Induction

Doctors today will only let you go 14 days overdue, and then they will recommend induction. Some doctors recommend induction before 14 days for reasons such as: low fluid levels inside the womb, baby’s weight is getting too big, or mother has medical warrant. Obviously if there is fetal distress, a Caesarean will be scheduled. But most doctors realize that a Caesarean, because it is a surgery, is less preferable than a vaginal birth as long as there is no reason why a vaginal birth couldn’t occur. You can also get recommended for induction if you are dilating considerably (i.e. 4cm) but not going into labor, or if your water breaks but labor doesn’t start. That is to avoid infection or other concerning birth issues that can occur by waiting.

Induction is intravenous medicine (usually Pitocin) given to start (“induce”) uterine contractions. You go to the hospital, usually in the morning if you are scheduled beforehand—and Mondays/Tuesdays are particularly popular for hospitals—and get hooked up to the IV. You can eat something small before you go to the hospital but once you’re on the IV you can neither eat, drink, or move around. This is the stinky part of induction. The other stinky part is that between the IV and the continuous fetal monitoring, you really feel roped in. It is difficult to labor naturally because you really can’t change positions easily.

Plus, the contractions are artificial, quickly repeating, and therefore arguably more painful… most ladies end up getting an epidural. (Although not too early in because they don’t want the epidural to counteract the good contracting—you have to be over 2cm dilated, preferably 3.) I had four inductions (at 42 and then 41.5 weeks) and I went in at 6am, got hooked up by 9am, and started contracting about every two minutes by 10am. They start you on low doses of Pitocin just to get going and ramp it up about every 30 min or so until your body is doing fairly heaving contracting about every 1-2min. And they check your dilation pretty regularly but not overly so.

The goal is to get your body doing the labor thing even though it doesn’t want to. Which is why the process is slow. Depending on how ready your body was before the induction started, it can take almost all day. The nurses basically want you in by 9am and delivered by the end of the night. My first baby came just after 9pm, another at 6pm, another at 5pm, and another by 10pm. For the last baby, probably because my body really wasn’t read, she almost didn’t come at all. Pitocin isn’t magic. Your body can resist it. And my contractions, even though they were coming almost every minute for 8 hours, were just not working the baby out! She resisted the encouragement until around 6pm when my midwife had pity on me and got special permission to give me even more Pitocin (20 is usually as high as they go, she got permission for me to go up to 30). And somewhere around the 28 level, just as I was crying and my husband and I were packing the bag to get ready to leave the hospital, the familiar severe pain began. I knew it was going to work after all, I got the epidural at 7, my water broke, and 2 hours of pushing later, she was out.

The rest of the labor experience is pretty standard if you have had a hospital birth before. An induction is nothing to be afraid of, nor is it dangerous for the baby. In fact, because the baby is on the monitor all the time, and you don’t have to have a surgery, it is a safe option when there is benefit to the baby to being born sooner. Nothing about the Pit (as they call it) can affects the baby once born, or the breastfeeding, or your own body once it’s over. In fact, the Pit helps your body during the afterbirth (some women are put on it through an IV even if they have gone naturally), and the epidural, if you get one, eases the immediate recovery period. So while an induction and epidural may wreck your birth plan, it does not wreck the birth. It’s important to keep this perspective even if it is not the way you dreamed the end/beginning would be!

Update: After watching Ricki Lake’s “The Business of Being Born,” I have a deeper understanding for what the natural childbirth camp is trying to achieve. I am not against making the natural choice for women more available. I am against the demonization of the medical establishment, however, for the promotion of another option. This is not giving more power or “choice” to women; this is convincing them to trade one route of delivering for another (often through guilt and fear). While it is a worthy goal to reduce unnecessary medical interventions, one should not confuse inductions for good reasons with inductions for bad. There is real scientific evidence that inducing (and Caesareans, fetal monitoring, etc.) can prevent drastic circumstances in certain situations. Epidurals may be more worthy of debate, but the fact is that some conditions warrant medical interventions and in those cases (or ones that in the heat of the moment seem warranted), it is right for conscience’s sake to give it.

One-on-One time with my Three Year old

A close friend who has a three year old and two babies recently asked me what she could do with her oldest. She is a fabulous mother and has years experience in daycare, so she is probably the picture of Mommyhood when it comes to care-taking. But perhaps she felt a little intimidated by her three year old who is growing so rapidly, getting so smart, but also needing one-on-one time with mommy now that he is sharing her with two other tiny brothers. What should she do with him when she has that alone time with him, other than read to him, to help him educationally?

Here are some things I mentioned that have been hits in my house. Some things are silly but you make do with what you have!

• Making more complex structures with legos/blocks: fire stations, hotels, hospital, school, garages, airports. Talk about the specific looks and purposes of each building. If you want to make vehicles or have them already, talk about them too (how the fire engine is different than the police car and has a different siren sound.) Play with them using imagination and a simple skit when finished so they can practice.
• Learn more complex shapes: octagons, pentagons, ovals, cones, cylinders. Once the basic triangle, square, circle have been mastered, little kids are ready for more shapes and it is good for their analytical skills.
• Practice drawing. Little kids who don’t have much experience can work on triangles, circles, square/rectangles, as well as happy/sad faces and simple letters (x, o, v, t…). Once they master those basic things, add harder pictures either free hand (tree, house) or have them start dot to dots.
• Start learning to color inside the lines, and talk about the black line being a “wall” that the color can’t get past. Put your hand on top of theirs to guide if they are not holding the crayon or making strokes right. Master colors if they aren’t already. Don’t be afraid to add less common colors (tan, turquoise) as well as teach the concepts of light and dark shades.
• Get a Potato Head and master the parts of the body (not just mouth but lips, not just hand but fingers). Once Potato Head is old, draw a body map on paper (trace your child’s outline) and start filling in less common parts (elbow, ankle, wrist, eyebrow).If your three year old is really smart, or closer to 4, you can start explaining other concepts about your body like bones, muscles, skin, and basic processes (like when you eat, your belly inside gets full).
• Pictionary. You draw, he guesses! (Use a portable Magna Doodle for ideal surface).
• threading macaroni, stringing beads, sewing cards
• Phonics, numbers, and animal flashcards. Don’t be afraid to get a complex set of animal cards… Most three year olds who watch TV already know quite a bunch already.
• Dominoes. Just easy counting, matching, and it helps them solidify 1-6 visually in their heads.
• Memory. (the board game).
• Go over the different sports and equipment if he doesn’t already know from TV. Work on the different balls: baseball, soccer ball, football, basketball, golf ball, tennis ball… Most boys absolutely love this. especially if you have them in your home. If you don’t, draw pictures or point at different ones in a magazine. If they can start identifying what type of player from their uniforms, you’ve got a future ESPN master!
• Play doh. Practice rolling, cutting, stamping, twisting, thumping, squeezing, and other fine motor skills. While it’s messy and annoying to keep fresh, the knowledge of textures (crunchy, crumbly, squishy, smooth…) and ability to work muscles make it one of the best hand exercisers ever for pre-kindergarteners. But you’ll want to supervise for awhile otherwise the constructive play disintegrates quickly. Also, you should do this over a hard floor because stamped pieces of play-doh are notoriously impossible to remove from carpet!

What is Asperger’s Syndrome?

I wanted to write about Asperger’s because many people suspect that their child has Asperger’s from reading symptom lists. As soon as they see their preschool child has some autistic symptoms but not the language delays, they will start wondering. (See my post on “It’s not all Autism” for similar commentary about this problem.)

But very few preschool children will be diagnosed with Asperger’s, and my personal belief is that in most cases, it is better to wait until the child is elementary age to diagnose. This is because most of the symptoms are, in essence, symptoms of relational immaturity. All children start out with these symptoms, to one extent or another. It is not until the child is older that you can tell his/her relational experiences have not led to maturity. In some cases, there are definitely diagnostic tip-offs before age 3. But many Asperger’s sufferers have become adults before discovering the truth. It is definitely one of the hardest disorders to capture on paper.

When you encounter an Asperger’s child, you often know. But you may not know exactly what the problem is. An Asperger’s child has a peculiar orientation to the world. They seem in it, but not of it. They seem interested but not attached. They know a lot, but their knowledge seems impersonal. They give inappropriate or inadequate responses to interactions, such as speaking too loudly, off-topic, unkindly, flatly, etc. They often don’t make eye contact, don’t seem to be gauging your interest as they speak, and are resistant to manners, customs, and teaching about such matters. In social matters, they just don’t seem to be “getting it.”

These are just some of the symptoms, which can be symptoms of other autism spectrum disorders. Essentially, Aspergers is a social/emotional detachment disorder which is neurologically based (i.e. not based on circumstances, stress, or intention). The cognitive hardware that receives and expresses emotional/relational input is damaged. Have you ever had an existential experience, like at someone else’s wedding, where you see all kinds of people having fun and participating, but you don’t really know them? You feel distant from them, as an outside observer, and recognize that however genuinely they are laughing and relating to one another, you have no connection to them. Nor do you have the relational capital necessary to go over and just join in the conversation. This is sort of the way having Asperger’s is described. From self-reports, we get the sense that many of them are having the truly existential (detached) experience of the world where they are smart enough to rationally understand what is going on between people, but they are emotionally and socially hindered from vicariously experiencing it (entering in), interpreting it, and reciprocating it back (expressing to others). Thus they come off as awkward, disrespectful, or self-centered.

But keep in mind, Aspergers is not a character or personality deficiency—it is a neurological problem. The person is unable to recognize or engage within themselves what needs to be changed.

Depending on the individual’s intelligence and verbal abilities, Asperger’s people may be able to overcome a lot. But they have rely on memory for many manners and customs, and have to be taught explicitly about all the rules which other people seem to understand naturally. (Of course, as special needs teachers know, “naturally” is not exactly natural.) They have to be taught to recognize relational cues, including those from faces, gestures, and circumstances. They have to be taught context cues, which is very difficult for the analytical mind to grasp. Until those context cues are mastered (and many can really only be mastered by intuition or discernment), the Aspergers’ patient will have trouble with many holistic concepts such as:

Diplomacy (hurting another’s feelings, being polite, respecting ethnicity/differences, respecting different tastes/styles, resisting sensitive subjects, acknowledging or reciprocating others’ contributions, recognizing when someone is embarrassed, obliging oneself to be charitable, perceiving boundaries, respecting authority, adjusting one’s style i.e. based on family from acquaintance, old from young, sick from ill)

Conversation (letting others talk, using appropriate tone/volume/voice, responding to others, initiating properly, ending properly, chit chat, giving others time to think/answer, asking questions, knowing when they’ve talked enough, reading between the lines)

Posture (giving others space, not leaning, touching others appropriately)

Character (not being prideful, not being bossy, Golden Rule)

Receiving/Expressing (sympathy, empathy, apologies, thankfulness, compliments, praise, congratulations, help, relief, thankfulness, being proud of someone else, humor)

Identity (sense of belonging, understanding one’s heritage, understanding a history/significance of one’s own past, believing in traditions, forming one’s own convictions, experiencing freedom, valuing friendships, perceiving whether one is accepted, wanting someone to be intimate with–spouse, best friend, pet!)

So you can see why these types of things are too hard to judge in a preschooler… none of them have these abilities!

You can also see why other disorders, including learning disorders, auditory or sensory disorders, communication disorders, and personality disorders could also be possible diagnoses rather than Aspergers. One of my sons who has had language problems since he was a baby, for example, was stalled in much of his social development because we could not talk with him about these concepts until he was over four years old. Little kids start picking up things like empathy and manners as young as one and two years old (just little seeds), and acquiring that relational capital for more understanding later. But if you are hindered in relating to your child for any reason in those early years, they can show significant emotional or social immaturity. Firstborns, only children, and spoiled children can too! The key difference between them and the Asperger’s patient, however, is that the Aspergers is not able to understand 9internally witness) what you are talking about. The non-Asperger’s should be able to understand what you mean, even if he or she doesn’t have the skills to talk about it or change their behavior right away.

In closing, Aspergers is an auto-recognition disorder that is hard to describe but causes a significantly socially peculiar spirit to a child. Essentially, they have an overly analytical mind which does not know how to process social/emotional/relational information. They may underperceive input, or receive it but not know how to interpret it, or know how to interpret it but not know how to reciprocate expressively. Because the nature of relationships is synthetic and often highly contextual, the Aspergers child will have to be given an educational program that is able to analytically break down the concepts they are struggling with, as much as possible. And because of the challenge in capturing the Asperger’s repertoire on paper, you do not want to jump to conclusions about your preschooler having Asperger’s unless you have some experience with the syndrome. It’s not one of those disorders you can diagnose in a three-year old who has some autistic-leaning symptoms. It should definitely be done by a professional.

How to make a toddler schedule

toddler schedules?  Wasn’t having one for a baby enough?

Well yes and no.  All little children resist your getting things done!  You usually need a battle plan.  But a babies’ needs are primarily physical and are dictated internally by routine.  You need a schedule mainly to make sure they are eating and sleeping enough, and getting enough stimulation.  A toddler’s needs, on the other hand, are much more mature.  They are very emotional and social beings, with short attention spans and an inexhaustable need for activity.  Just like babies, they are learning, learning, learning, but on a whole new expressive plane.  If you aren’t careful, you can end up losing your mind as you simply react to their energy and interest levels!

For this reason, I made my toddlers little schedules that I could fall back on whenever it was cold or rainy and we couldn’t go out.  Or when I was sick, tired, depressed, or had vacation days with everyone home.  Sometimes I would put the schedules away for awhile, and then I’d bring one back out if the kids were particularly struggling with boredom or each other.  I’d rework it for their ages and interests, and for new ideas that I wanted to implement.  Perhaps I just didn’t have enough motivation personally, but I found that staying at home with little children often caused me tunnel vision.  Things would get out of balance and I could go months skipping things I really believed in (teaching, storytime, cooking…) just because I was in Survival Mode.  I had things which I rationally believed were important but required too much emotional energy in the moment to accomplish.  A schedule helped me stick to my guns about what I really wanted to accomplish each day because I knew I had thought about it beforehand and planned a way to get it in.

So that is step one in creating a toddler schedule: think about what activities you want in your toddler’s day.  Think about their individual needs in terms of energy, physicality, sleep, etc.  Work in your values for them, and consider their development—identify areas you want to spend special time on, and spaces to fit them in.  Plan in their meals and rest time(s).   And plan in your shower, the laundry, the dinner, or anything else you value but don’t seem to be able to get done regularly.  Do you need a fifteen minute coffeebreak after lunch?  A run before breakfast?  What about that bed-making which never happens?  Make a spot for it that fits the logical flow of your household.  And then fill in the rest of the time as specifically or generally as you want to.  Maybe you don’t need any strategy for 3 to 5pm because those hours shoot by.  Maybe that’s exactly where you want a step-by-step plan for what to do every 15 mins.  Maybe you don’t care if multiple siblings are running around the family room together in the morning.  Maybe you want to separate them and rotate their activities to keep the noise down.  It’s up to you.  The goal of the schedule to should be to aid you and your toddler towards the ideal Mommyhood vision you have, without controlling either you or them.  Like a baby schedule, it should serve you, not you serving it.  You’ll see the results in your toddler’s development and attitude if you’re doing it right.

So, here are some things that might fit into a normal toddler’s schedule:

• breakfast, lunch, dinner
• snacks
• nap/rest time(s)
• bathtime
• storytime
• playtime outside
• playtime inside, free play
• gross motor skills (stair-climbing)
• fine motor skills (beads, spoon)
• musical play
• craft/art time (playdoh, crayons)
• time with a sibling
• one-on-one time with Dad
• TV/video time
• roomtime alone (ours always started with lots of toys, music on, for about 15-20 mins)
• independent skill time (toileting, dressing)
• chores or “Mommy’s Helper” time (laundry, kitchen, bed-making)
• clean-up time
• flashcards (letters, animals) or other educational one-on-one time

Once you have identified a list of activities you want in your toddler’s day, make a list of things you need to fit into your day, and any time restrictions:

• 7:45am and 2:40pm- transporting kids to/from school
• 30 mins dinner prep time
• one laundry load per day
• 15 minutes personal time (alone) two times a day
• 15 minutes Husband/Couch time in the evening
• 3:30-4:30- daughter’s piano lesson, waiting in car
• kitchen clean-up twice per day
• nap
• shower
• 30 mins of exercise
• breadmaker/slow cooker checks

Once you have identified a list of activities for yourself, try and start putting the two lists together in a logical flow.  You may need to separate your child’s activities into two categories: those that require your participation, and those that are self-entertaining.  The goal is to get your toddler to do self-entertaining things at the times you need to focus on something else (like the cooking).  Many times, your toddler will want to be with you while you are doing what you’re doing, which is fine.  But make sure you give them something of their own to do while you’re working or your dresser drawers will likely be emptied by the time you’re done your shower!

You’ll also need to be flexible with your own activities, working them around your toddler as you probably learned to do when they were a baby.  A 30 min shower, dressing, and make-up time might not be feasible first thing in the morning… you may have to sacrifice 10 or 15 mins, or switch to an unorthodox time like the baby’s 10am nap.  But at least you’ll get it in.  I’ve caught so many of my mom friends showering at 4pm or going for a jog just before it gets dark =)  You’ll have more of a say when your child is older, I promise.

Schedules can continue into the preschool years if your kids haven’t become self-entertaining yet.  Three and Four year olds often love schedules as long as they have some control over them, so Choice Time (i.e. where they pick chalk on the easel or playdoh) is often very effective.  But make sure YOU choose both Choices beforehand so you know you’re ok with them   Most preschool teachers use a visual schedule, which is helpful for kids with delays or control problems.  You can spend no money and make some picture cards yourself, tack them onto a bulletin board or tape them on a wall.  Or you can spend some money on software that has similar pictures preschool classrooms use for “bathroom,” “snack,” etc.  Some public schools even allow you to make an appointment to use their software and laminating machine.  But that’s only necessary if you’re an ALL OUT stay at home mom

Sometimes the visual thing is good for Mom too.  Especially if you have multiple children.  I used to use Excel and print out a spreadsheet whenever I was having a new baby, so I could work in the long nursing times or quiet activities around the newborn’s naps.  My husband found this helpful too, when he was trying to help.  I also had a playdate schedule for the times my friend used to bring her two toddler boys over for a couple hours and I didn’t know how to entertain everybody.

Don’t forget to rotate the schedule as needs come up, the kids grow, their interests change, their attention spans develop, and you get new ideas.  Toddlers need shorter activities and sensitivity in mixing stimulating ones with quieter ones.  Preschoolers are more resilient and can be taught to stick with activities longer than toddlers, to clean up when they’re done, and to require less supervision.

Lastly, kids aren’t robots so sometimes it is better to have a schedule where you only have the sequence of things laid out, instead of exact times lined up.  That way, if the day starts later, the kids take longer eating, the weather changes, an errand comes up, a toy gets boring more quickly, etc., you aren’t thrown off.  Remember, let the schedule serve you, not you serve the schedule.