Tuesday, July 2, 2013

Guest post: Who do I beep?

I'm a Internist and a Nephrologist (in my country, first you must go through Internal Medicine Residency and then through Nephrology Residency to finally become a Nephrologist). And since I  enjoy getting my hands dirty, I work more-than-sporadically as an ICU resident. I'm also the proud mother of a 4 1/2 month old.

One of the things I love about ICU is protocols (and of course the possibility of breaking them as needed) and the support you get from other areas of medicine. For instance, having gone through Internal Medicine and Nephrology residency, I find myself quite comfortable with vascular access. If by any chance I fail at establishing one the old fashioned way, I always have my faithful portable ultrasound by my side. If that doesn´t work, well, I can  beep the anesthesiologist on call, not without being absolutely embarrassed, but hey, the job has to be done. And if the anesthesiologist has a rough time placing the catheter (which I secretly hope, that way I feel less like a failure) or if he misses too (which of course I do NOT hope for), the vascular surgeon will do.

But now, I find myself with a four month old low weight infant. I went through a C-section due to IUGR and Preeclampsia and babyboy was born weighing 4 pounds. He has recovered quite well but still is below average. And he only dreamfeeds! When he is awake, he is so distracted by the world around him he will only feed 1 or 2 ounces at a time. No matter what I do, I can be standing on my head, singing, waving all his toys in front of him, or feeding him in a dark quiet room, nothing works. Needless to say, he rejected my breast almost a month ago.  And when he dreamfeeds he always eats less than he should.  Also eating so little by day, even If I give him a last 23:30 bottle, he still wakes up several times at night. The good nights at 4 am and 6 am, so we start the day at 6 am. The bad nights.... well at 2, 4, 5 or 6 am...

I´m the kind of person who always believed that you could accomplish anything if resourceful enough, but this little person, my little "bundle of joy" has my whole world upside down

How do I do it? How do I "get the job done"? How do I get him to be hungry enough to finish the bottle, to sleep more than two hours a night without waking? Who do I call, who do I ask for support, ..... who do I beep?

And the answer is no one; in this one I´m alone by myself (my dear hubby helps a lot, but let's face it, he has less patience than I do). And that is probably why, and hopefully why, I´ll end up being a better mother than a central-venous-catheter-placer

22 comments:

  1. Well, you beep MiM! I don't know if I can offer a solution, but I have empathy - your post is sounding a little bit familiar to me. I had a premature son as well - he was 5lb.6oz., a little bigger than yours. And after having a daughter that slept through the night at 3 months - I was blissfully unaware that the opposite might happen. Jack ate in small increments through the night for almost 8 months. It's a wonder I got through residency, doing research and chief resident, and passing boards, with him up half the night.

    I had to let him cry it out then for my own sanity, and I wish I would have done that a couple of months earlier in retrospect. He did eventually catch up. He's still a pretty skinny 8 year old (so much so that I get comments) but he is tall and gangly and eats a ton so I don't worry.

    I write this to say every kid is different - I don't know the answer to yours, but you sound like you are doing a fabulous job in mothering and medicine. And believe me, you are not alone. We are all there with you, awake in the middle of the night, worrying about work and our babies and if we are enough (A resounding YES, we are). Good luck to you and thanks for sharing - you brought me back to a scary but wonderful time in my life, with your words. Despite my lack of sleep and anguish I cherished the one on one time with my son while the whole world was sleeping. It is fleeting, in retrospect, but all consuming at the time I agree.

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    1. thank you for your kind words of support. Its good to know Im not alone in this.

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  2. Oh, I know saying "this too shall pass" is very trite when you are balancing worrying about your baby's health with your lack of sleep and sanity,

    Good luck to you and the baby, and I hope he starts eating more and sleeping more, soon.

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  3. What a well-written post! I love the way you tell the story of your dreamfeeder. He sounds adorable. You sound amazing! I think you have articulated one of the reasons why we MiMs can really struggle - babies defy understanding! They are unique little people, and we will never know what makes one a dreamfeeder and another a sleep-through-the-nighter. As doctors, we are used to protocols, getting the job done, being efficient and SOLVING PROBLEMS with our hearts and minds and hands (and beeper!). Then along come these little people who resist our tried-and-true logic. Our problem-solving skills (so well-honed) seem to be for naught, so we regroup and try again, and again, and again... and again. Yet nothing seems to "work". So, why won't your dreamfeeder sleep longer and feed more during the day? The answer is: I don't know. And: you may never know (I'm sorry). You sound like you are doing everything "right" in terms of varying the routine during the day, trying to feed more and longer at night, etc. I doubt I can offer you more advice. I can offer you a lot of empathy - being sleep-deprived and a high-functioning doc and mama is a supreme challenge. I can offer you support (you WILL survive this!) and cheerleading (you ARE doing a great job!). But as for advice... I think you've got this. I think you are doing exactly the right thing. I think you are following your instincts and making it work. I say this now only with the perspective of having had three babies during my long years of medical training. I wish you sleep-filled nights and bliss with your baby boy, always. But in the sleep-deprived interim, I wish you acceptance and survival and good people around you to help you and support you. You deserve it. Good luck!

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    1. That was my point exactly, after almost 5 months of horrible sleeping, getting up a couple of times a night specially sinceI can take a few turns with my hubby is not so bad. What is completely new for me is the uncertainty of it all, no protocols, no guidelines, no consistency in his behaviour. I try something one night and it works like a charm, but it doesn`t the next. One day he accepts the bottle completely awake, but for the next week he doesn`t want anything to do with it!. And worst of all, and what hurt most my own blown up pride, Is that I used to think that just because I was a successful career woman I`d have to be a great mother. BIG mistake! I`d say in my case it was completely the opposite. After all these months I`ve come to make peace with my own flaws and accept that no one is perfect and no one does everything perfectly. I might be a good doctor, I`m not such a a great mom, but thats ok; everyone who is good at something started by sucking at it in the beginning.
      Maca

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    2. Just saw this--you need to stop beating yourself up! Your child is alive and growing, and you have sacrificed so much for that to happen. You are a great mother!

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    3. To me this was absolutely the hardest part of maternity leave/parenting an infant. Not that there is not uncertainty in medicine, but I think a lot of us went in to medicine because we love data driven science. Nothing about my son is data driven!

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  4. I feel for you. My little guy (born 5#5.5, down to 4#9 by the time we left the hospital) was a nibbler. The first half of the first year was miserable. Our early mornings were always like your bad ones, and as an OB/GYN in private practice who went back to work at 8 weeks. I guess an obvious question is if you've asked your pediatrician for any feeding advice. Maybe a higher calorie formula or breast milk supplement? But if he's gaining weight appropriately, perhaps not. If your pedi isn't concerned, take that as reassurance that you guys are doing just fine. Maybe there isn't a major problem to be solved here (aside from sleep...more on that in a minute). Keep in mind that half of the kids out there are below average! (And it doesn't necessarily correlate with adult size--my brother was always below the 10%ile as a kid, but now he's nearly 6' with an athletic build.) I won't lie that I was excited when my son was 17%ile at his 2-year check-up, up from 8%ile at 19 months, but I have always seen it as reassuring that he's growing and that his doc has never been remotely concerned about him.

    That said, after 7 months of misery, we did make my son cry it out. Which is miserably hard but absolutely necessary when you NEED SLEEP. Yours might be a little small for that still, but once you and your pediatrician are comfortable with it, go for it. We could have done it earlier but felt guilty, so we waited until we were desperate. I wish I hadn't listened to my guilty conscience. In retrospect, he would have been fine doing it at 4 or 5 months, and we would have been a lot happier.

    Good luck. I can assure you that it will get better and WAY more fun. Little boys are an absolute joy.

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  5. P.S. It's OK if you feel like punching every parent who brags that his/her baby slept through the night at 2-weeks-old. Just don't actually punch them ;)

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    1. LOL, a colleague who is an internist had twins, both sleeping through the night from 2,5 months. Another colleagues wife had twins too, also sleeping through the night. A friend had a baby girl one day before I did, a chubby baby who eats and sleeps like a charm!. Sometimes I wonder what I might have done wrong, and what can I do about it, and I realize that the answer is "nothing", and just to "go with the flow". And THAT is the biggest difference in the way I have been living my life so far. For many years I have defined myself as a medicine student or a doctor, acted and lived like one. And this lifestyle does not work for parenting. The scientific method does not work in parenting. You don´t validate or discard hypothesis, an action does not always evoke the same reaction. Its a beautiful, fulfilling, yet chaotic and uncertain lifestyle which Im starting to get used to and most importantly, starting to love.
      Maca

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    2. My college roommate had her daughter when my son was about 5 weeks old. Two weeks later, she emailed me to complain about how HORRIBLE it was when her daughter slept through the night and her over-producing breasts got engorged and leaked so much she had to change the sheets. At the time, I was getting up every 2-3 hours to pump, even when my husband was on baby duty, had a paltry milk supply as it was, and was headed back to work in a few days with virtually no sleep for eight weeks. She is lucky she lives across the country because I probably would have slapped her had she told me this in person. I still haven't forgiven her insensitivity. Part of me realizes that she felt like she had it hard and had no idea how much harder it could be.

      The reality is that parenting is hard for everyone, but some situations are harder than others, so please make sure you give yourself credit for how difficult it has been for you. You are doing a great job at figuring it all out. But you're right, it's not like science. Too many factors to do a controlled experiment, particularly because your test subject changes so much in such a short period of time. Just when you think you've found the solution to your problem, voila, your little one will change and you have to start a new "experiment." I'm currently having that sort of frustration with potty training--he was totally reliable for 3 months and then suddenly, he can't be bothered--just a reminder that parenting "problems" are never "solved," and you just have to roll with the punches!

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    3. LOL, I would have killed her! Anyways its true, parenting problems are never "solved", just when you are chanting victory and enjoying newfound self confidence for overcoming some difficult situation, another one is lurking behind you to bite you in the rear!
      Maca

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    4. I had to chuckle a few days later when the same friend expressed concern that her newborn photo shoot appointment might disrupt the little one's schedule (at 2 weeks old!). I realized she had a lot to learn about motherhood.

      She still has a pretty easy-going kid, and I'm glad for her. Some of our kids are more spirited, which is more fun in the long run. And I wish her luck when that kid hits puberty. I thought I wanted a girl, but after finding out I was having a boy, I viewed my appointments with teenagers and their mothers in a whole new light. Thank goodness I have a boy!

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    5. So glad you brought this up. Been in that situation about 100 times! I can so relate to the feeling of wanting to punch someone!

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  6. so he's BOTTLE feeding (so doesn't need a lactating woman) but you are the one getting up for every night feeding? honestly, i take issue with that. if were a SAHM with the ability to nap when the baby napped during the day, it would be one thing. but as a working mother? that doesn't make sense! i am married to a vascular surgeon with a grueling schedule but i can promise you that if i had a baby waking up that often to take a bottle, he would be in charge of at least one nighttime feed every night. perhaps he could do the last evening feed (the one around midnight) and you could go to bed super early, then it wouldn't be as bad getting up 2, 4, 6?

    also, agree with asking the ped about the weight gain - perhaps he could benefit from a higher cal formula for a while, or maybe not, but it would put your mind at ease to ask.

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  7. My son is about a month older than yours and he was born at 39 weeks by repeat c-section. He is a chunk (17 pounds at 4 months) and still seems to think he needs to eat at least twice a night and sometimes more. I don't have any advice to offer, but just wanted to let you know that you're not alone! Our daughter is 2 1/2 and we finally had her cry it out around 9 months. She was always a better sleeper than our son is, though. Hang in there! Eventually we will be able to sleep.

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  8. ps: i am sorry if i sounded harsh above - i didn't mean it that way. and it sounds like you are doing a greatjob. just wanted to empower you to ask for help as the baby's father is capable of helping out at night, 'patient' or no!

    i also had a night waker until 7-8 months but since i really wanted to breastfed and had iffy supply (didn't pump that well) i had to get up and feed her. but if she had been getting bottles i would have gladly turfed a feeding each night.

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  9. aha, my hubby is also a vascular surgeon. The thing is I managed to get a half day job and he works the whole day so I try to take most of the night feedings. Plus I have nightmares of him being too tired in the OR and falling face over an open Aorta or Carotid. Still he gives him the 23:30 bottle and from then its my turn, although some nights when Im specially tired he offers to help himself
    Maca

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    1. okay, that makes sense :) i think that is what i would do too (have him do the midnight bottle and then do the rest). the way the above was written i was worried you were not having him help at all! also, you wrote above that you are not good at this -- there is no way that is true! it sounds like you are awesome at it and your heart is 100% into it. some babies just don't sleep as well as others. oh, and even after my daughter became a bit of a chunk she still wanted to b-feed in the middle of the night. we did some sleep training at 7-8 months (nothing extreme, she was not too hard to train) and since then she has been pretty good. (still an early riser sometimes but so are we so i can't complain too much!)

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  10. Have you consulted a lactation consultant? Have you tried cloth diapers? For some crazy reason my daughter slept really well in cloth diapers. my husband is a general surgeon resident. i can't imagine what you are going through. i like this woman based out of dallas. judy eastburn. google her. she is fantastic in getting mother's to calm down and give some fruitful advice. i used her with my first and called her about my second (we are no longer in dallas). i'm not sure i have any answers for you but i would look into hiring some help and getting at least one four hour stretch of sleep. my second started off really strong nursing and then she got lazy and didn't feed well. would not empty me out, would get distracted or lose interest quickly and it drove me insane. i had to calm down first (hard to do when i felt like i never had time for anything) and i had to get back to the basics of nursing. things improved when i put more effort into my technique. even though i was a seasoned bf mom with my first it was a whole new rodeo with my second. fatigue is the kicker. it really can make a not so hard task impossible. best of luck. you're not alone. we have ALL been there!

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    1. Thank you for your kind words of support, I did try lactating consultants, but I live in a country in which we still do not have professionals who specialize only in that area. Lactating consultants are more like "alternative medicine professionals" sort of. I ended up getting help from a Doula. Ill Google the woman you suggested.
      Thanks
      Maca

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