Distance

Today, while I was tidying up our bedroom, my 20 month old reached into a bathroom drawer and pulled out a bag my mom keeps at our house filled with essential toiletries. My parents (and in-laws) live across the country, but my mom used to (pre-COVID) visit frequently. To avoid buying new toiletries whenever she arrived, we started keeping a bag for her so that it would always be ready for the next trip.

My heart was heavy when I saw that bag. Who knows when the next trip will be? We canceled our trip last month as well as the upcoming one in July. She canceled her trip in June. The big unknown is August. Will she come out for this baby’s birth? She has been such an integral part of each child’s early days that I have no idea how we will handle it alone. And if school doesn’t open in the fall, how will we handle a newborn and a 2 year old while homeschooling a preschooler and kindergartener?

There are so many things to worry about. If she travels, are we putting her at risk for getting COVID? Would she need to quarantine for two weeks upon arrival? Would she be stuck here for the second surge of this pandemic? What if my father gets sick and she is unable to be there right away (and would she need to quarantine upon arrival)? Is she at higher risk of getting COVID around my kids than she would be at home?

Of course I want her to be here, but I also feel that it would be a selfish request. We’ll talk more about it as the date draws closer, but I’m going to prepare for the newborn days without her.

This pandemic has highlighted the distance between us. My husband and I have lived away from our families throughout the entirety of our 13 year relationship. We moved to California a decade ago. There have been times when it felt farther than others, but we always knew we were a (relatively) short flight away from home and our families. COVID-19 has changed everything. Flying feels so risky and it seems silly to endeavor it when we are so carefully sheltering in place in every other respect. I don’t see this changing any time soon, and the prediction is that this is going to last months to years. My hope is that our families stay healthy during this time, but I also recognize that we don’t have limitless years left with our parents and it is such a shame to missing out on time when they are well and able to enjoy their grandchildren.

So much to be sad about during this unprecedented time. For now, I’m going to keep my mom’s toiletry bag tucked in the bathroom drawer, hoping that her next trip is not too far away.

Pandemic Pregnancy

When I became pregnant, COVID-19 wasn’t even a thing. It was mid-December and I don’t recall hearing anything about what was happening in Wuhan until January at the earliest. So it was probably a thing, and there were cases, but the thought of closed schools, clinical work on hold and shelter-in-place were not on my radar. I was honestly mostly focused on the application process for private school for my two oldest kids. They were (and I recognize how ridiculous this sounds) applying for entry to pre-K and K, and my biggest worry was where they would be going to school the following year. Now I’m doubtful that they will even get to attend said school in person, but that’s a topic for another day.

On February 25th I screened positive for Trisomy 21 and perseverated over that for a week until my normal cell-free DNA results.

We slowly began to take precautions at work to screen for COVID-19. It began with questioning patients prior to their visit to see whether they had recently traveled from Wuhan (this eventually expanded to all of China, and as everyone knows that question soon became obsolete). We also asked about cough and fever. Carts with PPE were positioned outside of these patient rooms.

I developed a cough on March 6th, which was terribly awkward to have while everyone was on high alert regarding COVID (for the records, I have had a negative COVID-19 PCR and also negative IgG and IgM antibodies). One of my patients even sent me a personal note saying that he was worried about me because I had been coughing (I wore a mask in every patient room during this time) and seemed short of breath. I had to, with some embarrassment, tell him that I was short of breath due to climbing 3 sets of stairs while pregnant. Fortunately he was a patient I knew quite well.

I had an ob appointment March 10th and my ob was pretty close to 0% concerned about COVID. She told me the reports out of China were reassuring. Pregnant women seemed to fare well and there were no cases of vertical transmission. She also told me to drink a glass of wine, which was interesting because she usually errs on the conservative side (also for the record, I did not drink a glass of wine).

My close colleagues, however, were more concerned and ended up encouraging me to drop one of my higher-risk duties – seeing patients in the hospital. I stopped doing that the week of March 2nd. The week of March 9th I made a huge pivot in my career and left one of the clinics I had worked at for 6 years. Too many things weren’t working out. I was losing staff, knew I wouldn’t have any when I returned from maternity leave again (it was a drawn-out nightmare the last time) and was so exhausted from pregnancy and turning 37 that I knew it was finally time to call it quits.

March was a month of major upheaval. Our world paused in March – with school canceled starting March 12th (initially only for two weeks but that eventually progressed to no school for the rest of the school year) and shelter-in-place coming 5 days later. Everything was being canceled. It was such a crazy time.

We largely stopped seeing patients in person, with my last real clinic held on March 16th. Everything has been virtual since. To be honest, it’s been challenging. Some conditions in dermatology are easy to treat virtually (acne, for example). Other things, like checking over someone’s skin to look for skin cancer, are impossible. I have been seeing 1-2 patients a week for skin biopsy and evaluation of more serious rashes, but always wearing ample PPE (I have my own that I cycle through). We have just started talking about opening up clinic more robustly, and I am concerned about the plan (or lack thereof). It doesn’t sound like anything is changing, other than spacing out clinics and appointments to encourage social distancing. Of course, we are asked to wear PPE, although it is unclear whether this is readily available.

Normally, I wouldn’t be too concerned. But last week, at my follow-up ob visit, my doctor was suddenly very concerned. She told me there had been new reports of COVID-19 found in placentas, IgM antibodies in newborns, vertical transmission (from mom to body), second trimester miscarriages, stillbirths and premature births. The numbers of reports were small, but there was definitely more alarm. Moms are tested at the time of delivery at our hospital and COVID-19+ moms are recommended to separate from their newborns. Having had three kids, I can’t imagine how heartbreaking that would be.

In sum, I’m starting to worry about ramping up capacity to see more patients. I’m not reassured by the plan currently in place and now I’m much more anxious about doctoring while pregnant. At the same time, I feel a bit silly, because I don’t work in an emergency room or ICU, and certainly don’t do any high-risk procedures (any biopsies I do near the face are usually relatively quick and nothing compared to an intubation). I also feel a strong obligation to my patients. I know how scary it can be to have a spot that you are worried could be a skin cancer, or a rash that keeps spreading. Our patients have been so wonderful these past few weeks, understanding that we are taking every precaution to keep them safe, but I certainly don’t want anyone waiting months to be seen. Since I am taking maternity leave, I would be gone until early 2021. Finally, I care deeply about my colleagues. Although they might not be pregnant, they could have co-morbidities or take medications that make them immunosuppressed, live with elderly parents or in-laws or immunosuppressed children and spouses. I don’t want to burden anyone else with having to see my patients because it seems to imply that my pregnancy is more important than their personal circumstances.

It’s an uncertain time for all and I don’t envy our management who has to make some tough decisions moving forward. For now, I’ve reached out to my ob to see if she can give me some clarity on making a decision. If need be, I’ll reach out to my colleagues to see how to best mitigate risk. I’m taking leave at 35 weeks so essentially only 13 more weeks to go. Hoping those 13 weeks are as smooth and uneventful as possible!

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.

No more cornflakes

Today is Day 38 of no school for my kids and Day 33 of shelter-in-place. It’s 1:48am and I am up again. We’ve been battling bedtime with one of my kids for what seems like an eternity (a year perhaps?). With the extra time at home, less need to be at work first thing in the morning, and generally more exhaustion, I have started falling asleep on the floor of his room (his preferred sleeping arrangement) more often than I would like to admit. After sleeping a good 3-4 hours, I find it tough to seamlessly transition to my own bed. Thus why I am up right now – writing for the first time in ages.

The past few weeks have been an adjustment, to say the least. Before I go into details, I first have to say that we have been very fortunate. My husband and I are still employed and no one we know or love has been ill with COVID-19, despite much of our family living in New York and New Jersey.  I work at a hospital but my department has made patient, faculty and staff safety a priority, and this has helped to relieve a lot of exposure anxiety. I am also 19 weeks pregnant and my colleagues immediately volunteered to take over some of my riskier patient care responsibilities, as the evidence regarding COVID-19 and pregnancy continues to evolve (fortunately, it has been mostly reassuring, but we are learning more each day).

We are very blessed and acutely aware of this, but also affected by the monumental change that occurred in our lives these past few weeks as well as the uncertainty regarding the future. What began as a two-week hiatus from school after there was a confirmed positive in the larger school community was gradually extended, until they just recently announced that school would be out until the fall. Summer camps have started to cancel. There is talk of the 2020-2021 school year looking dramatically different.

I do feel fortunate that my children are young (1, 3 and 5). Mostly they have reacted to the news with glee. For them, it is an extended vacation and their parents are home all day on most days (I am currently going into the office one day a week for essential procedures). They say they do not miss school or their friends. We live in a warm climate where they can go outside each day – even if it is only in our backyard or a short trip around the neighborhood. But I do worry about the change in structure. This week in particular was tough became it came with some change in behavior. My 1 year old is undergoing a sleep regression – often crying before bed, waking up in the middle of the night (he woke up as I was typing this), and a few mornings waking up before 5am. My 3 year old finds his way into our bed more often than not (perhaps related to my falling asleep on his floor most nights?). My 5 year old, who is generally very well-behaved, started to act out this week. Small things, for sure, but they pile up quickly when my husband and I are home all day, trying to fit work into any snippets of time we can find, and generally exhausted/operating on fumes. Parenting 3 kids 5 and under while both working full-time was hard at baseline and then COVID happened and it seemed almost impossible. (But I remind myself daily that at the height of my struggle with infertility I would have prayed for this conundrum. No matter how many kids I’ve had, there is no way to forget that burning desire for motherhood, the disappointment that came with every negative pregnancy test, and the fear of it never coming to fruition.)

And yet. Today was a hard day (also a hard night, it seems, with 2/3 of the kids already up 2 times each) and I started thinking about one of my favorite books from childhood – No More Cornflakes by Polly Horvath. I had forgotten the general plot and had a good chuckle when I read the Amazon synopsis: “Hortense seeks the advice and friendship of her eccentric Aunt Kate when her mother spends her days eating cornflakes and hopping around in public, pretending to be a rabbit”. It is about a girl growing up in a changing household – her mother is pregnant (and apparently losing her mind?  I should go back and read this now that I am an adult), her older sister is out more/becoming more independent, and she finds solace in a deepening relationship with her quirky aunt. The one thing I vividly recall, even decades later, is her aunt’s advice to find an “oasis”, a small ritual you have for yourself each day – one that is yours and only yours, one that brings joy always.

I love this concept even more now. As our world has become smaller – confined largely to the walls of our home – as our social interactions have become non-existent, as our opportunities for experiences, vacations, etc., have dissipated before our eyes, how do we find solace in our day? What can we do to bring a sense of peace, calm and fortitude into our lives? I’ll be thinking about this deeply in the next few days, as we continue to refine our daily schedules, to bring small rays of sunshine into our lives.

For now, I am trying to focus on the positives. I have had the opportunity to experience staying at home with my children (I went back to work with all 3 when they were ~4 months old). They have had the opportunity to experience a different childhood (I sometimes joke that it is my childhood) – one without planned activities, playdates, structure. We, as parents, are working on encouraging more creativity and independent play. We are trying to find small pockets of time for ourselves while the kids are awake, so that we don’t have to cling so desperately to the post-bedtime hours. My 1 year old’s language has taken off exponentially now that his brothers are home full-time. My 3 year old rode his bike for the first time today without training wheels. My 5 year old has been reading on his own and doing math. We are eating at home every night (we always ate together, but did often eat out) and I am so incredibly fortunate that my husband cooks for us every day. We are finding the time to complete random items on our to-do list that always fell to the bottom of our busy days.

One day, as long as everyone stays healthy and safe, we may look back on this time with some degree of fondness. I wonder if it is the closest we will ever be as a family. Soon, if we are still sheltering in place and socially isolating when this fourth baby arrives, we will be even closer!

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!?

The Village

I was recently surprised to learn that I had lost my desire to move back to New York. As recently as a few months ago, when people would ask me whether I envisioned myself staying in California forever, I used to respond with “Probably, because I don’t think I can convince my husband to live anywhere else.” Now I pause, because the answer is that I can’t quite imagine living anywhere else.

When and how did this drastic shift occur? I left New York when I was 18 years old. To be honest, I was thrilled to do so. I lived in the suburbs outside of NYC, had moved during my freshman year of high school (NOT a good situation), and was excited to “discover the world”. I floated around New England for college and medical school, and spent a requisite year living and working in NYC. When it was time for residency selection, my husband (also an East Coaster) and I were adamant that we needed to get out of the cold. He wanted to work in California and I was game to live in California and so I applied and was accepted.

We flew to the West Coast with one suitcase. (I can imagine myself telling this story to my children one day, at which point they’ll roll their eyes at this particular sentence.) We had less than $5,000 combined in our bank accounts. My husband was unemployed (“between jobs”) and I was days shy of starting my intern year. We rented a small unit in a house of four units total and decked it out in IKEA furniture. My husband bought a Samsung flat screen TV which we still own 8 years later. We weren’t married yet but reasoned that we needed to move in together because the rent was too expensive to swing two apartments. When he proposed to me, the engagement ring was the most expensive thing we owned. We didn’t have much but we were so happy.

In the past 8 years, we’ve spent 5 of them living together (we were apart for 3 years while I completed my residency), got jobs, got married, bought a house, tucked away money for retirement, had 3 kids, tucked away money for college education, and created the life we always wanted – one we could have never quite imagined when we landed in California in 2010.

Yet there were bumps in the road. I started my first job out of residency in 2014 and had a baby 3 months later. I’ve had 2 additional children since. I had no idea how difficult it would be to raise a family away from our families. It often felt impossible. I vividly remember those first colic-filled weeks with our oldest. We had help for a few of them but were on our own most of the time and I cried constantly. When I went back to work I was convinced there was no way I could juggle motherhood and my career without help. Most of our acquaintances at the time were my husband’s friends and, although mostly good people, they just weren’t my people. Is that a terrible thing to say? I hope not. You know that feeling when you just click with someone? When you can tell them anything – lay all your cards on the table, be completely vulnerable – and they will accept you wholeheartedly? Let’s just say I didn’t get that vibe from his people. And that’s what I struggled with the most – not having someone I could text frantically when our first was up at all hours of the night, not having someone I could ask to watch him for an hour while I took a breather, not having a tribe to commiserate with.

So I put myself out there. I met a group of women I now call “The Mommies”. My first mom friends! Now, the group has changed dramatically these past 4 years as moms move away and group dynamics shift, but we have each other’s backs, an ongoing calendar of events, never-ending birthday parties, and most importantly the knowledge that we have known each other since our little ones were just months old. I rekindled friendships with people from my intern year and became closer to co-workers with young children. I met more moms through preschool and subsequent “new mom” groups as more children joined our family. We acquired a network of people who have helped us out in some capacity around the house – gardeners, painters, nannies, cleaning crews, etc. Today, our nanny saw that I was clearing out our shed for some upcoming work and (unsolicited) called her husband to see if he would be willing to pick up all of the items we were throwing out to save us the hassle. He came by an hour later and I was so happy I could have cried. With such distance between ourselves and our families, these random acts of kindness mean everything.

I also have to admit that there are serious perks to living in California: great weather, tons of diversity, generally liberal politics. It’s also true that we both love our jobs and our house. But the game-changer for me was truly the evolution of our community and little village. We’ll see how we feel as the kids get older and schedules become more demanding but, for now, I am truly loving where we live, and this is the first time since 2014 that I’ve been truly able to say that.

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.

36 weeks + 1 day

Almost to the finish line and I have so many mixed feelings about this:

  1. Incredulity – I can’t believe this pregnancy is almost over – where did the time go!?
  2. Panic – How are we ever going to complete our to-do list before the due date? I have so many things I want to accomplish before the baby gets here. Some minor home improvement projects, wrapping up everything at work (I am so behind – it seems insurmountable!)
  3. Anxiety – Labor is not the most pleasant experience so I can’t say I’m necessarily looking forward to that part! We also almost didn’t make it to the hospital when my second was born, so I’ve been thinking about scheduling an induction this time around. I do prefer to go into labor without intervention, but didn’t love how chaotic things felt with my last delivery.
  4. Exhaustion – I’ve been staying up late to get things done and work has been super hectic because patients keep calling to make an appointment before I go. I feel guilty leaving them for so many months (although have amazing colleagues who will see them while I’m out) and keep saying yes, even though the days are long. Also, my belly is getting heavy and being on my feet during the day is exhausting!
  5. Worry – Will baby be healthy? Will my older kids be alright with the new addition? How will we handle the sleep deprivation? What if this baby also has colic (like my first)?
  6. Sadness .- This may very well be my last pregnancy (definitely will be, according to my husband!). I know I’ve been incredibly blessed to be pregnant 3 times (especially after my fertility struggles the first time around), but it does make it sad to think about closing the door on my childbearing years.
  7. Excitement – Another newborn! I can’t wait to see and hold him. I wonder what he will look like. I had a growth ultrasound yesterday (still being monitored because of the false negative toxoplasmosis result) and they estimated that he was 6 lbs 9 oz. I couldn’t believe it! That’s like a real baby! He was so cramped in there – space is certainly getting tight.

In other news, our (current) littlest guy started preschool 2 weeks ago. It was ROUGH in the beginning. He had a tough time adjusting. As it happened, he wasn’t able to attend the first 3 days we had enrolled him because he woke up sick on the first day of school! We couldn’t believe it. This kid has been the healthiest since birth (despite a germ-y older brother), but of course he had to wake up with a fever on his first day. Fortunately, our nanny was available to help us out. However, she had other plans the last two days of the week, and my husband and I had to work, so we threw him right into the deep end – he stayed for the whole day those first two days! He was always so tired when we picked him up. And he cried…a LOT.

So the following week, we decided to stick with the half-day schedule. I wasn’t sure how this would fly with my oldest (they are at the same school but different classes, so I didn’t know if he would be confused/upset if his brother was picked up earlier), but he did great. We told him his little brother couldn’t stay the whole day yet because he was too small, even though he really wanted to. Drop-offs were still tough that first half of the week (he even angrily hit a teacher one morning after I left!), but he soon began to adjust to the schedule, and started to cry less and less at drop off.

This Monday, the sweetest thing happened. He clung to me like he always does when we arrived at school. But when I told him that it was time for me to go and that he should stay with his brother (they have a joint playtime in the morning while all the kids arrive), he took a few steps towards his big brother with tears welling up in his eyes, held his hand, and tried his best to look brave. He turned around to look at me when I left, but he didn’t bawl for the first time! And since then, it has only continued to improve. Today, he walked away from ME when I dropped him off, and happily took a spot next to his brother on his yoga mat.

Overall, he’s adjusting REALLY well and I am so happy this happened before the new baby comes to town. They’ll have their summer break soon, and then we’ll need to decide whether it’s time to enroll him in the full day schedule!

Here are a few books I found useful to prepare your little ones to start preschool. Both kids really loved these books during their transition periods, and I think they very plainly lay out the emotions kids may experience when leaving their parents for the first time.