Thursday, December 11, 2014

And Something Blue...

There's no wonder that women get postpartum depression. The weeks after pregnancy are extremely tough, both physically and psychologically - add wild hormones to the mix and you have a percolating pot that is ready to boil over. 

While I wouldn't diagnose myself as clinically depressed, I have been getting the blues and numerous times since my son has been born I've cracked and broken down in tears, in the foetal position on the bed. 

Lack of sleep is probably a major factor, but as an attorney in New York, I've run on a few hours a night for a long time and it's certainly not the tipping factor. Physical pain is one of the primary suspects. After the pain of childbirth, I had pain from the stitches for several weeks - the bleeding was so bad that I ended up in diapers, along with my son- and then when the pain and bleeding subsided, I continued to have breast pain. This pain continued to increase until at nearly 7 weeks, I have done the rounds of what could go wrong with breast feeding and am still recovering. My son was tongue-tied and until a lactation consultant came last week and advised him to have a frenulectomy, he had been chewing on my nipples and not effectively suckling, causing plugged 4 milk ducts, nipple bruising, mastitis, nipple thrush and vasospasm. I've had to pump for the past week to give my nipples a rest and have slowly eased back into breast feeding, although it is still very painful - and not to mention how painful it is when I'm out in the cold (does anyone make nipple mittens?). 

Apart from the physical pain of breastfeeding, the inability to solely feed my son from my breast and my milk has been crushing and I've felt inadequate. I never thought I would have issues doing something so natural. However, the more I have discussed it with people, including medical professionals and certified lactation consultants, it appears that although natural, breastfeeding is much more difficult than we thought. After all, childbirth is natural and many women died during it or had stillborn children for years. Likewise, many women couldn't breastfeed and either had the aid of a wet nurse or had to feed their babies cow milk, contributing to higher infant mortality rates. Although knowledge of these facts makes me somewhat more accepting of the situation, it still pains me. 

One other factor is the massive life change that occurs when the little one arrives and changes take some getting used to. Suddenly, the whole epicenter of your life shifts and everything you've done before seems like a distant memory. When you and your partner find time alone together while the baby sleeps, you pass out along with them ("was that sleep as good for you as it was for me?") or rush to get errands done that you otherwise could not do. While the change itself can be daunting, the change of having total responsibility for another life, that can only communicate by cries that you at first cannot decipher, can be overwhelming. As many books as you may read, you will encounter a perplexing situation which leaves you cuddling your screaming baby in your arms, having run through the gauntlet of possible solutions (feeding, changing diaper, burping, adding clothing/blankets, removing clothing/blankets), crying along with them. My husband and I, for instance, were extremely panicked around the end of week 4 when our poop monster became extremely fussy and did not poop for four whole days. Then we found out it was perfectly normal for a breastfeeding baby to go even a whopping 20 days without pooping as their stomachs get more efficient at absorbing the breastmilk and they undergo a "poop conversion" - how could we have ever guessed that??

There's also the physical aspect. I was 106 lbs when I got pregnant, now I look at the scale - and I never even weighed myself before!- and cringe when I see 132 staring me in the face. I still wear my maternity clothes and haven't even put my wedding bands back on (I'm afraid that if I try again to wear them and they don't fit, a deluge will follow). My mobility is also impaired - the other day I was flabbergasted that it took effort to do a shoulder stand. I also haven't been exercising since I gave birth as I was petrified of ripping my stitches until I saw the doc at my 6 week test and she gave me the go ahead. For a movement junkie like me, it has been another psychological toll. 

Each woman faces her own particular sets of pressures on top of the pain, the massive life changes, the added weight, the hormonal roller coaster and the sleep deprivation - for me, one major pressure was going back to work three weeks after I gave birth. I didn't go back into the office, but I did draft an opposition to a motion to dismiss and prepare for and attend a mediation on behalf of one my clients, for a case in which I was lead counsel and the opposing side were going to use any extension to prevent a mediation occurring (which my clients really wanted, believing the magistrate judge would persuade the opposing side to settle). While I filed my motion on time on the eve of Thanksgiving, to my chagrin, the opposing side asked for an extension for their reply due to the Thanksgiving holiday. It took some effort not to claw at my colleague opposing me in this matter, albeit I did question him as to why he pushed for all motion papers to be filed before the mediation, which I did so with great effort after giving birth and he, knowing full well when my deadline was due (and we all know we never file early) switched his tune right after. I felt overwhelmed and started to resent my clients and my life choices - for it was my decision for greater flexibility (ha!) to leave a larger firm and become of counsel to a smaller firm, thus controlling my own clients. Unfortunately, while week to week you control your own time in the sense that you do not have to deal with "face time" in the office any more, when it comes down it, owning your own business (which is essentially what of counsel do) means you have more inflexibility- there is no one to carry the load when you really need to off load it. Just like motherhood, minus the miracle and joy...


Thursday, December 4, 2014

The Middle Ground

Six weeks in to parenthood and I've already learnt a major life lesson. Flexibility. Preconceptions have gone out the window. 

We were determined to breast feed and while we have been breast feeding, we have also been supplementing to feed our hungry hippo, particularly since my milk production decreased after I got mastitis (more on that and my breast feeding travails later). I know many other parents that are resolved not to supplement while they sort out their particular feeding issues, but facing the line between possible "nipple confusion" (which I garner is really that babies, who are much smarter then we give them credit for, realize that if they don't take the breast, they have the supremely easier option of the bottle, for which they do not have to work to obtain their food) on the one hand and dehydration and emaciation on the other, we opted for the former. For the next couple of days, he will be getting more formula (usually a 95/5 ratio) as after severe bruising of my areolas (which is unbearably painful) my lactation consultant advised me the only way to heal was to not feed for a couple of days and pump instead. Before mastitis, I was producing 2 oz from pumping, now I am producing 1 oz and 1/3 if that. Not enough to satisfy my hungry hippo. And so we are supplementing. I feel very inadequate supplementing - as if I am failing in an intrinsic duty handed down to my sex and neglecting my son. I fear the look he gives me when he takes the bottle (whether it's my breast milk or the formula) is one of appeal mixed with confusion. Why have you denied me? While I had other concerns about formula - even the organic formula we use-  for instance, how well regulated are they to provide a sterile product that only includes what is on the label? etc I realized my main concern was my hurt ego and decided to swallow my pride and get on with it. 

The other major decisions we've had to make have concerned our son's hydronephrosis. From his second day of birth we were advised that our son should be on a daily dose of antibiotics. The dose would be low as it would be preventative, but the concern was that if he did have the antibiotics, he risked kidney infection, which at such a young age, could lead to permanent kidney failure and death. While both my husband and I believe we overmedicate in our society and utilize antibiotics too much - causing all sorts of havoc to our necessary gut flora and leading to antibiotic-resistant strains of bacteria-  and were determined to be very careful in our antibiotic use with our son, the risk of kidney failure was one risk we could not take. So from his third day of life, our son was placed on a low daily dose of amoxicillin. 

After two ultrasounds showed that it was not decreasing, the pediatric urologist advised to do a VCUG, which is an exam performed to see whether our baby had any reflux of urine going back into his kidneys, causing the dilation. Our little babe would have a catheter inserted inside him and dye so that once he peed, x-rays would follow the trail and see whether there was any reflux. We were worried about the radiation (thankfully, it was digital so the radiation was minimal), about the dye (not radioactive itself fortunately) and the catheter (which is much easier to insert in boys) and the possibility of infection. However, the option of not examining was more dire - continuing the antibiotics for a whole year, without a need to do so. We decided to do the exam and the people at Cornell were amazing. Unfortunately, the exam revealed that he had quite severe vesicoureteral reflux ie when he peed it flowed both ways - down the normal stream and up to the kidneys. This is a condition that one can have their whole life without any trouble if one manages to avoid a UTI. However, particularly the younger one is and the weaker the immune system, the risk of chancing a UTI is the risk of chancing kidney failure and death. Particularly as babies cannot control when they poop (and here we patted ourselves on the back for using cloth diapers, with another unforeseen benefit being the fact that babies are way more uncomfortable when they have done their dirty deeds, cry out sooner and therefore stay in their urine and poop for far less), we did not want to chance the risk. In the end, it was not so much the probability of risk that he would get a UTI that made us continue with the recommend course of antibiotics for a year until his problem either resolved on its own (one can hope!) or he had surgery, but the consequence of taking the risk, however small the risk was. The consequence that a UTI could lead to permanent kidney damage was sufficient for us, as wary of antibiotic use as we are, to call it. So our little guy stays on the antibiotics and we are giving him daily probiotics to aid his gut flora. 

A decision over antibiotics faced us again when I had mastitis as the antibiotic would flow through the milk and he would be getting essentially a double dose. I tried to heal on my own, by resting, letting my fever do its work and my expressing the milk (having got mastitis in the first place from another plugged milk duct). However, when my fever hit 103.9, I called it. I was not helping him by getting myself incredibly sick so that I was unable to take care of him nor continue to feed.

Another fine line we drew was to use, on limited occasions (he's had about eight in his six weeks of life), non-cloth diapers (we've been using Honest diapers, they seem to work well and do not have the harsh chemicals conventional diapers do, but have not finished our product research and there may be better products out there). We realised that for us, the ease of convenience on limited occasions outweighed the risks we were concerned about with regular diapers and also that products were available that addressed our risks of conventional diapers to some extent. 

Another major hurdle facing us is language. Once more, I had developed a very rigorous plan. I would only speak Serbian, my husband only Greek and he would learn English on the go. I was worried that if we mixed languages, he would not be able to differentiate the internal grammar and would end up speaking a broken mix of all three, retarding his development. However, it was only when he was born that I realized how difficult it was to stick to one language when I never do so on a daily basis, flowing naturally from one language to the next. It was far easier to pass judgement on people that mixed languages before I tried to do it myself. I am still teetering on what language to use - should I use my native tongue or the language I have more capability in? Should I develop his brain to know multiple languages, thus sparking connections that he would otherwise not have, or should I nurture the development of his main language? There are pros and cons of each side, but I am steering towards the former, albeit it appears that this too, will end up being somewhere more in the middle than I had previously planned.

The choices we have had to make thus far have placed us on a less rigid note and we have come to see how judgmental we have been of other parents, not understanding the mosaic of elements that underpin each and every decision. We now look at our criticism of parents that occupy their toddlers with ipads and iphones or TV and understand why they do so. Further, we understand that nothing is a hard line. Giving a toddler an ipad on very limited occasions is far different to using it as your regular babysitter. Additionally, you have the power to control programming with the ability to chose shows or games that stimulate the brain and aid in learning and development -the ipad itself is a mere platform and the consequence of its use is in the way you choose to utilize it. Possibly at three, my husband could teach our son rudimentary programming - would that be somehow bad for his development solely because it occurs on a piece of technology?

By throwing decisions in your wake and challenging your preconceptions, parenthood is a great learning experience. Particularly as parents make decisions on behalf of their children, this responsibility of making decisions for another person brings to light how much one's ego sways their decisions. For instance, with respect to breast feeding, I realized how much force my determination to be "a real woman" and breast feed without supplement was driving my choices and how little that should matter in the interests of my son. In no small way, parents grow up with their children.