#3 Figure out how you will get help with breastfeeding

Welcome to my birth and postpartum guide, item #3. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

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If you are planning to breastfeed, and you can swing it financially in any way, I STRONGLY recommend finding a lactation consultant in your area who specializes in home visits. I recommend interviewing at least two of them and going with the one that you like best. This does sometimes require scheduling a first home consult for the interview. Arrange for your lactation consultant to be on call and ready to visit you in the day or two after you return home from the hospital to check-in and offer any tips. This will likely be expensive. Insurance companies are required to cover breastfeeding support under the Affordable Care Act, but they often make you jump through a TON of hoops, use their preferred provider (of which there is often only one in a metro area) and may not cover home visits (and you DO NOT want to be traveling ANYWHERE the first two weeks after birth, when you most need lactation support). If you cannot afford one out of pocket, I strongly recommend asking for this as a baby shower gift — even if your friends and family pool together to support the roughly $250 that it might cost to have a prenatal and two postnatal consults in the comfort of your home. If you cannot find a way to have someone visit you at home, then figure out where you will go if you need help before you need it (you will not be thinking clearly in the week after your baby is born). Look for hospitals and practices that specialize in lactation support. Insurance is more likely to cover a visit at a hospital. Alternatively, find a neighborhood support group at a store that specializes in maternity services, which will be less expensive.

Also, once you arrive at the hospital for your birth (if delivering in a hospital), ask about the lactation consultants, and the folks who keep donor breast milk around. The lactation consultants at the hospital are often very helpful. If the hospital has donor milk on hand, definitely scout out options for getting some, if you think your baby is hungrier than you can manage in the days after birth or losing weight too quickly (which is common). Using a bit of supplemental food in the days after birth is unlikely to impact long-term breastfeeding success. And donor milk has the added benefit of conferring a mixed microbiome onto your little babe. 

Also, read everything on McSweeney’s about breastfeeding — it’s everything you need to know 🙂 Good places to start — 

HOW TO LATCH YOUR BABY TO YOUR LEFT BREAST IN A CROSS CRADLE HOLD IN 33 EASY-TO-MASTER STEPS 

TEN MEETINGS WITH LACTATION CONSULTANTS

WELCOME TO BREASTFEEDING CLASS, SURRENDER ALL HOPE

MY BREASTS’ LIST OF GRIEVANCES AGAINST THE BABY

Lastly, remember that millions of women around the world are trying and struggling and failing and succeeding at nursing their little dictators at 3AM too — you are not alone.

#2. Decide where you will have your baby

Welcome to my birth and postpartum guide, item #2. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

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If you plan to birth in a hospital, this will be largely determined by where your provider has hospital privileges. If you live in a metro area, and have a choice between two or more hospitals, I find that Google and Yelp reviews are often the most informative — search for “birth.” 

There are also some more objective hospital quality reporting systems, however, these are often so objective as to be rendered meaningless and rarely show statistically significant differences. 

A Health Affairs article (free access) summarized the state of maternity quality reporting:

“Despite the substantial morbidity associated with childbirth in the United States, there is currently no national system for reporting maternal complications.The number of obstetrical deliveries far exceeds other common causes of hospitalizations for which performance reporting already exists, but the quality of obstetrical care is not systematically reported in the United States. The Joint Commission collects a small number of quality measures, but maternal outcomes are not publicly reported.30

And yet, quality varies dramatically, “Working with a large nationally representative sample of more than 750,000 obstetrical deliveries in 2010, we found substantial differences in rates of major complications in US hospitals. Women delivering vaginally in a low-performing hospital were twice as likely to experience a major complication, and those delivering by cesarean section were nearly five times more likely to experience a major complication, compared to women giving birth in a high-performing hospital.” 

The most widely-available “quality” measure is the rate of c-sections performed in first-time births. However, from the Health Affairs article, “Interestingly, we found that hospitals with higher cesarean delivery rates had lower complication rates for women having either a vaginal or a cesarean delivery, compared to hospitals with lower cesarean rates.” And as a mom who experienced both a 4th degree tear from a vaginal birth and planned c-section, healing from the c-section was a piece of cake compared to the botched vaginal birth. I was pretty much completely recovered from the C-section by 8 weeks postpartum, while I experience ongoing issues from my tear.

Here are a few other places to check:

This USA Today database contains data from a minority of states.

A minority of hospitals nationwide also provide data to Leapfrog, including some helpful maternal quality measures. 

Medicare Hospital Compare has data from all hospitals, but is limited around maternity data. Once you go to their website, you can choose hospitals in your area to compare.

You will also want to consider what makes sense for your baby. If you think you are likely to need NICU services, then find a hospital with a strong NICU offering all of the services you are likely to need. 

Lastly, if you think (or know) you might need a c-section, I strongly recommend finding a hospital that provides family-centered cesareans as policy.

All that said, my last piece of advice (again from VERY limited experience) is that I would be cautious about choosing a “baby friendly” hospital. These practices can be implemented poorly. For example, these hospitals sometimes push breastfeeding so hard as to make it impossible to get supplemental food for your baby, even if you think he is hungry and your milk hasn’t come in. I struggled to get supplemental food for my first child until he had lost 12 percent of his birth weight and was dropping quickly. There are stories of women sneaking in formula to feed their baby at these hospitals, even though formula use in the early days when a mother is also trying to breastfeed her infant does not appear to reduce long-term breastfeeding success

EDIT: Oh look, several smart folks have written about the downfalls of “baby-friendly” hospitals. See “No Nursery, No Formula, No Pacifier Are “baby-friendly” hospitals unfriendly to new mothers?” and “The Failure Of “Baby-Friendly” Initiatives.” An article in the Journal of Pediatrics found that “baby-friendly” hospitals do not increase breastfeeding rates. And a review in Pediatrics noted that some baby-friendly practices have been associated with “near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds.”

Sasha Anne Mayer

Erin and I are so happy to announce that Sasha Anne Mayer made a slightly early arrival earth-side. She was plucked a bit early due to mom’s gestational hypertension (and an attempt to avoid a repeat of the severe preeclampsia from last time). She was born at a bit over 38 weeks and weighed 5lbs, 6oz and measured 18 inches.

So far the experience has gone much more smoothly than the last time. Everyone is doing well happy and healthy.

We are currently working on the name for Sasha’s chicken-shaped nursing pillow, Theo’s eventually was called “buck buck”. And yes, we had to get a second $50 nursing pillow because as soon as his mom suggested that his new sister would need his, Theo started sleeping with his pillow every night… Names currently in the running:

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  • Cuckoo
  • ChaChaCha
  • Clucky
  • Kikiriki (The Spanish word for a chickens sound)
  • Spark Plug

 

Amsterdam Recommendations

I have a couple times been asked by folks for various recommendations around Amsterdam. I visited a number of times as my previous job moved their HQ to downtown Amsterdam right on the canals. It was a lovely city to visit and is a great connection point for all over Europe. Erin joined me a number of times along with Theo and we always had a good time. Theo particularly enjoyed boat trips on the canal (including when he knocked my glasses off my head and into the water). Since the office was in the canals I generally stayed very close to the waterways as well, an easy walk to most of the popular attractions. Which means the majority of things I recommend are in that general area.

Activities

 

  • If you do a boat tour I highly recommend “Those damn boat guys” We have done that twice with Theo (who is now 2)
    • I have also done a number of larger tours with work, which was also fun
    • They are smaller boats/groups, and less stodgy very funny and factual kind of stand-up comedy history
    • Theo loved it both times, as have some friends and their kids
    • I have recommended it to others who went with them and enjoyed it
    • The pick up / drop off is across the canal from the Anne Frank house an easy to find the location
    • Watch all their videos/homework

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  • I haven’t been yet but Erin and Theo have and everyone has rave reviews about the Nemo Science Museum
  • Anne Frank house, obviously a popular stop.
  • Go through museum row (Museumplein), my favorite is the small Banksy museum there… Rijksmuseum, etc… all the others are great and as one would expect.
  • Vondelpark, frequently has music and other events going on just see what is happen while you are there
    • Rent bikes and cruise through Vondelpark, regardless of biking or walking Vondelpark is awesome on a sunny day
  • The splash parks everywhere are great, Theo basically travels the world to compare the splash parks, swings, and slides. If you travel to Amsterdam in summer there will be splash parks everywhere — the parks, the museums (including the Science Museum) and by restaurants. So, if your kiddo is young, make sure you are always prepared for him to get wet — have a towel, change of clothes and splash diaper if needed with you at all times, or you will just have either an angry or a wet kid.
  • Amsterdam is a great city for strollers — the bike infrastructure makes it very easy to navigate with a stroller and you will rarely be required to fold it up and lug it around (unlike most of Europe where a baby carrier is really the way to go).
  • Erin also recommends Red Light Secrets as a museum in the red light district to help you learn more about that part of Amsterdam’s culture and economy. Probably best for grown-ups. You actually get to go inside one of the brothels.
  • I would recommend going during summer weather, but it is beautiful and fun to walk through the snow-covered streets as well. If you do go during the summer and with your kiddos, beware the jetlag. Having the sun up until nearly 11PM can be tough on bedtime routines, but also quite fun if you are willing to go with the flow.

Food & Drinks

  • The Pantry: A slightly touristy but fun restaurant to try a bunch of traditional Dutch food
    • probably worth getting reservations as it can fill up (small not too many tables)
    • one of you should order the ham shank it is so good I get it once every visit to AMS (photo below)
    • The Pantry is also a Theo favorites

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  • In general if you like Asian food many of the Malaysian and Vietnamese places are great
  • Brewery: Might not work with kids your age but a really cool brewery in an old windmill, Brouwerij ‘t IJ
  • If traveling with young kiddos get them babychinos at the cafes (just frothed milk). Theo loved them.
  • Other restaurants: Piqniq, Winkel, Foodhallen, De Silveren Spiegel

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Honestly, my favorite part of the city is just walking around the canals, randomly stopping for snacks (chocolate covered waffles). I could easily waste hours away just walking around through the odd paths, walkways, alleys, and bridges that sprawl through the city. On work trips, I would listen to an audiobook while strolling through the streets in the evenings, which was always a pleasant way to spend an evening.

 

 

Our family is growing by one pair of shades this summer

Most folks already know, but Dan and I are happy to announce that we will be adding a new member to our family in June. I feel grateful, Dan is nervous, and Theo vacillates between being excited and not quite believing that there is really a baby inside of mama (which, admittedly, is kind of a hard thing to believe). He has slept with his old nursing pillow every night since I mentioned that we would need it for the new baby, which seems like an appropriate reaction.

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Oh yeah…we bought that sweet minivan in the background too
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Celebrating our birthdays

Moving Off Facebook

Hey folks, after the multiple data breaches and seemingly blatant disregard for privacy. I taking steps to remove FB from my life. I am following some of the lifehacker advice on reducing FB usage. Folks might have noticed that I haven’t been active for a good while, but I plan to hardly ever use it in the future and will use this blog to share photos and such.

Anyways, thanks for all the good times and helping folks to connect but there are other ways… Feel free to follow here and from time to time I will post a link on FB to stuff I share here.

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Anyways, a new year and a new plan… Here are some photos of 2018!

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Basically a Theo photo show…

Spoticus

October 7, 2018

Denver, Colorado

Spot Miller, 15 and a half years old, died peacefully at her home on Sunday surrounded by love and full of cheese, yogurt, tomatoes, brownies, bread, and hamburger.

Spot was born in Aurora, Colorado on April 26, 2003 to her mother, Standard Poodle Hershey Miller. Spot was the first of nine puppies to break out of the puppy pen — foreshadowing more than a decade of high jinks and earning a permanent place in her guardian’s heart.

A precocious pup, her first experience with formal education occurred when she went off to CU Boulder with Erin as a mere puppy. It was at Boulder where she perfected the skills of charming children and stealing food off of plates — those of her guardian and roommates — with a particular fondness for brownies, pie, and cake.

She tested Dan’s suitability for a life partner by moving into his Denver apartment 3-months into his and Erin’s relationship.

She accompanied Erin to graduate school in New York City — and while not a huge fan of cross-country road trips or planes, she understood the importance of accompanying Erin to her new city. While there, she honed her skills at using her nose to knock one’s hand off of a keyboard and onto her head for a pet — a skill she maintained for years. She befriended roommate Max, a 120-pound Great Dane/German Shepherd mix (fondly referred to as a “lab-mix” on rental applications) who she often framed for acts of stealing food from the small city kitchen by leaving the boxes and wrappers on Max’s bed.

She thrived in the young professional life of DC where she became a regular at monuments, a star of tourist photos, and enjoyed finding eager new pet sitters who didn’t know that she wasn’t allowed on the bed.

She was there for all of the successes and tragedies that occur in the transition to adulthood, heart aches, Erin’s miscarriage, and bringing Theo home from the hospital as a postpartum mess — and she was always ready to put a head in a lap for a pet and look up with understanding eyes. 

She found her rhythm in a house with a toddler — dutifully cleaning up under the high chair and happily helping with any leftover food. While referred to as Spot or Spoticus during most of her life, Theo’s fascination with her led to new honorific — “Dog Dog” — and was among the very first of Theo’s words. Theo often awoke in the morning talking about Dog Dog — leading to shrieks of glee when Spot came charging into his room. And later, once the stairs proved too much of an obstacle, we would come down in the morning to find Dog Dog so that Theo could practice his “gentle touches.”

Thank you, Spot, for your endless love and devotion. Thank you for stretching my heart. You made a permanent place for yourself inside it. 

 

 

Forced Wireless Headphone Adoption

I write this as I am on a plane using $7 only semi-functioning headphones to watch a movie… This is because of course, the in-flight entertainment system doesn’t support wireless headphones. The nice new multi-hundred dollar headphones I bought for the pixel 2 won’t work for the movie… My old Bose noise canceling would have worked for the in-flight but can’t work for the Pixel 2 (adapters never around / totally broken). I started this post on my flight out, on my return flight I had to buy the airlines headphones as I couldn’t get to my wired headphones buried in my back in the overhead bin, with only my wireless headphones in reach. The current situation of headphones is far worse than it was a few years ago.

An awesome plug

Why Buy a Phone without a Headphone Jack?

Well based on the latest flagship phones from Android and Apple, you don’t really have a choice as they are forcing the wireless issue on customers. I bought the pixel 2 despite the missing headphone jack because the new camera and portrait mode photos are truly awesome. I could have got a worse camera to buy a phone that still had a headphone jack, but in a couple years I am guessing that won’t even be an option.

Theo Portrait Mode

Experience Moving To A Jackless Phone

I bought a Pixel2, but that detail really it doesn’t matter. It has been a horrible consumer experience ever since. I want to detail in this post the dozens of times I have had a worse experience since moving to a phone with wireless audio.

  • I have been caught out with my wired headphones in my bag, pocket, and no dongle adapter dozens of times, each meaning I couldn’t listen to my device.
  • I have $200+ nice Bose noise cancelling headphones (the best headphones I have ever had), made fairly useless as they are wired
  • My barely year old phones wired USB-C “adapter” stopped working… It worked at first, then only some of the time when you wiggled it, and no longer works at all.
  • At all times my backpack needs to contain wired/wireless headphones as well as an adapter
  • The same Bose headphones I liked so much in a wireless version are about $400, even as my older pair work perfectly fine
  • I have been out with my wireless headphones only to have their battery die, or try to use them finding they are already dead… Or even more annoying start to give a low battery beep at nearly max volume ever few minutes.
  • The audio drops in an out randomly requiring repairing of the phone to headphones, this doesn’t happen often anymore but still never had issues like this with wired headphones
  • My phone has been paired with my headphones which were in some other room and I can hear audit taking me awhile to realize what is going on
  • My headphones have refuse to pair for whatever reason (likely paired to something else at the moment)
  • I am not even an audiophile and the quality difference is noticable
    • I bought some really nice wireless headphones and my old Bose far are still better
  • My wireless headphones seem to try to do actions every time I touch any part of them, which I often have to do as they don’t stay on as well as my Bose
  • Can’t get to correct headphones needed as I only took one set out of my bag before putting in the overhead bin.

This is not a feature

In no way has removing the headphone jack improved my customer experience. I had wireless headphones for my Pixel 1 and it had a headphone jack which I used about 75% of the time using the wireless only on occasion. Now as I am forced to use wireless headphones I just listen to podcasts and music on my phone about much less than I used to. I end up in one of the situations above so often I don’t trust audio to be available without significantly planning and testing prior to leaving the house. I am now considering just using an older phone or another device as a dedicate audio device because this experience sucks so much. I have a young child which means when I get him to fall asleep in my lap and don’t have all the right combinations of dongles, headphones, or charged wireless headphones in arms reach I am just not going to get to listen to anything. Which happened to me on my two most recent flights when traveling with Theo… Sitting quietly while the baby sleep son my lap, thinking about how angry I am that Apple and Google both decided to ignore the numerous consumer requests to keep their damn headphone jack.

Home again, infant travel tips, pt. 2

We are home. Theo was a terrific traveler and now has two stamps in his passport. We loved Amsterdam and walking along the canals, meeting up with old friends who now live in Berlin, seeing the art museums, and Theo mostly loved his first boat ride. Despite arriving home with a teething and jet-lagged infant, the trip was definitely worth it and highly recommended for folks who have a long enough maternity leave for it to be plausible. I think that a lot of the beauty of traveling is the ability to be present and just enjoying your surroundings — whereas at home when I’m holding or feeding Theo, I feel pressure to be managing email or dealing with the yard, while traveling I just enjoyed hanging out with my new baby, so it was a great way to spend the last few weeks of my maternity leave. A few additional tips for those considering travel with their infants:

  • We arrived home with a teething (see below) and jet-lagged infant. I definitely underestimated the potential complication of a jet-lagged infant, mostly because Theo has always (knock on wood) been a pretty good sleeper. He adjusted to Paris time quickly (going east) but is really struggling with the return home (going west) — he is WIDE awake at 4AM. The first night I fought this for hours (nursing over and over, swaddling, noise machine…) before giving up and just reading about how Dragons Love Tacos and playing with teething toys. Last night we gave up after about 45 minutes and Dan helpfully got up and just hung out with him through the small morning hours. We are trying ample doses of morning and evening sunshine and hoping that it resolves in a few days — a good friend said to remember that this too will pass, which is true, but hard to remember at 4AM. I thought these blog posts on baby jet-lag were helpful, and it’s apparently common for babies to struggle more traveling west.
  • Theo started teething on this trip (a bit early, but he’s such a precocious kid 🙂 so, I definitely recommend bringing infant Tylenol, which was a life-saver on a couple of days (and nights). Also, it probably makes sense to bring your baby’s thermometer — we didn’t do this and before it became obvious that Theo was teething, we wondered briefly whether he was sick; it might have been nice to be able to check his temperature.
  • Theo went on a brief “nursing strike” during our last few days in Paris — he would arch his head back and scream when offered the breast.  What caused it? Too much travel and stimulation? The start of teething? No idea. But it was heartbreaking for me. Thankfully, we have been supplementing anyway due to my low milk supply, so we had bottles (another side tip — I found this travel bottle brush set very helpful — probably not necessary, but it saved us having to figure out how to clean the bottles every time we landed, tired, at an AirBnB with a whole bunch of very dirty bottles) and a breast pump with us. We stopped trying to force nursing when out and about for a couple of days and just offered him the bottle at restaurants and I kept up with pumping 3-6 times a day. After really just a couple of days, the issue went away — though I am still a bit nervous every time we go to nurse. No idea whether others have experienced something like this while traveling, but a couple of tips — the Medela Pump in Style Advanced worked great for keeping up my supply, even though I had been using a hospital-grade pump at home.  You can’t plug it in abroad (even with an adapter) and it takes 8 double-A batteries so we brought a TON of batteries. But one set of batteries really lasted a week of at least 3 pumping sessions a day. And this page from Kelly Mom was helpful and reassuring, especially the parts about starting with the nursing sessions when he was tired (about to go down or first to get up) and trying to nurse when we were back in the apartment in a calm and familiar-ish place.
  • Traveling with grandmas for the win (Thanks Elaine and Mom!). It was great to have their help and it is so much more pleasant to brave restaurant dinners and international flights with an infant if there are three people to do hand-offs.
  • All our friends who suggested bringing a nursing pillow were dead-on — great bring. Helpful for naps on the flights and feedings once we got to our apartments. There will definitely be a moment going through security when you wonder why you are carrying this huge pillow, but as soon as you sit down on the plane it will be so worth it. (Bonus tip — this is the best nursing pillow –more functional shape and smaller than the boppy.)
  • As I mentioned before, we really liked having our Babybjorn travel crib — it was nice for Theo to have a somewhat-familiar place to lie down. Also, before we left, Theo had gotten really into his baby gym mat and we wanted some way to recreate that while traveling, without, obviously, carting around a baby gym. So, we took a travel drying line (great travel gadget) and strung it across his crib and dangled some of his hanging toys from it — it bought us dozens of minutes of free time several times a day. IMG_20170521_142520
  • We brought a light-weight travel stroller — and I remain agnostic on whether we needed it. It was definitely helpful for carting around baby gear — especially through the airports, but Theo was happy to spend most of his time in the Babybjorn and probably slept a bit better in the Bjorn anyway. I’m definitely glad that we had the smaller, light-weight stroller rather than a full-size, full-weight American one, since most apartments in Europe are walk-ups. We stayed on the second floor both times, but still, the stairs would have been really tough with a full-size stroller. Paris is not designed well for strollers, especially the metro, so in that city I think folks really don’t need a stroller with a young infant (though it did allow us to skip some of the lines at the Louvre). Amsterdam has good bike and stroller infrastructure, so we used the stroller more in that city, but still, Theo often opted for the Bjorn. Most restaurants, in both cities, did not have space for the stroller inside. But one benefit of a stroller is the European tradition of allowing a sleeping baby to stay in their stroller parked outside the restaurant while the parents enjoy dinner inside, so that’s an option.IMG_20170513_161759
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    Theo in the Bjorn while we use the stroller for stuff
  • We still have a lot to learn about packing with a kid. Our carry-ons were large because we wanted to be sure to have enough burp clothes, outfits, diapers, and pumped milk/formula for supplemental feeds in case of multiple airport blow-outs or a missed connection that required us to overnight without our bags — that mostly worked out OK thanks to the airline tradition of allowing families with young kids to board first, but required a lot of airport schlepping