Thinking About Baby #2

If I had conceived last month, WZW and baby #2 would be two years apart.  In fact, based on the timing of my menstrual cycle, my due date would have been only one day off from WZW’s.  Although there are worse things that can happen, having two children with birthdays very close, or perhaps even on the same day, would have been annoying for everyone involved.  So we figured we can hold off for a month.

But we are definitely thinking about #2.  Before having WZW, I thought I’d want to have my kids less than two years apart.  But the reality of life after baby is that it’s really tough.  It’s hard having such a demanding job, and also handling life with a toddler, who is naturally demanding in a different way.  So it’s taken me a while to get to the point where I’m ready to start trying for #2.

For a long time, I was hoping to get to a point where I could focus on eating better and exercising a little more.  But after a while, I realized that it’s not realistic given my current circumstances.  Even if I didn’t have a child, my job would take a significant amount of my energy.  When I’m there, I can’t half-ass it.  I need to give my 100%.  Not to mention the time- I would love to have a 40-hour work week, rather than my typical 50-something hour work week.  With the combination of needing my brain to be critically thinking most of the time, staying positive and friendly for my patients, and the long hours of doing so, my usual work day is very draining.

Between work and wanting to spend time with WZW, I just don’t have the energy to prioritize Paleo eating.  While I’m not going crazy with pizza and pasta, ultimately convenience wins out.  Not to mention after a stressful day, I gravitate towards comfort food.

One day my brother-in-law was helping watch WZW when the nanny was sick, and he was gracious enough to make dinner.  It was a fish and greens dish from Sun Basket (like Blue Apron, but faster to make and with Paleo options).  I ate it, and it was good, but I just didn’t feel satisfied.  I needed more- something with more carbs, and/or something heartier.  It’s too bad that even when a healthy meal was made for me and ready to eat, it still wasn’t enough.  It just goes to show how much my mental state can affect my eating habits.

Even if I finish work at a time that would potentially allow for fitting in a little exercise before heading home, that means less time that I’m spending with my son.  Of course, exercise is beneficial for my health and I need to prioritize that.  But still, when I don’t see WZW that much during the work week as it is, it’s hard to choose.  It’s easy to talk myself out of exercising by rationalizing that it’s because I want to see my son, when really part of it is that I’m feeling unmotivated.

I’m trying not to completely give up- if I can choose healthier options, or if I can fit in a little exercise, I’m going to try.  But committing to being fully or nearly Paleo, or exercising a certain amount, not to mention New Year’s resolutions- I feel like I’d be setting myself up for failure.  As a result, I find myself avoiding making specific goals.  I don’t want to have yet another thing to feel bad about, because I didn’t meet those goals.

I’m sure it’s common to feel a little nervous about the prospect of having the new challenge of a toddler plus a newborn.  I also worry about the challenges of pregnancy the second time around.  This time, I’d be entering pregnancy heavier and less fit than I was before WZW showed up.  I already have low back pain from lifting him and such.  So I’m expecting a second pregnancy to be harder on me physically.  A lot of my patients seem to have more pain the second time around.

My first pregnancy wasn’t bad, but the nausea in the first trimester was tough to deal with.  The thought of going through that again, plus probable additional physical discomforts the second time around isn’t something I’m looking forward to.

I can’t help but wonder- what kind of effect will it have on baby #2 if I’m not as healthy at baseline starting the pregnancy?  And I know based on my current habits that I won’t be able to eat as healthy or exercise as regularly during pregnancy compared to last time.  We know statistically that there are risks of obesity in pregnancy, which is why we recommend starting a pregnancy at a healthy weight when possible, and once pregnant, gaining the appropriate amount of weight based on one’s starting weight.

It does depress me a bit that I’m no longer in the normal weight category, but well into the overweight category.  So there are probably some subtle effects of being overweight, but if I keep waiting to get back to a normal weight, then it’s never going to happen.

It almost makes one wonder if it’s all worth it.  Ultimately, it would be nice for WZW not to be an only child.  There is nothing wrong with deciding on one child, and my husband and I are very grateful to have one healthy child.  But having grown up with siblings, we’ve always envisioned having a second.  I thankfully have a good relationship with my brother, probably more so now that he has twins and we can relate about parenting stuff.  I would love for that to be the case with my children.  I also wonder if I would inadvertently put more expectations/pressure on WZW if he’s an only child.

Beyond two, I don’t know how we would handle it.  I mean, we’ve talked about wanting a dog, but even that I’m not sure I can handle.  Given how challenging I find one child to be, I truly find it a bit difficult to understand how some people want like 4 kids.  I just can’t imagine staying sane, especially if they’re all close in age.

It’s funny, because despite all of the above fears, I’m also scared of the other possibility- what if it’s not so easy to get pregnant with #2?  Since I’m not keeping up with the Paleo lifestyle these days, and I’m a little older, what if I have trouble this time?  One of my friends was maybe 37 when she was trying for baby #2 and ended up needing to do IVF due to age-related infertility.

In any case, I can’t keep worrying about all the what ifs.  We’ll deal with what happens as it comes, right?



Happy 2017!

I’ve been wanting to post for a while, but things have been a little crazy lately.  We spent Christmas weekend through the end of the year moving, so it was hectic living out of boxes, and uprooting out lives, even though it was a local move.  Working during a surprisingly busy holiday season didn’t help things.  Now that I have some time off, I can finally get around to the things I haven’t had a chance to do.

WZW is now 16 months old, and it was interesting to see his transition to the new house.  He was of course excited to explore the bigger space, with all new drawers and cabinets to check out.  The first night, going to sleep wasn’t a problem.  I think it was another night or two in that he realized that this wasn’t a temporary trip, and he refused to go to sleep.  He would cry and cry, so we finally let him out of his room, and you could see him playing to fight the fatigue.  One morning I took him on a brief outing to go to the bank, and when we came back, he got very upset as I carried him in through the front door.  So much so that he held onto the door frame with both hands in an effort to prevent me from bringing him back inside.

But after a couple of days, he seemed to get used to it for the most part.  These days, he is busy climbing everything he can get away with.  We don’t have a gate for the new kitchen, so he has figured out that he can push a chair into the kitchen so he can climb up and try to touch the buttons on the oven or stove.  Which is just great for us parents.

He just recently started talking a little bit.  We’d been using a few hand symbols for things like eat and milk.  One of the newer ones was more.  Our little guy loves food, so it wasn’t too surprising that he first attempted to say “MO” for more oranges.  It started as a long “MOOOW” and now turned into a short “mo.”  He kinda uses the eat and more symbols interchangeably, but it’s easy to know he wants to eat.

It’s fascinating seeing how they pick up language and communication at this age.  He even used symbols to communicate something new to us.  WZW typically waves good night to us, and only uses his pacifier when sleeping.  So one evening, my husband was changing his diaper, and he did a symbol like eat (hand to mouth) followed by a wave.  At first he was confused- you’re hungry at this hour?  It took my husband a minute to realize the eat symbol was his way of communicating that he wanted his pacifier, and the wave was to go to bed.  What a refreshing change from the newborn days when it was a struggle to get him to sleep.  Now he readily tells us he’s tired, and will walk himself into his crib (which is on the ground) and put himself to sleep.

He says mama but not in reference to me.  In fact, since I’ll point to myself and say mama, and then point to him and say his name, he’ll then point to himself and say mama.  What’s even funnier is that when he says dad, my husband will ask him to say it again, and he’ll say mama.  Oh, toddlers.  If adults exhibited this kind of behavior, they’d be called bad names.

So we have an interesting update on WZW’s allergies.  We’d taken him to an allergy doc, who confirmed with testing that he has egg and peanut allergies.  The plan was to bring him back in a year (when he was around 2 years old) for repeat testing, since they often grow out of the allergies.

Well, one day when our neighbor was watching him, I’d thought to myself that we should probably remind her of his allergies since she doesn’t take care of him regularly.  We had told her initially, but it’s easy to forget.  I wondered if I myself would accidentally forget about things like peanut oil that might be used at a restaurant.  Though these days I would hope anything with peanuts is clearly labeled on a menu.  My husband apparently had been thinking the same thing, but didn’t end up telling her when he dropped WZW off at her place because she’d mentioned what leftovers she had that she was planning on feeding him, and they sounded safe.

Well, it was a good reminder that we need to remind caretakers of his allergies, because she fed him a poached egg.  Afterwards, he didn’t have a reaction but the Advice Nurse said to go ahead and give him Benadryl, which we did.  But given the time course, he definitely would have reacted by then.  We asked her if it was just the yolk, but she said he ate the whole thing.

A week later, we got around to emailing the allergist about it, to see if he needed further testing or anything.  The allergist said that feeding the actual food is the best test, so if WZW didn’t have a reaction to the egg, it meant he was no longer allergic.  Hooray!

We texted our neighbor to tell her the good news.  In the course of it, we mentioned that he just has the peanut allergy left.  She said um, he had a peanut butter & jelly sandwich while he was there as well.  My response was, are you serious?!  She said yes, they were all eating them so WZW had some as well.  Our response was shock, relief, and laughter.  We won’t be winning any parenting awards soon, but sometimes it’s better to be lucky than good.  We accidentally found out that WZW has outgrown both his egg and peanut allergies.

Please don’t try this at home.  This could have turned out very differently, so make sure to remind caregivers, particularly if they’re not frequent ones, about allergies.  We got lucky.  Very lucky.


Deficit of Play

The other day, my son had his first injury that caused him to bleed.  Thankfully, it was nothing big.  The funny thing is that I didn’t even see what happened.  I was at the table eating dinner, and he was doing his usual exploring nearby.  Because of where the table was, I didn’t see exactly what he was doing, nor did I hear a loud thump or the like.

All of a sudden, I looked down and saw blood at his mouth.  I thought for a second- did he just eat some berries?  No.  It was as I started to take a look to see where it was coming from that he started to cry.  It was hard to get a good look, but he calmed down quickly.  It wasn’t till later that we discovered a little cut on his upper lip.  He must have bumped the area or accidentally bit his lip.

It’s unsettling when even little things happen.  Of course what I fear are significant injuries.  One of my colleagues told me recently that her granddaughter had a burn injury.  She’s just under 2 years old, and she pulled down a bottle warmer by the cord, causing boiling water to go on her arm and hand.  She had to go to a burn unit, and might have to have skin grafts.  My colleague’s daughter (the toddler’s mother) is devastated.

It’s scary because as careful as one can be, it’s difficult to prevent every calamity from occurring when it comes to toddlers.  We’ve babyproofed as best as we can- put a gate so he can’t enter the kitchen when we’re cooking, bolted the large cabinets and bookshelves to the wall.  We keep dangerous items out of reach.

When going down stairs or climbing off of items, he’s figured out how to turn around and go feet first.  So as long as he’s not up too high, it’s fine.  But we can’t keep our eyes on him 100% of the time.  And we can’t babyproof everything.  He’s pretty steady, but he’s still a toddler and will often trip on himself.  So you never know what it is that’s gonna get him.  But we also can’t keep him in a bubble.

I came across this article a long time ago, before I had WZW:

It talks about how important playing is for a child’s development and learning.  Unstructured play, when kids are allowed to play with each other and figure things out themselves, is essential to social development.  When adults direct the play, it’s not the same.  If one kid is too bossy, or has a temper tantrum, it won’t go over so well with the other kids.  So they learn interpersonal skills.

Other young mammals play as well.  Why would it make sense evolutionarily for young animals to play and potentially put themselves in harm’s way?  Because it’s helping practice for adult skills, and the same goes for humans.  Kids need to expose themselves to some level of danger and fear, which helps with emotional regulation.  Without unstructured play, kids are at higher risk of developing depression, anxiety, and narcissism amongst other issues.

The article discusses it really well; the above is the general message.  As a kid, I was lucky enough to be able to play with my brother and the kids in the neighborhood regularly.  We used to wander around, riding our bikes to each other’s houses, visiting the lady down the street with 2 dogs and 4 cats.  My mom didn’t know exactly where we were at all times or what we were up to, but we’d come back when it got dark and it was dinnertime.  We did have TV and video games back then, but the bulk of our time was not spent in front of screens.

As a mom, it’s a little harder to stomach letting my kid roam around the neighborhood, not knowing exactly what he’s up to.  If anything were to happen to him, like the mom whose toddler got badly burned, I would never forgive myself.  The reality is that stranger kidnappings are extremely rare, and parents these days have gotten too cautious about letting their kids walk to school, much less wander around the neighborhood unsupervised.

I don’t have all the answers- ultimately I’ll have to figure out how to balance keeping my son safe, but also want to keep in mind that he needs to be allowed to play without adult supervision constantly.  We recently bought a new home (we’ll be moving next month), and one reason we chose it was the huge unfinished backyard.  At the very least, we hope to have it be a place where he can safely play with his friends, cousins, and hopefully a sibling.

I don’t know where my brother and his wife will end up on the spectrum of parenting, but since their twins and my son are only 10 months apart, I hope I can convince them of the importance of unstructured play.  It would be nice to have built-in playmates in the family.  And of course, we can hopefully find like-minded parents when he makes friends in the future.

Happy Thanksgiving, everyone!

The Powerful Food Corporations

I get emails from Thrillist, which is a BuzzFeed-esque website.  Their headlines vary from such things as Best Bar Food in San Francisco, and 29 Reasons I Skipped Your Dating Profile, to The Rituals of Orthodox Jewish Sexuality.  Amongst the frivolous topics, they also have health topics.  And some of them are quite informative.

I came across one recently entitled, Why It’s Virtually Impossible for Most of America to Eat Healthy:

The gist is that there are large, powerful food corporations that are doing everything they can to keep themselves rich, and don’t give a damn about your health.  It’s a summary of an article recently written by Michael Pollan in the New York Times.

For those who aren’t familiar, Michael Pollan is a well-known food writer.  Someone got me a copy of his book, Food Rules.  The one I have is the updated illustrated version, which is fun.  He has simple, yet valuable rules.  Things like, “Don’t eat anything your grandmother wouldn’t recognize as food.”  He’s not Paleo by any means, but he is basically advising people to eat real food, which is something that anyone living a Paleo lifestyle would agree with.

Michael Pollan’s article can be found here:

While longer than the Thrillist summary article, Michael Pollan’s article is well worth reading.  He goes into detail about the food corporations, lumped into what he calls Big Food, and why they are so powerful.  And why despite both Barack and Michelle Obama’s attempts to stand up to Big Food, they were unsuccessful.

It’s frightening and infuriating that these large corporations have such a stronghold on the food industry.  So much so that the Obamas could barely make a dent.  And as a result, the average American goes on eating their processed food and meat full of antibiotics.  And our children keep eating tons of sugar.  It’s unfair that my son was born to parents who are educated about what they eat.  And have the means to afford organic fruits and vegetables, and pasture-raised meat.  Most children in America (and the world) aren’t afforded that luxury.  And so continues the cycle of obesity and diabetes.

The silver lining, according to Michael Pollan’s article, is the Little Food movement as he calls it.  Consumers like me, and presumably those of you reading this blog, are becoming more aware of what we are eating.  And as a result, we will begin to push the food companies to start making changes: clearer labeling, and moving towards healthier products.  It will be a slow process, and the power of Big Food is not going away anytime soon.  But it’s nice to know that we can perhaps make a difference.  Even if it’s just convincing friends and family to think more about what they are putting in their bodies, and in my case educating my patients.  And of course, based on how we choose to spend our money.

More on Allergies

Meg’s comment on my last post reminded me of a talk I’d heard at work a while back.  There is a lot of research going on these days about the body’s microbiome- the mix of bacteria that is present in and on the body, and how it affects one’s health.

I had previously posted about it here, and how it may affect obesity:

Well, the particular talk I heard focused on allergies.  Unfortunately, I don’t remember the name of the speaker, and I wish I’d taken notes.  So everything I’m recounting here is based on what I remember of her talk.

She started the talk discussing how there are differences in babies’ microbiomes based on whether they were born via vaginal delivery or C-section.  What’s frightening is that whether they were breastfed or not, these differences persisted at one year of life.  Breastfeeding was beneficial, but there were still significant differences between the vaginal delivery and C-section babies.

A healthier microbiome appears to be one that has a greater variety of organisms.  From what I recall of the talk, there were certain bacterial species that were seen in the “healthier” individuals, but I don’t remember which ones they were.

In terms of an OB standpoint, the difference is thought to come from the natural vaginal flora that the babies are exposed to during a vaginal delivery.  I should also mention that prior to a C-section, mothers are given IV antibiotics to help prevent infections at the surgical site.

Now, I don’t want women to fear a C-section.  We do them when we have to, but our goal is to have a vaginal delivery whenever it is deemed safe and appropriate.  I’ve heard of some researchers looking into swabbing the mother’s vagina and then transferring the material to the baby’s mouth and nose in cases of a C-section.  But that is still experimental, so we don’t know if it’s beneficial or not.

The standard use of antibiotics, such as prior to C-sections, or for moms with a positive Group B Streptococcus (GBS) test, is done based on extensive research on the benefits.  However, this emerging research on the body’s microbiome may show that there are more subtle long-term effects from antibiotic use.

The speaker went on to say that the body’s microbiome has effects on allergies.  Asthma is a marker for allergies.  In other words, asthma is considered to be a manifestation of the allergic response of the body, along with conditions like eczema.

So this brings me back to Meg’s comment about her son eating dirt from their yard.  The speaker mentioned that prior to our modern days, we were exposed to certain bacteria, such as from dirt and exposure to livestock.  Her research is showing that those exposures reduced rates of asthma.  Individuals with a greater variety of organisms in their microbiome tend to have less asthma.

Since it’s not realistic for most of us to have a pet cow, she mentioned that households with dogs were shown to have a healthier microbiome.  The bacteria found in the homes themselves have a “healthier” mix.  Cats provided some benefit, but not as much as dogs.  Therefore, her research suggests that having a dog in the house can reduce your kids’ risks of allergies and asthma.

And I also think that letting your kid play in the dirt, which will presumably lead to ingestion of some of it, is probably going to help out their microbiome as well.  Knowing this, I have wanted to get WZW outdoors more.  Unfortunately our yard isn’t as conducive for playing in the dirt.  Thanks to the California drought, we have an artificial lawn.  And our landlords had put in some tanbark, which is not the best for WZW to be putting in his mouth.  But we’re hoping to buy a home at some point, so perhaps we’ll have a better yard for him to play in.

We recently went to my 80-something year-old aunt’s place.  She has an extensive garden in her backyard, so of course she has a lot of gardening tools.  WZW was having a ball playing with a little shovel and getting dirty.  She handed him a fresh apple from her tree, and he bit right into it.  Good thing since he only has 8 teeth, he can’t take large chunks out of it, so it wasn’t much of a choking hazard.  It was cute seeing him biting into an apple half the size of his head.

As much as I would love to have a dog, I just wouldn’t be able to take care of it.  I’ve tried to convince my parents to get one, but they’re not interested.  Ultimately, I try not to be too much of a germophobe when it comes to my son.  I don’t think it’s good to be going crazy with hand sanitizer and such.  In fact, the only times we use the hand sanitizer in WZW’s diaper bag are when we have to change a poopy diaper and there is no sink nearby to wash our hands.  I keep thinking we should take him to a petting zoo to try to expose him to healthier flora.  But like the peanut butter thing- it’s one of those things we think of, and have not quite gotten around to.

One Year!


WZW turned one on Monday!  Last year, I was due on Labor Day, and this year, he turned one on Labor Day.  It really is amazing how much has changed in a year.  Last year, I was coming off of the delivery, we were figuring out the whole parenting thing, and I was dealing with the new challenges of breastfeeding.  WZW was this immature little creature who would cry for no good reason, despite our best efforts.

Now, this guy is tons of fun and tons of work- in a different way.  For the most part, he’s a happy guy who is a joy to play with.  In the last couple of weeks or so, he has started walking.  He’s already been getting into everything- reaching as high as he can, opening drawers, taking items and strewing them all about, and rarely putting them back in.  When he does put an item into a container, it’s often his random decision.  So if we’re not careful, an item could end up misplaced since he put it somewhere strange.  The toddler phase has arrived.

His first word was “up,” said appropriately in context when going up the stairs.  Alas, he says “Mama” a lot, but not in reference to me.  He finally started using sign language recently.  We only did a couple of signs for “eat” and “milk” and have yet to expand on that.  But it is helpful to have him be able to signal his hunger as an alternative to crying loudly, which he still does as well.

He’s generally been doing well with feeding himself, so we’ve been giving him a variety of “real food” cut up into small pieces for him.  We still give him some baby food pouches, mostly for convenience when we’re in a rush or out in public.  And he’s now adept at drinking out of a straw.  Again, for convenience we’ll still give the bottle, but he’ll probably soon phase out of using them.

At 10 months, I discovered his egg allergy.  After that, I fed him a little of the peanut butter we happened to have in our pantry.  Then I realized it contained honey.  So it wasn’t until close to his first birthday that my husband gave him more peanut butter.  Well, unfortunately he developed another rash, so the pediatrician recommended that he see an allergist.  The allergist did tests for a bunch of food allergies, and confirmed the egg and peanut allergies, as well as one to brazil nuts, which hopefully will be a rare issue.

He said that there is a higher likelihood that he’ll grow out of the egg allergy, but less so with the peanuts.  There is a 25% chance he’ll grow out of the peanut allergy.  In hindsight, I wish we’d introduced peanuts to him earlier.  It was something I’d known about, that lately the recommendation is early introduction, but it was just one of those things we never really got around to.

Plus, I had been eating tons of peanuts while I was breastfeeding- a regular snack had become these particular Trader Joe’s snack bars that contain peanuts.  In my mind, I’d felt like that was early introduction for him.  And I had no reason to think he’d develop an allergy to peanuts, since no one in our families has a peanut allergy.  Well, my husband says he’s “allergic” to peanuts as a euphemism for them causing gas.  But that doesn’t count.

This is the first time that I felt disappointed in myself as a parent for failing to do something, which potentially caused an impact on my son.  I’m sure it will happen many times in the course of parenting.  And of course, as a parent, you can’t predict how everything will turn out.  But still, I do feel some regret at not trying to feed him peanuts earlier.

I really hope he grows out of it, but if he doesn’t, my concern isn’t necessarily the allergy itself.  A lot of people have allergies that cause rashes and such.  But what I fear is that it might risk an anaphylactic reaction.  The allergist recommended that we get EpiPens to keep on hand just in case.  These days, there is much more awareness around peanut allergies, so it hopefully won’t be an issue.  And I hope we never have to actually use one of the EpiPens.



All Gone!

WZW finished up the last of my frozen breastmilk recently.  We only had a little left, and my husband had planned to give him the last of it on his first birthday.  But he started to get a runny nose, watery eyes, and cough, so he decided to give it to him now.  Not sure that it’ll help now that he’s already sick, but can’t hurt.


It’s actually amazing that he hasn’t gotten sick thus far, since he’s been drinking almost exclusively formula for the last month and a half.  A couple of weeks ago, my husband, the nanny & her 5 year-old and I all got some stomach bug.  I had to call in sick for the first time in my five years at my current job.  Thankfully, WZW managed to avoid catching the illness that made the rest of us miserable.

Not sure where he got his cold, but it hasn’t been too bad.  He seems to be more or less his normal happy self, he just has gross snot running down from his nose.  And has more trouble sleeping.  One benefit of not having him in daycare is that he hadn’t gotten sick yet.  But then again I see my friend’s baby doing all kinds of fun and stimulating activities at his daycare, which I can’t expect my nanny to do.  So there’s pros and cons to everything.

I stopped breastfeeding completely the weekend of the 4th of July.  I hadn’t been making very much as it was, 1-2 oz per pumping session most of the time.  So I spaced out the feedings/pumping the week into it.  Then completely stopped.  A couple of weeks after that, I still noticed some milk leaking.  I got out of the shower, and at first thought I hadn’t dried myself off completely.  But then I realized it was my left boob leaking.  I had some pains occasionally on that side as well.

But otherwise, I thankfully never had any engorgement, clogged ducts, or any of the other issues I’d dealt with previously with breastfeeding.  It’s been quite nice not being tied to the pump anymore, and having to constantly worry about it.  I also no longer have to wear a nursing bra at night.

What’s funny is that I had started wearing socks to sleep after having WZW as well.  We have hardwood floors, and my feet will get dirty if I walk barefoot all the time.  Because I’d have to get up so often at night, I’d started wearing socks to sleep, which I’d never done all my life.  Well, now that WZW is sleeping better (still not consistently through the night, though) and my husband takes care of most nights, I realized I didn’t need to wear socks at night anymore.  My feet felt so FREE!  For me, it was even better than not having to wear a nursing bra to bed.

WZW didn’t seem to miss the boobs.  He hadn’t quite gotten to the point that he got a significant amount of comfort from them yet, so he never went looking for them.  Out of curiosity, I once flashed him to see if he would react, but he didn’t go for the boob then, either.  But now that he’s more vocal when he’s unhappy, I can see how it would be hard to wean an older infant.

It took a full 3 weeks to notice a difference in my appetite.  I was at lunch with my friend, and all of a sudden, I was full.  I looked at my plate- already?  I was only halfway through the large plate, whereas before it was a given that I’d finish it.  My appetite had been on par with a teenage boy’s.

With the change in appetite, I was hoping that would mean the weight would start to fall off.  But unfortunately it has stayed put.  Work has been busier than ever, so I’m spending tons of time at work, and not getting a chance to exercise.  It’s just too much effort to go back to being Paleo, so particularly at lunch, I’m eating whatever sandwiches and such are available on meeting days, and bring pre-made wraps on days I need to bring my own lunch.

I think with the stress and constant fatigue, it’s really difficult to eat better.  I’m a total stress eater, so being tired and overworked means I’m going to go for comfort food.  And exercise is nearly impossible to fit in when work is busy.  As it is, there are days when I get home and my son is already asleep.  So the only time I see him all day is in the morning, as I’m rushing about to feed him and get myself ready and out the door.

I can’t help but focus on my weight, since I have a daily reminder seeing all of my clothes in my closet that I no longer fit into.  At this point, I didn’t expect to get back to my pre-pregnancy weight, but I wanted to at least make a dent in my current weight.  But now I’m realizing how much work that would be, and unless work miraculously slows down, it would be really hard to do.

So it’s a tough balance.  I don’t want to completely give up on trying to eat better and fit in exercise when I can.  But I also don’t want to make myself depressed over not losing weight.  I have to remind myself that it’s tough to be working my full-time plus job, period.  And having a baby, even with a husband who’s been taking care of him when he wakes up at night, is not easy.  So I keep reminding myself that I have a stable job, which despite its frustrations provides me personal fulfillment.  I have a healthy, happy baby who is an unbelievable joy.  And a husband who continues to be an amazing father and partner in life.

There are a lot of people who desperately want to have just one of the above- to be a doctor (or whatever career they are after), have a healthy baby, or to find Mr. Right.  So some extra pounds, which perhaps I can work off at some point down the line, isn’t the worst ever.  We can’t have it all.  And I am only human.

In addition to my vanity, I worry about whether starting another pregnancy at a less healthy weight would affect baby #2.  But then again, my husband was born 13 months after his brother, which didn’t follow the conventional advice that it’s best to space babies at least 18 months apart, to let the mother’s body recover.  And he ended up playing sports at the college level, while his older brother did not.  Maybe I’ll be able to breastfeed baby #2 longer, which will sorta make up for it.

For now, though, I’m staying on the birth control pills because I cannot handle the idea of being pregnant again.

Sugar Content in Baby Food

So far, we’ve been buying baby food since it’s hard to find time to make our own.  We get the various jars and pouches that you find at the typical online and store retailers.  I’ve found that even then, it can be a time-consuming process to scour the various websites for which food to buy.  Of course I want to find the ones that are less expensive.  I want to find different varieties, to give WZW exposure to different foods.  And get a variety of ones with meat versus veggies.

In general, I’ve found Babies R Us to be disappointing, because even though we got a bunch of their gift cards at our baby shower, their prices are often higher than what you’d find on Amazon or the like.  And since we have Amazon Prime, we already get free 2-day shipping on most things, whereas with Babies R Us you have to pay for shipping, and it takes longer.  Now with the baby food, I find it annoying that they don’t have pictures of the nutrition labels, so even if I found something on sale, I’d have to cross-reference on other sites to check the labels.

Initially, I wasn’t checking labels too much, thinking that they would only have a few ingredients that were already listed on the front of the package.  But I quickly realized that there are all kinds of added ingredients.  Even with the baby foods that are pure fruit, the sugar content can often be quite high.  I don’t mind if he gets the sweeter all-fruit foods sometimes, but they often add apple or other fruit to make savory-sounding flavors taste better.  So if I’m not careful, even getting the ones that seem to have kale and spinach as the main ingredients end up also having sweet fruit added.

Once I started looking at labels, I realized that even with the baby foods that have no added sugar and are all fruit, you can still end up with 10 grams of sugar in a 4 oz pouch.  I know some of the fiber content helps, so it’s not like downing a cookie.  But still, I want to be mindful of what I give my son.  I was shocked when one yogurt and fruit-based baby food had a whopping 21 grams of sugar per 4 oz pouch!  Turns out they add concentrated fruit juice to it.  You might as well give your kid half a can of soda.

One of the brands I’ve found that has less sweet fillers is Earth’s Best.  They have pouches, but also have glass jars.  They do add starchy fillers like brown rice and whole wheat, but we’re not being THAT strictly Paleo for our son.  From what I hear from friends, different babies have different preferences, and some insist on feeding themselves from earlier on.  My guy still doesn’t mind getting fed from a spoon, and also does the pouches easily- which is nice for me, since they’re less messy.

I also bought a canister of puffs.  Again, they tend to have a lot of sweet varieties, but I found one that has a savory flavor.  I only give him a handful- like 5 to 10 in one sitting, and he can practice feeding them to himself.  And they don’t get messy.

Even in the recent TIME parenting newsletter, there was an article referring to a study done in the UK that showed that store-bought baby food was healthier and provided more veggies than homemade food:

But now that he’s getting older, I’m realizing that I’m going to have to deal with the messiness and have him start eating more regular food.  I had thought to myself that even if I prolong the pouch feeding, it’s not like he’s going to show up to kindergarten only eating pureed food.  Well, one friend said that her niece got spoiled by her family always feeding her.  So even at 3 years old, when a bowl of food was placed in front of her, she wouldn’t know what to do with it.  She would give my friend a look- wait, aren’t you going to feed me?

Part of the challenge is that it’s easy to revert to giving him starches- bread, rice, and noodles are so easy to feed babies.  So the thought of extra effort and time to figure out what healthier options to feed my son is a downer.  But after hearing the story above, I decided I needed to figure out options.  To start, plain scrambled eggs were quick and I already had the eggs in my fridge.  I figured they would be less messy than the yolk I tried before, and they are Paleo.  Well, turns out he had an allergic reaction.  Apparently it’s the egg white that has the protein that tends to cause allergies.

At first, I thought he was just bothered by the bib, which is not uncommon.  But then I realized he was breaking out in a rash around his mouth and under the jawline, above the neck.  I stopped feeding him, applied some hydrocortisone cream, and it rapidly faded.  It freaked me out a little seeing that for the first time.  Even though I figured it was probably just the rash, I was thinking to myself- please don’t go into anaphylaxis (an allergic reaction so severe, it affects breathing).

The baby books we have around the house said food allergies are common, and that most babies grow out of them.  These days, they recommend early exposure.  So I guess we should start exposing him to more of the common allergens, like peanuts, seafood, etc.  My pediatrician friend said I could try reintroducing the eggs in 3 months and see how it goes, but it can often take until kindergarten age to grow out of allergies.

Birth Control

One possible reason for my weight gain that I haven’t focused on are my progestin-only birth control pills.  It’s of course been something I’ve wondered about.  But I didn’t want to be one of those people.  I have patients who swear some random symptom is caused by their IUD, and I tell them that I think it’s unlikely.  Sure enough, they have the IUD removed and the symptom remains present.  I didn’t want to necessarily blame my weight gain on the pills, when the fact is I have had poorer eating habits and haven’t been exercising.

But the fact is that progestin-based methods of birth control are known to cause weight gain.  I spend a lot of time counseling patients about birth control methods, and I see it all.  It’s amazing how differently each method affects different women.  With any particular method, some women love it, and some women hate it.  There are certain side effects that are common or expected, like weight gain with the Depo-Provera injections.  But even then, sometimes I have women who don’t gain weight with it.  Once I had a woman who said she lost weight with a method- I can’t remember if it was the pill or what, but that was the reason she didn’t like it (and she wasn’t super thin).  Um, ok.  Everyone else would be all over that method if that worked for them!

Prior to pregnancy, I was on the birth control pills.  I’m lucky that they work really well for me.  I don’t have any of the unpleasant side effects, and if anything I have the good side effects.  Supposedly studies have not shown birth control pills to be effective at treating PMS.  But with my N of 1, I can tell you they’ve definitely helped with mine.  I used to get all moody and extra hungry and such prior to my periods.  On the birth control pills, even when I had regular cycles on them, I no longer had the PMS symptoms.

Better yet, I learned in residency that there is no benefit to having my periods.  So I started trying the continuous regimen.  In other words, I would continue taking the active pills for longer than 3 weeks to avoid having periods each month.  A lot of my patients think it’s bad not to have a period each month.  They are correct, in that if you are skipping periods on your own, that is not normal.  If you have oligomenorrhea, and are one of those women who don’t have periods for several months or more at a time, it can put you at risk for developing endometrial (uterine) cancer if left untreated.  Don’t worry, this usually takes years to occur.

But if we gynecologists are causing you to skip periods, that is perfectly safe.  That is because we are giving you hormones that make your uterine lining thinner.  That process, in addition to making periods lighter and/or less frequent, also helps prevent endometrial cancer.

Initially, I tried a couple types of pills, and every time I reached the 6 week mark, I’d start spotting.  So I’d have to give myself a short period every 6 weeks.  Finally, I found a pill that worked to stop my periods altogether.  Hooray!  So prior to trying to conceive, I didn’t have any periods for years.  And since delivering, I haven’t had one yet.

Now, this also works for me because I’m able to take my pills consistently daily, so my lack of period was never a fear that I might be pregnant and not know it.  For my patients who have difficulty with a daily pill, this is not ideal.

So after having WZW, I switched to the progestin-only pill or mini pill, which contains norethindrone only, as opposed to the regular pills that have a progestin (norethindrone or a different type) plus estrogen (ethinyl estradiol).  I chose it because it doesn’t affect milk supply like the regular birth control pills.  Especially now that I’ve breastfed, I understand how anything that might affect milk supply should be avoided if at all possible.  The downside is that unlike the regular pills, they have to be taken at the same time each day.  You can’t be late by more than an hour, or you’ll risk unintended pregnancy.

The other reason I avoided the regular pills is that my own doctor/colleague/friend said that she looked into it when she had her first child, and was concerned about some excretion into the breast milk.  I figured she was a reliable enough person to listen to.  If she didn’t feel comfortable taking it, then I certainly didn’t.

Just now I decided to check the drug information.  The package insert with the drug information says (I’m paraphrasing slightly) that some of the medication gets passed on to the child in the milk.  A few adverse effects on the child have been reported, including yellowing of the skin (jaundice) and breast enlargement.  It also says it may decrease the amount and quality of your milk.  You should consider starting oral contraceptives only after you have weaned your child completely.

Based on hearing that alone, it’s not a comforting thought to potentially risk those adverse effects.  I’ve had patients get pregnant not long after having one baby.  Sometimes because they stopped breastfeeding, sometimes because they thought they’d still be protected due to breastfeeding.  I certainly didn’t want to take any chances.

Since I knew I wouldn’t be waiting super long before trying for baby #2, I didn’t think it would be worthwhile to try the longer-term methods like the IUDs or implant.  Nexplanon, the implant that goes in the arm, is a very reliable method that lasts for 3 years.  While some women do great on it, it is also a progesterone-based method that tends to cause irregular, unpredictable bleeding for the entire 3 years.  Also, like the Depo-Provera injections, a lot of women gain weight with it, and/or have other hormonal side effects.  So it’s not my favorite, but it is good for women who really need something reliable, because it’s nearly impossible to mess it up.  Plus, many women don’t feel comfortable with the thought of something in their uterus like an IUD.

I think after baby #2, I would consider the Mirena IUD.  I haven’t needed to try it before, since the pills have always worked so well for me.  But taking the mini pills around the same time each day is a pain.  One trick I found is that if I anticipate waking up late on the weekends, I can take an extra pill in the evening Friday, and that way it doesn’t matter if I take the pill later than usual on Saturday morning.

The nice thing about the Mirena IUD is that the progestin hormone mostly acts in the uterus.  That means it thins out the uterine lining, causing periods to be lighter and less frequent.  For some women, it stops cycles completely.  As I mentioned before, this process decreases one’s risks of endometrial cancer.  The hormone activity is much lower systemically, so the side effects are less common compared to the other methods like the Depo-Provera injections, Nexplanon, and progestin-only pills.  Therefore weight gain is less likely.  And once it’s in place, there is nothing to remember daily.

You can keep it in for up to 5 years.  And actually, good research has shown it to be effective up to 7 years.  So sometimes when I use it for menstrual control in my ladies in their late 40s or even 50s, I have them keep it for up to 7 years.  Especially for the morbidly obese patients whose excess fat tissue has increased estrogenic activity- these patients are at higher risk for endometrial cancer, so the Mirena helps reduce that risk.

Overall, I love the Mirena for my patients and place many of them.  The downside is that either type of IUD can sometimes expel spontaneously.  It doesn’t happen that often, but it’s not something you can control.  Sometimes it moves down too low in the uterus and into the cervical canal, or comes out completely.  In that case, one would not be protected from pregnancy.

The ParaGard, or copper IUD, is just as effective at preventing pregnancy as the Mirena, but doesn’t have hormones.  So you still have your normal periods, but they will tend to be longer and heavier.  I personally wouldn’t want that, even though my periods were normal.  So I find that it’s less popular.  But like all methods, there are some women who are very happy with it.

I’ll never know how much of my weight gain was due to the progestin-only pills versus breastfeeding, since I’m stopping both concurrently.  In any case, I’m hoping I won’t be as hungry and can work on my weight control.  This week, I was looser on the pumping schedule, and then over the weekend I minimized the breastfeeding.  It seems like despite not pumping during the day, I did continue to make some milk when he would breastfeed.  It makes me a little sad not to continue at least breastfeeding without pumping, but mentally, I have decided that I need to stop completely.  I need to get back on the regular pills and attempt to get back on track with my own health, before I reach the point of no return.

I took a pic of his last breastfeeding session yesterday evening.  It was getting dark, so the picture came out more grainy- which is probably better, so you can’t really see my boob.  He’s grabbing onto my nursing bra.  He was finally starting to enjoy it more, so I will miss that.  But I can also see how weaning an older baby who gets a lot of comfort from breastfeeding would be challenging.  My mom once told me that her mother, who breastfed 8 kids, would put a little wasabi on the nipple to wean.  Yikes!  Not sure I’d recommend that, but I guess it worked.



Hormonal Changes with Breastfeeding

Thank you so much for all of the support after my last post.  I really appreciate the positive feedback and tips from my little community of readers.  I usually take a week off every few months to maintain my sanity, and at the time of my last post, I was on my last week of work before my vacation.  I was definitely feeling it, and it came through in my post.

I would like to say that after a week of vacation I’m all refreshed and ready to take the bull by the horns again.  I’m not quite there, but nevertheless it was a nice week off.  We had our first night away from WZW.  We drove to Sacramento on Friday and stayed with our friends who watched him over the weekend.  It helped for us to be there the first night so he could acclimate to them and their house.  Then early Saturday morning, we headed to Lake Tahoe (about 4 hours away from home) where we spent a night before heading back to pick up our little guy on Sunday.

It was so nice to do simple things.  We went hiking, which was tough given the elevation and how out of shape I am, but I did it!  And going out to dinner without worrying about the baby trying to touch everything and knock everything down was great.  Of course, we missed our little guy and it was nice to see him again.  Thankfully, he had lots of fun with our friends.

During my week off, I continued to breastfeed and pump, but have grown increasingly weary of it.  It’s frustrating to want to relax, do stuff, and enjoy myself, but every 4 hours I have to remind myself to pump or feed.  Often, I’d be engrossed in whatever I was doing and forget.  And then I’d feel upset.  WZW’s schedule often doesn’t match mine, so I don’t end up breastfeeding directly much.  Plus my husband knew how hard of a time I’d been having, so even though I was off work and he wasn’t, he still took care of nights so that I could rest up.  So I was going for longer stretches at night.

Not surprisingly, my supply has decreased now that I’m back at work this week.  For a while now, I’d been thinking of stopping around 10 months.  Partly because it’s been such a daily struggle, and partly because I’m going to a friend’s bachelorette for a weekend next month.  Even though there will be other moms there who would understand, I just don’t think I can stomach having to worry about pumping the whole weekend.

One of the comments after my last post mentioned this article:

Why Didn’t I Lose Weight While Breastfeeding??

(Couldn’t figure out how to undo that large space)  It talks about the hormonal changes that occur with breastfeeding that prevent weight loss in some women.  Namely, the low estrogen and progesterone.  Now, I’m the first to admit I’m not that knowledgeable about hormones and the nitty gritty of how they work as described in the article.  What I do know is common knowledge amongst obstetricians that breastfeeding causes a low estrogenic state.  That low estrogenic state causes such fun things like vaginal sensitivity and pain.  With that said, I’ve also had patients who aren’t breastfeeding who have vaginal pain for months postpartum, which must be from the lacerations or something.

After reading the article, I feel better.  Although I’ve felt like my body has been hijacked since I became pregnant, I thought a large part of the weight gain postpartum was from the chronic sleep-deprivation.  But maybe more of it has to do with breastfeeding than I thought.

What I’m not sure about is the progesterone.  The article says that if you are not ovulating (which is generally the case if you haven’t gotten your periods back), then it lowers progesterone levels.  But I’m taking the progesterone-only birth control pills, which inhibit ovulation, but also are adding back progesterone.  So I’m not sure how that factors in.  Progesterone-based birth control methods, most notoriously the Depo-Provera injections, can cause weight gain.  So based on what I already know and what the article says, both added progesterone and low progesterone can lead to weight gain?

In any case, I’m looking to stop breastfeeding soon.  It’s interesting, because I’ve found it pretty terrible for the most part.  My husband has seen how difficult it’s been, and has said he wishes he could pump for me.  But I’m sure he’s relieved he can’t!  He fully supports stopping now- at this point, the little benefit from the few ounces of milk I’m able to provide our little guy isn’t worth the huge hassle.

So you’d think after all of my bitching and moaning that I’d be excited to finally stop breastfeeding and be free of my invisible shackles.  Well, I’ve found that I have some hesitations and fears as well.

At this point, it’s all I’ve known since WZW was born, so it’s a little scary thinking about how it’s going to be when I stop.  There’s the reaction from habit- the amount is decreasing?  Must pump more!  Also, as I see my milk supply diminishing further, there is a disappointment to it.  In general, I feel a sense of accomplishment when I get a lot of milk, and it’s disappointing to see only an ounce or two.  As it diminishes even further, there is some sadness to that.

I’m a goody goody who likes to follow the rules.  So I’d always hoped to practice what I preach.  Every single pregnant patient of ours hears the recommendation from the American Academy of Pediatrics- to breastfeed exclusively for 6 months, and breastfeed total of a year or more.  I do feel slightly disappointed to not quite make the year.

Also, in the last month or two, I have found that WZW seems to get some comfort from breastfeeding.  He is still all over the place, frequently coming off the breast, getting distracted by other things, pulling on my clothing & hair, etc.  But the fact is that he still takes the boob.  Even though it takes more time and work to get a couple of ounces, as opposed to chugging down 8 oz in a bottle, he still keeps breastfeeding.  So there must be some inherent benefit/comfort for him, which has made me enjoy breastfeeding a little more lately.  Just a little.

I wonder if I will feel significant changes.  My dental hygienist said she felt depressed when she stopped breastfeeding, even though she’s normally not a moody person at all.  And part of my fear is that even when I stop breastfeeding, I’ll still have a hard time changing my eating habits.  I decided to weigh myself recently, and sure enough I’ve continued to gain weight- so now I am close to the weight I was at the end of my pregnancy, nearly 30 lbs. heavier than I used to be.  Yikes!

Despite all of this, as the comments on my last post reminded me, I am grateful for all that I have.  When I hear about bad outcomes with patients and their babies, or see patients who are having difficulty conceiving, it reminds me how lucky I am to merely have one healthy baby.  Though it hasn’t been easy, I have a normal baby who was able to breastfeed, and somehow or another I’ve managed to make it to nearly 10 months.  I’m sure it helps that he’s not in daycare, but he hasn’t gotten sick yet.  And neither have I, even though my husband and nanny have.

Many of my patients end up with more significant physical changes postpartum.  Not just bad stretch marks.  I’m talking about significant vaginal lacerations (sometimes involving the rectum), urinary incontinence, vaginal prolapse.  Things that aren’t as easily corrected as weight gain.  If gaining 30 lbs in exchange for my beautiful little guy is all I have, it’s not that bad in the scheme of things.  And despite the stress and long hours, I have a stable job that provides personal fulfillment and financial security.

I am most grateful for a husband who might be secretly superhuman, as he continues to go above and beyond to help take care of WZW and me, especially when I’ve been having a rough time lately.  He has insisted on taking most of the nights, despite his own rigorous work schedule.  Without him, I would go certifiably insane.

So we shall see- as I stop breastfeeding and move onto the next chapter, it will be interesting to see how things go.