Tuesday, March 31, 2009

2 Months and Counting

My days at home with Annalise are now so limited in number... I have less than two weeks left at home. A few months back, the idea of 11 weeks of maternity leave sounded like heaven... There were so many things that I imagined that I would do: shopping, writing, reading stuff for work, spending time with my mom/dad/sister, gardening, meeting up with friends to go on walks, baby & me fitness class, etc etc etc. Well, I've done most of these things (except the "reading stuff for work" and baby & me fitness class parts), but none of them nearly as much as I had imagined. And now my time at home is almost over and I am mourning it. It's not that I dislike my job, but I guess I just like having free time so much more. Also, I do not feel that I am the perfect mom by any means, but I feel like I am currently the best person to meet Annalise's needs.

We ended up meeting up with a home daycare provider, Cindy, and we really liked her, so Annalise will be going to her home. She is also caring for 2 other children; I believe that they will be 7 months and ~14 months when we start. I have no idea how she can do it, but I pray that she can.

I still have very serious concerns about Annalise's willingness to feed from a bottle. Please, anyone out there who is breastfeeding and who may return to work: START your baby on a bottle at some point in the first 2-3 weeks! I read that 3 weeks was the optimum time, and that earlier than that might cause "nipple confusion" and make them reject breastfeeding. Yes, perhaps, but we tried our first bottle at 4 weeks and she was already somewhat reluctant to take it. She was fussy afterwards, and I worried that she had gas, so I spent a few days looking for a fancier bottle (a Dr. Brown's) and didn't really give her a second bottle until 5 weeks. I think she refused it a time or two but eventually took it. Then someone told me about Playtex VentAire, and I tried that, but again, she was not thrilled.

Meanwhile, we were just not good about giving it to her every day. Starting at about 6-7 weeks I got really serious about it, but she is getting more and more stubborn against it. I have now also bought two other bottle systems which are supposed to be designed for picky breastfeeding babies such as my own: the Nuby Natural Nurser and the Adiri. Well, she is not thrilled with these, either. I have also tried moving her to a Stage 2 Dr. Brown's nipple, but that also has not made a difference. We have tried all kinds of combinations: different people giving the bottle (me, S, S's mom, my mom), positions that mimic breastfeeding, positions that are nothing like her breastfeeding position, room temperature breast milk, slightly heated breastmilk, heated nipple, and starting the feeding when she is really hungry, sort of hungry, or not hungry at all. She generally either plays with the nipple in her mouth but never latches (when she is in a good mood), or gets really upset and tries to almost push it away (when she is hungry).

Anyway, I am genuinely afraid that Cindy will not be able to calm her and that she will get really super hungry and fussy and tearful when I am away at work. My first day back is a Monday, and Mondays, unfortunately, are my worst day in that I am busy seeing patients all day long. I won't be able to leave work if things aren't going well. On other days, I could theoretically do so if necessary. One idea is to start her in daycare next week (before I go back) to see how it goes, and I will probably do this for part of the day on a couple of days, but I am still insanely worried about it. My anxiety was heightened by the fact that my mom came over today and was generally unable to calm her down when she was crying, but when I would hold her, she would pretty much calm down within a minute or so. I hope that Cindy has a "magic touch" with little babies.

Let's see, in other news, she had her two month appointment last Friday. She was 22.5" and 11 lbs, 7 oz. She is growing so quickly! I have put her newborn clothes aside and now she is in 0-3 and 3 month stuff all of the time. She has great eye contact now, and makes adorable cooing sounds and loves to smile. She doesn't really reach for things as far as I can tell, but she does seem to be getting a little bit more purposeful with her hands (bringing them to her mouth to suck on her fist, for example). I have not been good about enforcing tummy time since she seemed to hate it so much, but the doctor suggested that it was OK to put a rolled up towel under her chest to make it a bit more pleasant. That does seem to help, so I guess we'll be doing it more. She can certainly hold her head up well from my chest, but from the floor she can really only raise it a few inches at this point. I know she'll get getter with practice, though.

Saturday, March 14, 2009

Childcare Worries

I am now actively searching for childcare. Let me preface this by saying that from the beginning, I have been in favor of daycare, and S has favored a nanny-type arrangement. Of course, we wish my mom could provide care, but she is only 55 and not yet able to retire from her job. S and I are both willing to consider the other's viewpoint, and so we are looking at both options.

I like daycare for the following reasons:
-- there are lots of adults present to monitor each other (less chance of any kind of abuse or neglect, hopefully)
-- we're not relying on someone to show up at our house every day (ie, I don't want to hear about someone else's experiences with traffic, car trouble, etc when I need to be to work at a certain time, ya know?)
-- the child gets to interact with other children (more important when the child is older, certainly)
-- there are games and activities not present in the home environment

I'm wary of nannies/solo daycare providers because:
-- who knows what they're doing when you're not there (TV for hours? ignoring her cries? or worse)
-- I don't want to trap the nanny in our home, but the idea of Annalise in someone else's car, rocketing down the freeway, makes me really nervous.
-- If I am really honest, I know that I could be threatened by a close relationship between a nanny and my precious baby. Particularly if I was otherwise "threatened" by the nanny, I think. For example, if we have a young, attractive, energetic nanny that my baby adores, that would make me feel worse than if a grandmotherly type was her object of affection.
-- obviously, they are much more expensive. I won't use this to make the decision, but saving a bit of money would be nice.
-- I don't think that hiring a nanny is a guarantee of a consistent, loving bond for Annalise. Nannies quit, need to be let go, etc. We know several families who have gone through 4+ nannies in just a few years.

S likes the idea of a nanny because:
-- he wants her to develop strong attachments with her care provider (and wants the care provider to be equally attached and invested in her well-being).

I think that our mutual concerns about daycares are reflected below, so I won't list them.

Have I mentioned that S is a clinical psychologist, and that half of his patients are children? At his urging, I've been reading this book of his called "The Irreducible Needs of Children" by Brazelton and Greenspan, and lemme tell ya, it's a very interesting read, but it will make you feel really crappy about putting your child in daycare. It kinda makes me want to quit my job and be a SAHM. Which would be nice, in many ways, but is not practical in my particular profession. I think the ideal think, really, would be to work part time with set hours and no call, etc. Kinda like that per diem Kaiser job (urgent care/same day appointments) that I did before starting heme/onc fellowship a few years ago.

I have visited 4 daycare centers so far, and we have an appointment with a home daycare provider on Sunday. S came with me to one of the daycare centers -- the one affiliated with my workplace, and only blocks from each of our offices. He was enthusiastic about the infant room, which has an amazing 2:1 child to teacher ratio. We were much less impressed with the toddler room (12-24 months). There is still an outstanding ratio of 10 kids to 3 adults, but we didn't like what we saw during the outdoor playtime. First of all, several of the children were sick; one with a wet cough and at least two with snot literally running down their little faces. Some of the children seemed kinda lonely/lost in the play area. Two of the teachers were talking to each other and generally ignoring the little ones. I think it was probably worse than normal because the "lead teachers" were in a meeting at the time we toured, so there were fewer teachers than usual around to supervise. Still, one can imagine that a shy (yet compliant) child could potentially be ignored for hours at a time. It made us really sad. Oh, and I didn't yet mention that this center actually has ZERO available spots. I got on the list a few days after finding out that I was pregnant last May, and yet I probably will not get a spot until she is well over a year old. My university has thousands and thousands of students and employees but only 6 infant daycare slots!

Two other centers that I toured are farther from our workplaces and have worse child to teacher ratios. I toured both of these during naptime, so I didn't get much sense of the interaction between staff and kids.

I visited one other center yesterday, and it is pretty ideal in terms of location, but again has a 4:1 ratio of children to teachers in the infant and toddler rooms. I stopped by yesterday and saw a lot of adorable babies (mostly in the 6-12 month range, it seemed) playing with various toys, but the adults were pretty busy changing diapers, feeding a crying child, etc, so that again, I can see that individual kids might not get attention for hours at a time if it is not their time to be changed, etc. I also can't quite picture how a less than 3 month old will fit into that environment, other than being set down in a crib for hours.

I am pinning all my hopes right now on a home daycare provider in our neighborhood. She was recommended by one of my colleagues, and I have spoken with her by phone and she seems nice. She cares for only up to 3 children at a time, and right now she is caring for a 6 month old and a 1 year old and has one available space. On the other hand, she has her own children (ages 6, 11, and 15), so they will be there too after school and presumably during summer vacation. We are meeting with her tomorrow and I am really really hoping that we click with her and love her, and that her house is decently clean, that there are no big dogs there, and that there is no swimming pool in the backyard.

As for nannies, my attempts to get a direct recommendation from someone have fizzled. Craigslist depresses me, and I haven't yet place my own ad or inquired with any agencies.

This feels like such an important decision, and I am dreading the day when I have to leave her with anyone.

Friday, March 13, 2009

March Marches On

I can't believe that Annalise is already 6.5 weeks old. How time flies!

We are getting used to each other, I think. Back when she was around 2 to 4 weeks old, she had much more of a tendency to cry without clear reason. Some of it was mere fussing, and some of it was downright wailing complete with red face, trembling jaw, and tears. This is the kind of cry that makes you feel like the worst parent in the world when you can't make it stop. I literally could not get anything done, and at times I felt almost trapped in the house because I didn't think she would tolerate going out. I think I had a touch of the baby blues, too. I could cry at anything. In fact, I started crying when song "Another Day in Paradise" (early 1990s song by Phil Collins about homeless people) came on the radio. S was back to work, and it was hard for me to deal with solo newborn care for ~12 hours per day.

These days, Annalise still has her moments of fussiness, but they are not nearly as frequent as they were. In addition, she rewards us with heart-melting smiles like this:

That was at 5 weeks.

We have gotten into a pretty good rhythm with breastfeeding. It is no longer painful, and she gets near the breast and knows what to do. I still have problems with what the lactation consultant calls "over-active letdown." This means that not only do I leak and drip milk, but sometimes jets of milk squirt all over the place. This does not only happen at the beginning of a feeding; it can happen even if she is basically finished on a particular side. The milk goes all over the place -- most of it on Annalise's face and head, but some onto the nearest couch, desk, Macy's dressing room... wherever I happen to be feeding. It is pretty crazy.

One thing we have not mastered yet is bottle feeding. We tried the first bottle at 4 weeks, and while she eventually took it, it was followed by her fussiest night ever and lots of gas. We weren't sure if the two were related, but we were concerned enough that we didn't have the mettle to try again for another week or more. I also got fancier bottles: one Dr. Brown's bottle, and then a pack of Playtex VentAire bottles on the advice of a friend. I have gotten her to take them a couple of times each, but usually she'll only take it after fussing and after she holds it in her mouth for ~20 minutes without seeming to understand that it is a nipple and that she can eat from it. I'm wondering if she is so used to a fast flow from me (see paragraph above) that she should go to the next stage of bottle nipple, which has a faster flow. We need to get this down because I'll be going back to work in about 5 short weeks (cry). I am writing an entire post devoted to the topic.

I just typed a LOT more about sleep and other topics, but the post-monster ate it. I didn't think that happened with blogger, but it just did. I'll have to write it all out again later.