to this is that the spouse isn't working every or even most days lately due to job reassignment, and is finishing at about 3:30pm at the latest, so it isn't like there's "no time" to call like might be the case other times.
In one of these conversations, I pointed out that if the spouse prefers, they could both go see our old doctor, because really, it's more important that they see SOMEONE than that it's someone here close by. There was nodding, and "yes, I'll get to it."
It's a really hard thing to co-parent rather than strictly "mothering" as it's traditionally defined. For me, I really like to pretend I control things and a lot of my control is to first ask someone to do something, and when it either goes unfinished or isn't done EXACTLY my way. The challenge is of course to AVOID doing exactly this. Health-related things are a favorite thing for me to control.
The first time I remember it hurting my heart to let the spouse be equally in charge of the kid it was at a doctor's appointment. As a 9 month old, she developed a cough and coughed for about 6 weeks. We got fed up with the coughing without any nasal symptoms or other apparent causes, so we took her to the doctor. No ear infections, no strep, so just to be sure, she needed a chest x-ray to rule out pneumonia or a scary fungal infection (which we knew to be a risk based on where we lived). We were both sitting in the x-ray waiting area with a fussy baby who'd recently been nursed and the tech comes to get her, and the spouse stands up with her and then they walked off to have the x-ray. My first reaction was to reach out and nab her back, to go with her myself.
When I caught that first reaction, I knew it was time to let it go. If we're going to co-parent, I cannot always be the boss. I have to accept that sometimes my way isn't the best way, or any better than the spouse's way. When something isn't my responsibility, I can't take back responsibility for it. I just can't.
So now I am struggling. I am struggling to the point where I'm writing this post, knowing the spouse reads my blog, as an extra little prod because I'm getting fed up with waiting for that appointment to show up in our joint calendar. I worry. I just want it done. I could offer to do it, but it isn't my job, and if we're sharing our parenting jobs, I need to take that seriously.
BUT I HATE SHARING.
I've requested, and the spouse agreed to, the spouse get an annual physical early along with the kid's 5 year old check up. Since she had all her pre-kindergarden shots last year, there's not a huge rush for her to be there the moment she turns 5, so I suggested that both these appointments be scheduled for when my MIL will be here to help manage Little Monster. Since it takes 6-8 weeks to see a doctor (!!!) I've been suggesting that these appointments be scheduled for about a month now.
At first, the conversation went: "Can you schedule your physical early this year?" "Sure. When were you thinking?" "How about when your mom is here? You could take the kid for hers too." "OK. Do you care which doctor we see?" "A breathing one, preferably female." "OK. I'll call tomorrow and schedule them."
In a week or two, I inquired again and "I'll get to it tomorrow" came up. In 3-5 days, I asked again (and yes, I did put reminders into my calendar so as not to nag immediately). Still no appointments.
Now we're getting to not so many weeks from the end of March and the ideal time for these visits. I decided it isn't my thing to call and schedule because A) one appointment isn't mine to make and B) nobody asked me to.
The caveat to this is that the spouse isn't working every or even most days lately due to job reassignment, and is finishing at about 3:30pm at the latest, so it isn't like there's "no time" to call like might be the case other times.
In one of these conversations, I pointed out that if the spouse prefers, they could both go see our old doctor, because really, it's more important that they see SOMEONE than that it's someone here close by. There was nodding, and "yes, I'll get to it."
It's a really hard thing to co-parent rather than strictly "mothering" as it's traditionally defined. For me, I really like to pretend I control things and a lot of my control is to first ask someone to do something, and when it either goes unfinished or isn't done EXACTLY my way. The challenge is of course to AVOID doing exactly this. Health-related things are a favorite thing for me to control.
The first time I remember it hurting my heart to let the spouse be equally in charge of the kid it was at a doctor's appointment. As a 9 month old, she developed a cough and coughed for about 6 weeks. We got fed up with the coughing without any nasal symptoms or other apparent causes, so we took her to the doctor. No ear infections, no strep, so just to be sure, she needed a chest x-ray to rule out pneumonia or a scary fungal infection (which we knew to be a risk based on where we lived). We were both sitting in the x-ray waiting area with a fussy baby who'd recently been nursed and the tech comes to get her, and the spouse stands up with her and then they walked off to have the x-ray. My first reaction was to reach out and nab her back, to go with her myself.
When I caught that first reaction, I knew it was time to let it go. If we're going to co-parent, I cannot always be the boss. I have to accept that sometimes my way isn't the best way, or any better than the spouse's way. When something isn't my responsibility, I can't take back responsibility for it. I just can't.
So now I am struggling. I am struggling to the point where I'm writing this post, knowing the spouse reads my blog, as an extra little prod because I'm getting fed up with waiting for that appointment to show up in our joint calendar. I worry. I just want it done. I could offer to do it, but it isn't my job, and if we're sharing our parenting jobs, I need to take that seriously.
BUT I HATE SHARING.
Friday, February 1, 2013
PING!
Because of my concern about decreased fetal movement (and we're talking about from 40+ kicks in an hour to 10-15, so still above the minimum) I got to go be hooked up to the machine that goes PING! for an hour to have a non-stress test. It was super, and by super I mean it was mildly uncomfortable and took a long time (an hour and a half total with waiting around for lab work).
Today I got to think about the abundance of caution versus high costs of healthcare while I was laying around pretending to be interested in the TV. Technically did I really need that NST? No. How about that repeat blood work verifying I don't have any diseases Little Monster can catch? Decidedly not since I had that whole panel done in pregnancy 4, less than 15 months ago, and have had zero new sex partners since then (shocking, I know. Monogamy in all its glory.) so two other docs have opted not to run this panel. Why did this doc decide to run it? Because if my results aren't on file, some well-meaning pediatrician will run all these tests on Little Monster once zie is born, and nobody wants a baby having to have a huge number of blood draws. Why did I decide to go with it? Because it won't cost me anything to have it done, so why not avoid having to opt out of it later?
If I had a midwife and not an OB? Probably wouldn't have had the NST just yet, just maybe a sooner follow-up visit. I stumbled into a press release from the American College of Nurse-Midwives about a study showing that women who deliver in nurse-midwife-run birthing centers rather than hospitals have a much lower c-section rate, and I am unsurprised. I've had 2 visits with anesthesiologists to make sure I have a good airway in case I need rapid intubation for an emergency c-section (and this is probably good to check) but has also included chatting about epidurals and how early in labor I can get one, along with other pain management options (aka drugs).
This is not to say that anyone has been unsupportive when I point out that I'm not planning to have any drugs at all. Both anesthesiologists were very friendly and not pushy at all about pain meds, but at the same time, nowhere else in this healthcare system is anyone talking about other ways to manage pain (aka various labor positions and self-hypnosis), and certainly not for 30 minutes with no interruptions. Man, if everyone delivering at this hospital got 30 minutes of undivided, attentive care from even a nurse on pain management outside of drugs... what a world...
The other really interesting item from the Nurse-Midwives' website was about a study on malpractice insurance costs (aka Why Babies Cost So Much and Why We Must Intervene Or ELSE!) that found malpractice claims were not higher than other areas of medicine. Let me say that again. No higher malpractice claims were found in OB than other areas of medicine, so there are actually not any higher costs associated with being an OB than another sort of doctor. It also found that mothers tended to be claiming malpractice as a result of substandard care (in fact, all this "prevent harm to babies AT ALL COSTS" stuff isn't impacting 3/4 of the malpractice claims that involve mothers getting bad care). Hmm.
One of the things that gets my goat is how much we perceive pregnant women as vessels for the unborn rather than people. You see it in the way we treat mothers with strolling-around-children as well. Babies first, mothers are some sort of second thought because they exist to care for babies and nothing else. It irritates me to no end. Being a person is important, and while I'm also growing an additional person, I remain a person with rights, needs, and interests unrelated to gestating.
I get why we like to pinch pennies from this realm of healthcare. It's a lot easier to say, "We could save 50% on a delivery that isn't a c-section! Let's avoid them!" rather than to say "nobody over 75 should have a bone density scan because the cost is high and the benefit of knowing how severe osteoporosis is is minimal" or "nobody over 80 gets chemo unless they pay out of pocket for it." There are clear downsides too to an excess of care in a fundamentally healthy person, and there are theoretical upsides to testing and treating very old people. BUT if we consider where all this money that doesn't make Americans healthier is going in our "healthcare system," it is not mostly going to unneeded c-sections. Most of the "waste" in the system is medications we aren't taking (and either people getting sick because they should have, or tossing them out after they are paid for by insurance) and end-of-life care that many people don't want but get because either they don't realize they could opt out or their family isn't ready to let them die just yet.
Knowing that I let my personal nerves go along with my doctor's quick fix for making sure everything is all right, I get it. It's nice to know everything is fine. It's nice for my doctor to have evidence that everything is fine. It's nice to know the twinging is actually contractions and I might need to pay some attention to it. But at what cost? Would I have been just as happy with a reassurance that since Little Monster's kick counts are still regularly above the minimum, things are very likely totally fine, and keep at the kick counts and come in if they decrease? Probably. Healthcare dollars saved! Relationship built!
On the whole, though, I'm hoping to avoid anymore scenarios involving the machines that go PING! and aren't telling us anything valuable beyond that the machine is really good at going PING! After the next NST scheduled for Tuesday of course...
Today I got to think about the abundance of caution versus high costs of healthcare while I was laying around pretending to be interested in the TV. Technically did I really need that NST? No. How about that repeat blood work verifying I don't have any diseases Little Monster can catch? Decidedly not since I had that whole panel done in pregnancy 4, less than 15 months ago, and have had zero new sex partners since then (shocking, I know. Monogamy in all its glory.) so two other docs have opted not to run this panel. Why did this doc decide to run it? Because if my results aren't on file, some well-meaning pediatrician will run all these tests on Little Monster once zie is born, and nobody wants a baby having to have a huge number of blood draws. Why did I decide to go with it? Because it won't cost me anything to have it done, so why not avoid having to opt out of it later?
If I had a midwife and not an OB? Probably wouldn't have had the NST just yet, just maybe a sooner follow-up visit. I stumbled into a press release from the American College of Nurse-Midwives about a study showing that women who deliver in nurse-midwife-run birthing centers rather than hospitals have a much lower c-section rate, and I am unsurprised. I've had 2 visits with anesthesiologists to make sure I have a good airway in case I need rapid intubation for an emergency c-section (and this is probably good to check) but has also included chatting about epidurals and how early in labor I can get one, along with other pain management options (aka drugs).
This is not to say that anyone has been unsupportive when I point out that I'm not planning to have any drugs at all. Both anesthesiologists were very friendly and not pushy at all about pain meds, but at the same time, nowhere else in this healthcare system is anyone talking about other ways to manage pain (aka various labor positions and self-hypnosis), and certainly not for 30 minutes with no interruptions. Man, if everyone delivering at this hospital got 30 minutes of undivided, attentive care from even a nurse on pain management outside of drugs... what a world...
The other really interesting item from the Nurse-Midwives' website was about a study on malpractice insurance costs (aka Why Babies Cost So Much and Why We Must Intervene Or ELSE!) that found malpractice claims were not higher than other areas of medicine. Let me say that again. No higher malpractice claims were found in OB than other areas of medicine, so there are actually not any higher costs associated with being an OB than another sort of doctor. It also found that mothers tended to be claiming malpractice as a result of substandard care (in fact, all this "prevent harm to babies AT ALL COSTS" stuff isn't impacting 3/4 of the malpractice claims that involve mothers getting bad care). Hmm.
One of the things that gets my goat is how much we perceive pregnant women as vessels for the unborn rather than people. You see it in the way we treat mothers with strolling-around-children as well. Babies first, mothers are some sort of second thought because they exist to care for babies and nothing else. It irritates me to no end. Being a person is important, and while I'm also growing an additional person, I remain a person with rights, needs, and interests unrelated to gestating.
I get why we like to pinch pennies from this realm of healthcare. It's a lot easier to say, "We could save 50% on a delivery that isn't a c-section! Let's avoid them!" rather than to say "nobody over 75 should have a bone density scan because the cost is high and the benefit of knowing how severe osteoporosis is is minimal" or "nobody over 80 gets chemo unless they pay out of pocket for it." There are clear downsides too to an excess of care in a fundamentally healthy person, and there are theoretical upsides to testing and treating very old people. BUT if we consider where all this money that doesn't make Americans healthier is going in our "healthcare system," it is not mostly going to unneeded c-sections. Most of the "waste" in the system is medications we aren't taking (and either people getting sick because they should have, or tossing them out after they are paid for by insurance) and end-of-life care that many people don't want but get because either they don't realize they could opt out or their family isn't ready to let them die just yet.
Knowing that I let my personal nerves go along with my doctor's quick fix for making sure everything is all right, I get it. It's nice to know everything is fine. It's nice for my doctor to have evidence that everything is fine. It's nice to know the twinging is actually contractions and I might need to pay some attention to it. But at what cost? Would I have been just as happy with a reassurance that since Little Monster's kick counts are still regularly above the minimum, things are very likely totally fine, and keep at the kick counts and come in if they decrease? Probably. Healthcare dollars saved! Relationship built!
On the whole, though, I'm hoping to avoid anymore scenarios involving the machines that go PING! and aren't telling us anything valuable beyond that the machine is really good at going PING! After the next NST scheduled for Tuesday of course...
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