Thoughts on pregnancy, birth, and parenting

Labor and birth with a 10-lb, 2-oz baby, as intense and demanding as they were, posed far less of a challenge for me than pregnancy did.

Labor and birth are fast-paced (at least for me) and breathtakingly acute, but they're also rather fascinating, and even somewhat magical. Sort of like an altered state of consciousness, there's something stark and kind of addictive about it.

Pregnancy, on the other hand, is certainly magical in its own way, but also full of long months of mundane discomforts. Swelling. Hemorrhoids. Achiness. Nausea. Exhaustion.

As Eden turns one month old, and her strong and opinionated personality starts to emerge from her former compliant newborn sweetness, I'm realizing that parenting is a lot more like pregnancy than it is like birth. Certainly, there's something magical about watching someone's personhood emerge day by day, and I can only imagine how much more awaits me beyond just the first month. But there's also the period every day where she's inconsolably crabby, and of course it always hits when there are still hours left before Matt will be home and I'll be able to give my aching arms and back a teensy break before my 11-lb baby needs to be nursed again. Furthermore, like pregnancy, the germination stage is a long one--measured in months and years, not hours.

Parenthood is also full of mundane discomforts. Achiness. Exhaustion. Repetition. Changing a diaper for the fourth time in an hour. Wondering if you'll ever be able to wear a shirt for more than fifteen minutes without getting milk down the front of it or spitup down the back of it. Wondering if she'll ever do the same. Wondering if you'll ever be alone in the bathroom again, or have the use of both arms for any length of time. Coming across an event or happening and thinking "What fun! Let's go to that," and then remembering that you really can't.

Then something comes along to remind you that there are those for whom parenting is anything but routine.

And it makes the above scenario, milky shirt and aching back and fussing baby, look pretty good. As Amy says, "Bring on the mundane."

Because stories like that make you realize that even in the midst of what seems like an exasperating day, there's magic there if you can remember where to look.

Thoughts on obstetrics vs family practice

photo by Orcoo

Rixa at Stand and Deliver has a really fascinating post about "Litigation and the obstetrics mindset." She states, "I am trying very hard to understand the obstetric mindset when it comes to risk, malpractice, and litigation in relation to choices such as VBAC or home birth." She presents a very thorough perspective on those issues, including quotes from discussions on obstetrical and midwifery message boards from those two specialties. The most intriguing part to me, however, comes about halfway through the post when she shares the perspective of a friend who is a family practice doctor. Here's what the FP doctor says. It's long, but it's all worth reading:

OB, as a surgical specialty, has a much different "flavor" than the FP [family practice] world I trained in. OBs are surgeons, and many have an "I can fix that!" kind of personality, where issues are seen as black and white, and they rely heavily on their judgment and skills and quick decision making. Surgical training is much more hierarchical than generalist training, and I think that builds in much more of the power issues that we see in medicine so much. OBs primarily view their clients as patients, and their decisions as scientific and don't concern themselves with the softer, social/emotional issues. Because of the power play issues and the idea that the OB is the knowledgeable important person in the relationship, I think this leads to a lot more worry on their part of the consequences of their decisions. The average OB is trained and socialized to be the decision maker and leader in the doctor-patient relationship, and to bear the responsibility for the outcome. They are also socialized to be very risk aversive - but only the risks that impact them the most. There is this overriding cultural expectation that OBs are expected to produce a perfect baby every time - but in reality, I think OBs propagate this much more than their clients do. I think so much could change if OBs (and many other kinds of doctors) could let go of the power differential and allow themselves to be seen as human.

As a family doc, even though I trained in a highly traditional medical setting, I was still trained by family docs, with a strong flavor of know-the-evidence, partner-with-your-patients type style. I think midwives, of course, lean even farther into the psychosocial part of their relationship with clients in their training. I think the more partnership or service style of practice leads to less fear that you will be held solely responsible for your decisions. Our generalist training, and in midwives' case, their woman-centered training, shifts more responsibility onto clients themselves, and I think leaves us feeling less worried about litigation, and more worried about quality care.

Of course these are big generalizations, and there are exceptions to everything, but in general the culture of the surgical specialty of OB is just so different than the culture of midwives, or even family docs.

I don't worry about getting sued very much. It rarely enters my mind as a factor in decision making. I worry a lot more about educating, and about encouraging my clients to make their own decisions. I worry about forming good relationships, providing room for disappointment to be expressed when things don't go the way we hoped, and making our decision making processes completely transparent and understandable to my clients. I worry about making sure my clients understand that there is a lot of uncertainty sometimes in what we do, that no outcome is guaranteed, and that I strive for excellence and hope for luck along the way, too. I hope that the relationships I form with my clients will mean that they can tell the difference between malpractice, and an honest human being doing their best.

Part of the lawsuit crazy fear really does seem incomprehensible to me, though. When I was pregnant with my fourth child, I went to a friend (or more acquaintance) who is an OB for prenatal care, and we had the weirdest argument over me being tested for gonorrhea and chlamydia in early pregnancy. I didn't want to be tested because I have zero risk, and it costs money. She kept saying that it was important to be tested, regardless of risk, because of "medical legal reasons." We went around and around until I finally said: "Look, 'medical legal reasons' only come into play if I sue you, and I can assure and guarantee you right now that I'm never going to sue you for not testing me for gonorrhea and chlamydia. I understand the risks and benefits of being tested, and I refuse. Period." She was terribly flustered that I'd brought up the word "sue" and terribly flustered that I said "refuse" and was clearly uncomfortable and it was so strange to me. In my practice, I matter-of-factly explain the benefits of being tested, and if clients choose not to be, I feel quite content that even if they are making the wrong decision, it's their decision and their consequences so I don't have to be personally invested in it - while she clearly couldn't let go of the idea that by not following the "standard of care" I could somehow accuse her of malpractice later. I still can't understand why so many OBs are so terrified of being held responsible for outcomes they can't control - why are they so frightened of allowing the decision making to rest with the folks who have to live with their decisions!?

This absolutely, 100% squares up with what I have observed from working with obstetricians on the one hand, and receiving my care from family practice doctors, midwives, and nurse practitioners on the other. In particular, we take Eden to a family practice group that I just absolutely love. I think Matt probably finds my swooning devotion a little bit odd, but when you've spent several years contending with just how excruciatingly difficult doctors can be, it feels so incredibly good to have your worries and low expectations blown out of the water by doctors and nurse practitioners who truly care and want to help you. Because that attitude is, I'm just going to say it out loud here, incredibly rare--I thought in medicine at all, but apparently mainly just in obstetrics.

An example: shortly before Eden's 1-month checkup, I found out I'd need a doctor's note clearing me to go back to work since I'd technically been on medical leave. Since schlepping a newborn baby to an appointment for me, and paying to have somebody say "yes, you're fine" didn't sound that appealing, I figured I had nothing to lose by asking the nurse practitioner at Eden's visit if she'd mind jotting a note for me. We were there anyway, right? I was prepared for her to say no, and imagining a response like "Do you know what kind of liability it is for me to write a note saying you're healthy, I don't know whether you're really healthy, and even if you're healthy today, how do I know whether you'll still be healthy when you go back to work," etc etc. Because that is really the kind of logic I see employed on a daily basis. Kind of along the lines of the above--"Even though you know you don't have gonorrhea, and you aren't going to sue me, we need to test you for gonorrhea in case you sue me. For not testing you for gonorrhea. When you refused to have it done." HUH?!

Instead? "Oh, absolutely! I'd love to. That's no problem at all!" The same kind thing when there was some confusion with the front desk as to whether our visit could be billed as a well-baby exam when it was technically just a weight check (meaning a difference of whether our visit was covered at 100% or we had to pay a $20-30 copay)--while many providers play (or are) dumb to the workings of their own offices, let alone the insurance companies, the NP stepped out, talked to them herself, and came back and said "It's straightened out now. There's no reason you should have to pay extra when she's here, she's a month old, and she's had her well baby visit!" Granted, that was the nurse practitioner, but we have found our family practice doctor to be just as delightful. Documentation for Eden's birth certificate? Happy to help. Want to delay vaccination? That's certainly your choice.

I'd wondered about this discrepancy between disciplines and I think the above sums it up very well: OBs are taught to worry about themselves, and family practice doctors (along with midwives and nurse practitioners) are taught to worry about their patients. As pointed out above, there are exceptions on both sides of this, but overall, it leaves you feeling somewhat sorry for obstetricians--but even sorrier for their patients.

A new chapter

Today, Matt goes back to work after having spent the past month on paternity leave. Ever since Eden was born, the three of us have barely left each other's sides, and it's been an indescribably wonderful, magical time. I don't know how I would have gotten through the first month postpartum without him, and I know that the reason I'm feeling great and functioning well is because of all the meals he's cooked, diapers he's changed, loads of laundry he's done, dishes he's washed, burps he's coaxed (out of the baby), and the countless hours we've spent just falling in love as a family. His love, tenderness, and support bring tears to my eyes.

So, while it wasn't without tears that I sent him off too work this morning, it was with a profound gratitude for the time we were able to spend together.

Fittingly, Eden also turns 1 month old today, meaning she's no longer a newborn. It seems like an appropriate time to turn the page from the suspended animation we've been in for the past 28 days, and begin the rest of our lives.

In honor of the occasion, here's a compilation of the pregnancy, birth, and first month with Eden.

Song: Praan by Gary Schyman

Family Saturday

Today we had an awesome Saturday as a family. We got up and made hootenanny for breakfast, which we've decided almost matches pancakes or French toast in terms of flavor and superbly beats it in terms of being quick and easy. Then we headed out to run a few errands. First, we were looking for a floor lamp because our living room tends to be a little dark--we live under a bunch of trees and so the room has no natural light. We'd looked on Craigslist, and there were a few for around $10, but nobody contacted us back. We started at the Salvation Army, where we found a couple of mediocre lamps for $16.99. Then we headed to our favorite Goodwill, out in Sterling, and found just what we were looking for for $8. Score! Next, we headed out to an antique store that Matt likes because it has a large selection of old tools. We didn't buy anything, but it was a nice little drive.

The real jackpot came this evening. Fabbioli Cellars is a local winery where we've done tastings before, and they were holding a sort of potluck picnic, wherein they were providing hot dogs, bratwurst, and sweet corn and everybody else brought a side dish. There was also live music and wine for sale. It was a rainy evening and so we were expecting a meager turnout, but we packed up a batch of pasta salad and headed out to see.

We were wrong. There were probably over 100 people there and there was an amazing assortment of pasta salads, vegetables, fruits, and desserts--and there is nothing I love like a good potluck. Best of all, it was all free. And Eden was an angel and just slept quietly the entire time, despite music that could wake the dead.

Now we're settling in for the evening, listening to the storm and watching Gilmore Girls. And I can't imagine anything nicer.

Parents' visit

We had a great time visiting with my parents when they were here. If I thought being pregnant cut down on our social activities when people are in town, having a newborn did so infinitely more--but since Eden was really what they came to see anyway, nobody seemed to mind! We all had a relaxed time talking, resting, and enjoying the baby. It was fun to see my parents in the role of grandparents, and nice to have a couple of extra sets of hands helping us out! Next up, we're looking forward to seeing Matt's parents when they get here later this week!

My famous mom!

Way to stir the pot!

Week three

Eden's third week has been more of a challenge than the first two. Our reserves have gotten pretty low, plus Eden is moving from that newborn, "whatever you guys want to do is cool with me" vibe to having more of an opinion on what she does and what's done to her. She's still a mellow baby, but she's definitely gotten more vocal about when she needs something. Plus, she's having much more distinct sleep and waking periods, and I'll just say that they don't fall, respectively, exactly when we wish they would.

Yesterday was kind of an all-around low point for us--she (and by extension, we) only slept three hours the night before, and they were not consecutive hours, either. We gave up and got up at 6, then headed out around 8 to go apply for her birth certificate--and boy, were we feeling it. That fuzzy, achy, allover weariness and and discomfort and barely-able-to-keep-our-eyes-open stupor. We gave up again around 11:00, and wound up napping until just around 1. We felt a little better after that, but Eden was somewhat fussy all day, probably because she was tired, and couldn't make up her mind whether she wanted to eat or sleep or be held or not or what. We went out to try to run some errands in the late afternoon, but she fussed whenever we took her in or out of her carseat, but then also fussed when we'd leave her in there. So finally, we gave up (are you noticing a theme here?!) and went home with our errands half finished.

Unable to face another night like that, we dedicated ourselves to trying to figure out ways to help her settle in for the night. We gave her a bath (which she absolutely loves--you can just see her relax and soften as soon as she hits the water) and did a little baby massage with some coconut oil, and decided trying to play soft music in our bedroom throughout the night, since we've noticed she sleeps like a rock whenever it's noisy but seems to have trouble settling herself when it's quiet. We'd received a couple of lullabye CDs as gifts (thanks, Mary and Pam!) and so we cued those up and braced ourselves. Like she usually does, Eden woke up at 11:30, just as we were ready to drift off to sleep...so I fed her, Matt changed her, and to our surprise, she fell back asleep.

The next time I looked at the clock, Eden was starting to stir and it was FOUR AM. As in, we had just had, like, FOUR HOURS OF UNINTERRUPTED SLEEP. Matt was as euphoric about it as I was. Then, I fed her, Matt changed her, and...she went back to sleep. Again!

We've noticed that Eden tends to spit up a lot if she doesn't sit up for awhile after she eats. Sometimes it's related to burping and sometimes it seems like gravity just makes her...overflow. So we were also utilizing that technique, which seemed to help her be more comfortable and fall back asleep better. AND THEN...the next thing we knew it was EIGHT THIRTY. Meaning we had had practically seven hours of sleep, several of them consecutive.

It's the best we've done in a long time. And Matt and I felt like a million bucks as a result.

Eden seemed to feel pretty good about herself too. She was in a great mood and as a result, we decided to walk her down to the farmer's market and to the Lakeside Cafe, where we first (and last) went just about exactly a year ago. We had an awesome breakfast and Eden slept the whole time in the Baby Bjorn.

All in all, it was just an absolutely lovely day. The temperature was probably in the low 70's (cooler than that in the shade, hence Eden's hat), the baby was in a good mood, and we had gotten more sleep than we'd had in weeks.

We'll see what tomorrow brings.

Out & about with Eden

We've had Eden out for a little walk or outing most days that we've had her, but last night we went on our first major "date" as a family: out to eat at Chipotle. (They're cheap, they're tasty, and they're sustainable, which are three major reasons we like to eat there. A fourth is that they're close by.) We ate outside, enjoyed our food and the 75-degree weather, and got lots of smiles and nice comments on our baby. After that, we took her (with Matt carrying her in a sling) for a walk around the Reston Town Center, where several people did a double take and said "Whoa, oh my goodness, there's a baby in there!" Evidently babies in slings aren't a particularly common sight around these parts? After the second or third time, Matt told me he was going to start telling people, "No, I just keep my gun and my smack in here."

On the way back to the car, we walked past a couple of older ladies dining outside who absolutely gushed over Eden, complimented Matt highly on being the one to carry/wear the baby, and told me how fantastic I was looking postpartum. Boy, you can't BUY that kind of three-for-one flattery. We'll have to keep taking these little walks!

One of my favorite comments of the evening came when we stopped into Whole Foods to pick up an item or two and a man in line asked about Eden, "She's what, around two or three...?" And Matt filled in "Actually, just one and a half." He said "Yep, I didn't think that baby was more than about two months old." And I had to correct him "Uh, no, that's one and a half weeks." He looked startled, then said "Oh boy, that's a big baby!" Yes, she is. And she's all ours.

A week later: settling in

Now that we've had Eden for just over a week, we're starting to settle into --not quite a routine, but at the very least a rhythm. We're getting to know her needs and habits, which helps things run pretty smoothly, if not always predictably. Of course, we're totally not on any semblance of a working schedule at this point (we've gone from waking up at 5:30 and going to bed at 9:30 to going to bed around 11 and getting up between 10 and noon, sleeping in what pockets of time we can manage between those times, and often napping during the day as well), but so far Eden is happy and eating well, and we're taking turns getting up with her as much as we can to allow each person a few uninterrupted hours of sleep where possible. For her part, Eden is a joy of a baby--she only fusses or cries when she needs something, she consoles quickly, and seems happy as a clam to go anywhere we do, whether in our arms, a sling, or a Baby Ergo carrier. Breastfeeding is going very well, we're loving our cloth diapers, and we're completely smitten with our baby girl. We're getting less sleep and doing more laundry than we could have anticipated--but we're also happier than we ever thought we could be.

The family bed

Last Sunday I woke up with the worst sore throat I've ever had, and I've been fighting a nasty cold ever since. While the adrenaline from giving birth and the relief at no longer being pregnant went a long way toward keeping me from feeling too badly, within the last day I started to feel the exhaustion and the cold catching up with me. Matt was also starting to develop a sore throat and a cough, and poor Eden has a very stuffy nose. So last night after attending a low-key Fourth of July barbecue, we resolved to spend today in bed together, hanging out and resting and recuperating. So far we've largely done just that, though we did get out for a couple of hours this evening to have some company. Other than that, we've just napped, read, nursed, eaten, and otherwise enjoyed each other's company in bed all day, and I think we are all feeling much better--not that we'll let that stop us from spending much of tomorrow the same way, both because it was so lovely and enjoyable, and also to make sure we're all truly on the mend.

Funny article in TIME

You know it's not my favorite publication, but I was amused and pleasantly surprised to read this well-written article in TIME by a new dad whose wife decided she wanted to have her placenta encapsulated. One of my favorite lines: "For those of you who have never seen one, the placenta is to the baby what Stephen Baldwin is to Alec Baldwin."