Showing posts with label motherhood. Show all posts
Showing posts with label motherhood. Show all posts

Saturday, March 24, 2018

Mau Man and the Chronicles of a Low Birth Weight Mama

BIRTH:
In early March, I became a mama for the second time. We have nicknamed our new little one Mau Man. Our home birth didn’t feel all magical like the pictures I see on the Internet but maybe after continued exposure to oxytocin while nursing I’ll change my story and in a few years I’ll tell you all about how magical it was (feel free to call me out on it!). It was intense and brief (he came within 3 hours but it felt like days). Similar to our natural hospital birth with our first Zo, the details are hazy and I feel traumatized. Did a human just burst forth from my body? Yup! He did. Did I feel like I would give up. Heck yeah, I felt like throwing in the towel a few times, but I didn’t. Was I scared. You bet I was! Did I feel powerful afterward? You know what, I sure did! And super tired too, just like with Zo. I feel like no matter where you deliver, birth takes over you, it takes hold of your being and you just have to submit to the intensity of the process.

LOW BIRTH WEIGHT, THE CONTEXT: Now we find ourselves with our newest little one who is healthy in every single way except he was tiny at birth. 2360 grams (or 5 pounds 3 ounces). Under the low birth weight cut off of 2500 grams. I have read countless studies of how Black women like myself, regardless of socioeconomic status, are at a higher risk of pregnancy complications, maternal and fetal mortality, preterm labor and low birth weight. At my Baby Sprinkle a few months ago, a group of my closest friends and I spent considerable time discussing this topic. Pretty morbid but we are all Black doctors, educators, and health care professionals. But somehow I thought, I would be insulated, I would be spared. I took my vitamins, exercised, meditated, saw a chiropractor twice a week. With all of the complications and losses friends and patients have had I realize that low birth weight is manageable but it still hurts. After our own loss last year, I realize that regardless of how small he was I get to hold him and touch him and smell him and snuggle him and nurse him and I will do everything in my power to get his weight up.

LOW BIRTH WEIGHT, THE COMPLICATIONS: Flash forward to Day of Life 3. His weight loss was more than what our Pediatrician and I liked and he was at risk of hypoglycemia and dehydration. He had a good latch but he just couldn’t muster up enough energy to transfer milk out of my breasts fast enough to grow. I had to start nursing and feeding him every 1.5 hours and start pumping several times a day to provide expressed milk to supplement him with. We worked with an amazing local Lactation Consultant friend first at our home and then in her office and started using a Supplemental Nursing System or SNS. This is a little tube that you attach to a syringe to feed babies at the breast or using a finger to help train them. This helps prevent nipple confusion by delaying the introduction of a bottle. Day of Life 4 was a blur with a ton of feeding and pumping. Day of Life 5 - he had begun to gain weight and his parents were exhausted. We were allowed to space him out to every 2 hour feeds. Day of Life 9 back to birth weight. Day of life 18 weight up to 6 pounds.

And this is where we find ourselves: Nurse and reposition the SNS 10 times. Pump. O finger feeds with SNS in the early evening so that I can sleep for a few hours (this is priceless! Many thanks to Lactation and our old school Pediatrician who made this a key part of our process). Smile. Cry. Have a melt down feeling guilty that I couldn’t make him fatter. Listen to a podcast. Take a lactation supplement. Play with Zo for a few minutes. Tell Zo to be gentle and not climb on me while I’m nursing. Get a pep talk from the hubby. Repeat.

I’ll keep you posted and can’t wait until I can throw this SNS out. I pray for the day he is exclusively breast fed and that breastfeeding soothes him.

My world at night: our 30mL  syringe, the SNS premature baby feeding tube, my 2 pumps - my Spectra electric pump for daytime pumping and my NatureBond silicone manual suction pump for easy night time pumping - I pop it on the alternate breast while nursing/SNS feeding. 



REFERENCES:
Adverse birth outcomes in African American women: the social context of persistent reproductive disadvantage. https://www.ncbi.nlm.nih.gov/pubmed/21213184
Black Women Disproportionately Suffer Complications of Pregnancy and Childbirth. Let’s Talk About It. https://www.propublica.org/article/black-women-disproportionately-suffer-complications-of-pregnancy-and-childbirth-lets-talk-about-it
Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206968/

What’s Killing America’s Black Infants? Racism is fueling a national health crisis. https://www.thenation.com/article/whats-killing-americas-black-infants/

Wednesday, February 21, 2018

Adventures in Pumping


Life is going pretty great for Team Kicks. Baby is almost 4 months old and is a complete joy. He has a sweet easygoing temperament and *usually* sleeps through the night. We are so spoiled and it is so easy to leave work behind and come home and cook dinner while we sing to each other - me from the oven and counter and Baby from his bouncy seat on the kitchen floor - then playing and rolling (!) until bedtime. Love.

However I grossly underestimated how not-fun it would be to be a resident and pumping. The number one thing I underestimated was how hard it is to keep and transport clean parts. There are CDC guidelines for this stuff - wash every time, let air dry, yada yada yada. Not happening. In the fridge the parts go. I have one friend who has an extra set of parts at work for each pumping session. Love the idea but my pump (Spectra) is huge. I was traveling with two bags for awhile (pump bag + work bag, not to mention a coffee thermos in one hand and a water bottle in the other) but I was clearly such a hot mess trying to keep all my things afloat my mom finally bought me a little wheelie suitcase that at least fits all my pump parts. So I wheel around the clinic and the hospital and started leaving my laptop at home which at least makes me appear a bit more together.

I told myself early on that breastfeeding was NOT going to be something I was going to lose my mind over. I was not going to schedule a middle-of-the night pump - if Baby is sleeping, I am sleeping. If I had to give up breastfeeding for any reason, fine. I was a formula fed kid and I turned out a-ok. As I tell my moms in clinic,  the best thing for baby is to be a fed baby with a minimally stressed mom. However, as I found myself pumping in my car on the way to work in a skinny little nursing sheath in subzero winter temperatures and a car that was slow to warm up, I questioned whether I was actually sticking to this sanity thing.

I would like to dedicate this post to my 3 pump-spirations - I have three wonderful co-pumping co-residents in my life. One has a similar go-with-the-flow (hehe pump puns) attitude towards breastfeeding as myself and was the first to recommend car pumping. One has a baby almost 6 months older and was answering my very basic pump questions via text months and months earlier. And one is so dedicated she has a middle of the night pump scheduled to keep her supply up and she is still a bomb resident every single day. My residency is so pump/breastfeeding friendly I've never seen a new mom resident without a breast pump along. So we can do this. Plus anything after 6 months I consider a bonus.

I still have so much more to share about pumping. Awkward conversations with older male specialists. An episode with a preceptor where I was about to run to my pump an hour later than planned when my preceptor started sharing this emotional story and all I could think about was...time to pump....time to pump.... So sanity = questionable. I do address pumping a lot more with my postpartum moms in clinic now - especially with my non-English speaking patients who I discovered I had been prescribing double electric breast pumps for but never addressing how/when/why to use it.

If I had any tips for pumping residents/students/physicians so far I would say 1) hands free pumping bra 2) pumping in the car is a game changer and 3) seriously go buy a wheelie suitcase with all the pockets if you don't have a nice pump bag. Anyone else have any tips? Still have a few months to go. Would also love to hear some ridiculous making-the-pump-work-at-work stories if you've got 'em.

Sunday, February 11, 2018

My almost-teen

“I saw J do the reading the other day at church, and at first, I thought it was you. She is becoming a young lady,” Maureen said to me on the sidelines of a soccer game.

My daughter is 12, soon to be 13, but has recently passed me in height. She is never far from a book – goes through them like that – and can’t help but blurt out her responses and reactions to the plot twists in real time to anyone around. “Anna betrayed her!” “I can’t believe he did that! They have the twins!”

She confides in me still, and each time we are there with the door closed to her room, and I am consulted in critical matters of friendship or fashion decisions, I try to proceed gently as if I’ve been let in to a secret society and don’t want to blow my cover. She recently cried into my arms over a friendship disappointment. I felt the same mixture of calm, responsibility, and honor I feel to be let into that moment as I do when a medical student starts crying in my office in my role as a student affairs dean. Or when a patient breaks down in front of me under the weight of a diagnosis.

She started taking martial arts recently since she wanted to learn self-defense. We found a low-key place that offers all types of classes for kids and adults. She does the kids Muay Thai and immediately following is the self-defense class for ages 13 and up; they allowed her to trial it to see how she would do. She texted me before the self-defense class and wrote “I don’t think I’ll do it,” and inserted a chicken emoji. I called her immediately. There were adults and older teenagers taking the class and she felt very intimidated.

“You should do it,” I said.
“But I’m scared.”
“Just try it! I can’t pick you up until after the class anyway.”
“Okay…” she said reluctantly.

I came to pick her up ten minutes before the end of the class and sat down on the viewing benches in the waiting room. There she was, practicing with her partner, a woman in her 30s in a pink hoodie. She was there among older teens and men and women—she seemed so grown up! She was clearly comfortable, holding her own, and loving it. The group huddled in closure and then started clapping and looking at J. She practically skipped out to me at the end of the class, face aglow.

“I want to come twice a week to this from now on. I’m thinking it might be hard in the fall with my two soccer teams, but I want to figure a way to do it!” She was breathless with excitement. “Can we get the gear? I’ll need the punching gloves and shin guards.”

My almost-teen is growing up. I love that she allows me to be there for her. Mothering now is more coaching, guiding, discussing. It’s confiding and listening. It seems like just yesterday she was an exuberant 3-year old who loved Dora the Explorer and would grab my keys, throw them under the couch and say, “Swiper, no swiping!”

I’m amazed by the person – the woman- she’s becoming. She is still that exuberant child, but now with a playful sarcasm, insight, a deepened faith, and strong sense of morality. I’m navigating my new role: sensing, adjusting, responding, and still gently pushing her to keep growing.

We’re both growing, and I wonder how long I'll be a secret society member. Is it life long? Since that seems pretty amazing.

Tuesday, November 28, 2017

Surprises

Hello everyone! Kicks here, and happy to announce the arrival of Baby! He is doing great and we are so in love. I am sitting in my rocking chair where he fell asleep in my arms contemplating how things have gone so far

I was surprised...

L&D:
...that after signing up for an induction, my water broke in the hospital with no pitocin needed!
...that I was such a puker. I have delivered about 40 babies thus far and I haven’t seen anyone puke like I did.
...how much I HATED the nurse who wouldn’t give me an epidural at 3 cm
...how much I liked her after getting me through early active labor and getting me to 8 centimeters before my epidural
...after how nervous I was to deliver at the hospital I will soon be working at, how much I am going to enjoy working with those fabulous nurses. I always seemed to have the right nurse at the right stage of the process, and we bought them all chocolates for the nursing station on day of discharge
...how well my husband did. He feels lightheaded at the sight of blood, but stayed by my side through each yucky moment. And even watched baby be born (we had a mirror at the end of the bed) which surprised us both
...how wonderful that first hour of skin to skin was. I always counsel my mommies that we will try to get them that moment but no guarantees, as many times something happens where we’re not able to make that safely work - however it was AWESOME. Baby and I cooed at each other for so long we completely lost track of time.
..how little I have learned about breastfeeding and breast pumping despite being interested in newborn care and OB. All I knew was breastfeeding is best for baby and Mom - but the mechanics were completely new. And that pump was so intimidating. I brought it out of its box a month before delivery just to stare at the pieces. And I had no idea what people were talking about “flanges” and “membranes”. Yish.
...how many interruptions we got during our hospital stay. I wasn’t completely clueless since I am frequently one  of those interruptions myself. So I expected baby’s doctor, and my doctor, and frequent nursing checks. But then early childhood stopped by to invite us to a new parents group. The discharge planner (who said she didn’t mind that I was nursing even though I was trying to make it clear I was new at this and I happened to mind at that time). Being  offered essential oils so many times I started to think the hospital was getting  kickbacks from Big Lavender (one nurse even taped a cotton ball to my little table while I was eating breakfast so I had a lavender flavored omelette). It got to the point that my last visitor on my second day was an adorable little old lady who goes around offering blessings to the baby - I was very short with her in my declining and trying to scoot her out of the room - even though later I felt bad and really wished I would have let her as she seemed so sweet and nice and I just snapped at her to get out.
...how ready we were to go home (see above)
...how hard it is to put babies in car seats

Home:
...how natural it was to slip into the role of Mom
...how hard it is to find good advice on the internet at 3 am
...how other moms survived before internet delivery services like amazon
...how defensive I was at Baby’s first doctors appointment despite the constant praise from Baby’s doctor. Must remember to try and do that for my own patients.
..how much I question everything I do with baby. Am I holding him not enough or too much? Am I giving him enough attention or should I get out of his face for a bit? Etc.
...how much Baby sleeps. And how deep Baby sleeps, where it’s still hard to resist the urge to poke him and make sure he’s still alive.
...how much Baby grunts or makes weird noises. Seemingly all the time
...how lucky I am to have family med docs and pediatricians one text away.

Work
...how fast maternity leave went. I thought I would be itching to leave the house but I really really didn’t want to go. I cried the whole way in my car to my first day back at work.
...how much I both enjoy being back and enjoy the people I work with - but also can’t wait to get home
...how much my patients asked about Baby and how things were going. And how much I missed some of my frequent patients.
...how happy I am to go back 2 days a week only for the next month. Jumping back to full time would have been overwhelming no matter how many weeks of leave I had.
...how much more like “myself” I feel after putting real pants on and using my brain a bit more. I didn’t feel “not myself” at home with Baby, but feel a little more normal now somehow.
...how much it is going to suck to try and fit things in between work and bedtime especially once I go back full time
...how awesome my family is at stepping in to take care of Baby when I go back part time and going to extra mile to help clean and cook us dinners.
...how much I love coming home to my little peanut!

Cheers!

Wednesday, July 5, 2017

Refining

So this is my introduction to you! I’m excited to be a regular contributor to Mothers in Medicine. I practice family medicine by day and wrangle my brood of three small children by night. My oldest just finished kindergarten and my youngest just turned one. I’m approaching my ninth year in a busy primary care practice in the Pacific Northwest. I enjoy the privilege and challenge of caring for a variety of patients, from newborns to nonagenarians. I used to practice obstetrics as well, but haven’t since having my own babies. I miss it sometimes.

After finishing residency, I studied tropical medicine in London and have worked at a rural teaching hospital in Kenya. My teacher husband and I dream of living and working abroad with our young family; maybe when the majority of them are out of diapers.

I began writing in earnest after I had my first child in 2011. I did write throughout medical training but it took the refining aspects of motherhood to get me to take my writing seriously. Nothing like even less time and an unveiling of your faults for some forced self-introspection! I’m curious if any of you have found motherhood to be similarly clarifying? I’ve studied narrative medicine and bioethics and have taught narrative medicine workshops. Particular interests include medical ethics, global health, motherhood as vocation and the intersection of religion and science. I blog regularly on these topics, among others, and I’m currently working on my first book. I still always cringe a little when I hit “publish” or “send.” I imagine it will always be hard, as a type A introvert, to put myself out there.

My third, and presumably last, baby just turned one and I finally feel like I can breathe again. It feels like a milestone, reaching this point, after having three children in five years, settling into my primary care practice, letting myself take my passion for writing seriously and expand into that vocation.

My life has been disrupted many times in the past year with unexpected challenges and writing and community have pulled me through. I think much in medicine and in motherhood is refining: the pressures of medical school and residency, the intensity of caring for babies and children who need so much.

I’m excited to join you all in this journey; to learn from your wisdom and laugh alongside you. If medicine and motherhood have taught me one thing, it’s that we all need each other desperately - for kindness, for encouragement, for understanding. These are the things to cling to and to provide for each other in this world. Thanks so much for having me.