Guest Post: Memo to Expecting Parents

This is a guest blog post from Katie, an amazing mother, partner, friend, and scientist:

To my expecting friends,

Congratulations on this exciting, terrifying and amazing path you are traversing! Here are a few musings that may be worth exactly what you are paying for them, but they are things I was thankful others prepared me for or things I did not know and wish someone had told me. In no particular order:

STOCK UP ON:

• Foods you can eat with one hand (burritos, protein bars, hard boiled eggs, you get the picture…)
• Fridababy Fridet Momwasher (perineal bottle) – the angling and spout design are amazing, for real
• Alcohol-free witch hazel – add a healthy squirt to the aforementioned Momwasher
• Epsom salts – add a couple of large handfuls to your regular bath or a small handful to your sitz bath
• Breast pads and comfortable nighttime nursing bras and/or pajamas – there is a fair amount of leakage early on, and the pads will also save your shirts if you need to use nipple cream/oil
• Aquaphor – great for covering baby bottoms and lubricating breasts while pumping (I used it daily—months into pumping)
• Bed pads – disposable or reusable – to put between each layer of bassinet/crib/bed sheets. Blow-outs at 2 am are a thing.
• ALL the free diapers (mom & baby) from the hospital

GENERAL TIPS:

• You know how hungry you get now? It gets even crazier. I was not prepared for how voraciously hungry I would be after delivery. Order ALL the food. At UNC, you can order once per hour. It takes about an hour for them to deliver your food, so plan ahead. I definitely ate six to eight full meals per day, including multiple times overnight, and had multiple snacks too. That hunger continues if/as long as you nurse. Carry snacks everywhere.
• It’s normal for new moms to cry. A lot. Especially postpartum days 3-4. I’m not a crier, and I found myself surrounded by puddles. Hormones are a thing, and life can feel entirely overwhelming. Call me. I’m always up for a good cry.
• Walking is very, very good for you after delivery. It may not be easy to get out of bed, but if you can, take a lap around the ward when you go to refill your water. If you have a good place near your home, go for short walks outside with the new baby.
• If you are planning to nurse, schedule an appointment with a lactation consultant within a week of returning home. Our LC saved my nipples and my sanity. If you are in North Carolina, I cannot overstate how wonderful the Women’s Birth and Wellness Center is, and anyone can see the LCs there. Partners – this is a great thing to encourage. Even better, schedule the appointment yourself!
• Nursing can be hard at first, and it gets easier—I promise. I was skeptical when my friend told me that, but it did get easier. I didn’t think I would, but I even came to enjoy it. It’s 100% normal to nurse all the time in the first two months. Fifteen times a day is normal, and I promise it isn’t like that every day. These kiddos are growing nonstop, and your supply is trying to work itself out. They also are learning how to eat and will eventually become more efficient. Use that time to read books to your little one (whatever interests you—I read Stephen King out loud) and watch Netflix (I recommend The Letdown and GLOW).
• Formula is great. We are lucky to have access to high-quality formula and safe water. It’s a great way to maintain sanity while you are nursing so that you can continue to nurse if that’s what you want (it’s best to supplement with formula after nursing), and it’s great if nursing just isn’t working out for you. You don’t need to apologize for providing your baby with any type of age-appropriate food.
• Enjoy your gorgeous hair while it lasts. You will lose approximately half of it sometime between 2-4 months.
• No time is too early for bedtime. For the first three months, I went to bed between 6:30 and 8:30 pm. It’s what I needed to feel human, and I did not apologize for it.
• Your parent-friends will tell you to text them anytime. Do it. You will be surprised by the number of people who are also awake at 3 am.
• It’s normal to feel like you’re going crazy. Call me when it happens. I still feel like that sometimes. It comes and goes.
• Do what feels right in your heart of hearts. There is no “right” way to parent. At the end of the day the things that matter are: love, shelter, food, and snuggles with your baby and partner.
• Your baby will grow and develop at their own pace, and it’s all okay.
• Parenting can be so hard, especially now that most of us don’t live on the same street as our entire extended families. We need to spend a little more time and effort creating our villages. Bryan and I are here for you! I sent many of my more experienced parenting friends and new peer friends late-night texts and random questions. Their reassurance helped preserve my sanity. Let us reassure you!

Last, but certainly not least, YOU ARE ENOUGH. You’ve got this!

Parenting Recommendations 3: Parenting Books

My final post on parenting for the moment: here's a list of postpartum parenting books I've read so far, again sorted by my rating, descending.

The Science of Mom (another evidence-based book for the first year postpartum) is the only top ranked of these for which I have notes:

• Good review of scientific method, publication
• Delayed cord clamping 2 min
• More blood, iron 88% higher iron at 6 months of age and low iron leads to lower test scores this is especially important for breastfed babies because breast milk does not contain much iron
• Vitamin k shot
• Get it
• Initial link to cancer disproven by subsequent research
• Eye profilaxis
• Consider delaying until after initial bonding up to one hour
• babies don't see as well with it so it may inhibit initial bonding
• could affect microbiome
• Breastfeeding
• Benefits primarily during infancy (eg immunoprotecton)
• possible long term benefits on cognitive development
• introduce solids 4-6 months (but let baby lead), continuing breastfeeding
• start with low allergenic foods and gradually introduce foods with greater allergenic potential one at a time
• avoid cow's milk until one year bc it can lead to iron deficiency
• Meat good for heme iron but limit liver to a few servings per week to avoid too much vitamin A
• Egg yolks good for iron and DHA
• Sleeping
• Safest place is in the same room but in separate bassinet
• Expose to natural light during day (even when napping) for first three months to establish circadian rythyms
• prepare baby for sleep before they become overly tired
• institute pre-sleep routines
• self soothing babies are put to bed while awake, not soothed to sleep because falling asleep is a learned skill
• wait a couple minutes to respond at night; confirm that crying is distress, not baby noises
• babies use sleep aids; make sure you aren't it
• use a sleep aid when you're all together to lay the foundation for making the transition to more independent sleep easier
• Feeding Solids
• Whole grains have more phytates, which could reduce iron absorption, than refined grains. Soaking grains reduces their phytates.
• Fruit instead of juice. If juice, dilute it with water and serve in a cup, not a bottle.

Parenting Recommendations 2: Prenatal Books

Each time we became pregnant, I was both elated and scared as it reminded me that I don't know anything about babies! My way of dealing with that anxiety was to read everything I could get my hands on. And since we were cumulatively pregnant much longer than nine months, I managed to read a lot! Some of the books were great, most were OK, and some were downright terrible.

Here are the prenatal books I read sorted by [my] rating, descending. And for the top books, here are my notes, because you may have other things to do than reading all the time! Caveat: these notes are not necessarily complete or good; they reflect what I took out of each book at the time.

Expecting Better (evidence-based analysis of "conventional" prenatal "wisdom"):

• obese women (before pregnancy) have more pregnancy complications
• up to 2-3 drinks / week first Tri
• up to 7 drinks / week rest of term
• avoid raw milk / raw milk cheeses / queso fresco
• avoid undercooked meat and deli turkey
• raw egg fine
• seek high omega-3 / low mercury fish, e.g. salmon, sardines
•  6 vomits average per pregnancy
•  vitamin b6, ginger for nausea
•  CVS and amniocentesis both safe, but CVS better/earlier
•  Avoid raising body temperature to 101+ during first trimester
•  Hair dye is probably fine
•  Avoid gardening or at least wash hands thoroughly
•  Gain 25-35 lbs during pregnancy but err on the high side
•  Regular exercise good but don't go above 90% HR
•  Kegels good and reduce labor time
•  Yoga probably good
•  Sleeping on back probably fine unless you feel faint
•  Medication - check safefetus.com and stick to A and B class drugs
•  Bed rest not effective for reducing pre term labor
•  Cervical effacement in addition to dilation a good indicator of labor readiness
•  Intermittent fetal monitoring better than continuous during labor
•  For labor augmentation, break water first then try drugs
•  Just say no to episiotomy - cutting the vagina
•  Vitamin k shot after birth is OK
•  Having a doula is good
•  Epidural has pros and cons
•  Drink fluids during labor (including calories like Gatorade)
•  Induction problematic so make sure fluid levels are measured deepest pocket, while well hydrated, and consider a second test
•  Clapping effective sugar ineffective for non stress test
•  Nipple stimulation and membrane sweeping work for inducing labor
•  Vaginal birth preferred

The Informed Parent (same, evidence-based approach but extending beyond prenatal to the first few years of childhood):

• No evidence for benefit of eating placenta
• Pediatricians: personal experience, beliefs, staying current on literature
• use online questionnaire (including this book's website) to interview pediatricians
• AAP (American Academy of Pediatricians)
• Induction: reduces risk of cesarean birth in late-term pregnancies
• Augmentation: combination of mechanical (e.g. forceps) and chemical
• (e.g. oxytocin) may help modestly speed along slow labor but either individually not effective
• Episiotomy not beneficial, often worse
• Pain
• Epidural works; combined spinal epidural (w/ local anesthetic) works faster
• Epidural associated with more cesarean and intstrumented (e.g. forceps) births
• Nitrous associated with dizziness, nausea/vomiting
• Sedatives work but not as well as opioids
• Immersion in water and relaxation/massage techniques may work
• Acupuncture associated with fewer interventions and cesarean births
• Water injection, aromatherapy, biofeedback - insufficient evidence that they work
• Cesarean
• slightly higher risk for mom
• First stage labor: 0.5-0.7 cm dilation / hour (for first time moms - 0.5-1.3 cm/hour for experienced moms)
• Second stage labor: outcomes good for 3 hours pushing (first time moms - 2 hours experienced moms); labor augmentation like forceps or vacuum => < 3% need cesarean
• Fetal heart rate: stimulation of fetal scalp, mom position change, amnioinfusion (saline into uterus) may address HR irregularities
• Induction does not increase risk of cesarean delivery
• Breech Position: external cephalic version => only 21% need cesarean
• Big Baby: < 11 lbs (or 9 lbs 14 oz w/ gestational diabetes) => evidence does not support automatic cesarean
• Circumcision
• Very few risks, most of which go away in modern medical procedures
• Benefits reduce risk of penile cancer, reduce rate of STI contraction, reduce rate of UTI
• Disposable diapers about even with cloth diapers for cradle-to-grave environmental impact - compostable disposables have an edge
• Breastfeeding
• Wide variety of better outcomes for children (dose-dependent: the more, the better)
• Especially when fed at the breast (rather than pumped bottle) as breastmilk composition adapts to baby's nutritional needs
• Exclusively breastfed babies need Vitamin K (shot) and sometimes iron and Vitamin D (supplement)
• Premature/underweight babies benefit so much from breast feeding that donated milk is prescribed over formula
• Up to 24 months of breastfeeding => benefits for the mom; after 24 months is understudied
• Not all women can breastfeed (primary lactation failure - unable to produce milk at all - vs secondary - something interferes with breastfeeding early on)
• Baby should breastfeed 8-12 times per 24 hours and should suck at least 10 min on each breast, feeling sleepy afterward
• Baby should have 6 wet diapers / day and 4 yellow, seedy, cottage cheese-like stools / day
• 44% of mothers don't get milk w/i 72 hours of birth
• Nipple pain common in first week but may indicate a problem after that
• Vasospasm: nipple turns white then blue as blood returns
• Thrush: yeast infection causing red, sore nipples
• Clogged ducts: tender lump
• Mastitis: infection causing red, hot breasts with pea-sized lump
• Expressed milk helps relieve nipple pain
• Tongue tie in 3-11% of babies (mostly male) easily addressed with frenotomy (~100% success)
• D-MER is a condition that causes negative feelings for mom during let-down but passes quickly
• Low milk supply:
• Relaxation can help a little
• Metaclopramide increases prolactin levels for 1.5 oz more breastmilk per feeding but should only be used for 3 weeks
• Fenugreek (~600mg) helped in a small, poorly documented study
• Milk thistle helped in a very small study
• Shatavari helped in a small study
• Torbangun helped in a small study
• Moderate caffeine and alcohol probably fine while breast feeding (no need to pump and dump) but we don't know much about marijuana
• LACTMED is a database of mom medications and their effects on breastfed babies
• Feed when baby is hungry; little/no evidence of benefits of feeding according to a schedule
• Feeding
• Teething usually 4-7 months
• No evidence that adding complementary foods at 4 months vs 6 months is beneficial (except slightly higher iron levels)
• One study shows better growth with meat as a complementary food vs cereal
• Preschoolers told to clean their plates ask for more food even when away from home
• Children for whom food is offered as a reward are more overweight
• Screen time associated with weight in children most likely due to mindless eating and advertising of unhealthy foods
• Inadequate sleep associated with childhood obesity
• Children who regularly drink sugary drinks are heavier and more likely obese
• Family meals reduce risk of obesity
• Portion size and plate size can reduce overeating
• CAN framework: make healthy food Convenient, Attractive, and Normal
• Vitamin D deficiency possible if exclusively breastfed - especially if Mom has it
• Cow's milk promotes vitamin D but inhibits iron; two cups a day seems to be a good balance
• To address child's resistance to new foods, eat variety of foods while pregnant and repeatedly expose child to new foods without comment, pressure, or urging. Also exclusive breastfeeding to six months helps.
• Allergies: small risk reduction when introducing potatoes before 4 months, oats before 5 months, meat and wheat before 6 months, rye before 7 months, fish before 8 months, and eggs before 11 months
• Tdap and flu vaccines recommended for Mom
• Cdc vaccine schedule recommended for baby
• Private cord blood banking not likely to be helpful
• Normal birth weight 5.5-8.8 lbs
• Get the vitamin k shot
• Erythromycin not helpful if mother is sti-free
• Delay cord clamping 2-5 minutes to get lots of iron-rich blood to babies since breast feeding won't get them much iron
• Mother-baby skin-to-skin contact immediately after birth associated with better breastfeeding outcomes, better mother-baby interactions 1 year later, improved blood sugar levels, decreased crying
• Either parent may not feel immediately bonded with baby - but fake it till you make it
• Crying
• Pain: rapidly escalating to maximum intensity with eyes squeezed shut (repeated like a siren at the highest level)
• Fear: rapidly escalating to maximum intensity with eyes open
• Anger: gradually escalating with eyes half closed
• Soothing:
• Swaddle
• Side/stomach
• Sway
• Shush (including mom singing)
• Suck
• Skin-to-skin (including breastfeeding)
• Pacifier benefits: pain relief, comfort, slightly lower risk of SIDS
• Pacifier risks: increased ear infection rate, increased risk of teeth misalignment after 18 months. No evidence pacifiers cause diads to stop breastfeeding sooner or nipple confusion.
• Sleeping:
• Mothers who spend awake time in front of screens (computer, TV, etc - phone?) are awake longer than those who don't
• Infants sleep average 13 hours / day, wake up 3 times / night, tend to transition to more predictable sleep patterns ~3 months
• Research on bed sharing safety not great - not nearly as categorically unsafe as opponents claim (most studies don't control for other risk factors, e.g. smoking, many blur the lines of what is considered "bed sharing," e.g. including infant deaths on couches, many don't consider whether parents routinely bed share and employ best practices)
• Increasing bed sharing risk: sofas, smoking, alcohol (or other depressant), multiple kids in bed, excessively tired parents, infant on pillow or blanket, premature infant, bed sharing with anyone other than parent, exclusive formula feeding
• Reducing bed sharing risk: firm mattress, infant on back without blankets / pillow / mother's clothing, no strangulation hazards nearby, infant can't fall out of bed or get trapped, no smoke / alcohol / drugs, mom is not a heavy or restless sleeper, only mom shares the sleeping surface, infant isn't at risk of overheating
• Sleep training is effective in ~80% of infants (4 months +) and no adverse long term effects have been found
• Bed time routines helpful for sleep
• Mother's emotional availability and responsiveness before bedtime helpful for sleep. Hypothesis: infant's feeling of security at bedtime persists through waking times so infant is more able to self soothe.
• BPA has a high correlation (and likely causation) with negative biomarkers
• No cough meds for children under 4 (unless doctor says so); honey (for children over 1) helps symptoms
• Children's acetaminophen and ibuprofen OK
• Avoid homeopathic and essential oils
• Melatonin can help autistic or ADHD children fall asleep with few side effects
• Keep guns out of the house; at worst, keep them unloaded and locked up. 1 in 3 parents of baby's friends will have guns so ensure they do the same.
• Children don't learn anything from things on screens until ~24 months old
• TV negative for children not just directly but also indirectly through less parental interaction
• Advertising on TV often leads to more childhood obesity
• TVs in child's bedrooms associated with poorer sleep and greater obesity
• Media violence is associated with more aggressive children
• Developmental Milestones
• 6 months
• Turns head when hearing name called
• Briefly sits without support
• Smiles
• Plays peek-a-boo
• 1 year
• Waves bye-bye
• Pulls to standing
• Might say "dada" or "mama"
• 18 months
• Follows pointing and also points
• Uses several words
• Walks
• 2 years
• Uses short phrases
• Can point to named objects
• Follows one-step instructions
• 3 years
• Uses sentences of 4-5 words
• Climbs
• Engages in pretend play
• Copies parents and peers
• Reading
• Infant reading programs don't work
• Talk to child as early and as much as possible
• Keep books around and expose early/often
• Read stories to child; ask open ended questions about the story/characters
• Discipline
• Children unable to reason before ~3yo => negative reinforcement ineffective
• Give attention for positive behavior, praise more effective for already compliant children
• Withdraw attention for negative behavior
• Maintain consistent routines
• Consistent, immediate responses to behavior
• Model the desired behavior (and not the undesired behavior!)
• Clear, calm verbalization in age-appropriate language of what child did wrong and what he should have done
• Help child make choices and understand consequences
• The stronger the attachment to the parent, the more effective discipline is
• Effective negative reinforcement:
• Nonverbal (looks)
• Verbal (calm and firm, not harsh, which is counterproductive)
• time out or removing privileges to reinforce the reprimands
• time out only works if "time in" is something child wants to be part of
• time out is a removal of privileges, not a punishment (must be done calmly, no shaming)
• 1 minute too short, 4 minutes effective for children age 3-6
• some studies suggest a sliding time scale is more effective: time out ends after some time of good behavior; the clock resets with each outburst
• Corporal punishment associated with 12 negative outcomes and dose-dependent
• No evidence for long-term positive effects from corporal punishment
• Toilet training
• don't rush, shame, or pressure
• 40-60% of children complete toilet training by age 3
• Girls usually master it (22 months) younger than boys (25 months)
• If child masters urination in the toilet but not BM, consider stool softening approaches
• Childcare
• Any effects of childcare are modest
• Family factors (home environment, socioeconomic status, etc.) have 2-3x more effect than childcare
• Quality of childcare matters a lot
• Childcare associated with very mild behavioral problems that fade away by 3rd-5th grade
• Childcare associated with stronger social skills, more self confidence, challenge management, self entertainment, more outgoing, less stress
• Higher quality childcare with better trained caregivers associated with better performance on standardized tests
• Daycare centers associated with independence, social skills, and higher test scores from age 2 through 3rd grade
• Regardless of childcare, least problematic children come from homes with sensitive fathers who encourage independence, mothers who let children decide their own activities, and parents who have a loving / emotionally intimate relationship with each other
• Families of daycare children lose an additional 13 days of sick leave (over the first 6 months?)
• These GI, upper respiratory, and ear infections are going to happen whenever the child first begins regularly interacting with other peers.
• Preschool offers academic benefits to lower class families, not much for upper-middle class families
• The home learning environment (being read to, exposure to computers, etc.) has a much greater impact on academic success

What's Going On In There (detailed look at prenatal and postpartum neural development)

• Get purposeful prenatal winter daylight exposure for babies born april-june, who have a higher chance (18% vs 12%) of being very shy
• First hour skin to skin contact does not seem to have extraordinary bonding benefits
• Increasing variety of touch stimulation is likely to enhance brain development
• Loving touch, stimulation, and massage have shown to improve health of infants
• Bouncing, rocking, carrying stimulates the vestibular system
• Breast feeding babies smarter than bottle feeding even adjusting for socioeconomic factors
• Taurine in human breast milk (also in formula) probably helpful for brain and retina nerve development
• Human breastmilk provides not just the essential fatty acids but also the enzymes with which to break them down
• Breastfeeding babies prefer (suck longer) variety in tastes that come through breast milk
• Alcohol still present in breast milk 3 hours after ingestion
• Brain growth spurt through two years of age => especially important to have adequate fat in diet
• Visual acuity develops rapidly - from 20/600 vision at birth to 20/20 later. Initially babies can only detect high contrast (e.g. black on white) and only "where" vs "what" but these both change rapidly. The most crucial period of development is 6-12 months so, if there are any visual abnormalities (e.g. crossed eyes or cataracts), get them fixed within the first six months.
• First two months peripheral vision more developed than direct
• Binocularity onset happens rapidly between 2 and 5 months as the cortex takes over image processing
• While vision develops late and matures quickly, hearing matures early and matures gradually.
• Sounds above 85 dB can damage newborn hearing
• Newborns don't recognize daddy's voice until a few weeks
• Up to one year of age, best for baby to hear one thing at a time, not lots of noise
• Motherese good after high pitch response develops around 3 months
• Lots of tummy time recommended to develop upper body strength, coordination
• Walkers don't help walking
• Holding baby upright to practice walking helps
• Gentle challenging helps
• Parenting style matters more than whether a child goes to daycare:
• Less sensitive mothers trend to have less securely attached infants
• Attached babies have lower stress response to unfamiliar stimuli
• Temperament is lower limbic system and is genetically determined while personality is upper limbic system and is experientially determined
• Parents must strike a balance between smothering attentiveness and fostering independence; children of always-attentive parents are less securely attached than those of parents who intermittently give them space to explore, fall down, etc.
• Babies distinguish speech (left brain) better with right ear and music (right brain) with left ear
• Toddler vocabulary usually explodes once they have 50 words
• Language development contributors
• Parents who talk to them more
• More positive feedback (in all areas, not just about language development); corrections not helpful
• Socioeconomic status of parents (Poor: 600 words a day directed toward baby, working class: 1200 words a day, professional class: 2100 words a day)
• *Repetition (eg same nursery rhyme) to reinforce neutral pathways
• Repetition with substitution and expansion
• books
• IQ physiology
• Head circumference correlated 0.14 with iq (born more than 14" average 7 pts higher than born less than 12.75")
• ‎brain volume correlated 0.35
• stimulus response time correlated 0.5
• Prefrontal lobes control wisdom and executive function, not iq
• High quality Daycare centers generally show better cognitive development than home care
• Student teacher ratio < 1:5 2yo, 1:7 3yo, 1:10 4yo
• Not the time for academic focus
• Iron helpful in second 6 months
• Breast feeding for a full year
• Rotate toys in and out weekly to combat habituation
• Exposure to other people and places associated with higher IQ
• But guard against overstimulation

Parenting Recommendations 1

Recently several of our friends have become pregnant for the first time, which has motivated us to send them lots of unsolicited advice. While our suggestions may be worth exactly what they're paying for them, I'm posting them here in case others might find them helpful. In no particular order, here are our first few:

1. We have really enjoyed the Longest Shortest Time podcast. Each episode is someone's story about prenatal, post partum, or parenting wonkiness. Some of the stories are sad, some are joyful, some are traumatic, some are inspiring. Some resonate with our own experiences, some don't. We found them all to help normalize the entire process of becoming parents for us - the good, the bad, and the ugly.

2. I won't claim that men are even on the same playing field as women when it comes to body changes during pregnancy but male partners DO also experience some physiological changes, including increased estrogen production. I found myself putting on weight and decreasing performance in athletic competitions around this time last year. This phenomenon, possibly combined with the psychological impact of less sunlight, led me to feel a little down until I recognized that it could have physiological roots. Something for men to keep that in mind in case they experience something similar.

3. If you are planning to try breastfeeding, go ahead and - long before you are due - schedule an appointment with a lactation consultant for a few days after your delivery date. You can always reschedule if you deliver late (Or early!) or if your baby is already breastfeeding like a champ. However, if breastfeeding isn't coming along as well as you might hope, you will already have the appointment scheduled. Most hospitals include some lactation support in the maternity ward but our lactation consultant at The Women's Birth & Wellness Center was orders of magnitude more helpful. Because she dedicated 90 minutes just to us, she was able to observe a full feed of our baby nursing, try a few different approaches with us, and measure the impact of each. Highly recommended.

4. Classes: NC Women's, where we delivered, offers many of them and we took them all. Here's a brief roundup of some that we took - and, if you aren't in Chapel Hill, there may be similar classes near you.

Childcare Options - this is really about the NC rating system for childcare centers. I was hoping for a bigger picture evaluation of pros/cons of different types of childcare - e.g. in home vs. childcare centers - but it was definitely helpful in navigating the rating system for centers.

Bootcamp for New Dads - As someone who knows nothing about babies, I was hoping for a more hands-on-practice class (This is how you hold a baby, this is how you change a baby, etc.) but this class was a little higher-level. What is the dad's role in pregnancy, delivery, postpartum, etc. Still very helpful, though. A cool feature was that they bring back dads from previous classes and their now 2-4-month-old babies for show/tell and a view from the front lines.

Accupressure for Labor - This was really cool! They demonstrated several different specific accupressure targets/techniques that ostensibly will help with labor. This was a very hands-on class so we got to try things out there on the spot and get help from the instructors. One of the attendees delivered a few hours later so it must have worked!

Sign Language for babies - also really cool! Because babies develop visual and motor skills before developing verbal skills, there is a significant window during which they can't communicate with you verbally but they can via sign language. The class covered the basic theory of baby sign language and then we practiced lots of relevant signs - milk, eat, diaper, change, etc.

4th Trimester - this was great! Each couple had a baby doll with which to practice diaper changing, swaddling, and putting in different types of wrappable carriers. It was a little "OMG watch out for this and don't do that" for my taste but overall was a really helpful three hours.

Infant CPR - this was good. They had mannequins to practice on so it was pretty hands-on. It was a bit longer than it needed to be and it was front-loaded with adult CPR so we were actually kind of rushed at the end for the infant CPR portion.

Breastfeeding - it also was longer than it needed to be as it spent a lot of time selling us on breastfeeding (We're already pretty sold -hence signing up for the class!). Once it got past the selling, though, it was great, providing lots of information on what a good latch should look/feel/sound like, showing videos of the inside of the infant's mouth during breastfeeding, and showing off all the different colors of infant poop as they progress from newborn to infant.

On Fatherhood on Father's Day

Today was my first Father's Day as the father of a living human child, a day of great joy and reflection. It began with a trail walk together as a family, continued with boot camp so I can try to stave off this dad bod, peaked with a Texas BBQ family brunch, and now it's about to wind down with Star Wars. I'm new to fatherhood, but so far I feel like we're doing it right!

Actually I'm not entirely new to fatherhood. In some ways I have felt like a father previously - ever since our first pregnancy several years ago. In this way, though, I felt like ultimate failure of a father. If you take one of a father's primary roles to be the protection of his offspring, I failed again and again and again. One might argue that there was nothing I could do about those pregnancy losses; I would both agree and respond that that feeling of impotence only exacerbated the feeling of failure as a father - and as a husband.

Now, with a healthy, beautiful child my relationship with my own fatherhood has changed. Fatherhood brings me joy and wonder. It brings me a new connection with my own dearly departed father that I share with him across space and time. It brings me a stronger bond with Katie, who is already establishing herself as such a strong, capable, tender mother.

Perhaps the greatest feeling fatherhood brings me today is gratitude. I'm so thankful to my child for, well, making me a father. And to Katie - without whom it wouldn't have been possible! And to our parents, family, and friends, who have all shaped me into the father that I am today.

I have been so incredibly blessed to have had excellent father figures in my life: uncles, teachers, coaches, mentors, friends - even my mom, who, as a single mother, was the best mom and dad a boy could hope for. They say it takes a village to raise a child. In my case, it has taken a village to raise a father!

So, on this Father's Day, I toast not just the biological fathers out there but all of those caring father figures who enrich the lives of kids like me - often without ever even signing up to do so!

Of the father figures I have been so fortunate to call my own, we lost a really good one last December. He will always be missed but his legacy endures in the outstanding father his own son has become and on the indelible mark he has left on me. So, a toast to him as well!

And a final toast: this one to all of the would-be fathers out there. As I mentioned in my last post, we know many, many people who are struggling with or have struggled with infertility. On a day honoring fathers, you guys may feel excluded. Whether you are still trying to become a father or whether you have made peace and moved on, I also honor you on this day - and I hope you will always remember that I'm with you.

So here's to you all: may the Force be with you . . . always!

On Infertility, Loss, Life, and Love

As astute followers of my blog know, Memorial Day - and May 28th in particular - is a significant day for me. Although the holiday is intended for remembrance of those who died while serving in the US armed forces, it is also the day my father died and so, for the last 28 years, I have observed Memorial Day with somber reflection. I even blogged about it in 2008, 2010, and 2013.

This year's Memorial Day observance has even greater reason for gratitude and reflection: Katie and I recently had a baby. You might be surprised that I haven't been shouting about it from the highest mountains (which would be much more "in character" for me!) but we have avoided as much of the "pageantry" of both pregnancy and birth as we have been able to get away with. Perhaps Memorial Day is a good day to explain why.

Six years ago we started trying to have children. Many things in life have come naturally and easily to us but conceiving turned out not to be one of them. After two and a half years we sought out medical help. We were diagnosed with "unexplained infertility," one of the most useless terms I have ever encountered. It was amazing to me that we could put a human on the moon and cure myriad diseases but still had so much unexplained about one of the most basic human functions, reproduction.

At long last, though, we managed to conceive, and we were elated! It was just before the winter holidays so we shared the news with our closest family members. We spent long evenings discussing all our hopes and dreams for this new chapter - baby names, parenting philosophies, house rearrangement, necessary gear, etc., etc. Everything had changed for us. And then - abruptly - it hadn't.

Shortly before Christmas we lost the pregnancy. It was heartbreaking. I was astounded just how bonded you could become to a tiny little cluster of cells - no personality, just the promise of a new life. We had already hopped on board the train to our new future - and then we were kicked off. It was not our best Christmas.

We are resilient, though, so we got back on the horse and lost a second pregnancy. And a third. And a fourth. Gradually the feelings changed from the acute stab of loss to a mounting fear that we may actually never be able to have children - and a feeling of impotence to do anything about it.

The irony was that we didn't want kids desperately. We have some friends for whom it was the be-all end-all desire and that just wasn't us. But it was something that we wanted, and our repeated failure to achieve it - especially in light of our peers who seemed to be bursting with fertility - just felt sooooo . . . disappointing.

In many ways my career in startup entrepreneurship had prepared me for this - repeated failures until you finally hit it big. I was more worried about Katie, who, no matter how much support she had from me, was still the one to bear all of the physiological consequences of both pregnancy and miscarriage. Katie proved to be strong, though, and resilient in the face of adversity. Although I wouldn't choose to have had the experience we had, it certainly brought us closer together.

At first we didn't share our struggle out of feelings of shame and failure. Eventually we opened up about it to some of our closest family and friends, though, and that made all the difference. Some of them (Surprisingly many!) shared their own experiences of infertility and loss. Some shared advice. Some simply shared compassion and support. It was exactly what we needed and we were/are eternally grateful for it. We felt less alone, which made it easier to persevere.

And now, having been through the dark times, our baby's arrival brings us all the more light. Rather than just the light of joy, though, there is the light of gratitude and humility as well. We don't refrain from tooting the horn of our baby's arrival because our joy is muted (And our joy for others who welcome new children into the world is no less in magnitude.) but rather out of recognition of our journey.

Now each Memorial Day we don't just honor those who made the ultimate sacrifice for our country. And we don't just remember my father on the day of his death. We also now remember our four little babies who didn't make it. And we remember those of all of our friends who have also experienced such loss.

We especially hold in our hearts all those of you who continue to struggle with infertility and miscarriage. Now that we have "succeeded," we haven't "graduated" from your tribe. Our journey has left an indelible mark on us and we will always be one of you. Please let us pay forward the overwhelming love and support we received along the way. We will always be here for you - on Memorial Day and every day.

Should Your Kid Be Allowed to Play Football?

The football world was rocked this week when Chris Borland, a promising, young linebacker for the SF 49ers, decided to retire rather than risk lifelong injury. As more and more evidence has been mounting that repeated head trauma (even when protected by a helmet) can have a lifelong, cumulative effect, this early retirement calls the question: is football fundamentally unsafe? For people in my age group (whose playing days are long behind us) the real question is: "Would I let my kid play football?"

I'm really divided on this. football was a really integral part of my development as a young man, as a leader, as a teammate, as a disciplined goal achiever, and (certainly at TJ!) as a prevailing underdog. Lifelong friendships were made on the field and lifelong experiences took place under the friday night lights.

Could the same have happened in another sport or even a non-sport activity? I would assume so, but, for whatever reason, football was just a better fit for me than baseball, wrestling, track, Boy Scouts, theatre, and all the other activities that slowly fell by the wayside as I grew older. I loved football and I was good at it so it became a fantastic "sandbox" in which for me to grow and develop. If I had a son, I would hope for him to have access to that sandbox too.

But we now know much more than we did back then about the implications of repetitive head trauma. I'm not sure I would let a son play today, knowing what we now know. Although I feel blessed to have made it through a college career without any major injuries or surgeries (which I can't say about many of my teammates), lord knows I played through some concussions in my day. And lord knows I dished out many more concussions than I received - something of which I was proud at the time but at which I look back now with regret.

New research seems to be implicating other sports - like soccer - as well in such head trauma, although I really can't imagine that it's at the same level. But it does remind me that the question isn't: "Is football dangerous?" It's "Is football more dangerous than other sports? If so, how much more so?"

At the end of the day, parents can't protect children from all dangers. In fact, it would be a disservice for them to do so, lest their children grow up completely unable to defend for themselves. So I suppose it's up to parents and athletes to make an informed decision about whether the [unique] risks of an activity outweigh its [unique] rewards. One thing is clear, though: in order to empower parents and athletes to make that assessment for football, we need more, better, and more available data.