Friday, October 05, 2007

Been Away

....haven't seen you in a while. Thanks for continuing to check in on me. I really have missed blogging and checking in with all of you. It is like a missing part of who I am, but who has the time? If I thought life was crazy before, it was nothing compared to working full time with a toddler and a newborn. As much as I hate to do it, I am being forced to become more organized, lest I pay the very hefty price when I neglect organization. I now try to shower, prep bottles for daycare, and, if I'm really good, lay out clothes for myself and the kids in the evening. If these three things are done consistently, mornings tend to be hectic, but smooth. If not? Unmitigated chaos.

Our daycare likes to complicate matters more by these ridiculous restrictions on the bottles that we bring in for Bean. For example, all bottles must be labeled with the baby's name (naturally), ounces in the bottle (mmm, okay, but can't you see the marker yourself?), and, here's the kicker, the date can only be the day prior or the date that the bottle is being used (seriously?? Don't they know that breast milk keeps longer than 24 hours in the fridge??) In addition, all bottles must have nipples on them, as they cannot rinse and re-use a once used nipple (ridiculous). This is a pain in the ass because half of the bottles we have are breast milk storage bottles, so nipples must be washed twice as frequently during the week. I have offered to provide a "doctor's note" that it is perfectly acceptable to re-use nipples and to use breast milk that is older than 24 hours, but no one seems to take that offer seriously.

So, every night we have to re-date bottles (because let's be serious, I'm not washing perfectly good breast milk down the drain, the stuff is liquid gold), wash and re-place nipples, and keep track of how many bottles are needed for the next day. It seems a small feat, but add that to feeding, entertaining, and bathing a toddler, feeding, bathing, and entertaining the newborn, and feeding (and in my case, bathing) ourselves, and things get a little more hairy. Then there are mornings like yesterday morning when we all woke up late, and Bean decided to give himself (and his mother) a different kind of shower. Now when changing a boy's diaper, unexpected sprinkles are not uncommon, but this one occurred in between the removal of the requisite "shield wipe" and the fastening of the diaper. The result was pee on his head and chest, my hair, my clothes, and all over the bed (he even peed over the chux that he was being changed on!) This earned him a quick wash down from head to toe with my closest available "washcloth" (a clean sock) and baby shampoo, and it earned me a whole new shower. Which,in turn, made me unable to go in for rounds and just barely on time for the office. Ah yes, life is different indeed.

On the work front, I am working with my staff to whittle my schedule back to a reasonable pace. For now I am restricting OB patients to 15 total deliveries per month, with the availability to go to 20 per month if my schedule allows. I have blocked time to pump throughout the day. I also have stopped having routine scheduled patients after 4 pm, leaving the hour between 4pm and 5pm for work-in patients and emergency room follow-ups. If there are no work-ins, then I have that time to do the office charts for the day, sign off on labs, and dictate. So far it is working well. Time will tell if I can keep that pace and still be profitable for the hospital. The call schedule is still less than desirable, only 4 days off per month is not going to hack it in the long term. I am holding out hope that the hospital will hire one (or two) more physician(s) sooner than later. If no help comes for the call schedule, no matter how much we like everything else, here, we will likely go looking for a better quality of life. My patients are happy that I am back, and that makes coming back a whole lot easier. I did miss the patients and the relationship I have with them. I love what I do, I just need to find a way to make my job fit more into my life rather than working my whole life around my job.

Eh, this entry is boring, but it is what is on my mind. I am glad to have this time to write, and will make an effort to make more frequent forays into blogland. As for topics, if you have any requests I'll be happy to try to work them in between the whiny me, me, me posts! :) Happy (OMG it is freaking) October!

10 comments:

Anonymous said...

Wow...

Day care is a pain for sure, geesh. My baby is 3 weeks old and I cannot imagine having to have to organize like that! She nurses so much, I know daycare would really be an adjustment.

Definitely do what keeps you sane. I know it's hard for a patient not to get "their" doctor, but I have had 6 babies and only had my OB there one time. I have had nurses catch 3 times. I am okay, and I think my OB has it a bit easier on the call times...much better than 4 days off per month. I bet you can find a practice somewhere that gives you more time off.

Congratulations on your growing family!

Dawn

Anonymous said...

Congrats on the Bean. We seem to have similar experiences both professionally and personally. I'm a bit ahead with a two year old that sleeps fairly well and I got through boards last year in Dallas - thank the stars! Best of luck when you head down there - it's a pretty crappy experience. Keep the blogs coming. It's therapeutic during a day at the office when I need a good chuckle!

Lulu said...

Welcome back! I have missed your blogs. This blog wasn't boring at all...it's good to know what you are up to. Hope it continues to run smoothly.

PE Mommy said...

Glad to see you back. We have missed you!!! Yes life is hectic with a newborn and a toddler. Our daycare has some pretty rediculous rules too. My favorites have been the poop ones. They kept saying my then 18 month old had diareah and she had to go home. Two loose poops in a day and they send them home. I was like that is NOT diareah and this is HOW she goes to the bathroom. Even after her dr wrote a note for her. My dr tells it how it is and she said they just didn't want to deal with a normal toddler thing. I agree. Can't wait till she moves into the three year old room (8 more months!!!). They have eased up on the poop thing since I demanded that they start sending home. Out of the diapers they sent home, 2 were possibly diareah in the last few months. GRRRRR. I hear ya on the daycare. I would ask their evidence for throwing out breastmilk after 24 hours. I would do what you were doing, relabeling! Maybe you should buy some more breastmilk bottles. Buying more bottles saved us a lot of time.

Celeste said...

Daycares have to comply with state laws and unfortunately that is probably where they got the one about the labels on the bottles. I just used Sharpie on masking tape for my labels.

I think you should buy some extra nipples just so you aren't forced to wash them out every day. Yes, eventually there is a pile of them, but to me it was worth the money to sometimes have a shorter task list.

You are just doing really great with being back to full time! I'm glad you found some blogging time.

rlbates said...

Welcome back. Remember this only temporary (the breast feeding) and your child will grow up way too fast. That may not make it any easier, but it may give you a different perspective. [similar to being on some of those med/surg rotations as a student or resident--this too shall pass].

Happy October!

Amanda said...

Not sure where you live, but I'm a Day care administrator, and those stupid rules regarding bottle prep and storage are state law here in Ohio. We think they're stupid too, but can't tell parents that, we just all have to live with them. Unfortunately a Dr.'s note doesn't override state licensing except in very specific instances where state law says it can. (Like a 16 month old- by law they must be 18 month's old- sleeping on a cot instead of a crib with a physician's signature on the correct form...)

Just found your blog, look forward to reading more...

Anonymous said...

We ended up with a nanny after bringing our youngest child home. It was cheaper than having two in daycare, and a lot more flexible, and mornings ran a lot smoother. Also, unlike the daycare, our nanny didn't refuse to care for him just because he had a little cold, or low grade fever.

I have a question. I read your blog in one afternoon, and I saw the avoided a c-section scenario played out several times, most notably in a post about a year ago labeled "Nurses". The baby is distressed, but the nurse doesn't panic, and manages to get the baby's heart rate back up, and avoid a c-section. Here's my question: Several years ago, I found myself in a new mothers' club no one wants to go to: the bereaved parent support group. Third trimester loss of twins. Anyway, during the next several months I heard about five stories like this one, except the baby suffered severe brain damage, and was taken off life support, and the OB was stuck saying, well, I've been doing this for x many years, and this has never happened before. No one, no one, no one I met lost their baby because of a planned C-section. My own eldest daughter also almost died during her delivery, and had to be resuscitated at birth, with a heart rate plummeting to the 50's while I was pushing (for three hours) and a birth apgar of 4. I realize a c-section is slightly risker for the mom, but believe me, I would rather take the risk myself than live through what we did. Why is avoiding a c-section such a praiseworthy accomplishment? Despite statistics, no one can explain to me why moms going in for sections come out with live babies, and vaginal deliveries seem to be more at risk. I also have three friends whose babies almost died during delivery, and had to have a crash section. One ended up in the NICU with aspiration. It really seems that a planned section is a reasonable choice (and much safer and easier to recover from than a crash section, let me tell you first hand!)

sincerely, and with respect,
Sari

dr. whoo? said...

Dawn~ Yes the organizing can be difficult! Especially if you are inherently disorganized, as am I! Luckily for me, the ladies at the daycare love my little man, and I know they are cuddling him and caring for him well while I am at work. It isn't easy to share him, but I am thankful for additional people in my children's lives that love them. I am praying that I find a good balance between lifestyle and work in my current situation. Take care of yourself!

Hi anon! Thanks for reading! It is good to know that there are others out there going through the same things, and I hope to keep you laughing! I am a'skeered of the Oral Boards. I am also an idiot and missed the application deadline (November, 06! I thought it was February) for this year, so I have to agonize for a whole additional year. I blame pregnancy.

Truth be told, I think I will study better when I don't have an infant, and this year I will be able to attend conferences for review, so maybe it happened for a reason. I'll take luck and any other voodoo you care to send my way! :)


lulu~ Thank you! I missed you all, too! Glad that you don't find the mundane posts boring. I promise to get back to fun filled, Hipaa compliant birthing posts soon.

pe mommy~ Thank you! It is great to hear that I was missed as much as I missed you! I know that many daycare guidelines are state legislated and I know they do the best they can, but it can be quite frustrating from time to time. I'm glad they don't have a "poop quota" in my son's class. He poops 6-7 times daily as a matter of course! We have a lot of bottles (I am pumping about a week ahead of need), but I am buying more nipples this month!

celeste~ Yes, I know it isn't their fault, I just like to whine. :) I am planning on buying more nipples this weekend, and I do the sharpie/masking tape too! I am glad to be back and hope to have more time to blog in the future! Thanks for reading :)

rlbates~ Happy October to you! I totally understand from whence you speak. It seems like I just snapped my fingers and CindyLou is 3.5 years old. I love nursing, don't get me wrong. I think it is awesome to be able to provide all the nourishment that my little guy needs. I just like to whinge a bit, that's all. I know nursing will be over before I know it (and so will the weight loss!)

Hi Amanda and Welcome! You look just like one of my friends IRL. It is crazy! Yes, I know it is state regulation here, too. I am not in Ohio, but the laws here are similar. I did find out that my whining caused the center to look up the guidelines, and now it is 48 hours instead of 24 hours for breastmilk...woo hoo! Thanks for reading, and I'll try to keep things entertaining!

Sari~ Thank you for reading, and you pose some of the most important questions (IMO) that face OB docs on a day to day basis. Let me start by saying that I am so very sorry for your loss. It is a fine line between necessary C-section and unnecessary C-section. That is the dilemma of the OB. Since the onset of continuous external fetal monitoring (EFM), this debate has raged. The C/S rate has increased as a result of EFM, but the clinical evidence is spotty on fetal outcome.

Many times, fetal distress noted on EFM does not compute with Apgar scores/blood gasses post birth.
Many practioners will interpret fetal strips differently. It is a fine line to walk, determining what constitutes true distress and what does not. There is an increased risk to the mother in C/S births when compared to vaginal deliveries, but I agree with your premise that a healthy baby trumps all.

Sometimes, though, we find that a C/S (and all the risks that go with it) is not warranted. It is just a matter of physician and patient comfort. If I am at all concerned with fetal status, I will lean toward cesarean delivery. However, many mothers will wish to avoid cesarean at all costs. It is the cross of the OB/GYN to make the call and suffer the consequnces, should there be any. Not an easy decision and one of the hardest parts of my field. Personally, you will see me section more for a bad strip than to wait it out, sometimes waiting it out will be beneficial to mom and baby....sometimes it is not. That is where professional opinion comes in, and, trust me, it isn't always black and white. Hope that you keep reading!

AtYourCervix said...

Welcome back OBGYN Kenobi!!! We've definitely missed your presence!

Glad to hear things are going ok, albeit hectic, for you and the new bean.