We live in California with our 18-month old. Our closest family is 2,500 miles away in Atlanta. Thank god for Skype.

I can summarize it in 2 words: It’s hard.

Yes, people do it all the time. Increasingly so. We go where our jobs and business opportunities are. Our parents tend to stay put where we left them. Our siblings do the same.

In the past year, I’ve written 3 full blog posts on this topic, mainly about how lonely it is.

And I never published a single one for fear of sounding like a whiner.

No mas. I’m coming out of the closet… “Hello my name is Meg and I’m often very lonely and I miss my family. I’m sure my kid misses her family too (if she were ever with them long enough to remember who they are), but she can’t talk yet so, yeah, I’m speaking for her.”

From May 12, 2011:

“Back in the day, women spent most of their day with other women in their extended family, and other women in the village. They cooked together, weaved, tended to their children, maybe even complained that their husband’s bison-killing skills weren’t up to snuff. Who knows.

We went to Seattle last weekend to visit my mother-in-law’s family. My husband’s uncle has 3 adult children and 8 grandkids; their house is bustling with activity and kid’s laughter fills the air.

When we arrived at their house, Aunt Doris said something to me like “go eat your dinner; the kids will watch her.” I was all “whaaa? whaaa? what do you… how do I…?”. And sure enough, the older kids watched her, played with her, and generally entertained her. She had a ball and required almost none of my attention. I ATE DINNER IN PEACE. What? A miracle, I tell ya.

I thought to myself… is this how it’s supposed to be? You mean, it isn’t normal for me to chase her around the house all day by myself. Just the 2 of us. Alone. Cuz I can dig this. Yes siree, this is something I can get behind. Whatever this is (motioning with my hands).

Oh yeahhhh. It’s called family, that’s right. I remember reading about it somewhere.

Since we moved to San Francisco, sure, we’ve made lots of friends. Good friends. We love them. But it’s just not the same, you know? When you have one of those days when your baby is puking all over you and you are sick yourself and, mother of god, you really need some HELP. Like, not a babysitter or someone you hire, but like — your mom, MIL, your sister or your best friend. And you realize you’ll have to settle for an over-the-phone vent/woe-is-me session where you are crying so hard you have to stop to catch your breath. That’s the fun stuff.

I want my own tribe, but unless Apple can invent an iHug or iVirtualFamily, I’m really not sure how it’s going to happen.”

I know I’m not alone in this (no pun intended). Too many of us are isolated from our tribe. And it’s not good. There is an emptiness. A void.

So if you are alone in your village of one, I encourage you to create your own tribe. Find other orphan mothers and befriend them, even if it seems like you might not have much in common at first. Because, as women, we need each other.

We just do.

“Put my baby on a schedule? You can’t be serious… like an Army cadet at boot camp?”

Not exactly. I believe in a loose schedule of sorts. More like a structured routine. Why? Because, much like adults, babies thrive on predictability.

I can’t tell you how many moms tell me they don’t want their babies on a schedule because they want them to be able to enjoy the freedom and whimsy that comes with being a child, blah blah blah. BLAH.

I get it. I really do.

But don’t confuse your own personal hectic/stressful work situation or daily schedule with the concept of having your baby on a routine. It’s not the same thing.

You see, when infants grow up in a predictable world, they learn that they can trust us to meet their basic needs. A routine is doing certain things in a certain order at about the same time. Routines create stability, structure and predictability. Over time, this helps build a child’s self-confidence by making it clear what to do and what will happen in a given situation.

Forget about all the books you’ve read, I have an easy method that I use to predict naps fairly accurately. It all boils down to one thing:

Respect Thy Intervals.

Infants tend to demonstrate consistency in the duration of time they’re awake before their next nap. This makes it very easy to predict and schedule your day, all the while giving your baby the sleep she deserves.

A Rough Guide to Napping at 4 weeks – 3 Months

After the first 4-6 weeks have passed (or fairly soon thereafter), your baby should be sleeping a lot (more) at night. If this is the case (and believe me, you WANT this to be the case), he will take about 3 naps during the day which can each range from 45 minutes to 2 hours.

The Formula:

The Morning Interval: 45-60 minutes. Starting when she wakes up in the morning (the first wake-up after sunrise), she will only be awake for a short while before taking her morning nap, typically about 45 minutes to an hour.

So, if your baby wakes up at 7am, you can expect her to go down again around 7:45 to 8am. If you’ve been up a lot the night before, this is a great time for you to go back to sleep too. Stay in your jammies, hold off on the coffee and get some extra shut-eye. I call this the mommy catch-up.

The Midday Interval This varies, but it’s roughly about *2.5 hours. Meaning, 2.5 hours after she wakes from her morning nap, she’ll be ready for her midday nap. She’ll sleep for about an hour and a half (*varies).

The Afternoon Interval: 3 hours. After her mid-day nap, this will be her longest stretch of being awake: about 3 hours. This is your chance to run errands and do things with your baby that require more time: grocery shopping, going to the mall or having a playdate. Your baby will be most alert and playful during this afternoon stretch, so take advantage.

Bedtime: 2.5-3 hours. “Bedtime” will occur roughly 2.5-3 hours after she woke up from her afternoon nap.

In the last hour or so before bedtime, she will be at her crankiest. This is a great time to have a warm bath, a feeding, and some quiet snuggle time before going down for bed. Keep stimulation to a minimum.

Developing a nighttime routine now will serve you well going forward into the future.

** 3 hours is a great rule of thumb for the maximum amount of time your baby should stay awake at this age (give or take). Anything much more than this and you are risking entering the realm of “overtiredness”, a place you don’t want to be. If your baby is turning into a gremlin at night and he’s been up for 4-5 hours at a time during the day, this could explain it…

Ok, so what does this look like? A sample daytime routine for a baby of your age is detailed below. Your baby’s intervals will vary, this is just a rough guideline. You can tailor yours to your baby.

Sample Schedule:

Bottom Line

Life is easier for both of you when you have a predictable schedule. You can plan outings, see people, go out to eat… you can get out of the house and live your life. This is when you start to feel really empowered — and soon you’ll learn that there isn’t much you can’t do with this little alien in your life.

In 2008, Intermountain Healthcare of Utah discovered that over a third of elective C-sections performed at their hospitals were done before 39 weeks of gestation.

Of these “early-term” babies, those born at 38 weeks were twice as likely to have respiratory problems and FIVE times as likely at 37 weeks. Many ended up with an expensive stay in the NICU and had other complications as well.

Because it occurred fairly infrequently in any given (and presumably small) OB practice, docs weren’t able to clearly recognize this cause and effect; but when analyzed over a much larger population, the evidence was clear:  delivering babies voluntarily before 39 weeks was NOT a good thing.

So they shut it down. Want a pre-39 week c-section at one of these hospitals? You better have a darn good reason.

The results were astounding: in one year, they prevented 500 newborns from ending up in the NICU with breathing problems and spared as many parents the frightening sight of seeing their infant hooked up to tubes and wires in an incubator. The measure also saved at least $1 million a year in unnecessary medical costs.

Since then, most hospitals in Oregon have followed suit. Insert a sarcastic “yay logic!” here.

The Last 3 weeks are Important

Just because a mom-to-be has reached the magic number of 37 weeks doesn’t mean that her baby is ready for the world. Nay, important things are still happening in the last few weeks, such as maturation of the brain and lungs.

According to the March of Dimes, babies born too early may have more health problems at birth and later in life than babies born full term. Babies born after 39 weeks are less likely to have vision and hearing problems and can maintain a warm body temperature; meanwhile, their smaller counterparts can have trouble sucking/swallowing properly and often struggle to stay awake long enough to eat.

Believe me, the last thing a new parent wants is the added stress of a baby with feeding or breathing problems. No thank you.

Why so early?

The answer is quite simple: everyone’s interests are aligned; the mom (get this baby out of me!), the *OB (who’d just as soon schedule a c-section so as to not interrupt his dinner plans) and the hospital?

“For-profit hospitals make lots of money from NICU babies, especially the very sick ones,” said an administrator from a major children’s hospital who asked to remain anonymous. “It’s not that we WANT babies to be sick, but we do make an extraordinary amount of money from them, especially now with the increase in IVF in older women, multiple births, etc. And we’re not exactly deterring early deliveries.”

Exsqueeze me?

*Aside: I don’t mean to be hard on OBs.  They work their butts off, but they ARE human and would – OF COURSE – prefer to deliver a baby during normal business hours than being up all night attending a long delivery. Wouldn’t you? Yes. Onward.

So who are the losers in this situation? Well, the BABY for one, who’s now in a plastic bubble in the NICU, isolated from his parents and missing out on crucial bonding and nursing opportunities. But also? Yup, you guessed it: whichever insurance company is footing the bills. Yet another perfect example of how people who don’t bear the direct cost of their medical care have no incentive to keep their costs low.

A Matter of Convenience

Let’s face it: scheduled C-sections ARE convenient. They’re convenient for moms, docs and hospitals.

“I was able to schedule my maternity leave, my parents coming into town, child care for our toddler, a dogsitter… everything,” said one woman in my mother’s group in San Francisco. “And at 38 weeks, frankly I was sick of being pregnant, so we just got it done! Plus, my OB was going on vacation the following week, so, yeah, we did it early”.

We all know darn well this is how it goes down. This is the reality of life these days.

Not only are c-sections being performed early, the same is true for inducements of vaginal deliveries. The fact is that inducing labor increases the risk that the mother will end up having a c-section. Unbeknownst to many, this can affect subsequent deliveries.

In one study of 7,800 first-time moms, those who were induced were twice as likely to end up with a c-section compared to those who went into labor naturally (Obstetrics & Gynecology, July 2010). In fact, more than 40% of all labor inductions end in a cesarean section.

Once a c-section, always a c-section

C-sections increase the likelihood of complications of subsequent deliveries. The fact is that once a woman has an initial c-section, it’s unlikely she’ll have a future vaginal delivery. This is mainly because many hospitals now refuse to perform VBACs (vaginal birth after cesarean) due to liability concerns and the high cost of full-time emergency surgical staff.

Furthermore, women who have multiple c-sections appear to be at risk of delivering prematurely and having life-threatening complications.  In fact, doctors do not generally recommend voluntary c-sections to first-time moms who want to have large families.

Bottom Line

Early c-sections and inducements can be very appealing for all involved parties, but may not be a smart idea.  This decision can have a cascade effect on future pregnancies as well; so even if your OB is okay with an early c-section or induction, it may not be in your best interest.

Hang in there and keep ‘em cooking! Your baby will thank you.

(Photo: Anti-circumcision protestors at California Pacific Medical Center in San Francisco)

I was at a doctor’s appointment last week when I ran into a group of protestors outside the hospital – near the door to the maternity ward.

Here is what some of the signs say:
“Jews for the RIGHTS of the child.”
“I don’t belong to you. My penis is NOT your property.”
“The foreskin has sexual function, don’t deprive them.”
“Circumcised America’s sexual disease rate [is] higher than [in] intact Europe,” from a group of anti-circumcision doctors

I knew that circumcision rates were dropping every year, but I’d never really witnessed a public display such as this. And I’ve certainly never seen a Jewish protestor taking a stand (turns out, she’s not the only one).

One of the protestors seemed to enjoy telling me horror stories of circumcisions-gone-wrong. After the 3rd disaster story, I had to politely exit the conversation (I have a weak stomach).

Was he right? Yes, things can go wrong in a circumcision. Things can go TERRIBLY wrong. In fact, approximately 117 neonatal circumcision-related deaths (9/100,000) occur annually in the United States.  What’s more significant are the countless number of “botched” jobs that I read about all the time in my mother’s group forums (ever heard of a penoplasty? I really hope not.)

Sadly, some botched jobs can leave men scarred for life. And it’s more common than you think (and good luck finding data on it, it’s not something doctors and hospitals like to about).

So I asked a Pediatrician friend of mine:  since it’s inconclusive that there are any medical benefits to people in first world countries, why do people continue to circumcise?

“Well,” he said, “it’s really just cosmetic surgery for the penis. Americans are used to seeing penises look… you know, a certain way.”

The Hooded Monster

I asked some of the moms in my playgroup why they chose to do it. My friend Jody says, “I remember my friend dating a guy in college who was un-cut. She jokingly referred to his penis as the ‘hooded monster’. I didn’t want my own son to be the butt of a bunch of giggling sorority girls because he looks different.”

Conformity is important to people, ESPECIALLY in the tender years of adolescence. The dreaded locker room situation (cue Jaws music).  But it begs the question; by the time today’s babies become adults, who will have more members on their team?

A New Norm?

Less than a third of baby boys born in America are now circumcised (wow, really?) In fact, circumcision rates fell from 56% in 2006 to 32% in 2009. (Bcheraoui, et al. 2010) However, it should be noted that rates of circumcision still vary drastically among different ethnicities and socio-economic groups (Medicaid no longer covers unnecessary circumcision in most states, for example).

So what WILL the modern American penis look like? It’s up to you, dear parents.

Talk to your doctor. Talk to your friends. Figure out what’s important to you and your little man.

Choose wisely.

^{“Just as we no longer practice the animal sacrifices in the traditional temple, so let us not sacrifice an important piece of our mammal in the temple of tradition,” — Rabbi Natan Segal, One Rabbis’ Thoughts on Circumcision, February, 2007}

Unless they’ve been living in a cave, women these days KNOW that breastfeeding is better for their babies. They just do.

So why isn’t every new mom getting on the train to lactation station? Sure, some have had surgeries or other medical problems that preclude them from the task, but for most? I theorize it’s something totally different altogether…

Deep down, many women cannot disassociate breastfeeding from SEX.

There, I said it.

Don’t believe me? These are all actual quotes from my subscribers:

• “I just can’t breastfeed. I have been conditioned throughout my entire life to see breasts as nothing more than an erotic, sexual objects.”
• “I grew up as a Baptist in the south. My mother thinks that breastfeeding is disgusting, perverted & selfish. I’m sure she’s praying that I’ll fail [at it].”
• “The thought of having an innocent little baby sucking on my boob seems so sexual that it makes me feel dirty and perverted.”
• “When I told my boss I had to go pump, he said, “that’s disgusting, your baby’s gonna be a perv. Why can’t you just bottle feed like everyone else?””
• “My husband has a major issue with it. He had my breasts all to himself until baby came along and now he’s jealous!”

People don’t like to talk about this particular issue; it’s awkward, personal, icky.

You’re much more likely to hear a woman say something like “my breasts belong to me and are not for sharing.” Ok, fair enough… but what’s really going on is something deeper.

Shameful, yet… verrrry sexy

Breasts connote two things in America: shame and S-E-X.

As girls growing up, we are taught to always hide our breasts. My friend Ashley laughs as she recalls what her mom taught her, “Later on, all the boys will try to touch them. Don’t let them. They are your PRIVATE parts.”

Any mention of milk? Sustenance? Feeding a baby, errrr… anything like that? Nope.

Janet Jackson has a costume malfunction and OH MY GAWD, we’re never letting our kids watch the Superbowl ever again! That was one powerful nipple.

And boobies take center stage when it comes to sex appeal in the media. I don’t think you need any convincing on this point. Just look at any billboard or magazine.

So it’s no wonder that some women are aghast when they are confronted by the concept of “shoving their fun bags into their baby’s mouth”, as one reader described it.

For nearly everyone else in the world, boobs really aren’t a big deal. Ever seen a Hooters in Spain? No way.

Sadly, something has been lost in this country. We must re-brand the breast in America.

Your Turn, Hollywood

Whether we like it or not, we are deeply influenced by what we see in the media. When is the last time you saw a woman breastfeeding in a movie, TV show, or commercial? Probably never.

However, we’re now seeing celebs coming out in support of the cause.

Let’s hope these displays of support help us reach the tipping point of acceptability in the mainstream culture.

The Full Picture

Recent research has revealed new benefits to breastfeeding – namely, reduced rates of cancer in baby AND mom.  Who knew?

So, in celebration of Breastfeeding Awareness Month, I present this infographic on Breastfeeding in America. This is NOT about shaming women who formula-feed, it’s about education, moral support and de-stigmatizing. For many, it’s simply about overcoming fear.