WORK/LIFE BALANCE FROM A MOM AND NURSE PRACTITIONER

First Month with two kids: Fake it til you make it

3/30/17
I've always thought of myself as an someone who is capable of juggling multiple responsibilities and challenges , but having two children in diapers has been a whole new challenge. Hats off to all the mothers of multiple children, and stay at home moms, because I have never been so busy in my life.

To start with, our baby girl, now a month old, is perfectly healthy and amazingly adorable. She has been exclusively breast fed the first month, and has gained all of her birth weight back plus more. The first couple of days when I was waiting for my milk to come in were stressful, however since day three but I have  any issues with my milk supply or her ability to latch. I wanted to put her on a daily feeding and sleeping routine early, as it took sooo long to get my son to sleep through the night, however trying to get a sleep schedule and take care of a two year old, and do literally anything else I might need to do has been impossible. I have also been struggling to keep her awake during breastfeeding, especially at night, which leads to more frequent nursing, and can be exhausting.  The longest stretch of sleep has been four hours at night, but often she wakes up three or four times a night. Once her umbilical cord stump fell off I have been giving her baths every other night, which she loves. Her eyes seem to still be blue and she has two little dimples, but it's hard to say which parent she resembles more closely (my husband says she's my clone).


My son has done much better adjusting to a new little sister than I could have ever imagined. He wants to look after her, picking up her blankets, hats, and kissing her. I thought there would be some jealousy or animosity towards a new sibling, but so far he has been nothing but adoring towards her. This is not to say he is an angel by any means. For the past year he has become more and more of a diva in the morning when I try to get him dressed or feed him. He has become so picky with his food and clothes that it can take so long to get him ready in the morning, which can send me over the edge when I've had no sleep. He talks back to me more than he did before, and he has even learned how to go to one parent to ask for something the when the other told him no. My husband and I have noted that his speech has seems to have become increasingly more advanced in the short month our daughter has been home. He goes to preschool 4 days a week, which keeps him with a routine and gives me a break during the week. We are still encouraging him to use the potty, but not actively potty training him. Once we get settled in with our daughter I want to try potty training again. It's been rough with two in diapers. The days I am home with the two alone I spend the majority of my day changing one diaper as quick as I can to tend to the other one that's crying or throwing a tantrum, only to repeat this scenario with the other child in the next 15-20 minutes.

The relationship between my husband and I continues to evolve with the addition of our daughter to the family. There are so many family dynamics now that we are more than a triad. We struggle with disciplining our son, maintaining our own time together, sharing household duties, handling our finances, managing both of our stress levels and our own personal space. My husband has done many sweet things for me in the past month, including getting my flowers, framing a print of Portland, Oregon for which I am homesick, watching the kids while I take naps, and buying me a gel sleep mask so I can sleep during the day. He went back to work two weeks after our daughter was born, but will take more time off when I return to work in a couple of months. The first week he went back to work was rough. He was stressed returning to work, and I was stressed trying to handle everything at home alone, and we were both running on no sleep. Needless to say we had a few blow-ups, but with some communication and empathy on both our parts, we have smoothed out the issues and have been working well as a team. I started pumping at three weeks post-delivery at the advice of my pediatrician (after she saw the deep bags under my eyes in her office) just so I could have my husband give the baby a bottle at night and I could get a break. I try to pump at least  once a day, to start stashing a supply once I go back to work. Most days I only get the chance to pump once.


As for my recovery this past month in the so-called "fourth trimester", it's been a bit of a roller coaster. Physically, I feel so much better than with my recovery after the birth of my son, which I attribute to staying active throughout my pregnancy. I have lost weight quicker, have so much more energy, and have felt very little pain or discomfort after the delivery the second time. I started going on walks and even did I three mile walk with both kids in the double stroller. I have 15ish more pounds to lose to get back to my pre-pregnancy weight. I plan to start working out more intensely in a couple of weeks once I have been medically cleared to do so. That being said, emotionally I have had a much more difficult time. I have had frequent spells of crying, feeling like a failure, and in general horrible moodiness. I've had talks with several close friends, who have been my emotional rocks these past years, and truly keep me grounded in times where I feel I'm falling apart.  I feel that the importance of having female friends standing cannot be understated. Although your spouse is your partner and best friend, your spouse will not be able to understand everything and all your emotions, especially those that come with pregnancy and giving birth. I digress, however I am truly thankful for the female friendships that have lasted through the years. I have been a lot more forgetful and clumsy than usual, which is probably the lack of sleep and stress getting to me. I have realized that my level of organization needs to be taken to an extreme level just to keep my head above water. I now keep a little notepad with me and write down notes daily on EVERYTHING, from lists to do and upcoming appointments,  who I spoke to when I make phone calls, last feedings and sleep times of the baby. I try to get naps during the day when I can, although anyone who's had a baby can tell you when the baby sleeps is your chance to catch up on the to-do list, so it's not exactly easy. My plan was to give up coffee while I was nursing, so as it would not affect my milk supply, and so I would not be so caffeinated that I couldn't take naps while the baby napped. The attempt to give up coffee lasted all of a week. My reliance on coffee, and my general love of the morning routine with coffee outweighs the benefits of giving it up. I usually drink a cup or two of coffee in the mornings, try to get cleaning and other errands done, take a walk with the baby and dogs, and then take a quick shower when I've put the kids down for a nap and then take an hour nap myself if the leaf blower isn't outside and the dogs start barking at him.... FML! The leaf blower every Friday has been my enemy ever since I started working the noc shift five years ago.


This stage of my life with this new addition to our family has definitely pushed me to be a stronger person each day. As I am reminded by a dear friend, this period of the kids being little will not last forever.  This is both a relief and a reminder to enjoy the little things, like my two year old's endearing little toddler voice and my daughter's new baby smell and little baby coos. I'll catch up on sleep eventually, and in the meantime there's coffee.
Stay tuned for my next book review!
3/13/17
It's time again for my monthly book review. I chose Sweetbitter: A novel based on recommendations from several other bloggers and was looking for a good novel to break up my nonfiction choices. I listened to this novel on audible, which I have started using more frequently while I'm commuting, doing chores at home, or on walks, as it's very hard to find time with two kids to read for leisure. As I discussed with a friend just yesterday, audiobooks can be hit or miss just based on the narration alone. A poor narration can just kill a good book. I have to say the narrator's voice on this one was pretty annoying to the point where I almost just bought the actual book because I couldn't take it anymore. If you are contemplating buying the audioversion of this book, I would advise you to think twice. Anyhow, moving along to the story itself. To really put my finger on what this book is about in a simplistic way, I would say it's a story about the maturation of a young women in her early twenties. "Tess" leavers her Midwestern hometown after graduating college to move to NYC for bigger and better things, although she has no idea what this might be initially. She lands a job as a back waiter at a well-established fine-dining restaurant, although she has next to no experience as a server. As she is thrown into the new world of the service industry, she becomes intertwined in a love triangle with the most senior and knowledgeable server "Simone" and the aloof bartender "Jake".  The plot of this novel is not riveting, but I did love the writing itself, and I found the story very reminiscent of my brief time in the service industry. After I moved to Portland in my early twenties I got a part-time job as a hostess to hold me over between jobs, which ended up turning into a full time server job for over a year. Although this was a very short time in my life, it stands out as one of the most formative periods. This novel captured the nature of the service industry, the close-knit culture of the staff, the debauchery, and the reasons people stay and leave in this line of work almost to a T with what I experienced. If you've read this novel leave your impressions below!

Arrival of our Baby Girl

3/3/17

Someone once told me the last two weeks of pregnancy and first two weeks post partum aren't pretty, and that has been spot on in my experience, but all part of the beautiful process. I wanted to share my recent labor and delivery of my baby girl. I apologize in advance, as this post will be long, and may be TMI for some that are squeamish.

I had been experiencing Braxton Hick's contractions sporadically in the last trimester, however, nothing regular, and no other signs of impending labor. My OB and I had discussed an elective induction at 39 weeks based on my first baby's large for gestational age (10 lbs 2 oz) and my group strep B + status requiring antibiotics before membrane rupture. I agreed to an elective induction, although we scheduled only two days before my due date and I was hoping to have labor occur naturally before then. I really wanted to experience a spontaneous labor, since my last pregnancy I was also induced, and tried all the common "old wives tales" to naturally induce labor with no avail. Despite my reluctance to be experience an induced labor again, I also did not in any way want to go past my due date and have another 10 lb baby. At 38 weeks I had an ultrasound to get more accurate measurements of the baby, and to make sure all was developmentally with the baby to induce labor. The perinatologist estimated the baby's weight at 8 lbs 11 oz at 38  weeks, so I already knew I was in for birthing another baby giant. As the day approached I became more and more anxious, as I remembered the horrific labor pain with my first labor. I tried to calm myself, and focus on what I could control, such as getting food prepped at the house and cleaning, but I still became more moody and anxious as the due date approached. On the day of my scheduled induction my mom adrrive to watch our son when we left. My son woke up with a low grade fever and was lethargic, which also lead me to be more anxious about leaving him. I kept him home from daycare, ran some errands, packed up some last minute items, did laundry, and squeezed in a quick nap. By that evening, my husband and I said goodbye to our son, checked his temperature (it was normal Thank God) and drove off to the hospital. The hospital was an hour away. To give you the back story of why we chose a hospital so far from our home, my last OB doctor retired right after the birth of my son, and I wanted to select a new OB I really trusted. I also previously worked at the hospital where my son was delivered, and thus received a discount on the hospital deductible. Now that I didn't work at that hospital I would be incurring roughly the same out of pocket costs regardless of where I delivered. The OB I selected came highly recommended and was in our insurance network, but unfortunately came with a long commute to both office visits and the hospital. My husband and I were both cranky as we drove in, and I had us going to a wrong hospital with the navigation, which sent my husband into a tailspin and led us to start bickering. When we finally arrived at the correct hospital, found parking and our way up to the labor and delivery unit we were told we had to register. The registration clerk also informed us that we wouldn't be able to check into a room until midnight since we would be charged an extra day for the room if we checked in at 10 pm, the time the  induction was scheduled. Another clerk then  promptly me if we wanted to pay any now towards the $500.00 deductible for the hospital stay, (It is a new year after all, she said cheerfully). Talking about hospital bills before any of the process had even started, was not exactly anxiety-reducing an already stressful situation, but that is the state of our for-profit health care system. Once we were checked into the room, and I had the IV started and was hooked up to monitors somewhere around 1:00 am we became more relaxed. The nurse was really nice, and once she found out I was a former ER nurse we started talking nursing. My OB had ordered to start a low dose pitocin infusion, ampicillin every four hours,  along with the insertion of a balloon-tipped catheter into the cervix to manually start dilation. After the pitocin infusion had started a nurse midwife on staff came in to insert the catheter. My OB had said I was dilated and effaced enough when she had examined me in the office the week before to allow for a catheter to be inserted, however after a very painful attempt, the nurse midwife was unable to insert the catheter as I was only at 1 cm. The plan was then to titrate up on the pitocin until I became further dilated and then try the catheter again. It was past 2 am at this point, and my husband and I were both exhausted. He fell asleep on the pull out cot provided, and I attempted to get into a comfortable position with the fetal heart monitor and IV hooked up. I was way to anxious to sleep and with the contractions starting, I just closed my eyes and tried to relax. I had brought headphones and I put on an album by my friend Emily Holmes a musician and former labor and delivery nurse who actually writes music for women in labor (Her album is available on itunes and is called "The Arrival" for any that are interested). The music actually calmed me down and I slept for maybe an hour before the nurse popped back in to check vital signs. At about 6:00 am the nurse explained to me I could receive three doses of IV Fentanyl for the pain while I was in early labor. After I had used my three doses of Fentanyl the next option was to receive an epidural. I wanted to hold off on getting an epidural for as long as possible, as last time I was unable to move my legs and had the epidural for about five to six hours, which led me to be extremely anxious. The next shift was coming on at 7:00 am and the plan was to attempt the catheter again at this time. I requested to get a first dose of the Fentanyl before they attempted the catheter again, as it was so painful last time. At change of shift the new nurse and nurse midwife introduced themselves and after I had been medicated with the Fentanyl the nurse midwife swiftly inserted the balloon catheter (I was still only 1.5 cm dilated) and simultaneously during the process my water broke. The nurse reassured me that labor should progress rather fast now that the water had broken and the catheter had been inserted, which was encouraging. I was supposed to be on a clear liquid, but I hadn't eaten last night so when the nurse stepped out of the room I quickly ate a protein cookie I had packed in order to keep myself going. My husband went down the cafeteria to get some breakfast, and when he came back we started joking because the cafeteria charged 10 cents per butter. The Fentanyl made me very drowsy and took the edge off the regular contractions, so I was able to fall asleep for a few more hours. The nurse continued to come in every hour to titrate the pitocin, monitor vital signs, and put traction on the balloon catheter, but not much was happening in terms of impending labor. As the afternoon rolled around, and I still hadn't started active labor, I began to get disheartened. I really didn't think I would be going into another long labor. I received another dose of Fentanyl and ate some Italian Ice, as I was still on the damned clear liquid diet. By around dinner time my husband was sick of the cafeteria food (I was sick of him eating in front of me) and went across the street to get some empanadas. He gave me a few bites when the nurse wasn't looking (after not eating for over 24 hours they tasted more delicious than anything I had ever eaten) and we attempted to watch some netflix to pass the time. By this point the catheter had been removed by the nurse, and this indicated that I was at least 3 cm dilated (they didn't want to check my cervix frequently to prevent infection since my water had broken already). My contractions were getting worse, and I couldn't really focus on anything else.  As change of shift came around again, I requested the epidural, as I was feeling absolutely defeated. I was going on 24 hours without a real meal, in the same room, and without more than a couple hours of sleep. The contractions were now severe to the point that I couldn't talk through them. The nurse checked my cervix, and pronounced that I was at 4 cm. The new nurse prepped me the epidural and the anesthesiologist came in to start the epidural. I got what is called a "walking epidural" which is a lighter cocktail of fentanyl and anesthetic that does not incapacitate you to the point where you can't walk. I felt relief shortly after the epidural was inserted, but soon began to itch all over from the medication. I was told I could receive a dose of benadryl for the itching, but I wanted to wait to see if labor was progressing so I wouldn't be lethargic. A few hours passed and I hadn't still started active labor, so I requested a dose of benadryl.  At this point with the fentanyl, benadryl, and lack of sleep, I could barely keep my eyes open. I went in and out of sleep and  chatted with the new nurse (who I loved) but still labor was not moving any faster. The nurse had to take the pitocin level down as the baby's heart rate had significant drops twice, which may have been part of the reason active labor still hadn't progressed. At some point they inserted a monitor to more closely monitor the contractions. At around 3:00 am, which was now over 24 hours since the induction had been started, my OB came in to see me. "You're going to have the baby this morning one way or another" she said. She said they would try one last increase with the pitocin, but if the baby was not tolerating the increase (aka if the heart rate was decreasing) then we would have to do a C-section. My OB said she was stay in the hospital until we either delivered or had to do the C-section. At this point I was so tired and foggy I didn't really care, but obviously I wanted to avoid a C-section. She instructed the nurse to "get out the peanut." The peanut is much like it sounds a big peanut-shaped bouncy ball that is put between your legs to help position the baby. The nurse went up on the pitocin after I had the peanut, and I felt a huge increase in the pain. By that point the pain with contractions were so bad even with the epidural they took my breath away. I grabbed onto the railing of the bed and my husband's hand and tried to breath through them the best I could, and recited the Lord's Prayer in my head, because that was the only thing I could think of to calm myself.  I was getting the urge to push, but I didn't say anything because I wanted the stronger epidural on board first. I told my nurse I wanted to increase the epidural and it took about 20 minutes for the anesthesia resident to come in and adjust the dose. By this point I knew the baby was coming soon. As soon as the epidural was adjusted I told the nurse I was having a lot of pressure. She asked " Like you are about to have a baby?" and I responded "yes" The nurse checked, and I was dilated to the complete 10 cm. At this point a swarm of people came in the room. There were two labor and delivery nurses, two pediatric nurses, the OB, and an OB resident. They positioned me up for pushing, set up the warmer for the baby, and my OB ran through how I should push. I could still feel the pain and pressure immensely and move and feel my legs completely, but the epidural definitely took the edge off the pain. I pushed for what seemed like 20 minutes until someone told me the baby had crowned. My OB had been trying to avoid an episiotomy, but informed me she would have to do one. She quickly made the incision, and and after one last great push our daughter was delivered! My OB stated " She pooped on my shoe." and I of course thought was referring to me (I didn't poop during delivery, which was one of my fears naturally) but my daughter had passed her first meconium stool right on my doctor's foot. From my view my daughter looked blue and had not cried, and she was quickly handed off the peds nurses and placed in the warmer. As the nurses assessed her, I kept asking " Is she okay?" and no one answered me. When I heard her first cry I felt a huge wave of relief, and tears welled up in my eyes as well my husband's. Apparently she had had the cord twisted around her shoulder, but her APGAR scores were good and she was completely healthy. She weighed in at 9 lbs 3 oz, which was right on my predicted weight for her. My husband was then ushered over to the warmer while they assessed her, and he cut her cord. In the meantime, my OB delivered the placenta and repaired the laceration. My daughter was then placed on my chest, and couldn't stop marveling at how beautiful she was. She immediately started suckling, and I initiated breastfeeding her without any effort. Overall the active labor phase was only about two hours, and felt like a breeze in comparison to that of my son's. I felt so supported by the nursing staff, my doctor, midwives, and my husband during the delivery, and that also made all the difference in the world. Approximately an hour after delivery we were moved to the post partum unit, and I was able to clean up, eat breakfast, and get a little sleep in between all the staff coming in and out of the room. Since I was recovering well, and our daughter had passed all the newborn tests with flying colors, we were able to discharge home the next day. With my son I had to stay a total of three nights in the hospital after delivery, so this was a very different experience. Coming home and the transition has also been a very different experience in contrast to my first, but I will save that for the next post.

I regret to say I loathed the changes in my body and discomfort during pregnancy, and was dreading labor, the lack of sleep, and the post-partum recovery so much, that I hadn't been excited for the arrival of my baby girl. When people would ask me if I was excited about her arrival, I would muster an unenthusiastic "yes" but secretly was thinking "hell no" in my head.  After she has arrived I feel so much differently and so blessed by the experience to have had two healthy pregnancies. I'm amazed that my body is capable of all the transitions that come with birthing a child. I'm amazed by our baby girl daily, and holding her is the best feeling in the world. My children are what I am most proud of thus far in my life, and every minute of discomfort was well worth it.

The day before my induction 39 weeks and 5 days. I was soooo sick of people telling me I looked like I was going to pop!

My daughter and I one day old after I had some time to rest.