All About Newborn Baby: A Mom’s Request To Visitors

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As I am approaching the last stretch of my second pregnancy, and at the same time, approaching the cold and flu season of the year, I have been having episodes of insomnia where I lay awake (like many other mothers do) anxious about the upcoming birth of my newborn.

Many articles state that moms in their second pregnancy are not as anxious as their first, and though there is definite truth to this in certain areas of what I would expect post-birth with my newborn, I am still anxious as far as what is to come and how I am to manage all of that… especially now that I know that all of that is going to happen.

So given this is my second time, and that I know what to expect (mostly), but with a marked difference that instead of giving birth in the Spring, I will be delivering in the Fall season, I have come up with what I feel are desperate “gift” requests from a mother who is going to have a baby soon:

1) Please do not visit me in the hospital – I recall with my first pregnancy the excitement of the entire birthing episode. Given this was our first baby ever, our families and friends were of course welcome to partake in the whole process. However, I realized after I got home how tired I was from all the visitations and what I really needed was the rest. Adrenaline only lasts so long before it wears off and leaves you a fatigued, empty shell. This usually occurs after you get home from the hospital. This request will be asked of my own parents as well – to limit the time spent hanging out in the post-delivery room, because I need to sleep and ample chances to work on breastfeeding my baby in peace.

2) Please do not visit if you are sick – This is a big one that’s been keeping me awake. Even if you think it’s allergies (it may not be), and I know how many of us self-diagnose all the time, I urge you to visit later when you are completely without symptoms. Pertussis (whooping cough) can just be a bit of coughing and sneezing at the very early stages, and I know many of you out there never got your Tdap boosters or even know what that iscough (I have had to explain this to many of my patients). Since most of you are interested in news stories, let me share one with you from the CDC about a baby who died, and her mother’s request: http://www.cdc.gov/vaccines/vpd-vac/pertussis/unprotected-story.htm. I will be getting my Tdap (the second in 2 years) this week (and I am still pregnant). This is my present for the baby. I urge you to do the same. I already got the seasonal flu shot 1 week ago. Since we’re going into the flu season as well, I also kindly request that you have your flu vaccination completed if you plan to visit. If you are not a fan of vaccines, we kindly ask that you do not visit our family until after our child is over 6 months old when she has had most of her early vaccines and her immune system is more equipped to handle the potential deadly diseases out there (and also flu season is over).adacel Also from a physician’s perspective, even if you “only” have a viral cold, if that is transmitted to a newborn within the 1st month or two, and she gets a fever, that would mean a trip to the Children’s hospital with an expensive admission to the hospital floor for a full work-up which includes blood tests, urine tests, and even a spinal lumbar puncture. The best gift? Please don’t make me go through this with my baby, and I would appreciate that tremendously, more than anything a person can buy.

3) Please wash your hands or sanitize your hands before picking up the baby – I am appalled when I see mom forums on the internet stating their “best friends” are so upset with them when they request that they sanitize their hands before handling their newborn baby.wash hands In a day and age when we are well equipped and knowledgeable at least about the spread of infection (we’re even graded on this in the hospital and office settings), I’m surprised some are upset that moms want to protect their babies. Let me reiterate that newborns and infants do not have the ability to handle infections like an adult or older children do. It is NOT a faux pas in my opinion to ask anyone to wash their hands before touching a baby. I am always held to the same standards at work and home. I expect that of my guests. I also sanitize my stethoscope before and after a baby encounter as well. It’s the greatest gift and shows respect for a baby and their parents.

4) Please be kind and limit your visitation time - unless you are a visiting guest staying in our house or grandma, please do not ring the doorbell (wakes baby up) and instead call our cell phones if you’d like to visit. It may be an inconvenient time (mom and baby are sleeping) or baby is breastfeeding, etc. Fatigue is definitely a part of the first few months, so please don’t mind me if I look tired and crabby – it can happen. We love that you love our family enough to care and come visit, but the best present for mom and baby is going to be rest, always. If you want to share the love on Facebook, and through calls and emails, that would always be a great gift and fabulously appreciated, and we won’t be offended at all! With visits, please never feel obligated to bring gifts or anything for that matter; we appreciate that you’re think of us and caring about our well-being.

5) Please leave your kids at home if you plan to visit – We’re already worried enough that our older daughter may infect the newborn with something (she’s currently coughing), and would hope we wouldn’t have to worry about everyone else’s. I’ve taken my child out of daycare 1 month early to help try to get her cold resolved before her sister comes. Kids tend to transfer illnesses to other kids the easiest. We also won’t have time to worry about another child running about the household while caring for our current two. For this reason, we kindly ask to keep the kids at home at least until our youngest is over 6 months old. sick kid

It may sound like I’m trying to put my newborn infant in a bubble to protect her. Frankly, I am, as much as I can. Epidemiologists also call a similar practice “cocooning.”  I am dreading the flu/RSV/cold season, and I have always dreaded pertussis. I am always worried about SIDS. I was worried enough that I took my eldest out of daycare early and thankfully had the ability to bring on a nanny (who is also getting fully vaccinated prior to the birth of my child).

I certainly hope my post doesn’t offend anyone. I’ve seen many sick newborns in the hospital setting, and I’ve heard of multiple cases of deaths of children. I am hopeful that none of our friends and family would ever wish that on our babies. And thus, we ask you all to respect our requests.

These 5 requests above would be the best gift you can give our family!13

My Adventures In The Search of A Fabulous Nanny

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Childcare: For all of you who are a household of 2 working parents planning to have children, take note: It is expensive. Now of course, if it is worthwhile for me to stay at home, I would do it in a heartbeat. However, both my and my husband’s careers (and the length of time, sweat, resources, costs invested in our lifetime to get here) warrants that we continue to work, for the livelihood and longevity and ultimately the benefit of our family. So we continue to work… and thus, find appropriate childcare.

With one child, it was a relatively easy option: daycare seemed the best solution. We were fortunate enough that my mother-in-law was willing to care for our little daughter full-time until she was about 15 months. After that, although it was difficult to transition her (and me) into a daycare situation, it worked out… albeit, a bit more expensive than I hoped.

Then the rates went up the next year. Our little girl caught illness after illness (every 2-3 weeks it seemed) and had a chronically runny nose since the onset of daycare. Grandma took ill and had increased frequency of flare-ups of arthritis, so even part-time daycare wasn’t an option anymore.

And, well. I’m pregnant and about to have my second child.

With the greatest trepidation, I went into the daycare office for rates for infant care. We thought this was the best option as childcare in our home would be quite expensive. Then the quoted rates floored us. It would put us at least $500 per week for the care of our 2 children full-time in daycare, subject to poor teacher-kid ratios, cesspools of infections (which meant no sleep for parents when we get home and more medical bills), having to get up much earlier to get baby and toddler out and ready for daycare before work, and rushing to pick up in time afterwards. It sounded horrendous, at $500+ per week and more.

So while I was in the midst of mulling about it this summer, we ended up at a friend’s baby shower, and at length was discussing childcare. They were in search for a Nanny. At first I thought, Nannies? They’re SO expensive, and there’s so much involved in keeping one, plus safety issues with a stranger in your home?… But then I thought, well, maybe I should just try to research on the topic. I spoke my fears to my friends, and they said it’s more affordable than you think… if you pay under the table.

Pay under the table? Oh dear, I thought. There is one thing I hate – dealing with taxes and the IRS, and the ultimate slap in the face: getting audited. So I mulled about it some more. Then I spent a whole weekend looking into the whole ordeal.

Advertisement - Looking For the Best Nanny Ever!

Advertisement – Looking For the Best Nanny Ever!

I found out that Nannies have a huge range of salaries – usually from 350 per week to some ridiculous 1000 per week. It depended on the number of children, amount of time they spent on the job, and the location where they work (higher cost-of-living places of course cost more). I looked around my area, and found that nannies were willing to work for about $400-550 per week here, live-out (meaning they don’t live with you and drive to your house on work days), full-time for anywhere from 40-50 hours a week. This seemed manageable to me. So I looked further. I found that most families pay these rates without reporting it to the IRS.

I thought, well, maybe the Nannies would be willing to work as an independent contractor and would get a 1099 at the end of the year. That seems fair. So I looked it up. Site after tax-site stated, no, this is not allowed. The IRS classifies Nannies as household employees, and should be taxed as such. I thought, oh my, that would make me an employer, which equates to paying payroll taxes – something I’ve never done before. That would mean I would have to pay Worker’s Compensation insurance and have them expect employee benefits. Oh, no. No wonder Nannies are considered only for the super-rich and wealthy.

I thought – well maybe we scratch that. It’s too much of a hassle. So I planned on daycare.

Then my toddler soon after caught a terrible cold. I was pregnant and uncomfortable, so my dear husband stayed up with her night after night for 2 weeks. Loads after loads of vomit-filled laundry later, we decided… no. Daycare is not right for our newborn. I can’t have the baby going into flu and RSV season at that age. We should just bite the bullet and find a fabulous nanny, even if it means my husband and I eat Ramen noodles only for the next 2 years.

So the hunt began. I asked friends and family and posted it on my social site. I got one response: check out Care.com. I thought, oh thanks, that’s so helpful. I could have figured that out myself. I checked Craigslist for listings, then I saw a news report about another Craigslist scammer/murderer/thief, so I scratched that. I posted a job on Care.com and Sittercity.com. And believe it or not, a few people started applying for the job. They appeared to be decent, honest candidates, some with background checks already on file. So I decided to pay the nominal fee for the privilege of contacting these people on these sites, and the ball got rolling.

5 Interviews later, I was down to 2-3 very good top candidates, who were willing to work within our rates as a legal tax-filing employee.

Up front, I tell them that I plan on filing as a household employer, which means I pay taxes, and you pay taxes. I find that some Nannies do not like that – it means less net take-home pay for them – which also means under-the-table cash-paying families have an upper hand against me in the Nanny hiring competition. I think to myself, however, that in the end, I will find someone who’s willing to have some longevity with our family, because there will be no tax auditing horror stories with us. And there is no surprise (albeit illegal) 1099 filed to the Nanny at the end of the year, making her pay a whopping 15.3% tax (minimum) instead of 7.65% tax for social security and medicare taxes (as I have seen as huge complaints on nanny forums when she was expecting no tax filing at all). And she gets Worker’s Comp insurance. The trouble is getting the Nanny to understand, that in the end, I’m helping her pay for part of her taxes, worker’s compensation (injury insurance), and federal unemployment insurance (which means she’s truly compensated at a much higher rate), and the ones who understand are ultimately keepers. The ones that don’t — good luck filing for unemployment benefits, because if a family doesn’t pay those taxes, it wouldn’t be available to the nanny when she’s in between jobs. Plus, both of you get audited for back-taxes and penalties.

1040, schedule H, quarterly ES payments -- such craziness! I advise looking into a payroll company to do the work for you, and to do it right the first time.

1040, schedule H, quarterly ES payments — such craziness! I  sincerely advise looking into a payroll company to do the work for you, and to do it right the first time.

I’ve sent out an offer to a candidate so far. She seems the most capable, willing to work and take initiative, even in non-childcare related household duties. She has great experience, a clean background check and stunning references. She didn’t get squirmy when I mentioned Nanny Cams. She loves tomatoes and the frogs in my back pond (like me). She doesn’t smoke, and is always early to our meetings. She’s fine with getting recommended immunizations – yes including those supposedly controversial flu shots. She uses my ideal time-out disciplining technique. She is the highest rate I’ve offered among all the Nanny candidates that just squeaks by our budget after taxes and fees. I hope to hear from her soon. I even made negotiations to start her 1-2 months earlier than anticipated just to secure her position with our family. I hope those cash-paying families that she’s interviewing with don’t ruin my good intentions.

In the meantime, I am finalizing my 6-page work agreement detailing my thoughts about how the household should be run. Does this make me formidable? I certainly hope not. I’m usually a pretty reasonable person – at least my medical assistant tells me so! It’s easier this way — I believe, as everything’s outlined about our expectations right up front. For Nannies out there, I highly encourage you to get a work agreement from your employer family to figure out what they expect from the get-go, and for prospective Household employers, I urge you to write it all down on paper, so your Nanny can refer to it when she’s not sure what exactly her duties and expectations are as your employee.

Good luck to everyone who’s in the market to find a good Nanny. It is a lot of work up front, but it might still be a plausible option instead of daycare for your children.

One other tidbit – I found Breedlove & Associates to be absolutely wonderful. They offered a free consultation regarding payroll taxes up front and answered my questions well. Their payroll service fees are higher than some of the other payroll companies, but I’m going to use their services because of their knowledge and customer service. And no, I do not own stock in their company.

A Baby Sign Language Experience!

When I first heard about teaching sign language to babies, I thought, “is this possible?” My friend Nancy told me about a super-mom she knew who did this with her baby and introduced the idea to me. I felt that I should at least research about it and see if it would work for me.

The approach seemed so reasonable. One would start signing with her baby around 6 months of age and then in a couple months she would pick it up. I started at about 5.5 months and at 8 months she still wasn’t really signing back to me. I began to wonder, maybe Vivi just isn’t cut out for signing. But in the end, I persevered.

Vivienne is in her 11 month now. When she was about 10.5 months, all the many months of fruitlessly signing random things to her seemed to click, and all of a sudden she was signing back to me, especially when she wanted something. I guess that’s kind of like a type of positive reinforcement.

So her first sign was milk. She always got formula as soon as she got up in the morning and so she knew “milk” was coming. When she discovered that the sign language was associated with milk, she ecstatically pumped her little fists with the milk sign most mornings when it was time for milk! It was fascinating to watch.

Soon after, I decided to teach her how to sign “please.” I thought, how far-fetched is this; a baby can’t possibly understand the meaning behind “please.” However, other experts beg to differ, I read. Apparently, the more you use and exercise the use of words, the easier it is to grasp the moral reason behind those words later. I thought “please” would be a difficult word to teach, but to my delight, she learned this within a day as soon as she discovered that with signing the word “please,” she could get many things. One caution, however; just because they sign “please” doesn’t mean you have to give them everything. This comment is mainly directed towards my husband! Setting boundaries at this age is of utmost importance.

Now recently she’s signing the word “more.” Although she’s not doing this 100% correctly, she has her own modified version (one finger poking the palm of the other) that is very similar. I think when she gets older, she’ll understand how to use the correct form.

Although I’ve read in books and articles of how a baby’s language develops early in regards to understanding things without verbal communication, I am still fascinated by how fast she learns and how observant she is of her surroundings. I love signing with her, because at least, I have some clue about what she wants and am able to address it before she turns on the fit of tears.

I hope you all give this a try! The only verbal things she says so far are mama and baba, and that’s pretty normal at her age. Signing gives a whole new perspective on how to communicate with your baby.

 

Sleepless Nights – Oh No!

A sleeping baby — ah, so peaceful, gentle, and soulful. Parents all around the world wish for those quiet moments when their baby falls asleep – no fuss, no fight, no incessant crying.

Really, I doubt there is any parent in this world who had not had a bad night of a non-sleeping, unruly, fussy baby. We should think of these nights as a rite of passage into parenthood. It is undoubtebly some of the toughest experiences I have ever experienced in my life. It definitely ranks alongside the stress of going through those sleepless nights as a resident physician taking care of sick, after sick people all night long.

Thankfully, sick people usually have an illness that can be tended and healed. A crying, fussy baby? Not all the time is there a 100% solution. After searching tirelessly for a cause for her screams of frustration with no end in sight, you finally give into the fact that — perhaps she’s just being fussy and that’s that.

There are many reasons for a baby’s cries: 1) over-tiredness, 2) pain of hunger, 3) an uncomfortable dirty diaper 4) a hair tourniquet on an unsuspecting baby toe, 5) needs a quick burp, 6) lonely, 7) bored, or 8 ) just needs to vent, among many other countless causes. When my daughter was young, I just tried my best to comfort and soothe her during these rough moments, especially when there was no solution – as everything I could think of was offered, changed, or checked over. Sometimes, loneliness sets in, and there’s nothing more you can do except hold her while she cries.

I’ve read numerous books around her second week of life to see what solutions there were for this fussy night-time habit. Experience shows that babies just tend to do this fussy night-time crying from 2 weeks, peaking around 6 weeks, and tapering off by 3 months. Of course, all babies have their own variation of this, but this served as a general guideline for me. I followed the advice of working her into a scheduled but flexible feeding routine, a start-of-day time and then a set night routine that starts at around the same time. Eventually, a schedule started emerging, and we just followed along with it. Soon, she only woke up once during the night for a feed, and to our greatest relief, around 7-8 weeks, she finally slept through the night.

Now, this isn’t the end of the story. There are times she would still wake up in the middle of the night. I’ve noticed during growth spurt times, sometimes after vaccinations, during teething (although you don’t discover this until later when the pearly white all of a sudden pops into view), and when she’s not feeling well. Typically, she plops back into routine on her own.

There are, however, times recently during her 7-9 month old stage where she started waking up during the night for no apparent cause other than feeling lonely or bored. These are the times when she’s fine when you’re holding her, refuses bottles offered, and have just had a nice diaper change, and has nothing else wrong with her, but screams the moment you put her down in the crib. Ah, well what to do now? There are two extreme theories to the resolution of this problem: 1) you comfort her until she falls to sleep… typically in your arms for 30 minutes or more so it’s a really deep sleep, then when you put her in her crib, finally, you can tip-toe away without a major issue or 2) you leave her in her crib to cry-it-out and learn to fall asleep on her own.

You may find me a little heartless, but I tend to lean towards #2. There are a group of people who will completely disagree with me – and that’s fine – do what you like with your own child, and if you like attachment parenting and have the patience for it, great. But as a full-time working mom, I can’t have a super-attached child. Is she going to turn into some heartless soul who leads a life of crime in the future because I let her cry a bit when it’s night-time? I doubt it, and I will argue this point to the ground if anyone wants to debate with me.

This is my theory: an 8-9 month old baby is old enough to understand you pretty well. Her brain has developed to the point that she can follow your commands. When I ask my daughter to come to me, she does. She can feed the dog her puffs. She has so many ways of communicating without words at this time. Sure, it is still pretty immature, but she knows what she wants and she knows what she needs, and she knows the typical routine at this time.

Now, I’m not so heartless that I just plop my baby in the crib every night and shimmy away. I actually give her a bath, massage lotion onto her, brush her teeth, put her in her pajamas, give her her bottle, and gently sit there with her for about 15-30 minutes with her while rocking and singing her to sleep. It is those moments that when she is drowsy or lightly asleep that I put her in her crib. She’s usually fine with this, but there are some nights she would fight tooth and nail. It is those nights that after one more rocking and singing session, I gently tell her goodnight and close the door to let her fall to sleep on her own. She’d typically fuss and cry out for about 3 minutes and we’re good to go for the night.

When she wakes up in the middle of the night, my heart often tells me there is a good reason, so I go check on her, especially if she’s wailing in an extremely needy fashion. Usually, it’s a full diaper ready to burst. Rarely, she’s just hungry and going through a growth spurt. Once in a few blue moons, she will scream because she’s just plain bored. It’s fine if she does, I still check on her if the wails are intense, but I wouldn’t if she just cries out once in her sleep and that’s it. Again, as with all parenting models: use your best judgement and your parental instinct for these moments.

Despite all that we do and all that we try, there will still be those sleepless nights once in a while, but if my husband and I can remain consistent with our parenting, I’m hoping she will learn to be a good sleeper for life.

Food Fight!

Photo source: WebMD.com

Photo source: WebMD.com

 

For the past week, my daughter has been quite stubborn about eating her baby food. Basically, she throws a fit if she doesn’t get her bottle right away. I’ve even noticed more soft bowel movements (formula bowel movements) because she’s not eating as much solids. Although it’s probably not that worrisome, as she is still growing quite well and doesn’t look starved, I find it a little frustrating that when I bring out baby food, all warmed and smelling good, she arches her back and smacks my hand away at the first spoon. How dare she?!

 

The "Bottle-Fix"

I’ve tried multiple methods to try to encourage her to eat her solids — because although formula is probably fine nutrition-wise, I want her to move forward to more independent eating which means, solid table foods, rather than back to the baby bottle fix, which, in a several months, she’ll need to start weaning off.

Maybe I’m moving too fast? Or then again, maybe not?

My first method was the good ol’ choo- choo- train technique: I tried to choo-choo the spoon towards her mouth in a fun, fantastic way, and she still smacked it away in disgust. She hadn’t even tasted the food yet! My second method was to try to eat a little off the spoon myself and make a big deal about how yummy it was. She took a few spoonfuls after that – so I knew – it wasn’t the taste of the food — it was something else. However, after the third bite, she smacked it away in disgust and made her sign for a bottle all the while shouting “maa-maaa.” Well, I thought, what do I do now? I wanted her to eat more solids because usually when she drinks her milk, she refuses solids outright because she’s full. My third method was changing the type of spoon used and as she opened her mouth to wail, I stuck a spoonful in — and she munched it and wanted more, so I continued to spoon it into her mouth – but at a rapid rate, as if she catches a lull in-between she gets cranky again and then she thinks about her bottle again. One other time, I had her hold her own spoon to scoop food herself – with guidance, of course, to scoop it into her mouth. It was a messy ordeal, but we made some headway with this.

Photo source: WebMD.com

I began to wonder: for the past 4 days, she has been doing this mealtime challenge with me, and so — is my 8 month old going through a growth spurt or a teething experience, or is she trying to assert her independence with me. At this age, she certainly can be doing either. I noticed that table foods she will eat on a dime, and her puff-o’s she’ll eat no problem, especially if handed to her to self-feed, but baby pureed foods… that’s questionable. Maybe she wants more self-feeding independence, and maybe she wants to eat what everyone else is eating. I mean, I don’t blame her. My 90-year-old patients in the nursing homes that have swallowing difficulty would avoid eating their pureed diet because it tasted bad, even though they were starving themselves to oblivion. In essence, I find that babies and the elderly very similar in many instances. For one certain 90-something, I had to convince the family to place her in hospice due to her malnutrition so that we can feed her what she wanted. Well with a baby, we don’t want her to choke and she shouldn’t be making any major decisions for herself, but she can certainly eat bite sized pieces at this stage, and so I’m going with that as my next step.

However, I will assert myself as the one who sets the mealtime rules at this early age – and if she continues unhappy mealtime behavior, I will be enforcing those boundaries with some Love-and-Logic empathy + crib time. I hope it all goes well… wish me luck.

 

Holiday Traveling With A Baby

This winter was the first time we have ever travelled with my daughter for over 1 hour in the car. Lots of preparation was required when planning travel for a baby. We had originally planned to use a cargo carrier to carry all her knick-knacks to make her stay at the hotel comfortable, but unfortunately, we found out that the roof rack on the SUV did not fit the cargo carrier size. Hence, we had to make some last minute decisions and changes.

Luckily, a week prior while I was imagining placing my daughter in the playpen to sleep at night in an unfamiliar place, I began having nightmares of her waking every hour on the hour and wanting to be comforted by my husband and me; which, would leave me staying awake the entire night holding her while I try to encourage some much needed sleep. Yes, that was a waking nightmare, and it had a potential to become a reality.

To avoid such a challenging situation, I decided to look for co-sleepers. You may wonder : “your last post talked about no co-sleeping in the bed, what could you possibly be thinking, you hypocrite.” Well, as all physicians may say, it’s never all-or-nothing. Sometimes, as a parent, you must assess the situation and if temporarily a riskier change is needed where the benefit exceeds the risk, then perhaps, it’s ok to do so. I would encourage discussing this with your physician if such a case arises.

Brica Fold 'N Go Bassinet

Finding a co-sleeper bassinet was extremely difficult because my baby was already 8 months old and on the bigger end of the average scale for height and weight. With great trepidation, I decided to purchase the Brica Fold ‘n Go Bassinet which barely fit her but, fortunately worked like a charm. It folded flat so we were able to store it in a crevice in the car to make room for the luggage for 4 adults and 1 baby. On a King Size bed in the hotel, I put it in between my husband and me above the comforters which left us enough room for comfortable sleep, and the sturdy sides prevented us from rolling on top of her. We were very surprised that she actually slept comfortably in it, although she needed to adjust herself a little bit, but remained able to sleep through the night, despite all the craziness in her schedule.

Which brings me to the next part of this topic: keeping the routine. As you may know, when you travel or go to any family reunion type thing, the activities tend to be late night, and when you have a sleeper who’s night-time schedule usually starts around 6:30pm, it can get hairy. Although the schedule was thrown off, we tried very hard to continue her usual bedtime routime to signal to her, it’s night-sleep time, and to allow her the naps she is used to during the days, even though sometimes, it requires holding her during her entire nap session, which is much shorter than usual. Also, keeping her feeding schedule on target (except for the last one; we usually give a bottle right before bed as part of her night routine) usually keeps her on track. Although there were nights we were unable to start her night routine until 11pm or midnight, she miraculously made it through the 4 days of change and went right back to normal when we got home in 1 day or so. This really builds confidence for our next outing if this occurs.

Perhaps next time, we’ll venture out on a plane, and I’ll make sure I keep you posted, especially if we run into time changes and even more challenging schedules.

SIDS and the Boring Crib

This fluffy, pretty, interesting crib is a big No-No in the world of SIDS prevention.

My daughter is now 8 months old and a crawling, active and loud baby. The unfortunate thing is that these days, SIDS prevention has become a huge deal, and that leaves me without much options when my daughter becomes “bored” in the middle of the night in her crib. This means she’s now crying in the middle of the night because she wants to play somewhere else… and not feel lonely.

Uh oh.

Sudden Infant Death Syndrome is something I certainly would like to avoid if at all possible, but I have wonder if the rules are a bit stringent for the older infants under one year of age. When they can crawl so quickly across the floor and roll from one end of the room to another in the matter of seconds, I wonder why I can’t put any stuffed animals, however small and non-choking sized in the crib to simply amuse her when she wakes up. Well, I am so in fear of the SIDS monster that I keep her crib pretty barren and desert-like with the hope that she can just amuse herself with the scenery of the crib rails and beyond and enjoy crawling around in the confines of her crib. I guess I could attach some kind of mobile but I’m sure a new recommendation will come out that it is unsafe to attach anything that can be easily removed or have strings that can strangle the baby. There really is not much left that we moms can offer a bored baby in the middle of the night.

Boring SIDS-Prevention-Approved Crib

If you’re reading this post and feeling the same way as I am, yet hoping for an new, alternative idea to amuse the baby, I’ll have to say, I am so sorry, but I don’t have any bright ideas. The kid just has to learn to enjoy the crib the way it is: hard, boring, and looking like a baby cage. But, this is all a matter of perspective, and I don’t really know what my baby is thinking at the time that she is crawling around inside the crib and peeking out the slats. I just know, I wouldn’t want to be her.

I hope one day, we find out exactly the reason why SIDS occur and then perhaps, we can lighten up a bit about this whole SIDS prevention business so that we can offer the baby (and moms) some options.

When SIDS occur, it is a most devastating tragedy and so for now, I do encourage following as many prevention recommendations as possible. If you’d like the most recent American Academy of Pediatrics SIDS Task Force recommendations, please go to the Healthy Moms & Babies Link to see my summary of the SIDS prevention task force technical report that came out this November 2011.

Mommy Blues

A new child in the family. A loving family basking in the deep love for each other and their new addition. A happy time full of joy and wonder. That is how I envisioned my first weeks when I had my first baby.

The first few days were full of wonderment, but quickly thereafter, the hormones started to rollercoaster, and I felt my mood drop to depths that I never thought it would ever reach in my life. I was in the midst of baby blues, and being a physician, I knew the signs and symptoms; and in my heart, I knew what was happening, but I wanted to deny it… just a little… because I wanted to believe that I couldn’t be that weak of a person. I suppose I’ve always thought of myself as an optimistic and adaptable person, but the first several weeks after delivery was another story.

The tell-tale signs were there: tearfulness, fatigue, poor concentration, poor sleep (that’s a given for any parent with a newborn), the non-desire to be with people, the very small appetite, and mostly… I just felt down. The stress of planning my return to work 2 weeks post-partum made things just a little worse. The stress (and pain!) of breastfeeding (yes! It can be stressful for a new mom!) and figuring out how I was going to pump in the middle of seeing patients in the office daunted me. I was dreading every feeding with my child because my cracked nipples never had the chance to heal. I checked and double checked and she was in proper breast feeding form, but it still took a toll. I was tired, stressed, and at the bottom of the mood chain. I wanted to crawl in a corner and just not deal with it anymore.

It can happen to any mom. “Baby Blues” is really not uncommon, and many moms experience it in one way or another, some more than others. I’m not a big fan of the term “Baby Blues” used in medical circles, because I don’t feel it is the baby’s fault that we moms are feeling down; it is due to the intense pressure of the circumstances that we tend to roller coaster into such an emotion.

I feel that society also places such high expectations on moms that instead of encouraging them, sometimes it tires them out. For example: the constant drolling messages about “breast is best,” or “you’re not a good mom unless you breastfeed,” makes me a little angry sometimes. Yes, breastmilk is wonderful as much research shows, and if you can do it for as long as you can, kudos to you. If you choose formula because you feel that’s the best way you can feed your baby and bond, then great, kudos to you, too. I don’t see why we need to find ways to make moms feel guilty about their choices as children still grow up strong and healthy even if moms don’t or can’t breastfeed. In any case, society continues to place a watchful eye on moms and this makes the whole parenting challenge (especially for new moms) quite stressful… let alone all the hormone fluctuations, body changes and healing required from the trauma of delivery.

My main message for this post to moms out there who are experiencing that bit of a blue feeling: you are not weak. You are a mom, and a good mom at that. You are experiencing something that happens to many other moms known as “Baby Blues.” If you get worse, see your OB/Gyn or Family Physician because Post-Partum Depression is a real disease that can occur if baby blues worsen.

Sometimes it’s helpful just to get out there to mom groups to share your experience and learn from other’s experiences. Support groups are great, but if you had wonderful support at home (like I did), the blues can easily be a passing phase. I deeply appreciate all that my husband and mom-in-law did to help me during that challenging phase. I am a very happy mom now, and looking back, it was certainly a time of trials, tribulations, and change, and it was all very worth it.

Disposables, Cloth, or Nothing At All?!

Yes, I am talking about… diapers! There are so many options these days that it is difficult for parents to choose what is best. I will go through a general review of these options as I’ve tried both disposable and cloth diapers and am currently trying a part-time elimination communication method for my daughter.

When my little girl came into this world, there was such a flurry of things going on that we naturally gravitated to the tried, true and very popular disposable diaper option. I’m talking about the Huggies, Pampers, Luvs, and multitudes of generics out there in the market. They were easy to put on, easy to take off, and a (mostly) safe bet that it will catch whatever came out of my baby’s bottom. We were also endowed with quite a few of these diapers as shower gifts, so there was no question — disposables were the choice at that time.

Around 6 months of age, my daughter began to gain the trunk muscles required to sit up on her own. It allowed us to move her from an infant reclining bath to the squeaking larger inflatable duck bath (which she hated at first by the way… but what baby doesn’t hate big changes). She acclimated to that change admirably. At that time, I was doing some researching online and happened to come upon a method called “elimination communication.” I thought, “interesting.” Further research into this method showed that it was controversial in some circles citing Freudian concepts that “early potty training” was detrimental to the young infant’s psyche and others including medical professionals that argue that babies are “just not ready” until they reach a number of milestones for potty training.

Again, there has been lots of miscommunication and misconception of many who have heard about this “early potty training.” I personally do not like calling it that. Potty training, in its entirety, certainly requires the baby to have a concept of: I need to go to the potty and sit on it to eliminate, I need to take off my clothes before I sit on a potty, I need to wipe my bottom after I eliminate, and I need to flush the potty (or tell mom or dad) that I’ve finished and put on my clothes. A child at 6 months of age… of course she can’t do all that! However, Elimination Communication (EC), in my opinion, is a segue into potty training in the future. It allows the baby to have a concept of using the potty, and if successful, saves many diapers and dirty bottoms along the way.

Many parents, when hearing that a parent is trying out EC, appear horrified and are concerned that the baby is too young, or that early training such as EC will create psychological damage in the future because of the “harsh training our parents used in the past.” I’m not sure we turned out so bad, though. In any case, EC is not about punishing young infants because they don’t make it to the potty or they don’t eliminate in the potty. I consider it merely providing them an opportunity to eliminate somewhere else other than his or her own diaper.

This Baby Bjorn Potty Chair was chosen for the high back, easy lift-and-clean system and dependable stability.

I decided to try this out part-time. I’ve read about moms who actually keep their baby diaper free to catch their “signs” about when they need to potty. I’m a full-time working mom who is unable to do such a thing. Plus, I like a clean house. So my adventure into EC started simply with, I’ll chose some times during the day to put my daughter on the potty and see what happens. My daughter almost always had bowel movements (BM) in the morning after her first feed of the day. It was almost a ritual; She’d finish her feeding and I’d place her in the “poop position” with her back propped up against my thigh and knees and her bottom sitting on my lower stomach/pelvis. Almost everyday, we’d produce a bowel movement like that and I was able to watch her facial expressions and listen to the noises she made to understand that indeed, she was having a BM. She usually urinated after naps, before or after feeds and before bathing and after the last feed of the day. Honestly, the urinating thing was very hard to catch on time. But the bowel movements? Since I’ve started, I’ve been 99% successful in catching her BMs in the potty. When she’s with grandma during the days when I’m at work, she has been about 75% successful with this. We were down to 4 disposable diapers a day.

Then I decided, well… if she’s not really making BMs in her diaper anymore, why don’t we try cloth diapers? Urine is much easier to clean, and since we did laundry almost every day in the house, smell is certainly a non-issue. So I bought a small set (note: they were expensive!) of cloth diapers to try out. My daughter didn’t mind the change. Cotton was more comfortable for her little tooshie, but it was very bulky indeed! Cloth diapers are… just ok, I concluded, but I guess it’s more environmentally friendly.

Now we’re down to 1-2 disposable diapers needed a day – one for overnight and one when going out of the house. Wow!

How’s my daughter faring on the potty? One may wonder. From day one she was laughing on the potty. I gave her a toy to play with and held her in my arms most of the time to make sure she didn’t decide to lean over sideways. She loves the bonding time. If she was ever too tired and gets cranky or fussy the minute I put her on the potty, I will immediately remove her from it. If she sits for 10 minutes and… nothing… then it’s time to get off the potty. I never want her to associate the potty with punishment or unpleasant things. She successfully urinates about 1/3 of the time in the potty and almost always BMs in the toilet. I am fascinated and amazed by this whole endeavor. I see no psychological damage in my very happy and lively baby.

This is a genuine narrative of my adventure so far in the world of baby elimination. I hope you find some thoughtful ideas through this experience. I will be sure to update again when the real potty training begins and any trials and tribulations that come with it!

Motherhood: The Beginning Of An Adventure

The day I found out I was pregnant, I really wasn’t planning on being pregnant. My husband and I recently returned from a vacation to Mexico and I had just stopped taking my birth control pills about a month prior. I thought, “what are the chances?” Despite my medical knowledge, I felt in my heart there was no way we’ll get pregnant right away. Well, let’s just say, I stopped the birth control pills, and a period never happened.

My emotions were mostly excited and elated, but there was also some reservation due to the anticipation of the unknown. “Wow,” I thought. “I’m going to be a mom. How does one do that?” It was a bit of enlightenment and enchantment, but altogether, a very special memory for me.

I remembered the day I started spotting. I was about 6-7 weeks into pregnancy and have not yet seen an OB/Gyn. Actually, like millions of Americans, I was in-between jobs and did not want to pay the enormous fee for COBRA insurance coverage. I was still covered under my husband’s insurance, but knowing so little from the patient end of dealing with insurance since I had been so healthy so far, I wasn’t sure what I would be responsible for in pregnancy. I decided that until I got my insurance from my new employer, I wasn’t going to let any insurance know that I was indeed pregnant.

Keep your cool — I thought desperately. I knew odds are, the pregnancy will be just fine, and it could be a number of things, but miscarriage was still in the picture. My family has a history of miscarriages and that really worried me. I think it worried my husband more.

I finally got in to an OB/Gyn at about the 9th-10th week. A urine culture positive for infection and an ultrasound that showed a little gummi-bear like figure with a beating heart made me realize, my baby is safe, alive, and the spotting was probably more urinary infection related. In my heart – a sigh of relief.

The rest of the pregnancy went relatively smoothly… except for a few bumps in the road here and there. I developed the most horrible heartburn in my entire life for which popping Prilosec was the only thing that kept my churning, pressure cooker stomach from developing into vomiting-producing nausea. I hate vomiting, but of course, I developed gastroenteritis around my 26th week that thankfully lasted only 2 days. It was the first time in about 20 years since I’ve actually vomited.

I developed the prototypical pregnancy related back and pelvic aches – but these were manageable. I tried to continue exercising but by about the 3rd trimester, huffing and puffing for 10 minutes holding a protruding belly did not seem very worthwhile to me, so I rested instead.

Finally, my due date came and went. I worked up until my due date, and then waited about 5 days before my OB induced my little girl into this world.

Induction and Labor & Delivery was a different world when you view it from the side of the patient bed.  The dreaded medicine called Pitocin that continued to make the uterus contract harder and harder took away my drive to try a non-anesthesia birth. I gave in about 6 hours into labor, and the Epidural allowed me to be pain free enough to take a 2 hour nap and have the energy to continue on until the 18th hour when after feeling quite nauseaus and vomiting (no, not again!) I pushed about 6 times and delivered a beautiful, big 8lb baby girl.

My newborn daughter distracted me mostly from everything else that was going on down below. I had a labial tear and a 2nd degree laceration. I thought, ah well, I’ve repaired these before, no big deal – they’ll heal up eventually. I kangarooed cared my baby and shared her with the family; pictures were taken, folks where shuffled away and I was settled into the bed for observation. I had a bit of a bleeding uterus from all the pitocin, but everything seemed to be just fine and I was moved to a normal patient room to be with my baby. We were able to leave after 2 days in the hospital.

The aftermath of the delivery… oh, the aftermath. This is the part that I regret I had not advised to other women, because I’ve never actually experienced it before until that day. When the epidural numbness wore off, I was given a clear squirt bottle, mesh panties with super large diaper-like pads (frozen) and helped off to the toilet for relief. Thank goodness for the super large diaper-like frozen pads because I really, really needed them day one post-partum. Thank goodness for the peri-bottle that sprayed like a makeshift warm water bidet — used that for about 8 weeks after delivery. It hurt like nothing’s ever hurt before, and I pride myself over a pretty decent pain tolerance. If they offer the plastic donut to sit on, take it. If they offer stool softners and ibuprofen, do not hesitate. If they offer more ice pads, hoard them like gold. Swelling is normal, but definitely painful especially if you’re lucky like me and got a number of stiches.

After I came home, I discovered a number of other maladies; it had never occurred to me that it would happen to me. I developed urinary incontinence – I had to wear a pad for at least 8 weeks because of this. I was so happy when this went away. I suffered the most painful bowel movements in my entire life. Remember those stitches? Well they’re in and around that area. Stool softners and senna laxatives — they were my best friends. Ibuprofen – I continued taking this for at least another 3-4 weeks. Working out at your 6th week? Lucky me had urine leakage every time I jumped during an aerobic workout. Kegels, ladies… Kegels as much as you can. Post-Partum blues? You bet. It took 3 weeks for me to get over myself. Back to work? 3.5 weeks… what a big mistake. Sleep? Forget it. Oh, it was crazy and horrid.

The 2nd week post -partum, I never wanted to do it ever again. I was more tired than I ever was when on-call in the hospital during 30 hour shifts. Let’s just say, I’ve learned a lot from pregnancy, mainly: don’t try to be a superwoman; you’re human, after all.

What had kept me sane through the aftermath was knowing that a little person’s life is completely and solely dependent on me and all she knows is that I am there to take care of her. Although stress, pain, fatigue and blues wore me down, she kept me going and wanting to do as much as I can and push as hard as I can — she was a light in the dark. Months later, when she smiles so broadly and sweetly when you come into the room, your heart goes out to her, and having another baby really wouldn’t be so bad after all.

Welcome to motherhood.