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!

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.

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.

Charley horses and baby kicks

A few days ago I woke up with a terrible muscle cramp in my right leg. It woke me up from my sleep, which was aggravating because I really love my sleep. But it was also incredibly painful! I had completely forgotten about Charley horses during pregnancy, but yes, it is a thing that happens.

(Speaking of things that happen: here’s another one no one told me about. After my second delivery, I experienced terrible uterine contractions – almost as bad as pregnancy – whenever my newborn nursed. This is apparently a thing. When you nurse, oxytocin is released, leading to uterine contractions. Because the uterus has less muscle tone after your first delivery, this contraction is often quite mild – it definitely was for me. However, with each subsequent pregnancy, they become more intense (as uterine muscle tone increases). I was literally doubling over in pain after my second was born, so I am NOT excited to experience this again!)

I have also started to feel this baby kick. At first (around week 17) it felt like very light flutters. It still feels light, but I am certain now that it’s the baby. This makes everything feel more real. We bought baby’s first outfit yesterday. I can’t go too crazy (I already have 2 kids’ worth of boy clothes) but I definitely wanted him to have a new hospital outfit.

I also have his anatomy scan this week. I am always so worried about this test, but trying to stay calm before the ultrasound.

 

My nanny is drinking pregnancy tea

This hurts my heart because she’s preparing for her second round of IVF and I feel like a terrible person for having two children already and now being pregnant with a third (and I haven’t told her about this yet, although I’m pretty sure she’s figured it out). It hurts my heart because I remember those days very vividly – wondering why everyone seemed to get pregnant so easily and why it was taking me forever. What was wrong with me? Would I ever be a mother? I wore fertility bracelets, temped, took supplements, checked CM, joined a yoga for fertility group, set up a meditation corner in my bedroom to relieve stress, started acupuncture, and on and on and on. And I think: how much harder would it have been if my job was to take care of small children? And how conflicting it must be when that job is paying for your opportunity to have your own child.

In addition to my nanny, I haven’t told a lot of people I’m pregnant yet, but there are two people in particular who I should have told but I have not. They are very dear friends to me. One recently miscarried in her first trimester after deciding to have a second child, and the second is undergoing her second round of IVF, having failed a first in an attempt to have a second chid. I should have told them, but didn’t know how to break the news directly after they announced what they had been through. And, to be honest, distance and our busy lives make it easy to evade. But I am 15 weeks tomorrow, so it’s time. And eventually I’ll need to tell my nanny, who likely already knows. I only hope that in a few weeks to months she shares the news that she’s expecting as well.

What people are saying

I am finding that the reaction you receive when you tell someone you are expecting your third baby is quite different than the reaction you receive when you tell someone you are expecting your first baby.

When people found out I was pregnant with baby #1, they were ecstatic. There were congratulations all around, experienced moms waxing nostalgic about those early days, huge baby showers to be had, and overall excitement. Everyone was thrilled.

When we were pregnant with #2, people were also excited, but perhaps a bit worried. They seemed pleased that our son would have a brother, but did sometimes comment that the less than two year difference in age was a bit aggressive. Overall, however, there was excitement.

With this baby, baby #3, we have definitely received a number of congratulatory comments. But we have also heard quite a bit of:

  • “Was it an accident?
  • “Was it planned?”
  • “What?”
  • “OMG, why!?”
  • “Let me guess – you’re pregnant” (in response to: “I have something to tell you”)

So, it’s been a bit different. But we ourselves are very excited for this third baby, for whom we did plan!