Visitors!

We've been fortunate to have a nice stream of visitors since Eden was a couple of weeks old. My parents came in mid-July, followed by Matt's at the end of July/beginning of August, and now my brother and sister-in-law are here for almost a week. It's been fun for Eden to get to interact with some of her family, and we also always enjoy showing off what there is to see and do in this area. Which is tons, though it's gotten a little bit trickier with an increasingly opinionated baby in tow!

Baked berry French toast

We recently made this unbelievably delicious baked French toast with mascarpone and blackberries. Matt's parents had brought the local mascarpone and black raspberries from Wisconsin, and we also happened to have some milk that needed to be used up, so this was a frugal dish for us as well as being absolutely heavenly. We even had some rum in the back of the cupboard that I'd forgotten about until now. Here's the recipe, and here is how we did it:

French Toast with Mascarpone and Black Raspberries

* 1 cup of fresh black raspberries
* 1/2 cup mascarpone cheese
* 1 egg yolk
* 1 large or 2 medium eggs
* 1 cup milk
* 1/8 cup melted butter
* 1 1/2 cup whole milk
* 1/2 cup of brown sugar
* pinch of cinnamon
* 2 tsp vanilla
* 1/4 cup rum
* salt
* 1 loaf bakery bread, sliced

Directions:
1. Preheat oven to 325°F.
2. Combine eggs and yolk with milk, butter, milk, brown sugar, cinnamon, vanilla and rum. Add a pinch of salt for taste.
3. Take bread and soak in egg/milk mixture.
4. Place bread in a buttered 9 inch baking pan. Squish each piece in until pan is full.
5. Top with a layer each of fruit and cheese. Repeat with remaining bread, x 2-3 layers. Pour remaining egg mixture over the pan.
6. Bake for 45 minutes or until golden brown. Top with more berries, and/or maple syrup.

Food for thought

I missed the boat on World Breastfeeding Week last week, but here's a related video, a little late:



Breastfeeding is interesting. Eden has nursed all over the place, from Bed Bath & Beyond to in front of the Smithsonian Air & Space Museum to a grassy hillside at Harper's Ferry to our favorite Indian buffet. I've always been a proponent of the right to breastfeed in public, but it wasn't until I had a baby myself that I realized on a pragmatic level just how much less conspicuous it is to breastfeed than to try to pacify a screaming, hungry baby. (And given that breastfed babies typically eat 8-10 times a day, the only option besides breastfeeding in public would be to essentially retreat from public life entirely.) We were out to lunch the other day, and I was doing the former and could hear someone across the restaurant trying to do the latter. Nobody noticed what I was doing, but every person eating lunch was aware of what she was doing. I felt bad for her. So far, I haven't had anybody raise an issue, and when people have noticed (like in the hallway at church), they're more apt to smile than anything else, which is nice.

We've also given Eden a bottle of pumped milk on occasion, in preparation for my return to work part-time. While I'm thankful she'll take it pretty easily, it still makes me a little sad to see her do it--but it also makes me even more thankful each time I do get to breastfeed her, even when that's at 4am.

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.