Through a Parent’s Eyes Only

I remember how the attending explained to a new dad an abnormal physical exam finding in his newborn son.  The dad started to cry.  The exam abnormality wasn’t so severe or concerning to prompt his sadness, but rather embarrassing for the father as a physician himself.  “That’s my specialty,” the dad confessed to us.  He was a senior fellow in the subspecialty that would treat his son’s condition.  “How could I have missed this?”  He was not only embarrassed that we had to report this finding to him but confused about why he hadn’t seen what was actually quite obvious, even to a third year medical student like myself.

At that time, I thought the fellow had missed his son’s condition because he was a sleep-deprived new parent.  I wouldn’t really understand until years later when I found myself in his shoes.

N was in the NICU for a few days when his nurse informed me that his bilirubin was high.  In disbelief, I inquired about what the value was and found that it was sixteen.  My first response was, “wow.”  My surprise did not come from how high the number was, but rather that I had been oblivious to his apparent jaundice, which this lab value confirmed.  After all, I had spent the past three years of residency judging newborn’s jaundice by their skin color, interpreting these bilirubin labs, and ordering phototherapy.  I had given at least half a dozen talks to medical students on this very topic, explaining the pathophysiology of hyperbilirubinemia.  I considered this one of the basics of pediatrics, my chosen career.

I knew enough about this disease process to know that N was relatively high risk, both from his prematurity and history of breastfeeding.  Had I been his physician, this would have been on my radar, but as his mother, it completely took me by surprise.  I began to understand the embarrassment and confusion that the fellow had shown years before.

jaundice

I keep this photo of a jaundiced N on my desk.  It reminds me of my error in recognizing his obvious yellow glow.  Instead of feeling shame over it though, I have come to see it as a source of pride.  I am not his physician, I am simply his mom and this situation is exactly why I make that distinction.  Yes, I now see the jaundice, but I understand why I couldn’t see it in the NICU.  No matter what my training should teach me about my child, when I see him, he will always look perfect.

Parenting In Pediatrics

digger

“Aren’t you a pediatrician?”  This rhetorical question was hurled at me while discussing my own frustrations and limitations in potty training.  Although I spend a good portion of each day doling out parenting advice,  I often struggle to meet the demands of my own recommendations.  Over the years, I have gained firsthand knowledge of how difficult these parenting tips are to execute.  Potty training has certainly been one of those things.

It does not matter how confident I am in the office with the textbook approach to potty training when I am on the front lines with my toddler.  My residency training taught me some basics, but the rest I learned through my own experiences.  After some failed attempts, we ultimately resorted to bribery and promised him a trip to Diggerland, a construction-themed amusement park, if he consistently used the potty for a week.  I informed him that you are not allowed to drive diggers at Diggerland unless you wear undies, which is not an official policy but luckily 3-year-olds can’t read the website.  Sure enough, a few days later we had successfully transitioned away from diapers and into superhero adorned underwear.  Shortly thereafter I found myself driving a skid steer around a dirt lot.  This isn’t exactly how the potty training books told me it would go, but it’s real life.

Potty training is just one example of the many parenting challenges that I bumble through like everyone else.  Friends often look to me as the “expert,” but there are so many parenting tasks that pediatrics training fails to prepare one for and instead experiential learning is required.  As much as others seem to expect that I would hold up the gold standard, I sometimes see some relief on their faces when I slip up too.  For example, when discussing how to get our toddlers to eat a healthy lunch, a friend seemed relieved to hear that my son eats macaroni and cheese most days of the week.  My struggles give a sense of normalcy to theirs.  However, it always stings a little when I show my vulnerability as a parent and am judged by my profession.  Yes, I completed my M.D. degree, but I am still working on my degree in parenting.

Desert Island Mama

nursing

An infant patient’s mom recently told me that she and her breast pump had a “desert island relationship.”  She explained that before traveling anywhere she looks around panicked to make sure she packed her pump.  “It’s the one thing I need to bring everywhere,” she said with a twinge of resentment.  “You know… it’s the top of the list of things I would pack for a desert island.”  I nodded with empathy, thinking about how I recently tucked my pump into my purse while going to a doctor’s appointment, afraid to be apart for more than a few hours.

Our conversation made me start thinking about what things a new mom absolutely needs for pumping.  What should she pack for her desert island trip?  With a few new mom friends around me, I have been running through this list to help prepare them, because motherhood shouldn’t be an island.  We talk about things that I never knew existed pre-children: breast pads, nipple cream, and nursing bras.

In that discussion, we have talked extensively about breast pumps– which ones we like, which are covered by insurance, which are most portable, which are good for hands-free pumping, which accessories are worthwhile and which are unnecessary.  While it seems like it should be as simple as here’s your pump, there are actually a lot of options!  None of the pump options though are as “elegant as an iPhone and quiet as a Prius,” as a recent NYT Motherlode blog post pointed out.  Instead, it feels like you are making a choice from a collection of outdated machinery that one would find on a farm.  Of the options out there, I really like my Medela Freestyle for home and Medela Symphony at work.

Like many things a new parent encounters, pumping has had its own learning curve.  After choosing a pump came the challenge of how to actually pump!  I remember when the nurse in the postpartum unit wheeled a pump and supplies into my room and left it there as if intuitively I would know how to use it.  Besides connecting all of the pieces and placing them to my chest, I had to figure out the dials and buttons that controlled the pump intensity, duration, and stages.  Then once I found myself plugged in like a dairy cow, I realized I had no idea how long I was supposed to actually pump.  Even now, 22 months of pumping later, I find that I am still learning things!

One of the many perks of breastfeeding is the ease of not needing to buy formula and wash bottles.  However, breastfeeding isn’t so straightforward for a working mom.  My breastfeeding journey includes my pump, bottles, milk storage bags, pump cleaning supplies, a charger, pumping bras, a drying rack, and the universal symbol of a mom returning to work: the black Medela pump tote bag.  When I’m not pumping, I’m storing, thawing, or cleaning.  I wake 30-minutes earlier than my baby so that I can pump and make a bottle for her morning.  My pump and I have a love-hate relationship.  I love that it allows me to provide breast milk for my daughter while we are separated, but I hate that it consumes my free time.

A friend recently asked when my pump and I would be parting ways… 1 year?  sooner?  later?  Much of this depends upon how long my baby and I decide to breastfeed.  With my son, I stopped pumping at 1 year.  Packing up my pump felt great and I look forward to doing that again, however, that also means the end of breastfeeding, which has been one of my most rewarding parenting experiences.  So while putting the pump away will be liberating, it also is a huge milestone.  Until then, we continue our desert island relationship.

 

[I have no affiliation with Medela.  I was not compensated for this post and all opinions are my own.]

Tuesdays with Mommy: At the Library

I frequently meet parents in my office looking for enrichment activities for their kids, but not wanting to spend a fortune to do so.  While Philadelphia has a number of fun and free kids programs, museums, and events, not all of them are easily accessible.  Schlepping kids across the city on public transportation can be a feat in itself, nevertheless taming them enough to trust them in front of priceless artwork, national landmarks, or water hazards.  So when advising families about where to find free fun in our city, I tell them to look no further than their local library.  With iPads and Kindles everywhere, recommending a library makes me feel old school.  Some of my best childhood memories come from running around the large, musty bookshelves in our local library, discovering an old tome that felt like a hidden treasure before my mom called us back to the kids section.  I am hoping my kids develop these memories too.

library

The Free Library of Philadelphia has a great kids website, full of games and reading lists for different ages.  You can also find a list of storytimes at branches around the city, which is how G and I found a baby storytime at our neighborhood library.  Surrounded by books, the kids section of the library also has stuffed animals, bean bags, mazes, puzzles, and other toys, encouraging play and exploration.  This is not a place where you are expected to sit in silence but rather a place to inspire language development, whether reading or babbling.

librarian

Lindsey, our librarian, led a group of 0-14 month olds in a series of songs, dances, and stories for 30-minutes.  G sat mesmerized for most of it, both watching the older toddlers dance around her and clapping her hands to the beat of “If You’re Happy and You Know It.”  I had to laugh as I remembered N singing his own rendition earlier that morning that went: “If you’re G and You Know It, Clap Your Hands.”  Watching my happy girl absorbing the bustling library around her, I think N was on to something.

listening

There are some beautiful libraries in Philadelphia and passionate librarians, ready to instill a love of literature in even the littlest Philadelphians.  In addition to regular storytimes, they run puppet shows, animal activist clubs, and music and movement storytimes.  The libraries also have movie nights, chess clubs, bingo, and art camps.  G and I have just scratched the surface of what the library can offer us, but we are looking forward to our next outing already.

Breastfeeding In the Bag

sleeping_baby

In many hospitals, new moms are given a diaper bag from the formula companies, full of information about formula feeding, free bottles, and formula samples.  Breastfeeding supporters blame these bags for some of the early cessation of breastfeeding, given the ease of having formula at hand during the difficult early days of breastfeeding initiation.  Philadelphia recently passed a new bag-free policy that will help many local hospitals get one step closer to the coveted Baby-Friendly Hospital designation.

I wish that our hospitals weren’t bag-free though.  I dream of a time when we could give all new moms a swag bag of breastfeeding goodies.  The first few days, even weeks, of breastfeeding are challenging and having a few helpful tools accessible can make the difference between a mom who perseveres and one who switches to formula.  In clinic, I often counsel moms about ways to help combat sore nipples or how to order a breast pump and we discuss where to purchase some of these items.  When you are exhausted and recovering from birth yourself though, it is difficult to get to one of the stores that sells these items.  It would be amazing if women were gifted these things early on though, as many moms stop breastfeeding before their baby’s first clinic appointment.

If I were building a breastfeeding bag, these are some of the things I would make sure were in it:

- lanolin: I found this to be the best thing to help soothe and heal sore, cracked nipples.  I advise new moms to keep it within arms reach for the first few weeks.

- boppy: finding a comfortable position for both mom and baby is important and having a good support pillow makes this much easier and spares you from back aches later on.  Hospitals typically don’t have any support pillows and instead ask moms to use hospital pillows, but it would be so much nicer if they provided a boppy that a mom could then take home!

- nipple shield: not every infant will need to use a nipple shield, but for those who do, having one easily available can be crucial to making sure their baby latches on correctly early on.

- nursing cover:  I am a huge fan of nursing without any cover, as covers often annoy infants and only serve to draw attention to the act of nursing rather than hide it.  However, there are many moms who prefer more modesty and infants who appreciate the veil to limit distractions.  A nursing cover can give new moms the confidence to breastfeed in public, which is often a huge barrier and leads to formula supplementation.

- breast pads:  once a mother’s milk is fully in, there can be some leakage.  Wearing nursing pads can make her more comfortable that there won’t be any embarrassing stains on her shirt when her visitors arrive.  I prefer cotton pads that can be thrown in the wash and reused the next day.

Of course, there are always the things that can’t be put into a bag, such as a breastfeeding support group, lactation consultant, and paid maternity leave.  While the Affordable Care Act requires most health plans to provide breast pumps and counseling to moms, there are some plans that are grandfathered in and even those participating make you jump through a few hoops.  Ideally women wouldn’t have to navigate the complicated world of health insurance red tape in order to get a breast pump either while pregnant or postpartum.  So let’s throw a breast pump in the bag too.

As we celebrate World Breastfeeding Week and our new bag-free Philadelphia, I am looking forward to a time when breastfeeding is not just something we recommend to women but something that we can truly support without mothers having to fend for themselves.  We need to provide them with the time and tools that one needs in order to be successful, and a bag of goodies would be a start.

 

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