Parenting after infertility

Tuesday was my anatomy scan for my fourth child. (I know this doesn’t sound like a typical infertility post, but bear with me.) I was a nervous mess. My husband came with me but wasn’t allowed into the room because of COVID precautions. My ultrasound tech was a woman of few words, who mostly complained about having to wear her surgical mask all day (another COVID precaution).

Some women announce their pregnancies the second they know about them, with elaborate pregnancy announcements and social media posts. I’m in the other group – moms who worry every step of the way. It’s exhausting. As soon as I find out I’m pregnant I worry that I will miscarry in the first trimester (for the record: I have never had a miscarriage). I hold my breath at every ultrasound until the doctor finds the heartbeat. I worry about the results of my nuchal translucency/first trimester screen (perhaps for good reason: I have tested positive – false positive – for Trisomy 21 twice now). I hold my breath waiting for the cell-free DNA results (normal 3 of the 3 times I have had to take this test). The anatomy scan is the worst, because by 20 weeks I tend to look pretty pregnant so people know, and how would I break the news to everyone that the baby had some terrible congenital abnormality that was incompatible with life? It sounds ridiculous as I am typing this out, but this is the world inside my head. When I was pregnant with my first, I refused to wash any of the clothing we had purchased for him until late in the third trimester. I couldn’t imaging folding it all up and putting it away if something terrible happened. With each pregnancy, I have worried about the baby not moving enough. With my first I vividly recall drinking orange juice at night and jostling my belly around to get him moving. Perhaps that is why he was born a night owl! Just today I took a 5 minute break to lay on my side in bed because I hadn’t felt this baby move in some time. Last year, my best friend lost a baby at 31 weeks. It was every mom’s worst nightmare. My heart aches for her, thinking of how she waited for labor to start days after she had learned that her baby was not okay, and ultimately delivered a stillborn baby. I flew out to see her right after the birth and there were no words to remedy how unfair and cruel the world can be.

My struggles have been minimal by comparison. I had hypothalamic amenorrhea and stopped getting my period for a decade. When I got married and decided to have kids, it (surprise!) did not suddenly make an appearance. In retrospect, I can summarize the story like this: I had hypothalamic amenorrhea and started eating more, gaining weight, and working out much less in order to promote natural fertility. I eventually got pregnant with minimal assistance from a fertility clinic. My subsequent pregnancies occurred without any intervention. However, the period from May 2012 to March 2014 was so more stressful than that paragraph reflects. I had no idea why I wasn’t able to get pregnant. I knew hypothalamic amenorrhea was playing a role but what if (a) it was irreversible and (b) there was something else? What if I would never be a mom? What if I had messed up my body so much that I would never carry a baby?

Once you have had any degree of infertility, you never take being a parent for granted. My first wouldn’t sleep. He had a strong startle reflex and broke through every swaddle combination we tried. He would cry all day and night unless we held him. I remember being exhausted to the bone, crying on the phone to my friend, telling her how guilty I felt for not savoring every waking moment after everything I had been through to have him. This has been my thought process on repeat for every child and for every step of the way. Every decision I have made for them has been fueled by the knowledge that their lives may not have been if things had worked out differently.

I know how fortunate I am to have these children. Once you are pregnant with your fourth (and to some degree your third), people start commenting on your reproductive decisions. “Isn’t the world populated enough?”, “Yeah, probably not a good idea”, “Why would you have another child?”. Quite frankly, it’s rude. In the same way I was hurt and offended when I couldn’t get pregnant and people asked me when I was planning to have a baby, I am hurt and offended by these comments. I don’t push back though – I’m never going to convince people who say those words out loud to consider another viewpoint. I know how much my children mean to me and my husband, and that’s all that matters. Although I would have preferred not to have gone through those years of infertility, I am grateful that they provided me with this perspective.

Maternity leave in review

In two days I’ll return to work after my third maternity leave. That’s one job, three pregnancies, three maternity leaves and three “first days back at work”. My first post on this blog was about returning to work after my second was born (see October 2016 archives) and now here we are again! In honor of this occasion, I wanted to spend some time (kid naps allowing) to reflect on the past few weeks.

This maternity leave started earlier than planned when my contractions started the morning after my last day of work. I had been expecting at least a few days (if not weeks!) of extra time to wrap things up, but baby had other plans. I subsequently spent the first 3-4 weeks wrapping up work. I know that sounds really terrible, but it was actually okay. Everyone knows that newborns don’t sleep, so it gave me something to do in the wee hours of the night, and it was something that would definitely prevent me from dozing off with the baby. I am also fortunate to have a lot of support staff and they helped me make phone calls to patients (since that’s not something that can be done in the middle of the night!).

My husband didn’t take his paternity leave right away, so it was a bit of a whirlwind. Even though we had family helping out, if I had to do it again I would ask him to take a few weeks off in the very beginning. It would have been immensely helpful to have a bit more overnight help those first few weeks and I would have probably been able to take some daytime naps without the baby! It seemed pretty stressful for him to work while so sleep-deprived and this definitely led to more bickering than usual. Fortunately, things improved with time (and sleep!).

We briefly had a night nurse helping us out…until she fell asleep holding the baby. I couldn’t believe it. As my husband always says “why are people so bad at their jobs? You have one job – learn how to do it right!” So I guess another thing I would do differently is not hire a night nanny. Yes, it was helpful to have someone hold the baby for a few hours overnight, but I did enjoy doing the bulk of evenings since so much baby bonding happens during that time. I also found that I didn’t rest easy when she was over, perhaps because I was worried about the above. Fortunately, our little guy persevered and now his sleep isn’t as atrocious (although it is definitely nowhere near ideal for having to go back to work!).

My older kiddos have done really well with their new little brother. Toddler Y (our middle child) had a tough time those first few days, but now he is sweet as pie. One of our major challenges when I return to work will be carving out individual time for all three kids. Right now, the older kiddos have independent activities on Saturday mornings, and I plan to build onto that time.

One of the highlights of maternity leave was seeing a lot of family. My mom spent a few weeks with us right before and after Baby Z was born – not quite as long as the last time, but just the right amount of time during the hardest days. We also had both of our families visit on separate occasions and I was able to visit home twice (the last time for 3 weeks!) during maternity leave. The kids have a blast around family, so it was so nice to see everyone on multiple occasions.

Another highlight was meeting an awesome group of moms with kiddos around Baby Z’s age. I have excellent mom friends whom I met shortly after my first was born. Some had second babies so I didn’t feel the need to branch out much with Toddler Y. But this time around I knew that Baby Z would need some baby buddies and went out of my way to meet people. Well, this group of moms is just awesome, and it’s been great getting to know them.

On an organizational front, I did a TON around the house. I cleaned out the whole attic, donated and threw out a bunch of items from all throughout our home (trying to get a head start on minimalism for 2019!), made headway on two home improvement projects we have been working on, had the guest room painted, reorganized the guest room/soon-to-be Baby Z nursery, cleaned out the entire shed and organized all of the kitchen drawers. I gave away a ton of baby things we no longer needed, worked on Baby Z’s scrapbook and first-year album and also researched and toured a slew of private schools in the area. I did much of this with the baby strapped to my chest, but needed a bit of assistance for the manual labor.

Of course, the highlight of maternity leave was the hours upon hours I got to spend with Baby Z. I wore him almost constantly in a sling (now carrier) during the daytime hours. He often slept in bed with me overnight (not necessarily by choice, but we made sure the bed was as safe as possible for infant sleep) and he accompanied me to appointments, a handful of work meetings and a slew of errands. He’s an excellent eater, and I will forever be grateful to my employer for allowing me to have all of this time with him.

When I return to work, he will be about 4.5 months old. I know international readers will balk at how little that is. However, having had all of my children in the US, I feel so incredibly fortunately to have had 4.5 months of paid maternity leave, as well as the assurance that my position is stable. When I return, I’ll be able to set time aside as I wish to pump and to adjust my schedule as needed to make this year as manageable as can be. In fact, I’m returning part-time this month, and I am so very grateful to be able to rev up gradually.

I will always be sad about leaving my baby. What will it be like for him to not be strapped to my chest all day? (Honestly, probably not as bad as it will be for me!) I will worry incessantly about something going wrong while he is out of my care and I will miss his little noises and tiny fingers and sweet smile. I will stress out trying to give everyone attention in the few hours we have before work and after work/before bed. But I have faith that it will all be okay. Not easy, but okay.

Many moons ago, when I was obsessing about going back to work vs not going back to work (not really an option for me at the time but an interesting hypothetical argument) and then obsessing about daycare vs nanny, the one thing that stuck with me was reading that kids will thrive with a decision as long as the parents are happy with that decision. So I always focus on the positive aspects of my job and the positive aspects of their relationships with other caregivers.

I also have this to get me through: my older kids are alright. They’re happy little clams, in preschool now. My oldest is four. If we repeat his life cycle 4 more times, he’ll be twenty – an adult! In other words: time flies. As my children have grown, I’ve had (some) opportunity to think about who I am independent on them, how my husband and I interact independent of them, what I will do once they leave. Yes, I am not very far in and they are still very, very small and very, very dependent, but there are snippets of time when these opportunities for thought arise. When they have arisen, I have always been very happy to be working. This is what has worked and been okay for me, but it may not be the best case scenario for anyone else, and that’s okay too.

So in less than 48 hours, I’ll be waking up and changing out of my pajamas first thing. I’ll put on make-up, grown-up clothes, triple check my bags to make sure I have my work things plus my pump things, and then I’ll leave my sweet little baby behind. First I’ll have to convince my older kids (who have been out of school for three weeks!) that getting dressed and leaving the house early is also a good idea. I am not sure which of those feats will be harder! And in a few weeks time, doing this will be the new normal, and these lovely (and hard) maternity leave days will be a distant memory!

The Blob Trimester: Baby’s Z’s 1st 3 months

As my youngest (baby Z) is one week shy of 4 months, I find myself fondly reflecting on the fourth trimester haze. If you are not familiar with the term “fourth trimester”, it is common terminology for the first 3 postpartum months. Due to human anatomy and the limitations of the birth canal, human babies are born neurologically premature. Thus my rationale for (very affectionately) calling my newborn a blob.

Let’s put it this way: newborns would never survive in the wild. They can’t hold their heads up, they can’t make meaningful movements with their arms and legs, they can barely see, and they are easily surprised. They can only communicate via crying and they spend a great majority of their days sleeping, drinking milk, peeing and pooing. This is one reason why the fourth trimester is so challenging for new parents: you are suddenly in charge of keeping a small, defenseless human alive. No pressure!

Prety daunting, huh? Couple this with the fact that new parents are chronically sleep-deprived (newflash: babies don’t know the difference between day and night, so you may find yourself pulling a lot of all-nighters), moms are experiencing a hormonal hailstorm (why does everything make me cry? why am I suddenly so angry at my husband? why am I so worried about every damn thing?) and everything you previously knew about yourself has gone out the window (so long hobbies, singular focus on career, social life). Given all of the above, we might as well also call this time period the sob trimester.

Never fear, however. Between 3-4 months, everything gets easier. Yes, there are still challenges (hello 4 month sleep regression!), but your little blob has turned into a reciprocal mini-human who tracks your movements, produces wide-toothed smiles and even cackles with laughter, which makes the experience much more rewarding.

For the sake of preserving my own memories, here’s a recap of Baby Z’s first 3 months:

  • Birth: By far the best of three (third time’s the charm!). Baby X was induced and we barely made it to the hospital with Baby Y. For Baby Z, we went to the hospital as soon as contractions started and were told to walk around until they intensified. We did this for quite some time, even coming home to shower and re-pack, so by the time we returned to the hospital, it was go-time but not baby’s-about-to-fall-out time. I was able to get an epidural (thank you, modern medicine), labor peacefully and when it came time to push, he was out after basically 3 pushes with no tearing involved.
  • Sleep: We purchased a Snoo for this guy, but I wasn’t quite comfortable having him sleep in it from day one. The rocking seemed a bit intense for me and I capped it (there is a function where you can limit the motion) and have kept it as such to this day. In the beginning, he honestly mostly slept in bed with me (my husband would supervise so I didn’t roll on him) and we also lay him down in the Snoo (without turning it on) or put him in the Rock n Play (which he honestly never liked very much and also isn’t safe for unsupervised sleep). We hired a weekend night nanny for those first rough nights and she fell asleep holding the baby on the third night she worked for us! As my husband would say: WTF? YOU HAVE ONE JOB!!! That was pretty traumatic, but baby was okay and we gently told her we were no longer in need of a night nanny. I have to be honest: the sleep was pretty rough early on. He would spend a few hours up each night and I often had no idea what to do with him around 2-5am. My husband was also saving his paternity leave so I tried not to bother him since he had to work the next day. It was pretty intense. I tried to establish an early bedtime for him, but he went to sleep around 11p for a long time! Just recently (close to/when he hit 3 months), he started falling asleep around 9. Early on, he would be up cluster-feeding for quite a few hours (e.g. 8p-11p/12a) but more recently he would do a longer stretch, waking up either at 1a or 3a. So most nights he’ll wake up 1-2 times. The first nap was also the first to fall into place, as it usually does. It’s the one I can actually set him down “drowsy but awake” for! At the moment, we are traveling (good-bye Snoo!) and have him in a Pack n Play. I have to say that he’s not loving it. Last night, he was up every 2 hours, and spent the bulk of the night in bed with me. I’m not sure if this is a Snoo transition issue, a travel/change of environment issue, or the start of the 4 month sleep regression, but I don’t like it.
  • Temperament: When we first brought him home, we were a bit concerned he would be colicky like Baby X. Turns out he was just a normal newborn who wanted to be held, cuddled and carried pretty much all day. With every need attended to/preempted, he’s happy as a peach. He likes tummy time, mat time, play time (songs and the occasional book when he gets his own) and of course still loves when we tote him around all day. So far, he’s a happy, go-lucky baby who can also entertain himself independently (for now, this mostly involves staring at something in the distance).
  • Feeding: Baby Z latched pretty easily. I had one of the nurses remind me of the appropriate position when they are little blobs and can’t hold up their heads, but he quickly got the hang of it. I don’t have him on any particular schedule at the moment. He should technically be eating every 3-4 hours, but sometimes it’s less. Of all the baby things, nursing has always been fairly easy for me. Yes, it was always painful in the beginning. I enrolled in a lactation class prior to the birth of my first, worked with lactation consultants in the hospital the first two times, and also had private lactation consultant visits after the first two were born. These steps allowed me to feel more comfortable nursing. And yes, I worried ALL all of the time whether they were getting enough to eat, especially my first. Was he colicky because he was hungry? Were those tears of starvation? Did he want to nurse all of the time because he wasn’t getting enough milk? I also always pumped just enough and was worried each time about how pumping at work would turn out. Yet I was able to nurse the first two for 15 months and pumped until they were 11 months, using up my freezer stash for months 12 and 13. We’ll see what happens with this guy. I’m a bit worried because I had 187 oz and 300 oz of milk saved up for my first and second, respectively, when I went back to work, but currently have only 55 oz with only a few weeks to go (poor third child!). But I am telling myself that the freezer stash really only helped me to stop pumping a bit earlier, so it isn’t the end of the world that his is so limited. After all, every lactation consultant I’ve spoken with has said you only need enough milk for your first day back (and this is true).
  • Developmental milestones: Baby Z was quick to roll from tummy to back. I know I sound like a delusional mom saying this, but he was doing it month one and still does it to this day. He’s flailing his arms around and kicking his legs much more now. He sees well, follows you around with his eyes, smiles and laughs, has coo-ing conversations, and has started to grip things and bring them to his mouth. Actually, everything is starting to wind up in his mouth – his hands, the carrier strap, teething toys, etc. He can also reach out with his hands to swipe things hanging above him on his playmat or on one of his chairs. His neck is pretty strong and I will often place him forward-facing in the carrier (if it’s not naptime) because he likes to observe the world. He’s actually starting to show interest in food already, which seems early to me, but I’m looking forward to introducing solids.

I honestly can’t believe he’s almost 4 months and am definitely patting myself on the back for getting through those tough first few months. Work is just around the corner (a story for another day), but I feel very fortunate to have had this time with him.

 

Not a sleep whisperer

I spend a good chunk of my day convincing little humans that sleep is a good idea. The other day, as I was prematurely patting myself on the back for getting all 3 kids to nap at the same time, my two oldest decided they were simply going to skip their naps. Of course, they were little (cute) monsters by the end of the day.

Right now, I’m struggling most with my middle child. He has recently started to extensively delay bedtime. He wants ten stories, ten songs, a million cuddles. Every time we acquiesce, he asks for more. After all of the above, he started asking for more lights on (we already have a nightlight). So we started with one, then two (after all, if he was truly afraid we didn’t want to be the mean parents who ignored this). This was enough for a bit but then the demands escalated. He wanted all the lights on but then also wanted us to hold him to sleep. The thing is, we’ve been down this path before. With both of our older children, we’ve always given in, and then regretted it some time later. Who doesn’t love the feel of their young child against them, all chubby cheeks and fat fingers, warm breath on your shoulder, kissing your cheek and saying “I love you, mommy”. I mean, what could be more precious? But it is hard to tack on an additional two hours for bedtime after a day packed with activities and attention doled singularly on the children. That extra times leaves us extra wiped, so we bring even less to our relationship, our home, and our work. And I am a firm believer in children needing to get a good night’s (or nap’s) sleep! When our kids put themselves to sleep, they fall asleep more quickly and wake up better rested.

This is on my hand because my middle child just cried himself to sleep for nap time. He only cried for five minutes or so, but it of course broke my mama heart. In truth, if I didn’t have a third child currently strapped to my chest for his own nap (we are visiting family and my oldest is sleeping in my room, where the crib is), I would probably just hold the kid to sleep. Again-who doesn’t love that feeling? So there’s the added guilt of attention being taken away from him by the baby. But we did try the “cuddle to sleep” method the last two days and he just ended up giggling, playing, and essentially doing everything BUT sleeping.

I reached out to our sleep consultant this week (honestly, at this point I should just have her on retainer) and she advised that if the gentle approaches weren’t working, to firmly return to business as usual. She advised either letting him cry or spending less and less time in the room with less and less physical or verbal interaction. The latter sounds like it would be torture to do, so we have settled to let him cry. Bedtime has improved dramatically (still delays, but not as many demands and we haven’t had tears for a few days). Naptime has proven to be more difficult, perhaps because there is less sleep inertia and it involves taking a break from playtime. I joked with our sleep consultant that I should print out a frame with “When in doubt, cry it out” for the nursery, because this seems to be what we resort to after a few days of failing at every other approach. Her philosophy, at least with our family/children, has always been: if baby/toddler/child is dry, fed, healthy, has gone to the bathroom and if you’ve addressed all of their fears, questions, and concerns, then there’s no reason why they shouldn’t be able to sleep by themselves.

I recognize this is a very Western philosophy. It is very foreign to my mom, who always had children in bed with her. In truth, our youngest (almost 4 months now) has spent more time in bed with me than I’d like to admit. This is mostly because I’m so exhausted when he wakes to feed that I accidentally fall asleep with him. I sleep alone (poor hubby has been banished to the guest room for this reason), with no extra pillows, blankets, or throws. I wear warm clothing so as not to cover myself and make sure the baby’s unswaddled and in the very center of the bed. It always fills me with great trepidation, despite all of these measures. For us, the main reason we haven’t intentionally shared a bed is fear. The second reason is that it’s been really important for my husband and I to have adult time after the kids go to sleep. We are not perfect in this regard, as I often allow housework or work work to bleed into our time, but it is theoretically more possible if there is no child in our room.

I’ll end on a positive note: my 4 year old has become a much better sleeper with time. He was our crazy colicky baby who refused to sleep on his back and had us up every twenty minutes as a newborn. We held him to sleep for naps until he was almost 3! But now this very same child will tell us he’s tired (before nap or at bedtime) and then go to sleep by himself. He sometimes needs a bit of encouragement when it comes to changing into PJs, but then he’ll happily settle in under the covers with his stuffed animal and put himself to sleep with no extra support. If you had told me this four years ago, I would have never believed it. It’s amazing how children change over time.

One of the greatest challenges of parenthood has, for me, been sleep. There are a good days and bad days, but definitely lots of sleepless nights, sleep regressions, and changes – potty training, separation anxiety, nightmares, travel, teething, etc., etc., etc., which seem to knock the schedule right off its track. But one day, these little humans will become (really) big boys, and then I will probably be nagging them for sleeping TOO much. Funny how things work. For now, I’ll try my hardest to revel in the baby snuggles and to try to focus less on the naptime/bedtime snuggles. However, I will never sleep when the baby’s sleeping, because when else would I get anything done!?

To have and to hold

I love weddings. It is so magical to watch people embark on their “happily ever after”. When I was single, weddings gave me hope that I would find the love of my life. When I was newly married, weddings were a joyous occasion with the knowledge that these newlyweds were as happy as we were. Now, more than half a decade into our marriage and brimming with children, weddings are a reminder of those exciting honeymoon days of a marriage. I love my husband dearly but I have to confess that marriage is very different with children than without children.

As a newlywed, my husband could do no wrong. His quirks were endearing, and I’m sure he felt the same way about mine. Now, after a full day of chasing after my toddlers and feeding/changing/rocking my baby, one of my husband’s quirks can quickly send me over the edge. After a full day with all three boys, my cup is empty, and I often feel like I have nothing to give to my husband. He too seems to need some time to unwind after the kids fall asleep. Don’t get me wrong – we love each other more than we did as newlyweds, but we have found that we need to be more intentional about conveying that love. We also need to take a step back to truly see and acknowledge one another. Most parents find that they have less time for self care once they have children and the same is true of spouse care!

When we argue, one of us may break the ice by bringing up two of the tricks we learned at our Catholic Engaged Encounter weekend, prior to our wedding. Both have always made us laugh. The first is to hold hands while arguing. If you try this, you’ll quickly learn that it is impossible to truly be angry at someone if you are holding their hands. The second is to consider whether your words are “life-giving”. If they are not, consider how they sound to the person hearing them.

We haven’t mastered the art of making time for each other since this last child was born (9 weeks ago). This is partly due to the fact that we live far away from family, but mostly due to the fact that we are exhausted. For now, we are focusing on not being short with one another, spending time together after the kids go to bed, finding joy in the mayhem, and allowing the other parent to rest when one of us feels more energized. This is about as “life-giving” as we can manage to be at the moment.

Chaos coordinator

I’m 3 weeks into having three children (one day I’ll get around to sharing the birth story, but for now I’ll just say: the baby was not born in the car and I was able to get an epidural, which is seriously the best medical innovation to date) and it is absolute chaos.

Let’s discuss some of the ridiculous things that have happened since bringing our baby home:

  • Our middle child, Y, bit new baby’s Z finger when he was only a few days old. Seriously kid!? Fortunately Z was okay, but it was a clear sign that Y was not going to warm up to him easily. We’ve since made sure that Y has a bit more one-on-one time with everyone, and we continue to call him our baby. He has since only given him lots of kisses, so perhaps our approach is working.
  • Z was not sleeping at all the first few days (and, truth be told, is not sleeping great now, but I’m giving him the benefit of the doubt since he’s still a newborn). I should clarify: he would sleep just fine as long as he nursed the whole time and/or I held him. We ended up hiring a night nanny, who came highly recommended by two friends. We had her spend 3 weekend nights with us so we could be as well-rested as possible for the big kids during the day. It was incredibly helpful (even though I still had to wake up every 2-3 hours to feed the baby), but on the third night we caught her catching a snooze with our baby on the couch next to her! As my husband would say: “Seriously!? You have one job.” So we don’t have a night nanny anymore. But Z is cooperating and starting to sleep a bit at night. We can usually get one or two 2-2.5 hr stretches. I believe there was one night when we got two 3 hr stretches. Glorious!
  • I took Z out with me to a store the other day, when he was 2 wks old. I’ve been trying to lay low and not exert myself too much (also trying to keep Z away from germs), but I have unfortunately had a few time-sensitive errands to run. On this particular day, Z bawled his eyes out in the car (his M.O.). After we parked, I was trying to load up the stroller quickly so that I could pick up the wailing newborn. I thought I had closed our SUV’s trunk, and didn’t see that it had ricocheted back to half-open due to an umbrella stroller wheel sticking out the back. Unfortunately, I wasn’t looking up when I walked behind the car again and I ran straight into the side of trunk door. It was a pretty good blow, but when I touched my hand to my head to feel it, I was still surprised to see my hand coated with blood. OMG. My husband was at work, my mom was at home with Y, and I was bleeding from my head in the middle of a parking lot 30 minutes from home, with a wailing newborn still buckled into his carseat in the car. The whole thing was ridiculous. I ended up keeping my appointment at the store (I’m sure the woman working there thought I was insane coming in with a newborn with a blood-soaked Kleenex pressed against my head, asking whether I could use their bathroom to clean out my wound). I called one of my surgical colleagues right away and asked whether she had time to squeeze me in that day because I was pretty sure I needed stitches. And that’s how my quick errand turning into an afternoon spent in my clinic getting stitches. Silver lining: at least this happened on my scalp, where the scar will be hidden by my hair, and not on my forehead!
  • Negotiating 3 sleep schedules has been tough. As I mentioned, Z is not sleeping great. X has woken up really early a few days (e.g. 5:30am). I wouldn’t care if he could just sit quietly in bed, but he usually uses the restroom and calls someone to wipe him (so that’s one adult who needs to wake up) and then he goes back into his room, usually noisily, and wakes up Y (since they are now sharing a room). I also wouldn’t care about this if Y was a morning person, but he likes to sleep in, so this automatically makes for a cranky pants morning. Y still takes long naps (3 hours) so we pick him up after a half day of “preschool” and let him snooze at home. Honestly, it would be much easier to have him stay at school all day as opposed to driving to this school three times per day (drop-off for both kids, pick-up for Y mid-day, pick-up for X end of day), but the times we’ve tried a full day of school (including today) have been an absolute disaster. Y is a zombie and in a TERRIBLE mood, so it’s honestly more miserable than taking an extra drive mid-day. Just a few nights ago, I had finally settled Z out of my arms and into the Rock ‘N Play. Then, all of a sudden, I hear crying coming from X&Y’s room (it’s around 9:30pm so this shouldn’t be happening since they had fallen asleep some time before). I check out the Nest Cam and see that Y is standing up in his crib bawling. Oh no. If he wakes up X, we’re going to have a problem. And why is he up crying!? I rush into the room to make sure he doesn’t have a dirty diaper or a fever. Negative on both counts. I carry him out of the room to comfort him and then tell him calmly that he’s going to have to sleep in his crib tonight. That doesn’t go over very well. Ultimately, I let him cry it out in his crib and spend the whole time praying that X doesn’t wake up. By some miracle, he does not, and Y settles to sleep after a few minutes. And, of course, Z wakes up just a bit after that.
  • Family outings are a nightmare. I’m serious! It takes forever for us to get out of the house and we seriously need a rolling suitcase as opposed to a diaper bag whenever we leave. My mom has been in town, so right now we have a 1 adult to 1 child ratio. However, when she leaves, we are going to be in big trouble! X and Y always seem to dart in different directions. Z has blowouts literally only when we are out somewhere! And without fail someone will throw a tantrum.

In sum, things are crazy. I feel like I am barely surviving when all 3 kids are home. That being said, I would choose to have a third child a million times over. I love the chaos and would honestly love a fourth child (crazy, right? Pretty sure there’s no way to convince my husband that this would be a good idea). I also know that these days are fleeting. In just a blink they’ll be teenagers, looking for ways to escape into their rooms. So I’ll enjoy the endless cuddles, each boy vying for mom’s attentions. And I’ll even take the tantrums, tears, and sibling rivalry.

A-holes on airplanes

My kids were much better behaved on our trip back and we had a much better flight with an extra set of hands (thanks to my husband who flew out just to fly us home). I should mention that the flight ended with my oldest projectile vomiting, which was not, as I assumed at the time, motion sickness, but was actually a horrible GI bug that he is still grappling with and that I am desperately hoping no one else in our home contracts. But that’s a story for another day, because first I’d like to talk about a-holes on airplanes.

I have flown a ton with my kids in the past 3.5 years. I have been fortunate to encounter nothing but gracious people, who have tolerated some tears, tantrums, and other infant/toddler behavior on our flights. The kids are actually great travelers, and I think this is part of the reason we have never encountered animosity on airplanes – they don’t scream/shriek the entire time, they are not rude, and obviously they are incredibly cute and win everyone over (biased mom here). Part of the reason we get a lot of sympathy is also that my husband and I always come equipped to entertain them, and we hustle the entire flight to keep them as calm as possible. We don’t let them run around willy-nilly, we are mindful of how their movements and noises affect surrounding passengers, and we try to have new/engaging/interesting items on hand to pique their interest.

However, we did meet our first disgruntled passenger on this week’s flight. We boarded the airplane first, and barely noticed an overweight, older gentleman board a few minutes later. He was seated two rows in front of us. Because we had boarded so early and the majority of seats were empty/passengers were still getting situated, I let my youngest sit on my oldest, start hugging, and begin to play as I set up our seats (safety harnesses, waters, books, wipes, etc). They were basically hugging and making noises. My youngest was saying things so that my oldest would copy him, and they were having a blast. Cue grumpy old man: “I’m sorry, but that is unacceptable behavior.”

I was taken aback – was this man talking to me? It sure looked like he was staring in my direction, but what could be unacceptable behavior? Well, never fear, he proceeded to explain: “It is unacceptable for you to let them hug and yell and cause a commotion for everyone.” First of all, the cabin wasn’t even 25% full. Second of all, who gets angry at playing toddlers who are literally just sitting in their seats!? We hadn’t even been on the airplane for five minutes! If this guy was already annoyed, he was definitely in for a treat during the 5+ hour haul.

I was honestly speechless. I was also slightly embarrassed (was I an oblivious parent? Had my kids actually been loud/obnoxious and not cute/endearing?) and wanted to stay calm for my kids. I was also worried that he would start cursing in front of the kids or become otherwise belligerent. And I didn’t think there was much point in arguing with someone who would yell at a pregnant lady traveling with 2 toddlers – what were the chances he would honestly empathize? Plus you see all of these viral videos these days of families getting kicked off flights for the smallest things, and I did not want any trouble on this flight. My husband, who was sitting across the aisle from us, had zero of these reservations.

He got into it with this man, telling him not to talk to me like that, asking if he had ever flown with children, and on and on. The grumpy old man yelled something back about common courtesy/being nice and I pretty much zoned out and tried to distract my kids, while simultaneously asking my husband to calm down. It was an ugly scene and I was not in the mood for confrontation.

I felt pretty crappy the rest of the flight. We worked as hard as we usually do to keep the kids calm, but it felt different – like we were somehow acquiescing to his demands. I was grateful that both of them napped and were generally in stellar moods. I also felt very grateful to have my husband there. I don’t know how the scene would have played out if I were solo, except that perhaps more passengers would have come to my immediate defense. A few gave us smiles of solidarity after it happened, told us the grumpy old man passenger was a jerk after the flight landed, and also commended us for having well-behaved kids. We were grateful to those people for their small acts of kindness. And a special thank you to the passengers across the aisle from us who handed me a barf bag when they saw my oldest vomiting and me searching frantically for something to contain it.

And if you find yourself on an airplane with parents who have young kids, try to have some empathy. I get it – you paid for your flight, you’re tired, you want to sleep/read/watch a movie/etc. But guess what? It’s not a private jet. Most (I can’t speak for all) parents are trying their best to keep their kids contained and respectful, but kids aren’t robots. These families have also paid money for their seats – in our case, we purchased four of them – and have the right to talk, walk around within reason when the seatbelt sign is off, and so on. And no matter how little you think you’re relaxing by the kids being in your mere presence, the parents are relaxing 100% less trying to entertain them. Moral of the story is: try not to be an a-hole on airplanes. After all, isn’t that what common courtesy is all about?

Worried and kicking

It’s been 5 days since I learned about my possible toxoplasmosis infection and I’ve just been a rollercoaster of emotion:

  • doom and gloom: worst case scenario congenital toxoplasmosis situation. How will we adjust to having a severely disabled child? Is this fair to my other children? How will our lives change?
  • denial: this MUST be a false positive. I don’t spend time around cats, I don’t eat meat, I have barely eaten raw fruits and vegetables this pregnancy and never without washing them. Then I think about the one time our cat lady neighbor picked up two packages for us while we were away. This was back when I was very early pregnant, 1-2 mo. What if one of her cats pooped on the packages and then I grabbed them? Is this enough contact to transmit toxoplasmosis? Would my IgG be positive if this were the case?
  • anger: why did my ob check this lab? There seems to be no clear guideline to doing so (for asymptomatic patients without exposure risk). I switched to this ob primarily to have the same person I saw for regular visits deliver my baby instead of a resident (to clarify: not because I didn’t think they’d do a great job, but because I would prefer for residents I work with not to see me in labor. Although, two residents did deliver my second and I can barely remember who they were) but now I’m having second thoughts. Should I have stuck with my original group, who didn’t check for toxo because it’s not standard of care? Now I’m on this wheel of test after test after test (what I’ve been trying to avoid since my first induction for suspected pre-eclampsia) and I’m mad at myself because it’s of my own doing. I also wish she had a clear algorithm in mind. If she sends off a test, then she should have a clear plan as to what to do if it’s positive or negative. Yet, I know that this is not always true in medicine, and this is how we learn.

My husband is a level-headed, pragmatic individual. He is not worried at all. He says that worrying won’t change the situation. There is literally nothing I can add to the situation by worrying, and I need to relax and wait to see what the doctors say next week. I have an ultrasound scheduled and will follow up with high-risk ob the day after (by phone at least). I wish I could be reasonable like him and not worry, but I have a tough time doing so. I worry about the need for invasive testing or treatment which could be dangerous to the baby. I worry about being in a perpetual state of worry (is this the ultimate sign of anxiety or what?) during this pregnancy. I worry that the baby will need unnecessary testing when he’s born. And I think about what it would be like to have a baby with congenital toxoplasmosis – how different from my prior newborns. How will I handle that on top of having a newborn and 2 toddlers?

In the past few days, the baby has started to kick more. He was moving early on this time around, but his movements have been much more intense and exaggerated. I like to think that he’s telling me not to worry, to calm down, that he’s alright. I hope this is true. Only 3 more days until I have my ultrasound. I pray that everything is normal.

Bad news

This month has been hectic. It started with a lovely get-away (without kids!) for my husband and I. It was lovely. We were away for a week and were able to sleep 10-12 hours per day, finish both our conversations and our meals, lounge leisurely by the pool (under an umbrella, of course), walk along the beach, read, and simply be.

As always, I returned home with a desire to incorporate some of that into my daily life: taking a few minutes per day to just be together, reading more for fun, enjoying leisurely meals, exercising. Except we came home to a 1 year old and a 3 year old and two full-time jobs so none of the above happened.

It’s also a busy time. I’ve been taking advantage of my second-trimester energy to complete a few projects, including submitting plans for a minor home renovation. I’ve also had a pesky cough since our time away and though it would go away but it didn’t, and the coughing would often rob me of my energy and cause me to feel even more tired than usual. To top things off, my oldest came down with hand foot mouth disease (HFMD) and was home the entire week prior to a flight I was taking solo with both kids. He was in pain and cranky the entire week (apologies to all of the moms I counseled on HFMD by saying it was merely viral and would blow over) and, the worst part of all was that he wouldn’t sleep through the night! So the first few nights my husband and I stayed up with him. And then my youngest got a fever (but fortunately did not erupt into HFMD) and then HE wouldn’t sleep through the night.

So I set off with both kids in recovery ALONE on a 6 hour flight and it was by far the worst flight we’ve ever had. My kids have traveled a lot because even though we don’t live close to family, I think it’s so important for them to spend time with them. They are usually shockingly well-behaved. I come prepared, keep them entertained, and they generally keep their crying and tantrums to a minimum. But last week was a different story. Both kids were on the mend, I felt like crap from a combination of not sleeping as well as fighting off this cough (oh and being pregnant), and they wouldn’t nap! So we kept things pretty together until the last 30-45 minutes. And then when the plane landed, all hell broke loose. Both kids wanted to be carried but I only had two hands and had to carry the carry-on bags (we only had travel backpacks with us but it was a lot to juggle!). Then my oldest started throwing a tantrum about everything – he didn’t want to let me into the aisle to organize our bags, he didn’t want his brother to sit by the window, and on and on and on. Meanwhile, I’m frantically trying to organize everything while his little monkey of a brother is climbing over the seats. My oldest won’t move from his spot so I tell him “I’m going to pick you up and sit you down here so that I can grab everything” and do just that. He loses his **** and starts yelling “Mommy you HURT ME!”. Meanwhile, I’m dying.  As calmly as possible, I tell him it’s time to get off of the plane. A very nice lady helps with one of our bags, I carry my youngest off the plane, and my oldest begrudgingly drags his bag and follows behind, complaining all the way.

At the gate, I have to find and unfold our stroller, which was a waste of effort because neither kid will sit in it (but at least I can pile some bags on it). The oldest is crying and blocking people as they walk off of the plane while the youngest just wants to be held. I hightail it out of there with the oldest hitting me on my backpack and throwing the world’s greatest tantrum. We are the last people off the plane and the pilots are begrudgingly walking behind us because (I learned on another trip) they can’t leave anyone behind when they leave the plane. Awesome. And then, to top it all off, I have to walk approximately 20 minutes with one kid in my arms and one kid whining the whole way because we have landed at a huge airport, at possibly the furthest airline!

It was a total disaster. I saw my parents at the exit, handed the kids off to them, and then walked off to baggage claim to burst into tears. I could tell the security guard knew I was going to lose it because he let my parents follow me to the baggage claim to help out with the bags.

Until yesterday, I thought that was the worst thing that had happened. Then, my ob called me. Before I left, I had a few third trimester labs drawn. Apparently, one of those labs was toxoplasmosis. I had already had this checked in January (at 7 weeks) and both IgM and IgG were negative. For some reason, my ob rechecked it. She admitted that this was controversial – that many people don’t recommend rechecking due to low likelihood of infection in our area and false positives. But then she told me that I had a new positive (IgM, with IgG still negative). She wasn’t sure what to make of it. She had spoken to the high-risk obstetrics group at my hospital and they would follow up with me and likely have me return for an ultrasound, as well as labs, maybe an antibiotic, etc. She told me not to freak out so I promptly did just that – freaked out.

Toxoplasmosis!? That’s one of the terrible infections we learn about in medical school that can cause a slew of problems in newborns. WTF!? But I don’t own any cats…and I’m a vegetarian! I couldn’t believe it. I did what I always tell my patients not to do – turned to Dr. Google, and PubMed, and every person I know who is an obstetrician or infectious disease expert. I received a slew of responses: it’s probably nothing/a false positive, you definitely should not ignore this, you need serial ultrasound monitoring, they need to test the baby, there’s nothing you can do anyway because you’re 24 weeks along.

I’m also a bit annoyed at my ob. Why did she check it if it’s controversial? Her exact words were “I’ll probably change my practice after this”. And I am not entirely sure she knows exactly what to do at this time. She referred me to the high-risk ob, and that person called me, but I’m traveling and can’t be seen tomorrow, and she’s going to be out of town next week. The ID expert I spoke with told me to get labs ASAP, but the ob told me it wasn’t time-sensitive. Her exactly words were “I’m going to be blunt with you because you’re a doctor: if this is a true infection, there’s not much you can do at 24 weeks”. But shouldn’t it matter if it’s a true infection?

So I’m just waiting here, anticipating the worst. And it’s made me realize that I’m done having kids. I always thought I wanted a fourth, but pregnancy is too tenuous and stressful. I think about the experiences I’ve had with my kids – my pre-eclampsia scare with my first and him being in the NICU after birth (the briefest NICU stay ever, but seemed like the longest to me), my positive first-trimester screen with my second and having to see genetics for additional screening to rule out a chromosomal abnormality, and now this with my third. I pray that he will be healthy. That this is either a huge misunderstanding (false positive) or that he does not catch this infection. I’ll have an ultrasound in one week and hopefully will have some additional information at that time – and hopefully it’s all good news.

Updates from the 1st trimester

I’ve been thinking of all of the things I want to remember from this first trimester. With my first pregnancy, I journaled all the time. With my second, I journaled less. This time around I forgot the password to access my (very sophisticated) Word doc journal and haven’t written anything since before becoming pregnant.

So first I’ll start with early pregnancy symptoms. I hate early pregnancy symptoms because they can literally be anything, so when you’re trying to get pregnant every little twinge becomes a reason to obsess over whether you could be pregnant.

I honestly didn’t feel any different than I have during my last few cycles. A bit of back pain a few days prior, but I’m pretty sure that’s more related to my 40 lb 3 year old and 25+ lb 1.5 year old. We flew for the holidays and I felt incredibly nauseous on the descent, but didn’t think much of it as I had experienced nausea with some prior cycles. What really tipped me off was this: no hormonal acne. Around the time of my menstrual cycle, I develop a few cystic acne lesions. I had zero by day 30 and this definitely piqued my interest. When I went to bed that night, I thought I felt something developing on my chin, but it was gone by the next morning. And that was it-I took a pregnancy test the next time.

During these first few weeks, I’ve felt:

-general stomach uneasiness

-nausea, usually worse in the early evening

-cravings for: carbs, juice (orange and mango), pineapple

-no desire to drink coffee (usually a staple of my diet) and no real desire to eat chocolate (another staple of my diet)

-intense moodiness

-incredible fatigue

I’ve also felt great worry, which is a staple of my pregnancies. I honestly wish women didn’t start showing until ~week 20, after the anatomy scan. With this pregnancy, I am showing EARLY. A handful of people know for a number of pragmatic reasons, and this makes me even more nervous! With my first, we didn’t even tell my family until I was almost 12 weeks pregnant. I didn’t notify my new employer until I was 14 weeks pregnant, and my colleagues at the time didn’t know until almost 16-18 weeks! With my second, I didn’t say anything until honestly around 20 weeks+ (although our families knew right away). I was negotiating a new contract at the time and didn’t want my pregnancy throwing a wrench into the plans.

I had one bit of good news at 7 weeks: baby had a heartbeat. But this is only minimally reassuring. The miscarriage rate on a population level is still 5%, and I’m sure we all know people who returned for their second check-up to find that the baby’s heartbeat was gone. So I am trying to stay sane until my 11 week appointment. And the week after I have my nuchal translucency/first trimester screen and my appointment with a genetic counselor (I’ll be 35 when this baby is born so I’m adding Harmony/Panorama/non-invasive prenatal screening test onto my routine prenatal testing). I think if I can get past the next 2 weeks (which are also riddled with work deadlines), I’ll be able to breathe a little more easily. Although then I’ll have the anatomy scan hanging over my head.

Well, I feel fortunate to be pregnant for now, and will try to keep my anxiety in check while I count down the days! The crazy thing is that in just 2 weeks I’ll be done with my first trimester, and then there are only two to go!