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The Fifth Trimester

April 21, 2017 By Dr. Drake Leave a Comment

The Fifth Trimester is my favorite new title for parents. The book’s author, Lauren Smith Brody, tackles the incredibly tricky, highly important, but often buried period when a mother returns to work, what she calls the fifth trimester. What I love most about this book is that Smith Brody works hard and succeeds at providing all of the information that a working mother needs to make the decisions that suit her best. She collected 700+ surveys from working mothers across a wide range of careers, socioeconomic situations, and domestic situations and interviewed some experts (including me!). Somehow, she managed to distill all of this information into what feels like a community of insightful fellow working mothers that lives in the pages of a book.

Smith Brody’s agenda here is to support as much balance and good health and good work as possible. Nothing more. It is incredibly difficult to write with each individual reader’s best interest in mind which is why so many well-meaning parenting titles fall in to the trap of promoting an overly simplistic, one-size-fits-no-actual-person pseudosolution. Not this book. Lauren knows from her own experience as a mother with a big job and big ambition how important it is to be lifted up and respected and actually supported rather than condescended to and devalued. I am so so pleased to have this book to offer as a resource to my patients and my friends.

Filed Under: Book Reviews

Play The Forest School Way

October 24, 2016 By Dr. Drake Leave a Comment

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Play the Forest School Way is a lovely introduction to the Forest School philosophy of nature-based play. The authors, Peter Houghton and Jane Worrell, are Forest School leaders and they use this book to share some of the activities that they have found to be the favorites in their sessions over the years. As a city parent who can sometimes feel out of place in, well, nature, I found the introduction particularly helpful. There is definitely a push for formal Forest School, but they go on to calm and encourage those of us who feel the need to shore themselves up with a book against the idea of having to come up with things to do with our kids in the forest. For each activity, there is a quick list of what you’ll need to prepare, some of the objectives for the activity, and then specific instructions to help you facilitate the activity. They use an adorable “Get Ready”, “Get Set”, “Go” format that I thought was great. And, most importantly, the activities are really clever and original. All around fantastic and fun!

Filed Under: Book Reviews

Before Work…

October 19, 2016 By Dr. Drake Leave a Comment

before-work

I saw a mother sitting with her son – a young-ish toddler, on the subway this morning. I was early, before 7am, and I imagined she was taking him to his caregiver or preschool before heading to work herself. She was dressed stylishly and professionally in the way that many women in New York are.

I couldn’t hear all of what they said to one another, but the dynamic was clear. They were happily engaged in the routine of their morning commute. She chatted to him, tickled him to keep him happy and in his seat. He fussed a bit, she soothed him and he responded. He laughed and showed her the little toy he was holding. The rest of us looked up from our reading material, noticed them, and smiled to one another.

Seeing this mom and baby pair got me thinking about what mothers and fathers do each day before we arrive at our workplaces and what this may mean for our work. For starters, there is no need for fueling up and waking up when we arrive. Parents have already been planning, negotiating and collaborating – they may even have put out a few (hopefully just a few!) fires. They have used their aesthetic minds to groom and dress their little ones. They have packed lunches and snacks in tidy containers and may have emailed a teacher or friend to schedule a meeting or play date. All the while they are choosing the best of the available options, prioritizing, fighting against perfectionism and toward action. And just as important as what they have given during their pre-work morning, they have received loving looks, giggles and hopefully some of the feeling that comes when they have satisfied their child’s needs. They have felt useful, masterful and have left home with a healthy dose of perspective on what matters most.

This picture stands in such contrast to the caricature of a tired, harried working parent – and it is much more the norm. Mothers and fathers are assets to their companies precisely because they are parents. It is all that they do before work each morning and after work each evening that makes them better thinkers, collaborators and innovators. Parents are acutely aware of the needs and the prickly spots of their clients and their projects because they are finding solutions and presenting them at almost every moment. Let’s remember this, of ourselves as workers as well as employers, and fight that nasty image of the forgetful, overwhelmed parent. I have not met him or her and I think that is because he or she is imaginary.

Filed Under: Header Post, Insights

Understanding The Science

October 7, 2016 By Dr. Drake Leave a Comment

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We are presented these days with a great deal of information, some of it from scientific studies, that may be useful to us as parents. This has the potential to be a very good thing. However, we are only rarely provided with much information about these studies beyond the attention-grabbbing headlines. As a result, some of the recommendations that follow from these headlines cause undue worry that we parents are doing things incorrectly. Unfortunately, it falls to us to sort it all out. So, here is a quick guide to help you evaluate whether the next bit of scientific data you read or hear about is worth your consideration.

1. What does the study itself, not the press report actually say?
It is worth clicking through a news report to the study itself and looking at the abstract – a quick summary of the study written by the authors. At the end of the abstract you will find the author’s conclusions and recommendations for further evaluation. I don’t suggest that you read the entire study if that does not interest you, but it is wise to read beyond the version presented by the popular press. You may be surprised at how often and how dramatically the study itself differs from the article you just read. It will take just a few more minutes of your time and may go a long way to ease your concerns.

2. Who performed and funded the study?
Scientific studies are funded by four main sources: government agencies, pharmaceutical and biotechnology companies, consumer product companies, and industry lobbies. The source of funding for a particular study is an important bit of information to have because you would, of course, value a positive study on the benefits of say, apple juice, that was funded by a company that makes apple juice differently than you would if that study were funded by a less partial source. It is certainly not the case that every industry-sponsored study is biased. However, we must remember that these are businesses and some have regrettably come to use scientific-looking studies to promote their products. So, it would be wise to read a study produced by a source with potential conflict more closely. Finding and researching the source of a study may take an extra few moments of your time, but it will go a long way to put in perspective the topic you are interested in. If you can’t find a study’s funding course easily it is not a reputable study.

3. How many subjects were studied?
This question is important in understanding how generally the study results may apply. If a study includes, say, 10 mothers and their babies, its results may be able to raise an interesting question for further study. But it will be far from high-powered enough to warrant a recommendation to the general public. There is just too much chance that coincidence could be influencing the results. In contrast, a study that includes a large and varied population of mothers and babies and finds a particular result would be more likely to apply to you and your baby.

4. Were the subjects humans or animals?
Obviously, babies are not mice. But sometimes interesting animal results are reported as though they apply to humans without the human follow up to warrant such a conclusion. This is another example of prematurely reporting preliminary data. An important animal finding may certainly be newsworthy because of the scientific achievement that it represents. It is not typically cause to alter the recommendations we make to people.

5. Is this an exploratory study or has the research been replicated?
The second or third of fourth time that an association or outcome is found is typically less exciting to the popular press than a new discovery. But any doctor would argue that replicated results are actually the most exciting. Researchers work very hard to minimize the effects of random chance on their data. But we all feel most comfortable making recommendations based on data this has been duplicated over and over again by independent teams of researchers.

Filed Under: Data

Book Review: Sparky!

August 2, 2016 By Dr. Drake Leave a Comment

Sparky

Jenny Offil’s Sparky! is the adorable story of a girl who choses a sloth for her pet. She chooses him to meet her mother’s requirement for a pet that doesn’t need much care, but then learns that Sparky does essentially nothing but sleep. He can’t do tricks or play games like her friend’s pet and after some disappointment, the girl (we don’t learn her name in the story) comes to accept Sparky just the way he is. There are opportunities through Sparky! to chat about accepting our friends even when they cannot do the things that we wish they could. There is also space to discuss how we treat friends and how we would like them to treat us. The girl has a neighbor named Mary Potts who is quite competitive and has a rather unkind attitude. The conflict is light enough that it would not upset little listeners, but it may be interesting to hear your little one’s thoughts about the girls’ friendship. Chris Appelhans’ illustrations are lovely and subdued, perfect for bedtime reading. Sparky! is one of our favorites.

Filed Under: Book Reviews

On Staying Until the End

July 13, 2016 By Dr. Drake Leave a Comment

Clock

The ends of things – conversations, performances, lectures, films – tend to encourage reconciliation of events, consolidation of ideas, space for us to do some processing and enjoying of the thing that is ending. One of my favorite endings before I became a mother was the end of my exercise class. We would take 5 minutes to stretch, thank ourselves and our teacher, be together as a group after a tough workout. I had always noticed the women (the class is almost always women) who would leave before then end. Maybe seeing them do this over the years gave me the idea that this was a possibility. And so when I returned to class after Miss Pumpkin was born, I began to leave early as well. I was squeezing class between my morning with patients and my afternoon teaching responsibilities. To be honest, I was pretty proud of myself for making the time. I continued this way, doing the most intense parts of class and scurrying out before the cool down and stretch – those were not the most important parts of class anyway, I figured. I had decided they were luxuries that I would not have.

A full year into my new routine – I was still very proud of myself for going to class at all – I had a break from my teaching duties and I found myself with nothing to rush off to after class. That day, I stayed until the end. I remembered all of the wonderful parts of the end – the kindness I would send my own way, the exhausted smiles shared with the others in the class – and realized that if I needed these five minutes before Pumpkin, I definitely needed them now.

The trouble was that my five minute indulgence would translate to about a 30-minute delay in my arriving home at the end of my day. Small delays in the shower line-traffic pattern-elevator line-subway matrix would add up to about that much time.

You see, motherhood very often causes us to feel quite guilty about any time we are spending away. It’s an understandable and perfectly natural emotion. It serves to keep us close to our pumpkins and solidifies our bond to them. But it can also cause us to neglect the things that we need. Post-baby us can get carried away shifting more and more of the things that pre-baby us had felt were “needs” into the category of “wants” or the even more judgmental category of “luxury”. But pre-baby us was no fool. She might have even been our biggest advocate. Perhaps we could take a few of her suggestions more seriously.

Filed Under: Insights

Cute Stroller. Want to Have Coffee?

June 28, 2016 By Dr. Drake Leave a Comment

Coffee

At some point, we find ourselves ready to emerge from the one-on-one love fest that we do with our little ones and start to want some contact with other adults. The little ones really don’t know the difference until they are around 2, so this early seeking of parent-friends is really about us. So how do we choose these friends?

Honestly, many of us choose parent friends by proximity in time and space. Then, once we find ourselves in the same music class/gym class/art class at the same time, we give each other a once over and decide who feels right. It is very much like how we choose who to play with in grammar school. And we must remember that some of those choices yielded us amazing long-lasting friendships and some of them did not. This is ok, for the best really. If we can come away from the little one’s earliest years with one or two true friends, that is really fantastic.

I find that there are a few scales that need to be somewhat aligned for these new relationships to really come together:

Your parenting style along the permissive to rigid spectrum is very important here. You may really begin to take stock of this aspect of your parenting style – one that you will be examining agin and again in years to come – when pumpkin and company start to get some mobility. The key here is not to be judgmental of your or another parent’s style. Rather, to notice your own style and then figure out what feels comfortable for you and pumpkin. You might find it quite stressful to be with another parent who is frequently redirecting their child or you might find it uncomfortable to feel that pumpkin’s playmate could use some reigning in. You and the other parent don’t need to be an exact match here, but being within a comfortable range is key.

Another factor to consider is what you are both looking for in this relationship. Is it someone to chat with at the playground? Or would you enjoy a more involved friendship? How would you both feel about involving your partners and about seeing one another outside of time with the kids? There is no one correct answer to this question, but it does matter an awful lot that you are synced up in this regard. It can be quite uncomfortable to have to repeatedly decline invitations and enforce boundaries with a parent who is looking for more that you have to give and similarly disappointing to be on the other side – looking for more from a potential friend who doesn’t have the space to offer what you want.

And finally, the kids have to like each other well enough. A boisterous, physical little playmate might not be pleasant for your pumpkin if he or she prefers quieter play at this particular moment in time. Likewise, it won’t be much fun (for either of you) if your little one is more spirited and his or her playmate is upset by that level of energy. Again, the kids won’t be very friendly with each other just yet – just wait until they start to develop their first friendships, heart melting! But their being able to play in the same general area can give you all the feeling that it’s ok to give the kids a little space and everyone benefits from this.

A nonjudgemental but realistic stance is so important here. Remember that the goal is to find some company that you really enjoy and some support for this wild journey that is parenting. You have quite a lot to take care of at the moment, so this is not the time for collecting higher maintenance relationships. This is a chance for some much needed fun!

Filed Under: Insights

Can I Eat That?… Seafood in Pregnancy

June 20, 2016 By Dr. Drake Leave a Comment

fish

Pregnant women are bombarded these days with recommendations about what they can and cannot eat.

Unpasteurized dairy? No.

Deli meats and cheeses? Definitely not.

Seafood?…It’s a bit less clear.

We know that Omega 3 fatty acids from seafood are supportive to baby’s neurologic development. We also know that high levels of mercury can harm baby’s developing brain. Beyond this, the available data is less straightforward. There is a British study showing that infants born to mothers who consumed only small amounts of seafood during pregnancy were more likely to have suboptimal neurodevelopment as compared to infants born to mothers who ate larger amounts of fish. The women in the lower consumption group ate about 12 ounces of fish per week. But 12 ounces per week is the upper limit of the current recommendation from the FDA and the EPA. Confusing, right? Why isn’t it simply that more low-mercury fish is better?

The trouble is that the current EPA and FDA guidelines (2 6-ounce servings per week) have not been updated since 2004. Also, we have become more aware of how much of the fish we consume may contain harmful pesticides from agricultural runoff and other chemicals used in fish farms. So this has left pregnant women and their doctors in the position of having to come up with what they believe to be best and safest recommendations regarding seafood consumption. Many obstetricians are concerned that their patients are so frightened by the potential for harm that they are eating far less fish than we think is beneficial.

What I think is a reasonable recommendation is to strictly limit your fish consumption to low-mercury species and to have a goal of having about twelve ounces of wild fish per week. However, if you are having local fish or farmed fish, limit your consumption of that fish to six ounces in that week and try to make up the difference with wild fish. If you don’t know where the fish has come from, assume the worst. That system will limit both mercury and pesticide levels while still allowing for the dietary benefits of seafood. And of course, no raw or rare fish at all… I know, I know. More torture.

You and your healthcare provider should also discuss whether a DHA supplement made from wild, small fish is a suitable complement to your prenatal vitamin regimen. This may provide some of the benefits of eating whole fish without the worry about source, type or tolerability to nauseous tummies.

NYC has produced and handy guide to the mercury content of some common types of fish here.

Filed Under: Data

Book Review: A Mother’s Circle

June 20, 2016 By Dr. Drake Leave a Comment

motherly-2015-11-40c339ff-9248-4bfa-9c3f-5a7d26329c47-a mothers circle

A Mother’s Circle is my hands-down favorite new parent book. Two of the authors, Jean Kunhardt and Lisa Spiegel, are the founders of Soho Parenting where they have been running groups for new parents since the late 1980s. This book uses the journey of one of their groups to tackle issues from feeding to sleep to the changes in a marriage that come with parenthood. The authors move expertly from the general raising of an issue to sharing how the issue was discussed in the group to encouraging the reader to explore how the issue might be relevant to her or him. The book is readable – I read it for the first time during Miss Pumpkin’s early overnight marathon feedings – and does a genius job of easing a new mother or father into some of the more prickly parenting topics. Despite the title, I encourage new fathers to read A Mother’s Circle as well. The information and reassurance is even more valuable if new parents can share it with one another. Really just fantastic all around!

Filed Under: Book Reviews

Swaddling Safely

June 20, 2016 By Dr. Drake Leave a Comment

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An article was published in the Journal of the American Academy of Pediatrics in May of this year that addressed the potential for a relationship between swaddling and sudden infant death syndrome. The article caused a bit of a stir and, unfortunately, the data was presented in some scary ways in the press. So I thought it worthwhile to review what the study actually tells us and what it does not.

The design of this study, a meta-analysis, is meant to pool data from several smaller studies in order collect enough power to look at a given outcome. In this case, the authors found four collections of data looking at sudden infant death syndrome that included information about whether the infants were or were not swaddled, the ages of the infants, and their sleeping positions. The collective data spanned the years between 1988 and 2006 and included subjects in the US, the UK and Australia.

What the authors learned about their data during the analysis is very important. They found that there was significant heterogeneity among the studies. This means that the original study protocols were quite different from one another which complicates the idea of pooling together the data and treating the group of individual studies like one big study. To account for this complication, the researchers needed to apply a statistical calculation to make sure that they were not drawing conclusions that could be attributed to chance.

So, when the researchers compared the swaddled to the not swaddled group BEFORE accounting for potentially problematic differences among the studies, they found that swaddled babies were 1.53 more likely than babies who were not swaddled to die of SIDS. However, when they did account for the differences in the original studies, this increase in risk disappeared. Of note, the study authors call this set of data “of borderline significance” but it is actually statistically insignificant. They then drop one of the studies from the calculation and recalculate. The risk continues to be, statistically speaking, insignificant. However, they apply a substandard definition of statistical significance here again.

Where the data does seem to hold up is in the authors’ analysis of risks of swaddling older babies and risks associated with swaddled babies sleeping in any position but on their backs. The data revealed a trend toward an increased risk of SIDS as age increased with the highest and most statistically significant risk in infants older than six months. Babies who were found swaddled and on their bellies were rare in the study, but were 19 times more likely than unswaddled babies to die of SIDS. In a subset of the data that included the position in which the babies were last placed as well as found, it became evident that the practice of placing swaddled infants on their bellies to sleep was very rare and so it seemed that the babies who were found on their bellies had rolled over.

In their discussion, the authors offer the insight that in the Netherlands, a country with low rates of SIDS, swaddling is encouraged but parents are advised not to initiate swaddling after the fourth month and to discontinue swaddling any infant who is signaling that they are interested in rolling over and all infants at six months when they are very likely to be able to roll over even if it has not yet been witnessed. These seem to be very reasonable recommendations given the information that is available to us including how useful swaddling can be in soothing young babies. Perhaps the most useful takeaway from this study is the need for improvements in messaging to parents considering swaddling from the medical community here in the US.

The article can be found in its entirety on the AAP website here.

Filed Under: Data

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MEET CHRISTIN

I have started Real Mothering to provide a place for parents to find information that is in my opinion useful, reasonable, sound, and considerate of the incredibly special role of parenthood.

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