Can't Sleep? Me either.

I was thinking of waiting until this pregnancy insomnia haze passes before writing another blog post, for fear of writing things not worth reading, but then I decided this is only beginning of sleeplessness – might as well write about that too. Plus, odds are, I will become fairly more entertaining as the hormones mount, then dismount.

I’m 30 weeks tomorrow, and I am realizing what this pregnancy insomnia is all about.  (80% of pregnant women experience at some time in their pregnancy, most likely in the third trimester.) There is no better education than experience.  Please allow me to vent to you, internets, because venting about sleep to Daddy MD, who worked all day from 6:30 am - 6:30 pm, then reattached a thumb at 9pm until 3am, and then reported back to duty at 6:30am (three hours later), just doesn’t seem reasonable.  Yeah, not much room for pity for me in the sleeping department. 

Anyway, tired as I may be, I lay in bed (as comfortable as possible with my awesome Snoogle pregnancy pillow) and I just cannot turn off my brain and fall asleep.  How many times have I counseled patients about the same?  Hundreds.  I think it’s a cycle really.  I can’t fall asleep, then I start thinking about how early our energetic Peanut will be up in the morning and how much I need to sleep ASAP, so then, you know, it’s just too much pressure to sleep.  And, I hate wasting time.  I think that’s what gets me the most.  If I am just going to be lying in bed, I think I should be using that time more wisely, so I start making a mental list of what I should be doing instead.  Note: making mental to-do lists is not compatible with falling asleep.

I do eventually fall asleep a couple hours past my intended bedtime, usually.  On a good night, Peanut, aka Insomniac Jr., doesn’t wake up just after I fall asleep.  And if it’s a really good night, Daddy MD’s pager doesn’t go off either.

Here is some general sleep advice that is kind of working:

•           If you can’t fall asleep in fifteen minutes, get out of bed and do something mindless in a different room for a while, then try to sleep again. 
•         Leave the electronics in another room.  We’ve seen studies on teens sleeping more poorly due to sleeping with their phones.  It goes for adults too.  I, too, have been guilty of just checking one more thing on the phone before sleep.
•          Exercise during the day, but not within a couple hours of bedtime.
•          Eat a lighter dinner.
•          No caffeine after 2 pm.  The half-life of caffeine is about 6 hours – that means that If you drink a cup of coffee at 2:00pm, then half of the caffeine you drank will still be in your system at 8:00pm.
•         Practice some relaxation techniques.  One effective technique is progressive muscle relaxation.  Here is a link to how to do this. 

Off to Work

It's been a busy week since starting my new job! Daddy MD came across this article about the medical group I joined.  It was started by the physician who founded Epocrates, which is pretty cool!  I am really enjoying the experience so far!  More updates to come...

Ask Dr. A: Rice Cereal

Question: Will rice cereal help my baby sleep through the night?

Answer: This is a very common question, and misconceptions abound, but luckily we have studied this hypothesis.  The truth is, no, unfortunately, adding rice cereal to your baby’s bottle will not help him sleep through the night. 

In fact, your baby needs the essential fats and nutrients found in breastmilk or formula during this delicate period of weight gain and development, so you don’t want to fill his tummy with rice cereal instead.  Your baby’s stomach is only as big as his fist, so it’s normal for him to be hungry every 3-4 hours or every two hours in the newborn period or growth spurt.

The AAP recommends the introduction of solids at some point between four and six months of age.  Once baby can sit up well supported in a chair, has good head and neck control, and loses his reflex to force everything out of his mouth with his tongue, he may be ready for solids. 

She may have eaten her other sock, hard to tell among the carrots mess

 To start solids, put the cereal on a spoon mixed with breastmilk or formula.  Please do not add cereal to a bottle.  The only reason cereal should be added to a bottle is in treatment for acid reflux, directed by your doctor.  Solids at this age are really for practice, with the majority of baby’s nutrition coming from breastmilk and formula for the first year of life. 

"Would You Look At This"

What do two MDs do after a long week of work once Peanut is in bed? Watch You Tube videos, of course!  Ah, laughter is the best medicine.

Here's one we got a kick out of... Would you look at this!?

"Working Mother Monologue"

Although keeping up this blog has been intellectually stimulating in many aspects, Social Media has its disadvantages.  Occasionally, I stumble upon articles that really fire me up.  Here’s one that was particularly pregnancy hormone-receptive.

Dr. Siebert is a female anesthesiologist and mother, who claims in her article that women in medicine are contributing the physician shortage in our country.  She gives emphasis to those of us who chose to work part-time at one point in our career or partake in the “mommy track.”  I’d like to debate her points, put I don’t think my blog is the place.  Let me just say that simplistically blaming female part-time physicians does not even scratch the surface of the underlying causes of the impending physician shortage crisis.  I’ll leave it at that. 

However, being a female physician, who is currently working part-time (albeit very short term) in order to spend more time with my toddler and soon to arrive newborn, I can’t help but feel a little defensive. 

Here’s the thing.  I am a family physician.  I value families.  Quite frankly, I wouldn’t choose a family doctor for myself, or my family, who didn’t prioritize her own family.  Your physician’s family values will affect the way she understands and sympathizes with your family values.

So, when I’m mid-day on my patient schedule and I get a call from Peanut’s daycare saying that she has a fever of 103 and is laying in the corner while the other kids are playing, I know that Peanut is the patient who needs me the most at that moment.  Since Daddy MD is usually literally elbow deep in surgery and we have no family within 200 miles of us; that means I will be the one rushing to her side.  I want to be the one to console my child.

Luckily, healthcare has evolved and we have team-based system.  I’m fortunate to have partners who prioritize their families the same way that I do, who are thus willing to cover for my sudden absence.  I hope all physicians, men and women, are afforded the same practice environment, enabling them to avoid physician burnout and to maintain their own physical and mental health, in order to better care for their patients.

Yet, I still, like most women in medicine, have this constant internal struggle with my own work/life balance.  I’ve worked my entire adult life to become a physician.  I feel privileged to care for patients, and I want to continue to enhance my medical knowledge.  At the same time, there is a little girl who I want to be with most of all, pulling at my arm while looking up at me with pools of blue, asking “Mommy, play.”

Working part-time this year has been a blessing, but at the same time, it makes this internal struggle all the more difficult.  I know what I am missing.  I see how much she changes every.single.day.  I don’t want to pass up another morning on the couch, when Peanut says, “I want to snuggle with you Mommy.”

I know the benefits for Peanut and for myself of continuing my career.  I read often on this work/life balance topic, trying to find some absolution, but I’m afraid a career mommy or daddy will always have to manage the multiple strings pulling at them.  “Work/life balance” is a strange concept really, because work is part of life, and balance will only be achieved when one is happy with all the parts of her life.

I write this the night before I start a new part-time job.  I will now have two part-time positions: one at Urgent Care and my new position at an innovative outpatient medicine practice.  The opportunity in this practice was difficult to decline, because their practice of medicine is unique to my experiences, and will allow me to grow as a physician.  I will be exposed to alternative and natural medicine within the practice, as well as learn about a different business model for an outpatient practice.  When I return home from work, I will appreciate my evening with Peanut and Daddy MD even more.

"First Day on No Nap"

Peanut had her first day of school yesterday!  It was a no nap day (these days are happening more and more often lately), so of course, everything was just a little more difficult.  She was refusing to have her first day of school picture taken.

First day pic

I thought this captured it best.  I snapped a few more along the walk, but it turns out I should have had my camera ready when I came to pick her up.  Huge smiles, and an arms wide-open run to mommy.  She loved school.

While Peanut was at school, I read this about a child's nap routine.  I'm having a hard time letting go of Peanut's nap.  It just seems so early, especially when 20% of kids are still napping at age 5.  I was hoping she would still be napping once Sweet Pea arrives, because the closer I get to delivery, the more memories of my sleep-deprived zombie phase, which was present for the first several months with Peanut, come screaming back to me.  I'm breaking out the "getting baby to sleep" books again this week.  

There are no clear rules about when a child is ready to give up her nap.  We know most preschoolers need at least 12-13 hours of sleep in a 24 hour period, but how they divvy up that sleep time may be different for each child.  Individual child and behavior based, most parents know when their child needs a nap.  We still try one everyday.  I let her have quiet time in her crib with "Nemo" and "Wocket"and if she is still laughing and playing 30 minutes later I get her out.  If I let her out, I am prepared for the bedtime sass to start a little early that evening.  Most days she still sleeps, as in today, which gave me time to write this blog.

"Preschool for Play"

Peanut was in daycare when we were living in Michigan, and as much as I struggled with the decision to enroll her, it ended up being great for her development and socialization skills.  Here in California, since I am working part-time, Daddy MD and I are fortunate to be able to care for her mostly on our own.  It has been wonderful.  However, I wonder if she is missing out on benefits of a childcare setting. 

I decided to look into a preschool for Peanut to attend a couple days a week, mostly so that she could meet new little friends here.  As we drove to check out the preschool, I told Peanut, “We’re going to look to see if you like it -if you do, tell Mommy, and you can go to school, but Mommy can’t go to school with you.”

When in doubt, leave all big decisions to a two year old, right?

We no further than walked into the school and looked around for 30 seconds, when Peanut blurted out, “I like it!  I can go here with the other kids!”

After our visit, Peanut asked me, “Do Harry and Julia go to school here?”  Sweetest thing – Harry and Julia were Peanut’s best friends at her former daycare, and she hasn’t seen them in four months!  Melted my heart that she still thinks about them.

Still, the preschool is quite an investment, and it’s precious time away from Mommy that I may only have this year.  I weighed the pros/cons, and in true Mommy MD fashion, I pulled some studies.

1. It’s only two hours a day, two days a week.  The perfect amount of time to get in a workout, an OB appointment, or maybe even a sane grocery shopping experience.  Odds are, I’ll pick Peanut up feeling refreshed, and ready to stimulate her for a few more hours of hide and seek and other various toddler games before the bedtime routine.

2.  I choose a play-based curriculum, especially since she’s not quite 2 ½ yet; I really didn’t want anything too structured. She’s at such a tender age of development, and I had read that a teacher-oriented approach (as opposed to child-oriented learning) may actually be detrimental in the preschool years. Here’s a couple studies, but the gist is that children are great imitators, so if you show a child how to do something, he/she will only try to do it that way, instead of finding alternative solutions on his/her own.  The authors claim a teacher-oriented preschool may hinder creativity.  Creativity, I have read, is the most important trait for future CEOs.  Now, I wouldn’t want to rule the CEO career path out at such a young age (I’m being sarcastic here).

Seriously though, I think most parents naturally have some anxiety about giving their children the best possible start, and I wonder if some of these early, academic-driven preschools thrive on that parental anxiety.  What I found is that this can actually backfire, and that what kids really need to do in the toddler years is play! This is not meant to infer that no preschool is better than preschool.  In fact, the benefits of preschool starting at age 3 have been well documented in several studies.  

The preschool I found in our location to be compatible with our needs uses the Reggio Emilia play-based approach. It just so happens that they also do Yoga at this school, so I justified purchasing Peanut the cutest little $8 yoga pants at Gap Kids.

3. Of course, some American Academy of Pediatrics (AAP) reading, for completeness.  The quality of the childcare center and/or preschool is highly correlated to toddlers’ developmental outcomes.  The AAP has narrowed it down to some specific quality indicators, which predict success, and are actually fairly easy to identify in a childcare center you may be considering.

All of this said, what the preschool decision really came down to is a fit with our family and our schedule, and fun and friends for Peanut.  Anxiously awaiting that first big hug and smile after her first day!

"A Name for Sweet Pea"

What's in a name?

Umm... right now: Stress.

I've already spent hours pouring over baby names, lists of all sorts, from "cool names," to "vintage names due for a revival," to "names that will get your baby into Harvard."  Now, most of these lists are nonsense entertainment I'm sure, but I can't help but join the millions of other parents with anxiety about that first important decision in raising a child.

Those of you who read the popular book, Freakonomics, will recall the chapter about naming a baby and the potential consequences of choosing the wrong name.  I'm not too worried about choosing the wrong name, but rather a name that the family and most importantly, Sweet Pea, will love.

Despite the name-finding stress, on the bright side, it has become a new topic for family bonding.  Our nightly family snuggle time (highly recommended by the way) is even more special lately, as we talk to Peanut about her baby sister and ask her what names she likes.  Peanut has really progressed in her understanding about baby sister, since the beginning of the pregnancy when she thought Mommy ate too much.  She would say, "Look at Mommy's belly - she's full!" Now, Peanut melts our hearts when she reaches for Mommy's belly to feel for baby sister, and excitedly proclaims, "She's moving!"

Well, I have about 12 weeks for Daddy MD, Peanut, or I to have an epiphany about the name.  Until then, I'm sticking with "Sweet Pea."

"Friends"

When you become a working mother, you don't stop being a sister, a daughter, a wife, and a friend.  Today's post is a tribute to my friends.  Last night Daddy MD and I were able to hang out with my long-time friend Lori and her husband.  Previously, Lori was my randomly selected freshman dorm roommate.  Now, 13 years later, we are both family physicians living in the same "city by the bay," on the other side of the country from our alma mater.  I am blessed to have a friend like Lori.  To all of my friends, I appreciate our friendship!

Oh, and one more thing... O-H!

enjoying a Giants' victory :)