Sunday, August 7, 2011

Hello again - Birds leave the nest

Well, the summer has been flying by. As a mom to older children, my birds have been leaving the nest so things have been a bit hectic and that, with other issues, has pre-empted my posting for a long time.

You never know how kids are going to react to new things. Whether driving across the country to a new job and place to live, or moving into an apartment, it's new and unusual and takes time to adjust. How fast kids DO adjust reflects, I think, how much independence they have been given growing up.

I watch in amazement as mothers with small children refuse to allow them any freedom. I have friends who still pick out full outfits for their school age children. Other friends, with high school age children, drive them everywhere and try to plan their futures for them (one co-worker is currently "helping" her child find a college. The requirements include close enough for mom to drive out there and bring home child for the weekend EVERY weekend!)

I don't get it. I encouraged my children to be independent. Yes, they got injured at times. Yes, they experienced bad things. Yes, they suffered from homesickness while away at camp, fights with friends, and deaths of classmates. But they have grown up into independent adults. I know if anything were to happen to their father and/or me, they would be able to cope in today's world. I don't know if some of their friends or some of these other children will be able to.

Sunday, May 15, 2011

Sex and Immunizations...HUH?

I read a lot about immunizations. As the mother of two (now mostly grown) children, I didn't really give them much thought back in the day. As a nurse, I was well aware that immunizations had risks. My children's doctors, back in the day, always made sure I was aware of that immunizations they were given, risks, and side effects. Outside of some after-shot crankiness and fevers, my children had no issues with any of their immunizations.

Hepatitis B was not a recommended vaccine when my children were born. I knew it was out there, and, at the time, it was given only to those infants at risk (mothers with positive tests, persons from areas where Hep B is common as exposure could be an issue). As a nurse, I knew it was not just "sexually transmitted", and the issue of a "biter" in daycare was as important as blood or body fluid transmission. But, it wasn't offered, so they did not get it then. I DID see a young child with Hep B in the hospital where I worked. But it wasn't common so at that time I put it out of my mind.

When it was recommended, I did make sure they got the Heb B doses. And yes, to be honest, I delayed (only a few years; it was not recommended until they were nearly school age for those who did not get it at birth) until they were middle-school age so they would be protected during the highest at-risk years sexually. (At that time, it was felt the immunization was only effective for 10 years, so I wanted to give them that 10 years when they would need it most.) Later reviews have shown that once someone has developed antibodies from the vaccine, they may be protected for life.

Gardasil. The vaccine that protects against that other sexually transmitted disease HPV. Only sexually promiscuous girls would get HPV, right? Wrong. One of the problems with HPV is that your system can clear it, or you get it, or, in rare cases, it becomes dormant. I had a patient who, after 30 years of monogamous marriage (on her part, per her report and on his part per HIS report), developed an HPV infection. Both firmly denied extramarital activity. Upon probing, the husband recalled that many years prior to marriage, he'd had 'warts' on his penis that went away and never came back. Guess where the wife got HPV from? Loving husband. Their marriage survived, but she had several issues with abnormal pap smears leading to additional treatment. If you asked her, she would have gotten the HPV vaccine in a second.

In the back of my head I always see the young teenage girl who was brought to the gyn clinic I worked at. Her mother was concerned because her daughter always cried when urinating. When I went in to examine her, I was horrified...I could not see anything because this girl was one huge mass of warts from pelvic bone to anus. If you touched them, they bled. Every time she uninated, the warm urine over the bleeding warts hurt her immensely. We called in the physician to manage this case. The upshot was many, many weeks of care to burn off the warts and be able to see this girl's urethra and vagina. This girl had had sex once. If you had asked her, she certainly would have preferred a vaccine over the care she required.

When the vaccine became available, I asked my children if they wanted to get it. I got the literature from the doctor's office, verified with my insurance as to whether or not it was covered, and let them make the decision. Both opted for the vaccine, and got the series of 3 with nothing more serious as a side effect than a brief dizzy spell (younger hates shots and needles and hyperventilates).

So, yes. I am pro "STD" vaccines. I am pro all vaccines, because the risks of the disease outweigh the risks of the vaccine. As a child who got a vaccine that is no longer given - smallpox scars in the US designate a certain demographic. I have one, my brother has one. Our younger sister does not have one because, lucky girl, she was born after it was eradicated in the US. My children did not have to have it because they were born after it was eradicated world-wide. Maybe, in the future, my grandchildren or great-grandchildren will not need vaccines against other diseases that have only human vectors, like measles. Wouldn't that be wonderful?

Sunday, May 8, 2011

Still Here

Just a note to say that I am still around. I have several posts in mind but have been very busy in real life so haven't posted any of them. I promise that one should be coming. I may get it done tonight (Moms get to do whatever they want on Mother's Day, right?).

Saturday, March 26, 2011

Breast is Best or when Bottle is Better...

First of all, let me say that I am a huge fan of breastfeeding. If a woman wants to breastfeed, she should have all the support and encouragement she needs and wants. I breastfed my children for as long as possible. Neither child made it to the magic "first year" nursing. One quit at 9 months (she would take a bottle, but much preferred being an adult and using a cup), the other, who decided that nursing was the cause of her ear pain (not the raging ear infection she had, with NO symptoms), quit at 6 months. (I tried for 3 days to get her to nurse...latch her on in her sleep, nope. She would awaken and scream, even after the ear infection was gone.)

Breast milk, of course, is meant to be fed to babies. Studies have shown that breastmilk changes as a baby grows, and that the breastmilk made by a mother who delivers prematurely is different from that made by a term mother. And as the baby grows, breastmilk changes to support the baby's needs.

Although women are "born" to breastfeed - we almost all have the right equipment (breasts, nipples, milk ducts), some women don't. Genetics plays a part in an ability to breast feed and throughout history, women who have been unable to nurse have found substitutes. Milk nurses, bottles, a friendly lactating cow, goat, whatever...all through history you will find women who couldn't breastfeed due to physical issues. And that is not counting the women who can't nurse due to starvation, illness or injury.

So, what about women who CAN breastfeed but don't? Are they failing their children? Are their children any different than breastfed children?

A patient of mine, long ago, told us at her very first prenatal visit that she did not want to breastfeed. In our practice, we remained non-judgmental, as we did with all our clients. All clients were given information about breastfeeding benefits. This client steadfastly refused to even look at the literature. Late in her pregnancy she confided that she had been sexually abused as a young girl, and having her breasts touched by anyone made her physically ill. She would not even allow her husband to see or touch her breasts. For this woman, bottlefeeding was definitely better for her and her baby. As we told her, better a happy bottle-feeding mother/baby pair, then a baby who senses with every breastfed meal that his/her mother hates what is happening.

Other women, without the problems of this woman, also choose to bottle feed. The reasons are many - convenience, family pressure, need to work in an environment where continuing nursing is not possible. Unfortunately, these women are often condemned by the "all natural, all the time" mothers.

So, what is your attitude? What have you experienced? And how can we promote breast is best and not neglect those women for whom bottle IS better?

Saturday, March 5, 2011

I had a (mother) who read to me...

Well, sorry for the break but I've not been quite my usual self so blogging got put by the wayside until I had some energy.

I've been thinking about baby gifts, because I have friends who are expecting. Usually I give them copies of books. "Good Night Moon" and "The Runaway Bunny" are most common, but if I know they have those books, any books that catch my eye. I almost always give copies of the cardboard types, so the babies may enjoy the books and mom and dad don't have to worry about torn pages.

I have to admit, I am a bookworm of the first order. My husband has often threatened to leave me if I bring home ONE more book (he hasn't left yet, BTW...). But I do have books and books and books. So do my children. I fully believe that kids have the right to own books, their own books - that they choose, read, mutilate, whatever.

From baby-time on, either my husband or I read nightly to our children. Early on, the books were the traditional - "Pat the Bunny", "Good Night Moon", "The Runaway Bunny". We had bought several of the cardboard-type books at one of the big superstores and the children both loved being read those books and being allowed to "read" them whenever they wanted.

Our eldest caused quite a fuss one night. I was at work and she was demanding that her father read 'hush book' to her. Unfortunately, he hadn't a clue what she meant. He finally called me at work, and I told him that she wanted "Good Night Moon" - her version of the title was due to the fact that I always emphasized the word hush when reading the sentence "...the quiet old lady whispering hush..."

Later on, we wandered into other books. We read Beatrix Potter (and had some beautiful VHS tapes of the books; unfortunately who has VHS any more? We still have the tapes). We read Dr Seuss. I don't know when my children learned to read but I know that it was well before school age. We also belonged, for a while, to one of those "Children's Book of the Month" Clubs and got some very charming books that way. Unfortunately, the children grew but the age of the club's reading material didn't, so eventually we dropped the club.

Books were never forbidden to the children. If they wanted to read them, they could. If they got bored or disliked the book, they put them back. The only requirement was that they handled it with care.

Reading material was never censored, either. Babysitter's Club books (all types), Goosebumps, American Girl, Alcott, Tamara Pierce, Caroline Cooney, Nora Roberts, J.D. Robb, Tolkien, J.K Rowling...whatever they wanted to read, they could. I found new authors from them and they learned new authors from me. We discussed books and events. Fiction, nonfiction, graphic books (there was a period when it seemed we owned every manga book on earth), they were all allowed.

So...reading material. What do you read to your kids? What do you allow them to read? Do you have trouble with getting your kids to read? Do they like to read or hate it?

Monday, February 21, 2011

Epidurals - the Good, the Bad, and the Ugly

Reading the book review by Dr Harriet Hall on SBM regarding pain relief in childbirth made me stop and think. Like breastfeeding, epidurals seem to be a tender point. So, let's talk about them.

First, let me say that I am one of those women who didn't have an epidural, has never had an epidural. Why? Because I have a phobia. I am totally, irrationally afraid of needles going into my spine. Even when suggested for non-childbirth related procedures, I panic too much. As I said, totally irrational.

Let me preface this by saying most anesthesiologists are fantastic. It can't be easy to put an epidural in. I admire their ability to perform their job, even when they are "trying to hit a moving target".

The Good: a good epidural is one that has been discussed in advance and agreed upon (as either a definite choice or a possible choice) by the patient and her care giver. She is aware that an epidural provides pain relief but she will probably still feel touch, pressure and temperature changes. (Personally, I would like to know more about the 'walking epidural' that supposedly women get in some European countries. It sounds like a win-win situation - pain relief without immobility). These women may or may not have problems with the epidural - spinal headaches being the most common - but they are happy with their choice.

The Bad: a bad epidural is one where the patient has irrational expectations. I have seen women be very distressed that they feel anything at all. They may be totally numb to pain, but since they feel pressure and touch, they often feel betrayed because they were "promised that they would not feel anything." In this category also falls the epidurals that "don't quite work". Some women do not get pain relief, others get pain relief in all areas but one (a window, we call it). I always felt very bad for those women; it seemed that having only one area feeling pain made the pain much worse. These women feel very betrayed and are unhappy with their choice.

The Ugly: my category for a physician-ordered epidural when the patient does not wish to have one. The one instance that stands out in my mind: a woman came in to the hospital in labor, dilated 9 cm. She was coping and did not wish any pain relief. When her physician was informed of her admission, he ordered an epidural (All of his patients ended up with epidurals). The patient did not want the epidural and, due to her very advanced stage of labor, the nurses called the OB resident who delivered the woman shortly thereafter. The attending was irate when he arrived and found the patient had not had the epidural. He tried to write up the nurses for "disobeying his order". Only the intervention of the anesthesiologist on call, who stated that he would not have given the epidural anyway, saved the nurses. These epidurals were rare.

However, before I left OB nursing, I found more and more commonly that patients were being told "they would get an epidural as soon as they came in." Some women were very happy with this. Others, who had plans for natural, unmedicated childbirth until they learned late in their pregnancy that their OB really didn't support this, were quite unhappy. So, here were the good and the ugly.

I always felt epidurals had their place. I strongly believe that not every woman needs one, but that they should always be an option. Personally, I would like epidural to be the last option for pain management instead of the first, but that's the midwife in me speaking. I never talked a woman out of an epidural. On a few occasions, I did talk women into having an epidural. Rare occasions and generally extenuating circumstances.
(In one place I worked, there was a very toxic childbirth instructor who preached that pain medications lead to mental retardation and epidurals caused fetal death. Her students were very hard to care for if they were unable to cope with labor contractions using the childbirth techniques. We tried to steer women away from classes with her; there were other instructors who taught the same method without the hyperbole whom we recommended. Many of those instructors were 'on-call' for us if we got toxic-teacher's students in who really needed pain relief. They would give the student permission to get the pain relief - TT also convinced her students that they needed permission from the instructor for it!)

Rather a rambling post. So, epidurals. Good, bad or Ugly? What has been your experience?

Sunday, February 20, 2011

Name Change

Well, as you can see, I changed the blog name. I haven't changed the address so I hope this doesn't mess up anyone's bookmarks. One nice thing about the name change is that I was able to make it more inclusive - parents instead of mommy. Let me know if you have problems with accessing the blog.

I have another post in the works and hope to get it up either later today or tomorrow.