anna in med school

The last thing John said last night was, “I love the man who invented that swing.”

I don’t want to jinx it, but our darling girl has given us much-needed 5-hour sleep stretches for the last three nights.  Perhaps just as appreciated is that we can set her down into the swing before she’s asleep, and she’ll just look up, mesmerized by rotating leaves and birds, herself cooing away, as she gently drifts off into slumber.

The hilarious thing is that now we both associate the crooning of the swing’s mechanical-sounding lullaby with our own relaxation and sleep.  As I hear it playing upstairs, I’m struggling to keep my eyes open.

Anyone who criticizes this device as being a non-human babysitter has clearly not known 10 weeks of continuous sleep deprivation.  We are abundantly appreciative of its existence.

One of my attendings during my pediatrics rotation sent me a congratulatory email shortly after the birth of Aurelia in which she stated, “Now you have to get used to ‘no guilt allowed.'”  I took that to mean that I should try not to feel ashamed if it was suddenly 2pm and I hadn’t managed to wash my face yet (to wash my face before noon, now that was a great accomplishment).  I stopped thinking twice before spending the extra 29 cents for precut vegetables at Trader Joe’s if it meant one less step on the way to a healthy meal.  (During clerkships, home-cooked meals most weeks felt like a choice: a decent dinner or an extra half hour of studying.  During my first six weeks of parenthood, setting my wailing infant down for a few minutes only for her to cry louder did not always feel like a choice.  Thank God the woman in the duplex next to ours spends most nights at her boyfriend’s.)  Any and all shortcuts are welcome in this household.

I like crafts.  And when I think back on holidays as a child, it’s the homemade stuff that made the magic.  Part of me wanted to make a first ornament and a stocking for my firstborn, but the better part of me wanted that time to actually spend with the babe, her father and her visitors, or to spend that time sleeping.  So without guilt I turned to some of the craftspeople on Etsy.

Jacki of City Details made the most beautiful, simple ornament in what seemed like the blink of an eye.

Since John and I had our first tree together in 2005, we’ve gotten a new ornament each year.  Jump back to 2005 (whoa):

And we thought it might be time to retire the 99-cent felt stockings, names written in puffy paints, we once bought at Kmart.  In lieu of putting my surgical suture-tying skills to the test, we wisely connected with Heather of EverydayGraces, who created these rustic beauties:

I like the fact that the money is going, for the most part (that I know of), directly to the craftsperson.  And you can develop a sort of rapport with the artist, which makes everything feel a little more personal.

Below is a sliver of our home explosion of merriment, mixed in with all things baby.  I can’t help but laugh that even our dining room cannot escape, as it is the place we park our BOB stroller, our carseat, and our apocolapse-size Purell dispenser.  Our dining room table has also become our work space, since I can set the babe on the floor of the living room for a few moments before she goes ballistic on me.  Our life looks so different from six months ago.

Recorded over Thanksgiving.  I love how much she appreciates her food.  Apple doesn’t fall far from the tree.

Goodness, I’m still marveling over her muscle control.

a.k.a. “giving birth without an epidural.”

I would like to preface this post by saying that I’ve been dragging my feet in the writing and posting of it.  I have many conflicting thoughts, and I’ve tried to restrain myself with hopes of coherence.  Here goes…

One night, when he was on his OB rotation during his intern year of residency, John came home stressed, and the first words words out of his mouth were, “Please tell me you’ll want an epidural.”  At the time, it was a no-brainer to me.  Of course I’ll want and get an epidural.  In the U.S., it’s associated with minimal risk to mother and baby, and it allows mom to experience childbirth with less trauma.  Since it doesn’t act systemically, it doesn’t create the 1950s/60s vision of drugged-out-of-her-mind mama and, consequently, child.  In fact, it many hospitals, it’s use is associated with a lower cesarean rate.  Why the hell wouldn’t I want it?

But I am incredibly susceptible to peer and social pressure.  As more of my friends started considering unmedicated childbirth (note the wording, which is still problematic; personally, I consider birth with an epidural just as “natural” as safe births without), I weighed the advantages and disadvantages.  My thought process on the advantage side was as follows:

1. Having been catheterized twice before, I thought I would prefer not.  That said, I hear once you have an epidural, you could care less.
2. In my mind, I thought it might be nice to be able to walk around, and the ability to do so is compromised by epidural.  Although, as I learned during my OB rotation, anesthesiologists nowadays are really good at their job…if you want to walk, they can try to help you walk with an epidural in place.
3. I did not, and I still don’t, like the idea of continuous fetal monitoring.
4. I kind of liked the hippydippy idea of experiencing birth with my child, and I wanted to at least try to not have any element of that sensation and awareness to be dampened.

Here’s the hilarious thing: not one of my stated advantages actually came to fruition:

1. Although my lacerations were relatively minor (second-degree: into the perineal muscle but not into the rectal sphincter), they were both posterior (toward the rectum, common) and anterior (toward the urethra, less common).  Therefore, a straight catheter was recommended for the repair in an effort to minimize the risks of future problems during urination.
2. By the time I got to the hospital, I was fully dilated.  As soon as I got on my back to be examined, I was not on my feet again until post-repair.  I guess it was kind of nice to be able to get up to use the bathroom and change the chucks saturated with blood…but this was not a highlight of the whole birthing experience.
3. Again, when you show up to the hospital fully dilated, you lose a few options, such as walking around, receiving any type of medicated pain control (epidural, nubain, or otherwise), and intermittent auscultation.  Everyone gets monitoring for at least 20 minutes to look for accelerations and variability…if your baby happens to be delivered before the 20 minutes or up, then looks like you have a monitor strapped to your abdomen during the delivery.  You know what?  I didn’t even remember that detail until I just now jotted down my reasons to try without an epidural; it was a non-issue.
4. Maybe some sense of awareness will come with my next delivery, if I’m lucky enough to have one.  Because this delivery was an absolute shit show.  I was so unaware that I mistook transition (the dreaded limbo period before you’re fully dilated but you feel a strong, uncontrollable urge to push) for early labor, and I thought I might literally lose my mind.  I don’t remember some ethereal joint birth experience with my daughter–I did what I was coached to do by my husband and the midwife on-call to have a healthy birth, and I mostly remember the wave of love, happiness, and relief when my wailing girl was placed on my stomach.

Truth?  I wanted to prove that I was strong enough.  I wanted to somehow feel woman enough to be able to experience labor in full force.  I wanted to be a “war hero.”  And when I was transitioning in the upstairs hallway of our duplex, I desperately wanted anything that would pull me out of it, but I worried about how I would be perceived if I caved.  How absurd is that?  I, at least in that moment, thought more about image than the safe birth of my child.

So it was with both relief and disappointment that I read the passage below in Bringing Up Bebe.  I dislike the attitude toward epidurals that seems to have taken over the culture of childbirth in our country.  I recently found out that a friend of mine (a badass, strong as hell, and brilliant woman) was publicly criticized for her decision to undergo a scheduled c-section when her baby was still breech at full term by a woman who preferred to do things “naturally.”  Are you kidding me??  Or, in reference to this fantastic article (thanks Anne!) that I read every time I feel like my mind is going to explode with all the free advice being doled out, “really?!”  JJ Keith goes on to say, “Childbirth is just one really rough day with — odds are very good — a happy ending.  Prepare for it, but don’t let it define you.  Epidurals suck, but there’s no gold medal for pain endurance.  If you get a C-section, you still get a baby.”

Without further ado, the eloquence of Pamela Druckerman:

Birth, like most everything else, is something we try to customize. My obstetrician says she once received a four-page birth plan from an American patient, instructing her to massage the woman’s clitoris after the delivery. The uterine contractions from the woman’s orgasm were supposed to help expel the placenta. Interestingly, this woman’s birth plan also specified that both of her parents should be allowed in the delivery room. (“I said ‘no way.’ I didn’t want to be arrested,” my doctor recalls.)

In all this talk about giving birth, I never hear anyone mention that the last time the World Health Organization ranked national health-care systems, France’s was first, while America’s was thirty-seventh. Instead, we Anglos focus on how the French system is overmedicalized and hostile to the “natural.” Pregnant Message members fret that French doctors will induce labor, force them to have epidurals, then secretly bottle-feed their newborns so they won’t be able to breast-feed. We’ve all been reading the English-language pregnancy press, which emphasizes the minute risks of epidurals. Those among us who deliver “naturally” strut around like war heroes.

Despite being the birthplace of Dr. Fernand Lamaze, epidurals are now extremely common in France. In Paris’s top maternity hospitals and clinics, about 87 percent of women have epidurals, on average (not counting C-sections). In some hospitals it’s 98 or 99 percent.

Very few women make a fuss about this. French moms often ask me where I plan to deliver, but never how. They don’t seem to care. In France, the way you give birth doesn’t situate you within a value system or define the sort of parent you’ll be. It is, for the most part, a way of getting your baby safely from your uterus into your arms.

In French, giving birth without an epidural isn’t called “natural” childbirth. It’s called “giving birth without an epidural” (accouchement sans péridurale). A few French hospitals and maternity clinics now have birthing pools and giant rubber balls for laboring women to hug. But few Frenchwomen use these. That 1 or 2 percent of nonepidural births in Paris are, I’m told, either crazy Americans like me or Frenchwomen who didn’t get to the hospital in time.

The absolute earthiest Frenchwoman I know is Hélène. She takes her three kids on camping trips and breast-fed them all past age two. Hélène also had an epidural at each delivery. For her, there’s no contradiction. She likes some things au naturel and some with a giant dose of drugs.

Last night, John and Ari attended Christmas Eve dinner with family and friends.  By request, I sat on my in-laws’ couch watching Bridesmaids while sipping Glenmorangie and eating cocoa-flavored goat cheese on apple slices.  It was my first time alone at home since her birth, and it felt…really good, though I missed them as soon as the car pulled away.

Dear friends,

I wish you and your families a very merry Christmas!  I’m far behind on thank-you’s (my apologies), but this holiday season we are acutely grateful for the outpouring of love that has been shown to our daughter in the last two months and, of course, for the support throughout my pregnancy, in our respective professional lives, and other developments along the way.  2012 has been quite a year!  Simply and sincerely, thank you.

Although Ari is way too young to remember this set of holidays, having a child has definitely rekindled the magic of the season.  I’ve cherished singing a multitude of carols, ingrained in my memory after years of chamber choruses and holiday pops, and watching her respond so predictably (at least in my imagination) to the familiar melody of “Lo, how a rose e’er blooming.”  I’m looking forward to reading her Madeleine L’Engle’s The Twenty-Four Days Before Christmas and celebrating the Oppenheimer family version of a secular Advent.  And I am thankful for the opportunity to introduce her to so many loved ones who have helped make these days together merry and bright.

xoxo

jj & ajx2

This evening Michelle and I will do what I know every parent in America will do, which is hug our children a little tighter.  We’ll tell them that we love them and we’ll remind each other how deeply we love one another.  But there are families in Connecticut that cannot do that tonight and they need all of us right now.  (President Obama)

Words cannot adequately express the heartache I feel for the students and teachers of Sandy Hook Elementary School, and to their families and friends.  This tragedy is simply unimaginable.  

I’m leaving my daughter for part of this night to attend a class party in celebration of the end of clerkship year (for most of us, I still have psych and neuro to complete in the spring).  Although she will be in the loving arms of her father, it will be so hard to leave her.  Not in comparison at all to the horrific events in Newtown, CT, but Aurelia had her two-month vaccines today (one oral, three shots).  I was holding her in my arms, attempting to breastfeed her as this look of utter shock and pain washed over her face and she let out a bloodcurdling scream.  And then I burst into tears.

John said I had to go out tonight.  I told her to be good to her.

Him: I’m always good to her.

Me: I know, but be extra good.  Like, if she were older, it would be the kind of night when she could have ice cream.  And an extra story at bedtime.  It would be that kind of day.

Him: <smiling sympathetically> Okay, honey.  It’s that kind of day.

To those directly affected by the events at Sandy Hook (though in a way we are all directly affected), I am so sorry for your loss.  My thoughts and a great part of my heart are with you tonight and for a very, very long time. 

Clearly trying really, really hard:

She’s been flashing reflexive smiles during (supposedly) REM sleep for a while.  (BTW, isn’t’ it fascinating that babies spend 80% of their total sleep time in REM sleep, while adults only spend about 20%?  One theory as to why is that the primary function of REM sleep is to stimulate central nervous system development.)  Now we’re getting some real responsive smiles, clearly elicited by the most ridiculously animated facial contortions we’ve been making 12-18 inches from her face (ideal distance for her still pretty terrible vision).  This is the best form of encouragement for sleep-deprived moms.

John likes to call home at least once a shift to check in on his girls.  Sometimes he has a hard time holding in his high-pitch cackle of laugh when I reveal a new trick his daughter’s demonstrated.  At two weeks of age, it was the ability to, the moment after I finished bathing her, while she was still naked in my arms, dump of load of mustard-colored stool over my arms and stomach while simultaneously vomiting down my chest.  She was not phased by this experience in the slightest.

At six weeks of age, while we were practicing smiling, she managed to vomit in my mouth.  Apparently I don’t learn, my daughter has perfected her aim, or I find her so irresistibly adorable that I can’t help but continue with the big-mouth smiles, as I have once again found myself spitting out my own curdled breast milk.

Look at her plotting away:

You would think I would be disgusted.  I’d love to know more about the hormones, genes, neurons, or whatever that make us hard-wired to not be completely repulsed by the many things that are expelled from our progeny’s orifices.  Or what makes us inherently proud of each milestone, regardless of how minute it must seem, or each demonstration that the body is functioning appropriately.  I think about this when my heart simply melts with each owl-like coo-hooing Aurelia’s been rocking out recently, or when I exuberantly exclaim, “Nice work, honey!” when she startles herself with her own long, wet fart.

What do you do when you have an infant recovering from GERD who just wants to snuggle?

The answer: watch Christmas movies on ABC Family all. night. long.  I turned the TV to Home Alone just in time to see one of my favorite holiday scenes: when Kevin and Old Man Marley talk in the church while a children’s choir rehearses “O Holy Night.”  I think all choir geeks love this scene.

Other holiday favorites include Jamie’s proposal to Bonita Aurelia in Love Actually, and pretty much anything involving muppets:

Happy St. Nicholas Day!

Poor Aurelia!  It can’t be easy to be the first born of a doctor and a (hopefully) doctor-to-be.  Too many wet diapers and we worry about malabsorption.  Too few, pyloric stenosis.  Of course, the latter has definitely been on the radar because our girl is a vomiter and we have a family history (there is a genetic predisposition).  John had surgery as an infant for pyloric stenosis, a narrowing of the opening between the stomach and the first part of the small intestine that causes projectile vomiting, dehydration, and hunger.  Her recent weight gain makes us much less concerned.  Some kids just vom a lot.

When I fixated on another possible diagnosis, I knew I was being paranoid…who is it that said a little knowledge is a dangerous thing?  Although infant reflux is common, actual gastroesophageal reflux disease (GERD), where the baby experiences discomfort due to the reflux of stomach acid, is less common.  We’re shown videos during our peds rotation of Sandifer’s syndrome, when an infant forcibly arches her head and neck backward to lengthen the esophagus and partially relieve the discomfort of reflux.  John and I watched our darling girl perform the same maneuver accompanied by a high-pitched screech during or shortly after feeding–absolutely heart-breaking to witness.  For about five days, Aurelia was unconsolable for stretches of time (felt like forever, though they were probably only 2-5 minutes each).  One day, she was hoarse from crying, and likely from reflux as well.

We called our pediatrician first thing Monday and, while trying our best not to be annoying, paranoid, know-it-all parents, we presented Aurelia’s symptoms…and we might have politely mentioned our suspected diagnosis.  She was started on a trial of Zantac (a.k.a. Ranitidine, a histamine H2-receptor blocker that inhibits the production of stomach acid).  Two days of treatment and our sweet Aurelia is all snuggles again.  Although I had hoped Zantac would be our silver bullet, I’m amazed by the nearly immediate change it made to her disposition–or, I should say, the affect reflux had on her disposition to begin with.  Then again, considering how reflux during my 35th week of pregnancy affected my attitude toward everything (and yes, I know, just one week, I can’t complain!), I shouldn’t be surprised.

Now if only someone could come up with liquid Zantac that doesn’t have a taste that makes my daughter purse her lips deliberately as though I’m feeding her Campori or something equally disgusting.