Tuesday, 30 June 2015

2015 Challenge Update #3

After the drywall work was done, things began to move quickly with our projects. The weekend after Memorial Day, Husband and I painted the garage. Yes, we took the easy way out and painted the ceiling and wall the same colour...

Husband installed motion sensor activated ceiling lights, as well as several new outlets in the garage and he re-organised the electrical panel. When the city inspector came to evaluate, he thought things looked good and admitted that he forgot his tester. "Here, use mine" Husband offered. The inspector commented that good contractors seem to want to show off their work. Personally, I think Husband was that kid in class who reminded the teacher if she forgot to assign homework.

Next, we had a professional Epoxy treatment to the floor. 


And After!

The next "fun" project was installing the storage unit, but at last we could move the contents of our garage out of our house.

Finally, the garage doors were installed! 

There are still a few projects left to do, such as painting the doors in then next 30 days per HOA regulations, but fortunately, we'll have my dad here to help. Most importantly, we have a functional garage in time for baby's arrival! 

Thursday, 18 June 2015

...and They Have a Plan.

Last year, while I was preparing for my maintenance of certification exam, I came across this practise question in a review textbook:

1. The patient asks you about birth plans during her initial prenatal visit and inquirers as to your attitudes toward pregnant couples who wish to participate in decision making for the conduct of labour and delivery. How would you respond?

A. Birth plans are not a good idea; usually something goes wrong and the couple is disappointed
B. Birth plans are not a good idea; they frequently lead to unresolved guilt to the couple
C. Birth plans should be avoided; perinatal morbidity and mortality are usually increased
D. Birth plans are an excellent idea; everything always goes according to plan
E. Birth plans are a good idea; they involve the couple in the planning for the baby's delivery and can be an important part of the prenatal, postnatal and postpartum care

Here is a situation where I would argue that you have to read the questions carefully. If they are asking, 'what is the best answer?', then obviously they are leading you to select choice 'E'. However if the question were phrased 'what is the correct answer?', then I would go with choice 'A'. When I was working on Labour and Delivery, the majority of my patients were young girls for whom nothing about their pregnancies nor births were planned. However, there is something about the body at that age that is conducive to giving birth. Many of my patients had the all natural, unmedicated, intervention free vaginal births that the older patients on the floor desperately wanted. I always detected a sense of slight annoyance whenever one of the nurses was caring for a patient with a birth plan, but more so, the universal consensus from the nurses, to the midwives and obstetricians, to the anaesthesiologists and the OR techs, is that the more detailed the birth plan, the more likely the delivery would end up as a Cesarean. Even the Unit Clerk would ask about booking an OR if a patient handed her a 5 page birth plan upon her admission.

My thoughts on birth plans is that they can lead the couple to focus too much on the process and not the outcome and too often, disappointment is expressed when things didn't go according to plan. When Myrtle recounted her birth story, she described that she starting feeling cramping and uncomfortable around 11 PM. She went to bed and woke up around 5 the next morning and could tell she was contracting. She walked around her tiny condo for an hour and as the contractions picked up, they decided to go to the hospital. She was 5 cm upon her arrival and little Myrtle was born via a Vacuum Assisted Vaginal Delivery at 11:45 AM on her due date. Barely 12 hours of labour. Most of my patients and my infertile jealous self could only dream about having a delivery so perfect. Yet to Myrtle, there was one flaw. "I had to have an episiotomy, which I did not want." she complained. Oh, for fuck's sake Myrtle. It's not like you're at the deli and you're telling the guy behind the counter that you don't want pickles on your sandwich. I wanted to say these words to her, but as little Myrtle was in the Newborn ICU with breathing issues, I held my tongue.

Co-worker is the only patient I know who had a birth plan that went according to plan right to the letter. She drafted it right after learning she was having twins; 'I want a C/section'. Prior to learning of my placenta issues, my birth plan would have been 'let's just see how things go...' which has really become the approach for the since the discovery of the previa. As the placenta had moved past the os by 32 weeks, I no longer needed to be delivered between 36 and 37 weeks, but it still hadn't moved enough to allow for a vaginal delivery. So we had yet another follow up at 35 weeks and 5 days. The placenta was now 1.5 cm away from the os. It needs to be 2.0 cm to permit a vaginal attempt. The perinatologist that I usually see was on vacation, so of course, the one filling in offered a completely different opinion. He suggested re-scanning at 38 weeks to allow the placenta a little more time to move, and if it does, and as long as my blood pressure is controlled and the resistance index of the umbilical artery is normal, then I could go to 39 and a half weeks before he would induce. (The original perinate recommended delivery between 38 and 39 weeks due to my chronic hypertension).

So the latest birth strategery looks like this: If the follow up scan at 38 weeks indicates that the placenta has not moved enough, then we'll schedule my C/section the following week. If it has cleared 2 cm, then we'll induce at 39 weeks and 4 days, if I don't go into spontaneous labour before then. Hopefully not on July 4th. The petty aspect of my birth plan is that I desparetly want to avoid a 4th of July baby out of consideration for my English in-laws. It just feels like it would be very in-your-face to have their grandchild born on such an American holiday. Husband and I have discussing the pros and cons of each option. At times, the suggestion of a vaginal delivery makes me wishful for the conveniences of a scheduled C/section and most importantly, the opportunity to have my stomach muscles reapproximated. Other times, I feel that since we've come so far from a possible accreta and potential hysterectomy, then I sort of owe it to myself to try to avoid any major surgery by attempting a vaginal delivery. There are a few awkward logistical issues. My parents booked their flights when we thought I'd be delivery early and the baby would be 2 weeks at the time of their arrival. Now there is a chance they could arrive a week before the baby. Additionally, as we have been anticipating a Caesarean delivery, we've been factoring 8 weeks disability. My actual return date (not the one assigned to me by the DS) is predicated upon our trip back east at the end of October. If I have a vaginal delivery, it will be more costly as I'll only get 6 weeks leave and will have to take two weeks unpaid. Just as I was reflecting how shitty it is that women have take this into account with delivery decisions, Husband cheerfully piped in, "Best case scenario: you go to 39 weeks and 4 days, but ended up needing a C/section anyway!' Sometimes it's amazing how such simple concepts can rule the male mind...

So now that we've established a p-l-a-n, it's going to invite the Universe to fuck with it. The first potential variable is my blood pressure. It has been so good, I've almost been back in denial on whether or not I really have chronic hypertension. I tested myself by taking my Labetalol a few hours late and obtaining a reading. It was creeping up to 132/88. Sorry Jane, it's the real deal. I also know my well controlled blood pressure doesn't provide too much reassurance as I've seen patients go from zero to full blown severe pre-eclampsia in a day, if not, within hours. The other variable is Jate himself or herself, who won't stay head down. I suppose the former gymnast in me should be proud that he/she is essentially doing cartwheels in my uterus. At my twice weekly NST appoinments we've seen the head on the left side, the right upper side, cephalic presentation for the perinatologist, and most recently spine down transverse with the head on the right lower side. It's been like Mark Twain's description of the weather in New England; just wait a few minutes and it will change. I feel a little more encouraged as baby can spontaneously vert into a cephalic position and I've been doing the Forward Leaning Inversion and Breech Tilt, which is supposed to help with a transverse baby. I've been trying to determine the position, but it's hard to do Leopold's maneuvers on yourself as your hands are at the wrong angle. When a transverse presentation is confirmed, it feels as if I have something sitting across my lap, and I have much more pressure on my bladder when baby is cephalic. Transverse presentation is a little more frustrating to manage than a breech. If an external version is to be attempted, then an induction should follow immediately if successful as transverse babies are more likely to vert back than a breech. It's also recommended to deliver between 38 and 39 weeks as there's a higher risk for cord prolapse if spontaneous rupture of membranes occurs.

Alas, we wait and see. I still have no idea when, how or why I'll be delivered...

Friday, 12 June 2015

If you leave, don't leave now...

Sadly, I'm old enough to remember when Bill Clinton signed the Federal Medical Leave Act (FMLA) into law, and it was considered a legislative victory and represented progress for women's rights. Twenty plus years later, it's widely recognised that FMLA protection is rather inadequate as it only secures one's job while he or she takes twelve weeks of unpaid leave after the birth or a baby, adoption or need to care for an ill family member. Additionally, FMLA is rather restrictive as one must be a full time salaried employee for at least one year at a company with more than 50 employees  in order to even qualify. It is projected that 40% of employees are not even eligible for FMLA protection. Last Week Tonight with John Oliver recently broadcast a brilliant piece on the shitty state of maternity leave in the United States, and he featured some clips from the opposition to FMLA, which sound so familiar. There were claims that it would "cost jobs" and it was a "suffocating regulation being shoved down the throats of businesses and families" (from a female Congresswoman). Tom Delay, who many will remember was indicted on charges of conspiracy to violate election laws among other dodgy allegations, claimed the bill was "unfair, invasive, anti-business, anti-growth and deathly expensive". Yet less than 10% of business expressed any negative effects about complying with FMLA mandates. California broke ground in 2002 with the introduction of a Paid Family Leave, which provides partial pay for six weeks and is financed through payroll taxes. Over 90% of California businesses report a 'positive' or 'neutral' impact of the paid leave. As John Oliver describes, "It's like having an ice hockey game on at a bar. It's not bothering anyone and some people are actually really into it."

When I first spoke with the Disability Specialist (DS), I took note that she seemed reluctant to offer any information and only replied to specific questions. It would seem that she were just lazy or incompetent, but now I appreciate that she is a very diligent employee who has probably been trained to be evasive. She wouldn't tell me how much leave I could take, only that it would depend on my eligibility, which couldn't be determined until I submitted my request. I was instructed to apply for my leave 30 days before the intended date. As my latest ultrasound had revealed that my placenta is moving and my delivery date could be pushed out, I emailed the Disability Specialist to ask if it would be better to file 30 days before the earliest possible date of my leave and then change the date as needed. She never wrote back to me and as my office manager kept asking if she should open my schedule for another week, I decided to say 'fuck it' and planned to file a week later with the hope that I would need to change the date and would create extra work for the DS. At last when it was 30 days before my intended last day, I clicked on the weblink that the DS had sent me so that I could sumbit my request online. I couldn't get passed the first page before the site crashed. Repeatedly. I tried calling the 800 number that was listed, but after waiting on hold for twenty minutes, I had to leave a message. I called again and waited for another 20 minutes to no avail. When I didn't hear back from anyone at the end of the day, I called the DS and received her voicemail. I left a pissy message indicating that I did not want to have to work past my intended stop date and did not want to have to take unpaid leave just because her department didn't have their act together.

The following Monday, I finally reached the DS. There was no mention of my prior messages or email. She took my information started the process of my leave application. Two days later, I received a formal letter from her. According to my paperwork, I was approved to take six weeks off from my delivery date. She had already slated my return to work date, which was exactly six weeks to the day from my original due date. As that date falls on a Thursday, I would be expected to return on a Friday. As in 'don't be cheek enough to think you can take one more day and restart on a Monday...' The icing on the cake? She mentioned that I could use my PTO time, but according to her records, I had zero hours of stored PTO to apply. Cue freak-out from an emotional, hormonal pregnant woman.

I just couldn't escape the feeling that I would get screwed over by the process. I am a hard working, tax paying citizen who has never had to use the system, let alone have any idea how to work or manipulate it. One of our affiliate offices hired a new doctor who was about 4 or 5 months pregnant when she started working. She only took 6 weeks off,  as she wasn't eligible for California benefits since she hadn't been an employed state resident long enough. I've been a full time employed resident of California for the past 8 years and I have all the receipts to prove that I've paid my taxes. I realise that she has to put something down for my return date, and it was probably arbitrary, but it's hard to believe that when you're looking at an official looking document that also states how you can be penalised if you don't return to work on your anticipated date. Still it felt insulting. As if this was all the time I was allowed to take, six measly weeks, which I know is a reality for many new mothers. She was proposing that I take the shortest possible time as I needed to get my ass back to work right away. What was so aggravating, is that thanks to my cousin, I am aware of the paid leave options provided by the state of California. Why was she seemingly so reluctant to let me know my leave options? FMLA allows me to take up to 12 weeks. I wondered how many employees wouldn't challenge this letter and would only take 6 weeks off. She doesn't actually work for our company, so there is no benefit if I take less leave, which is financed by payroll taxes and does not accrue costs our company. Actually they probably save money as they're not paying my salary while I'm out, although they lose the income generated from my productivity. Maybe she was offered some incentive to screw me over.

I sent her another email and I revealed that I had a family member who is a Human Resources director and had discussed my leave options, including California's Paid Family Leave. Her simple response: "that's a different leave. You'll apply for that when your disability leave finishes". I wanted to write back to ask when or if she even planned to discuss this leave with me and why any mention of it was omitted from the forms in my 'Leave Packet'. I sat on my hands to prevent myself from writing such a message. Firstly I figured that she would just reference the extremely vague and confusing handbook that can be downloaded from the company's intranet. Secondly, until everything is complete, it's probably best not to completely piss her off. I emailed the Bean Counter to inform her of my intended leave, which included my Pregnancy Disability Leave, Paid Family Leave and my 4 weeks of PTO, which I knew were available to me. Much to my surprise, the Bean Counter actually asked the DS to remove the arbitrary return date as she did not want my schedule to be opened, which could lead to booking erroneous appointments for patients.

The California disability leave also allows pregnant women to start their leave four weeks prior to the due date. I've always held a certain admiration for women who work up until their due date. One of my colleagues in Connecticut started contracting as she finished seeing patients in the afternoon session. We hooked her up to the office monitor and she finished her charting while banging out contractions every 3-4 minutes. Once she was done, she walked over to Labour and Delivery to be admitted and her baby was born later that night. Over the past few weeks, I've developed an apprehension as I leave the office each night. If I had to be taken out of work, how many tasks would I be leaving for others to finish? Thus, it's become a push not to leave anything for the next day. All my billing, results reconciliation and other correspondence must be complete each night. I realised that it would actually be less disruptive and less of an imposition to my colleagues to have a set end date, even if it does mean starting my leave earlier. Additionally, there really is no benefit to working longer, except that it's more time get paid on your full salary than partial disability pay. I've heard some patients say "I'd rather work up to the due date to be able to take more time off after the baby is born", but the four weeks prior to the due take is a 'take it of leave' it proposition. You can't apply it to the leave after the baby is born. My new mantra; don't be a hero. It's better to leave on your terms.

It's funny how over a year ago, I was longing to be able to take a maternity leave as I was starting to feel burnt out. As my work load has been much more reasonable, I no longer feel such a need to escape. Since I entered the work force, I've never taken longer than two weeks off at any given time. I fear I'll lose a little of my identity during my leave. I'll miss my patients. I wonder how many office policies and procedures will change while I'm gone. I wonder how rusty and out of sorts I'm going to feel after four months off. Mostly, I wonder how lonely it's going to feel going back to work without Jate. I've grown accustom to his or her company.

Thursday, 4 June 2015

Welcome to the Jungle...

Husband sacrificed his home office to create a nursery for Jate. I had a small desk that I kept in our guest room, which I didn't really use. We moved Husband's work space into the guest room, and moved my desk into the living room, which means I have to keep it presentable. We decided not to change the paint colour in the room. When we first bought the house, we hired a professional colourist to select a colour scheme for the entire house. This particular paint, is actually in the grey family, but looks blue in the room. More so, the name of the paint colour is "Husky Grey" which connects to my Connecticut roots.

This is the photo that inspired the jungle theme. Many years ago, I spotted it at the Embarcadero craft market, and even though I didn't think I would want to have a child at that time, I decided that I would want this photo in the nursery. I bought some other prints from the artist, so I was able to track down her email address and made arrangements to order this photo.

The crib was provided by my cousins, although we purchased a new mattress. It was used by both of their boys and had been stored in their garage for the past few months. We cleaned it with some Chl.orox wipes and a Mr Clean Magic Eraser, which really does have magical powers. I don't think the crib has been this clean since they first took it out of the box. It took Tyler all of two seconds to find his way into the crib...

What do you mean this is not my room?

The glider will go into this corner. The baby supply store has signs indicating that they offer a plethora of fabric and colour choices, but they don't state that a custom order takes at least twelve weeks to receive. Twelve weeks! That's almost an entire trimester! We'll move the bassinet (also offered from my cousins) into our room once the baby arrives. I thought the bassinet seemed a little flimsy, but it has been used by four other infants, so that's a good indicator of quality control. Someone else has offered to test out the bassinet for us.                

The end table/book holder was a random Internet find. Does anyone remember the significance of that book?

When we thought we might be facing a pre-term delivery and NICU stay, Husband wanted to wait until baby was born before purchasing any furniture for the nursery. I convinced him to take a leap of faith, which was a good idea, as I tried to order this changing table from Ama.zon, only to discover that it was backordered for weeks. Fortunately, I found it at Way.fair for almost half the price! Score!

We're going to try cloth diapering through a local service. I was cloth diapered and I felt proud that my parents were so environmentally conscious, until my mother explained that it was really because they were poor. We found that the cost of using a diaper service is about the same as using disposables, but the other advantage of using a service is that their washing process uses less energy and less water than cleaning the nappies yourself. Husband has been busy practicing his technique.

I tried to find a simple mirror as I was going to stencil some animal designs on it, but in my search, I came across this mirror from P.ier1 and I decided that I had to have it. Unfortunately, it was also backordered, but I had a saleswoman at a local store track one down for me and secure the sale price! Not only does it compliment the colours in the room and is an interesting decorative piece, I love how it captures the reflection of the tree design and other pictures in the room. It took us nearly three hours just to hang the mirror and the pictures. Really glad we didn't put this off until after the baby's arrival...

The final detail was a small little basket for toys. I made the lining myself. I wanted to place the stuffed animals on a small shelf, but it would impede opening the closet door, so on the floor they sit...

It was a lot of fun to put the nursery together and we hope Jate likes his or her room. The jungle theme not only works well from a gender neutral standpoint, but 'welcome to the jungle' seems to be a good metaphor for parenthood...