Noises

Now that our little one has hit the 5-month mark, she's started making high-pitched squeals. There's little rhyme or reason to them. She makes them when she's sad, happy, hungry, or needs a change. We've tried to discern a pattern but have so far been unable to find one.

It seems the only thing she's discovered through her squealing is that if she makes these noises at maximum volume, Daddy makes funny faces and says things like, "oh, God, make it stop!"

Otherwise, we've been very lucky with her. She's healthy, sleeping through the night on a semi-regular basis, and cries only when she needs something. A cousin of my wife's, in contrast, has an infant boy who wails constantly. After first, when my mother-in-law told me about him, I thought she meant it felt like he cried constantly. No, she said, empirically, the kid cries on a near-constant basis. His pediatrician has so far found nothing medically wrong but the crying persists. His poor parents are at their wits' end.

I don't blame them.

Our daughter has started to coo a lot but, thankfully, her loud noises have been so far minimal. Other than the squealing. But, given what some other parents have to deal with, I think I can live with it.

Wetness

The little one's caloric intake continues to increase. Drop by drop, her daily feedings become more filling, more voluminous, more... wet. I've had to tuck both a bib and a burp cloth under her chin to make sure her clothes don't become saturated with formula or breast milk.

We've moved up a size in the bottle nipples, which means she's gone from drinking to guzzling whenever I feed her. Add to that the onset of Drool Season and her ability to pee like a fire hydrant and you have a very wet baby. My only consolation is that she almost never spits up. Thank God.

We're still sticking to cloth diapers, though. My sweetie has managed to keep up with the laundry. My brother has already predicted an end to that because, he says, our next kid will in fact be twins. There's a history of them in my sweetie's family. We'll see how that little prediction turns out.

She's gaining weight, too. She tipped in at almost 12 pounds the other day, which makes her nearly double her birthweight. Not bad for a kid who was barely bigger than my lunch bag on her birthday.

So far, so good.

Children's Tylenol Recall

CNN reported today that the makers of Children's Tylenol have issued a voluntary recall after finding bacteria in an unused portion of an inactive ingredient. The products, manufactured between April, 2008, and June, 2008, were named in a McNeil Consumer Healthcare press release:

Lot # Product Description
SBM041, SBM067, SCM037, SDM027, SEM109 Children's Tylenol Plus Cold MS Suspension 4 oz. Grape
SBM042, SCM015, SCM036, SDM034 Children's Tylenol Suspension 4oz. Grape
SBM043, SBM044, SCM029 Children's Tylenol Suspension 4oz. Bubble Gum
SBM045, SCM011, SCM030, SDM035 Children's Tylenol Suspension 4oz. Strawberry
SBM064, SCM033, SDM020 Infant’s Tylenol Grape Suspension Drops 1/4oz.
SBM065, SCM005, SCM006, SDM032 Infant's Tylenol Suspension 1/2oz. Cherry
SBM066, SCM068 Children's Dye Free Suspension 4oz. Cherry
SBM068, SCM035, SCM070, SCM080, SDM005 Children's Tylenol Suspension 4oz. Cherry
SBM069, SBM070, SCM081, SDM006 Children's Tylenol Plus Cough & Runny Nose 4oz. Cherry
SCM012, SCM067, SDM007, SDM068 Infant's Tylenol Suspension Drops 1/2oz. Grape
SCM013, SCM014, SCM069 Children's Tylenol Plus Flu 4oz. Bubble Gum
SCM016, SFM024 Children's Tylenol Plus Cold Suspension 4oz. Grape
SCM017 Children's Tylenol Plus Cough/ST Suspension 4oz. Cherry
SCM082, SDM039, SDM040 Infant's Tylenol Suspension Drops 1oz. Grape
SCM083, SCM084, SDM008 Infant's Tylenol Dye Free Suspension 1oz. Cherry
SDM064 Children’s Tylenol Pediatric Suspension 1oz. Cherry
SDM038, SDM009 Infant's Tylenol Suspension Drops 1oz. Cherry
SDM033 Children's Tylenol Plus Cold/Allergy 4oz. Bubble Gum
SDM078 Infant's Tylenol Drops 1oz. Grape
SCM034 Infant’s Tylenol Grape Suspension Drops H/G 1/2oz.
SDM028 Children's Tylenol Suspension 4oz. Cherry, Hospital Govt.

Neck Crud

My daughter has all sorts of folds in her skin that trap all sorts of stuff but it turns out that her neck, especially, is a magnet for crud. For the first couple of weeks, we didn't even think about cleaning the folds of her neck. We were careful about keeping her clean while she fed and, since we didn't see anything spill past her chin, all was good, right?

It turns out her neck is a breeding ground for bacteria that feast on the dribbles of sugary breastmilk that escape her bib and the burp cloth we keep around her neck at each feeding. My first clue of a problem was a blue cheese smell when I picked her up to kiss her. Imagine my surprise when I saw what looked like a yeast infection in the folds below her chin.

My sweetie and I have been doing our best to stay on top of it and wipe down her neck every day but the bacteria are still there. We had to give her a thorough scrub-down - after a bath! - this evening to clear some stuff away. Some days, it seems to get better. The redness largely disappears and the folds are mostly dry. On other days, it flares up again and we end up back where we started.

I think this is going to last until she's able to hold her head up, which won't be for another couple of months at least. Until then, we keep cleaning her with water and Witch Hazel, then dry her off. Lather, rinse, repeat. But it seems to be doing little good.

Any suggestions?

Baby Talk

She's lying on my lap, looking me in the eye, smiling, and making all sorts of noises.

This is life, as it is meant to be lived. And I wouldn't have it any other way.

Sleep Positions

I keep forgetting how flexible babies are. When my daughter stretches, she does a back-bend that would snap my spine in half. If I hold her under the arms and gently swing her legs back and forth, she's as loose as a limp cat. As I write this, she's on her back in the crib, arms thrown over her head, feet together, knees apart, fast asleep.

Everything we've read tells us that babies are best kept on their backs or, if they're old enough, their sides when they sleep. Sleeping face-down increases the risk of SIDS, Sudden Infant Death Syndrome, because very young children lack the ability to lift their heads. Face-down positions can cause the mouth and nose to be blocked, leading to suffocation. So my sweetie and I are vigilant about ensuring that our daughter sleeps face-up.

Of course, as with anything else related to babies, there's an industry catering to, and doubtless profiting from, sleeping. A quick cruise through the relevant Amazon page reveals a boatload of devices designed to keep your baby in an optimal sleeping position. Other sources include the comparison sites NexTag and Epinions. Target even offers buying guides, including one for cribs, lest you lose an opportunity to part with your hard-earned cash.

My wife and I haven't gotten anything resembling a sleep positioner yet but, if we do, we'll probably check with Consumer Reports before rushing out to get anything. It'll cost, of course, but reliable knowledge is almost always worth buying.

The question is, are sleep positioners?

The Joys of Cloth Diapers

When it came to diapers, my sweetie and I realized that we are, above all, two things. We are environmentally conscious. And we are cheap. The environmental benefits of using cloth diapers instead of disposables were obvious. The economic benefits, after running the numbers, became obvious as well.

Still, we'd heard all sorts of things about cloth diapers, few of them good: the constant washing, regular changing, storage issues... disposables were, and are, far more convenient. Use once, throw away. Repeat until college.

Courtesy of an online community called Diaper Swappers, however, my wife found a whole stack of bargains on secondhand cloth diapers. After persuading me to try them, she made several purchases, all of which came through as promised and all of which arrived fresh and clean. They turned out to be a lot more sophisticated than I thought. After all, they're cloth diapers. How fancy can they get? They're just absorbent giftwrapping for the presents baby leaves for mom and dad, right?

It was here that I learned a fundamental truth about marketing anything to parents: nothing is too fancy.

First, disposable inserts are an option, which makes life a lot easier. Slip one in between the skin and the diaper and you've got a piece of what feels like smooth, heavy paper to catch the solid waste, aka "poop," while the rest of diaper would catch the urine.

Second, the diapers have a separate breathable poly-vinyl outer skin called "Thirsties" that goes over the outside of the cloth diaper. Once the whole package is on baby's bottom, it looks like a thick swimming diaper. You can even color-coordinate the Thirsties.

In other words, it wasn't nearly as primitive as I thought it would be. In fact, it was kind of fun. But what really cracked me up were the names of some of the cloth diaper brands. Bummis. Fuzzi Buns. And my favorite: bumGenius. These names rank right up there with Boudreaux's Butt Paste.

I guess if it isn't cute, you can't market it to the parents of babies.

Anyway, my wife put together a spreadsheet/chart/graph presentation worthy of a White House briefing that showed that even with the purchase of a brand-new washing machine, we'd still spend more in a year buying disposables instead of using cloth. Plus we can keep the diapers on hand if - when - we have a second child. We went ahead and bought the washing machine so my wife wouldn't have to pack up our daughter on daily trips to the apartment laudromat with a bagful of dirty diapers.

So far, the laundry hasn't defeated my wife. My day-long in-service training regimen finally ends tomorrow - and you thought teachers had summers off. Ha! - so I'll be able to start helping with that. I'm the primary cook now, which free my sweetie up to care for the baby and stay ahead of the other household chores. She's even managing to get something approximating enough sleep. So far, so good.

All in all, I'd say that the cloth diapers were certainly worth it. Tedious, yes, but not nearly as much as I'd feared. Plus we keep a stock of disposables on hand, just in case. We haven't needed them yet but with only two days worth of cloth diapers in steady rotation, you never know.

In fact, I have only one major complaint: the diapers don't wash themselves.

The Baby Always Wins

That's because the baby, when you get right down to it, is the one in charge.

Oh, we adults think we're the ones running the show. We pick the outfits, the crib, even the baby's very name. Rainbowchild Moonflower? Sure, why not?

But with one simple, monotone vocalization, the baby asserts its dominance with such crushing speed that we're compelled to come running no matter the day, no matter the hour. The adult is tired? Irrelevant. The adult had a bad day? Irrelevant. The adult has no idea what the baby wants? Irrelevant. The baby wants it and the baby wants it now.

The baby, like the Borg queen and her drones, bends us to her will. The baby doesn't need to work out how to communicate with us. No, it's up to us to figure out what she's saying. If she's unintelligible, well... that's not her problem. She starts making noise and doesn't let up until she's satisfied. How to satisfy her is our problem.

It's like communicating with a politician... except that when all else fails, you can always smack the politician upside the head. Do that to a baby and all you get is... more crying.

It's lose-lose. Except for the baby, of course. Because the baby always wins.

Sleeeeeeep...

It's not that the baby doesn't sleep. She does sleep. A lot. She's slept 16 hours in the past 24. You'd think that with the average adult needing only 8 hours a night, this would be no problem for her intrepid parents. But she doesn't do it all at once. And it's making us a little crazy.

We're very lucky in that I'm on summer vacation and able to help with the daily routine. Being a public school teacher doesn't pay much but if this time with my daughter is the trade-off, it's worth every penny I'm not making. I'm able to do the little things with her: feed her, bathe, let her fall asleep in my arms. Even changing her diaper is nice to do, if only because it means my still-recovering sweetie doesn't have to do it all herself.

The constant activity, though, leaves little time for a solid block of sleep. We're like doctors on call, only doctors actually get off call every now and again. Neither my wife nor I can imagine how single parents do it. Or, for that matter, how married couples without an external support system manage.

I've read in several places that children place a huge strain on a relationship, especially if that relationship wasn't terribly strong to begin with. I can see the wisdom firsthand in that. My sweetie and I talk constantly, work together, plan together, and are as much a team as we can be and we still have disagreements, exacerbated by lack of sleep. How it must be for couples already having difficulties I can't fathom.

I'd keep writing but I'm sleepy and actually getting to go to bed. Goodnight.

Feeding Mom

There are many benefits to breastfeeding: breastmilk contains everything the baby needs, it costs nothing (technically), it's absorbed so efficiently that solid waste is rare for the first few weeks, and it stimulates the production of oxytocin in the mother which helps her uterus shrink back to its normal size. Good things, all.

Here's one more: the mother needs to eat more.

My sweetie and I didn't know this until after our daughter was born but in retrospect, we should've guessed. Producing milk burns calories, which means my wife has to eat about 500 more of them above her normal daily requirements. That's 2,500 calories a day. That's a lot of ice cream.

Usually, we eat as healthy as we can. Lots of fish and lean poultry, fresh vegetables, fruit, whole wheat pasta, and rice are our staples. I indulge in corn chips to go with my mother-in-law's killer homemade salsa - the recipe is a family secret so don't bother asking - and have a handful of M&Ms when the chocolate craving hits. My sweetie's weakness is cheese. Unfortunately, the markets in our rural community can't match the variety you'd find in a major city but she's usually happy with what's available. Beyond that, though, we don't splurge much.

The problem - if you can call it that - with our diet is its bulk-to-calorie ratio. We eat a lot but much of what we eat is naturally low-calorie. Filling up doesn't break the calorie bank, which is great... most of the time.

There's a second problem my sweetie's been having, one a bit more serious: just when she needs to be eating more, her appetite has been suppressed. We don't know what's causing it. She's simply not as hungry as she used to be.

It might be a post-partum re-tuning of her digestive system or a function of the chronic fatigue that comes with having a newborn in the house. We don't know. Neither does her doctor, who urged my wife to force herself to eat more even if she's not up to it. Her body has only so much in reserve and the milk has be as fortified and nourishing as she can get it.

We're going grocery shopping in a couple of days. Our hope is to find some things that are high-calorie but still relatively healthy. Things like nuts, avocados, and fatty fish might fit the bill. I'm open to other suggestions, the cheaper the better.

If her appetite were good, my sweetie would be in heaven. Our pantry would be overflowing with cheese, fruit, and ice cream. Ah, the sacrifices we make for our children. Unfortunately, we have to tinker with the formula a bit. It may mean eating some things she doesn't quite like but, after all, baby comes first.

Someday, baby will learn to bring breakfast to her mother in bed. Someday very soon.

What to Pack for the Hospital

The nurse who taught our birthing class gave each couple a list of things we might want to pack to bring to the hospital when the time came to deliver. The basic philosophy was that it's better to have things you don't need than need things you don't have. As it happened, we had a lot of things we ended up not needing.

A quick check online reveals numerous checklists of items to tote along when headed for Labor and Delivery. Parents.com, A Healthy Me, and The Labor of Love all offer fairly comprehensive packing lists of what you might want to bring.

The most important thing to remember is to have it all packed ahead of time. My sweetie made sure we had everything packed by Week 36 which meant that by the time her labor started, we could simply grab our stuff and go. If you throw it all together at the last minute, you risk forgetting any number of things.

In the end, we ended up not needing a lot of the things we brought. Our pack of playing cards went unopened. We played only two of a dozen or so CDs. The box of cereal bars I'd brought along as a snack is even now in like-new condition. I have to admit, though, that some of these went untouched because her labor went a lot faster than anyone expected.

Some other things we brought proved invaluable. My sweetie said that she found the music - for which we'd purchased a cheap portable boombox from Wal-Mart just for the occasion - very effective for soothing and concentrating even during the peak of transition labor. The camera, of course, saw heavy use. I even took a picture of the placenta... not that I'm going to post that anywhere. For a snack, I'd packed a bag of leftover popovers as well as the cereal bars and the home cooking was much more enjoyable in the hospital than the pre-packaged bars would've been. And having several changes of clothes came in handy as we stayed in the hospital three days and two nights.

Finally, I had to run back home for three items we didn't think we'd need. First, the breast pump. We're breast-feeding our daughter but she had some early trouble getting anything out of my sweetie's breasts. The pump helped get the colustrum flowing and the nipples a bit perkier for easier latch. Now, a few days later, she's still pumping since milk production has ramped up and is making things a bit uncomfortable for my sweetie when she sleeps.

Second, gym shorts. For me. I don't bother with pajamas unless it's winter but I realized too late that I don't like sleeping in jeans and plodding around a public hospital in my boxers wasn't exactly dignified. A pair of mesh gym shorts quickly solved that problem.

Finally, our laptop computer. We'd initially decided to leave it at home rather than risk having it lost or stolen. My in-laws live an hour away and were present for the birth. My parents, though, live overseas and I have have other family scattered across the map so we were able to use the hospital's free wireless internet and do some online videoconferencing so show off the newest member of the family. If your hospital has high-speed internet access and you have a computer with a camera, I strongly recommend bringing it along. My parents were so enthralled with their first grandchild that my wife and I joked about leaving the camera trained on our daughter while we went for a long walk.

The key to packing for labor is to pretend you're going on a trip where you'll be out of touch for a while. Bring your own entertainment, your mobile phone, your own music. Pack light and pack an extra outfit or two in case you're stuck in the hospital longer than expected. And if you have friends willing to run errands for things you need, take advantage of the offer. Because once the baby's here, there's a lot of work to do.

Finding Out Baby's Gender Ahead of Time

Some people want to preserve the mystery. Others can't stand not knowing. My wife and I fell into the latter category and I'm glad we did.

I had a feeling our child would be a boy. She thought it would be a girl. As with so much else in our marriage, she was right and I was wrong. For once, though, I don't care.

Coaching my wife through the pain, hearing her cry out after the woefully inadequate analgesics had worn off, and concentrating on her comfort during seemingly endless contractions took all of my attention while she was in labor. I was so focused on her that it was only a chance look at her obstetrician that reminded me why we were here - the baby's head had emerged and the OB said, "one more push, one more push... it's a girl!"

My daughter's insistent wailing filled the air. In that moment, I forgot about my wife. Heck, my wife forgot about my wife. Despite her exhausted state, she gasped and murmured, "we have a baby." All I could do was stare at that crying little infant and for the first time, the words "my daughter" popped into my head. I felt such a flood of relief and joy that I slowly exhaled and for several seconds forgot to breathe back in.

For us, not knowing the gender in advance prevented some of the biases that might have otherwise crept into our planning like decorating the room in pink or loading up on sports-themed baby outfits.

Although if anyone has a lead on diapers with the New York Yankees logo on them - on the inside, of course - please send me a link.

I cannot now imagine any other scenario. I cannot imagine how I would feel had my child been a boy, although I doubt my emotions would be any different than they are now. And I don't want to. I love my daughter.

That's all I need to know.

Got Her Home Intact

Back from the hospital. Very tired: Mom is exhausted and napping, Dad is in the office next to the crib, watching his little sweetheart doze. The baby is doing reasonably well, although her weight loss is a bit more than her pediatrician would like. We're going back for follow-ups tomorrow and the next day.

I'll follow up with a more proper blog entry in the next day or so, once we're more settled.

She Has Arrived

Our daughter was born at 11:34AM yesterday. Baby is healthy, mom is recovering well.

Life is good. Confusion will doubtless follow.

The Breast Pump

I have to admit, I find this device intimidating. I imagine there are some men who would happily sign right up to use a machine that attaches itself to a sensitive part of their anatomy and then sucks bodily fluids from it. But after seeing it in action... I don't know.

It's innocuous enough. Ours looks like an empty airhorn with a grammophone top and was, I thought, horrendously expensive... until I started shopping around. I've discovered that breast pumps, like anything else related to parenting, is an industry unto itself. There are kits for these things, entire pumping systems, each more expensive than the last. I believe I'm in the wrong line of work.

As for the pump itself, there's a large trigger mechanism along the top that activates it. Plug it in, use the battery, or use the manual pump. Any one of the three will get things flowing. So to speak.

Once it's going, the nipple is gently pulled into the grammophone top (which Avent calls a "sealing disc" but I like "grammophone top" better), released, pulled in, released in a regular rhythm. You could set a metronome to it. In, out, in, out, in , out... Like I said, some men might find it... titillating.

Sorry, couldn't resist.

Anyway, the pump runs quietly on electric mode, which is good. If it were too loud, we'd limited in its use to time when the baby was awake. And mobile babies are often hungry babies. Manually expressing milk, while silent, would probably fry our wrists in an awful hurry. Even though my sweetie will be at home for the time being, she'll likely be teaching the occasional night class at the local junior college. And since *I* can't express milk, the pump should prove quite useful in preparing for those evenings when she won't be around.

So we now know how to use the pump and have assured ourselves that it works as advertised. I've also read that stimulating the nipples can encourage labor by releasing oxytocin. Pitocin, which is a chemically identical manufactured version of oxytocin, is used to induce labor so perhaps this will bring some regularity to the on-again, off-again contractions my sweetie has been enduring for nearly a week. My only concern is the warning that excessive nipple stimulation might lead to too much oxytocin release, resulting in overly powerful contractions that can harm both mother and child.

With that in mind, we tested the pump for perhaps three minutes before stopping. Better to suffer a few more days' pregnancy than risk harming our child.

But haven't we suffered enough?

To Induce or Not to Induce

As you may have read below, I've been very impatient for the birth of our first child. Under other circumstances, I might not be but the premature labor pains my wife endured earlier this week got me very excited about our impending arrival. So she and I have been talking, on and off, about the benefits and drawbacks of medically inducing labor.

Benefits: the baby is born on our schedule, we can plan in advance when we can expect to bring the baby home and have the apartment ready in time, and my wife can finally stop carrying 35 extra pounds around.

Drawbacks: we're not thrilled with the idea of tinkering with her body's natural rhythms, labor could prove more painful since the cervix hasn't finished preparing itself for dilation, and as of right now, there's no medical reason for it.

I did a little research and found a very good resource at the Mayo Clinic that discusses the effects of and reasons for inducing labor. From the website:

Your health care provider may recommend inducing labor for various reasons — primarily when there's concern for your health or your baby's health. For example:

• You're one to two weeks beyond your due date, and labor hasn't started naturally.
• Your water has broken, but you're not having contractions.
• There's an infection in your uterus.
• Your baby has stopped growing at the expected pace.
• There's not enough amniotic fluid surrounding the baby.
• Your placenta has begun to deteriorate or separate from the wall of your uterus.
• You have a medical condition that may put you or your baby at risk, such as high blood pressure or diabetes.

Rarely, inducing labor is a matter of practicality. If you live far from the hospital or you have a history of rapid deliveries, a scheduled induction may be best.

There's an important caveat, however. If you've had a prior C-section, you may not be a candidate for labor induction. After a prior C-section, inducing labor increases the risk of uterine rupture. This rare but serious complication — in which the uterus tears open along the scar line from a prior C-section — can cause life-threatening blood loss, infection and brain damage for the baby.

There are, however, several folks methods - like castor oil and spicy foods, which I mentioned in a previous post - that supposedly work. We've largely ignored them, although I never say no to spicy food. Instead, my sweetie has continued to do light exercise and the contractions, although still not very strong, have increased somewhat in intensity and duration.

Since none of the medical reasons apply to us, and since we're taking as naturalistic an approach to her labor as we can, it seems that induction isn't in the cards for now. Once we hit Due Date Plus 10, then we can talk about it.

In the meantime, she and I are sitting out the hours, enjoying our final few days of peace and quiet before our new arrival. I know that someday we're going to look back nostalgically on these last days. Right now, though, that's pretty hard to imagine.

Choosing a Pediatrician

About two months ago, somewhere around Week 30, my sweetie and I started looking for a pediatrician for our child. Throughout the pregnancy and through the labor, our baby's health is the responsibility of my wife's obstetrician. The moment mother and child separate, though, Junior is going to need his or her own doctor.

Choosing a pediatrician is both harder and easier than it sounds. If you already have a child and you're happy with your kid's doctor, you're all set. If your friends and family have a pediatrician or pediatric practice that satisfies them, great... assuming they're taking new patients. For many new parents, though, it's not quite so simple.

In our case, my wife and I each have family all over the place and none with children living nearby. We don't know too many people in our neighborhood with kids - I suspect that'll change soon enough - but, in the meantime, we're more or less on our own in terms of finding a pediatrician.

I should mention here that my wife is the only child of a career soldier who retired at the rank of sergeant major after 26 years of military service. He has a natural inclination towards compulsive organization, a habit the Army did little to correct and much to encourage. And my wife is very much her father's daughter.

One of her first actions was to track down a the names of doctors at the pediatric practice affiliated with her OB and put together a list. Making a list may sound like a lot of work but in this case, it saved us a lot running back and forth for information. It was made easier in our case because we asked the nurse teaching our childbirth class if she had any recommendations. This list became the base of our search.

She printed out the list, noted where they went to medical school, conducted - although, if you know any doctors, you'll probably agree that "endured" is the better word - their residency training, and how long they had been in practice. Once the list was complied, we went over it together. And this where my biases crept into play.

I don't care about my doctor's ethnicity, religion, gender, or sexual orientation. I don't care about those things in my kid's doctor, either. What I do care about is where my doctor went to medical school and where they did their residency training. This may be due to conversations I've had with a former girlfriend - herself a doctor - who never a met a student from a Caribbean medical school who was remotely competent or interactions I've had over the years with friends and classmates who've gone into medical practice. I don't know. What I do know is, I want a doctor who trained in the United States or, failing that, Great Britain or Western Europe. What I don't want is someone who attended medical school in the Caribbean. I'll get into why in a minute.

Say what you will about the present state of the American health care system - and there is a lot to say about it - I would still argue that the United States as a whole consistently produces the best doctors anywhere. I want to stress the words "as a whole." I have no doubt that European, Asian, and Indian medical schools produce some outstanding physicians. In most cases, however, the level of resources available to train doctors is far higher in the U.S. than elsewhere. The result is that, knowing nothing about else about my child's potential caregiver, I'm more comfortable with a U.S.-trained physician than one who was educated overseas. In places like, say, the Caribbean.

Many American students have over the years gone to medical schools in the Caribbean. Despite their idyllic locations, however, places like Ross University and St. George University have lower admissions standards than their U.S. counterparts and lack an academic medical center at which medical students can train. This, to me, is a major strike against them.

Students at these schools typically spend their first two years studying basic science, just like their American counterparts. For their third and fourth years, however, they are scattered to the four winds, sent to hospitals around the U.S. and U.K. in largely piecemeal fashion to get their clinical training while American students typically stay in the same area, rotating through their home medical center and nearby hospital affiliates.

Academic medical centers in the U.S. see a huge variety of cases and have eight- or nine-figure research budgets, giving medical students an exhaustive - in every sense of the word - range of learning experiences. These hospitals typically don't teach students from foreign medical schools, including those based in the Caribbean, concentrating instead on teaching students affiliated with their own medical education programs. Foreign students are consequently forced to take on clinical rotations at hospitals with fewer resources for training and don't see the range of cases that students at a major medical center would encounter. The result is that Caribbean medical students tend to receive a lower quality of basic clinical training, which hampers their ability to land a high-quality residency.

In fact, when it comes time to find a residency, graduates of foreign medical schools are at a distinct disadvantage. Highly competitive specialties tend to have few or no foreign medical graduates at all, with those spots going to the cream of the U.S. crop. Unfair? Perhaps. But medical education is as much about opportunity as anything else. A med school graduate from Harvard or Columbia, or even the University of Arkansas, will have had many more opportunities to engage in a wide range of clinical experiences than a graduate of a school in the Caribbean.

I'll be the first to admit that Caribbean medical schools might not be getting a fair hearing. But as long as recruiters from those schools continue to recruit applicants who couldn't get into American medical schools, they're going to be stuck with a reputation as second-rate, a reputation that will limit their training opportunities and count against them when medical residency directors rank their wish lists of applicants.

The long and short of it, then, is that my wife and I wanted an American-trained pediatrician. Personally, despite everything I've written above, I'd be willing to overlook a Caribbean medical degree if the doctor in question had done his or her residency at a reputable medical center in the U.S. A top-flight residency can make up for most deficiencies in earlier medical training and I'd be comforted knowing that Dr. X passed a rigorous training program. As it happened, though, that was a non-issue.

In fact, most of the pediatricians in our area were educated and did their residencies either in our state or a neighboring state. This isn't surprising. While a neurosurgery or dermatology practice may have a roster of physicians from the best medical schools and residencies in the country, pediatrics is one of the least glamorous - and lowest-paying - medical specialties. And where a Park Avenue or Beverly Hills pediatric group might boast a collection of Johns Hopkins or Stanford M.D.s, this is not the norm in most parts of the country. And that's fine.

Training standards at major academic medical centers are high enough to reassure me that the doctor I choose will be competent to handle 99% of whatever afflicts my child. For the other 1%, I can always see a specialist (assuming my insurance agrees to cover the costs, but that's another post). So as long as the pediatricians we were considering had done their training at a major university hospital, we would be happy.

We narrowed our list down to a small handful of candidates at the local pediatric practice, all educated at state university medical schools, all with residencies within driving distance of our home. Unfortunately, some of the factors we might have used to winnow the list further didn't apply.

All had the FAAP designation following their names, meaning that as Fellows of the American Academy of Pediatrics they were committed undergo regular training to update their skills and knowledge base. So the lack of that couldn't be used to narrow the list.

We asked our OB, herself the mother of 3 school-age kids, if she had any recommendations or reservations, and were told that she'd be comfortable with any of the doctors in that practice. So that didn't help, either.

I also skipped over two doctors who were in their sixties, although it didn't matter much to my wife. While there's a lot to be said for decades of clinical experience, my wife and I didn't want to be in the position of looking for a new doctor again in five years because our current pediatrician retired. We want to build a stable, long-term relationship with someone who knows our child and I thought that an older doctor might call it a career before Junior called it a childhood.

My wife then picked up the phone and tried to schedule brief appointments to meet with the two doctors left on the list. One was available, the other couldn't commit to a time right away. So my wife met with doctor #1, a 40-something man with an approachable demeanor, and came away impressed.

A short while later, she met with doctor #2, who was the head of the practice. Saying that your kid's doctor is the chief of pediatrics at X Hospital may impress at cocktail parties - and if it does, that's kind of sad - but the head of a practice isn't always the best doctor. It's usually the doctor most willing to take on the administrative workload involved in managing the practice, often in return for a larger piece of the practice's income or a reduced clinical or overnight call load. All that paper shuffling takes time away from patient care and I didn't want my kid to have to compete with paperwork for his or her doctor's time.

Like I said, choosing a pediatrician is both harder and easier than it sounds. If you're stuck in the "harder" end of things, there are many good resources available to help. Start by asking your obstetrician or perhaps your primary care doctor for referrals. If you don't have a regular OB or if you prefer to look online, you can warm up at Parents Magazine or Baby Resource. An excellent list of questions for your prospective pediatrician comes from Children's Hospital in Boston. And if you're not happy with the referrals you've gotten locally, you can try the referral service run by the American Academy of Pediatrics.

My wife and I were lucky in that our local pediatricians met our requirements and were available to take new patients. For some, it might be this easy. Others may have a tougher time. The most important point is to not rush into this decision. This is your kid's life on the line. Do your homework and take your time. It's as much for your health as your child's.

Waiting for the Birth

This past Monday, my sweetie started having contractions. We very calmly went to the hospital, only to be told after two hours of monitoring that the labor wasn't progressing and to head back home. That was three days ago. She's still having contractions. We're still waiting.

I'm an elementary school teacher, which means that right now, I'm on vacation. It also means that I've been at home for the past 3 weeks, helping prepare the apartment for our impending arrival. At this point, all of the prep work has been done. The crib is built and mattressed, the car seats are installed, the baby monitor is plugged in, all loose wiring is secure, the changing table is positioned by the crib, even the diaper pail is bagged and ready.

All we need now is the baby.

We don't want to induce, certainly not with the due date still a few days away. Maybe if the baby overshoots the due date by a week, sure. Right now, though, it's way too early. Still, those contractions are driving me to distraction. I know, I know, my sweetie feels them more than I do. And she does. Yet, she's taking this much more calmly than I am.

Right now, she's splitting her time between very light exercise and reading. I'm burning off my nervous energy blogging. I've become very impatient. I want my kid now!

My sweetie has taken to exercising in the apartment partly because it's insanely hot outdoors right now and partly to help speed labor along. We spent part of this afternoon online looking up various ways to progress labor without resorting to medication. There aren't many options.

Some of the stranger ones include the consumption of castor oil - apparently suggested by well-meaning Little Rascals fans unaware that a woman does not in fact excrete her baby - and eating spicy foods.

The one that made the most sense, actually the one that made the only sense, was light exercise. Walking is the simplest and most cost-effective. Lace up your shoes and step outside. Or, if your summer's been as hot as ours, stay indoors and pace back and forth with the TV or radio on for company.

Stair-climbing is another option, assuming you don't push yourself too hard and are in reasonably good shape.

Swimming would be my choice - it takes pressure off the joints while still providing a moderate cardiovascular workout - but my sweetie wanted to stay out of the 105 degree heat index presently outside our window. I can't say I blame her.

So she's walking back and forth, resting, doing a few squats. Me? I'm just sitting here. Waiting.

In more restrained moments, I realize that in a month or two, I'll have moments when I want to send the kid back. I know this. I accept it. I still want my kid now.

I want to know what the baby will look like, feel like, sound like. I want to know if it's a boy or girl.

I want to show my child what the outside world is like, what's waiting, what having two sets of doting grandparents is like.

I want to share my passion for writing, reading, travel, and games with my child. I want to share all those little moments of discovery: how to walk, how to pile blocks, how to speak, which parent is mama and which one is usually confused.

I'll have those moments, and countless others besides. I know this. I do. I'll have more moments than I'll know what to do with.

There's just one small problem. I want to start now.

Infant Intelligence

My baby, although still in the womb, is the smartest baby ever. My evidence? Although my wife is now at term, our baby has apparently decided to stay right where he/she is and avoid the stress of the outside world a while a longer. Genius.

But, seriously, if we're talking about infants, is being "smart" really that big a deal? And if it is that big a deal, does it mean more to the child or the parent? I once noted to an acquaintance that her baby was holding her head up on her own about a month ahead of the developmental average. The acquaintance, a woman with an Ivy League law degree, took it as a complement - to her, not her kid - even though I'd meant it only in a "hey, cool" sort of way.

And while we're at it, how exactly do you measure intelligence in a baby? What constitutes "smart" for a person who thinks feet are for sucking, not for walking?

There are so many hypotheses about the nature of human intelligence it's hard to know where to begin the conversation. There's no universally accepted definition of intelligence, never mind an accepted way to measure, gauge, or assess it. The result is a slumgullion of arguments guaranteed to keep academics squabbling and parents fretting for generations to come.

Here's what we do know in very, perhaps overly, simplified terms: from an undefined moment in utero until the moment it shuts down for good, the brain constantly gathers information. The flow of information causes neurons to connect, interconnect, and multiply (up to a point). Those connections guide behavior and perception, which in turn affect the processing of incoming information, which influences how neurons connect and interconnect, which further guides behavior and perception, and so on.

Just because the information is going in, however, doesn't necessarily mean that it's being processed in any meaningful way. And even if it is processed meaningfully, articulating that meaning may still be impossible.

I could spend the next hour trying to teach a one-year-old how to do algebra. I guarantee that the information is going into his brain through multiple pathways: the eyes, the ears, even the hands if I give him a calculator. But if I then stick an equation in front of him and say, "solve for X," he'll most likely chew on the end of his pencil and then wet himself.

So how do we measure an infant's intelligence?

"Intelligence," if you'll let me provide my own definition, is a measure of the brain's output in response to external and internal stimuli. In other words, intelligence is how the brain responds to certain triggers. And it has its evolutionary advantages. If you're in the woods and a bear starts charging toward you and your brain says, "RUN!!!", you're more likely to pass your genes on to the next generation than if your brain says, "ooo, look, a pretty rock!" In theory, therefore, all you have to do to measure intelligence is measure the brain's responses to selected stimuli. And this is where it gets messy.

Intelligence testing has a long and controversial history going back decades. About 100 years ago, two guys, Alfred Binet and Theodore Simon, drew up the first modern intelligence test while studying mental retardation among French schoolchildren. In 1916, Stanford University psychologist Lewis Terman made some modifications, which led to the test being dubbed the "Stanford-Binet" test. An updated version is still in use today.

The Stanford-Binet has been widely criticized for its generalizability (how well it applies equally to all people) and reliability (how accurately it measures what it claims to measure). Two kids can get identical scores and proceed to go in opposite directions in terms of academic performance. Despite this, it remains the gold standard for intelligence tests. If you've ever taken an IQ test, it was probably a version of the Stanford-Binet.

Another common and highly popular intelligence measure was devised by Havard education professor Howard Gardner. His seminal book, Frames of Mind, lays out what Gardner calls the 8 "multiple intelligences" or MI. Rather than restricting intelligence to a narrowly-defined intellectual exercise, Gardner argues that intelligence is expressed through numerous facets: athletics, music, spatial reasoning, mathematical ability, interpersonal skills, etc. in ways unique to each individual.

Naturally, Gardner, too, has his critics. Opponents have argued that MI is too relativistic to offer any meaningful measure of intelligence and that it could allow teachers an excuse to play to a student's strengths while glossing over his weaknesses, emphasizing music, say, over math. Despite criticisms, however, MI has taken hold in many schools that have adapted Gardner's theory to the practical matter of devising a curriculum. If your children attend school in the United States, I'll take even odds that MI plays at least some part in the curricular structure.

Many other intelligence measures have cropped up over the years, each with its strengths and weaknesses, none of them the Holy Grail, end-all-be-all test that provides once and for all an irrefutable, definitive measure of a particular person's intelligence.

Naturally, that doesn't stop test-makers and theorists from trying. It remains a lucrative business. There's gold in them thar' brains, just waiting for the right test to unearth it.

Parents of young children, of course, tend to be as concerned about what goes into the brain as what it spits back out. The success of the Baby Einstein line of products - which is what inspired this post in the first place - tells me that some parents will go to any lengths to have a "smart" child. And what better way to stack the odds in favor of having a "smart" child than to have a "smart" baby?

And if that's all there is to it, fine. Buy your kids the toys, show them the videos. It can't hurt. Heck, it might even help. If a child knows left from right, how to tie her shoes, and how to read consonant-vowel-consonant words (like "cat" and "dog") by the time she's 4, great. It'll thrill her kindergarten teacher.

I suspect, though, that in many social circles, parents measure their self-worth by way of their children's accomplishments, even if that accomplishment is as mundane as little Johnny holding his head up a month ahead of schedule. And if that's how parents are using Baby Einstein and his copycat spawn, they're missing the point.

It's not about you. It's about your kid.

Yes, we all want our children to be smart. I'll be the first to tell you that I hope my child is intelligent, both in terms of intellectual capacity and the good sense to put that intellect to constructive use. (By the way, Junior, if you're reading this post and it's many years old, close the browser and go finish your homework. Then get back to me.)

Intellect tends to lead to success. The most successful people - by almost any measure - tend to be highly intelligent. George Washington, Enrico Fermi, Mohandas Gandhi, and Michael Jordan are or were very smart. Whatever else you may think of your own local politicians, they, too, are highly intelligent people. I say that because deviousness is, after all, an expression of intelligence.

All of which brings us back to the intelligence of the infant. I could in fact actually have the world's smartest baby, capable of feats that are the stuff Nobel laureates' dreams. Unfortunately, brilliant or not, my baby will be physiologically incapable of expressing that intelligence for quite a while. This means that my baby - and yours - won't be the subject of parental bragging rights anytime soon. Someday, perhaps. But not for a while.

Like I said, I hope my kid is smart. As someone who likes to set high expectations, I'm tempted to say, "my kid will be smart." And maybe my child will be. Heck, maybe my infant will be.

But how will I ever know?

In The Beginning

In the beginning, there were two of us. My sweetie and me. And it was good.

I went to work each day, trying to corral 22 hyperactive third graders and maybe teach them something while my sweetie stayed home by day and taught a class at the local junior college at night. It was a sweet, almost pastoral existence, minus the sheep. But, last October, after waiting for the maternity benefits to kick in on my insurance, we decided to finally try to conceive.

We'd heard all sorts of stories from people who'd tried for months, years, to have a baby before conceiving. Since we were in our early 30s, we assumed we were in for at least several months of vigorous trying. We couldn't wait.

One day, about 3 weeks after we started trying, my wife called me at school while the kids were lining up to go home. She'd just taken a pregnancy test. It came back positive.

I vaguely remember spending several minutes - after the kids had all gone - skipping up and down the hall.

Fast forward nine months. We're now in Week 39 of her pregnancy. So far, so good. The baby is developing normally, my sweetie's weight gain and health are right where they should be, and the apartment is filling up with all the bits and pieces that signal an impending birth. We were, we told ourselves, ready.

Then, last night, she went into labor.

I'm a calm person. I really am. So when my sweetie came out of the bedroom to the living room around 9:30 and said she was having mild contractions, I just nodded and asked if she was okay. She said yes. For the next hour and a half, we monitored her contractions. I hummed Semper Fidelis while timing them and read the same page in William Cohan's House of Cards over and over for about 90 minutes, jumping - calmly - every time she said, "another one's starting."

Of course, I told myself, I wasn't really a ball of nerves. My asthma hadn't kicked in, after all. My inhaler was still on the office desk, untouched, unneeded. My breaths were nice and deep. Calm.

Around 11:00, we decided to head for the hospital. The nurse at our birthing class said that if we weren't sure if the baby was coming or not to go to the hospital anyway, just in case. So we got dressed and got our stuff together. Weeks earlier, we'd packed a gym bag with clothes, a tote with books, CDs, and snacks, and my camera bag. Along with a nursing pillow and a portable radio/CD player, we had everything we needed to spend a few days in Labor and Delivery.

I carried everything but the pillow down to the car, my sweetie on my heels with the pillow in hand. Everything went into the back of the car. We got into the front seats. I started the ignition, pulled out of the parking lot, and started down the road. A minute later, I checked my pocket.

No inhaler.

I carry that thing with me everywhere - work, home, car, plane, walks. I sleep next to it at night. As Milhouse van Houten once said, I need it to live. And I'd left it at home. For a second, I debated whether or not to go back for it. After all, if you're going to have an asthma attack, a hospital is the best place for it. But my sweetie urged me to turn around and go back for it. So I want back and five minutes later, we were once more on the road. A minute later, I checked my watch.

No watch.

It, too, was at home, sitting on the printer where I'd put it after her last contraction.

"Should I turn around for it?" I asked.

My sweetie gritted her teeth. "No."

Fifteen minutes later, we pulled up to the ER. Since we'd already pre-registered, check-in was simple. Fork over my insurance card - which, thank God, I hadn't forgotten - sign a couple of sheets of paper and off we go to the maternity observation room. Since we had no idea where it was, we asked the admissions clerk.

"Go around to the left and you'll see it on your right."

No problem. We went around to the left, walked a little, and saw on our right... the ER. Okay. We passed a man, woman, and 8-year-old boy huddled together on a stretcher and walked up to the main desk.

"My wife is in labor," I pointed to my sweetie, who smiled, hands on her abdomen. "Is this where we go for maternity observation?"

The nurse frowned. "That's upstairs. Second floor. Go back out the way you came, make a right, and take one of the elevators up."

Upstairs? The clerk had forgotten to tell us that part. But that's okay - I was still calm. We went back the way we came, made a right, and took the elevator up to the second floor, where we found the Labor and Delivery unit. We went to the main desk and repeated what we'd said downstairs.

"Observation?" the nurse said. "You have to go downstairs for that."

"But we were sent up here."

"You were?"

"Yes."

"Maternal observation is downstairs," the nurse said, "on the first floor. If you're standing in the elevator and step out, you go left and it's down the hall on your right. The sign is small but it's there."

My sweetie let out a breath. I was still calm. I swear.

We caught the elevator down to the first floor, turned left down an empty hallway, and started looking for the sign. We saw lots of signs. "Anesthesia." "Surgery." "Maintenance." But no "Maternal Observation."

We went back to the elevator and went down a different hallway. "Benefits." "Administration." "Do Not Enter." But no "Maternal Observation." We tried a third hallway. Again, no "Maternal Observation."

It was like a boring Hitchcock movie.

Back at the elevators, we met some of the hospital's maintenance crew. A very nice woman with a power buffer gave us our first useful direction. Maternal Observation isn't on the first floor, she said. It's on the ground floor. The nurse on L&D had neglected that minor detail.

So we went down one more floor, made the left turn out of the elevator, and finally found it halfway down the hall.

By now, we had no idea where in the hospital we were but it was approaching midnight and we didn't care. A very nice nurse set my sweetie up in a curtained-off bed, hooked up the contraction and fetal heart rate monitors, and checked to see how dilated she was. One centimeter, she said. "We'll keep you here a bit. I'll be back to check on you in about an hour."

We watched the contractions on the monitor, gently sloping up and down. From start to finish, they were, my sweetie said, uncomfortable but not painful. Every 3-4 minutes they came, sloping up, peaking, easing down. The only other sounds were the wet, steady whoosh-whoosh of the baby's heart and the murmured goings-on on the other side of the curtain.

My sweetie drifted off to sleep and dozed for nearly an hour. I spent most that time pacing - calmly - and watching ESPN on the wall-mounted flat-screen television. I sat down for a little bit, watching my sweetie's pulse throb gently in her neck, and resisted the urge to kiss her. She deserved to rest.

After some 90 minutes, the nurse reappeared, checked my sweetie's cervix again, and found that it was still 1 centimeter dilated but "very soft." Still, it seemed that baby wouldn't be arriving any time soon.

She gave us our discharge directions - come back if the contractions get stronger, if my sweetie's water breaks, if there's any bleeding or spotting, or if the baby suddenly stops moving - and unhooked my sweetie from the monitor.

Getting out was a lot easier than coming in. It turned out that from the registration desk we had to go left, and then left again. Details, details.

We drove home, disappointed. But we'd at least figured out what was where in the hospital, what we might forget when we leave home, and how we'd react under pressure.

I, for one, would remain calm.