Wednesday, June 22, 2011

Oh, the places I've pumped!

I have this week off from school, and my daughter will be turning 1 shortly, so I'm taking the opportunity to wean myself off the pump and get her transitioned to cow's milk during the day.  I've been breastfeeding and pumping for close to a year, but I'm now finally almost done.  (For this baby, and with the pumping, anyway...I'm planning to continue nursing in the evening for as long as my supply holds up).

Given the momentousness of this occasion (I get my lunch breaks back!  I can wear dresses that don't pull down in the front!  Regular bras!), I wanted to take the opportunity to reflect a bit on how pumping at work has gone.

Over the last 3 months I've rotated through neurology, psychiatry, and outpatient medicine at Stanford hospital.  For most of the time, I've ended up using my trusty Medela manual pump.  Its size, ease of cleaning, quietness, and speed has endeared me to it over my electric pump and even over the hospital-grade pumps available in the maternity ward of the hospital.

I've pumped:
-in the maternity ward lactation room (it has 3 chairs for the entire hospital campus, so there's often a line, but it has some perks, namely the conversations through the curtains with other moms, and that you can check out the newborn nursery on your way in for an oxytocin boost)!
-in bathrooms all over the place.  Gross, but sometimes convenient.
-in my car
-in my team room (with a cover), so that I wouldn't miss a call back from a patient's primary care doctor
-during class
-in empty clinic rooms (which are the best!  There's a computer for internet browsing, magazines to page through, and even a sink)
-during morning report with the neurology department (with a cover, sitting in the back and trying hard to look nonchalant)

totally worth it
I've had to be flexible, to say the least.  The fact is that as a medical student, you have little to no control over your schedule, so although there is guaranteed to be time, in an absolute sense, to pump during the day, that time is unlikely to be exactly according to your pumping schedule.  So you make do!

But the nice thing about being a medical student is that you're surrounded by doctors, who are comfortable with bodily processes and most of whom have at least a passing familiarity with the health benefits of breast milk.

I can't imagine that I would be comfortable pumping during a meeting at any other job...but then, at any other job, I would probably have enough control over my schedule to take 15 minutes to pump when I needed to!

Have you ever pumped in front of colleagues?

Tuesday, June 21, 2011

Why you shouldn't get a dog

This a public-service announcement to my large and growing group of friends who are settling down and now thinking about getting a puppy.  To those who have already gotten a puppy--sorry this is too late!  (Although I doubt I would have dissuaded you anyway).

To the others:

Ever since you graduated high school and left behind your family dog, you have wanted a dog again.  A puppy, with that milky smell and the too-big paws and its earnest eagerness.  I understand.  Here you are, with your new partner/boyfriend/husband/girlfriend/wife, settled in your new place.  You make dinners together and look around at your new place and think "the only thing missing is a wagging tail."

Please think again.

It may not seem like it right now, but in just a few short years (or less!) you will be thinking about having a baby.  No big deal, right?  Dogs can get used to having a baby around.  I even wrote about it here!

Yes, but.
Your life will be full enough, no dog needed!

Having a child is wonderful, precious, life-altering--and also, as you may have heard, it is an ungodly amount of work.

Most of the women I know are going to go back to work after having had a baby.  There will be a lot to do around the house.  The LAST thing you will want to do is walk your dog.  The second-to-last thing you will want to do is groom your dog.  The third-to-last thing you will want to do is feed your dog.  And because you will spend hours cuddling your adorable baby every day?  You will never, ever want to cuddle your dog.  

I'm sure that at some point, in about 10 years, when all of our children have grown out of babyhood, it will be nice to have a dog again.  The kids will want to play with them, and walk them.  It'll be great.  Too bad by then our dogs will be old and decrepit and gray around the snout.

As it is, if I could wave a magic wand and, in the most humane possible way, my dogs would disappear? (Preferably to a large partially-wooded farm where they would chase rabbits all day and then curl up in the evening by the farmhouse hearth).  I would do it in a millisecond.

So please, think very carefully before you get a dog.  Sure, it seems like a great way to "practice" having a baby.  But to use a passé SAT analogy:  the work of a dog is to the work of a baby as boiling water is to cooking a 14-course meal.  They are not, in fact, comparable.  It is hard enough to be a good working parent; the extra obligation of caring for an animal will quickly become tiresome.

If you also have a dog (or dogs!) and a baby, please feel free to chime in with all the other ways in which this complicates your life.  I can think of a few more off the top of my head:
--even harder to get away for a weekend
--tough to find a car that fits carseat, stroller, and dog safely
--babies are expensive and you will not want to spend money on the dog-walkers and groomers which will suddenly be necessary now that you don't have time to do it yourself
--crawling babies necessitate a very clean floor, which is difficult with a dog,
etc., etc., etc.

(Please note that I think the situation could be different if you're planning to be a stay-at-home parent. Although that is a TON of work, the extra work of caring for a dog might in that case be worth having the extra companionship at home with you.  Maybe).

Monday, March 14, 2011

Planning a professional pregnancy, part 2: put this on your calendar

This is the second part of a two-part post.  In the first part, I talked about the factors that I considered when deciding when to pregnant.  Now I'd like to  turn to a discussion of some aspects of conception, pregnancy, and the postpartum period that you may want to consider in planning how your own pregancy might fit into your professional life.

[A warning:  this post may be pretty boring for those readers who have been pregnant/had a baby.  It's primarily meant for those who have not yet started a family!  The first few stages of this are also not going to be that useful to those who are using IVF or other methods to get pregnant; I just don't know that much about that experience, but will add any links here that readers might suggest.]

Arguably some of the most major events happen during the first 8 weeks of development; since you may not know you're pregnant until week 4-5, you'll want to start making choices that will be healthy for your body and for a growing embryo before you find out you're pregnant.  Stay active, stay rested, and eat well, for starters.  Cut down on caffeine (which can reduce fertility and increase the risk of miscarriage when consumed in large quantities), and alcohol.  Additionally, it's a good idea to start taking a prenatal vitamin with folic acid (to prevent neural tube defects) a month or two before you start trying to conceive; it can take a little while for folic acid levels to build up in your body.

If you're on hormonal birth control, try to switch to a barrier method at least a few months before trying to conceive; although you certainly can get pregnant in your first month after stopping the pill (and there appear to be no adverse consequences to the fetus if this happens), most research shows that it takes at least a few months to return to full fertility after stopping hormonal birth control (but that in a full year of trying to conceive, the same number of women who were using hormonal birth control prior to that year will become pregnant as women who were not using hormonal birth control).  (1).

If you're the type who doesn't usually pay attention to when your periods stop and start, it may make sense to keep track of that for a few months prior to trying to conceive, because you'll be able to get some idea of when you're ovulating and therefore when you're most fertile.

This may seem self-evident, but if you are trying to conceive in a particular month, you should have a lot of sex that month.  So it's probably not a good idea to try to get pregnant when one partner or the other is going to be traveling a lot, or working late.  What little research there is suggests that the best strategy is to have sex every 2 to 3 days after your period stops, and then every day during the days leading up to and including the day of ovulation--then back to every 2 or 3 days.

You can buy kits that tell you when you're ovulating by peeing on a stick, but ideally for conception purposes you should have sex before you ovulate, so those kits aren't actually that useful (unless you just use them for a few months before you start trying, to see what your cycle is like).

You can even buy iPhone/iPad apps for tracking your cycle.

Post-conception, you ask?  Don't you mean pregnancy?  No, no, I don't.  This was one of those surprises for me.  If you've paid attention to your cycle, and you're really trying to get pregnant in a given month, then you will realize that there is a 2 week period after you've ovulated, while you're waiting for your period to come and/or to take a pregnancy test.  People call this the 2-week wait.  If you're like me, these 2 weeks will find you more distracted, impatient, and daydreamy than you have EVER been in your entire life.  Am I pregnant?  Am I pregnant?  Oh my god, if I'm pregnant, then gastrulation is probably happening, like, right now!!! (Admittedly, if you're not a medical student than that last thought probably won't occur to you).   Anyway, it's worth keeping in mind that it may be particularly difficult to stay focused and/or evince an interest in anything other than the contents of your uterus during these 2 weeks.  Happily for me, I got pregnant during our women's health block in medical school, so no one thought it was weird to want to talk a lot about fertility and development.  I highly recommend this approach.

Another warning:  make sure you get one of the pregnancy tests that comes in a 2-pack, because you will inevitably take the first one too soon, and it will be negative.  Take another a few days later.

The first few weeks:
Most people will feel fine physically in the first few weeks after learning that they're pregnant.  Your main dilemmas will be figuring out whom to tell (I told my parents and brother and a few close friends right away--oh, and the women that I attended a Medical Students for Choice conference with, during week 7!--and waited to tell other people till I'd had a healthy ultrasound at 12 weeks), and starting to ask around for recommendations for a healthcare provider for your pregnancy (a midwife, family doctor, or OB).

The first trimester:
This was surprise number two.  Somehow I'd always assumed that pregnancy was physically exhausting because you were huge.  That can be true.  But for most women, the fatigue during the first trimester will be worse than anything later on.   There was about a month during which I really had a hard time doing anything other than lie around and groan melodramatically.  I was lucky in that I never threw up, but I was nauseous and exhausted all day.  I napped often, despite sleeping at least 9 hours a night.

So although you might think that the first trimester would be a good time to be productive at work...think again.  You're not likely to be at your peak performance during these months.  I was lucky enough that winter vacation, which was nearly a month long, coincided with the worst of the first trimester for me.  If you can have helpful family members visit, this is a good time (although they shouldn't expect you to be much fun).

In terms of getting to work, this trimester can be frustrating for another reason.  You don't look pregnant yet, but largely because of bloating, you may already be unable to wear your pants...and yet maternity pants will be far too big.  This can make it difficult to look professional.  Longer-length tops and something called a Bella Band (a band of stretchy fabric that you wear over your belly and the waistband of your pants, allowing you to leave them unbuttoned and unzipped) will be crucial.

When things go wrong:
One reason to think carefully about whom to tell that you're pregnant is to consider whom you would want to tell in case the pregnancy ends.  Somewhere between 8 and 20 percent of pregnancies will end spontaneously; 80% of the time, this happens in the first 12 weeks.  Many women choose not to tell their  professional colleagues and more casual acquaintances until the 12 week mark, for this reason.

The second trimester:
For many women, this is their favorite stage of pregnancy.  I emerged gradually from the cloud of nausea and fatigue between weeks 12-14.  I was actually able to enjoy eating again, which was nice, and bought a few pairs of maternity pants, which helped my self-image!  In terms of work, this is a good time to let your colleagues know that you're pregnant, and maybe to begin discussing maternity leave options with your boss.

One difficulty in terms of working during the second trimester is that doctor/midwife appointments begin to eat up a lot of your time.  Although check-ups are still only monthly at this point in your pregancy, there are also a number of standard screening tests during this trimester, so between one thing and another, you wind up spending an awful lot of time in waiting rooms.  It's a good idea to think proactively about how you want to use that time, and come prepared with something to do.  I worked my way through a good chunk of my boards review book just sitting in the doctor's waiting room.

It can also be helpful to ask to schedule your check-ups farther in advance than might be typical for your doctor's office.  I realized that there was one time on Wednesdays that was convenient for my check-ups, and at some point during my second trimester, I went ahead and scheduled my check-ups for the rest of my pregnancy.  This made it easier to fit in other obligations later.

One nice thing about becoming more visibly pregnant is that you may find other women at work or school offering advice and mentorship.  They've been there, and they want to help.  Occasionally the advice will not be welcome for one reason or another, but often this companionship will make you feel like you've joined a secret society that you never knew existed.

The third trimester:
There's a lot of variation in how energetic women will feel during their third trimester.  I stayed quite physically active during my pregnancy, even biking everywhere until somewhere past 7 months (when I finally got my very first car!); I think this helped my energy level throughout my pregnancy.  But a lot of it is probably luck!

If you sit a lot at work, my best advice is to buy a bouncy exercise ball and use it at your desk.  Yes, you will look silly (although some people have pointed out that you would fit right in at a number of Silicon Valley companies...), but the back pain common during the third trimester is exacerbated by sitting, and relieved by sitting on this ball.  I took my boards when I was 7.5 months pregnant, and so between months 6-7.5 I spent up to 8 hours a day sitting and studying...and the ball helped a lot.  As a bonus, bouncing on the ball can also feel great during early labor, rocking with your chest on the ball feels good in later labor, and newborns often love being held while you bounce on the this is a useful purchase in many ways.

On the other hand, if you are on your feet a lot at work, fear not!  Yes, you should wear comfortable shoes, and you may get somewhat swollen feet/ankles, but in general, being active is great for your comfort and health and may also help the baby to get into a good position for birth.

Sometimes I hear people exclaim (and I've been known to do this myself, prior to having a baby) that "she worked up to the day she delivered!"  Now what would I say?  Sure!  If you're in good health, there's no reason not to work right up until the end.  In fact, I found that when my academic obligations ended just after 8 months, I got kinda bored sitting around--at least, once all the getting-the-household-ready-for-a-baby stuff was done.  It's true that in the last few weeks especially, you may start getting more tired and swollen because of  your sheer size.  I developed carpal tunnel because of swelling.  But otherwise, work can help keep you from obsessing over whether that twinge you just felt was possibly a contraction.  Plus, working at 8+ months pregnant makes you look--and in some ways feel--like a superstar.  Certainly if you have to choose between taking time off before the baby comes, or after...I would go for after.

Well, I have a lot to say about childbirth and the ways that it is both managed and mismanaged in the modern medical model...but that doesn't really have a lot to do with your life as a professional, so I'll avoid that topic for now, except to say this:  for professional or other reasons, you may be tempted to "schedule" your birth via labor induction.  You should know that induction, even at term (40 weeks), is associated with greater risk of requiring a Caesarean section and with iatrogenic prematurity (meaning an infant who is born premature as a result of a medical intervention).

It's worth considering ahead of time how you might want to announce your baby's birth to various groups of friends, coworkers, and acquaintances.  You might even draft an email, or at least the To: line of an email, so that you don't have to think about it later.  Make sure you let people know how you feel about visitors, so that they don't have to guess.  If you do want visitors, you can be sure that they will not arrive empty-handed, so don't be shy about letting people know (if they ask) what would be most helpful.  Prepared meals were definitely my personal favorite visitor's gift!

Postpartum: the first few months
It is unbelievable to me that 6 weeks is considered an acceptable maternity leave at some workplaces.  In my experience, my body was just starting to feel somewhat healed after 6 weeks, although I was by no means back to normal.

For the first three weeks after birth, you may not feel tired at all, despite sleeping only a few hours a night, thanks to the endorphins that flood your system during and after labor.  But the sleepless nights do usually catch up to you after the first few weeks...and then you will be incredibly tired all the time, although you may not even realize it.  I would not recommend trying to do anything especially intellectually challenging for the first 2 months postpartum.  I didn't realize how tired I was until I attended a medical education think-tank at about 7 weeks postpartum, and found that I was barely capable of putting together a cogent, grammatical sentence.

Despite having read about it, I was still shocked by how much time I spent breastfeeding for the first few months.  Newborns nurse every 1.5 to 2 hours, and that's measured from the beginning of a nursing episode, which could last up to 45 minutes.  So basically, you could be looking at (worst-case scenario) nursing fully half your time.  And it's a two-handed job for a while--meaning that doing anything else is quite tricky, if not impossible (although I did get pretty good at surfing the web with my toes)!

Even if your husband is committed to being an equal partner, it may surprise you how little he is able to do at first.  Sadly, he just can't lactate.  I also found that since my husband went back to work after 10 days, it made more sense for me to get up with our daughter even for non-nursing needs at night, since he had to get up to go to work in the morning and I didn't.  At least, that's how I reasoned at the time.  In retrospect, I think this deprived my husband of some opportunities to both bond with and learn how to care for our daughter, and we may do things differently when we have another child.

Preparing to go back to work
In terms of what you will need when you eventually return to work, my best advice is to plan ahead for the introduction of a bottle.  You don't necessarily have to try to introduce it until the recommended 5-6 weeks (although the small existing body of research suggests that as long as breastfeeding is going well, even 2-4 weeks is probably fine)!  But you should start thinking about it well before then.  The reason for this is that figuring out the equipment involved in pumping and storing breastmilk, and then putting together a bottle, can be quite daunting.  I would highly recommend finding some time in your third trimester to have a new mom show you how her pump works and how she stores milk and prepares bottles.  (I would have been/am happy to do this for another mom)!

Then buy a few starter supplies; you can wait until later to really stock up on bottles, nipples and such, but at least get a few things so that you can practice using the pump and are able to make a bottle by the time the 5-6 week mark hits.  I did not think ahead, and by the time I got everything together to give my daughter her first bottle, she was 8 weeks old, and she did NOT like it.  This meant that (a) it was very difficult for me to leave her in the care of others (until finally, around 5 months, we had a break-through with the bottle), and (b) it made it difficult for her father to bond with her, since he never had the opportunity for a peaceful feeding session--she would only take a bottle after a significant amount of screaming, which was traumatic for them both.

These are the basic supplies you will need to make up a first bottle of breastmilk:

  • A breast pump (manual or electric; you can buy a used electric pump and simply buy new tubing and sterilize the flanges!)
  • A couple of milk storage bottles that fit your breast pump's parts.  (I have a Medela electric pump and a Medela hand pump, and use the Avent glass bottles which can be attached directly)
  • A bottle and nipple with the slowest flow you can find, suitable for a newborn.
  • At the beginning you do NOT need: milk storage bags (just use bottles at first), special sterilizing equipment (boil things before you use them the first time for a few minutes; after that, hot water and soap is fine), a special bottle brush or drying rack, or a bottle warmer.

Going back to work
I began doing some part-time work, 2 afternoons a week, when my daughter was 3 months old.  This felt right to me; it gave me a chance to get out of the house a bit, and it gave my daughter a chance to get used to another caretaker.  When she was 6 months old, I was working or attending class or clinic about 20 hours a week.  I'll be going back to school/clinic full time when she is 9 months old.  Not everyone has the luxury of such a long maternity leave.  But no matter the length of your leave, I think that a graduated return, if you can do it, is a good way to go.  It gives you an opportunity to work out the kinks in your baby routine--and for you to refresh your professional skills after some time away.

If you are self-employed, or a graduate student slogging away at a dissertation, you may think you've got it made--you can do your work at home, AND take care of your baby!   Be aware that most people find it very difficult to get work done with a baby around.  Naps are frequent in the early months, but irregular; many babies also want to be held most of the time when they're young--even during nap time!--so this time may not be as useful as you think.  I'm not saying it's impossible to do anything, but it can be difficult to be productive when you're stopping and starting all the time.  Once a nap schedule has been established, you do have a couple hours a day to work...but you may find that there are lots of other things (eating, showering, cooking, cleaning, napping) that you also want to get done during that time.

I hope you found some of these tips useful; they were based on my own experience.  If you disagree with some of my advice, or have additional tips or tricks to share, please share your disagreement and/or tips in the comments!

Friday, March 11, 2011

Planning a professional pregnancy, part 1: when's the right time?

In this two-part post, I'd like to talk a little bit about the factors that I considered when deciding when to get pregnant (part 1), and then turn to a discussion of some of the aspects of conception, pregnancy, and the postpartum period that you may want to consider in planning how your own pregnancy might fit into your professional life (part 2).

When is the right time?
My husband and I were married at a relatively young age for our social milieu and Reform Jewish/Buddhist backgrounds--we were 23 and 24.  At the time, I remember thinking how very odd it was that the act of marriage was in some way, at that age, rebellious--or at least sorta fringe!  I'm quite sure that a lot of people thought we were too young.

5 years later,  I think we can say that our "early" marriage has worked quite well for us, including for one reason that I hadn't considered when we were planning our wedding.  Namely, if you want to avoid having to get pregnant during the 35-and-up years of dwindling fertility and increasing chances of developmental problems, then getting married a little sooner makes sense.  Getting married at 23 meant that we had a few years to settle into life as adults together: we both tried a career path or two, we learned to run a household, we lived abroad and traveled...and having done all that, we were still just hitting our late twenties when we felt ready to start a family.

Of course, starting a family in your mid-to-late thirties also has its advantages.  You are even more settled in your career and you probably also have greater financial resources.  But these days, having a baby in your mid-thirties is the more expected choice (for educated professionals, anyway), so I wanted to present the other side of the coin here.

Contrary to the popular wisdom that "there's no good time" to have a baby, in fact I think that there are more good times to have a baby than we really allow ourselves to consider.  I even think that for a particularly emotionally mature young woman, with a committed partner, college could be a pretty great time to have a baby.  Just think--by the time you're getting serious about your career, your kids could already be in school!  I know this sounds crazy.  But I think that for the right couple, it could work.

In my opinion, school in general, and medical school in particular, is a pretty great time to have a baby.  You probably have more control over your schedule than you will once you've entered the workforce, and you can often take a really sizeable maternity leave without leaving a telltale "baby gap" in your C.V.  When I entered medical school, I knew that I wanted to start a family during school.  We felt ready, we had family nearby, and there is a natural break after the first 2 years of medical school during which it would be relatively easy to take a maternity leave.

With that in mind, I set about planning my pregnancy very purposefully, with an academic calendar for my medical school in one hand, and a menstrual cycle calendar in the other.  I doesn't sound very romantic, does it?  But having once determined the starting date for trying to conceive, you can throw the calendars out the window.  Everything worked out well for me and for our family--I had an astonishingly easy pregnancy and birth.

But there were still plenty of surprises along the way.  There were times when the popular knowledge I'd absorbed about pregnancy, birth, and the postpartum period turned out to be dead wrong.  In the second part of this post, I'll discuss some of the factors to consider as you think about weaving the experience of your pregnancy and birth into your professional life.

[Postscript:  Although this post is about planned pregnancy, it's important to note that about half of all pregnancies in the United States are unplanned.  Education and access to affordable birth control can help women avoid becoming pregnant when they don't want to be; Planned Parenthood is an organization that provides such education and access, as well as counseling and access to abortions.  Medical Students For Choice is another organization I've been involved with, which advocates for and supports reproductive health education in medical training.  Please support these organizations if you have the means!]

Sunday, March 6, 2011

Going back to work...& automating our household

I go back to school full-time in a few weeks, and although I can't wait to dive into the "fun" part of being a medical student (that is, actually working in the hospital, rather than taking classes), I'm also feeling apprehensive about having enough time to spend with my daughter once I'm working 12+ hour days.  As much as possible, I'd like to make sure that when I'm at home, I'm with her--or my husband--and not doing mundane household tasks.  To that end, I'd like to tell you a little bit about my plans to automate my life.  Please share any other time-saving tips you might have!

#1:  Finding a housekeeper
The plan is to find someone who will give the floors a good clean, dust everything, and leave the kitchen and bathroom sparkling once a week.  This will cost some money.  But I think that what it will save in time (not to mention a better relationship with my husband) will be well worth it.  However, given that we have two dogs constantly tracking in dirt and liberally shedding everywhere, this won't be quite enough to keep the floors as clean as they need to be now that we have a baby who can crawl, which brings us to...

#2:  Getting a robot.

Jetson Time!  These vacuuming robots have been around for years, but I've always hesitated.  Seems like now they've worked out a lot of the kinks.  It has little side-brushes for walls and corners, avoids rug fringe, focuses on dirty areas, and docks itself!  A number of Amazon reviewers who are also proud parents of young children AND multiple dogs swear by this model, so I think we're going to take the plunge.  I'm also secretly hoping that the robot-ness of it will make my husband want to take charge of making sure that the robot gets run every day or two.  Then again, he isn't the one who studied robotics at summer camp, so this may not work out the way I think it will...

#3:  Buying food
We do our grocery shopping at Trader Joe's (although we buy all our produce at the farmer's market), and for the last couple months we've been doing a lot of experimenting with the prepared foods, or almost-prepared foods, there.  The frozen asparagus risotto, for example, is quite good (especially if you add in some clams or sardines...).

We are also considering having more of our food delivered.  Since we live in northern California, there are a ton of local CSAs that will deliver a box of local organic fruits and vegetables every week.  The thing is that I really enjoy our weekly trips to the farmer's market, and I also suspect that they're good for our daughter--so I'm not in a hurry to cross that off my to-do list.  Of course, this may change once I get a taste of being in the hospital 60-80 hours a week...

There's even a local service called Michal the Milkman that will deliver dairy to your door weekly (milk, eggs, butter, yogurt).  If we do start using a CSA, I would probably sign up for dairy delivery too, since then we could get away with less-frequent grocery store trips.  Then all I would need is a bakery that will deliver bread...

#4:  Making meals
Mark Bittman's Kitchen Express: 404 inspired seasonal dishes you can make in 20 minutes or lessThe Trader Joe's Companion: A Portable CookbookAs I mentioned, we've already started experimenting with eating more prepared foods from Trader Joe's. I'm tempted to buy a well-reviewed cookbook which provides recipes based on the foods available there.  We do have one other favorite "quick and easy" cookbook, by NY Times writer Mark Bittman, called Kitchen Express:  404 Inspired Seasonal Dishes You Can Make in 20 minutes Or Less.  We've probably tried about 20 of the recipes so far, and I don't think there's been a single dud.  It's a particularly good cookbook if you buy your produce at the farmer's market, since it's organized seasonally.

We're also probably going to sign up for weekly Indian food delivery from Tiffin Dinner, a local family business that delivers home-cooked Indian meals to the Stanford area; on Tuesday nights they offer free delivery to our neighborhood.  They're reasonably priced and quite tasty!

#5:  Buying household goods
I think we've found two ways to reduce the number of trips we have to make to a Big Box store to buy household staples like toilet paper, soap, etc.  First, we've switched to reusable products rather than disposables where we can.  That means cloth diapers, lovely cloth napkins, flour sack towels instead of paper towels, dish cloths rather than sponges, and glass containers or washable cloth bags for storing food rather than ziplock bags.

But we still need laundry detergent, bar soap, shampoo, toilet paper, and so on.  And then I saw this article in the New York Times "Your Money" section yesterday, about a "Subscribe and Save" service from, through which you can sign up to have them automatically send things to you every month or 3 or 6, with free shipping, and save 15% off the normal cost.  My husband and I were so excited that we immediately proceeded to subscribe for soap, detergent, toilet paper, etc.  The only thing I will say is that the quantities are sometimes better suited for a larger household than ours--there were some things we would have gotten except that we couldn't possibly use their minimum amounts every 6 months.  Still, it's a really neat idea.

Do you have any household shortcuts to share?  How do you make sure that your time is spent where it counts, rather than doing chores?

Tuesday, March 1, 2011

PSA: How long should I breastfeed?

So, I'm a medical student.  And lots of my friends are also medical students (hi guys)!  Recently I've fielded a number of comments from that group of friends, along the lines of "So you're still breastfeeding, huh?"

My daughter is not yet 8 months old.

And then I realized...if I was just a medical student, and not also a new mom, I probably wouldn't know how long you're supposed to breastfeed, either!

God knows that that wasn't tested on Step 1 (the standardized test of medical knowledge taken after the first 2 years of medical school).  And I don't know how much emphasis is given to breastfeeding during OB and pediatrics clinical rotations.

So, here's a little public service announcement for my medical student readers (and maybe some moms too):

The American Academy of Pediatrics recommends that "Breastfeeding should be continued for at least the first year of life, and beyond for as long as mutually desired by mother and child" [emphasis added; for full guidelines see here].

That's right, folks.  At least a year.  After the first teeth.  After crawling.  Possibly after walking and talking, depending on the baby.  So, yeah, I'm still breastfeeding.  We'll see how it goes once I'm back at school full-time (in a month--eek)!  I'm expecting that I won't be able to pump quite as frequently as I currently nurse, and that my supply will gradually decline, but I hope to continue breastfeeding as much as possible until my daughter is a year old (and beyond, as the AAP says!).

If you're a medical student desirous of more information about the physiology and clinical management of lactation and breastfeeding, check out the AAP's online curriculum for residents in pediatrics.

Wednesday, February 23, 2011

How to vacation with a baby, part 3: out and about

This is the final part of a multi-part post about how to vacation with a baby.  Part 1 was about staying in a hotel, and part 2 talked about eating in restaurants.

Structuring your day
Having a realistic sense of what can be accomplished in a day with a young baby is the key to having a good time.  Remember that each additional stop will require loading and unloading a car, getting the baby into the stroller, and probably either a trip to the bathroom or needing to nurse.  You're bound to move more slowly than in the days when it was just you and your partner.

Wiggle time on the lawn at a Ritz-Carlton,  age 3 months
If you have traveling companions who are not parents, or who were parents in the distant past (such as, um, YOUR parents), it may be worth reminding them that they are traveling with a baby, so they should be ready to spend a lot of time at each stop.

Besides needing to nurse regularly, there are two important things to build into your day:  time to play (I call this "wiggle time"), and time to sleep.

I still have trouble remembering to leave room for wiggle time.  But I definitely think that my daughter is in a better mood the rest of the day if she gets at least 20 minutes of active play time on the floor in the morning, afternoon, and evening.  When you're traveling, this means that you have to be a little relaxed about the kinds of floors you put baby down on.  You can always use your scarf, jacket, or nursing cover as a surface for play time.

You also need to leave time for a nap or two.  Depending how difficult it is to get your son or daughter down for a nap, this doesn't necessarily mean that you have to return to the hotel.  But it does mean that you'll need to stay put somewhere reasonably quiet for the duration of the nap, whether it's in a carrier or a stroller.  I've found that my daughter does well taking her shorter, late morning nap "on the go," in a stroller, while her longer, late afternoon nap goes much better if it is in fact in a tent/crib/bed in a quiet room.

Finding rest spots
There are many places to which you can take a baby for a few hours, but which become a nightmare if you have to spend all day in them.  Shopping, museum-going, and eating in restaurants can all be done with a baby...but you're going to need breaks.  Baby needs to stretch out on a blanket on the floor occasionally, you need to be able to change her on an actual changing table rather than on the bathroom floor, and you'd like to have a comfortable chair to nurse in from time to time.

Where to go to get these needs met?  You have a few options.

Choice A:  A baby-focused business.  
These places can be fabulous, but you won't always be lucky enough to have one around.  Think of places like birth centers (Blossom Birth in Palo Alto; Natural Resources in San Francisco), cafes that are specifically geared towards kids, or children's activity centers and some shops.  They will often have changing stations, some floor space set aside for play, and comfortable chairs for nursing.

Choice B:  A five-star hotel.
This may sound like a bad idea, but trust me, it's brilliant.  Go have coffee and a pastry in the restaurant or lounge cafe of a really nice hotel.  Then proceed to use their lobby area as a base camp.  There are usually comfy couches for nursing, nice clean carpeted floors to play on, and deluxe changing tables in the marble-covered bathrooms.  Honestly, it's a great way to go if you're stuck in a big city with a baby all day.

Choice C:  A department store.
Wherever you are in America, you're usually not too far from a mall.  And where there is a mall, there is a Nordstroms, Saks, or Macy's.  Whatever.   Believe it or not, these often have, in addition to cafes and nice restrooms, carpeted lounge rooms specifically intended for nursing mothers.  Which can work for nursing, play time on the floor, or even a place for baby to take a nap while your traveling companions browse the rest of the mall and you read.  Which brings us to...

What to bring
This is going to be very dependent, obviously, on the age of your baby, whether you're breastfeeding, and whether you use 'sposies, cloth, or EC.  Most of us already have our diaper bag packed with the usual.  Here are a few non-standard things to consider bringing for a whole day away from home.
  • large scarf for you: can double as nursing cover, play surface, or stroller-cover for naps
  • magazine: entertainment for you during nursing or nap time
  • meal supplement bar:  I like Odwalla bars, personally, but anything with some protein and a couple hundred calories will work; meal-times can sometimes get pushed back by baby's schedule, and you can get starving very quickly when you're nursing.
  • reusable water bottle:  because nursing makes you thirsty
  • baby carrier: even if you're bringing a stroller, since many places are way more accessible with a carrier.
  • pocket umbrella: just in case