Cuteness

I have some serious posts in mind... but it is hot*, and I'm 35 weeks pregnant, and I have a lot to do before the baby is born (right this minute, I should be printing out directions to day care for the people on call to go get Pumpkin if I go into labor during the work day)... so I'll just do yet another post about the cute things Pumpkin says.

My current favorite Pumpkinisms are:

• "Hopen" instead of "open"
• "Bobbin" instead of "bottom" (I think I've mentioned this one before. I love this one.)
  
• "What happen to you, Mommy?" anytime I complain about anything. I complain a lot these days (see the comment above about being 35 weeks pregnant)
• The way she starts sentences with "Hey!" and ends them with "though". As in "Hey, Mommy! I want some milk, though."
  

Pumpkin's speech is getting much clearer and more correct. I'm mourning the loss of a lot of Pumpkinisms. Yesterday, she was helping her Daddy look for "his" TV remote control, and I realized she actually says "remote" now. I miss her old pronunciation, which was "rowboat". Oh well.

*OK, not really. The high today in the coastal region where I live and work was probably 85 degrees F. Its cooled off nicely now, and is only 74 now. But I've been living in San Diego for a long time. We think we have a right to have our temperatures hover between 68 and 76 AT ALL TIMES. Go ahead. Laugh. I used to laugh at this, too, when I had just moved here from Chicago by way of Phoenix. But then I stayed too long, and now I need a jacket if it gets down to 66 and start turning fans on when it creeps up past 78.

Working Mum: Achieving the 40 Hour Week

I've been meaning to write a post about some of the techniques I use to keep my work week to something close to 40 hours (most weeks). I've touched on this topic a few times in comments on other posts- most recently in my post about combining motherhood with a career in science. I really think that one of the reasons I'm a happy working mother is that I don't have to work (most) weekends and I almost always leave work early enough to have some time with Pumpkin before dinner. I do this without guilt, because I have always worked this sort of schedule. I guess I've always been the sort of person who needs a break from work in order to be productive. I'm satisfied with the career advancement I've achieved working this schedule, so I don't feel much pressure to work longer hours.

I will admit that my choice of fields certainly plays a role in my reasonable schedule. I work at the interface of biology and computers. My current job is a mix of management, information technology and science. Even when I'm doing pure science, I'm working on a computer. I do not have to plan around the sometimes fickle growth schedules of bacteria or the length of time it takes to run a protein purification column. I'm familiar with these sort of scheduling problems from graduate school, and did occasionally have really long days because of them. (However, I mostly remember working reasonable days in grad school, too- I was lucky to have chosen an adviser who judged on the amount of work produced and not the number of hours in the lab!)

As I've thought about this topic, I have come to the conclusion that the most important technique for working reasonable hours is prioritization. I always know which of the tasks on my to do list are the most important- and I generally consider "important" to mean "has the earliest due date". In general, I work on the things that are coming due the soonest. This method helps to minimize the number of times I have to stay late to meet a deadline. I don't achieve my reasonable work schedule by letting deadlines fly past me. I hate missing deadlines- in fact, I pride myself on NOT missing deadlines.

Another thing I do is negotiate my deadlines. If someone asks me to do something, I usually ask when it needs to be done. If they give me a schedule that I can't meet, I tell them so. I'll discuss the task with them, and see if there is some meaningful portion of it that I can complete in time for their deadline. If we can't agree on a schedule, I tell them when I CAN get the task done, and promise to try my best to get it done earlier. My reputation for not missing deadlines helps me with this discussion. People know that if I say I'll get X done by next Friday, I really will do that.

I will occasionally stay late for a day or two to meet someone's deadline, but I'll only do that a limited number of times. If someone habitually brings me tasks without allowing enough time to complete them, I miss their deadlines. I tell them I can't meet their schedule, and I don't meet it. I tell my boss what has happened so that he or she will be prepared for anyone who complains, and I've never had an negative repercussions from this approach. I suppose I'm lucky that I've never had a boss who habitually sets unrealistic deadlines. I suspect that if I do come across such a boss, I'll start a job search. I always make it clear that I'm willing to work long hours for short periods of time to meet important deadlines- and I back this up with action. I find that I can sustain a 50-60 hour work week for a month or two without losing productivity.

The third thing I do is write lists. I have written before about how lists helped me function at work despite the sleep deprivation of early motherhood. I love lists, and always have. I particularly love the feeling of accomplishment I get when I cross things off my lists. I don't just have a to do list- I have an entire system of to do lists:

• I have a few "global" lists of things that need to get done. Items on these lists are always associated with a due date of some sort, even if I have to assign one myself. These currently include my departmental goals list, a running task list I share with the other person in my department, and a list of things that have to be done before I go out on maternity leave. These lists are usually stored in files on my computer. (We have a global to do list at home, too- but that is perhaps the subject of a different post.)
  
• I have an "upcoming tasks" list, which includes only the tasks that I plan to complete in the next week or two. This list always has my top priority items (according to due date). It usually also has some "gee, it would be nice to get this done" tasks. These are tasks I can work on if I finish all my top priority tasks, or if I am having a low motivation day and need something lighter but still productive to work on.
• If I'm really busy and/or really struggling with motivation, I also make a daily to do list. This list actually sometimes lasts for a couple of days. If I'm really busy, it has only the most urgent things on it. If I am struggling with motivation, it has "component" tasks on it. I take whatever big task I can't motivate myself to tackle and break it down into little tasks. Then I put some of the little tasks on my daily to do list and put the list in a place on my desk where I can't avoid seeing it.
  

I'll be the first to admit that my to do list system might not work for everyone. I think that work organization is a very personal thing. However, I think that the prioritization piece probably would be useful for most people. I have noticed a strong correlation between the unwillingness (or inability?) to prioritize work and long hours worked to meet deadlines. People like that sometimes look at people like me and assume that we must not have as much work to do. I don't think that is true. At times, I have ridiculously long to do lists. I always leave work with things left to do. Its just that none of the things left on my to do list are due the next day.

Bedtime

"Mommy, stay."

I was getting Pumpkin down last night, and I wanted to get up and go potty. I thought maybe she was sleepy enough that I could leave her to try to finish going to sleep on her own. I slid out of her bed, and gently extricated her fingers from my hair. She looked up at me sleepily, and patted the space on her pillow that I'd just left.

Usually, when I try to get up too early, she commands me to "lay back down!" But last night, she just said "Mommy, stay."

I leaned in and kissed her, and said I had to go potty, but that I'd come right back.

And I did come right back. I settled back into her bed, with my back to her (as she prefers- better access to my hair). I felt her little knees nestle into the small of my back, listened to her breathing get more regular, and waited for her hands to stop twirling my hair.

Then I slid out of bed again, and went off to get ready to go to bed myself.

I suspect that I'll regret not breaking Pumpkin of her bedtime Mommy habit before the new baby arrives. There will probably be some painful nights, when I have to be with the baby and Pumpkin wants me to snuggle her to sleep. But the 20-30 minutes it takes for her to fall asleep with her hand twined in my hair (the other hand is usually wrapped around the tail of her stuffed zebra) seems like so little time, really. Most mornings, she waves me bye-bye cheerfully. I occasionally have to beg for a good-bye hug and kiss. She has even started playing more independently after work, letting me crash on the sofa and rest. She seems more and more like a little girl and less and less like the "big girl toddler" she calls herself every day.

So I stay. She understands so much these days, which gives me hope that maybe we'll be able to explain the need to change the routine when it becomes necessary to do so. (This, of course, assumes that we finally come up with an explanation for our desire to change her bedtime routine that does not blame the new baby and thereby sow the seeds of sibling conflict.) I may miss this bedtime ritual more than she does, whenever we are finally forced to break it. I hope so.

Following the Evidence

Last week, I read Birth Day, by Mark Sloan. This is a fascinating tour of the history of childbirth and discussion of the modern practice of obstetrics, through the eyes of a pediatrician.

I should probably go back and read the book again, because it is the least combative and most informative thing I've found so far on childbirth options. Those of you who have never given birth may be unaware of the fierce battles that are waged around many things related to labor, delivery, and the care of newborns. Do epidurals represent the chance to minimize childbirth pain that all emancipated women should demand? Or are they an unnecessary intervention foisted on us by a medical establishment that has "medicalized" a natural process and is trying to scare us into submission? Is the increase in the number of C-sections an indication that we're taking appropriate measures to minimize the risk to mother and baby? Or an indication of how our health care system is out of control? And of course, there is the newly stirred up controversry about breastfeeding. The opposing sides allow no middle ground and distortions of the research are common. It is difficult to find an impartial guide through the research.

All of this hits you at a time when you're not really functioning at your peak levels of critical thought. First, you've waded through the murky risk analysis of choices during your pregnancy- should you avoid fresh strawberries for fear of Listeria? Is that handful of peanuts going to increase the chances that your baby has a peanut allergy? Will well-meaning strangers ever stop giving you advice on your baby's health? (Note to women pregnant with their first child: the answer to the last question, as far as I can tell, is NO.)

Then you go into labor. Even before it is intensely painful it is not exactly comfortable. Your hormones are doing something you've never experienced before. You and your partner are excited and more than a little bit freaked out. Then the real pain hits, and you either decide to have an epidural or work through the pain. Neither is a perfect option, and neither option is without risks. Despite the research you've done ahead of time, you really can't know what you'll do until you feel that pain. And even if you choose to have an epidural, labor isn't really an easy time in which you can sit back and weigh the pluses and minuses of the interventions on offer, Nor, as my experience with my first labor shows, will you necessarily remember the research you've done ahead of time.

Once the baby is born, you go on another brand new hormonal ride, this time with the added spice of extreme sleep deprivation.

There is no area in my life in which I feel less capable of being able to wade through the evidence and make good, sound decisions about what to do than this one. And yet, it is the area where it seems I most need to do it. Practices that the evidence clearly show will increase the chances of an uncomplicated birth (like, for instance, pushing in a more upright position) are not only not routinely used, sometimes they aren't even offered. I actually think my doctor and his nurse practicioner are fairly up to date on the latest research and give me good advice- but neither of them is likely to be there when I give birth.

In Birth Day, Mark Sloan cites some convincing research about how having a continuously present birth attendant (who is not the laboring woman's partner) greatly increases the chances of an uncomplicated birth. However, our current standard practice does not include this- the labor and delivery nurse is responsible for multiple laboring women, and so cannot be a continuous presence for any of them. It seems that doulas, which I had earlier dismissed as an unnecessary expense, may be well worth the money. Unfortunately, I may be coming to this conclusion a bit too late- I don't have the energy to research and interview doulas right now, and the first few I have come across are too "alternative medicine-y" to be a good fit for me. We will probably just rely on a "cheat sheet" to help Hubby and me remember what we've learned and the fact that second labors are usually a lot faster than the first.

What I really want, though, is a medical system that bases its care of me on the evidence. I want to rely on the medical staff attending my labor and delivery to guide me to know what that evidence says and to follow it- they are supposed to be the experts, afterall.

A Good Day

Yesterday, we took Pumpkin to the beach. She ran to the water before Hubby could even get his shoes off. This is such a difference from last year, when it took three visits before she'd even go down to the water.

Pumpkin splashed in the water a bit, but her main activity yesterday was carrying buckets of water from the bay to her spot on the sand. Once she got to her spot, she'd dump out the water, maybe play with one of her other toys for a bit, and then run back to get more water.

Hubby had bought her a boogie board this week, and he convinced her to go down and try laying on it while he pulled her. She never really got over her suspicion of that, so mostly she pulled it around after her. She had lots of fun doing that.

Pumpkin had lunch at the beach, and then took a brief turn on the nearby swing set. She fell asleep on the way home.

After her nap, she played outside a bit in her new playhouse- a mint condition hand me down from a colleague of mine whose girls have outgrown it. Pumpkin loves that house. I love that she'll play in it on her own, leaving me to sit in a chair and watch. I'd complained to Hubby about how uncomfortable our outdoor chairs are, so he got my camp rocking chair out and set it up (its a folding canvas chair, but with rockers on the bottom). As I sat in that, and watched Pumpkin bustle around her little house, it struck me that it had been a very good day.

-----------------------

Today, Hubby and my sister are taking Pumpkin to the zoo. She is excited to see the giraffes and the elephants and the flamingos (that last said in a cute way that I can't figure out how to transcribe). I was sad to kiss her goodbye and not go with them, but a proper visit the San Diego Zoo involves a lot of walking, and I'm not really up for that right now. I am huge, and achy, and can't believe I still have about 6 weeks to go on this pregnancy.

I have one chore to do (grocery shopping), but otherwise I am just supposed to rest. I will definitely do that. I might also go through the stacks of outgrown clothing and shoes that are piling up in Pumpkin's closet and put them in bags and boxes. This is a chore that absolutely can't be done when Pumpkin is around, because she wants to try on the shoes and she pulls her favorites of the clothes out of their neat stacks.

A Miracle Has Occurred

Tonight, Pumpkin allowed Hubby to stay with her until she fell asleep while I was in the house.

This was so unexpected that I hadn't even kissed her good-night when she went in to read stories with Daddy- I assumed that I would be called in to "read the last story" and snuggle her to sleep, as I have been most most nights since we moved her to the big girl bed.

(For those who don't know- before the move to the big girl bed, Hubby and I were able to trade off nights getting Pumpkin to sleep with no complaint from Pumpkin.)

Some of the blame for the recent situation surely goes to the fact that in early pregnancy (around the time we moved Pumpkin to the big girl bed), I was too tired to do any of our evening chores, and so having me get Pumpkin down every night was a reasonable arrangement.

There is a certain irony in the fact that we are only breaking this habit now that I am once again too tired to be much help around the house.

Health Care Rant

The "debate" about health care reform (or "health insurance reform" as its now being called, presumably to make it sound less scary) is really annoying me these days. I put "debate" in quotes, because it is not a debate at all anymore- it has turned into theater. The "news" about health care reform is dominated by coverage of vocal, incoherent protests. I have no problem with people protesting policies they don't like. I don't even think it is wrong to disrupt meetings if you can't get your opinions heard any other way. But the protesters don't seem to be trying to voice their opinions or participate in any sort of discussion about what health care should look like in this country. They are just shouting and waving signs with pithy sayings that don't actually SAY anything. They shout down anyone who says anything other than what they want to hear. If my two year old behaved like that, people would expect me to take her outside until she calmed down.

The other aspect of the "debate" that is bothering me is that people seem to be free to just make things up. The ridiculous discussion of "death panels" is just one example. Either the people making these claims have incredibly poor reading comprehension or they are cynically trying to scare people so that they can get their way. I can't really see any other explanation for taking a provision that would allow Medicare to pay doctors for the time they spend consulting with their patients about end-of-life decisions and using that to claim that we're going to have panels of government bureaucrats deciding when a person is not productive enough to live. When I first heard these claims, I just laughed because they seemed so silly. Now, they have apparently led the Senate finance committee to remove all end-of-life discussion provisions from their version of the bill. This is a shame. I don't know why we wouldn't want people to talk to their doctors about these issues. Where would we rather they get information about their options?

Even before the debate got this silly, though, I was frustrated by it. The people opposed to reform seem to be able to set up strawman arguments unchallenged. And the people in favor of it seem to want to dodge reality and avoid talking about some of the difficult decisions we really do need to make.

Before the death panel nonsense, the favored scare tactic seemed to be that we were heading for rationed health care. This claim also made me laugh, because we already ration health care. When was the last time you chose to get a treatment that your health insurance doesn't cover? Have you ever switched medications because the medicine your doctor originally prescribed is not on your insurance's formulary? Why is it OK to have insurance bureaucrats making decisions about what treatments are covered but it is not OK to have government bureaucrats making those decisions? Personally, I don't care if the bureaucrats are paid by a private company or government. I only care that there is good oversight and that the decisions are made based on evidence about what works.

The difficult decision we most seem to be dodging is the decision about how much personal responsibility for insurance we should require. Why is it OK to require employers to provide insurance but not OK to require people to buy it if they can afford it? Why do we think people should be allowed to dodge this responsibility but not the one to insure their cars? It seems to me that if we aren't going to go to a single payer system supported by taxes then we need to go to a system that requires people to buy insurance if they can afford to do so. Otherwise, we'll still have a group of people relying on emergency rooms for their health care- which is the most expensive way to provide it. We all pay for emergency care, via our taxes and higher costs. I can't imagine we'd ever say that we'd deny such care to people who chose not to purchase health insurance, and I wouldn't really want to live in a country that would do that. So why can't we talk rationally about how to make sure that no one relies on emergency care as their primary care?

Why can't we talk rationally about all of this? I thought we were finally going to get something approaching universal coverage in this country. I thought we might even take this opportunity to try to craft a truly better system for all of us. I didn't expect the final system to look exactly like I would want, but I did expect a somewhat civilized debate about what that system should look like. I am incredibly disappointed to see this chance slipping away under a deluge of lies, half-truths, and theatrics.

File Under: Stories, Not Serious

I've been kicking around a follow up post about labor and delivery (I've just finished reading Birth Day, by Mark Sloan, and found it to be very interesting and useful).

I've also been kicking around a follow up post about the wider issues in our health care system. (I have a funny story about my first trimester screening, which I was just notified was disallowed- not by my insurance company but by the medical group who performed the screen! My insurance company was as confused as I was by that one, which I think I have now sorted out.)

But I'm tired. I'm really, really tired. I'm wondering how I'm going to make it through the 6 weeks of work I have in front of me before my planned exit for maternity leave. I keep trying to take a day off, but finding that I have too much to do to allow it.

So I'll tell a couple of cute Pumpkin stories instead:

1. On Sunday, we picked up a hand-me-down Little Tikes playhouse and a Litle Tikes table and chairs set from a colleague of mine whose kids have outgrown them. Pumpkin adores her new house and her new table and chairs. She likes to line up her chairs, and tell me which of her friends will sit in each chair. "M- will sit in the middle. E- will sit in back. And Pumpkin will sit in front!" She was very concerned by the fact that the little playhouse only had two bench seats at its table. But then she decided she could bring one of the other chairs into the house, so all was good again- both M- and E- had a place to sit.

Earlier, when we had first brought out the table and chairs, Pumpkin sat in one chair and shooed Hubby out of the other, because it was reserved for "baby sister". I guess we should be glad that she is now reserving the seats for her playmates, since it will be quite a while before baby #2 can join in her games.

2. We took Pumpkin to the beach on Saturday morning. She ran straight to the water- none of the hesitancy we saw as recently as our Christmas-time trip to Hawaii. She splashed happily in the water with her Daddy, and got very excited when they saw a fish. She came running over to where I was standing, talking excitedly about how she'd seen "a little fish, Mommy!" Hubby tried to get her to participate in the time-honored tradition of exagerrating the size of fish, but she was having none of it. It was a little fish, and she held up her hands to demonstrate. Hubby says she got the size about right.

At one point, she lost her footing and fell over backwards in the water, effectively dunking herself. She was surprised, and had to be taken up to our blanket and wrapped in a towel to recover, but she went back in the water later. I think she would have played longer in the water, but she got cold. It is easy to forget how little she is, and how little body weight she has to help keep her warm. We dried her off, fed her the lunch we'd packed, and took her over to the adjacent playground for a long stint on the swings.

3. Despite the fact that Pumpkin's spoken vocabulary far exceeds her signed vocabulary at this point, she still enjoys signing. She loves to show us the signs for words. This weekend, she spent quite a bit of time showing us the sign for "surprised", which involves making exclamation points out of your pointer fingers, right next to your eyes. She'd come up and yell "SURPRISE!" at us, while making the sign, and wouldn't stop until we did it back to her.

Later, she showed us the sign for green, but she got very upset when we didn't do it right. No matter what we tried, it wasn't right, and that upset her greatly. We finally promised that we'd watch the Signing Time DVD later, and see if we could get it right.

I have a feeling there are more stories I should be capturing, in addition to more thoughtful posts to write. But those will have to wait for another day. Right now, I want to go lay back down on the sofa.

Thoughts on Labor

I've never written about Pumpkin's birth. That is largely because labor and delivery was inconsequential when compared with all that has come after it. But now that I'm looking ahead to the birth of a second baby, I'm thinking about my first labor and delivery, and what I might do differently.

Pumpkin was born 5 days before her due date. I'd been having occasional contractions for a couple of weeks, and was already dilated to 2 or 3 cm, depending on whether it was my doctor or the nurse practitioner doing the measurement. My water broke at about noon on April 4. I was admitted to the hospital at about 2 (dilated to about 4 cm, if I remember properly), and because I am strep B positive, I was induced when active labor hadn't started by 8 p.m. I was free to walk around, but hooked up to an IV (with antibiotics- again, because I'm strep B positive). I didn't feel much like getting up and about because of all the amniotic fluid. I probably should have made more of an effort to do so, anyway.

Once I was induced, labor proceeded relatively quickly. Contractions came fast and hard, as advertised for induced labor. I got an epidural, but I think I only pushed the button to administer more drugs once. I started pushing at about midnight, and I could feel the urge to push, which had been my goal in resisting the lure of the epidural drug delivery button. I also had feeling in my legs, so the policy at the hospital I was at would have allowed me to change positions in bed. I didn't do that, though, and no one encouraged me to do so. I pushed Pumpkin out from a half sitting-half reclining position on the birthing bed.

I pushed for four hours. A doctor came in and said that if the baby didn't progress further soon, I'd have to have a C-section. This made me push harder, and after a couple more pushes, Pumpkin was down far enough that they could use the vacuum extractor to help finish the job.

I've since learned that four hours is about the cutoff for when they'll move you to a C-section, and that the doctor wasn't lying to me- I was really close to having a C-section.

I look back on this experience and am fairly happy with it, except for the part about pushing for four hours in a position that has been shown to be suboptimal for pushing. I have since learned that all beds in this hospital have squat bars, which can be put on to allow women to labor in the squatting or semi-squatting positions that use gravity to help with the pushing process. I had feeling in my legs, and could have done this. But no one suggested it. Instead, they were going to let me go and have major abdominal surgery.

This illustrates to me how badly broken our current health care system is, even for people like me, who have good health insurance and are reasonably healthy.

Some of my friends, upon hearing my birth story, tell me I should have had a doula. Maybe. But if our system is set up so that I need someone other than my doctors and nurses to help me avoid surgery, then that additional person should be a standard part of the labor and delivery process, not an extra person I have to find and pay outside of my usual payment scheme. Otherwise, there is one level of care for people wealthy enough to afford a doula (usual fees are about $700-$800 in my area) and another level of care for people who can't.

Others have said that my husband should have advocated for me. Maybe. My husband has many wonderful qualities as a labor and delivery coach, but assertiveness is never going to be one of them. Should my labor and delivery really depend that heavily on my husband's personality traits? And what happens to women who don't have a coach?

There is a lot of concern about our C-section rate (which was 31.1% in 2006, and is apparently still rising). I do not know what the "correct" C-section rate is- the WHO says about 12%, I think, but this article argues that that number is not really based on firm evidence, and that the best rate in terms of protecting both maternal and infant health may be higher. Regardless, it is pretty clear to me that I shouldn't have been as close to a C-section as I was back in 2007. The baby wasn't in distress, and there at least one other, much cheaper and frankly better option to try- namely, changing my position. As I said earlier, the hospital 's policy allows this with an epidural, as long as the patient can feel her legs and stays in the bed. They even have beds equipped to facilitate this.

So why did no one suggest I change positions? Hubby thinks it is because of liability concerns and that the C-section option is the "safer" one from the standpoint of not having a catastrophic outcome that leads to the hospital being sued. (I should point out that he has no evidence on which to base this theory. My hospital's C-section rate is about 20% and they are considered one of the more progressive hospitals in my area.)

I don't know. Maybe I had an old-school nurse who doesn't believe in using different labor positions. I saw at least three different doctors during my time in the delivery room- maybe they all assumed someone else had said something. During some recent research into what my options are for labor and delivery #2, I came across a blog post from a medical student who is going to do a study to try to find out why upright positions aren't used more during the pushing stage of labor. I wish her luck.

Anytime someone tells me that we shouldn't reform our health care system because we might "break what we have" I have to stiffle a laugh. It is already broken. The story of Pumpkin's birth is just one tiny illustration of one small way in which it is broken. If I weren't so tired tonight, I'd probably go on and on about my thoughts on the current health care debate. I'm fairly disgusted by most of the public participants, to be honest. I'll probably get disgusted enough that I come back and write up my thoughts later. In the meantime, you can read my comment on Pundit Mom's post on the issue if you're really curious about what I think!

Her First Written Word

Pumpkin tells us this spells "Mimi".