Thursday, December 30, 2010

Late Night Freakonomics!

My daughter has her days and nights confused. This has resulted in a lot of late night feedings. My husband stays up with her to let me sleep when he can, but she wants to eat, and there's not much he can do to help there, so I end up awake quite a bit during the night. Since I don't want to wake my husband up (the poor guy has to work, after all), I don't want to turn the TV on, so I've been reading. The latest thing I read was  Freakonomics by Steven Levitt and Stephen Dubner. (I know I'm late to the game; I read a lot of paperbacks.)

This book is an interesting hodge podge of analyzed data sets. It is also apparently a movie I hadn't heard anything about.
Chapter 5 is entitled "What Makes a Perfect Parent?" and comes to the conclusion that parenting "isn't so much a matter of what you do as a parent; it's who you are." The authors analyze a large set of data that correlates elementary test scores with a wide range of variables. They find out that there is a correlation, for instance, between having highly educated parents and scoring well, but not between scores and moving to a better neighborhood. Children with books in the home tend to score better, but it doesn't matter if those books are read every day, and it doesn't matter how much television the child watches.

The overall message seems to be that the ovebearing parents of the world believe in correlations for success that don't exist. It doesn't matter if they spend weekends shuttling their children to cultural events, evenings reading age-appropriate books, and days structuring the child's activity to avoid mindless downtime. A child's ability to succeed (at least on standardized tests) is determined by factors that are already in place before the child is born (or even conceived). A child born to well-educated, English-speaking, thirty-year-old plus parents of high socioeconomic status performs better. Period.

It's a little disheartening to look at this data at first. It makes it seem like all those hours spent trying to be a good parent don't matter. (And I know I've only had four weeks with my daughter, so I know there are a lot more hours to come). I did, I'll admit, feel a little relieved to see that there is no correlation between whether a child has a stay-at-home mother and test scores. Daycare isn't proven to stunt her ability.

But what of that ability? Do I really care if my child can perform well on standardized tests? Especially at the elementary level?

I'm not very keen on testing. I work with a lot of students, and I've known many that just don't test well. They are smart, creative, engaged, and headed for great things, but they don't test well. I also have known plenty of students who test great but have been lazy and uninterested in their education. Furthermore, I think that our societal focus on test scores is a large part of the problem with our current education system. (In another chapter in Freakonomics, the authors analyze standardized test scores from the Chicago school district and find that many teachers were cheating, skewing the answers so that they would get promotions.) All of this focus on tests, especially in the early years of education, seems to leave little time for experimental educational programs and creativity.

Creativity. The authors admit that this data doesn't measure things like creativity or ingenuity. It measures ability to take a standardized test, which is a dream for data analysis, but not always such a practical skill in real life. What if reading all of those books helps a child become more creative with language? This probably wouldn't show up on the test, but it's certainly something I want my daughter to be able to do. What if all of those museum trips (which do nothing to help with test scores, apparently) help a child interact with other cultures better? How would we analyze that correlation?

I find the data interesting (and the book as a whole very fascinating), but I'm not convinced that standardized tests really tell us much about who someone is as a person. Therefore, I'm not ready to take a correlation with them and use it to make decisions about parenting. Plus, isn't reading books and going to the museum fun?

Tuesday, December 21, 2010

IV Fluids and Weight Loss

I agreed to have IV fluids during labor when I started throwing up and was afraid I'd get dehydrated.
Today, I saw this study suggesting that getting IV fluids during labor might make the baby's weight read higher than it really is. In turn, this can cause the baby to seem like he/she has lost too much weight and, for breastfeeding mothers, can cause doctors to suggest supplementation when it's not really needed.

I don't know enough about the subject to have much of an informed opinion, but it sounds reasonable. I was so worried when my baby hadn't gained weight, but I was also confused because she'd been eating really well. It'll be interesting to see what comes of this finding.

Some Thoughts on Breastfeeding

Breastfeeding is a curious thing. It's unlike anything I've ever done before, and it has brought up a lot of complicated considerations.

The Good
- I love knowing that I'm providing my little girl with the nutrients she needs to grow and thrive. She's already changed so much in three short weeks, and knowing that my body is producing the stuff that's growing her into the amazing little person she is makes me feel pretty good.

- Even when I've gotten no sleep and she's crying for what seems like the hundredth time in a single night, as soon as I pick her up and she tilts her head back to look at me with those big eyes, I can't help but smile.

- She smells so good! I love cuddling up with her in the bed. 

- I have a new appreciation for my body and what I put into it. Suddenly everything I eat and drink has become so apparent to me. I think about ways to eat more nutritious food. I force myself to drink water after every feeding whether I am thirsty or not. I appreciate my body's ability to create food for my daughter, and it's made me much more aware of my responsibility to give it the tools to do so.

The Not-so-good
- Sometimes I feel like a milk machine. I know a lot of women say they feel like this when they're pumping, but I don't really mind pumping; I don't have to pay much attention to the process. I just read or watch TV until I'm done. But when I'm feeding the baby, I am tuned in. This can be nice, but sometimes her dad will be holding her and she'll be completely content, and then she'll get hungry and fussy, hear my voice, and try to wiggle over to me, but I know it's not me she's coming after, but the milk.

- I am not a good sleeper. This is a long standing problem. I've suffered from on-again, off-again insomnia since middle school. The main problem is I can't fall asleep fast. It takes me at least 20 minutes. When I have a child who insists on nursing every hour, this basically means I get no sleep. She's recently spaced out the feedings at night (though not during the day--yesterday she clusterfed for four straight hours), and I've become much more human-like by getting 4-5 hours of sleep in hour-long bouts. Before that I started to zombify.

- It's a lot of pressure! At her two-week checkup she hadn't gained back her birth weight. She was close (8lbs 12oz, she started at 9lbs), but the doctor said I might have to supplement with formula. I felt so guilty. Was she starving? I was feeding her every time that she acted hungry. Was I doing it wrong? Was I not eating enough? Was I not drinking enough? The doctor gave me the weekend to see if her weight would go up on its own; it did.

- I feel a little trapped. My husband and I agreed to equally shared parenting, but that's not really possible when I'm the only one who can feed her. I know that it will get better as she gets older, and he's been doing everything possible to help out. But none of that changes the fact that she spends the bulk of her day eating, and I'm the source. I feel like I can't leave the house because her feedings aren't really regular yet. Sometimes she'll go two or three hours in between, but sometimes she wants to eat every forty-five minutes.
I bought a bottle of Disaronno that's been sitting unopened on my kitchen counter. I haven't had a drink in a year because I stopped drinking when I started trying to conceive. I just want one drink! But I'm scared to have it because I'm afraid that'll be one of the times she won't wait two hours.

I'm going to offer her a bottle of expressed milk sometime in the next week so that I can make sure she takes it before I go back to work in three weeks. I'm hoping that will help take some of the pressure off. Overall, though, it's a pretty amazing thing.

Wednesday, December 8, 2010

Bilirubin Blues

I did not shed a tear during labor (I also only cursed about three times, which is a major feat since I cursed no less than six times today while watching CSPAN). I did, however, bawl my eyes out in the children's hospital ER when my daughter was three days old.

See, I wanted very badly to get out of the hospital, and I told them that I'd like to be released as soon as possible. They decided to let me go about 30 hours after the birth under the condition that I make an appointment with my pediatrician for the next day. Baby had slightly elevated bilirubin levels, which they assured me was normal because I was exclusively breastfeeding and my milk wasn't in yet.

My milk came in Friday night. Though my daughter still didn't have as many dirty diapers as they wanted her to have, I felt sure that things would be fine in no time now that she was getting more than a few drops of colostrum to eat. They had to stick her heel at the pedi appointment and told me the labs would be back in the next morning (Saturday).

Saturday afternoon I get a call saying that I need to go to the children's hospital ER for another blood draw because her levels were going up. I asked how worried I should be, and the doc told me that it was probably fine. When we got there, here levels were even higher, and they told me they'd have to keep her for a day or two on the UV lights to break down the bilirubin and get rid of the jaundice. I recognize now that we're home and safe and healthy that this wasn't that big of a deal. I had a clear view of the helicopter landing pad from our hospital room and thanked my lucky stars and God each time I watched them land. I knew it could be so much worse.

But at the moment, when they took my tiny daughter out of my arms and held her down to jam an IV in her little bitty arm, I lost it. I was trying not to cry in front of the nurses, but I wasn't very successful. As soon as they left the room, I sobbed uncontrollably, managing between heaving sobs to tell my husband that I felt like a complete failure. It was my job, I sobbed, to give her the food she needed, to make sure she was healthy, and I hadn't done it.

She was only on the lights for about ten hours, and her levels were dropping right away. My husband and I slept on a fold-out cot and remembered how we had shared a twin dorm bed for months our first two years of college. I watched my daughter sleep and squirm beneath the eerie blue lights and fed her throughout the night.

Though I know that I overreacted (probably a combination of stress, sleep deprivation, and hormones was largely at play), I also recognized something about how different my life now is. The responsibility I feel for this little girl is insane. The pressure to keep her happy and healthy is tangible. It's mostly a pleasant pressure. As I feed her, I love knowing that I'm helping her grow and thrive. When I hold her and she leans back to look at my face, I love thinking about all of the things we'll talk about. As I curse politicians on CSPAN while nursing, I love thinking about introducing her to the world. But it won't always be positive. Sometimes, things will go wrong. It's not like I didn't know this before we went into that ER, but I didn't know how much it would hurt me to watch them happen. When the power and control was taken away and all I could do was watch and hope that things would get better, I felt completely worthless. She's rearranged the focus of my priorities in only a few short days.

Wednesday, December 1, 2010

She's here!

I heard many, many versions of the same comment as I reported my early labor frustrations to various people: “You’ll know when they’re real.” Of course, this is only true in retrospect. It’s like walking up to someone who has never heard of apples and peaches. You tell him, “I’m going to hand you some fruit. Some of them are going to be apples, and some are going to be peaches.” You hand him a Red Delicious apple, and he asks which it is. You tell him it’s an apple. Immediately after, you hand him a Golden Delicious. He thinks to himself, this is shaped differently, it’s a different color--it must be a peach. “Nope. Apple,” you tell him. Then you hand him a Granny Smith. This tastes completely different, and is yet another color; surely this is a peach, he believes. “Nope. Another apple.” Then you hand him a peach, and he has a clear understanding of the difference, but that doesn’t keep him from making accurate observations about the other apples.

I was handed a peach Tuesday morning: the morning of my due date. I had scheduled a doctor’s appointment that I was so sure I wouldn’t need to keep, and yet there I was. When I went in, they checked me and told me I was 4cm and 75% effaced. Progress. I had walked 7 miles that last weekend and had been having regular contractions for a week. When I left the non-stress test at the doctor’s office (routine since she was measuring big (10lbs 4 oz!!) on the ultrasound and was about to be past due), I was having contractions that felt clearly different. They hurt more, they moved differently, and I was sure it was the start of something.

It was. I called my cousin and mom--the two people who were to join my husband as labor coaches. They decided to come down and hang out even if it wasn’t the real thing. They got to my house and sat with me as I helped some students with online papers and moved through contractions. At 5:15, my water broke while I bounced on the birthing ball. I called the hospital and they said to come in right away. After our 10 minute drive turned into 50 due to an accident (good thing I didn’t wait longer like I had wanted to!), we made it, got evaluated and admitted.

This is where things took a frustrating turn. I have been working towards natural child birth through most of this pregnancy, and I had a birth plan I had worked out with my doctor. It included intermittent monitoring, using the shower to control pain, moving around as much as possible, using a heplock instead of running fluids, and having my birth team in the room with me. The hospital had sounded very on board with these things during the tour, but things weren’t quite what they seemed.

They insisted on continuous monitoring. They told me I needed fluids immediately. Since my water was ruptured, I couldn’t get in the shower. Not only that, I couldn’t even stand up out of the bed for risk of the cord sweeping into the birth canal. I started to panic; there was no way I could handle those contractions on my back. I knew I’d never make it without pain medicine.

I tried to find a balance between being my own advocate and not being a pain in the ass. I said that I was happy to have continuous monitoring if I could still move around--I wouldn’t get in the shower. I was not willing to stay in the bed, and since the head was engaged, I felt the benefits of pain management outweighed the risks. I asked to delay fluids as long as I could continue to drink and feel fine on my own. My husband pulled aside the attending doctor and explained that I really wanted all three of my coaches there with me the whole time; the doctor said okay.

I labored in several positions: sitting on the edge of the bed and standing to lean on my husband during contractions, kneeling on the floor and leaning over the birthing ball, kneeling on the bed and leaning over the raised head. I hated being checked. The pain on my back was miserable. I felt like a crab scrambling to get away from it, unable to get any control over it as it surged through my body.

I was admitted around 7pm and progressed pretty nicely from that point forward. I really felt like some of the doctors and nurses didn’t take me seriously at first. One doctor even said, “you want to go natural. Yeah, we’ll see how that goes.” They only offered me medication--Stadol--once, and I promptly refused. By about 7cm, I felt like they were taking me more seriously. They also left us alone, for the most part. My birth team was AMAZING. My husband constantly told me how great I was doing as he worked through each contraction with me, my cousin rubbed my hips, my mom brought me every single thing I asked for. I couldn’t have done it without them.

I started pushing around 5 or 5:30, and though I was sort of out of it from all of the focus the labor was taking, I distinctly remember pushing being a HUGE relief. It didn’t even hurt. I wanted to do it constantly, but--of course--contractions spaced out, so I had to wait between them. There were a ton of people in the room, but I hardly noticed who they were or why they were there--though I do remember several of them introducing themselves at some point. It’s a teaching hospital and it was right at shift change; I think a lot of people from the night shift wanted to stay to see the end. I had about three doctors encouragingly telling me “This is it. This is the push!” for what felt like fifty pushes. I was getting really dejected and kept asking/panting “Are you sure I’m doing something? It doesn’t feel like anything is happening!”

At 7:21 this morning, the day after her due date, my 9lb0oz, 22inch baby girl was born with beautiful clear skin and a head full of black curly hair. I got to hold her immediately for half an hour. Then they took her and cleaned her up and brought her back to breastfeed. It was an amazing experience. We’re both in the hospital now, but everything is looking great, and I think we’ll get to go home tomorrow.

As for my natural birth goals, I wavered a little bit. I didn’t get an epi or any narcotics. I did decide to get the fluids when I started to get really exhausted around 2 am. I think it was a good decision. I also chose to get Lidocaine injected while I was pushing I knew that I was likely to need stitches because the baby was predicted to be 10lbs, and I knew the drug wouldn’t have time to get to the baby. I don’t regret that decision, either. Other than that, I labored without any kind of medical pain management, and I truly would do it again. As long as I could move with my body and trust it to work, I was on top of the pain.