Crazy ideas

I had a post partum visit recently with a woman who was fussing and complaining because there was no way to attach the breast pumps to her chest when she was using them so she had to sit and hold them in place to express milk. She was so offended that she is creating and marketing something to hold the pumps in place while expressing. This will allow her to "do things" while she is pumping out the breast milk so that she can feed her baby with a bottle. Now, I asked the obvious question "Why don't you just nurse your baby at the breast and then you won't have to worry about pumping?" Well, my patient replied that she just couldn't get the hang of it and by pumping and bottle feeding she could be "doing something" while her baby is eating because she could prop the bottle and of course once she perfects her pump holding harness she will be able to "do something" while pumping her breasts as well. I cannot imagine it is more efficient to pump the milk from the breasts and feed in a bottle (going thru the middle man as it were) than to just learn how to put the baby to breast and have the milk go directly from the manufacturer to the consumer. I just shake my head in wonder and dismay. Perhaps I am getting old and cynical. I think breastfeeding is a unique and wonderful way to feed a baby/child while establishing a bond of closeness and demonstrating to said child that you have time to meet said child’s needs and that "doing something" is not more important than the child or the child's needs.

Thoughts on instant gratification

I have been thinking for a long time about the role of breastfeeding in infant development and growing up. I have come to an interesting insight. When formula feeding, the moment the bottle is in the mouth there is food coming out - instant gratification. This happens from the first feed forward. There is no wait and no no learning. With breastfeeding, the infant goes to breast and has to work to suckle, there is the comfort of being close to Mother's heart and touching Mother's skin but there is not an instant food reward. In fact, there is a lot of suckling that goes into getting the first little bits of colostrum out and there is a lot more suckling that goes into bringing in the milk. In fact, it is work to get the breastmilk out of the breast. Now, we know that breastfeeding helps decrease infection. Breastfeeding also helps with facial development and eye development. At this point, I am thinking that breastfeeding also helps with learning that instant gratification is not the way of the world. Breastfeeding lays the foundation that one has to expend some effort in order to receive pleasant things (i.e. food). So not only does the breastfed infant learn to feel safe at the breast, the infant also learns the very basic idea that one has to work to gain things one wants - there is no instant gratification.

My first birth on my new knee

I am recovering nicely from my total knee replacement. My midwife partner is burning out fast working alone for 11 weeks doing all the births and taking all the call. In order to save her and ease myself back into the practice slowly I have been taking all the call from the answering service and working in the office half days for a couple of weeks . Friday afternoon I went on call at the hospital to do births on my new knee. I was on call all night Friday night and Saturday until 6pm when my midwife partner returned and saved me - boy was I tired. However, I did have a wonderful birth while I was on call. The patient was over due and she really wanted an unmedicated birth. We got her wish. She was awesome and pushed the baby out just beautifully. Dad helped deliver and a great time was had by all. It was a fantastic first birth back and my knee did great.

Then there was the not so fantastic. I also had an induction for placental insufficiency which turned into an unnecessary cesarean delivery. We brought the patient into the hospital for a slow induction so we didn't stress the baby. The family got all hot and bothered because the baby didn't come the first day we worked on it. We discussed plan of care with them, let Mom eat dinner and have a good sleep and then start the induction up again on day 2. Oh NO - the father of the baby was all in a fit and stated that the patient needed a cesarean section because this was taking too long. My consulting physician immediately said yes and told them it would be later in the day, today. So this woman who has successfully delivered vaginally twice before at term with easy fast labors is having a cesarean section on demand because the father of the baby is tired of waiting. When I talked with my consulting about my discomfort with cesarean on demand he said that if we forced her to have a vaginal delivery and anything was wrong or the baby was not perfect she would believe she had grounds to sue us because she had asked for a cesarean and we did not comply, we made her and her baby endure labor. So he feels that if a patient demands a cesarean delivery we are better off capitulating to that demand and doing the surgery. I am frustrated. On the one hand, physicians are painted as talking people into cesarean deliveries and on the other they feel they will be sued if they don't honor the patient request for cesareans on demand. I know from past instances that this woman will probably be sorry that she chose this route, but by then the damage is already done. Now we have to wait for enough women to realize that they made a stupid choice and become verbal about it in order for the pendulum to swing away from cesareans on demand.

Back to work

I put myself back on call for non hospital related stuff on Wednesday. So far it hasn't been bad. My midwife partner is quickly burning out and I thought that if I could give her a bit of a rest, she would appreciate a break. I start back at the office on half days, on Monday morning 4/7. As I am working with clients on the phone and using the electronic medical records, it is starting to feel like I can successfully go back to work. I really didn't miss the psychic drag of dealing with other peoples problems and I have loved the time with my husband. If only there was a way to maintain my current standard of living without working - hum this is the issue for most of us though. As I return to work I am going to valiantly try to maintain my autonomy and not be consumed by the work. I do want to continue to do a good job and to continue to be admired/desired by my clients but I don't want to be tired all the time and have no life outside of work. This is a new juggling act to learn as prior to this point I just dedicated myself totally to my work. Now, I want to have a good relationship with my husband and I have to maintain my body to keep my knee flexible and strong and this requires time and energy. I'll have to work this thru. Today it seems like I can do it, we will see what Monday brings.

Recovery and travel

I am 8 weeks out from my knee replacement and life is good! We went out to visit our daughter and the grandchildren in Virginia. We hiked in Great Falls National Park. We spent a day at the National Zoo. We visited the National Geographic Museum. We visited the Museum of Natural History. We did Geocaching with the kids. We had a wonderful time. The kids are a blast and my knee did great. I had NO PAIN in all my adventures. I took exercise walks daily and rode the bike on the trainer to maintain my flexibility. We had a wonderful time.

On the return from the east coast we stopped in Colorado and had a brief interlude with my sisters and my Mom. It was Mom's 75th birthday and we had a surprise party for her. It was great. I spent several weeks prior to the trip doing an electronic photo album for her on an electric picture frame. So far she is not using it at all (bummer), but I have hopes. There was a slight change of plans as my sister (who had an emergency hysterectomy 3 weeks prior) developed a DVT (deep vein thrombosis) and was on bed rest and anticoagulation therapy. Because of the DVT we were not able to go to the cabin in the mountains, but we still had a good time and Mom was pleased and surprised.

We visited with our other daughter and her partner in Portland on the way home and spent a day doing wedding dress shopping. That was an adventure and she didn't find anything that she really fell for so I am making a muslin dress for her to try on in a style that we didn't find while out and about. Hope to get that done this month.

I visited the office yesterday to pick up my paycheck and see how everyone was. I had them start booking me with patients for Monday, April 7th for half days 9-noon. So the grind begins again. Since I have been gone my partner has been doing 20-25 deliveries per month. I know that she is looking forward to having some time off. I'm not sure that I'm looking forward to returning to the grind. Both my children expressed concern that I'll get too tired and burned out again and that I will not have energy to be "Mom". They both voiced the opinion that they liked the fact that I had my knee fixed and that I was full of energy and get up and go just like they remembered. I hope it is the new knee and that I will be able to maintain the positive attitude and the energy. I guess I'll see how it all goes once I'm back in the saddle full time. I return to full time April 28th and I will return to doing deliveries at that time too.

It is better

I am now almost 5 weeks out from my knee replacement. I am walking 2 miles on relatively flat ground, pedaling my bike backwards for 10 minutes and forwards with almost no resistance for 15 minutes twice daily and going to physical therapy 3 times per week. It is getting easier. I am shocked at how out of shape my body got while my knee was deteriorating. It is appalling to realize I let myself get so out of shape. I am also facing the return to work quandary. I really do love baby catching, but I do not want it to rule every waking moment of my life. I do still want to work, but I don't want to work 80+ hours a week. I am so much enjoying being with my husband and having time to be silly and be rested. I admit that "training" (getting back in shape and getting the use of both legs equalized) is not tough but it does take a lot of time. When I go back to work I want to still have time to work on my body and be with my husband. I'm not sure where that fits in with working 80+ hours a week. Right now my midwifery partner is doing it all (taking all the call, doing all the births, doing all the visits, assisting with all the cesarean deliveries), when I go back, I'm so going to owe her time off and that means that I will be doing it all. I'm not sure how that is going to work out or how I really feel about that. I guess I'll have to keep thinking about it and see what works out.

On a brighter note - in one week we leave to go see the Grandkids and their Mom & Dad. I am so excited for that I can hardly wait. It is going to be a blast!

YES, I can!

It has been a joyful 24 hours. My youngest daughter phoned last night to share that she has gotten engaged to be married. We are very excited for her and wish her all the best. She and her guy have been together a while and have decided to tie the knot.
Today at physical therapy I was able to pedal the stationary bike all the way around! This is truly exciting because I am 15 days post total right knee replacement. I do not imply that it was fun, or easy, I merely state that I previously had not been able to do it and now I can. I am very excited. I am also exhausted. I didn't realize that pedaling slowly for 5 minutes with no resistance could make one so tired. It will get easier, It will get easier, It will get easier, It will get easier, It will get easier, It will get easier, It will get easier.