Paid Maternity Leave

I had just written a response to a partner’s email regarding outpatient coverage and the focus of work-life balance.  I think it’s a great initiative that she is tackling while brainstorming what could help the group with flexibility as well as some normalcy while raising a family.
This made me think of changes to antiquated practices we currently have in our work environment… primarily, paid maternity leave as well as paid sick leave.  Many of my male colleagues can continue to work and can take as little or much leave as they would like for family bonding or vacation time to spend with their newborns.  This is their option.  Unfortunately, the women physicians in our group are not afforded that same luxury.  There is a 6 week medical leave of absence with a vaginal delivery or an 8 week leave of absence with a C/S as proposed by the OBs.  During this time, we are not paid.  State disability is a joke bc it’s not even enough to cover a mortgage payment.  Look at other large companies, there’s often paid leave or sick leave available to the employees.  Therefore, women who choose to have kids while working as a physician in our group are penalized, especially if they are the breadwinner.
Not only that, even while off on medical leave, we are required to pay into the trust and pay ridiculously high premiums to cover the wide age gap of partners in our practice.  I would be happy to look elsewhere for my medical coverage, but I simply cannot come off our medical insurance plan.
Therefore, I propose there be a fund set aside to create a pool or trust for persons creating families (just as we do for our more distinguished and elderly physician population with our health insurance plans and exorbitant premiums) who will have families and work in our group.
Here are some examples in the news of what is and has been in the pipelines….
Here are examples of companies getting it right:
Please consider updating some or all of the policies for paid maternity leave.  I am open to your thoughts and considerations.

 

Poll on Maternity Leave

What it’s like to be a female anesthesiologist…

Advertisements

Severe Pre-eclampsia and Anesthesia

Chief Complaint: elevated blood pressures, now with elevated liver enzymes

SUMMARY OF RECOMMENDATIONS
1. Nifedipine 60mg ER BID, next dose at 0900.
2. Continue q4hr blood pressure monitoring; increase to q15mins should she have systolic blood pressure >160 or diastolic blood pressure >110. Please call Perinatologist should that occur.
3. NPO for now.
4. Follow-up serum preeclampsia labs at 1200, along with type & cross x2 units.
5. If AST/ALT continue to rise, would recommend primary cesarean section at that time.
6. Continue magnesium sulfate for now, and for 24 hours postpartum.
7. NICU aware.

PROBLEM LIST
1. INTRAUTERINE PREGNANCY AT 25w6d
2. SUPERIMPOSED PREECLAMPSIA WITH SEVERE FEATURES
3. TRANSAMINITIS, NOT YET 2x THE UPPER LIMITS OF NORMAL

HPI/HOSPITAL COURSE: 37 y.o. G1P0 at 25w6d, hospitalized for exacerbation of chronic hypertension, found to have preeclampsia with proteinuria. Patient received betamethasone and magnesium sulfate course. Since <deleted date> with change of her regimen from labetalol to nifedipine 30mg XR BID, patient had had normal to mild range blood pressures.

Patient had acute exacerbations in her blood pressures to the severe range. Please see my note from <date> in regards to her antihypertensive course. After her 10mg IV hydralazine yesterday evening, starting magnesium sulfate, and increasing her nifedipine to 60mg XR BID, she has now had normal to mild range blood pressures overnight. However, her 0000 and 0600 AM labs show an acute rise in her LFTs above her baseline, with AST now 74 and ALT 81. Platelets remain normal range, as is serum creatinine (0.5). Magnesium level this morning at 6.4, infusion rate decreased to 1gm/hr.

Review of systems: denies headache, visual changes, RUQ or epigastric pain. No contractions, leakage of fluid, or vaginal bleeding. She is feeling fetal movement this morning.

Allergies:
• Amoxicillin Rash
CONV. REACTION:Rash
• Penicillins

Exam:
Vitals:
BP: (!) 140/97
Pulse: 89
Resp: 18
Temp: 36.7 °C (98 °F) 36.7 °C (98 °F)
TempSrc: Oral Oral
SpO2: 98% 98% 98%
Weight:
Height:
General: no acute distress
Cardiovascular: regular rate, normal rhythm. Intact S1/S2
Pulmonary: clear to auscultation bilaterally
Abdomen: gravid, non-tender to palpation
Extremities: non-tender; trace lower extremity edema, symmetric. 2+ brisk patellar reflexes

Ultrasound (12/5): Cephalic presentation. estimated fetal weight 28th percentile, 776g. Normal umbilical artery dopplers.

Labs:
Lab Results
Component Value Date
WBC 14.4 (H)
RBC 4.51
HGB 13.7
HCT 41.3
MCV 91
MCH 30
MCHC 33
RDW 11.8
PLT 313
PRENEUTROABS 9.56 (H)
DIFFTYPE Auto
NEUTOPHILPCT 66.4
LYMPHOPCT 24.0 (L)
MONOPCT 7.9
EOSPCT 0.7
BASOPCT 0.9
NEUTROABS 9.56 (H)
LYMPHSABS 3.46
MONOSABS 1.14 (H)
EOSABS 0.11

Lab Results
Component Value Date
NA 133 (L)
K 4.0
CL 102
CO2 22
GLUCOSE 84
BUN 11
CREATININE 0.5
OSMOLALITY 275 (L)
ALBUMIN 4.0
LABPROT 7.4
CALCIUM 7.0 (CL)
ALKPHOS 91
AST 74 (H)
BILITOT 0.2
ANIONGAP 9
ALT 81 (H)
GFRCNAFA >60
GFRCAFA >60

NST: appropriate for gestational age and magnesium sulfate administration. Baseline 135, mild to moderate variability, occasional 10×10 accelerations. Rare variable decelerations.
Toco: irritability

Assessment/Plan:
37 y.o. G1P0 at 25w6d, admitted for superimposed preeclampsia with severe features.

With preeclampsia with severe features, we do try to wait until 34 weeks for delivery; however, delivery is recommended once in the steroid window for the following: persistent symptoms of preeclampsia (i.e., headache, vision changes, upper abdominal pain), worsening or uncontrolled blood pressure despite medication therapy, development of pulmonary edema, placental abruption, eclampsia, HELLP syndrome (i.e., platelets < 100,000 or LFTs > 2x normal), evidence of acute kidney injury (i.e., creatinine >/= 1.1 mg/dl), eclampsia or non-reassuring fetal testing.

I discussed my concern that her liver enzymes, which had mildly been elevated on admission, are now acutely rising, which would be an indication for delivery at this time. However, at 25+6 weeks, I recommend rechecking her preeclampsia labs again at 1200. If there is a further acute rise, I do recommend delivery via cesarean section at that point.

We discussed the risks/benefits/alternatives of primary cesarean section, as well as the possibility for a classical hysterotomy, in which she would not be allowed to labor in the future. Risks of cesarean section discussed included:

Risks of cesarean section:
1. Bleeding, with the possibility or requiring a transfusion. Risk of transfusion include allergic reaction (1/50,000), transmission of HIV/Hepatitis B or C 1/1.5-1.7 million. The patient is accepting of blood transfusion if needed, and a type and cross x2 units will be ordered at noon.
2. Infection, requiring intravenous antibiotics and potentially prolonged hospital stay
3. Damage to surrounding organs, not limited to baby (<1%), bowel, bladder, nerves, vessels, ureters.
4. Possible need for hysterectomy in the event of irreversible catastrophic bleeding
5. Wound complications not limited to separation and/or infection
6. Medical complications not limited to deep venous thrombosis, pulmonary embolism, cardiovascular accident, myocardial infarction, death.

I would not advise induction of labor at 26 weeks, as the chance of a successful vaginal delivery prior to 28-30 weeks in a primip is low.

Patient will remain NPO and on magnesium sulfate (for maternal seizure prophylaxis and fetal neuroprotection) at this time, as we await her 1200 labs. Will continue q4hr blood pressure monitoring, and she will be given her 60mg XR nifedipine at 0900.

Scientists-discover-critical-molecular-biomarkers-of-preeclampsia
From Debuglies.com

Spinal Anesthesia in Severe Preeclampsia. Anesthesia & Analgesia: September 2013 – Volume 117 – Issue 3 – p 686–693.

PDF version of article above

Subarachnoid block for caesarean section in severe preeclampsia. J Anaesthesiol Clin Pharmacol. 2011 Apr-Jun; 27(2): 169–173.

Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section. Anesth Pain Med. 2016 Jun; 6(3): e11519.

Recent advances in pre-eclampsia management: an anesthesiologist’s perspective! Anaesthesia, Pain & Intensive Care ISSN 1607-8322, ISSN (Online) 2220-5799.

Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia. Anesthesiology 5 2008, Vol.108, 802-811.

Traveling with an Infant

We took our first trip as a family of 3 to Maui (or should I say 4 since I’m 14 weeks pregnant).  Granted, it’s a roughly 6 hour/5 hour plane ride to/back.  I had read up on multiple blogs regarding what to bring, how to travel, what to expect, etc.  I’ve created a bullet list of must-have things to travel with or pack for your little one (ours was 7 months old at the time of travel) Continue reading “Traveling with an Infant”

Pregnancy #2

July 22, 2018

Well, this is quite the title.  We knew we wanted to expand our family.  Arden has been such a good kid, and we felt like we could handle another kiddo.  But little did we know it would/could happen so soon.

The first day of my last period was May 31.  I’ve never had a regular period, so I didn’t think my period would be any different post-pregnancy.  Arden had a mixed formula/breast milk feed since she was about a week old.  Despite breastfeeding/pumping 12x/day, I could never get my milk supply to meet her feeding needs.  Even knowing this, I still tried to pump for about a month at work before my supply went completely down to nothing.  So, my pumping ended around June 20, 2018.

As it was nearing Arden’s 5 month birthday, my husband and I thought I should take a pregnancy test just for kicks as I hadn’t had my period yet… but that wasn’t out of the ordinary for me to go 30-40 days between periods.  But something gave me an inkling that the pregnancy test may be positive.  About two weeks before the pregnancy test, I had what felt like a period cramp right in the middle of my abdomen.  It lasted for about a day, and I thought I was going to get my period soon.  Then, I also had breast tenderness… but that wasn’t uncommon as that’s a common symptom for me prior to my period.  But two weeks passed after these symptoms and still no period.  So, I took the pregnancy test a day after Arden’s 5 month old birthday.  Lo and behold it was positive!  I couldn’t believe it!  I had to show my husband.  He was shocked and happy all at the same time!  We get our first ultrasound in two weeks and this time I promised my hubs that we could know the gender before the delivery.

This slideshow requires JavaScript.

Week 7 – Aug 6, 2018

Today I’m 7 weeks, 6 days.  I had my first ultrasound a week ago and by ultrasound the Nugget measured 6 weeks 6 days.  The fatigue has been unrelenting.  I need naps daily or I hit the sack early like 9p.  Last night, Arden kept rolling over onto her tummy and I was getting up every two hours to turn her over.  It makes me a little nervous for her to be on her tummy still as she still hasn’t mastered rolling over to her back.  The Nugget’s due date is March 19, 2019.  That means the two kiddos will be 13 months apart.  Whoa!  For right now, I still have my Mondays off… but that is going away mid-October.  I’m a little worried when it does go away.  I haven’t been able to workout for the last 3 weeks bc of fatigue.  I just have no energy.  But I know I need to do something so I’m trying to still get evening walks in before Arden goes to bed.  I ordered a 1 year subscription to SugarySixPack because she has workouts for pregnancy and they’re safe as she’s a certified trainer and she did them herself throughout her pregnancy.  Obviously, listen to your body and see how it feels… everyone is different.  Another workout plan that I thought was helpful (but I only did during my third trimester) was Expecting and Empowered.  Cravings have included pineapple, baked potatoes, sandwiches, ice cream, VG plain donut, Nilla Wafers, potato chips… let’s just say it’s not the healthiest cravings.  The morning sickness is getting more intense and certain foods are turning me off (fried foods, onions, sauces, tomatoes).

Week 8 – Aug 14, 2018

This week was a rough long week at work.  I worked for 13 days with one day off (Sunday – post OB).  Also, this week, Arden got hand, foot, and mouth disease at day care.  My post of her illness is here.  The worst of it was probably the first 3 days she had the illness.  My morning sickness is getting better.  I find that I have a little more energy to go for walks around the block and not just be a dud on the couch.  Feeling better this week despite the work hours.  Thanks to my mom and husband for being here this week to help out with Arden.  And the craving of Le Croix is back!

Week 11 – Aug 28 – Sept 3, 2018

Cravings this week:  mashed potatoes, pizza, Le Croix, cookies…. everything but healthy.  On weekends, I find that my energy level is zapped!  My best productive times are from 7a-11a and then 5p-8p.  From the hours of 12p-4p… I’m pretty much a zombie or need to nap during that time.  It’s a bummer bc I feel like such a bore.  My poor husband!  Earlier this week, I took the NIPT to test for common genetic issues in our baby.  It came back negative for any of the common chromosomal abnormalities.  And, we found out we are having a little boy!   I am so excited to hear this news!  For some reason my husband was thinking we would have another girl… and I was thinking ‘oh man, we’re gonna have to try again for a boy if it’s a girl and I don’t know if I can handle being pregnant a third time.’  Well, luckily, we hit the jackpot and we couldn’t be more thrilled!!  So far everything is looking good for our lil Nugget!

Week 12 – Sept 4 – 10, 2018

This week, we’re going to surprise the moms with the announcement of our pregnancy.  I found a cute lil shirt on Etsy for Arden that says “Look Whoooo’s going to be a big sister!”.  I also ordered gluten-free cupcakes with blue buttercream filling on the inside as a gender reveal for the moms.  Lastly, I was able to get a colleague to help cover my #2 day from 5p-8p so I can witness my mom’s happiness when she is here.  I’m so glad we’re telling them this week as I’ve been starting to show probably since week 9.  That’s way sooner than I showed with Arden.

This slideshow requires JavaScript.

Week 13 – Sept 11 – 17, 2018

This week was a blur!  Trying to get ready for the trip and making sure everything is packed.  meeting with the contractor, interior decorator, and architect for our lil building project.

Work hours = 40.5 (in 3 days)

Week 14 – Sept 18 – 24, 2018

We were in Maui this week for our first family trip with Arden.  (Click here for advice on traveling with an infant).

Work hours = 0

Week 15 – Sept 25 – Oct 1, 2018

Although I didn’t anticipate this to be a busy week… it was.  Bear had multiple deadlines and was really worked this week.  I missed seeing Arden 2 days this week.  That’s so heartbreaking for me.  The days that I don’t see her really makes me stop and think about priorities and changing my work schedule.

M O M  G U I L T.

Yes, it’s a real thing.  Before Ardenbug, I focused on my education and career.  I didn’t have a problem putting in the time, staying up late, covering extra shifts, taking extra call, working on weekends and holidays.  Then it all changed when she was born.  My priorities changed.  I’ve learned to give up my weekend calls and happily take the early day home if need be.  It was an adjustment.  But I want to be as present and available to my lil girl.  There are still days/nights where I won’t see her.  This past week, I didn’t see her two of those days because I left before she woke up and got home after she went to sleep.  Those days are especially hard for me.  Not because of the work hours, but because I didn’t get to see my Ardenbug’s smiling face.  I ever thought it would hit me so hard.  I was never the baby type.  But, this whole process proved me wrong.  And that’s ok.  I’m human.  And I want to be present as much as I can.  So, if I don’t say YES to weekend activities or things…please don’t take it personally.  I just want to see my kiddo and spend time with her because time stops for no one.

Work hours = 33 (in 3 days)

 

Week 16 – Oct 2 – 8, 2018

Nothing new this week.  Arden started really crawling and getting about the house this week.

Work hours = 44.75 (in 4 days)

 

Week 17 – Oct 9 – 15, 2018

Arden has been having a productive cough and sometimes the mucus will cause her to gag and vomit.  Poor thing has vomited 3x this week.  And to top it off, Bear and I both got some food poisoning over the weekend.  After multiple episodes of vomiting and diarrhea, I called my OB bc I wanted to check on baby G.  One of the midwives said I probably ate something that didn’t agree with me and it wasn’t food poisoning.  Nope.  My hubs and I were both having diarrhea and vomiting.  So, I called Bears’ mom for backup and as soon as she got to our place, Bear and I headed to the ER and got 2L LR, Reglan, Zofran, and some labs.  Lil G looked good on ultrasound (I HAD to come and check him out,….couldn’t help it).  After a couple of hours, we headed home and laid low and slept for most of the afternoon/evening.  Thank goodness for the moms being relatively close by (my mom would’ve helped but she got a stomach bug too).  We’re now on the mend!!

Work hours = 36.5 (in 3 days)

 

Week 18: Oct 16 – 22, 2018

I had this week off, but was able to pick up some work at some surgery centers.  It was nice to be able to pick Arden up from school.  She’s such a happy kiddo!  This week, we’re moving everything out of the downstairs bathroom, bedroom, den, and laundry room in anticipation for our renovation.  I really hate moving bc I hate the packing and unpacking.  Luckily, my Bear is super supportive and is the muscles behind the move.  This week, I’ve been feeling Lil G’s kicks and I have missed that feeling of those lil flutters in my belly.  I’ve also been feeling pretty tired this week.  Not sure if it’s bc I’m still recovering from our sickness last week, or if I’m just overall more tired.  Seems like nap time wants to hit me around 2pm.

Work hours =  23.25h (in 5 days)

Week 19: Oct 23 – 29, 2018

This has been a busy week!  We have moved all the stuff from the downstairs bathroom, bedroom/closet, den, and laundry room.  We moved the upstairs couch downstairs, and the downstairs couch upstairs.  We re-arranged the newly placed downstairs couch.  We’re exhausted.  Not only that, Chase Travel rewards happened to screw up our flights that we need ASAP.  So that was a stressful debacle just now.  Just found a super great website for traveling with baby to decrease lugging stuff across the country:  Baby’s Away.  

Work hours = 22.75 hrs (in 3 days)

Week 20: Oct 30 – Nov 5, 2018

Had an excellent vacay up in Nor Cal!!  We stayed in a cabin in the woods and went hiking in the forests/redwoods.  Big Basin Redwood State Park and Henry Cowell State Park were my fave.  Is it bad that I have an inkling to move up there?  Not gonna lie that I browsed Redfin for housing.

Work hours = 10.25 hrs (1 day)

Week 21: Nov 6 – Nov 12, 2018

First full week back to work.  Was a bit brutal of a call night and pre-call day.  Had this one patient on OB and the husband was trying to make all the decisions for his wife.  She was a primip and he insisted on a C/S for his wife when she was just slowly progressing.  I placed her epidural and she was comfortable and went from 1.5-3cm dilated in about an hour.  However, apparently it wasn’t fast enough for his liking.  So, he insisted on his wife having a C/S.  Baby looked fine on the monitor, and had been looking great since admission.  It’s unfortunate that bc he felt he was a doctor (a plastic surgeon) that he could make these decisions for his wife.  The OB and I proceeded to talk to him that it was normal to take some time to progress for the first pregnancy, but he wasn’t having it.  Once she finally gave consent (but you could tell unwillingly), I spoke to her about the risks/benefits of anesthesia for C/S.  The doctor husband said he’s very familiar with anesthesia.  So, I asked if he was an anesthesiologist and he said he was a plastic surgeon.  Unless you did an anesthesia residency and are well-versed in the basic knowledge of anesthesiology, please do not confuse your plastic surgery/medical degree with my expertise.  He set a great example of how I will never be with another physician or healthcare worker who is providing care to me. (end rant)  🙂

Lil G is moving around and kicking nicely.  🙂

Work hours = 40.75 (in 4 days)

Week 22: Nov 13 – 19, 2018

Arden turned 9 months old this week.  Otherwise, feeling good and about 10 weeks ahead in size vs my first pregnancy.  The peeing on myself when I sneeze has commenced again.

Work hours = 34 hours (in 3 days)

Week 23: Nov 20 – 26, 2018

This week was busy and rough.  Work the day before and after Thanksgiving.  Got the Christmas tree up yesterday!  Lil G is kicking around.  Got my glucola test today (11/26) for my 24 week test.  This time I stayed NPO.  My diet has NOT been good this pregnancy.  Everything sweet has been so appealing to me.  Sweets and carbs have been my jam.  But, I have no real cravings like I did with the first pregnancy.

So I got the results back from the 1 hour glucola test and my BS is 155, and it should be less than 130.  Ugh!  I read this girl’s blog entry and totally related.

Now, I work on diet, portion control, snacks, and exercise.

Work hours = 43 hours (in 4 days)

Week 24: Nov 27 – Dec 3, 2018

This was a hectic week.  Got a bunch of things squared away with the renovation.  It’s coming along.  We’ve passed two inspections so far.  Got my eating in gear with no sugar and meal planning in place.  Really cut back on the sweets.  I actually feel better.  I’ve even managed to get in two workouts over the weekend!  Lil G is an active kicker!  There’s not set time when he gets active… I just feel him kicking around randomly.  That is so different from Arden bc she would typically be quiet throughout the day and then kick around 8pm when I sat down on the couch.

Work hours = 53.5 hours (in 5 days)

Week 25: Dec 4 – 10, 2018

I have been clean eating for the last two weeks since I failed my 1st glucola testing.  Today, I did an experiment of doing random blood sugars.

7:00a — fasting since 8pm the night before.
BS = 84
8:58a — done one hour after my last bite of breakfast (1/2 cup greek yogurt, strawberries, paleo granola)
BS = 97
9:22am — last bite of homemade beef and bean paleo chili (1 cup). 1 tbsp unsweetened, unsalted organic crunchy peanut butter.
12:33p — last bite of work soup (1/2 chicken and sausage jambalaya, 1/2 lentil and chickpea, salt load thru the roof).
13:43p — BS 93
16:45p — last bite of grilled chicken, brown rice, veggie bowl from FlameBroiler.  1/2 an orange.
17:36p — BS 120
19:15 — granny smith apple; 1 tbsp natural, organic crunchy peanut butter.  1 piece of dark chocolate.

More info I found on glucola testing and GDM:

Work hours = 56 hours (in 6 days)

Week 26: Dec 11 – Dec 17, 2018

This was a really rough week for me.  In fact, this past month has been really tough with the increased work hours, remodel, baby at home.   This is the most I’ve been depressed in a long time.  I know it will pass.  But, there’s no ME time for just the self and there’s no together time with husband.  It’s taking it’s toll on me, but I know it’s temporary and that it will all pass.  I was really lucky to not have any postpartum depression… but this is how I imagine it would feel.  Somedays I’m lucky to see my lil girl for an hour before she goes to bed, but lately it’s been 30 minutes.  I’m exhausted.  I’m sad.  And I’m ready for December and the holidays to be over.

The Dangers of Hidden Depression

Depression Hotline

10-characteristics-of-PHD
From https://drmargaretrutherford.com/the-ten-characteristics-of-perfectly-hidden-depression/

Work hours = 54 hours (in 5 days)

Week 27: Dec 18 – Dec 24, 2018

Hubs and I had our first date night out without baby in at least 10.5 months.  It was wonderful.  Went close by to Amaya… but we were both exhausted.  We need to make some changes to when the moms come to help.  I think if I’m working late… that would be a good time to help hubs.  Or I proposed a weekly date night and I think that will help get back to that closeness we had before baby.

Work hours = 41.75 hours (in 4 days)

Week 28: Dec 25 – Dec 31, 2018

We had Christmas at both families’ homes.  With two kids and my work schedule coming up, I’m not sure how long that will be sustainable.  I’m more than happy to have everyone come to our home.  Simplicity and less stress.  We had a terrific Christmas at home.  Arden absolutely loved hearing the gift wrapping tear and the sights and sounds of Christmas.  She always acknowledged the Christmas tree everytime she woke up in the morning as well as when she woke up from naps.  She got so many wonderful gifts and I had so much fun watching her interact with her new toys.  we put the fireplace on for the first time and she got to see fire, which intrigued her greatly!  On the 26th, we drove up to Big Bear to show our lil one some snow.   She totally looked like the bundled up kid from A Christmas Story!  She wasn’t too fond of getting all the layers on, but once she got out into the cold, she was ok.  She got to see snow falling down as well as snow on the ground for the first time.  We also took her sledding, which she seemed to be open to the idea when we would drag her on the sled.  But when we got on the sled with her on a little slope, she would cry at the end of the run.  It was so completely cute!  I’m glad she could have this experience.  One of my main goals in being her mom is to give her many different experiences.  I don’t want her to be spoiled with stuff…. but I do want her to be spoiled with healthy food, cultural experiences, and travel.

This slideshow requires JavaScript.

Work hours = 7 hours (in 1 day)

Week 29: Jan 1 – Jan 7, 2019

Back at work… lil G has been kicking up a storm.  I’ve started kick counts and he has no problem meeting the 10/hour during the day (whereas Arden would get her kick counts around 8pm when I sat on the couch).  The reno was on hold for the holidays.  I’m definitely looking forward to it being done by the end of January!  Talked to hubs about potential middle names for our #2, and I’m really loving Lukas.  🙂

Work hours =  40 hours (in 4 days)

 

Week 30: Jan 8 – 14, 2019

I am off this week. What that really means… I have no work responsibilities. But, I’m getting up in the middle of the night to nurture/feed Arden and getting her ready for school in the mornings and taking her to school. She’s such a good kid, but there is definitely more effort involved in getting all these things ready. The last two days, I’ve taken Arden to school in my sweat pants and no makeup. And honestly, I’m ok with that. I really do appreciate my husband bc he normally takes Arden to school on his way to work. We don’t have the moms coming this week as they really were a huge help this past weekend to allow Ross and I a baby-free weekend. The Reno project has restarted from the holidays. Tiling will be started this week! Garrett has been kicking like crazy and meeting his kick counts. The meal prep has been going well.

Felt a bit lightheaded one night this week.  Not sure what happened… I hadn’t been working.  I’ve been doing very well with my diet, healthy stuff, no sweets.  Everytime I would standup (esp after being bent over), I would feel lightheaded.  It wouldn’t help with sitting either… I had to go full on horizontal and lay down to feel better.

Took my 3 hour glucola test and passed the first two blood draws (fasting, and 1 hr after 100g drink)… then got the call that my glucose was slightly elevated on the last two draws (2 hours after the drink and 3 hours after the drink).  I’m disappointed that now I have to go and meet with a diabetic educator.  Pretty much since I found out that I had a positive 1 hour glucola test, I have been on a lower carb, no-sweets diet.  That’s been about a month and a half.  Ugh.  So, I’ll have a separate entry on Gestational Diabetes Mellitus (GDM).

Work hours = OFF!

Week 31: Jan 15 – Jan 21, 2019

I’ve been battling a nasty cold that I got from our Bug, which she got at daycare.  It’s an upper respiratory infection, most likely viral in nature.  A lot of coughing, sinus pressure, headaches… but I’m going the minimalist route for now — good wholesome foods, fluids, rest, and Tylenol.  Lil G has been kicking around as usual.  He’s so active compared to Bug.  I feel him all throughout the day and night.  Makes me worried that he won’t be a good sleeper.

Work hours = 37 hours (in 4 days)

Week 32: Jan 22 – Jan 28, 2019

I’m still battling my cold.  It’s been almost 2 weeks.  I have an OB appt today, so I’ll kill two birds with one stone and just get a second opinion.  The reno is coming along: baseboards are in, W/D is in, tiling has occurred in the laundry and downstairs bathrooms.  Plumbing and toilet are in.  Waiting on paint, vanity, bath accessories, cabinetry, and countertops to arrive… the end is in sight!  The project was supposed to be done by the end of January, but realistically looks more like mid-Febrary.  LLC established and getting business accounts setup.  It’s been busy, despite my random days off.  I’m getting up to pee every 2 hours…so I just feel tired all the time.

Work hours = 50.25 hours

Week 33: January 29 – Feb 4, 2019

This week has been a blur!  Everyone at home has been sick.  I worked on Super Bowl Sunday.  Happy Chinese New Year — it’s the year of the pig!

Garrett will be a lil Chinese Astrology pig!

Feeling bigger…. having to pee more…. eating smaller meals….

An interesting article from NYT on pregnancy and alcohol.

Work hours = 48.5 hours

Week 34: Feb 5 – Feb 11, 2019

I’ve started splitting my night calls as I just don’t have the stamina (nor can I get comfortable sleeping in the call room) to do a full night call anymore.  I’m definitely feeling more tired this go around.  Lifting and chasing Arden, preparing meals, working full-time, it’s tougher.  But, I’m still planning on working until I go into labor or have my set maternity leave (whichever comes first!).  Not only am I tired, I’m insatiably thirsty…despite drinking 3x 32oz waters throughout the day and 2x 32oz waters at night…. waking every 2 hours to pee…. eating such small meals bc I have early satiety…. constipated despite my best efforts to get in green juice and poop tea. 😉  I think the month leading up to delivery is the hardest.  Lil G is active as usual and definitely more active than Arden was in utero.  Hopefully he’ll be a good sleeper like his older sister.

Work hours = 33.5 in 3 days

Week 35: Feb 12 – Feb 18, 2019

I am off this week.  The reno should be near complete this week!!!  It’s been going on since the beginning of November 2018!  I’m ready to have the garage back as well as a porta-potty out of the driveway and access to our movie room and downstairs bathroom and hallway again!  There was a lot going on with this and coordinating things.  Plus, I watched the Bug on Friday and it is A LOT to take on…. especially while pregnant.  I have a huge respect for stay at home moms who tackle this daily!  I was exhausted after the day.  But, we went out to the Aquarium Friday afternoon and she had a wonderful time looking at the fish and seeing the movement of the water.  It was great to get her out of the house and I know she enjoyed the external stimulation.  Sunday, she ended up developing a fever of 102-104F and that scared the crap out of me.  I gave her Tylenol immediately.  She was lethargic after her second nap (she typically has two naps for 30 minutes at a time, but this time she had 2 two hour naps!).  Plus, instead of wanting to play after her nap, she just wanted to be held… she’s typically not this cuddly.  After calling urgent care to let them know we were on our way, the answering service transferred me to the nurse and they both kept telling me that they close in 5 minutes…despite us living 5 minutes away and with our daughter having such a high temp.  I was furious.  I hung up and opted to go straight to our Children’s hospital ER.  They were fabulous.  After Bug went through a series of vitals checks and physical exam (which she was not stoked on), she got some motrin and we were in and out of the ER in an hour!  That’s a huge feat by any medical facility!!  By the time we got home, her fever had subsided to 99F and she was wanting to eat, drink, and be merry.   We watched her like a hawk all night and the rest of the holiday weekend.

Tylenol 15mg/kg

Motrin 10mg/kg

Hours worked = 0

36 weeks: Feb 19 – Feb 25, 2019

Bug went back to school today.  Her highest temp after the ER visit was 99.  We still gave her some tylenol this morning before school just to help her through the day.  She also has molars coming in…. so that can help with the pain.  Lil G has been meeting all his kick counts.  I’m still peeing every 2-3 hours at night…and drinking about 100oz daily.  I have this insatiable thirst esp during the 3rd trimester…and that has been with both babies.  He’s looking large in the belly.  We had our 36 week growth scan and everything looked good.  He’s looking like he’ll be 7.5 lb at birth.  NST/AFI was great.  No issues.  Had my last OB shift on Friday and it was busy!  But luckily, got to go home around 9:30p and didn’t get called back.  Saturday, my mom and aunt came and watched Arden while hubs and I organized the media room, Arden’s new room, and Garrett’s room.  Lil G’s bassinet is setup in our room and ready to go.  We cleaned, dusted, mopped, vacuumed and were exhausted.  I’m super thankful that my aunt cooked up some great meals that got us through the day!!  Sunday, Ross’ mom came to help watch Arden while Ross did some heavy cleaning of the garage (where I could park the car again!! woohoo!).  The construction has come to a close… they moved the port a potty on Friday, Feb 22.  The construction guys have been using the house toilet, despite me paying for a port a potty, so I was pissed.  Now, we just have a final walkthrough and some flooring to tackle and painting.  It’s so great to have this done.  Arden has been having some little colds/runny nose, but has been playing and her happy self.  She’s started becoming more vocal about what she wants and what she doesn’t want.  She had a lil temp (100F) and we gave her some Tylenol.

Hours worked = 48.5

37 weeks: Feb 26 – Mar 4, 2019

This week was brutal.  We are on the home stretch with our renovation.  The grandmas now come on the weekends to help with Arden while we organize, clean, and recover from the reno.  It’s crazy to live in the space during the reno…I’m not sure I’d do that again.  There were 3 days this week that I didn’t get to see Arden bc I was at work late those days.  That absolutely killed me.  As much as I love my job, I love my kiddo more and I feel like I’m missing out on her activities, milestones, etc.  This week, I also caught Arden’s cough — it’s productive, but I’ve felt ok (no sinus pressure, headache or fever).  My sleep has gotten noticeably worse this week — I’m insatiably more thirsty; drinking about 60 oz at night.  I pee every 1-2 hours and can’t catch up with my thirst.  My blood sugar checks for GDM have been stellar.  Fasting blood sugars have been less than 90.  Lil G is kicking away and moving.  All is good on the home front… just looking forward to meeting this lil dude!  Had a realization with Ross… how the heck are we going to do this without losing our sanity?  2 kids under 14 months?  Arden will be 13 months old in a week.  We just re-enrolled her for the next school year, and our future son is on the waitlist and they couldn’t tell us when we could start.  That’s super stressful for us bc we both work full time jobs.  Our moms are out of town.  I’m just annoyed and stressed that he may not be able to go to school at 4-5 months.  But, we just have to wait and see.  4-5 months down the road….Arden will be 17-18 months and eligible to move up to the toddler class.  So hopefully this will all work out and I won’t have to be worried about that.  There’s been a ton on my mind and my memory is not keeping pace.  Perhaps it’s the sleep deprivation for the last 2 months (getting up to pee)… or just trying to remember everything going on in life.  Does it get easier?

Hours worked = 48.5

Week 38: March 5-11, 2018

Final walk through with inspection completed this week.  Final painting, flooring, and touch ups.  It finally feels like this project is coming to an end and I am grateful!!  Last night, Arden was super tired and fussy to go down to sleep.  We were working on transitioning her from her bottle to a cup, but there’s something soothing for her about the nipple that the cup simply won’t comfort.  I’m getting up every hour to pee.  My U/S looked great.  AFI was 14.  NST was terrific.  Cervix is still high and just waiting for lil G to come on down.  He’s still super active and kicking.  It’s nice to be able to be home and laze and eat and pee when I want/need to.  I weighed 161 lb,…the exact same since Nov 2018.  The only thing I did was change to a modified Whole30/paleo diet cutting out processed sugars bc of the GDM.  Don’t worry, lil G is growing… him pushing on my stomach and decreasing my food intake and more intake of healthier meals is probably causing my weight to just plateau.  We have weekly U/S and NSTs moving forward.  Dr. W and I discussed possible induction on March 18 bc I really don’t want to go beyond 40 weeks with this pregnancy.  I’m just not comfortable in this state.

 

Screen Shot 2019-03-06 at 11.22.04 AM
Hours Worked with Arden

 

Screen Shot 2019-03-06 at 11.23.27 AM
Hours Worked with Garrett

Neuraxial anesthesia and External Cephalic Version

ACOG: If Your Baby is Breech

What is an external cephalic version?

External-Cephalic-Version
From Pregmed.org

Wikipedia: external cephalic version


Randomized trial of anaesthetic interventions in external cephalic version for breech presentation. British Journal of Anaesthesia 114 (6): 944–50 (2015)

  • Conclusions: Spinal Anesthesia (SA: hyperbaric bupivacaine 9mg + fentanyl 15mcg) increased the success rate and reduced pain for both primary and re-attempts of External Cephalic Version (ECV), whereas IV Anesthesia (IVA) using remifentanil infusion (0.1mcg/kg/min) only reduced the pain. There was no significant increase in the incidence of fetal bradycardia or emergency CS, with ECV performed under anaesthetic interventions. Relaxation of the abdominal muscles from SA appears to underlie the improved outcomes for ECV.
  • Editor’s key points: There is no consensus on best anaesthetic technique for external cephalic version (ECV).  In this study, success at ECV was higher using spinal anaesthesia compared with remifentanil infusion or no intervention.  Pain was also reduced in the remifentanil group but success at ECV was no different to the no intervention group.  The effect of spinal anaesthesia in ECV may relate to relaxation of the abdominal musculature.

Neuraxial blockade for external cephalic version: Cost analysis. J Obstet Gynaecol Res. 2015 Jul; 41(7): 1023–1031.

  • Neuraxial blockade is associated with minimal hospital and insurer cost changes in the setting of external cephalic version, while reducing the cesarean delivery rate.

External cephalic version with or without spinal anesthesia: a cost-effectiveness analysis.  American Journal of Obstetrics and Gynecology, January 2016Volume 214, Issue 1, Supplement, Pages S206–S207.  

  • It is both effective and cost-effective to utilize spinal anesthesia to perform ECV in term, nulliparous women with breech fetuses. Translation of this potentially impactful approach into broad obstetric practice should be undertaken.

Effect of Regional Anesthesia on the Success Rate of External Cephalic Version: A Systematic Review and Meta-Analysis. Obstet Gynecol. 2011 Nov; 118(5): 1137–1144.

  • Six RCTs met criteria for study inclusion. Regional anesthesia was associated with a higher external cephalic version success rate compared to intravenous or no analgesia (59.7% vs. 37.6%; pooled RR 1.58, 95% confidence interval [CI] 1.29-1.93). This significant association persisted when the data was stratified by type of regional anesthesia (spinal vs. epidural). The number needed to treat with regional anesthesia to achieve one additional successful ECV was 5. There was no evidence of statistical heterogeneity (p=0.32, I2=14.9%) or publication bias (Harbord test p=0.78). There was no statistically significant difference in the risk of cesarean delivery comparing regional anesthesia to intravenous or no analgesia (48.4% vs. 59.3%; pooled RR 0.80, 95% CI 0.55-1.17). Adverse events were rare and not significantly different between the two groups.

Does Regional Anesthesia for External Cephalic Version Increase the Risk of Emergent Cesarean Delivery? Obstetrics & Gynecology: May 2016

  • Neuraxial Anesthesia (NA) for External Cephalic Version (ECV) increased the risk of emergent cesarean delivery (CD) without impacting ECV success. These findings differ from previous randomized controlled trials (RCTs). The increased risk and decreased success of our ECVs compared to ECVs performed in the context of RCTs could be explained by patient selection, variation in operator experience or technique, or variation in anesthetic management.  Future studies should further evaluate the risk of NA for ECV in true practice scenarios outside of RCTs.

Clinical outcomes after external cephalic version with spinal anesthesia after failure of a first attempt without anesthesia.  International Journal of Obstetrics & Gynecology. Volume139, Issue3. December 2017: 324-328.

  • Repeat ECV with spinal anesthesia after a failed first attempt without spinal anesthesia increased vertex presentation at birth and decreased the rate of cesarean delivery.

Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial. Anesthesiology 10 2017, Vol.127, 625-632.

  • Results: A total of 240 subjects were enrolled, and 239 received the intervention. External cephalic version was successful in 123 (51.5%) of 239 patients. Compared with bupivacaine 2.5 mg, the odds (99% CI) for a successful version were 1.0 (0.4 to 2.6), 1.0 (0.4 to 2.7), and 0.9 (0.4 to 2.4) for bupivacaine 5.0, 7.5, and 10.0 mg, respectively (P = 0.99). There were no differences in the cesarean delivery rate (P = 0.76) or indication for cesarean delivery (P = 0.82). Time to discharge was increased 60 min (16 to 116 min) with bupivacaine 7.5 mg or higher as compared with 2.5 mg (P = 0.004).
  • Conclusions: A dose of intrathecal bupivacaine greater than 2.5 mg does not lead to an additional increase in external cephalic procedural success or a reduction in cesarean delivery.

 

 

 

 

3 months postpartum and time to start a new workout regimen

Three months have flown by since Arden was born.  I started doing Classpass about a month ago to get back into pilates.  During my experimentation with Classpass, I found barre classes to be quite tough and intriguing.  From the various barre studios around me, I found Studio Barre to be fun, encouraging, girlie, and upbeat.  For a good cardio burn, both Cycle Bar and 9 Round were great at keeping my heart rate up!

From https://anomalily.net/classpass/

In about a week and a half, I have to go back to work.  Right now, I have mixed feelings about this as I’ve enjoyed my time with Arden.  I think the first week will be tough.  It’ll be the first time I’ve been away from her for any length of time.  Our hospital did a roll out of Epic, which is an electronic medical record — I’m nervous as this will be my first time using it when I go back.  I haven’t given an anesthetic in 3 months… this means I need to dust off the cobwebs and put my thinking cap back on.  I can only imagine I will be drained with the early mornings and late nights and plenty of mental stimulation.  It will be a different kind of tired vs. child-induced tired.

I want to put myself in the best place to handle these stresses.  Despite my current passes at my various studios, I will need a home workout to do when I can’t get out of work in time.  This led me down a rabbit hole last night of searching for various home workouts and reviews.

I’ve done plenty of home workouts as evidenced here and I appreciate everything it provides.  However, how do you keep the workouts fresh and non-repetitive?  The P90X series is awesome for a tough cardio and sculpting workout in 30 minutes with great results.  But there’s only so many times I can do the same exercises over and over again.  Then, I went to Sweat/BBG by Kayla Itsines.  This app/workout program got me wedding dress ready in 3 months!  This was a fabulous workout that had plenty of cardio, jumps, squats, upper/low/full body, weights, etc.  But I had the same problem of repeating workouts.  I was getting great results, but I couldn’t stay motivated to do the same workouts over and over again.

Searching for a constantly changing workout regimen led me to Alexia Clark.  There was just a little bit on her website describing her workouts, but I wanted more info.

After reviewing all this information, I decided Alexia Clark’s program is the way to go.  My classpass/barre pass ends at the end of May.  I’m pulling the trigger to start Alexia Clark on June 1.  My husband watched a bit of the review video with me and says he would start with me.  Now how’s that for motivation?

 

And this nifty little macro calculator was just what I needed to help me get my diet on track.

 

Do you have any recommendations or workout programs I should check out?

 

Pregnancy, epidurals, and birth plans

A little background info… I’m an anesthesiologist for a fairly busy practice. That means we get called when you need an epidural or c-section. I am currently in my first pregnancy (so I haven’t experienced my own birth process), however I’ve seen and managed thousands of epidurals for delivery.

One of the most important things moms can do for their pregnancies… Eat right (clean, get plenty of veggies and fruits) and exercise. This is the best prep work you can do! Secondly, have an open mind when selecting your birth plan. You are not in control of what will happen. What happens with your baby is what will dictate what you will need and what will be best for your baby. Many mothers have opted for a “natural” delivery and have been successful. Some mothers have been in a fully equipped medical center and have had bad outcomes unrelated to interventions for their baby.

Your goal as a mom is to guide and give direction to your delivery team of your wishes — but this is a process that changes throughout your labor so flexibility is key.

Epidurals are NOT harmful for your baby. There are multiple studies that’re well backed with huge sample sizes that prove this. Epidurals can slow certain stages of labor, but it’s NOT harmful to you or your baby. There are a lot of misconceptions about epidurals. Whether it’s patient experience, epidural effectiveness (and this can be patient controlled), or fear of the unknown… epidurals have been given a bad reputation and sometimes these traumatic experiences are passed down without rhyme or reason (similar to the anti-vaccine movement which is dangerous!).

So, pick a birth plan… be flexible with it. Do what you can to optimize your health (and birthing experience) via diet and exercise. Lastly, no one loses when they’re comfortable. Comfort leads to a good experience and overall a happy mom, baby, and family.

Here’s my plan (which isn’t for everyone):

1) more plant-based diet w some fish

2) exercise via walks, hikes, and pilates/yoga/barre

3) birth plan: vaginal delivery with minimal pain (epidural immediately: I don’t want to feel a thing)… but anything to get the baby out safely.

4) breastfeed like crazy if possible

5) go back to work after 3 months

6) breast milk for at least 6 months (but will try for a year)

My plan isn’t for everyone… it’s for me. Good luck!!