I guess it's time for me to cough up the deets about my own birth experience. It's probably good for me to write it all out before I forget the details...
I was ready to give birth from about 36 weeks on. I generally loved being pregnant, except for those last few weeks. I remember laying in bed at about 39 weeks and referring to rolling over as "coming about". But I worked until a week before my due date -- 12 hour shifts on my feet -- and generally tried to keep busy. By 40 weeks I was totally over it and was pretty disappointed to see my due date come and go with no baby. By then I'd tried every trick in the book -- spicy food, sex, Dr. Christopher's PN6 herbs. I even baked a batch of "jump start your labor cookies" -- all to no avail.
At my midwife appointment on my due date (a Tuesday), she told me that if I hadn't gone into labor by Saturday I should come to her office and she'd try to stretch my cervix a bit. So Saturday came and, sure enough, no baby. I walked to her office and she told me I was 1 cm dilated. She said if I hadn't had the baby by our next appointment on Tuesday, she'd get a bit more aggressive with the cervix stretching, but till then I just had to wait it out.
That night at about 11:30, I lay in bed reading when I felt a weird gurgle & a trickle. I did a gravity defying horizontal exit from our bed, took two steps into the bathroom and knew that I was leaking amniotic fluid. It was only a little bit of fluid and it was clear, but it was unmistakeably amniotic fluid.
So I called my midwife. She asked me if I had any castor oil in my house and when I said no, she said she'd put some in her mailbox if Mr. Stewgler wanted to walk down and fetch it. We hatched a plan -- I was to set my alarm for 5 AM. If I hadn't started contracting by then I was to make a cocktail out of castor oil, OJ, vanilla ice cream & a shot of vodka (not kidding) and then go back to sleep. The idea with the castor oil is that it gets your bowels in an uproar and the peristaltic contractions of your bowels sometimes gets uterine contractions going. The OJ & the ice cream are to mask the taste and texture of the castor oil. The vodka was supposed to chill me out (yes, my midwife is one of the raddest people on the planet).
So we went to sleep. Actually we laid in the dark for a while listening to our hearts pound and then we went to sleep. I didn't need my 5 o'clock alarm.
By five AM, I was contracting regularly -- every five minutes or so. I got out the laptop and started timing them with contractionmaster.com. By 5:30 I'd woken up Mr. Stewgler & called my parents to tell them it was on. My mom planned to be in the delivery room with us so she packed her bag and headed for Brooklyn.
And so it went. I walked around the apartment, sat on the exercise ball, and breathed through my contractions. Even without the castor oil, my bowels were in an uproar. I spent the better part of the morning walking back and forth to the bathroom. At some point I called the midwife back to tell her I was in labor. She said she'd come over when ever I wanted her to and suggested that I try a shower and a nap.
My contraction pattern was kind of funny. I'd have runs of intense contractions -- where each one was a little worse than the last, capped off by a total monster which would leave me barfing my brains out. But then I'd get a little break -- they'd space out and get a little less intense. My labor happened in waves.
By early afternoon I was getting pretty uncomfortable. Mr. Stewgler insisted that I call the midwife -- she answered the phone saying that she was just putting on her coat to come see me whether I wanted her or not. She arrived and listened to the baby with her doppler for about 20 minutes. She then suggested that I try taking a bath.
Mr. Stewgler filled the tub & when I got in I instantly hated it. Our tub was too shallow and the sides were too steep and I just couldn't get comfortable.
Of course, I also couldn't turn off my brain. Mr Stewgler tried to make me a bath pillow out of a towel -- I worried that it was our last clean towel & that my mom wouldn't have a towel to use. As much as they tried to get me to focus on the task at hand. I was much more interested in playing the hostess. Was the midwife hungry? Had she tried the jump start your labor cookies? What were they planning to order for lunch?
I think I got in and out of the tub twice. I just couldn't decide what I wanted. I remember saying, "Oh God, I'm one of those laboring women."
At some point I asked the midwife when she'd check me to see how dilated I was. She replied that because my membranes were ruptured she didn't really want to check me until I felt the urge to push. Because we were still at our house, I was kind of disappointed by this news. I had hoped to head to the hospital somewhere around 6 or 7 cm's -- late enough in my labor that I'd spend most of it at home but early enough that I wouldn't be trying to walk three blocks to the hospital in the dreaded transition stage of labor. So I asked her to check me, even though she didn't want to, just so we'd know where we were in the process. She declared that I was 5-6 cm's. Woo-hoo. I seem to remember that my mom and I high-fived and then we started getting ready to head to the hospital.
Getting to the hospital was a feat in and of itself. We live three blocks from the hospital so we weren't about to drive there, but in that moment three blocks seemed like a long way to go. I made it down our five flights of stairs with no contractions, but I had three contractions (one per block) en route. My mom took photos of each contraction and they're hilarious. Even without the photos I think I will forever remember those spots. When I walk down the street I can't help but feel a special fealty with the fence and mailbox and bench that I hung on -- my special connection with Hicks St.
At the hospital, we walked straight into the labor room. My midwife gave me the option to have an IV or not. Knowing that I hadn't kept anything down all day I opted for some IV fluid. I even offered to let a nursing student or orientee start my IV since I have great veins, no needle phobia & a BIG karma debt to repay. They put me on the fetal monitor for about 30 minutes and, of course, I watched it like a hawk. I explained the whole thing to Mr. Stewgler while my mom & the midwife talked about knitting.
By the time my 30 minute monitoring strip was finished, the jacuzzi tub was filled and I was so excited to get in. That tub was the greatest thing EVER. I had two jets on my lower back and it felt totally awesome.
I just re-read the last few paragraphs and I feel like I need to mention that I was indeed having MAJOR contractions every 3-4 minutes. The great thing about contractions is that when they're over, they're over and you really feel fine. So, sure, one minute I was huffing and puffing my way through a contraction, but the next I was talking about fabric or Japanese food. As my midwife says, "That's the beauty of labor."
OK, so I'm in the tub for about 20 minutes when I start bearing down involuntarily. I seriously couldn't stop myself. At this point I've been at the hospital for less than an hour. So they haul me out of the tub (in this hospital you can labor in the tub, but you can't deliver in it) and my midwife checks me again... 9.5 cm's! Awesome. I was totally psyched to have progressed so quickly.
The only problem was that I felt like pushing but I wasn't fully dilated. My midwife declared that if I needed to push then she needed to reduce my cervical lip. Translation, she needed to push the little ring of remaining cervix up over the baby's head while I pushed (because cervical tears are nothing nice). Let me tell you folks, this hurt like crazy. Mind searing pain.
I think it was around this time that I asked for an epidural. I knew, in my head and my heart, that I didn't really want one, but it felt good to ask. My midwife totally ignored my request. Seriously, it was like she was deaf to the word epidural. Hilarious.
Pushing was kind of an out-of-body experience. For the first 45 minutes I was dealing with the cervical reduction. For the next 45 minutes I felt like I wasn't making any progress. For the last half hour I was digging deeper than I'd ever dug before. By the end I was holding my own feet & was fully committed.
The final details are kind of a blur. I guess that's just the way it is -- one second you're pushing and the next you're holding a baby. I remember my midwife telling me to reach down and grab her. I remember her eyes popping open right away. I remember her cord feeling kind of short. I remember that pushing out the placenta was one of the best feelings in the world.
In hindsight, I think it's really interesting that any sort of somatic memory escapes me. In this moment I can't describe or even really remember what it felt like. Do contractions feel like strong menstrual cramps? I have no idea. I remember that it hurt at times and didn't hurt at times and that's the best I can do.
I know this -- giving birth was the most empowering experience of my life. Bar none. Hands down. My mantra at the end of my pregnancy was that childbirth is one of those rare opportunities to really see the stuff of which you're made. I know now that I'm made of will and guts and power. Mountains and mountains of power.
Wednesday, August 27, 2008
Lapses and Gaps
We here at Stewgler HQ have been all over the place in August. We spent a week in SoCal with the west coast cousins which was totally awesome -- IK's first flights included. Upon our return, I had to work six (12-hour) days straight to make up for the days I missed while in California and IK went to her first session of "Camp Nana" since my work schedule was so nuts.
All is well, but we're still digging out from the mayhem. I'm determined to get back to a more regular posting schedule soon.
To tide you over, I'm posting my birth story which I've been working on for a bit. Enjoy.
All is well, but we're still digging out from the mayhem. I'm determined to get back to a more regular posting schedule soon.
To tide you over, I'm posting my birth story which I've been working on for a bit. Enjoy.
Tuesday, August 5, 2008
Seriously
Why would anyone ever make baby food with a hand-cranked food mill when the Cuisinart blender wand is in the world?
Yes Doctor, Do You Take Cream and Sugar?
Since I went back to work, it's been nothing but HUGE babies and c-sections. Honestly, I'm beginning to think that I'm jinxed. Actually, I've been thinking that maybe IK was my good luck charm (she was with me in utero from the first day I worked on L & D).
In eight months on L & D I never had a baby bigger than ten pounds. In the last four shifts, I've seen THREE eleven pounders! After hours of valiant pushing all three mom's ended up in the OR. I'll be the first to admit that in all cases a C-section was indicated, but it's never been more clear to me that some sections are better than others.
Scenario A: Midwife attended delivery. Mom pushed for two+ hours in a variety of positions, after laboring down (meaning that she waited a while to push after she was fully dilated -- this allows the baby to descend using the strength of the contractions rather than having the mom push with the baby in a high station). When it became clear that the mom's pushing wasn't bringing the baby down, the midwife consulted a physician who agreed that a c-section was indicated. The parents were involved in every decision and went into the OR feeling confident that we'd tried EVERYTHING to make a vaginal delivery happen. Though it wasn't the delivery that the parents hoped for, the vibe in the OR was happy and everyone celebrated the arrival of the 11-pounder.
Scenario B: MD attending delivery is covering for the doc who provided all of this patient's prenatal care. He proclaims the patient fully dilated and instructs me to start pushing with her right away while he reads the directions on the Via Cord cord blood collection kit (he'd never seen one before... RED FLAG). So we start pushing though the patient is totally numb from her epidural and has no urge to push and no sense of when she's contracting. We push for an hour and as far as I can tell she's making no progress. At my hospital nurses don't do vaginal exams so I pop out to check in with the MD. He's MIA so I ask the resident on duty to page him, "You mean he's not in there pushing with his patient?" Nope, I say and she rolls her eyes and picks up the phone. He moseys into the patient's room fifteen minutes later, does a dry glove vaginal exam, declares that she's pushing great & disappears again. By the time he comes back, she's been pushing for two hours -- we've tried a few different positions to no avail. He walks in and seeing no baby about to enter the room he announces that it's time to do a c-section. The patient says, "No, I can keep pushing. I don't want a c-section." To which he replies, "The risks of C-section include blood loss, organ damage, infection and death." (I swear those were his exact words). The patient asks for a second opinion.
Long story short, we end up in the OR. By then I'd mopped up the situation to the best of my ability -- tried to soothe her fears, answer her questions and offered my speech about childbirth being great preparation for parenting. So the 11 pounder is born and in the midst of the cord blood collection the MD sticks himself with the needle. He strips off his gown and gloves and goes out to wash his hands. When he returns he asks me to get the patient's chart so he can see the results of her last HIV test.
From that moment on he never stops putting himself first -- he asks the resident a litany of questions over the patient's open abdomen (what are the side effects of AZT?, what are the chances that he'll get hepatitis if she has hepatitis?, etc.). Keep in mind that the patient is hearing all of this. So then he orders me to draw blood on the patient for new HIV & hepatitis tests. I ask if it can wait till we're out of the OR (since I'm supposed to be attending to the newborn AND have to do three more counts to make sure he hasn't left any instruments in the patient while he's busy worrying about himself) and he doesn't answer. So I go about my business until he stops me in the middle of an instrument count to order me to draw her blood for labs NOW. I explain that we're not supposed to stop in the middle of a count and he says he'll walk out of the OR if I don't draw her blood. I should have told him to go, but instead I threw him a look and stopped my count to draw her blood.
Never once did he offer his happy congratulations on the birth of this beautiful child. He never spoke to the patient again except to ask for her consent for an HIV test. The whole thing made me so sad.
My point, I guess, is not to have you pity me for having to follow this a-hole's orders, but rather to warn anyone out there who might not yet have met their OB's covering doctors. Sure, this patient picked the hunky young MD who gives his patients every chance in the book to deliver vaginally and is willing to put the time in to help her push to make it happen. It's not her fault that she had her baby on a Sunday and therefore got the dorky old doc with a self-aggrandizing attitude problem and a penchant for c-sections that allow him to be home for lunch.
Word to the wise. Ask the hard questions about what happens if you have your baby on a weekend or a holiday or during a week when your doc is pool-side in Cabo. And remember, it's probably not too late to switch to a midwife.
In eight months on L & D I never had a baby bigger than ten pounds. In the last four shifts, I've seen THREE eleven pounders! After hours of valiant pushing all three mom's ended up in the OR. I'll be the first to admit that in all cases a C-section was indicated, but it's never been more clear to me that some sections are better than others.
Scenario A: Midwife attended delivery. Mom pushed for two+ hours in a variety of positions, after laboring down (meaning that she waited a while to push after she was fully dilated -- this allows the baby to descend using the strength of the contractions rather than having the mom push with the baby in a high station). When it became clear that the mom's pushing wasn't bringing the baby down, the midwife consulted a physician who agreed that a c-section was indicated. The parents were involved in every decision and went into the OR feeling confident that we'd tried EVERYTHING to make a vaginal delivery happen. Though it wasn't the delivery that the parents hoped for, the vibe in the OR was happy and everyone celebrated the arrival of the 11-pounder.
Scenario B: MD attending delivery is covering for the doc who provided all of this patient's prenatal care. He proclaims the patient fully dilated and instructs me to start pushing with her right away while he reads the directions on the Via Cord cord blood collection kit (he'd never seen one before... RED FLAG). So we start pushing though the patient is totally numb from her epidural and has no urge to push and no sense of when she's contracting. We push for an hour and as far as I can tell she's making no progress. At my hospital nurses don't do vaginal exams so I pop out to check in with the MD. He's MIA so I ask the resident on duty to page him, "You mean he's not in there pushing with his patient?" Nope, I say and she rolls her eyes and picks up the phone. He moseys into the patient's room fifteen minutes later, does a dry glove vaginal exam, declares that she's pushing great & disappears again. By the time he comes back, she's been pushing for two hours -- we've tried a few different positions to no avail. He walks in and seeing no baby about to enter the room he announces that it's time to do a c-section. The patient says, "No, I can keep pushing. I don't want a c-section." To which he replies, "The risks of C-section include blood loss, organ damage, infection and death." (I swear those were his exact words). The patient asks for a second opinion.
Long story short, we end up in the OR. By then I'd mopped up the situation to the best of my ability -- tried to soothe her fears, answer her questions and offered my speech about childbirth being great preparation for parenting. So the 11 pounder is born and in the midst of the cord blood collection the MD sticks himself with the needle. He strips off his gown and gloves and goes out to wash his hands. When he returns he asks me to get the patient's chart so he can see the results of her last HIV test.
From that moment on he never stops putting himself first -- he asks the resident a litany of questions over the patient's open abdomen (what are the side effects of AZT?, what are the chances that he'll get hepatitis if she has hepatitis?, etc.). Keep in mind that the patient is hearing all of this. So then he orders me to draw blood on the patient for new HIV & hepatitis tests. I ask if it can wait till we're out of the OR (since I'm supposed to be attending to the newborn AND have to do three more counts to make sure he hasn't left any instruments in the patient while he's busy worrying about himself) and he doesn't answer. So I go about my business until he stops me in the middle of an instrument count to order me to draw her blood for labs NOW. I explain that we're not supposed to stop in the middle of a count and he says he'll walk out of the OR if I don't draw her blood. I should have told him to go, but instead I threw him a look and stopped my count to draw her blood.
Never once did he offer his happy congratulations on the birth of this beautiful child. He never spoke to the patient again except to ask for her consent for an HIV test. The whole thing made me so sad.
My point, I guess, is not to have you pity me for having to follow this a-hole's orders, but rather to warn anyone out there who might not yet have met their OB's covering doctors. Sure, this patient picked the hunky young MD who gives his patients every chance in the book to deliver vaginally and is willing to put the time in to help her push to make it happen. It's not her fault that she had her baby on a Sunday and therefore got the dorky old doc with a self-aggrandizing attitude problem and a penchant for c-sections that allow him to be home for lunch.
Word to the wise. Ask the hard questions about what happens if you have your baby on a weekend or a holiday or during a week when your doc is pool-side in Cabo. And remember, it's probably not too late to switch to a midwife.
Wednesday, July 23, 2008
Wouldn't you like to be a hippie too?
I'll admit that I've always had a bit of a fringe streak. In high school, my skater friends called me "Grateful Kate" (though for the record there's nothing I hate more than jam bands, The Dead included). I never really embraced space dancing or tie dye, but I always tried to live gently and mindfully.
As an adult I've tried to walk the line between our urban reality & our farm fantasies and as a mom I'm trying to mind our family footprint.
Living in NYC there are a few things we have going for us from the start. We have access to awesome public transportation and we use it. Sure the subway can be maddening -- it seems always to be too hot or too cold, too smelly, too crowded & too slow -- but it makes this city work and is often the best/fastest/easiest way to get from point A to point B. I'll admit that I tend to avoid taking the stroller on the subway because it means I'll have to navigate stairs & locked gates, but I'm sure I'll get used to it. So yeah, we drive little & subway much.
We live in a small space. There is no space in our apartment that isn't used and used well. Yes I often long for modern conveniences like a dishwasher, garbage disposal, washer/dryer and would LOVE to have a coat closet, designated parking, a yard or space for a garden, and a second bathroom, but it feels good to live so small. I once had a friend visiting from Cali tell me that he loved my kitchen because it was organized so that everything was in arm's reach. I pointed out that my kitchen was so small that if it wasn't in arm's reach it was in the living room. The point is that I'm proud of how we use our space. We aren't afraid to reorganize so that we're making the most of what little we have.
Brooklyn is the height of neighborhood living. We could live our entire lives within a 15 block radius. Hospital, funeral home, clothing stores, food shops, book stores, five & dime, butcher, bakery -- you name it, we can walk to it. Because of this concentration of commerce, we can live our entire lives on the shoe leather express. Now you know why we splashed out for a fancy stroller. Keeping it in the hood is a great way to keep it green.
In terms of baby stuff we're trying to make green choices. G diapers instead of disposables (LOVE the flushable option -- no diaper stink in our house). Organic formula. We're planning to make as much baby food as we can (hopefully with locally grown organic produce from our CSA). We clean the house with baking soda & white vinegar (though we don't combine the two as that would turn cleaning day into a science fair). We buy organic & local when we can.
I think that's the point of all of this. We do what we can. Yes, we'd love to be canning the products of our garden and living off of its bounty all winter, but we have to come to grips with the fact that we don't have a garden to grow veggies in or a pantry in which to store its fruits. I'm not saying that we give ourselves a pass because we live in the city. I like to think that the benefits of the city and the concessions to city living tend to balance out.
My challenge to everyone is to do what you can. If we all did a little bit to "green up" our lives, the collective benefit would be great. Here are a few suggestions of little ways to make a big difference...
As an adult I've tried to walk the line between our urban reality & our farm fantasies and as a mom I'm trying to mind our family footprint.
Living in NYC there are a few things we have going for us from the start. We have access to awesome public transportation and we use it. Sure the subway can be maddening -- it seems always to be too hot or too cold, too smelly, too crowded & too slow -- but it makes this city work and is often the best/fastest/easiest way to get from point A to point B. I'll admit that I tend to avoid taking the stroller on the subway because it means I'll have to navigate stairs & locked gates, but I'm sure I'll get used to it. So yeah, we drive little & subway much.
We live in a small space. There is no space in our apartment that isn't used and used well. Yes I often long for modern conveniences like a dishwasher, garbage disposal, washer/dryer and would LOVE to have a coat closet, designated parking, a yard or space for a garden, and a second bathroom, but it feels good to live so small. I once had a friend visiting from Cali tell me that he loved my kitchen because it was organized so that everything was in arm's reach. I pointed out that my kitchen was so small that if it wasn't in arm's reach it was in the living room. The point is that I'm proud of how we use our space. We aren't afraid to reorganize so that we're making the most of what little we have.
Brooklyn is the height of neighborhood living. We could live our entire lives within a 15 block radius. Hospital, funeral home, clothing stores, food shops, book stores, five & dime, butcher, bakery -- you name it, we can walk to it. Because of this concentration of commerce, we can live our entire lives on the shoe leather express. Now you know why we splashed out for a fancy stroller. Keeping it in the hood is a great way to keep it green.
In terms of baby stuff we're trying to make green choices. G diapers instead of disposables (LOVE the flushable option -- no diaper stink in our house). Organic formula. We're planning to make as much baby food as we can (hopefully with locally grown organic produce from our CSA). We clean the house with baking soda & white vinegar (though we don't combine the two as that would turn cleaning day into a science fair). We buy organic & local when we can.
I think that's the point of all of this. We do what we can. Yes, we'd love to be canning the products of our garden and living off of its bounty all winter, but we have to come to grips with the fact that we don't have a garden to grow veggies in or a pantry in which to store its fruits. I'm not saying that we give ourselves a pass because we live in the city. I like to think that the benefits of the city and the concessions to city living tend to balance out.
My challenge to everyone is to do what you can. If we all did a little bit to "green up" our lives, the collective benefit would be great. Here are a few suggestions of little ways to make a big difference...
- Buy a stainless steel water bottle. Plastic is bad for the environment, but it's also bad for you. Drink your water from the tap (tap water is more tightly regulated than bottled water) out of a reusable metal bottle rather than buying plastic bottles of water.
- Replace your Comet with baking soda. You'll be amazed how well baking soda works to scour your sinks & tubs. And it's CHEAP.
- Walk more. Don't let me catch you moving your car around within a strip mall parking lot. If I can carry all of my everything up and down five flights of stairs, you can walk from Target to Bed Bath and Beyond.
Rainy Day Shopping
I call it the law of inverse reality. The less money I have, the more I shop. I am totally in the hole right now and yet I'm spending IK's nap cruising the internet rather than cleaning the bathroom, running the roomba, putting away the laundry, etc.
Here's what I have my eye on...
Here's what I have my eye on...
- G Diapers: IK's soon going to outgrow her small sized G's so we need to get some mediums. I keep seeing G diaper banner ads with all sorts of cool colors and prints, but they're not actually for sale on their website. I imagine that maybe they're selling down their current stock (which seems to be dwindling as many of the colors they do have are sold out in certain sizes) in anticipation of launching these new patterns, but come on people don't tease! You know how I feel about delaying gratification.
- Svan Highchair: Yes, you're right, IK's not eating solid food and she can't sit up yet, but the SVAN is on sale!
- Ecotobi Envirosax: Now I know I have PLENTY of canvas bags from professional conferences in which to carry my groceries, but damn, these are cute.
- Some sort of vintage or vintage looking locket that I can put IK's photo in to wear to work (Frau Von Schnellinger... I KNOW I'm a dork so you don't have to tell me).
- Baby food freezer containers: I'm trying to motivate to make some baby food out of this summer's bounty (AKA our CSA stuff that we can't manage to eat in a week). I have a food mill and a food processor, but I need some sort of container to freeze the food in. I could go low cost and get a couple of extra ice cube trays and a box of freezer bags (freeze the food into cube sized servings & then store the cubes in labeled freezer bags). Or, I could get something like these freeze and serve cups. Maybe I'll start with ice trays.
Saturday, July 19, 2008
Reality, crashing
Ever since IK was born, folks have been asking me if I like motherhood. I freaking love it. I mean what's not to love? You get to hang out with a baby who gets more and more interesting every day. You bask in the unconditional love. You spend early mornings snuggling her tiny bod & afternoons drinking iced tea in the park while she snoozes in the stroller. You watch the balance in your checking account dwindle to nothing.
So yeah, motherhood is great. Motherhood on maternity leave is totally awesome. And then there's working motherhood.
The last four months have flown by & it's time for me to go back to work. I'm really excited about it. I think it will be great for IK to spend some more quality time with her dad & I'm looking forward to having something to talk about other than her. OK, OK, so I'm freaking out a bit. I'm mostly nervous that I don't remember my job, but I'm sure it's like riding a bike (she said hopefully).
Which isn't to say that I don't get nauseous every time I think about tomorrow. I feel like the last 3.5 months has been "la-la motherhood" in which I got to spend all day every day with her. Now we're leaving fairy land and entering reality.
Wish me luck! Wish us all luck. I know she'll be fine & will have an awesome day with her dad... I just hope that I don't sob all the way to the subway.
So yeah, motherhood is great. Motherhood on maternity leave is totally awesome. And then there's working motherhood.
The last four months have flown by & it's time for me to go back to work. I'm really excited about it. I think it will be great for IK to spend some more quality time with her dad & I'm looking forward to having something to talk about other than her. OK, OK, so I'm freaking out a bit. I'm mostly nervous that I don't remember my job, but I'm sure it's like riding a bike (she said hopefully).
Which isn't to say that I don't get nauseous every time I think about tomorrow. I feel like the last 3.5 months has been "la-la motherhood" in which I got to spend all day every day with her. Now we're leaving fairy land and entering reality.
Wish me luck! Wish us all luck. I know she'll be fine & will have an awesome day with her dad... I just hope that I don't sob all the way to the subway.
Thursday, July 17, 2008
When cleaning house gets the better of me
We're going to this fancy evening wedding in Hollywood in August & I've had no luck finding something to wear. Post-preg lbs + huge boobs = nothing in my closet fits (I was trying all my dresses on back on the day that IK pooped on her bouncy chair). Add into the mix the state of my bank account in these waning days of my maternity leave and you see the problem.
I was mulling things over on the car ride back from Jersey yesterday when I had a stroke of genius. If I fit into the floor length black strapless boho chiffon number that I wore to my friend's wedding in Atlanta about five years ago, I could hack the hem off below the knee and it might actually look tres au courant. It has one of those unfinished hems anyway so I wouldn't even need to bother sewing it -- maybe just sneak a nail scissors into my clutch in case I noticed any stray threads on the way into the reception. Problem solved!
So today, I bided my time until Mr. Stewgler left for "work" (by which I mean that he's probably on his way to the apple store for an iphone) & topped of IK so she'd doze and then I dove into the nether regions of my closet.
And it's gone.
Believe me, I triple checked. I even looked on Mr's side in case I stashed it over there one day when its long-ass hem was getting in my way. Gone. I stood there stumped for a moment and then had a hazy vision of myself packing it carefully into a trash bag with a bunch of old college counselor clothes to take to the Goodwill.
Damn.
I was mulling things over on the car ride back from Jersey yesterday when I had a stroke of genius. If I fit into the floor length black strapless boho chiffon number that I wore to my friend's wedding in Atlanta about five years ago, I could hack the hem off below the knee and it might actually look tres au courant. It has one of those unfinished hems anyway so I wouldn't even need to bother sewing it -- maybe just sneak a nail scissors into my clutch in case I noticed any stray threads on the way into the reception. Problem solved!
So today, I bided my time until Mr. Stewgler left for "work" (by which I mean that he's probably on his way to the apple store for an iphone) & topped of IK so she'd doze and then I dove into the nether regions of my closet.
And it's gone.
Believe me, I triple checked. I even looked on Mr's side in case I stashed it over there one day when its long-ass hem was getting in my way. Gone. I stood there stumped for a moment and then had a hazy vision of myself packing it carefully into a trash bag with a bunch of old college counselor clothes to take to the Goodwill.
Damn.
Sunday, July 13, 2008
Sleeping Like a Baby
Recently Jen over at Surviving Wyoming sent me an article from Slate about "Ferberizing" your baby. It's gotten me thinking about baby sleep.
I should start out by saying that Baby Stewgler is good sleeper. She started sleeping 6-8 hours at a stretch when she was six weeks old and has been sleeping 11+ hours since she was about three months old. What can I say? She's an awesome baby. She's like a special emissary from the society for Irish Twins.
I won't pretend to be an expert on sleep because, frankly, I feel like I got lucky. I feel a little guilty even bringing it up. I felt similarly guilty one day in mom/baby yoga class when all of the other mom's started bemoaning their 6, 12 & 18 month old babies' sleep patterns, or lack thereof. I had the youngest baby in the class by far & she was clearly the best sleeper. I can't necessarily take credit for it, but I'll share our thoughts about sleep in the hopes that maybe our ideas might help the sleepless.
First let's start with Jen's question... No, we're not "ferberizing" Baby Stewgler. Which is to say that I never read his book & don't know the specific tenets of his sleep plan. I saw that Ben Stiller movie, but that's pretty much all I know about Ferber.
My main advice is this... talk with your partner about your plans for baby sleep before he/she's born. I'm convinced that WHATEVER sleep plan you implement you're better off if you get it going from day one. Co-sleep or crib, cry it out or rock 'em to sleep -- you should have a plan in advance.
So here's what we decided in our house...
1. IK sleeps in a crib. It's in a different room (OK, it's a closet -- in NYC you have to be creative). I think it's good for her to have her own space & we appreciate that we have our own space too. My sense (from vacations and visits to Nana's where we have IK in our room) is that sharing a room makes you hyper-reactive to the baby's mid-night noises. There have been many times when I've heard IK make noises on the monitor & I've found that many times she quickly goes back to sleep on her own. I guess my point is that you should ignore the first few noises. If she's really awake you'll know it soon enough. If she's not really waking up, you're better off if you let her drift off again rather than reaching for her and waking her up for sure.
2. IK will sometimes cry it out. When we put her to bed we are sure that all of her needs are met -- clean diaper, tight swaddle, full belly, binky, etc. If she cries, we'll sometimes give her binky back a few times, but we're also not afraid to let her cry. When we put her down, we set a timer for 15 minutes. If, after 15 minutes, she's still crying we go back and reassess. We might feed her a little more or hold her for a little while. In her life, she has only ONCE cried for more than 15 minutes. These days she cries for about five minutes. Sure, even those five are torture and when she was only days old it was heart breaking to hear her cry, but I'm glad we did it. I recommend setting the timer because each minute of crying feels like a lifetime & having a running timer helps you keep it all in perspective. Credit for the timer idea is due to IK's Nonna. Worked for the last generation & seems to be working for this one.
3. We're not afraid to depend on crutches. IK's Nonna sent her a "Sleep Sheep" which we set to ocean noises -- in the early days the white noise really helped (people also recommended running the vacuum or setting a radio to static). We also have a music box which works as a distraction technique when she's crying -- she seems to like to listen to it and will often quiet down so she can hear it. She loves watching her mobile and will often drift off while mesmerized. The swaddle is key -- even at 3.5 months old we still swaddle her at night. We'll stop doing it when she seems like she's fighting it, but even now she seems to relax once she's swaddled. I think many of these crutches turn into sleep cues & she's learning that crib + swaddle + mobile + music + ocean noise = bed.
4. Feeding. As I've mentioned before, because of breast milk production problems on my part IK has been getting some formula from the beginning. I think it's helped her sleep because it seems to stick to her ribs a bit more than breast milk. Our pediatrician agrees. She was telling me that she'd noticed that during her residency when she worked at a hospital clinic with a population that largely bottle fed their babies she rarely got questions about sleep. Now that she's in private practice in a tony Brooklyn neighborhood where her patients are predominantly breast fed she spends all day talking about sleep problems. An unscientific study, no doubt, but interesting. According to my mom (who's a family NP) babies over nine pounds don't "need" mid-night feedings -- meaning that they have sufficient reserves to get through the night without eating. IK's Nana also recommends that you don't make the mid-night feedings a party -- turn on as few lights as possible, don't turn on the TV, don't make it fun for the baby or else they might start waking up just because they're looking forward to seeing you and the fiesta you create for them.
5. Remember that you can't will your baby to sleep. In IK's first few days at home I made the mistake of thinking that she wouldn't fall asleep if I didn't rock her. She was clearly tired but as much as I rocked her she just wouldn't quiet down and sleep. That's when Mr. Stewgler passed on his mom's advice that we should meet all of her needs & then feel OK about putting her down. I do believe that babies need to learn how to fall asleep on their own. This means that they need to be AWAKE when you put them in their bed. Sometimes it feels like tough love, but I have every confidence that it will pay dividends down the line. In fact, it already seems to be paying off.
So, yeah, the thing about Ferber, or any of these sleep specialists is that they pretend that all babies are the same. They're not. I know that & you know that. You just have to make a plan, try to stick to it & hope for the best. When IK's dad and I talked about baby sleep, we tried to imagine what we'll hope bedtime will be like when she's, say, three years old. We want her to have a consistent routine -- bath before bed, story time before bed, bed time at a vaguely regular time each night & then that's it, she's in her bed drifting off to la la land with no great battles. Because that's what we're working toward, her infant sleep routine is largely the same. Think of it this way, you don't want your ten year old in your bed or needing to be rocked to sleep at his first sleep-over.
I don't know how it will work out over time. She's such a good baby that we know we're going to have the pay the piper eventually -- maybe she'll rebel and announce that she wants to be a tri-delt in college, maybe her younger sibling(s) will be a total disaster. In the mean time we're working to create a routine so that she knows what to expect from us & as a benefit we're learning what to expect from her. It's proven to be a great balance.
I should start out by saying that Baby Stewgler is good sleeper. She started sleeping 6-8 hours at a stretch when she was six weeks old and has been sleeping 11+ hours since she was about three months old. What can I say? She's an awesome baby. She's like a special emissary from the society for Irish Twins.
I won't pretend to be an expert on sleep because, frankly, I feel like I got lucky. I feel a little guilty even bringing it up. I felt similarly guilty one day in mom/baby yoga class when all of the other mom's started bemoaning their 6, 12 & 18 month old babies' sleep patterns, or lack thereof. I had the youngest baby in the class by far & she was clearly the best sleeper. I can't necessarily take credit for it, but I'll share our thoughts about sleep in the hopes that maybe our ideas might help the sleepless.
First let's start with Jen's question... No, we're not "ferberizing" Baby Stewgler. Which is to say that I never read his book & don't know the specific tenets of his sleep plan. I saw that Ben Stiller movie, but that's pretty much all I know about Ferber.
My main advice is this... talk with your partner about your plans for baby sleep before he/she's born. I'm convinced that WHATEVER sleep plan you implement you're better off if you get it going from day one. Co-sleep or crib, cry it out or rock 'em to sleep -- you should have a plan in advance.
So here's what we decided in our house...
1. IK sleeps in a crib. It's in a different room (OK, it's a closet -- in NYC you have to be creative). I think it's good for her to have her own space & we appreciate that we have our own space too. My sense (from vacations and visits to Nana's where we have IK in our room) is that sharing a room makes you hyper-reactive to the baby's mid-night noises. There have been many times when I've heard IK make noises on the monitor & I've found that many times she quickly goes back to sleep on her own. I guess my point is that you should ignore the first few noises. If she's really awake you'll know it soon enough. If she's not really waking up, you're better off if you let her drift off again rather than reaching for her and waking her up for sure.
2. IK will sometimes cry it out. When we put her to bed we are sure that all of her needs are met -- clean diaper, tight swaddle, full belly, binky, etc. If she cries, we'll sometimes give her binky back a few times, but we're also not afraid to let her cry. When we put her down, we set a timer for 15 minutes. If, after 15 minutes, she's still crying we go back and reassess. We might feed her a little more or hold her for a little while. In her life, she has only ONCE cried for more than 15 minutes. These days she cries for about five minutes. Sure, even those five are torture and when she was only days old it was heart breaking to hear her cry, but I'm glad we did it. I recommend setting the timer because each minute of crying feels like a lifetime & having a running timer helps you keep it all in perspective. Credit for the timer idea is due to IK's Nonna. Worked for the last generation & seems to be working for this one.
3. We're not afraid to depend on crutches. IK's Nonna sent her a "Sleep Sheep" which we set to ocean noises -- in the early days the white noise really helped (people also recommended running the vacuum or setting a radio to static). We also have a music box which works as a distraction technique when she's crying -- she seems to like to listen to it and will often quiet down so she can hear it. She loves watching her mobile and will often drift off while mesmerized. The swaddle is key -- even at 3.5 months old we still swaddle her at night. We'll stop doing it when she seems like she's fighting it, but even now she seems to relax once she's swaddled. I think many of these crutches turn into sleep cues & she's learning that crib + swaddle + mobile + music + ocean noise = bed.
4. Feeding. As I've mentioned before, because of breast milk production problems on my part IK has been getting some formula from the beginning. I think it's helped her sleep because it seems to stick to her ribs a bit more than breast milk. Our pediatrician agrees. She was telling me that she'd noticed that during her residency when she worked at a hospital clinic with a population that largely bottle fed their babies she rarely got questions about sleep. Now that she's in private practice in a tony Brooklyn neighborhood where her patients are predominantly breast fed she spends all day talking about sleep problems. An unscientific study, no doubt, but interesting. According to my mom (who's a family NP) babies over nine pounds don't "need" mid-night feedings -- meaning that they have sufficient reserves to get through the night without eating. IK's Nana also recommends that you don't make the mid-night feedings a party -- turn on as few lights as possible, don't turn on the TV, don't make it fun for the baby or else they might start waking up just because they're looking forward to seeing you and the fiesta you create for them.
5. Remember that you can't will your baby to sleep. In IK's first few days at home I made the mistake of thinking that she wouldn't fall asleep if I didn't rock her. She was clearly tired but as much as I rocked her she just wouldn't quiet down and sleep. That's when Mr. Stewgler passed on his mom's advice that we should meet all of her needs & then feel OK about putting her down. I do believe that babies need to learn how to fall asleep on their own. This means that they need to be AWAKE when you put them in their bed. Sometimes it feels like tough love, but I have every confidence that it will pay dividends down the line. In fact, it already seems to be paying off.
So, yeah, the thing about Ferber, or any of these sleep specialists is that they pretend that all babies are the same. They're not. I know that & you know that. You just have to make a plan, try to stick to it & hope for the best. When IK's dad and I talked about baby sleep, we tried to imagine what we'll hope bedtime will be like when she's, say, three years old. We want her to have a consistent routine -- bath before bed, story time before bed, bed time at a vaguely regular time each night & then that's it, she's in her bed drifting off to la la land with no great battles. Because that's what we're working toward, her infant sleep routine is largely the same. Think of it this way, you don't want your ten year old in your bed or needing to be rocked to sleep at his first sleep-over.
I don't know how it will work out over time. She's such a good baby that we know we're going to have the pay the piper eventually -- maybe she'll rebel and announce that she wants to be a tri-delt in college, maybe her younger sibling(s) will be a total disaster. In the mean time we're working to create a routine so that she knows what to expect from us & as a benefit we're learning what to expect from her. It's proven to be a great balance.
On vacation
Hey peeps --
Sorry I've been totally MIA lately. Thanks to the largess of IK's Nana (who paid for a big family beach house in Sea Isle City) & her Uncle Steve (who always invites us to his dad's incredible place in Brigantine when he comes up from Brazil) we've spent the last few weeks at the beautiful and exotic Jersey shore. That's the beach in NJ for those of you in Cali who've never actualy heard anyone use the word "shore" in a sentence. We've been lounging around & eating ice cream & generally living the good life. IK's dad is surfing the ground swell kicked up by hurricane Bertha. IK got to spend some QT with her cousins -- a.k.a. "the entertainment committee". I actually managed to take a run -- my first real postpartum cardio. Of course the same day I burned my shoulders so bad that I have yet to put my sports bra back on. Oh well.
But anyway, for all six of you who read this, sorry there's been some radio silence.
Sorry I've been totally MIA lately. Thanks to the largess of IK's Nana (who paid for a big family beach house in Sea Isle City) & her Uncle Steve (who always invites us to his dad's incredible place in Brigantine when he comes up from Brazil) we've spent the last few weeks at the beautiful and exotic Jersey shore. That's the beach in NJ for those of you in Cali who've never actualy heard anyone use the word "shore" in a sentence. We've been lounging around & eating ice cream & generally living the good life. IK's dad is surfing the ground swell kicked up by hurricane Bertha. IK got to spend some QT with her cousins -- a.k.a. "the entertainment committee". I actually managed to take a run -- my first real postpartum cardio. Of course the same day I burned my shoulders so bad that I have yet to put my sports bra back on. Oh well.
But anyway, for all six of you who read this, sorry there's been some radio silence.
Thursday, June 26, 2008
Traveling with baby
We just put Baby Stewgler's west coast grandparents on a plane for home after a five day visit. We love playing tourist when they visit and this trip was no exception -- a Circle Line cruise around Manhattan, a walk across the Brooklyn Bridge (happy 125th BB!), a lovely afternoon in the NY Botanical Gardens in the Bronx. Traveling by boat, train & automobile with the bambina adds an extra little wrinkle, but is certainly not a reason to stay home and miss the fun. Here are a few things that made our daily junkets a little easier.
- A good stroller: I did massive stroller research during my pregnancy and finally settled on the Micralite Toro. I'll be the first to admit that it isn't perfect (why does it take only one hand to fold it closed but takes two to unfold it? And why don't they tell you that on the website?), but it comes close. Mr. Stewgler is a major stroller hater and even he admitted that our travels around the city were aided by the Toro. Big air-filled wheels make it easy to get up over curbs & drivable over cobblestones and bumpy Brooklyn sidewalks. It's light enough to get it up and down subway stairs. And it's damn cool looking.
- Formula "sticks": These pre-measured packets of formula make on-the-go bottle mixing a breeze. I'd pack the diaper bag with a couple of bottles filled with the correct amount of water and when we needed one it would only take a few seconds to add the formula powder. No fuss, no muss.
- Skip-Hop Pronto diaper zone: It's just good to have all your diapering necessities well organized and well contained within your diaper bag. Added bonus to have a cool-looking pad to put between the little one's naked bum and, say, the bird poop encrusted benches at the botanical gardens.
- Extra hands: Grandparents are the greatest!
Saturday, June 21, 2008
Ask Nurse Stewgler: The thing about birth plans
These days, the question you hear most as a pregnant woman is, "Have you written your birth plan?". Sure, folks still ask about your due date and strangers on the street will inquire about the gender of your unborn one, but those old school inquiries seem to take a back seat to the birth plan.
I'm sure my sense of this is skewed. I work at a busy Manhattan hospital where the well-heeled patients check their blackberries between contractions. They've planned every aspect of their lives to the Nth degree -- of course they'd turn up with a birth plan. As we gain more and more control over our fertility, we seek more and more to control the birth experience too. It all goes hand and hand, I guess.
I really appreciate the spirit in which the birth plan is intended. I feel strongly that if more people exerted demands over their health care, our system would serve us all better. It is dangerous to put yourself lock stock and barrel into the hands of your health care provider -- we should never abdicate that much control over our own bodies. A birth plan is evidence that this person has done research about what to expect from her hospital stay -- a great sign!
But here's what I've come to know about birth plans -- they almost always come to naught. The folks who arrive on L & D with a three page type-written list of all of the medical interventions they refuse to consider, seem to always end up in hysterics when the reality of birth starts to diverge from their plan. It's so sad to see those folks wasting emotion and energy lamenting the loss of their birth plan.
I tell people that the experience of childbirth is a lot like parenting. You can organize and plan all you want, but when the kid has a melt down in the middle of the perfect day you planned you'll just have to roll with the punches and work around it. Childbirth is the same way.
When I'm at work, I take birth plans seriously. I make time to read them and talk about them with the patients. I ask questions about the motivation behind each request or decision and I try, when necessary, to point out places where their requests run afoul of hospital policy or state mandates for patient care. Mostly though I try to prepare folks for possible forks in the road right from the start.
For example, a common statement on your average birth plan is this, "I want the baby placed immediately on my chest with as much skin to skin contact as possible." No problem. That's pretty much standard operating procedure -- even the seriously old school docs will put the baby directly on mom's chest. But, if in the midst of labor we find that there's meconium in the amniotic fluid, the baby will first be taken to the warmer first to have his airway suctioned out (if the baby aspirates meconium it can lead, in some cases, to pneumonia so we want to get as much out as possible). I think it helps to explain this early on so if it happens folks are prepared.
I think this is the best possible scenario -- an educated consumer and a health care provider having a dialog. If everyone considered their birth plan as nothing more than a conversation starter, we'd be OK. Things go wrong when folks expect that their birth plan is a set of demands etched in marble.
Before I became a L & D nurse I took part in a three day doula training course just to get some experience in the non-medical aspects of birth. On day two we broke into pairs to go through a birth preferences exercise. We were given about 20 cards -- each one had an option on either side of the card. They said things like hospital birth/home birth, pain medication/unmedicated birth, access to food & drink during labor/ice chips only during labor. There was even a card that said "Healthy mommy & baby" (there was nothing on the other side of that one).
The idea was that you would ask the pregnant woman to go through and turn each card to the side that reflected her preferences for the birth experience that she imagined. Once she'd made her choices, you'd ask her to flip five cards over to the other side. There were plenty of things that seemed like no big deal -- you could flip over five without "losing" much. Then, you'd ask her to flip over five more, and then three more after that. By the end she'd be left with her four or five absolute stone wall resolutions for her birth experience.
That's reality folks. Even if you're CERTAIN that you won't consider anything other than the details on your birth plan, you might change your mind when the going gets tough. Every person is different and every birth is different -- there's just no predicting how it's going to go.
So by all means, write your birth plan. Talk about it to strangers on the bus. Have the small of your back tattooed with "NO epidural". But when you do, please save yourself and your providers some grief by softening your language -- "I would prefer..." rather than "I refuse...". Once it's written, ask yourself if it sounds like a dictum that might court ire from your providers or a polite set of talking points that will inspire collaboration. Remember that the medical establishment is not out to thwart your ideals, they work hard to see that you are happy with your care. But in the end, they care only that mom and baby are healthy.
So remember that you can't control a force of nature. Be prepared to roll with the punches. Keep in mind that when it's over no one on the subway will ask how close your actual birth experience came to your birth plan. They will ask how you feel and they will coo over your gorgeous little one. And that, my friends, are the only two things that matter.
I'm sure my sense of this is skewed. I work at a busy Manhattan hospital where the well-heeled patients check their blackberries between contractions. They've planned every aspect of their lives to the Nth degree -- of course they'd turn up with a birth plan. As we gain more and more control over our fertility, we seek more and more to control the birth experience too. It all goes hand and hand, I guess.
I really appreciate the spirit in which the birth plan is intended. I feel strongly that if more people exerted demands over their health care, our system would serve us all better. It is dangerous to put yourself lock stock and barrel into the hands of your health care provider -- we should never abdicate that much control over our own bodies. A birth plan is evidence that this person has done research about what to expect from her hospital stay -- a great sign!
But here's what I've come to know about birth plans -- they almost always come to naught. The folks who arrive on L & D with a three page type-written list of all of the medical interventions they refuse to consider, seem to always end up in hysterics when the reality of birth starts to diverge from their plan. It's so sad to see those folks wasting emotion and energy lamenting the loss of their birth plan.
I tell people that the experience of childbirth is a lot like parenting. You can organize and plan all you want, but when the kid has a melt down in the middle of the perfect day you planned you'll just have to roll with the punches and work around it. Childbirth is the same way.
When I'm at work, I take birth plans seriously. I make time to read them and talk about them with the patients. I ask questions about the motivation behind each request or decision and I try, when necessary, to point out places where their requests run afoul of hospital policy or state mandates for patient care. Mostly though I try to prepare folks for possible forks in the road right from the start.
For example, a common statement on your average birth plan is this, "I want the baby placed immediately on my chest with as much skin to skin contact as possible." No problem. That's pretty much standard operating procedure -- even the seriously old school docs will put the baby directly on mom's chest. But, if in the midst of labor we find that there's meconium in the amniotic fluid, the baby will first be taken to the warmer first to have his airway suctioned out (if the baby aspirates meconium it can lead, in some cases, to pneumonia so we want to get as much out as possible). I think it helps to explain this early on so if it happens folks are prepared.
I think this is the best possible scenario -- an educated consumer and a health care provider having a dialog. If everyone considered their birth plan as nothing more than a conversation starter, we'd be OK. Things go wrong when folks expect that their birth plan is a set of demands etched in marble.
Before I became a L & D nurse I took part in a three day doula training course just to get some experience in the non-medical aspects of birth. On day two we broke into pairs to go through a birth preferences exercise. We were given about 20 cards -- each one had an option on either side of the card. They said things like hospital birth/home birth, pain medication/unmedicated birth, access to food & drink during labor/ice chips only during labor. There was even a card that said "Healthy mommy & baby" (there was nothing on the other side of that one).
The idea was that you would ask the pregnant woman to go through and turn each card to the side that reflected her preferences for the birth experience that she imagined. Once she'd made her choices, you'd ask her to flip five cards over to the other side. There were plenty of things that seemed like no big deal -- you could flip over five without "losing" much. Then, you'd ask her to flip over five more, and then three more after that. By the end she'd be left with her four or five absolute stone wall resolutions for her birth experience.
That's reality folks. Even if you're CERTAIN that you won't consider anything other than the details on your birth plan, you might change your mind when the going gets tough. Every person is different and every birth is different -- there's just no predicting how it's going to go.
So by all means, write your birth plan. Talk about it to strangers on the bus. Have the small of your back tattooed with "NO epidural". But when you do, please save yourself and your providers some grief by softening your language -- "I would prefer..." rather than "I refuse...". Once it's written, ask yourself if it sounds like a dictum that might court ire from your providers or a polite set of talking points that will inspire collaboration. Remember that the medical establishment is not out to thwart your ideals, they work hard to see that you are happy with your care. But in the end, they care only that mom and baby are healthy.
So remember that you can't control a force of nature. Be prepared to roll with the punches. Keep in mind that when it's over no one on the subway will ask how close your actual birth experience came to your birth plan. They will ask how you feel and they will coo over your gorgeous little one. And that, my friends, are the only two things that matter.
Wednesday, June 18, 2008
Ask Nurse Stewgler: No, you didn't pee your pants
I want to use this blog to offer insights from my job as a L&D nurse in addition to my job as a mom. Perhaps I'll add a weekly post to that effect. If you have a burning question for me, something you've ALWAYS wanted to know about pregnancy, labor, delivery, hospitals, etc. please let me know. Please be aware that the information or advice presented here is not intended as a substitute for medical care or information from your own provider.
Did my water just break?
Ahh, the eternal question and, you'd think, a simple question to answer. Why then are labor and delivery triage areas filled to the brim with women who think their water broke? Let's just say that, it rarely happens in life the way it happens in the movies.
First, let's talk about amniotic fluid. Amniotic fluid has two sources -- in the early months of your pregnancy your body produces the fluid and in the later months it created as a by product of the fetus' kidney function (meaning it's fetal urine). It is contained within a membranous sac inside your uterus -- this sac is called the "amnion" (hence the name).
The fluid is crucially important -- it cushions the fetus, cushions you against the kicks & punches of fetal movement, contributes to the growth and development of the fetus (it contains nutrients key to early development), and most importantly it aids in fetal lung development. As your fetus matures, he or she "breathes" in amniotic fluid which prepares the fetus' diaphragmatic muscles for the work of actual breathing upon birth. In addition, the fetus will ingest amniotic fluid -- you'll see the byproduct of this in the baby's early poops called meconium.
OK, so now that we know what we're dealing with, let's get back to the question at hand. Did your water break?
Let's set up an ideal scenario... you're 39.5 weeks pregnant, you've been contracting every five minutes for the last three hours, you're wearing waterproof pants while you bake a last minute batch of brownies to hand out to the nurses at the hospital (hey, I said ideal, OK)... when all of the sudden you get an unmistakable GUSH of fluid. It will feel warm, wet (duh) & perhaps slightly slimy. Get used to it because you'll be leaking fluid from now until you deliver.
Now what? OK, let's be realistic... the first thing you'll do is mop up the situation. Literally. Change your clothes, put on a pad (or three), call your partner to clean up any puddles, or change the sheets. As you clean up, you need to make note of one REALLY IMPORTANT detail. WHAT COLOR IS THE FLUID? Amniotic fluid might be totally clear, it might be blood tinged, it might be yellow or it might be green. It may smell briny, but it shouldn't be foul smelling.
Next, you need to call your provider. Your conversation is going to go something like this... You: "Hi doctor/midwife. Sorry to wake you. Uhh, I think my water just broke." Doctor/midwife: "OK. What color was the fluid?" Ok, Ok, so they might first ask you when it happened or whether you felt a gush or a trickle, but trust me they're going to want to know about the color.
Why do they care about the color? Primarily, they're trying to find out whether the baby has passed any meconium in utero. It's a fairly common occurrence -- especially in babies that are past their due date. Meconium in the amniotic fluid is sometimes an indication of stress on the fetus and may mean that your labor & delivery will be closely monitored (we can cover that in a future post). Be aware that meconium in the amniotic fluid can cause subtle color changes -- it's best to compare the color of the fluid against something white like toilet paper or a maxi-pad.
Your provider will also want to know if you see blood in the fluid. It's totally normal for "clear" fluid to have flecks of blood in it or to be very, very pale pink. If the fluid is dark pink or red your provider needs to know ASAP. It could be a sign of a placental abruption which is a medical emergency.
But what if you don't get a gush?
First, try to rule out peeing your pants. Does the fluid smell like urine? Is it yellow (but remember, this could be amniotic fluid stained with meconium, so don't be fooled)? Did you just sneeze or cough (stress incontinence is pretty common in late pregnancy because there's so much pressure on your bladder)? No, no, and no? Well, you may be in business.
If you have any question as to whether or not you're "ruptured", you should call your provider. They may ask you to come to the hospital or to their office to be evaluated. You may undergo a speculum exam during which they'll test a sample of the fluid with a nitrazine swab (the pH of amniotic fluid will turn the nitrazine paper/swab blue).
Because any break in your amnion could be an entry point for infection you should be careful to to put anything in your vagina if you suspect that your water is broken -- no sex, no tampons, no fingers, no douches and don't take a tub bath (a shower is OK). And because infection is a risk once your membranes have ruptured, your provider will likely want to deliver your baby within the next 24-48 hours.
Which brings me to my final point... ruptured membranes might happen because you've been in good labor for a while, but it might also happen before you ever experience a contraction. It might bring on contractions or make existing contractions WAY more intense. In any case, breaking your water means GAME ON.
So get those brownies out of the oven, you're having a baby.
Did my water just break?
Ahh, the eternal question and, you'd think, a simple question to answer. Why then are labor and delivery triage areas filled to the brim with women who think their water broke? Let's just say that, it rarely happens in life the way it happens in the movies.
First, let's talk about amniotic fluid. Amniotic fluid has two sources -- in the early months of your pregnancy your body produces the fluid and in the later months it created as a by product of the fetus' kidney function (meaning it's fetal urine). It is contained within a membranous sac inside your uterus -- this sac is called the "amnion" (hence the name).
The fluid is crucially important -- it cushions the fetus, cushions you against the kicks & punches of fetal movement, contributes to the growth and development of the fetus (it contains nutrients key to early development), and most importantly it aids in fetal lung development. As your fetus matures, he or she "breathes" in amniotic fluid which prepares the fetus' diaphragmatic muscles for the work of actual breathing upon birth. In addition, the fetus will ingest amniotic fluid -- you'll see the byproduct of this in the baby's early poops called meconium.
OK, so now that we know what we're dealing with, let's get back to the question at hand. Did your water break?
Let's set up an ideal scenario... you're 39.5 weeks pregnant, you've been contracting every five minutes for the last three hours, you're wearing waterproof pants while you bake a last minute batch of brownies to hand out to the nurses at the hospital (hey, I said ideal, OK)... when all of the sudden you get an unmistakable GUSH of fluid. It will feel warm, wet (duh) & perhaps slightly slimy. Get used to it because you'll be leaking fluid from now until you deliver.
Now what? OK, let's be realistic... the first thing you'll do is mop up the situation. Literally. Change your clothes, put on a pad (or three), call your partner to clean up any puddles, or change the sheets. As you clean up, you need to make note of one REALLY IMPORTANT detail. WHAT COLOR IS THE FLUID? Amniotic fluid might be totally clear, it might be blood tinged, it might be yellow or it might be green. It may smell briny, but it shouldn't be foul smelling.
Next, you need to call your provider. Your conversation is going to go something like this... You: "Hi doctor/midwife. Sorry to wake you. Uhh, I think my water just broke." Doctor/midwife: "OK. What color was the fluid?" Ok, Ok, so they might first ask you when it happened or whether you felt a gush or a trickle, but trust me they're going to want to know about the color.
Why do they care about the color? Primarily, they're trying to find out whether the baby has passed any meconium in utero. It's a fairly common occurrence -- especially in babies that are past their due date. Meconium in the amniotic fluid is sometimes an indication of stress on the fetus and may mean that your labor & delivery will be closely monitored (we can cover that in a future post). Be aware that meconium in the amniotic fluid can cause subtle color changes -- it's best to compare the color of the fluid against something white like toilet paper or a maxi-pad.
Your provider will also want to know if you see blood in the fluid. It's totally normal for "clear" fluid to have flecks of blood in it or to be very, very pale pink. If the fluid is dark pink or red your provider needs to know ASAP. It could be a sign of a placental abruption which is a medical emergency.
But what if you don't get a gush?
First, try to rule out peeing your pants. Does the fluid smell like urine? Is it yellow (but remember, this could be amniotic fluid stained with meconium, so don't be fooled)? Did you just sneeze or cough (stress incontinence is pretty common in late pregnancy because there's so much pressure on your bladder)? No, no, and no? Well, you may be in business.
If you have any question as to whether or not you're "ruptured", you should call your provider. They may ask you to come to the hospital or to their office to be evaluated. You may undergo a speculum exam during which they'll test a sample of the fluid with a nitrazine swab (the pH of amniotic fluid will turn the nitrazine paper/swab blue).
Because any break in your amnion could be an entry point for infection you should be careful to to put anything in your vagina if you suspect that your water is broken -- no sex, no tampons, no fingers, no douches and don't take a tub bath (a shower is OK). And because infection is a risk once your membranes have ruptured, your provider will likely want to deliver your baby within the next 24-48 hours.
Which brings me to my final point... ruptured membranes might happen because you've been in good labor for a while, but it might also happen before you ever experience a contraction. It might bring on contractions or make existing contractions WAY more intense. In any case, breaking your water means GAME ON.
So get those brownies out of the oven, you're having a baby.
Tuesday, June 17, 2008
One for the Road
We're going to be spending a couple of weeks on the beach this summer -- one at the Jersey shore with my family and one in SoCal with Mr. Stewgler's family. So we're packing up the surfboards and the sunscreen and heading for the sand. Sometimes the best thing about living in New York is seeing the skyline in your rear-view mirror.
These will be our first vacations with the bambina so there are a few things we need to work out. Sleeping arrangements have proven a cinch -- for Jersey we borrowed a pack-n-play & the Cali rental can provide a crib. We'll make room for the fancy stroller when we pack the car for NJ & we're hoping that one of the west coast relatives can loan us a stroller since we don't want to bring ours on the plane (we borrowed an umbrella stroller just in case). The biggest issue is proving to be all of the food paraphernalia.
In the grand pro/con list of bottle vs. breast feeding, the big con is bottle prep. Sure, "breast is best" but the real reason you should breast feed is because preparing bottles is a huge pain in the ass. You have to wash them and boil them and prepare boiled water to fill them with. Oh, and breast milk... it's free, whereas formula costs $25-30 a can (which lasts a week).
So far, we've had two scenarios when we've left town. 1. We've gone to visit my parents where there's this amazing thing called the dishwasher (and a grandmother) that does the washing and sterilizing for you. 2. We've gone to a wedding in the Catskills where we didn't have access to anything but a bed and a bathroom. For the former, we just took all of our bottle stuff along. For the latter, we bought pre-filled, no-refrigeration-needed bottles and the lousy nipples that fit on them.
I'm feeling like these beach vacations will test my bottle skills. In NYC, we own seven glass bottles (Dr. Brown's and Born Free) -- and we're constantly juggling the nipples, rings & vent parts that go with them. Yes we'll have a dishwasher in our beach rentals, but do I really want to cart all of this crap to California?
So here are my questions for all of the moms out there. How do you handle bottle feeding on the road? Any thoughts about Playtex nursers as a possible work-around?
Help!
These will be our first vacations with the bambina so there are a few things we need to work out. Sleeping arrangements have proven a cinch -- for Jersey we borrowed a pack-n-play & the Cali rental can provide a crib. We'll make room for the fancy stroller when we pack the car for NJ & we're hoping that one of the west coast relatives can loan us a stroller since we don't want to bring ours on the plane (we borrowed an umbrella stroller just in case). The biggest issue is proving to be all of the food paraphernalia.
In the grand pro/con list of bottle vs. breast feeding, the big con is bottle prep. Sure, "breast is best" but the real reason you should breast feed is because preparing bottles is a huge pain in the ass. You have to wash them and boil them and prepare boiled water to fill them with. Oh, and breast milk... it's free, whereas formula costs $25-30 a can (which lasts a week).
So far, we've had two scenarios when we've left town. 1. We've gone to visit my parents where there's this amazing thing called the dishwasher (and a grandmother) that does the washing and sterilizing for you. 2. We've gone to a wedding in the Catskills where we didn't have access to anything but a bed and a bathroom. For the former, we just took all of our bottle stuff along. For the latter, we bought pre-filled, no-refrigeration-needed bottles and the lousy nipples that fit on them.
I'm feeling like these beach vacations will test my bottle skills. In NYC, we own seven glass bottles (Dr. Brown's and Born Free) -- and we're constantly juggling the nipples, rings & vent parts that go with them. Yes we'll have a dishwasher in our beach rentals, but do I really want to cart all of this crap to California?
So here are my questions for all of the moms out there. How do you handle bottle feeding on the road? Any thoughts about Playtex nursers as a possible work-around?
Help!
Monday, June 16, 2008
Going Live
It seems my little caprice has been discovered. I've been quietly writing this blog while the baby naps, but I hadn't really worked up the guts to tell anyone about it. Now I come to find out that my college roommate has a blog too and in her first post she linked to mine! I'm still not sure how she found it -- I've always figured that my name was too common to google with any success -- but now that I'm out to her (Hey shug! How's Jackson Hole?) I figure I should be out to the rest of you.
So here it is... I have a blog. I'm going to try to make it more than just a "mommy blog" but I don't have much else going in my life right now so you'll have to forgive if these early posts are all baby all the time. I have some more interesting posts planned, but if you want to find out my ideas you'll just have to bookmark me & check back.
So here it is... I have a blog. I'm going to try to make it more than just a "mommy blog" but I don't have much else going in my life right now so you'll have to forgive if these early posts are all baby all the time. I have some more interesting posts planned, but if you want to find out my ideas you'll just have to bookmark me & check back.
There's no place to sit!
Well, we've survived our first little parenting hiccough. Yesterday at about noon, Baby Stewgler had a bit of a blow out. I'm not sure how long she was sitting in a poo diaper -- I was busy trying on clothes that no longer fit me while she was (I thought) asleep. By the time it was all said and done, we'd made a mess of her, me, and, most notably, the bouncy chair.
Now I've taken some derision of late for the amount of time that my child spends in said chair. It seems that every time I send a photo to my girls, she's sitting in it. I could try to defend myself and point out that it's tough to hold her in my lap and snap a focused photo at the same time or mention that she really likes it or insist that it makes a spectacular backdrop, but I absorbed the jab and its accompanying grains of salt. It's true, she spends some serious QT in that chair.
Never was this more clear to me than the last 24 hours when we had no chair to put her in. Because we have no washer & dryer in our fifth floor walk up, I do a fair bit of hand washing in the bathroom sink. It's really no sweat -- the bouncy chair cover was clean in a jiffy, but because my forearm wrings don't quite measure up to a spin cycle and because we're in full summer mode with 80%+ humidity, the cover took its sweet time getting dry.
I have to admit, I didn't realize how crucial the bouncy chair was to my parenting style. It seems I depend on the chair to keep her safe, content and contained while I eat, shower, wash dishes, make cappuccinos, check my email, do the crossword, etc. Lest you think I'm a terrible mother, let me point out that the best thing about the chair is its portability -- I can use one foot to keep it bouncing while I wash dishes in the kitchen and she's within arms reach while I'm in the shower should her binky become dislodged. OK, I still sound like a terrible mother. For the record, I've never left her in it while I walked the dog or gotten my eyebrows waxed. Redeemed?
My point is that having no chair threw me a curve. The last 24 hours felt a lot like the first 24 hours (minus the hemorrhoids, of course) -- I had to figure out how to do everything all over again.
And while I was trying to come up with someplace to put her while I made a smoothie ("wanna watch your swallow mobile in your crib again? Oh boy, oh boy!") I started thinking about July 20th. That's the day that I'm going to wake to my alarm clock instead of my baby, put on my scrubs and walk out the door without her, not to return until after my 12 hour shift.
I'm worried that day will be less like a curve ball and more like a curve planet -- for me, for her dad, and for her. I know we're all going to figure it out and settle into that new reality eventually, but if the lack of a chair necessitated a complete reinvention how will we handle the lack of me?
Now I've taken some derision of late for the amount of time that my child spends in said chair. It seems that every time I send a photo to my girls, she's sitting in it. I could try to defend myself and point out that it's tough to hold her in my lap and snap a focused photo at the same time or mention that she really likes it or insist that it makes a spectacular backdrop, but I absorbed the jab and its accompanying grains of salt. It's true, she spends some serious QT in that chair.
Never was this more clear to me than the last 24 hours when we had no chair to put her in. Because we have no washer & dryer in our fifth floor walk up, I do a fair bit of hand washing in the bathroom sink. It's really no sweat -- the bouncy chair cover was clean in a jiffy, but because my forearm wrings don't quite measure up to a spin cycle and because we're in full summer mode with 80%+ humidity, the cover took its sweet time getting dry.
I have to admit, I didn't realize how crucial the bouncy chair was to my parenting style. It seems I depend on the chair to keep her safe, content and contained while I eat, shower, wash dishes, make cappuccinos, check my email, do the crossword, etc. Lest you think I'm a terrible mother, let me point out that the best thing about the chair is its portability -- I can use one foot to keep it bouncing while I wash dishes in the kitchen and she's within arms reach while I'm in the shower should her binky become dislodged. OK, I still sound like a terrible mother. For the record, I've never left her in it while I walked the dog or gotten my eyebrows waxed. Redeemed?
My point is that having no chair threw me a curve. The last 24 hours felt a lot like the first 24 hours (minus the hemorrhoids, of course) -- I had to figure out how to do everything all over again.
And while I was trying to come up with someplace to put her while I made a smoothie ("wanna watch your swallow mobile in your crib again? Oh boy, oh boy!") I started thinking about July 20th. That's the day that I'm going to wake to my alarm clock instead of my baby, put on my scrubs and walk out the door without her, not to return until after my 12 hour shift.
I'm worried that day will be less like a curve ball and more like a curve planet -- for me, for her dad, and for her. I know we're all going to figure it out and settle into that new reality eventually, but if the lack of a chair necessitated a complete reinvention how will we handle the lack of me?
Tuesday, June 10, 2008
What's working & what isn't
Now that we're ten weeks into this parenting adventure, I thought I'd reflect on what, of all the baby stuff we received/bought/inherited, has proven to be worth the space it's taking up in our apartment.
WORKING
WORKING
- Oeuf Baby Lounger: Baby Stewgler LOVES this thing. Turns out it's crucial to have someplace (other than the crib) to put the baby. Seriously, you don't want to have to hold 'em every minute. In shopping for a bouncy chair, we definitely prioritized the look of it and the size of its footprint. Yes, there are cheaper chairs (some of which bounce themselves), but this one is really well made, comfortable for the baby & it matches our design aesthetic. Bonus.
- G Diapers: Without a washer and dryer, we were hesitant to use cloth diapers, but we also felt really guilty about disposables. G diapers are a great middle ground. G's have three parts -- a cloth exterior, a impenetrable snap-in liner, and a flushable/disposable/compostable/biodegradable absorbent core. We mostly use them at home (we use 7th generation disposables when we anticipate changes out in the world) where we can flush and reset with ease. Sure, we have the occasional blow out & you can't be faint of heart if you're going to have to hand-wash the liners in the sink (Dr. Braunner's peppermint soap is working well), but all in all we're totally sold.
- Swaddlers: From the beginning, Baby IK has been sleeping in a swaddle. Mostly, swaddling helped to keep her moro reflex in check which has allowed her to sleep longer. Dr. Harvey Karp says that swaddling helps replicate the womb. In the beginning, the bambina was swaddled almost all the time, now she's just swaddled at night. They say she'll tell us when she'd had enough. We have lots of different swaddlers -- simple square blankets made with love by Aunt Maureen, the miracle blanket, Halo sleep sack swaddler, Swaddleme -- all of which work well. In our house, swaddling has helped to make our baby a good sleeper.
- Aden + Anais muslin swaddle wraps: In theory, these are great. Swaddling a baby in summer feels tantamount to torture, so the prospect of a gauzy swaddler sounds awesome. The problem is that these wraps are huge -- once you have the baby swaddled, they're wrapped in so many layers of muslin it might as well be a wool blanket. I recently cut one of the wraps in half which makes it slightly more effective. I think the design of these wraps fell prey to serving too many masters -- I'd rather have a well-sized muslin swaddle wrap than a too large wrap meant to swaddle, serve as sun cover, breast feeding cover, emergency crib sheet, etc. I wish I'd bought my own muslin at $2.99 a yard.
- Graco SnugRide: Let me first say that I think this car seat is perfectly safe which all that matters in the end. My beef is with the handle -- moms NEVER have two hands to do anything so why would they design a car seat handle that takes two hands to adjust. There are two big, cheap-feeling, tough to engage "buttons" on each side of the handle and you need to push both of them at the same time in order to move the handle. Stupid. Totally stupid.
- Similac 2 oz "nursers": We bought a case of these ready to feed bottles to take on a trip where we wouldn't have a place to clean & sterilize bottles. They served us well in that regard. The bummer is that the nipples seem to have a pretty fast flow. Baby Stewgler is normally a pretty chill eater -- with those nursers she was coughing and sputtering and drooling formula all over the place. As added insult, I discovered that the bottles are made of number 7 plastic which is reported to infuse liquids with bisphenol A -- an endocrine mimic which is particularly damaging to babies and pregnant women. Awesome.
Monday, May 19, 2008
Babies LOVE Sugar
Baby IK has been eating some formula from the beginning. Just a little bit to supplement my low production boobs. We started out giving her the Similac Advance that we got as a sample can from the hospital. When that ran out, we switched to Earth First Organic which gave her crazy gas. So then we went back to the Similac Advance. The lactation consultant told us that Similac made an organic formula so we were delighted to try that out next.
Similac Organic seemed like the right answer for us -- the organic ingredients assuaged our guilt about having to feed her formula in the first place and IK seemed to tolerate it well. We were psyched to have settled on a formula.
IK's Nana then started mining her contacts at work to get the pharmaceutical rep's opinions about their various products. The Enfamil rep pointed out that the organic Similac contained sucrose as its primary sugar rather than lactose. Sucrose??!? Turns out the third ingredient is cane sugar. That's the same ingredient in swedish fish and Fruit Loops.
Ugh. Back to the drawing board.
Turns out I'm not the only one suffering this conundrum. An article in the NY Times points out what IK and I have already figured out. There are no easy answers to the formula question. We can read every label, every article, every study, but in the end we just have to listen to our babies and our guts and try not to suffer the guilt when the decision you make still doesn't feel like the right one.
Similac Organic seemed like the right answer for us -- the organic ingredients assuaged our guilt about having to feed her formula in the first place and IK seemed to tolerate it well. We were psyched to have settled on a formula.
IK's Nana then started mining her contacts at work to get the pharmaceutical rep's opinions about their various products. The Enfamil rep pointed out that the organic Similac contained sucrose as its primary sugar rather than lactose. Sucrose??!? Turns out the third ingredient is cane sugar. That's the same ingredient in swedish fish and Fruit Loops.
Ugh. Back to the drawing board.
Turns out I'm not the only one suffering this conundrum. An article in the NY Times points out what IK and I have already figured out. There are no easy answers to the formula question. We can read every label, every article, every study, but in the end we just have to listen to our babies and our guts and try not to suffer the guilt when the decision you make still doesn't feel like the right one.
Thursday, May 15, 2008
Dressed by Noon
While I'll be the first to say that blogging seems largely narcissistic, I've decided to add my voice to the din. As the mom of a six-week-old gorgeous little munchkin, I guess I'm looking for a way to connect with the world during my maternity leave. Staying home with baby is awesome, but isolating. Hence this little tether to the outside.
The name of this blog is an homage to my mom. About two weeks after IK was born my mom admitted that her goal when my brothers and I were kids was to be showered and dressed by noon on Wednesdays so she wouldn't have to greet the cloth diaper delivery guy in her PJ's. Now, mind you, my mom is a super hero. She worked as a nurse and a nurse practitioner, raised three great kids, cultivated a garden most summers, drove me to ballet and my older brother to soccer and my younger brother to music lessons, helped my dad rehab a 150 year old farm house, and she did it all without air conditioning. I'm not saying that I imagined that she got up in time to put on makeup for the 3 AM feeding, but it never really seemed hard for her to keep it all together.
So when I was struggling to adjust to motherhood in those early weeks it was a HUGE relief to hear that what-a-mom had struggled too. Now that IK and I are finding our way I maintain my mother's goal to be showered and dressed by noon. Sometimes I make it, sometimes I don't. There's no diaper delivery guy keep me honest, but it helps to have something to shoot for.
The name of this blog is an homage to my mom. About two weeks after IK was born my mom admitted that her goal when my brothers and I were kids was to be showered and dressed by noon on Wednesdays so she wouldn't have to greet the cloth diaper delivery guy in her PJ's. Now, mind you, my mom is a super hero. She worked as a nurse and a nurse practitioner, raised three great kids, cultivated a garden most summers, drove me to ballet and my older brother to soccer and my younger brother to music lessons, helped my dad rehab a 150 year old farm house, and she did it all without air conditioning. I'm not saying that I imagined that she got up in time to put on makeup for the 3 AM feeding, but it never really seemed hard for her to keep it all together.
So when I was struggling to adjust to motherhood in those early weeks it was a HUGE relief to hear that what-a-mom had struggled too. Now that IK and I are finding our way I maintain my mother's goal to be showered and dressed by noon. Sometimes I make it, sometimes I don't. There's no diaper delivery guy keep me honest, but it helps to have something to shoot for.
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