Cost of Baby, Part Two

Today I got an itemized bill for a particularly large portion of my hospital stay. Some notes:

Although I was given a manual breast pump along with a diaper bag, with the nurses acting as if they were both free, I was charged $72 for a breast pump that was exactly like the one I had at home... which cost me $35 at Babies'R'Us.

Each dose of 400 mg of Ibuprofen cost $15.36.

I shouldn't complain - my insurance paid for almost all of the $16,000 bill (96.5%, for those of us who are quantitative). And as a former medical social worker, I shouldn't be that surprised about charges that seem ridiculous to me. But geez! what a messed up system. I think health care will probably be the issue that influences me most in the upcoming presidential election.

Crying over spoilt milk

In order to give me a bit of a break and give Papa some time with Mini-Me, I suggested a few days ago that Papa take over bedtime for a while. He could do the last nighttime feeding via bottle. The first night was a disaster - baby wouldn't take the bottle, couldn't be soothed, and finally she and Papa both fell asleep, exhausted, on the floor of the nursery.

Last night I wanted to use up the milk I thawed for Papa the night before, so instead of breastfeeding her I tried to give her a bottle for a mid-night feeding. She shrieked, fussed, and generally refused. I suspected either a problem with the nipple or the milk, and decided to sort it out in the morning.

Today I tasted the milk in the bottle, and almost retched. This was milk that I had frozen on 10/31, less than a month ago. The scientist in me realized I was not keeping good track of how many days the milk sat in the fridge before it got frozen, meaning I didn't know how many days it could sit in the fridge after being frozen. Plan to figure out a notation system to fix this problem. Also will stop storing milk in the fridge uncovered (in the pump - much easier than fussing with transferring it to another container at 3 in the morning).

I feel incredibly guilty for trying to feed the baby spoilt milk (twice) and concerned and upset about the possibility that *all* the milk I have stored in the freezer may be spoilt too. Until I figure out the problem, new house policy is that Papa or I taste the milk right before it goes to the baby, every time. Also I'll start tasting the milk before I start putting it in the freezer.

I've been weighing Mini-Me at a local baby resource center, since my pediatrician and I are concerned about MM's weight gain slowing down as a result of reflux. I was relieved, right after we started using the medication, that her gain had picked up to 1.5 oz/day, which is what it was during the first month of her life. So you can imagine my surprise when yesterday I discovered she had only gained 1.5 ounces in the entire past two weeks.

I'm not quite paranoid about it to keep a nursing journal yet, but I am going to pay more attention to what times I feed Mini-Me and how long we go between feedings. I hadn't noticed her nursing dropping off, but my husband commented that it seemed we were having feeding sessions less often. Also new plan is to try to feed her on both sides every time. I tried that today, but she kept falling asleep after her first course...

The Cost of a Baby ($24,500-$42,000)

Or: "The stupid health-care system that will cause my wonderful community hospital to be closed."

I have a good friend who had a baby eight months before I did. Her labor story and mine were very different. She was induced on the evening of Day 1, was on IV pitocin etc. until evening of Day 3, and finally had a C-section later that night. She was released from the hospital on the afternoon of Day 5. She was in very painful labor during Days 2 and 3.

I went to the hospital already fully dilated in the early morning of Day 1, gave birth vaginally four hours later, and was released in the afternoon of Day 3. Mini-Me needed a pediatric appointment on Day 4 and labs on Days 4 and 5 because of jaundice.

My friend's labor and birth, before insurance, cost $42,000. Mine cost $24,500.

The hospital I went to for my birth is a community hospital which is known in the city for supporting natural birth (ie no drugs or interventions whenever possible), has the lowest C-section rate in the city, and has a high proportion of Latino and uninsured patients. The hospital has a strong midwife program and tends to attract low-risk pregnancies.

The big hospital across town, which has a much higher proportion of (white, and) insured patients, is also the default hospital for high-risk cases in the city. At one point they had a policy restricting or barring doulas from births because of a single case where a doula interfered with a patient's care in an inappropriate way. The two hospitals are part of the same medical center.

My little hospital is not profitable. The other hospital is. And it appears that my hospital will be closed sometime in the next 1-3 years. Which really sucks. It is so troublesome to me that a hospital with a reputation for providing such good care for pregnant women is going to be closed, especially since a big part of their excellent care is avoiding interventions that may be unnecessary and potentially unhealthy for laboring women.

...like riding a bike

I rode my motorcycle today for the first time in almost a year. Man! did it feel good. An hour and twenty miles along the beach on a gorgeous day does wonders for my psyche...

I tend to make decisions slowly, and for the past few weeks I've been mulling over whether to begin working again in January. It would take some effort to re-open my practice and build up a clientele, but my husband would be able to take the baby on Sunday afternoons while I work with clients. It wasn't the immediate plan for me to go back to work; living on one income has proven to be too little.

I've been up with Mini-Me from 2 AM until now, 5 AM, trying to get her back to sleep as she fussed. With only three hours of sleep already tonight, I was having difficulty tolerating her fussing, and found myself getting angrier and more resentful the longer I struggled with her.

It gave me some time for contemplation, and I finally came up with this:
I'm not really getting any meaningful relief from Mini-Me's care. My husband takes her out for a few hours at a time, but it's usually when she's already sleeping or in a good mood, and it doesn't do a whole lot to help me recuperate from being on duty 24-7. I'll be damned if I'm going to carve 6-8 hours out of my week to take on clients. The last thing I feel like doing is committing to taking care of anybody else. Maybe I'll be ready for it in March or in the fall when Mini-Me is weaned, when I'm getting more sleep, when something changes, but right now I just can't imagine how restarting my job will be healthy for me.

I'm writing this down now, while I'm thinking of it, because after I'm less angry and I've had more sleep, I may forget that I already feel like "butter scraped across too much bread".

Baby's a swinger

Thank the gods for the portable swing lent to us a few weeks ago. Mini-Me has had a few really tough days lately - as far as I can tell it's tummy troubles, which means hours of writhing, shrieking, desperate attempts at feeding and occasional projectile vomiting. Even though I feel I should stick with her and have her calm down and gently fall asleep in my arms, the fact of the matter is that plopping her in her swing and leaving her to chill by herself is the best solution I've found yet.

I've been grappling with an interesting problem lately: I take care of Mini-Me pretty much full-time, including almost all feedings (bottle or breast), all nighttime wakings, etc. My husband is home on weekends and in the evenings, and he has been taking her out with him for a few hours at a time, but when we are both home I am the default baby-care. Papa also travels for business, so Mini-Me and I are alone together at least a few nights a week.

Today (and last weekend, come to think of it) I got Mini-Me calmed down after a feeding, and Papa wanted to cuddle with her for a while, maybe settle down for a nap together. And Mini-Me started fussing, eventually ramping up into full-on hysteria which required popping her on the breast for a while and an hour of rocking until she finally fell asleep. What I struggle with: when to intervene, if at all, when Papa and Mini-Me are having a hard time connecting. I spend so much time with her, of course I have some expertise in soothing her, but I don't want to undermine Papa's bonding time with her. And I can't stand it when I can hear her crying like that, especially when I have ideas about how to help and Papa doesn't want to hear them. Sometimes I've coped by getting snappish, sometimes by taking Mini-Me and soothing her myself, sometimes by leaving the house or going to a sound-proof place to wait it out.

I would never be concerned about my husband deliberately hurting the baby, but how much crying and hysteria would it take to be traumatic? Is it more important that Papa figure it out for himself, or more important that baby gets soothed more quickly? How much of this is about protecting my husband's ego and how much is really about needing to feel like my time and effort with the baby have value? Papa's best interests or baby's? Or are they the same thing? Need to mull this over and talk to my husband about it more. This is where a trusted cadre of mommies would be a helpful sounding board!

Better

As before, sun and some solid sleep make the mood funk go away. Found a super-duper playground in the city today. Fun to see so many parents and kids of all sizes.

Low, low, low

Feeling isolated, bored and unappreciated today. Husband and I have been bickering and completely missing each other communication-wise, lately. Went for a walk together, came home feeling worse than when I left. At least Mini-Me has stopped shrieking - medicine must have kicked in. Last night I pulled her into bed with me, and we got six hours of sleep in two shifts, an improvement..

Honesty: Best Policy (not!)

I've been making the rounds of mother's groups lately, and I must say, I've met a lot of weird looking babies in the last few weeks. I think mine is cute as a button, of course, but I wonder whether I would ever know if people thought she were odd looking. Like that boyfriend I dated when I first moved here - all my friends thought he was unstable but no one said anything until a year ago, ten years after I dumped him...

We all smell like vomit

So, Mini-Me is on medication for reflux, as the pediatrician agreed that her symptoms matched up with reflux and we saw a decrease in her weight gain in the two weeks before the appointment. Since we've started on Zantac, there's been less fussing, and it seems like there's been more frequent spit-ups but they're not as voluminous and not as curdsy.

Mini-Me stopped sleeping in nice 4-6 hour stretches at night and started waking up every 1-2 hours. I attributed this to the fact that she doesn't exhaust herself fussing in the afternoon, but my friend the family doc informed me that Mini-Me is due for a growth spurt right around now (she'll be seven weeks in a few days) and she is feeding constantly to increase my milk supply to meet her new demand. Cool biology, but I am already starting to unravel after two nights of sleep in one-hour chunks. Hopefully she'll settle down in the next few days.

Oversensitive

It bugs me when my mother-in-law calls Mini-Me "our baby". I did all the work before she was born and I'm doing most of the work now!

Also, it bugs me that the baby smiles at her Papa, her grandmother, and the housecleaner but not at me.

Duh

It only took me how many weeks to figure it out? The cottage cheesy spit-up, the crying and fussing and squirming, the hiccups, needing to sleep semi-inclined? Baby has reflux! There are other signs too - we see the pediatrician tomorrow so we'll find out whether I might be right and whether Mini-Me can get some relief... hopefully it'll mean I can go back to saying "oh, she's such a good baby, not fussy at all!" and maybe we can start getting more sleep! Already I am less frustrated and more understanding/patient when she shrieks inconsolably.

Mini-Me slept in her swing last night for the first time, after an entire day of squirming and fussing. It was clear she was exhausted, and when she finally got to sleep she slept for six hours at a stretch! I woke up before she did and went to check on her, since I was alarmed and surprised that she was still out cold.

Quick brain dump

Do not fear, things are not as dire as they sounded when I abruptly disappeared from the blogging world. I've had two *really* low-mood days in the last few weeks, both of which lasted less than 24 hours. Getting out with for a nice long walk with the baby in a sling helps a bunch.

Therapist wisely reminded me that when I feel regret and wish to go back in time, it's nothing against Mini-Me in particular, just missing aspects of my old life. I've started feeling less guilty. Also have started requesting time off while my husband is home, not just for sleeping and housework but for fun things like making stained glass and goofing off on the internet.

Mini-Me and I have gotten into a pretty good groove with sleeping and eating and our general routine. She sleeps in threeish hour shifts at night, with about an hour of feeding in between, and snacks and naps intermittently for most of the daytime. We started having her sleep in her own room, until the early morning (5 AM or so) feeding shift when I pull her into bed with me because I'm too sleepy to sit up and feed her in any other position. (She breastfeeds at the intermediate-advanced level, having mastered the side-lying nursing position at just two weeks.) Her afternoon crankiness is usually related to gas or being overtired.

Even though I'm not getting much more sleep than before, my mood has been much better, partly because the weather has gotten sunny and warm again, and partly because I have gained confidence that I will eventually get the baby back to sleep. It rarely takes me more than two hours, so I can count on getting back to bed by a certain time.

Tricks to get the baby to sleep:

• swaddling - absolutely necessary for sound sleep almost all the time
• swing - works well with baby is already sleepy
• sling + walking - evening walks around the neighborhood have been nice, treadmill and TV in the basement is a last resort
• mummy wrap + piano - just discovered this one a few days ago when I sat down to play a bit of music to soothe my own nerves. Mini-Me fussed for a few minutes then conked out.
• sucking - pacifier or pinkie finger save my nipples from getting chomped to death
• wait it out - I'm not an advocate of the "let them cry it out" theory, but Mini-Me is learning to soothe herself, and sometimes if I give her an extra minute before I rush in to soothe her, she manages just fine herself.

Now that she's asleep, I'm off to do the zillion things that are zooming around my brain.