Birthing a Love Story

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Unlike all other Wednesdays, this one had me crying in the shower hoping that my water did not actually break prematurely and ended with my baby being rolled away to the Neonatal Intensive Care Unit (NICU). So when my preschooler first asked me to tell him about the day he was born, images of the scariest day of my life flashed through my head. There were some happy moments in between the terror, like when I held him for the first time or saw that he was healthier than we expected for his age. Overall, it was a day full of uncertainty and fear, with the usual nerves of a new parent mixed with the knowledge of a pediatrician parent who knows the risks of premature birth. My first foray into parenting was wrought with drama. It was all too complicated to explain to my now five-year-old son, so I thought for a while before extracting a few positive notes that I could simplify and G-rate for the wild imagination of a preschooler.

There is much about his birth story that reflects what I would later learn was his personality and he chose to show it to me from the very beginning. Had I known him already, I could have imagined that he would storm out of my uterus screaming. I would have known that he would come whenever he was ready and with great determination. Everything about his birth terrified me, yet I remember how eager I was to meet him and knew that while he would continue to make me nervous, he would also bring me peace. Every worry that fluttered into my mind was swatted away when I nuzzled our faces together, fanned his tiny fingers over one of my own, or inhaled his sweet newborn smell.

So when I look at my son, now a healthy six-year-old, I tell him this story:

You and I could not wait to meet each other and we were in such a rush to meet that you came six weeks early so that we could spend more time together. Then we were so happy together and even though you were little, you were strong, and we were stronger together. You were so tiny they had to keep you in a special box to stay warm but you ate and ate and grew and grew and they let you come home with mommy and daddy forever. We are so lucky that we had six extra special weeks with you.

While this silver lining version of his premature delivery made me feel warm and fuzzy each time I told him, it left me wondering how I would describe his sister’s post-dates birth. If his preterm vaginal birth was the story of an organic, eager, and resilient love, what was the theme of her drawn out labor and caesarean section? It was two days beyond my due date, three days of labor, and two hours of pushing until they had to cut her from my body. I felt defeated, devastated, and debilitated. For me, her birth story was one of mixed success and failure. I felt a great accomplishment in carrying her to term after her brother’s premature birth, but incredibly disappointed that her delivery ended in a caesarean section. It seemed like the entire pregnancy led up to this moment of failure, which lasted only a few minutes but left a literal scar on me forever. How could I spin this story to be cheerful and blameless when it still stung to recant it?

Like her brother, her birthing personality would hold true for what I would later describe as her personality: independent, indecisive, and sweet. When I felt a loss of ownership over the labor, I knew that she was in control. She was the captain of the ship. Her full term pregnancy became a badge of honor and although I had to reconcile the unnatural delivery that culminated those nine months, her health was more than enough justification. And so, like her birth, her story was more difficult to extract but eventually sat comfortably in my heart:

You and I were so happy together that we did not want to part. You nuzzled yourself with your head facing up, as if looking at me, and I rubbed your back as it pressed along the right side of my belly. You wanted desperately to stay with me, which is what I had hoped for the entire time you existed. You were so smart and beautiful that you amazed us all. Although some may have seen you as being stuck at birth, I think you blazed your own route. You were nothing like what I expected and yet exactly who I dreamed of my entire life.

Much like a horoscope, I imagine that I could read what I needed to hear from these situations. I could be projecting my own hopes and biases onto a single moment in our joint medical history or glamorizing these events for the sake of passing along an oral history my children will enjoy for years to come. I want them to have these shiny versions though that tell the story of our individual and unique relationships. How deeply I love both of them, yet differently, just as our first and most intimate interactions were varied.

My children ask me to repeat their birth stories to them often and so the glamorized versions that I created to protect them from the reality of childbirth are weaved into their personal narratives. A story they will someday reflect on as they prepare for the births of their own children. It tells the story not only of their first days of life, but of us. So as I recite these personal tales as bedtime stories with them snuggled in my arms, I respect that I have avoided the usual birth story platitudes and polished a narrative that reflects the beauty of our relationships; they are the love stories of my life.

When to Have a Baby in Pediatrics

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One of the questions that I get emailed most is, “when should I have children?” This comes from pediatricians in varying stages of training, and even those in college thinking about a future career in pediatrics. It’s a great question with no answer! The answers to this depend on so many personalized factors and there are pros and cons to each. To oversimplify, there are few suggestions I can offer that may help you in your decision, but they are unapologetically biased by my personal experiences.

During medical school, I saw two women choose to have their first child between the second and third years, taking one year off. This allowed them to take a break between the didactic and clinical years of medical school. At the time, I thought this seemed like an unnecessary delay in training. Later on though, I thought this idea seemed brilliant. The pros include: a long maternity leave and younger age at childbearing. Their children were then three years old when they entered residency, which could certainly have its own pros and cons. For one, they were done breastfeeding and waking overnight. Their children were more independent and in preschool. However, they are also old enough to know when you are missing for 80 hours/week and remember it. Also, unless you are then willing to have a second child during residency, there will be a large age gap between children.

I saw many co-residents have children during residency. This is much harder to generalize as the experiences are very variable. In general, it’s hard to be pregnant during the first two years of residency, which include many more inpatient months and overnight calls. Maternity leaves tend to be shorter too, depending on your delivery and residency program, you typically only have 6-8 weeks off. Due to the long hours of residency, you will likely need a very flexible partner and/or nanny or au pair to have enough childcare coverage. Raising a child and affording high-quality childcare can be expensive on a resident salary as well.

Many colleagues chose to have their first child during fellowship, which similarly to residency is often more challenging in the first year. Later on in fellowship though, there are more research months, which gives you more flexibility and more time for sleep! Depending on your fellowship program, you may be able to extend your maternity leave.

For those not doing fellowship, having a baby as a junior attending is the sweet spot. Longer maternity leave, better hours, higher salary. The only real con is older maternal age.

For me, I had my first child during 3rd year of residency and if you have read this blog before, you know that he came at 34-weeks gestation. Nothing about it was easy. We had an eleven day NICU stay and 6 week maternity leave. My second was born during my second year as an attending and things were much smoother. My pregnancy was easier, my maternity leave was 12 weeks, my hours were shorter, and my salary was higher.

The real answer though is that you have to have your children when YOU are ready. You have to make the choice that feels right for your growing family. Consider your own health, time, family support, financial situation, housing, etc. and then follow your heart. In some ways, there is never a perfect time to start your family. Even if there were, you never know how your pregnancy will go, how healthy you and your baby will be, or what effect having a baby will have on you. I have friends who have a post-partum stroke, miscarriages, and infertility. Every day I take care of families who have children with complex congenital conditions and life-changing diagnoses. Having children is hard in so many ways.

And yet it is also the greatest. Of course having had a preemie I have regrets and wonder what if, but in holding my sweet six-year-old, I can’t imagine changing a thing. I love being a working mom and know that although my career has made me miss a lot of time with my children, my work is worth it. I know that being a pediatrician makes me a better mother and in many ways, being a mother makes me a better pediatrician.

 

I would love to hear reader thoughts on this! Share your stories in the comments.

Mommy Call Book Club

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After reinvigorating my passion for reading with my neighborhood book club, I decided to start a Mommy Call Book Club on Instagram. Inherent to the success of my return as a reader is the fact that my children are now older and play nicely with each other. I reached a critical milestone recently: reading while my children played independently in public. It felt like a dream. So, I figured I could take on another book club, one where I would curate some of my favorite parenting books for you. I’ll do the heavy reading, or in some cases, skimming, so that you have some ideas before making a purchase. This also helps me in clinic, so I know what books my patients’ parents are reading and what to recommend to them when they present with particular issues. If you want to follow along, search for #mommycallbookclub. In the meantime, here are some of the books I already covered and links to purchase!

How Toddlers Thrive by Tovah Klein, PhD. I have raved about Tovah’s book before, as she was my college mentor and taught me most of what I know about toddlers. This book is a great resource for anyone trying to understand the toddler years: parents, teachers, babysitters. I channeled Tovah’s toddler whispering abilities so many times in the past 5 years. One of the lessons that stuck with me most is not ascribing my own thoughts onto my children’s artwork. Instead of asking them what they are drawing, I comment on their use of color or space. Perhaps the scribble is meant to be an elephant or perhaps it is just a scribble, but it is up to them to decide what they want it to be and what they want to share.

The Explosive Child by Edward M. Hallowell, MD. I learned about this book from a psychologist when I asked for advice on an ADHD patient. I think this is a great read for anyone living with or caring for a child with challenging behaviors that are on the extreme end of the spectrum. There are great tips for how to stop punishing kids for things that are not malicious and instead partner with kids to find preventative strategies. I found this book very practical.

The Sensory Child Gets Organized by Carolyn Dalgliesh. As we enter a new school year, you may want to keep this book nearby for your sensory kid struggling with new routines and demands. There were some parts that I didn’t like as an MD, but overall if you are looking for practical organizational tips to make the day-to-day easier, this was good.

Taking Charge of ADHD by Russell A. Barkley, PhD. One of the things I like about this book is that it looks at raising a child with ADHD from a research perspective, but also gives realistic parenting advice, a developmental approach, and treatment options. The author also addresses the effect that ADHD children have on their parents and siblings.

Sensational Kids by Lucy Jane Miller, PhD, OTR. Unlike the Dagliesh book mentioned earlier, this one has a heavier focus on diagnostics, comorbidities, and interventions. Like the others, it also uses cases to illustrate the definitions and demonstrate scenarios.

There are so many other great books that I want to share with you, but I would also love to hear from you about what you are reading! This list is ADHD and sensory heavy, but there are so many more great parenting books to come, so stay tuned.

 

[I am an Amazon Affiliate and I do profit from purchases made from my links. So please do use them! The opinions expressed above do not necessarily reflect those of my employer.]

National Coffee Day: pay it forward with coffee

image001There is no coffee in my house. But when I heard that Dunkin’ Donuts and its Greater Philadelphia franchisees were celebrating National Coffee Day (today, Friday, September 29th!) with a buy one get one coffee deal, I wanted to share this with Mommy Call readers in need of a little caffeine to make it to the weekend. Even this tea drinker can get behind coffee if it supports Dunkin’ Donuts donating 500 pounds of coffee to the American Red Cross to  support those who volunteer in disaster relief efforts and biomedical services.

So head over to Dunkin’ Donuts (participating stores only) today and purchase a medium, large, or extra-large cup of the brand’s signature hot coffee to get an additional medium-sized hot coffee for free to give to a friend or neighbor. I love random acts of kindness!

 

[I have no affiliation with Dunkin’ Donuts and was not compensated for this post.]

City Happenings: A September Guide for Families in Philadelphia

Little Moon + ArrowNow that the children are back-to-school and you aren’t going to the beach this weekend, there are many things happening in the city to keep you busy. A few in particular recently came across my radar that I wanted to share with Mommy Call readers. Some of these are happening this weekend, so don’t procrastinate (like I did in writing this blog post).

Lume Creative Learning Studios

Lume not only offers art classes for kids and adults but is a community gathering and event space for Passyunk Avenue and offers birthday parties. Where else could you find a Drag Queen Storytime?

Evelyn’s Corner: Grand Opening September 16, 2017

You may not think the city needs another kids art studio, but Evelyn’s Corner is bringing a new perspective to the kids’ art class scene. The website alone inspires creativity. In addition, they offer private classes and in-home birthday parties.

Momo’s Treehouse: Grand Opening September 16, 2017

If you loved their Old City location, the new Fitler Square space promises to exceed your expectations. Their Grand Opening celebration will be joined by Baby Wordplay and the Igloo and includes a petting zoo at the Grays Ferry Triangle from 10:30-12:30.

Penn Museum Family Game Night: September 15th, 2017, 6-9 PM

The Penn Museum is creating an adventure-packed evening for children 6 and up, including ancient board games, artifact guessing, hieroglyph decoding and more. Admission is $15pp or $50 per family of 4.

MOM’s Organic Market: Grand Opening September 8-10th

This new organic market in Center City not only aims to bring high quality, organic produce, but also sustainable insect proteins, a beekeeping section, car charging stations, sustainable seafood, growler-filling stations, liquid bulk products, and a recycling center. The grand opening celebration will include meet and greets with local green leaders, tastings, henna art, and kids activities.  5% of Grand Opening sales will be donated to the Philadelphia Orchard Project and Pennsylvania Environmental Council.

Play Arts: One Year Anniversary Party September 10th

I’ve written before about my love of Fishtown’s uber-cool Play Arts. They have been celebrating their one year anniversary all week, but the festivities culminate on Sunday, September 10th, with a party from 10AM-12PM. As if you need additional reasons to attend, they will be serving Cake Life cupcakes, dishing out door prizes, and offering discounts! RSVP is required!

Rock to the Future

This is a nonprofit that provides free and low-cost music education programs for Philadelphia youth. Their MusiCore program is where students learn their choice of instrument, form bands, write and record original music, play cover songs, participate in vocal ensemble, attend creative workshops, work with real musicians, and perform live. This program is open to grades 6-12 and operates Monday-Friday 3-6PM.

Little Moon + Arrow (photo above)

If you have been to the parent store, Moon + Arrow, you can imagine how adorable and crafty their version for the littles is. Their new space is drenched in sunlight and with all the pillows in the windows you will wish you could stay all afternoon.

Mister John’s Music

Queen Village cult favorite, Mister John, has upgraded to his own space in the Italian Market. He’s transformed a spice shop into a cozy studio with beautiful old world charm. With new teachers on staff and all their new square footage, there are new class options as well.

Franklin Ice Cream Bar

Sometime this Fall, Franklin Fountain is opening an Old City sister store where you can build-your-own ice cream pop shaped like the Keystone that is the symbol of Pennsylvania. There are even vegan options. I’ll see you there.

Bartram’s Garden: Philadelphia Honey Festival, September 10, 2017

Nothing is cuter than a bunch of children parading around in bee costumes. As the Honey Fest wraps up at Bartram’s Garden (10AM-4PM on 9/10/17), expect this as well as beekeeping demos, honey extractions, a marketplace and garden tours.

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