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Maternity Leave For Physicians in Training

We hear all the time that maternity leave in the U.S. is in shambles. Let’s clarify. There’s no such thing as guaranteed maternity leave. Some companies are obligated to give some leave to some employees – that’s as good as it gets. No companies are obligated to give paid leave.

Medical training adds complexity to parental leave. Residents and fellows are expected to be deferent, the lowest on the totem pole, privileged to receive training.

As a first time expecting mom, I approached requesting maternity leave from this same position, not understanding the varied priorities of those involved in determining my leave. I learned quickly after becoming a mom, that maternity leave was not about me, it was about my child. I was accustomed to deferring for myself, but for my baby – that I could not swallow. Being a mom gave me a backbone. It gave me purpose. It made me so sad for all the other mommies and babies out there who haven’t gotten enough time to heal and bond.

I got a lot of mixed messages when I was pregnant with my daughter. Human resources would say one thing, program director another, google another. I was so confused. I think everyone involved was confused. Now I realize that there are different sets of rules and bottom lines for everyone.

I’m just one person, and who knows if anything I say will change anything, but I think I can help break down the variables and various parties involved in determining maternity leave in medical training so you guys aren’t as confused as I was going in.

Vacation
This is variable per program and typically you must exhaust your vacation time before other types of leave will kick in.

Sick Leave
Also variable per program and can be tacked on to your maternity leave. Typically exhausted after vacation.

ACGME
This regulating body requires that programs have a parental leave policy and that they inform their trainees of this policy upon entering. It also requires that programs communicate how prolonged leave affects satisfaction of graduation requirements. As of 2015, for endocrinology (my specialty) the ACGME leave requirements state, “The continuity patient care experience should not be interrupted by more than one month, excluding a fellow’s vacation,” but otherwise does not specify amount of leave allowed by ACGME.

FMLA
A law that protects the jobs of certain employees for 12 weeks of unpaid leave per year. Companies with more than 50 people are subject to this law. Employees who have been with the company for more than 12 months are eligible. If you are a first year resident or fellow, you may be out of luck.

Short Term Disability (STD)
Your program may or may not have short term disability for its trainees and some, but not all, plans will cover maternity leave. If covered, typically six weeks are covered for vaginal delivery and eight weeks for c-section. Coverage can change in special circumstance e.g. you have complications and your OB says you are disabled longer and your disability application is approved by the company providing STD. Long term disability (the kind of disability insurance those of us with our own disability insurance usually have) does not kick in until 90 days and your claim also needs to be approved in order to get payment.

Human Resources (HR)
One of the roles of the human resources department is to ensure that the company is in compliance with laws and company policies. These may not be the same as ACGME and program-specific rules.

Program Director (PD)
Your program director is responsible for a lot of things: staffing, graduating fellows, maintaining ACGME compliance to ensure funding, board pass rate, etc. Their interests may not align with yours on maternity leave; however they will be a huge part of determining your time off and potential program extension. I recommend being equipped with your university/company STD policy (available from HR), your specific program’s parental leave policy (required by ACGME) and FMLA when you have the maternity leave discussion with your PD.

Don’t assume your superiors (PD, chief residents, attendings) know more than you when it comes to parental leave. I wish I’d realized this from the start.

It is impossible to know the emotions and responsibility that come with motherhood before that tiny person comes out and changes your world. Just remember, your new baby depends on you 100% in the early days and the time you are able to spend with them matters more to him or her than you.

Gluten-Free, Vegan Booby Boosting Bites – A Yummy Alternative to the Lactation Cookie

Disclaimer: I’m neither a food blogger nor a chef. I’m more of an eat to live person. Efficiency is the name of my game, so when I make something quick, easy and with minimal clean up that also actually tastes pretty good, I call that a win.

Seriously guys, when I was in med school, my friends will tell you, I ate a protein grilled on my George Foreman grill (remember those??) and a veggie every night I ate in. It checked my protein and fiber boxes and I was done. It wasn’t until I met my husband – a true foodie with the patience to follow long detailed recipes – that I truly started appreciating food a bit more.

Yesterday, I was in the mood to try a different lactation cookie. I searched Pinterest, and I couldn’t believe I could not find a single reasonably healthy one. I’ve been spoiled by Dr. Illuri’s vegan, gluten-free lactation cookie recipe. The other recipes I found all contained tons of refined sugars and flours – certainly not good for postpartum weight loss or anyone in your family’s health!

My newborn was sleeping so using my Blendtec to make the oat flour for the above recipe was out of the question, so I decided to experiment with my own. Turned out great and hubby and toddler approved!

One KichenAid stand mixer bowl, a few measuring cups and spoons, 10 minutes and done!

5 from 1 vote
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Booby Boosting Bites

Lactation boosting bites. No baking required!

Course Dessert
Keyword Lactation
Prep Time 10 minutes
Total Time 10 minutes
Servings 4 people
Author RiverwalkDoc

Ingredients

  • 1 cup gluten-free rolled oats
  • 1/4 cup ground flaxseed
  • 1 cup shredded, unsweetened coconut
  • 1/2 tbsp Brewer's Yeast
  • 1/4 cup 70% cacao chocolate chips
  • 1/2 tbsp cocoa powder
  • 1 tsp ground cinnamon
  • 1/2 cup almond butter
  • 1/3 cup maple syrup
  • 1 tsp vanilla

Instructions

  1. Place all ingredients in bowl. *Using your measuring cup for dry ingredients first makes for less clean up!

  2. Mix until even in consistency.

  3. Form into bite-sized balls.

  4. Refrigerate if desired - these do well both in the fridge or at room temperature!

Recipe Notes

Next time I may consider using mini chocolate chips or cacao nibs to make the balls stay together even better - the regular ones did the job, though!

Health benefits of this recipe
1. No refined sugar or flour. Refined sugar and flour lead to rapid increases in blood sugar and insulin release leading to weight gain.
2. Gluten free therefore fine for those with celiac disease. Also trendy!
3. Lactation boosting ingredients: flaxseed, coconut, almond, oats, Brewer’s yeast
4. ≥ 70% cacao containing chocolate has many metabolic health benefits

Diabetes Myth Busting

Almost all my patients have diabetes. In the hundreds of patients with diabetes I see every month, I’m saddened by how little most patients know about their disease. Worse, many patients have been given incorrect, dangerous, detrimental information. This post is to address common diabetes misconceptions for patients and providers.

1. I have to eat six times per day because I have diabetes.
False. Diabetes causes high blood sugar, not low blood sugar.
– If you are having low blood sugars, it is more than likely a problem with your medications and dosages. Common medications that lead to low blood sugar are sulfonylureas and insulin.
– Why is this myth dangerous? Eating more leads to weight gain, worsening insulin resistance, thereby worsening diabetes. “Snack foods” are often the worst of all.

2. Breakfast is a must.
False. In fact, one effective way to lose weight and decrease insulin resistance is intermittent fasting. Skipping breakfast is the easiest way to intermittently fast for most people.
– Many of my patients tell me they eat breakfast even if they are not hungry, and are relieved to hear they don’t have to!
– Some of my patients with type two diabetes on high doses of insulin have been able to stop insulin completely using intermittent fasting.
– Want to learn more about intermittent fasting? I highly recommend this book

3. I can cure type one diabetes with diet.
False. Type one diabetes is an autoimmune disease where one’s body attacks its own pancreas – the organ that secretes insulin. If you have type one diabetes, you will die without insulin.
– Caveat: You can significantly reduce your insulin dosages with diet changes even in type one diabetes.

4. I can never eat sweets because I have diabetes.
Kind of false. You can eat sweets just recognize that your blood sugar will go up.
– If you take insulin, you will need higher doses to cover high carb foods like most desserts.

5. Diet drinks and artificial sweeteners are healthy.
False. While these may have less of an impact on your immediate blood sugar, they can lead to worsened weight gain and insulin resistance, the underlying causes of type two diabetes.

6. My blood sugar is all over the place with no rhyme or reason.
Usually false. Usually with a thorough history and a physician experienced in appropriate diabetes management, we can figure out the problem.
– I have seen thousands of patients with diabetes in the hospital, which is a more controlled setting than home. Here I can recall very few patients we had trouble figuring out. It gets tougher in the clinic, because home life is unpredictable.
– If you are struggling with this, make sure to bring your doctor a detailed meal, snack and blood sugar log. There are many other things that can affect blood sugar including illness, medications and hormones, so also consider seeing a specialist.
– Continuous blood glucose monitors such as the FreeStyle Libre or Dexcom can also help.

7. I have to stop all other medications when I start insulin if I have type two diabetes.
Usually false. Unless there is a specific reason to stop them (e.g. kidney disease, side effects), many medications can be used in conjunction with insulin. In fact, keeping insulin doses as low as possible by using other meds that don’t cause weight gain actually decreases the weight gain associated with insulin.

Hope this clarifies some things! Leave me a comment if you have any further questions!

20 Ways Dad Can Help with New Baby

Long before baby is born, mom feels how her baby moves. Ava was a fluid dancer, Sri spastic – they came out exactly the same. The growing babe keeps her up at night and constantly reminds her of his presence with kicks, elbows and hiccups. She adjusts her schedule for OB visits. She plans for maternity leave with her workplace. Her body changes. Her wardrobe changes. Her diet changes.

When baby finally arrives, of course it is jarring, but mom has been changing her life for this tiny human for the better part of a year. It’s no surprise that most of us flow into motherhood much more smoothly than dads into fatherhood.

My sweet husband requested a post to help dads be more supportive and involved in the early days with baby. He said despite being on our second child he still feels clueless. He recalls he didn’t feel helpful until Ava was eight months when I specifically asked him to wash bottles and pump parts (he’s right, he wasn’t!), says the specific request was a relief, not a burden, and he hopes to be better for number two.

We struggled a lot when Ava was born – not from a lack of love but from a lack of communication. So my first word of advice is keep talking and talk about everything. After all, you are raising a child together now – you need to be on the same page.

Dropping the passive aggressiveness, being adaptable and recognizing issues to promptly come up with creative solutions are huge. Your husband loves you and wants to help, but, like mine, he may just really not know how.

I read a bunch of articles on how dad can be helpful, and I was happy to see my husband really does all of those things (maybe he’s been reading them??). In summary I found: help with chores, change diapers, make your wife feel desired. These are all great!

I hope my list will tackle some more specifics and may be more tailored to family’s with high intensity jobs like our’s.

20 Ways Dad Can Help with New Baby

  1. Your nuclear family has become more important than ever, but somehow people outside of it think this is the right time to drop in their opinions and needs. Ignore the noise and focus on your wife and kid(s). Everyone else is still loved and hopefully they can wait until things have settled down at home.
  2. Keep the nursing mama’s water glass full.
  3. Don’t finish the Gatorade, cookies or ice cream.
  4. Check your phone and TV at the door – mom has probably had minimal adult interaction or intellectual stimulation all day, so talk to her about your day, the news, etc.
  5. Cater to guests when they come over. She’ll want to, then be exhausted. You might have quite a few guests wanting to meet your perfect new baby!
  6. Plan a healthy dinner at least once a week – yes, she’s been home all day, but for some of us, this takes a lot of bandwidth that we don’t have. Eating out is easy to fall into and unhealthy. This doesn’t even mean you have to make it – just give her ideas!
  7. Don’t talk about how tired you are. Everyone is tired and fatigue is not quantifiable so you may actually be more tired than her, but still, this is not the time.
  8. If you have tasks for her to complete, send her a text with the list. I forget everything my husband asks me to do.
  9. Make the lactation cookies.
  10. Change diapers and burp baby promptly and if possible without being asked. Moms hate to ask for help. The longer you wait, the less time she has in between feed, wake, sleep cycles, and every minute counts when there are kids around.
  11. If your changing table is in the bathroom, leave the door unlocked when you shower.
  12. Give her privacy when in the bathroom and shower. These are her few moments of me time.
  13. Be cognizant of when you are needed. For example, playing with toddler from 4:30-6:30p while baby is sleeping and then taking a nap or phone call or shower at 6:30p when tot needs to get ready for bed and baby needs to nurse is not helpful.
  14. Learn how to clean baby poop out of clothes. Here’s a link to help you.
  15. Put things where they belong. Here are some specifics:
    • Dirty diaper and ALL dirty wipes belong in the diaper pail.
    • Baby’s dirty clothes belong in the washer or hamper.
    • If you take the Rock ‘n Play downstairs to watch baby while she sleeps, thank you! Make sure to put it in an easily accessible place when you return baby to her to nurse.
    • If you borrow her computer or phone, return it to where you found it so she doesn’t have to search for it when baby is hungry and screaming. Nursing gets super boring without them.
  16. Carry the diaper bag and the baby (or the heavier kid if there is one).
  17. Take over newborn’s bath time.
  18. Pay attention to her mood. Postpartum depression is real and she won’t be able to tell you if she has it.
  19. Love on your baby as much and often as possible. It’s tougher for dad to connect than mom, but working on that connection makes everyone feel good. Trust me, the breastfeeding mom is getting enough skin-to-skin. She will not be mad if you temporarily take the child away from her.
  20. Be a quiet sleeper. There’s nothing more frustrating than waking baby up with a huge sneeze or cough. Shaving and omeprazole have helped my allergy and reflux-prone hubby

Bonus: If you can afford it, invest in a housekeeper. Even better, especially if you work a lot and there’s a toddler in the picture, find someone to help in the evening with prepping dinner for tot, clean up, and toddler’s bedtime OR at least to hold baby while mom does these things so she’s not completely overwhelmed by multiple needy children and too few hands. Evenings tend to be the witching hour for most kids. The stigma of hired help making for disconnected parents is unfair. E.g. I can chat with my girl during dinner or sit under a blanket and read with her when nanny is there to make her dinner and pick up one million peas off the floor.

Keeping it Real – Maternity Leave

Maternity leave – a hot topic or not? While we hear about it a lot, I think it is one that is completely misunderstood. Here’s my two cents on why.

Let’s start with some things I heard before I popped (usually from moms!)

“Do you get any vacation after your baby is born?”

*Hello! Recovering from major surgery with a needy toddler, a screaming, pooping, suckling, tiny creature, sore nipples and LOTS of bleeding is NOT vacation. Beach with my husband, champagne and no alarm clock – that is vacation.*

“You get three months. That’s awesome!”

*Three months without a salary, with new expenses, husband needing to work long days and nights with above toddler and adorable creature at home, who mind you, most likely will not be sleeping through the night until at least four months, if ever, is NOT awesome, but I’m glad I have it. Thank you.*

You are expected to smile in a agreement and be gracious for what you get.

It is impossible to understand maternity leave until you are in the thick of it. Before I had Ava, I thought I was going to back to work in four weeks, no problem. Turned out, I wasn’t medically cleared for ten weeks and at four weeks I couldn’t even walk across the street faster than the signals changed. You aren’t supposed to pump until three to four weeks postpartum. Managing a busy inpatient service in a huge hospital would have been impossible, and I would have had to resort to formula.

Then there’s the sleep deprivation. No matter how smart and strong you are, chronic sleep deprivation is unhealthy and bad for brain function. At four months of Ava, I truly feared accidentally harming patients. Here’s a glimpse on why:

Last night:
Started with mild headache from lack of sleep in the previous 24 hours
9-10:30p: Sri ate, pooped, slept
11:40p (2h 40 min feed interval – appropriate): Sri wide awake, ate, pooped
12a: diaper change
12:15a: Sri wide awake, still eating, pooped
12:30a: diaper change
1a: still eating, pooped
1:30a: diaper change, still wide awake, put down, screamed with no end in sight, so held him
2:15a: tried to put him down, more screaming
2:25a: raging migraine, attempted to wake sleeping husband (for the first time in three weeks), unresponsive, sat on said husband and slapped his back and face, still unresponsive
2:30a: sat in bed and cried (as loudly as possible) while holding baby, husband still unresponsive
2:45a: put swaddled baby on nipple – fell asleep within 10 seconds (WTF?!), put down in crib without taking migraine meds in fear of not being able to wake up to feed baby (husband clearly would not wake)
Baby finally slept until 4:30a, feed cycle went a little more smoothly this time, took migraine med, because hopefully hubby would be up by next feed.
Sri up for the day at 7:30a. Hubby at gym 😒
*I absolutely adore my loving husband who works long days and nights to provide for our family so that I can have time off with our babes. Nonetheless, this is true and more amusing to me than anything.

This was a particularly bad night for Sri. It would’ve been a great night for Ava (goodness, I love her, though!), but think about it. For the first *at least* four weeks if you are breastfeeding, baby will be sleeping four hours max at night. This means, baby eats and poops, which takes about an hour and then *max* 3 hours until the next feed – baby may sleep or may not during this stretch so sleep is not guaranteed. This is the most ideal situation. I have rarely gotten more than 2.5 hours of sleep at a stretch. The idea of dad giving a bottle so you can get more zzz’s is great, but bad for milk supply. Also, you may have to deal with dad complaining about how tired he is the next day because he only got seven hours, and you might kill him. You will be chronically sleep deprived.

So what’s the deal with breastfeeding if it makes life with baby all the more complicated? Everyone agrees that breastmilk is superior to formula. You may not think you want to breastfeed for long – I certainly did not plan to. It is a personal choice and not the best for every family. But when you become a mom, you start to have crazy mom thoughts, “If my child does poorly in school, will I feel guilty that I gave up breastfeeding early?” “What about if my child is overweight? I’ll never be able to forgive myself.” Then there’s also the pressure from everyone around you. Mom guilt is real, man.

I’m not even going to start on how jumping back into work is detrimental to postpartum weight loss – that’ll be for another day.

Before leave with Ava, my plan to return to work at four weeks was touted as a show of strength by my superiors. We see things thing like, “Beyoncé went on tour two weeks after giving birth! #momgoals” Yahoo’s CEO publicly went back to work super soon and recently Kate Middleton looked perfect hours after delivery. I love these women, too, so no hate, but we have got to have some realistic expectations. If every woman had the resources these women have, their need for public figure status and an image created by a few snapshots circulating on Instagram and mainstream media, things would be different for us.

For all we know, Kate and Will had a huge fight with Charles and the Queen about that media appearance because her breasts were engorged and she was constipated during those photos and she cried for an hour after those photos were taken – but who wants to hear about that?

The challenges of postpartum recovery and adjusting to life with baby cannot be understood by anyone who has never gone through it. Sorry, dads, you will never get it. Further, I believe that we forget its intricacies soon after we move on from those initial postpartum months – the pain, the sleep deprivation, the confusion, the crazy emotions, the unpredictablity, the breastfeeding struggle. I did. Perhaps it’s nature’s way of blocking the trauma from our memory to prevent the end of the human race.

That’s why I’m writing this now.

This post is getting long, so more to come on confusing topics like FMLA, paid maternity leave, short term disability and maternity leave during medical training.

 

Breastfeeding: Episode Two – Public Nursing

It took me six months to get comfortable nursing Ava in public. I was self-conscious, feared making others feel awkward, didn’t have a comfortable nursing cover and had no idea how easy it can be. Once I started nursing unapologetically anywhere, life got way better.

Breastfeeding is isolating. You are feeding the kid all the time. Whenever we had guests, I was in the bedroom nursing Ava for the majority of time they were over. When we were out, I spent half the time in the car, a public restroom stall (ew!), a fitting room or alone in someone else’s bedroom feeding her.

I’ve had people tell me I should “just pump” and give her a bottle while out. For anyone who has never pumped, I suggest never recommending pumping or using the phrase “just pump” to a nursing mom if you care for your friendship with her. I don’t expect people who have never had a breastfeeding relationship to get it, but anyone who has ever nursed knows it is not that simple.

Here’s a few reasons why:

  • You have to pump for every time you give a bottle to maintain supply. So it’s either mom is isolated pumping somewhere while baby takes a bottle from someone else or she just nurses her baby.
  • Pumping less effective at milk extraction than a baby, so it leads to increased risk for supply issues and plugged ducts – ouch! I speak from experience.
  • Pumping sucks (no pun intended) and can be painful.
  • Every time you pump and give a bottle you have ten items to wash, sanitize and dry when you add up pump and bottle parts.
  • Pumped/thawed breast milk is great but not as good for baby as milk straight from the source.

The maintenance of the nursing relationship and supply takes conscious effort and it is best to nurse your baby as often as possible. As a working mom a.k.a pumping mom, nursing opportunities can be few and far between, making taking them even more important.

This nursing cover was a saving grace with Ava and already is with Sri. The muslin is soft and breathable, so no overheated, sweaty baby trying to eat. It covers well and stays put. You can see baby over the top, which is super helpful, and it is easily machine washable.

Go Bag for Baby

Less is more when it comes to packing your delivery hospital bag. The hospital stay is short and the hospital provides most of the things you need. Also, the hospital is gross, there’s a lot of shuffling and people coming in and out of your room, so definitely not a place where you’d want your nice things to get ruined or lost. You can’t get too comfortable in your labor and delivery room either, because they move you to a new room after baby is out so don’t unpack all your stuff once you get there. Childbirth and baby’s first few days are overwhelming, and the last thing you want to worry about is your stuff.

Here’s my list:

  • Flip flops for the shower
  • Zip up hoodie
  • Coming home outfit for you and baby
  • A couple of shirts, pants, PJ’s, socks, for dad
  • Your favorite chapstick
  • Hair ties
  • Travel-size lotion you like
  • Toothbrush and toothpaste
  • Body wash or soap you like
  • Shampoo and conditioner – I mean real wet shampoo – taking that first nice shower feels amazing
  • Deodorant
  • Face wash and face lotion
  • Makeup: This might sound dumb. I’m not saying bring your whole Kaboodle, but it definitely made me feel better to shower and put on a little powder foundation, blush, mascara and lipgloss a day after delivery the first time around. The second time, this got left behind since I went straight from my clinic to the OR for c-section. My poor post-call hubby already had to meet his crazy, laboring-while-seeing-patients wife and the last thing he needed to figure out was whether I’d be feeling NARS vs Becca blush. I actually did miss it, though.
  • Towel from home – Another thing I missed the second time. The hospital towel made me choose between covering my boobs or my butt – not an easy or fun decision.
  • Sleep mask! Hubby brought mine on night #2, and it made a HUGE difference. We all know which one I love.

  • Boppy pillow with slipcover and waterproof liner


  • 1-2 nursing gowns – I felt like this was way more comfortable than PJ pants/shorts since there is so much going on…down there…I keep reading to pack the softest, fanciest PJ’s ever on other lists. I disagree. Once done with nursing, I wanted to throw all my clothes away (and I mostly did). Tossing $100 PJ’s would be painful. I have a couple of these:

  • A few snacks – no one needs a hangry husband!
  • Phone charger
  • List of important delivery info: pediatrician name and number, cord blood choices, etc. – do not expect your husband or mom to remember these details

There are other things you will need but should be provided by the hospital:

  • Maxi pads
  • Lanolin
  • Large water cup
  • Mesh undies
  • Sticky, non-slip socks
  • Sleepsack for baby
  • Bassinet

Sleep Your Way to Successful Weight Loss

More than a third of American adults are not getting enough sleep. Similarly, more than a third of American adults are overweight or obese. These statistics are not surprising; however, the link between them is less obvious.

After just one week of sleep deprivation, people had worse metabolism for carbs, higher blood sugars and higher cortisol levels in one study. All of these changes cause insulin resistance and high insulin levels, which lead to obesity and type two diabetes.

Targeting insulin resistance and high insulin levels makes for effective weight control, and sleep  is an important part.

Recommendations

  • Get at least 7 hours of sleep/night
  • If you are sick or recovering from sleep debt, sleeping more than 9 hours/night may help
  • Limit daytime naps to 30 minutes
  • Avoid caffeine and nicotine close to bedtime
  • Exercise during the day
  • Avoid foods that cause indigestion near bedtime (ex: spicy food, citrus, fatty/fried foods, carbonated drinks)
  • Expose yourself to natural light during the day
  • Establish a relaxing bedtime routine
  • Sleep in the dark, the following can help:
      • Sleep mask : I highly recommend this one!
    • Black out curtains
    • Turn off the TV, cell phones, lamps, night lights
  • Optimize your sleep environment with:
    • Comfortable bed and pillows
    • Cool bedroom (60-67 degrees Fahrenheit)
    • Earplugs

Shaping metabolism starts young (probably even in utero), so make sure your kids have good sleep habits, too. They need even more sleep than adults.

  • Infants 4-12 months: 12- 16 hours per 24 hours
  • Children 1-2 years: 11-14 hours per 24 hours (including naps)
  • Children 3-5 years: 10-13 hours per 24 hours (including naps)
  • Children 6-12 years: 9-12 hours per 24 hours
  • Teens 13-18 years: 8-10 hours per 24 hours

“CDC Newsroom.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/media/releases/2016/p0215-enough-sleep.html.

Paruthi, Shalini, et al. “Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine.” Journal of Clinical Sleep Medicine, vol. 12, no. 06, 2016, pp. 785–786., doi:10.5664/jcsm.5866.

“Sleep Hygiene.” National Sleep Foundation, sleepfoundation.org/sleep-topics/sleep-hygiene.

Spiegel, Karine, et al. “Impact of sleep debt on metabolic and endocrine function.” The Lancet, vol. 354, no. 9188, 1999, pp. 1435–1439., doi:10.1016/s0140-6736(99)01376-8.

Watson, Nathaniel F., et al. “Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion.” Journal of Clinical Sleep Medicine, 2015, doi:10.5664/jcsm.4950.Consensus Conference Panel: Nathaniel F.

 

 

Phoning a Friend

It’s the height of flu season and today I was super sick. My husband is working nights. I have a clingy almost 2-year-old and I’m 30 weeks pregnant.

So what did I wake up thinking? Absolutely nothing different. Hubby will sleep, I get Ava up for bath, breakfast. Maybe we can watch movies together since I’m not feeling well. I hope she poops today.

During my last month of pregnancy with Ava I had a slew of medical problems. I had quadriceps tendonitis and couldn’t walk after literally running between hospitals to take care of patients. If anyone knows how hilly Pittsburgh is, they know that nobody should run the mile incline from Magee Women’s hospital up to the VA – pregnant or not.

At the begging of my orthopedic surgeon, “Arti, I really don’t want to have to do surgery on a 9 month pregnant lady,” I sort of took two days off – I did rehab at home over a weekend and covered the inpatient consult service overnight by phone.

I returned to work on the inpatient service on the busiest month of the year, January. I developed pneumonia, could not sleep at night due to a productive cough for the last month of my pregnancy and broke a rib from the hacking cough.

Thanks to my iPhone’s activity tracker, I knew I would walk 4 miles between hospitals and up and down stairs before noon. I had such severe edema in my legs, I gained 20 pounds just from the swelling in that last month. I thought I was getting fat, but when I was below pre-pregnancy weight within two weeks of delivery, I knew the swelling was legit.

I have no health problems normally and I’d had a very healthy pregnancy until the end. Ultimately Ava came into the world after an arduous 40-hour labor that ended in an urgent c-section. My OB could only chalk up the complications to the stress I’d put my body through in the few weeks leading up. All this because partially, I feared the consequences of advocating for myself and because I really thought I was doing the right thing by not requesting help.

Flash forward to this weekend. Hubby came home from a long night shift – his fifth night out seven. Luckily he’s an intensivist who sees the sickest. After checking my vitals, he got the toddler up and ready and insisted we need to ask for help. I hemmed and hawed. He finally convinced me by saying our daughter needed limited exposure to me so she doesn’t get sick, too.

We phoned a friend, and I felt awful. I would happily help anyone in the same situation, but asking for help seemed like asking for so much. For the sake of my kid and so my husband could get some sleep, I acquiesced.

He dropped us off, I loaded up on Tamiflu and cough syrup, and crashed in my friend’s guestroom while my daughter played with her’s, ate lunch and napped. I felt so much better than I would have if I’d stayed home by myself and tried to do it myself. And as far as I know, my friend still likes me.

I’m not the only one who has this awful and wonderful combo of being a type A physician mom who thinks she should be able to do everything alone. But sometimes, we just need a little help from our friends, and having the courage to ask can save everyone a lot of trouble in the end.

*written 1/27/18

Eating for Two

As soon as I got pregnant with my daughter, the advice started rolling in.

“Stop running.” “Don’t exercise.” “Eat more.” “You’re too skinny.”

The age-old line, “You’re eating for two,” bombarded me all day, everyday.

Pregnancy number two was no different.

We grow up with this notion that pregnancy is a blissful time when a woman should indulge her cravings. I grew up in a culture that has no expectation that a woman will return to a normal weight postpartum.

As a physician who focuses my entire life on metabolism, I know this well-intentioned advice is not only wrong; it is dangerous.

Ladies, let me be the one to break it to you – pregnancy is not the time to load up on pies, fries and ice cream. It is not the time to pack on a ton of extra weight with a plan to lose it later.

First of all, you are eating for 1.1 at max, not even close to two. My 28-week- old fetus weighed just a tad more than 2 pounds when I had my most recent oral glucose tolerance test. Sure he’s growing fast, but he does not need the 1200 calories I typically need for an average day. Eating for two will make you rapidly gain weight.

Second, all of us have increased insulin resistance during pregnancy. For some women, this manifests as gestational diabetes that needs close monitoring. Even if you are not diabetic, you become more glucose intolerant during pregnancy and this programs us to lay down fat.Worse, women who are overweight or obese are likely to gain more weight than recommended during pregnancy and to gain weight postpartum.

Third, eating right in pregnancy is hard between nausea and reflux. If we don’t try, we will fail.

Why is this important?
1. Gestational diabetes: If not well-controlled, GDM can cause birth defects, big babies with delivery complications, dangerously low blood sugar in the newborn, and increased risk of obesity and diabetes for your child.
2. Losing the baby weight is hard: Studies showed that around 20% of women have more than 10 pounds hanging around long-term after having a baby. Excessive pregnancy weight gain and postpartum overweight directly correlate with overweight decades after pregnancy leading to detrimental health consequences.

3. Your child’s long-term health: Kids whose moms were overweight or obese while pregnant are pre-programmed to be at higher risk for obesity and type two diabetes during their lifetime due to persistent high insulin levels transferred during gestation.

Recs:
– Eat nutritiously during pregnancy – avoid processed foods
– Talk to your OB about recommended weight gain
– Stay active during pregnancy
– Get enough sleep
– Work on stress management
– Invest in your partner for support

Gunderson, Erica P. “Childbearing and Obesity in Women: Weight Before, During, and After Pregnancy.” Obstetrics and Gynecology Clinics of North America, vol. 36, no. 2, 2009, pp. 317–332., doi:10.1016/j.ogc.2009.04.001.