Monday, October 25, 2010

Positive reinforcement

Donovan poops on the potty, and I think, well, he's old enough for some positive reinforcement, and I go get him a sticker. Before I get a diaper on him, he sticks it to the end of his penis.

I'm sure I'm not alone in thinking this is hilarious. And, fabulous! He's maybe putting two and two together and getting that the sticker is for achievements having to do with his nethers.

But, then he tries to pull it off, and unfortunately this is a very sticky sticker. He cries, I put him in the sink and start running water over it, he keeps crying and trying to pull it off, I keep running water over it, he stops trying to pull it off and starts batting my hand away after I think it's soaked enough to come off easily, it finally comes off, and... there goes my positive reinforcement.

Year of Wonders (contains spoilers)

I love books that are so vivid I can smell the environment, that I get completely lost inside, that become so real to me sometimes I forget I'm reading fiction. I just read Year of Wonders by Geraldine Brooks, and this was one of those books for me. Because of that, I rank it among the best books I've ever read. And part of me wishes I hadn't read it. Not now, anyway.

I won't touch Beloved either. I read it in high school and it ranks among my favorite books, but I'm not sure I'll ever read it again, now that I'm a mother. And I'm not sure I'd recommend Year of Wonders to mothers. (In fact, if you're reading this and you're in the first year postpartum, I ask you to abstain from reading it until after your baby's first birthday. Second birthday if you had any kind of PPMD.)

The reason I am not sure it was good for me/mothers is the combination of that vivid prose with the topic at hand. I knew it was going to be a dark but hopeful novel from the description: a plague-stricken village decides to quarantine itself to avoid spreading the disease. What the description left out is that the heroine, who was described as a housemaid, is a widow whose children are the 4th and 5th plague victims in the village. The way their lives and deaths were painted by Brooks will haunt me for a long time.

I felt I would have liked the warning that I would cry Where the Red Fern Grows style three times within the first third of the book.

And yet, within that, was the most beautiful depiction of motherhood and of a mother's love that I have yet to read. I'm not sure I would take that away to get these fictional dead children out of my head.

Other pieces of the book were brutal as well, but less traumatic to me.

Another interesting part of the book for me came when the village midwives/healers are killed as witches, and later, reluctantly, the heroine becomes the midwife. It made me realize that I have always been the kind of girl who would have been burnt at the stake 400 years ago: I'm a skeptic, I see things in shades of grey instead of black and white, and I've always been a bit different. Prime recipe for trial by drowning. Perhaps that is part of why I'm less daunted than others to be a midwife - a profession that is still on the fringes, still suspect, still more likely than others to get me burnt at the now-metaphoric stake (lose my license, lose everything in court, and thankfully no longer in CA but still in 24 states, get thrown in jail). I also noticed for the first time that, like my parents but few others in today's world, I am doing the same thing with my life that I would have done 400 years ago. Pretty cool!

The descriptions of birth that were in the book were overdramatized and unrealistic. I do believe that birth was more dangerous in Europe in 1660 than in most locales in 2010, but 3 out of 4 births in this book were near-death situations that were resolved in unlikely fashion. (Woman with severe blood loss to the point of losing consciousness before the baby is born, has a frank breech baby which won't come out, which is turned by internal maneuvers, comes easily once vertex, squalls immediately, and both survive. Ya may have just crossed from improbable to unbelievable, yo.) I'm working hard to forgive this aspect of the book. It's hard to imagine what the scope of a midwife would have entailed in another time, what she may have resorted to in desperation to save a mother or baby, and I wouldn't expect an author to be able to imagine in realistic terms - even if she consulted with an obstetrician, OB's likely have pretty backwards ideas of what midwives of old did. Most of them have backwards ideas of what midwives do currently!

Overall, I'd recommend this book highly to anyone who does not yet have children. To parents and especially mothers of young children, you've been warned as I wish I had been.

Tuesday, October 19, 2010

Earnest, now: American postpartum depression

On October 1, 2010, Kristi Couvillon-Wise committed suicide as a result of postpartum depression. I didn't know her, but it cut me.

I take it very personally when women are knocked down or even let down by what is considered normal in our society. And while postpartum depression crosses all cultures, we have a unique set of variables here in the US.

(Note that when I say "we" and "us" I am talking about the predominant culture of both laypeople and obstetricians. I am not talking about myself, my community of birth professionals, or midwives in general. That "we" does much better, which I'll address toward the end of this post.)

We have high rates of risk factors: cesareans, twins and higher order multiples, cessation of breastfeeding, among others. We have competitive mothering and the desire to continue the illusion of perfection to others (see earlier post). But what came to mind for me the most is a refrain that Mason tells our pregnant mothers frequently: "In this culture, we often worry about the wrong things." Usually she's talking about adequate rest, stress reduction, and nutrition. Reading about Kristi's death, I realized how much it applies to postpartum depression.

We worry about birth emergencies that are not truly emergencies. We also worry about birth emergencies that are extraordinarily rare. We worry about harming our babies with sushi or by lying on our backs. But how often does our society pay attention to the most common complication of the childbearing year?

Can I say that again... the most common complication of the childbearing year. Postpartum depression is the primary complication and it deserves our attention. Women deserve our attention. Mothers deserve care providers and a culture at large that work for prevention, that recognize the signs, that destigmatize postpartum mood disorders, and that make simple management and more in-depth treatment easy to obtain.

As for midwifery care? (Enter new use of "we" - those maternity care providers, including MD's, who provide the midwifery model of care.) We can not prevent all cases of postpartum depression. We can do a lot. We reduce risk factors by ensuring that cesareans are only used judiciously, by enabling breastfeeding to proceed as best it can, and by emphasizing the importance of social support. We promote self-care for all, which acts as prevention and treatment: adequate sleep and rest, good nutrition, sunlight and fresh air, time to honor the self. We offer superior postpartum care, seeing mothers 3-6 times during a span of time in which mainstream obstetric providers only see a new mother once, and we check in with their emotional well-being, not just their physical healing. We refer to professionals who understand postpartum mood disorders, rather than using a single line of pharmaceutical defense.

For harm to come to a mother, her baby, or both as a result of postpartum depression is, thankfully, rare. Suffering is common, and it's time to stop accepting that and change our society's focus to the benefit of women and babies.

Wednesday, October 13, 2010

Music

Me: Oh Cecilia, you're breaking my
D: HEART!
Me: You're shaking my confidence daily... oh Cecilia, I'm down on my
D: KNEE!
Me: I'm begging you please to come
D: home. Ho-o-ome. Uh uh uh, ooooooooo Ciiiia ooooooooo.
(translation: makin love in the afternoon with Cecilia up in my bedroom)

Kessa (as "I Will Survive" comes on): "Eliana! Eliana! Look, mom found disco on the radio!"

Eliana (via email): "Mom, guess what? I played betovens 9th sipheney on the piano!"

Thursday, October 7, 2010

Getting real

The thoughtful post about how our society lets down new mothers and babies by focusing on all the wrong things is, indeed, coming.

But I've been stopped in my tracks by the new and suddenly popular blog, Single Dad Laughing. Despite the name, and his usual lighthearted posts, he has written three hearty, soul-searching posts that have gone viral. If you haven't read them, they are all worth reading, but get the tissues out, because at least one is sure to get you.

Memoirs of a Bullied Kid
You Just Broke Your Child. Congratulations.
The Disease Called Perfection

All three made me feel and think deeply.

While I was never popular, I was also never singled out and targeted, so the first wasn't too painful. It is more the nagging feeling that I could have done more for those who were singled out that bothers me through my adult life. I appreciate this post giving tools to adults and children to try to help those who truly suffer at the hands of others.

I had good parents and I am a good parent, so "You Just Broke Your Child" served me as an excellent reminder of how important I am to my children, even in the little ways. That reminder is not only helpful to keep me in line with being there for them, but also to keep me sane when it feels like I am on a hamster wheel of parenthood.

It was "The Disease Called 'Perfection'" that got to me the most. The raw truth to it was staggering. And as someone who has always been harder on myself than anyone else has been on me, it was a painful mirror.

I also live in one of the most competitive areas in, likely, the world: the San Francisco Bay Area. It's just a part of the culture here to keep up appearances. A dear friend - who is from outside of the US, lived nearby for over a year, and is living in another country entirely now - put it this way: "I hadn't seen people clinging to the illusion of perfection on such a scale anywhere before I moved to California."

The post calls on us to be real. I have always agreed with that - we lock ourselves into despair by believing we're alone in it. It's a catch 22, because the shame of admitting it means we won't ever tell someone else they are not alone, and they will never say the same to us. But except in rare instances with close friends, I have not lived up to my ideals. I have not been brave enough to be real. This post spoke to me and tonight I'm going to tell you some real.

If you've read this blog for a long time, you know how much I love my children. You know the cute things they do and say, and how ridiculously smart they are. All this is true. But the reality is there's more.

Real #1:
My babysitter quit without notice two weeks ago. I sobbed. Not because she was a fabulous babysitter - in fact it's been a bit of a relief having her gone - but because this is the 4th time in 3 months that I am looking for childcare, and this is making me feel like a failure as a mother.

Mothers, whether they work or stay home, see it as their responsibility to raise their children. In our society, fathers may parent well, but mothers raise the children; in the same way, mothers may earn money, but the father carries the burden of supporting the family. (I know this is a generalization but it is also the cultural norm and hard to erase from our psyches, even in families that have chosen to have a working mother and stay at home father.) I carry this weight on my shoulders: to take wonderful care of my children, including making sure they are well taken care of while I am not with them, whether that means they are with their dad, another loved one, or a childcare provider.

I am not living up to my own expectations in finding solid childcare for my children. This is the number one stressor in my life right now. It has even made me think about staying home with my kids - as Mason says, women aren't about to stop having babies. But the trade-off would be greater and more stressful: I would miss my work. I would miss out on what I call my "reset button" (the refocusing I do at births and even at prenatal appointments brings me home refreshed and ready to appreciate what a gift my children are to me). I would be vastly disappointed in myself for leaving my apprenticeship. I would resent my kids for driving me away from my calling. I would feel as though I was failing in different ways, some related to parenting and some to self. None of this would be pretty. None of it would serve my kids better than pushing forward with finding them a new childcare situation, to be strong, reframe "failure" into a past mistake and succeed in the future. That is what I need to do, and while I am struggling with the feelings around this, I am hopeful. I am grateful to have a preceptor who also chose to push through her apprenticeship with small children, because she understands how I can be stressed out about it and yet remain dedicated to midwifery.

Real #2:

Read this list: Cognitive distortions

Eliana has every single one. In massive doses.

I've known she was an intense and passionate little girl for a long time. I've read and re-read the definitions of ADD and ADHD, confirming each time that no, that wasn't what was going on. So what was?

This summer, she got in trouble for something - I can't even remember what it was, normal kid disobedience stuff, and I told her to go wait for me in her room... standard discipline in my house, to separate and then reconnect, talking over the issue after reconnecting. This time, however, when I went to reconnect, she said to me, "You don't like me because I'm ugly."

WHAT???
For those who don't know me, I didn't give that to her.

It is one of my highest priorities and perhaps the biggest output of energy in my life to cope with Eliana's huge personality and guide her through her issues without, as Single Dad Laughing would say, breaking her. She is an incredible kid and it would be horrible to subdue her - to destroy not only the parts of her that hurt herself and others, but the beauty and vibrance that is at her core.

And here's your real: I don't know what to do, and I'm terrified. After finding this list of cognitive distortion, I'm definitely up for counseling, but I don't know how well it's going to work for her. I don't know how to love her any better than I do, I don't know how to help her feel better about herself, more or less discipline ain't gonna help. And here's what scares me the most: cognitive distortion is a prime recipe for depression (if not a symptom of it!) and she hasn't even hit puberty yet. This needs to be ameliorated before hormones are thrown in the mix.

Real #3: Today, I would have really liked not to be the mom. I love these kids so much, but just for one day, I would have liked not to be the one feeling guilty about using friends for childcare, to not be the one doing the nanny interviews, to not be the one who bears responsibility for getting my wonderful, hurting daughter the guidance she needs to become a well-adjusted adult. I'd love to be the auntie for a day and play and love on these children with all my might and none of the weight of parenthood.

For the record, this is not a plea for help fixing these issues; thankfully, I've got plenty of resources and I'm working on it. For me, right now, help looks like your love, support, friendship. It looks like stability wherever I can get it. It looks like grace and understanding when my bandwidth is taken up. It looks like an open heart that can feel the love I have for you even when it comes in small glimpses.

It IS a plea to listen to Single Dad Laughing and get real. Let down your guard. Let's not all pretend to be perfect. You're lovely the way you are.

Tuesday, October 5, 2010

American priorities for mothers: version one (snarky)

Birth and postpartum the standard American way:

"Why would you want to have a baby at home? Something could go wrong! You could need a c-section! Your baby could have the cord around its neck! You could bleed to death in five minutes! And the hospital is life-saving! You want to check out before 24 hours? Ludicrous! Your baby could stop breathing! You could get an infection! Stay here where it's clean and we take good care of you!

OK, now go. Go home. No we don't need to see you any more. Sure, your baby absolutely needs to go to the pediatrician, at one week, two weeks, four weeks. Absolutely. You, though, you just go take care of yourself and be thrilled with your baby. Breastfeeding is tough? That's okay, formula is perfectly fine. Here, have a free sample. No, we don't care how you're doing, not until your six week visit. Then we'll be happy to tell you how much less you should weigh by now, how breastmilk is best - oh whoops, I forgot, of course formula is fine, no I didn't mean to make you feel guilty! Now of course, you wouldn't imagine stopping at one child, but you'd better go on the pill right now so you can space them appropriately and not ruin your body or screw up your kids irreparably.

Isn't motherhood amazing? Oh, it's hard? Well, what did you expect, it's a baby... you could've just bought a cat if you wanted easy. You don't seem depressed at all, you just need to sleep train your baby and then you'll feel better. But isn't motherhood amazing?"

I will follow up with an actual thoughtful post on the culture of fear of birth, blame on mothers, and complete ignorance of postpartum depression.

Monday, October 4, 2010

Pink parts

Eliana comes in the kitchen tonight to tell me that Kes needs to wipe better because her vulva is red. So Kes pulls her pants down and va-moons me. I tell her it's not really red, just a little pink, but it wouldn't be a bad idea to wipe a little better after she pees. She says, "Can I go look at it in your mirror?" and I give her permission to open up my room to access the full length closet mirror.

A few minutes pass, and I totally forget about the previous conversation, lost in chores. Until Kes comes running full speed down the hall toward me:

"Mommy, mommy! It's such a lovely pink! My vulva is beautiful!"