With the arrival of the third child came yet another child care arrangement: We hired an au pair. We wanted to find someone who spoke Polish and didn’t manage to find a local Polish nanny before I chanced upon the Cultural Care Au Pair website. There we found Natalia, who has turned out to be a great addition to our family. She’s sweet and loving with Sonoma. She can manage all three kids. She’s excited to be in the U.S. and in California especially. And both she and we have enjoyed her presence on various family trips.
The overall kid care arrangement is somewhat complicated. Moby started kindergarten in August. Seth takes him to school in the morning on a tandem bicycle. After school Moby gets on a school bus and Natalia walks him home from the bus stop. Arlo is in day care and usually opts to play alone at home for half an hour and have Natalia walk him to day care than to have me walk him over without the play time. Sonoma stays home with Natalia, where “stays home” includes all the walking Natalia does to get the boys where they need to go.
The au pair program has restrictions and rules unlike just hiring a local nanny. The Department of State sets a wage, maximum hours per week, maximum hours per day, amount of annual paid vacation, etc. The visa is a student visa, so Natalia is also required to take classes and earn a certain number of credits during her year here. We provide housing and food. Natalia is living upstairs, where Seth’s mom Cherry used to live when she took care of Moby, though the upstairs has been renovated since.
Natalia works Monday through Friday. Weekends are hers. We’ve invited her to join us on some weekend outings and she’s accepted. We’ve taken her to the Aquarium of the Bay in San Francisco; the Monterey Bay Aquarium in Monterey; Bear Valley, where she’s hoping to learn to ski this winter; Lake Conesus in upstate New York (from where she ducked out for a couple days to see New York City); and Belgium.
In October I had a business trip to Belgium. I had the option of either taking Sonoma and Natalia, or going alone and pumping a lot of milk and then convincing airport security agents to let me bring it all home. I told Natalia that she didn’t have to go and gave her the option of working her regular hours in California while I traveled or of joining me in Belgium. She enthusiastically opted for Belgium. I had a much better trip than if I’d had to pump every three hours for five days; Seth had a much better week than if he’d been left in charge of three kids for bedtime and mornings; and Natalia got to see Belgium and her brother. Win, win, win!
I needed to travel to Europe for work. But what to do about the little person who relies on me for her food supply?
I saw two options: (1) pump on the trip and come back with a half gallon or so of milk, or (2) take the baby and figure out child care.
First I considered pumping. My sister-in-law Stefanie coincidentally had a multi-stop international trip during which, on my behalf, she asked every security check person about transporting milk. Everyone consistently told her that frozen milk is ok but liquid milk is not, so I’d have to freeze all the milk and keep it frozen until at least my last security check. TSA rules say breast milk is permitted through security, but if security employees don’t know that, getting through might be a headache. And then there’s pumping every 3 hours or so, including on the plane. And then there’s food safety: Most breast milk storage guidelines recommend using defrosted or unrefrigerated milk within 24 hours, so I’d need to ensure adequate chilling over the 18 or so hours of travel time. And then there’s the husband who would have three kids, including the nursing baby, to put to bed every night and get readied every morning. What a logistics nightmare!
So then I considered traveling with a baby. This required child care in Europe for the days I had meetings scheduled. Since we have an au pair who was enthusiastic about the trip I had a logistically simple answer — but it would cost an extra plane ticket. When time came to plan the trip, I explained the dilemma to the co-worker who was doing trip planning. This was unlike asking to bring a spouse or boyfriend in that it wasn’t really optional; I’m my baby’s food supply. He agreed. And when he presented the request to my manager, my manager agreed.
Tesla bought two plane tickets on my behalf: one for me to fly with a baby in my lap, and a second for my au pair to provide child care while I work. I guess my manager really wants me to go.
There seem to be no rules, no guidelines on these sorts of things. Which with good management is a good thing, since it allows leeway to do the non-standard thing if that’s what’s best for everyone.
Now we are five. With the arrival of baby Sonoma, our family feels complete.
This post is duplicated on my old blog.
After birthing three babies and watching a fourth born, I’m in the unusual position of having first-hand experience about four hospitals and six obstetrician/midwife practices in the Bay Area.
El Camino Mountain View: My tour of Bay Area practices started in 2009 at the Altos Oaks Medical Group, located at El Camino Hospital in Mountain View. I learned I was pregnant three days before a trip to SCUBA dive in Antarctica. I made a quick OB appointment to ask whether there was anything I should know about the first trimester on a trip where medical help might be days away. Luck was on my side: My doctor was a certified deep sea diver and thus uniquely qualified to speculate about the risks of diving while pregnant. After advising extra caution on depth and duration, he wished me a great trip. It was the second appointment, after crossing the Drake Passage there and back, that turned me off El Camino. The doctor admitted to a 30% C section rate, double or triple what the World Health Organization (WHO) recommends, and the doctor had no qualms. The hospital tour told me women in labor were allowed only ice chips in labor, no food or drink, regardless of duration. Hospital fliers were accompanied by a sample of formula but no information about breast feeding support. This did not seem like my best option for a maximally natural birth.
UCSF: My next experience was with the midwifery group at UCSF, with appointments in Daly City and delivery at the Parnassus campus. I can’t recommend enough the Centering Pregnancy program in which check-ups are replaced by group prenatal care. After a very brief individual check-up, the midwife meets with a group of women all at a similar stage of pregnancy to discuss relevant topics and answer questions. I was reassured to hear what other women are going through. I felt confident that the UCSF staff was well trained in normal birth and had the skills to encourage a vaginal delivery even in case of complications. UCSF is one of very few hospitals in the US to offer nitrous oxide for pain relief, which I believe really helped me have an easy delivery. I had only two complaints. My first complaint was the frequency of post-partum check-ups in the 36 hours I stayed at the hospital after delivery: a nurse came to check on me every 2 hours, and another to check on the baby every 2 hours, and since they didn’t coordinate I was awoken every hour. Had I known it was an option I would have asked to “decline care” for 8 hours overnight so I could rest. My second complaint bothers me more as time passes, and that is that the staff did not delay cord clamping as requested in my birth plan. My baby emerged purple and not breathing. He needed some rubbing and agitation but nothing that couldn’t have been done by the bed side. As time goes on I see more studies showing that letting the baby get the blood from the placenta by delaying cord clamping has measurable positive effects.
Homebirth: With my second baby I hoped for a home birth. I asked my OB for a recommendation and of the few names he gave me I chose Rosanna Davis. Her Village Prenatal Care was very similar to UCSF’s Centering Pregnancy and, again, I loved the community of other moms going through pregnancy with me. Unfortunately due to a medical complication (placenta previa) I was unable to attempt a vaginal delivery and did not deliver with Rosanna.
Sequoia C-Section: Placenta previa is one of the ways women and babies used to die in child birth before invasive modern medicine. I’m grateful to be alive and thus grateful for the C-section that delivered my second baby. The staff at Sequoia were wonderful (except a rude male NICU nurse). My surgeons, Drs. Rydfors and Bluvas, operated quickly and I lost very little blood. I had scheduled a C section for three weeks before his due date but I started bleeding before the date. Dr Rydfors recommended surgery that same day so my C section was rescheduled for three hours after our conversation. I was amazed to be allowed to sleep all night, a far more restful first night after major surgery than I’d had after an uncomplicated vaginal delivery at UCSF. On his second night, baby Arlo started breathing oddly and was moved from my room to the NICU for observation. At four weeks early though he would latch at my breast he wasn’t strong enough to get enough milk. Every feeding consisted of Arlo nursing, followed by Arlo getting a bottle while I pumped for the next feeding. In between I’d walk, slowly and painfully, from the NICU to my room to get some sleep. The nurses were wonderfully supportive of this complicated process, of the pumping, of the golden yellow milk, of encouraging my rest. I was quite pleased with Sequoia.
Stanford: I was honored to attend my friend E as she birthed her baby at Stanford. E was induced but eventually her body took over and her body did all the work of active labor without medication. In mid-2014 Stanford got two portable nitrous oxide units and E used one. I’m so pleased that their anesthesiology department provides this option, though as of late 2014 when E delivered most of the staff seemed rather clueless about it. The anesthesiologist on call had to get help from a more senior staff member to set up the machine. The nurses didn’t have any advice on how or when to use it. Before having my first baby I’d read the 2002 paper by “Nitrous oxide for relief of labor pain: A systematic review” by Mark A Rosen which notes: “There is a time lag of approximately 50 seconds after the onset of administration before the full analgesic effect can be expected.” And indeed, in my first labor I quickly realized that starting to breathe the nitrous oxide about a minute before a contraction was most effective, ensuring I was fully under the influence when the pain peaked and also allowing me to set aside the mask and breathe more freely then. I guided E to do the same and she later agreed this was a good technique. E was happy with her experience.
Stanford, Take 2: My third baby was due March 2015. Though I’d planned for an unmedicated vaginal delivery at Sequoia, towards the end of my pregnancy I hesitated. It had been a rough pregnancy and I was generally tired. I wasn’t sure in my tired state I could handle the pain; an attempt at getting nitrous at Sequoia fell through; and since I’m sensitive to pain killers I was afraid of an epidural. I switched practices from Dr Bluvas to a Stanford doctor, call him Dr S. Several medical professionals recommended Dr S as absolutely wonderful so I went to my first appointment very hopeful of a wonderful relationship, a VBAC, and nitrous. I assumed Dr S would protect me from Stanford’s reputation for overly interventionist practices. Instead, I learned that Dr S intended to monitor me more invasively than Dr Bluvas, than UCSF, than ACOG recommendations for VBACs. Dr S would break my water to put an electrode into my baby’s scalp upon my arrival; all those other experts resort to internal monitoring only if external monitoring fails to give reliable results. I fled back to Dr Bluvas.
Sequoia, Take 2: I had a wonderful (if you can call something so painful “wonderful”) VBAC (Vaginal Birth After C-Section) with Dr Bluvas at Sequoia. The nurses were diligent at continuous external monitoring, as is standard for VBACs, but otherwise let me birth as was most comfortable for me. The birth was straightforward, a bit of luck for which I’m grateful. The pediatric nurse waited to clamp the cord as we’d requested. He placed the baby on my chest and attended to her there for the first 10 or 15 minutes, and only after a while took the baby for a few minutes to suction her nose and weigh her. The nurses were kind and competent. I was ready to check-out of the hospital in the morning, some 9 hours after the birth, but they talked me into staying for some tests that are best done at least 24 hours after the birth. We walked out the hospital door 25 hours after little Sonoma’s emergence, pleased to have stuck with my experienced and not overly interventionist doctor, pleased with the Sequoia staff.
I’m one of few women in the U.S. to have birthed one baby with nitrous oxide and another without. Having experienced labor both with and without, I’m a big fan. A really big fan. This is the story of how nitrous made the two births different.
I birthed my first baby, Moby, at the UCSF Medical Center, a choice driven largely by the availability of nitrous oxide (full birth story here). I birthed my third baby, Sonoma, at Sequoia Hospital with no pain meds. Nitrous oxide, commonly used in labor in other developed countries, is offered for pain relief in labor in only a handful of U.S. hospitals.
Nitrous helped me labor. Moby’s birth hurt and hurt a lot but I didn’t fight the pain. I relaxed with the contractions. Nitrous dulled the pain to let my body let the baby out. In contrast, with no pain medications during Sonoma’s birth, once my body started pushing the pain was so severe that I fought the process. I pushed only after I became desperate enough to need the suffering to end. After I started to cooperate it only took two or three pushes to get Sonoma out, two or three horrifically painful and desperate pushes. The few final pushes which squeezed out Moby were involuntary, my body doing its effective best while my nitrous-assisted mind still focused on relaxing since no one had told me I was fully dilated.
Nitrous also helped me find a rhythm. Managing the nitrous to match my contractions gave me something to do, a way to focus on the labor without focusing on the pain. It also brought on a light mental haze. With Sonoma I was more distracted by the people around me and never able to effectively shut out the distractions of the labor room.
Nitrous doesn’t take away the pain entirely. It’s not a substitute for an epidural. It’s a tool for making labor a little easier. For women hoping to avoid epidural and IV anesthesia, nitrous oxide can be enough to avoid a desperate last minute request for stronger pain relief, just enough not to fight and undermine a body that can do what it needs to do.
Given how helpful I found nitrous oxide and what I saw it do for a friend in labor, I certainly wish more U.S. hospitals offered it. It’s probably the safest of the medical pain relief options in labor. And yet few U.S. hospitals offer it, probably through some combination of hospital tradition, anesthesiologist disbelief that partial pain relief is worthwhile, and cost.
If every working woman had the opportunity for this sort of maternity leave, I bet far more women would stay in the workforce after becoming mothers.
This was my Friday:
9:00 Bicycle to work with 8 week old baby in trailer
10:00 Meeting with manager of another group, at his request, to explain the technical reasons for some decisions. Nurse in meeting.
10:30 While changing diaper, my manager came by. Technical discussion ensues.
11:00 Group meeting. I presented a slide that spurred my manager to make some important decisions. None of the 5 guys flinched when I changed a second poopy diaper mid-meeting, though my manager did make a comment about changing his kids’ diapers.
12:20pm Group lunch. Co-worker helped with my plate since my hands were full.
1:00pm Bike home.
2:00pm Nanny arrives. I spend the rest of the afternoon working from home and doing a couple small things around the house.
5:15pm Nanny leaves with baby to walk to boys’ day care.
6:00pm Boys come home from school with nanny. Husband returns from work. Family dinner.
Sleep. Technical conversations with adults. Respect. Breast feeding. Exercise. Time with baby. Time not in charge of baby. Balance.
Thanks to my husband and to the people at Tesla who made it possible.
This page is duplicated on my old blog.
It surprises me that a focus on nutrition for children isn’t more mainstream than it is. The CDC issues scary warnings like “that the number of Americans with diabetes will range from 1 in 3 to 1 in 5 by 2050.” Major scientific journals question “the relationship between dietary fat content and the prevalence of obesity,” bringing up “the so-called fat paradox” that obesity is on the rise in spite of people eating more low-fat products and less fat, and speculating whether refined carbohydrate foods are actually the culprit behind weight gain. We’re even seeing books by science writers pointing at rigorous studies showing that the most consistent risk factor for developing heart disease, as far as diet is concerned, is the intake of carbohydrates. And the first lady tries to improve health among children with her Let’s Move initiative. Meanwhile, my sons’ Learning Links day care center falls far from meeting the USDA’s nutritional guidelines for young children, erring far on the side of filling the kids’ diet with carbs in place of vegetables and proteins. In spite of devoted teachers and a generally great environment, nutrition somehow hasn’t made the top of the priority list for either operators nor the owners.
The day care is owned by the City of Mountain View, who contracted first with CCLC and since Feb 2014 with Community Gatepath to operate the day care. (Learning Links is the name of the day care, while Community Gatepath is the mother organization.) CCLC’s regional director clearly told me that Chefables, the snack vendor, is very convenient and she wasn’t interested in changing a convenient relationship for the sake of improving nutrition. The Community Gatepath/Learning Links staff has been more open, explicitly acknowledging an interest in improving the nutritional content of the children’s two daily snacks but without a significant impact over their first 10 months of operation in Mountain View. Three times now I’ve been told that Learning Links is asking Chefables for a change to the menu; we’ll see what the New Year brings, but the first two menu changes suggested a lack of initiative more than a concerted effort. My kids eat breakfast and dinner at home; a home-made lunch at school; and two Chefables snacks daily. For some children at the center, the morning snack is breakfast. So the day care provides 2 of my kids’ 5 meals, and 2 of 4 of some kids’ meals. It bothers me that the lesson all these kids are learning is that a cookie, pastry or bread constitutes half the menu in half of their meals.
Given that our day care is in Silicon Valley, one of the wealthiest and best educated parts of the country, I wonder what goes on in less fortunate parts of the country or at less expensive day cares. I wonder how this bodes for our children’s and our society’s future. It’s a little scary, truth be told.
This page is duplicated on my old blog.