Five things I learnt when I resumed working after becoming a mother!

With my daughter Aanya at a function after work

by Dr Parul Chopra Buttan

She was 2 months old.

I remember looking at the divine baby in my lap, sleeping blissfully, warm in her mother's cuddle, full with milk from my breasts. I felt, this is it...this is heaven...and eternity...and everything in between! Hormones surging through me, I felt so complete, so fulfilled in that moment, I needed nothing else.

I decided then. I'm not going back to work for the foreseeable future!! How can I? It's inconceivable that I should leave the pleasure of this divinity to go to work! Seemed so mundane! Like leaving saakshaat God's company to chat with a friend, a mere mortal!

As days passed, I reaffirmed my resolve to soak in my baby every living moment of the rest of my life! The fact that I was financially secure and didn't really need the money to pay bills further added steel to it.

Then, I spoke with some of my cousins who were working, with children. Young mothers, kickass lawyers, HR professionals, marketing managers...regarding how could they step back into work leaving these little Gods home! I was curious to hear the other side of the story too: "Even though you feel like this currently, it'll change. You can surely take it as it comes. Years of study and learning can't be put to waste. You'll need a break from the baby too!! Babies are just fine with mommies working."

Over days, I realised my decision was stemming from bliss but also, from some fear. Fear of missing out on my child, fear of distance from her, possibly also of her needing me less & less in my absence and adjusting to it comfortably!

I probed my thoughts for weeks and finally got some clarity and some courage! After 2 more months I felt sort of ready, like just slightly ready for a short part- time sort of thing. As it happens, the universe sensed it.

Papa, a general physician, received a with-family invite for a one hour laparoscopy (key hole surgery) conference. Knowing my interest in it, he suggested we make a family outing of it. (Yes, that's how sometimes family outings look like in a family of doctors!!)

They took turns babysitting my 4 month old daughter Aanya, while I soaked in the scientific feast excitedly! It reminded me of how happy my work makes me, how it fulfills my soul, how it's my calling, not just a career!

The next day, a physician we met at the conference called me with a job offer. Just the ideal serving from the universe! A one hour OPD within one kilometre of our home! I met the hospital's Director and we finalised.

I remember I started leaving my daughter to sleep in the afternoon with her daadu daadi. I would quietly check on her every 10 minutes but soon, I realised she quickly settled down happily in the routine. So I gathered my courage and took my first step out of the house without her!

As I reached the OPD, just sitting in the doctor's chair, free from thoughts of diapers and feeds, concentrating on my clinical stuff, I felt an exhilaration! I remember I saw my first OPD of 4 patients with a grin plastered across my face! I couldn't get it off, even in reminding myself they must think the new doctor is funny for smiling so much!

Oh, the feeling returning to work gave me! Indescribable fulfilment!

This is what I learnt over the next few months as I expanded my work to full time attending consultant at Max Hospital, Gurgaon when she was 8 months old.

1. Happy women make happy mothers  make happy children. If your work fulfills you, by all means go ahead, arrange a safe environment for your baby and go to work! It's more than worth it. The joy you generate at work flows into your home which in turn generates joy and enthusiasm for you to take on work! It's a win-win and you are bathed in joy all the time!

2. Arranging care for your baby in your absence is paramount. So you're not worrying about it at work and can be fully present wherever you are. In my opinion, there is no one better than grandparents and family to be with. But for those not having that option, a trusted babysitter or good day care facilities are a boon. Remember to check on them once in a while and be reachable by phone all the time in case of an emergency.

3. Babies are fine with our absence for a couple of hours and it can even be productive for their growth. She developed such deep beautiful relationships with her grandparents nourishing them all in the process. Having such relationships will enhance your baby's emotional and social quotient, an essential life skill.

4. Start slow. There is no right time or a right duration of work to start. Go as per your comforts but don't be scared to push it just a wee-bit more. Listen to your intuition as pregnancy and mommyhood would have begun to teach you already!

5. You can continue to breast feed. I did so for over 2 years. All options are possible. Milk expression and storage. Bottle feeding or paladay feeding. Top feeding. You could come back home for a quick feed at lunch time, work from home if possible a few days a week or the baby could visit you at work some time!

Once a month I had 24 hour Sunday shifts and my husband would bring her over. While it was heavenly to see her, sometimes she would get quite hassled if I wasn't free and made her wait. Sometimes she would even howl when leaving and once mummy had to come in to hold her as my husband drove back. I felt horrible naturally. The key thing to remember is only you remember this time! Babies blissfully live in the present and do not recall when they were pained by separation from you.



Aanya now happily waits at my clinic on some days, for me to finish work

Go ahead, women! Pursue the life of your dreams! Make it fulfilling and inspirational and happy!! You owe it to yourself. Not despite having a baby, but because of it. And they will learn the art of living from you.

The "Complete" Family

Written by Dr Parul Chopra Buttan

I've been caring for a lot of women in their second pregnancies currently. Often, at the second delivery, I hear sighs, usually from well-meaning relatives, "Oh! Had it been a boy, their family would've become complete!" or "Wow! It's a girl! Family complete ho gayi!".

I have a serious issue with this statement. What does it really mean? Does it imply that when they welcomed their first child, a boy or a girl, their family was somehow incomplete? Waiting to complete when a second child of the other gender arrives? Why then, with two children alone, is the family complete? As the girl child doesn't have a sister & the boy doesn't have a brother, I find the two-child (one of each gender) concept equally incomplete!

I am the eldest of three siblings and have a younger sister & a younger brother. I couldn't think of a more fulfilled scenario and often pitied my friends who didn't have a 'real' brother or sister to boast of! Till one fine day at school, I saw my friend's elder brother demonstrate his protectiveness by shooing away a classmate who was bullying his kid sister. 8 years old & I felt such a pang of need for an elder protective sibling. What was worse was I could ask mom for more younger siblings (though I know how that would've been responded to!! :)), but how could I get myself elder siblings now?!

Ah, the tragedies of being first born!! I looked to my close knit cousins and found my lovely bhaiyas & ḍiḍis to guide me along and somewhat satisfy the need to be the kid -sister myself. But my concept of a 'complete family' somewhat changed. So now the family was complete if you had mummy, papa, an elder sister, elder brother, younger sister and a younger brother. This picture worked for a while till the little me realised that this concept too was flawed! You see amongst those 5 children, only the middle kid's family is complete! The other 4 children are bereft of this ideal scenario!

So then I tried expanding the brood and instantly realised that the number of children then stretches to infinite and the ones on the extreme would still be left without the completeness!! I discreetly remember feeling sad for a while and wondering why does this have to be so. Why can't we have a complete family wherein everyone has their full set of elder and younger brothers and sisters? As it happens in childhood, I got over my pondering and left it at that. A sense of incompleteness and emptiness where there should've been siblings of the right birth order and gender to fulfil it!

After 15 years, as a young postgraduate obstetrician working in a busy labour room, I was witness to all sorts of emotions to babies of both sexes born at all imaginable birth orders. Birth order one to my personal record of birth order 14, yes fourteen! A common thread that ran was the squeals of delight or relief at a baby boy and a silence or worse, disappointment at a baby girl. I took this quite personally, being a girl & a growing feminist! In my immaturity, I sometimes wished that the woman who so insisted or prayed for a boy, be only blessed with baby girls! I would get particular happiness in delivering baby girls!! Even if it started as an immature response to a misguided stereotype, my happiness passionately grew as I delivered the cutest loveliest baby girls! I prayed fervently for one of my own whenever I planned to become a parent.

Growing in maturity through my senior residency, I was filled with empathy for all my expecting parents and wished they get what they want. (I wrote about my experience in an earlier post 'Kudiyan di Lohri'.) I became happier delivering the baby safely and witnessing joy on their faces if it was the sex of their choice. As a consultant, I further gained insight when a young Anesthetist told my patient on whom I was performing a caesarean, "Jo aapke liye accha hai, wahi aayega ya aayegi!" (Whatever is good for you, only shall come to you!) I learnt so much in that one statement of hers and my attachment to the sex of the baby nearly disappeared.

I am a proud parent of a daughter now. I see how she fills up the home with her unending charm! Our house truly became a home, an almost blissful abode, since she arrived. It was like every knot in relationships just opened loose. The slightest of negativity got replaced with golden light. I'm sure little boys do the same for their families. It's a quality of the new beautiful soul entering the world. How many to have is as much determined by the couple's desire as by circumstances or destiny, if you may call it.

But I would like to stick my neck out and say this. Your family is complete the moment it welcomes a soul. The moment it gives forward the love and care and protection, and begins a new legacy. So, whether you are a parent to one or two or any number of children, whether they are of the same or different sexes, whether your child is your own biologically or adopted, whether this new life is a human or a pet or an organisation or an idea - if you feel like a parent and you have something to give forward to, you are complete and so is your family!

As I was in the middle of these thoughts, I happened to have delivered a beautiful baby girl to a lovely couple who have a 3 year old daughter. It was on the day of the Sun Goddess during the auspicious navratri, her dad told me. And I haven't seen a more joyful father and a more welcoming family as I came out with their bundle of joy! Thank you, Captain Saab, for making this "complete family" myth redundant at least in some families!

Captain Saab with his lovely wife and elder daughter

 

World Health Day: Winning the War against Tobacco

Written by Dr Parul Chopra Buttan

Today is World Health Day. Our third new year resolution for a healthy 2016 was to quit smoking. I hope this post helps those of you who are bravely waging a personal war against tobacco.

Thankfully, I don't share this resolution as my knowledge in this regard is limited by lack of personal experience! However, I've helped a few of my patients in their efforts to 'kick the butt'. And am happy to share the insights gained.

It's probably not surprising to know that smoking is on the rise among urban women in India. And thanks to being surrounded by smokers, passive smoking is several times more common & just as dangerous.

Why you must quit

That smoking causes (and the causal relationship is well established now) the following is common knowledge. But it deserves a reiteration -

1. Lung cancer
2. Lung disease like emphysema, COPD
3. Oral cancer
4. Anemia
5. Bladder cancer
6. Decreased fertility
7. Faster aging
8. Anxiety & irritability
9. Heart disease
10. Stained teeth & fingers
11. Blood clots
12. Erectile dysfunction in men

How you can quit

 

Here is a five step path that might help you get started on this, or any other, life-altering journey.

 

1. Do you really want to quit?

A lot of people say superficially that they'd like to quit, but don't mean it deep within. Saying it without conviction erodes your self confidence and makes you question your ability to act on your decisions. Check within. Are you somewhere happy and comfortable with it or are you unhappy with the dependence, troubled by its effects.

2. Delve deep into yourself.

Remember the first time you picked up a cigarette and tried one. Who were you with? What was the setting? Why did you inhale? Some of the answers my patients tell me - peer pressure, belonging to the cool group, boredom, curiosity - hide within them a way out.

3. What was the point of infection?

Notice the transformation point when it became a need from simply being a voluntary choice. When you started depending on it for feeling well & nice. How has the consumption grown, maybe from one occasional cigarette to several a day?

4. What are your present circumstances?

Once you understand what your circumstances and motivations are, you can channel them to help you prioritise this lifestyle shift. From involuntarily reaching out to the smoke, to consciously dealing, in other ways, with what it is that you're feeling.

5. Professional help

Set yourself up for success. Tie up with a professional for ongoing support. Just like people find run-buddies for marathons, find yourselves buddies in this endeavour. Shift the paradigm from taking cigarette breaks with smoke buddies - take healthy breaks to celebrate the win over it with them.

If you have the 'want' to quit, the 'how' to quit will follow easily.

When should you visit your doctor during pregnancy?

Written by Dr Parul Chopra Buttan

In one of our earlier blog posts, we had talked about things to do and keep in mind when you are planning a pregnancy. This post discusses the visits you should make to your obstetrician during the course of your pregnancy. If you haven’t had the pre-conception visit, then a good time to start is as soon as you realize that you are pregnant.

 

Pregnancy is not a disease! Why see a doctor then?! Well, it's a special physiological state and needs special care. It's important to see the doctor to ensure all is well with both, the expectant mom and the baby, and to take corrective measures when required. Often couples delay the first visit and sometimes, may land up in an emergency with early pregnancy complications.

 

Organised prenatal care (care of an expectant mother) was introduced in United States by social reformers and nurses in 1901. This work of nurse visits to women enrolled in the home delivery service of the Boston Lying-in hospital was so successful that an outpatient prenatal clinic (one of the first) was established in 1911. In 1954, Nicholas J. Eastman credited organised prenatal care with having "done more to save mothers' lives in our time than any other single factor"!

 

We've come a long way since then and can salvage a lot more babies and ensure healthier mothers. Follow this guide to know when you should visit your doctor during pregnancy:

 

1.     Scheduled visits

 

Through the course of pregnancy, there are visits scheduled at regular 3-4 weekly intervals in the early part and as frequent as weekly towards delivery. Every such visit has a specific purpose. We discuss your symptoms, note some points on examination, review the investigations, order some tests and give you a general idea of how it's going medically.

 

It is a wonderful opportunity when you have 100% of the doctor's attention and can discuss any and everything about your pregnancy in detail. Subtle things are also noted by the doctor such as your general well-being, attitude, family support etc. which go a long way in fostering a good rapport based on trust and mutual understanding. In life-changing moments such as the birth of your baby, it is of utmost importance that you place your and your unborn baby's life in the hands of someone you trust to be competent and acting in good faith.

 

Every practitioner has a plan for scheduled visits in pregnancy and it may vary slightly from one to another, though generally the visits are 3-4 weekly in the first 6 months, 2 weekly from the 7th month onwards and weekly in the last 4 weeks prior to the expected date of delivery. Stick to the plan your doctor suggests as it is easier and safer, and there are less chances that something important may be missed.

 

2.     Special visits, for any discomfort you may be feeling out of the ordinary

 

Even a simple cough and cold in pregnancy that doesn't settle in a day or two needs evaluation and merits a visit to the doctor rather than a text or phone call. Infections can be much more severe and complicate faster in pregnancy. If you feel pain or discomfort in the abdomen different from the one your doctor has reassured you about, then you should consult and visit them immediately.

 

Some of the other symptoms could include:

 

-          swelling in one leg or severe swelling in both legs

-          breathing difficulty

-          suspected infection e.g. sore throat, burning in the urine, fever, boil or painful pus filled swelling

-          excessive vomiting

-          inability to keep food down

-          vaginal bleeding or excess discharge

-          decreased fetal movements

-          any other symptom that is persistent or recurrent or worrisome for you

 

Ladies, do not shy away from dropping in to your doctor's clinic for a check-up /chat /reassurance.

 

Wishing you a safe and happy pregnancy!

Kudiyan di Lohri!

Dr Parul Chopra Buttan with her daughter Aanya

I'm not a great fan of the 'selfie' & hardly take one. But on this special evening, I had to click - to chronicle the day I returned to a full-time job after becoming a mother!

As a daughter and the first child in my family, I was my grandparents' and parents' pride, and they put in so much to provide me with the opportunities I have had. I've said this before but what the heck, I'll say it again - as my awesome luck would have it, marriage brought me into a family where those horizons only expanded.
 
I worked hard and completed three post graduate degrees after my marriage (my MS exam was two months after the wedding!), including cracking one of the toughest exams in obstetrics and gynaecology the world over (MRCOG - London).
 
On her first Lohri, my daughter was four months old and exclusively on my feed. That's when I started working again part time, after the maternity break. In the seflies above, she was eight months old and I had taken the the pics the day I joined Max Hospital, Gurgaon, full time as an attending consultant.
 
I'm so grateful for my family and friends who make it all so joyful and rewarding...and possible. I can rush to attend an emergency in the hospital or my clinic at anytime of the day or night; and everything from my baby's care to my food to my car gets arranged!

My mother in law who is a qualified ophthalmologist struggled at my stage as a mother of two, and couldn't practice as much as she would've liked. Result - she ensured every possible help to me and now lives out her 'high flier doctor woman dream' by helping mine come true!
 
My mother who cared for three kids alone for several years (battling a neurological illness with vision deterioration when papa was posted out of station) has been my biggest source of strength, putting in everything she could for our education, especially mine, being touted as the promising child who'd grow up to be a doctor.
 
My father has worked the hardest of us all to get me through medical college – it being as much his ‘tapasya’ as mine. My beautiful little sister has held me through thick and thin, and her wise counsel has always stood me in good stead.

My brother has been my true partner-in-crime through studies and games. My father-in-law has been as much a father to me as to my husband. And my husband is the soul-mate who makes my every dream bigger and his own, to achieve and cherish together.

The effervescent punjabi festival of Lohri takes on an even brighter tone when it marks a family's first Lohri since the arrival of a child. I hope to give my daughter ever widening horizons and pass on the immense love and pride that I've been blessed with. How I wish every daughter would have what I do. I'm living the #KudiyanDiLohri every day and it's a beautiful dream come true!

A daughter brings so much warmth, so much bubbling fulfilment in a family! Being an obstetrician, I'm happy about every baby I ever delivered but these little girls are slightly more special :) 


Aanya with dada and dadi on her first Lohri

 

Five Simple Resolutions for a Healthy = Happy New Year!

by Dr Parul Chopra Buttan

It's that time of the year when we will all bring out our buckets full of lists-to-do next year! The truth is that many of us know already that we won't be able to make them all. But have we paused to wonder why? It's not our resolve that is weak; in many cases it's our bodies.

A healthy body keeps a happy heart and a happening life. Commit to these easy-to-follow health tips and prepare yourself for a spectacular sixteenth year of the century...


1. Plan your day

The first 30 minutes of your day - spend with yourself. Meditate, concentrate, stretch. Use the time to plan your day. Could be a list of to-do tasks you'd like to accomplish or qualities you'd like to manifest. E.g. I'll be kind today. Visualise yourself living the day of your choice and strengthen your self to do the same. Have a similar ten minute 'me time' in the afternoon to check on progress and adjust; and then have another quick one before you go to bed to gather the learnings the day brought, savour the joys and offer thanks. Immensely helpful for reducing stress!

2. Drink plenty of water

Water is the elixir of life, yet we so often do not hydrate ourselves enough. Less water intake contributes to ineffective metabolism, low concentration, obesity, voice abuse, low concentration, urinary infections, tendency to stone formation. Women, because of their body structure are especially prone to urinary tract infections which can be recurrent and troublesome. It's helpful to have set times in the day when you replenish your body with a glass full of clean drinking water. E.g. on waking up, 11am snack time, reaching home from office etc.

3. Say no to smoking

With stress levels going through the roof, smoking in women is on the rise. The new year is a good time to 'kick the butt'. Smoking, besides causing lung cancer, throat cancer, mouth cancer, stomach cancer, bladder cancer amongst other damages is especially harmful to women.
Unbeknown to most youngsters, smoking is associated with ovarian decline and infertility. In pregnancy, it can cause miscarriage, premature birth, growth restriction and stillbirths.

4. Work out

Incorporate some fitness routine into your day. Be it walking, cycling, jogging, running, zumba, pilates, swimming, gymming. It's great to have a fitness buddy to keep up your motivation and add value to your workouts too. You could choose your neighbour, friend, your husband or even your smartphone! It's never too late to begin.  If you are not accustomed to exercise before, do consult your doctor before starting. Start with age and current fitness-level appropriate workout regime and build up gradually.

5. Sign up for health

We ever so often postpone our appointment with the doctor even for a discomfort. Somehow, suffering the tooth sensitivity or the nagging backache seems more tolerable than making the effort to fix it. The woman of the house can hardly afford to fall sick as she carries the whole family through the day, juggling a dozen things! A 'well woman check-up' according to your age and needs is highly recommended. Certain annual checks like the breast examination, pap smear are a small step that go a long way in preventing dreaded diseases like breast and cervical cancer.

Let's make 2016 a healthy one. Let's give our body and mind the care they deserve. Let's take charge of our happiness and start afresh!

Happy New Year!

Surviving miscarriage

Written by Dr Parul Chopra Buttan

I was reading a newspaper report on Paris recently when my inquisitive 2 year old comes by and seeing the picture of a woman crying, asks innocently, "Mumma, aunty kyun ro rahi hain?" Not wanting to thwart her curiosity, I answer despite my discomfort, "because her baby got hurt" [her child was killed]. "Why did the baby get hurt?" I noticed the 'Why' instead of 'How'. That's one deep question, Why? Why do innocent people get hurt? Why does it all happen? Why do we go through this pain of untimely loss?

I couldn't find words and I wasn't prepared for this conversation, so I kissed her and distracted her into a game, much lighter, more age-appropriate for her. But I could sense her disappointment at not getting her answer. I lived with it, mentally making a note to work on an answer and get back better prepared the next time around.

I was dwelling intermittently on this need for an answer to everything, when a conversation with a very intelligent patient of mine happened. She said, "Doctors are like the barrier between us and death, us and mishaps. And when they fail to give us answers, it's deeply disappointing."

Yes, it's 2015. Yes, we are sitting on a mountain of medical research of the past two and a half centuries. But no, we don't have all the answers yet. Our knowledge, even though, has come a long way, certainly has a long way to go. I talked about miscarriage in my last post. In almost 20% of the pregnancies lost early, despite extensive investigations the exact reason for miscarriage may remain unknown. We will not be able to pin the occurrence of a miscarriage on something you did or did not do. We will not be able to justify the guilt you may be feeling or the blame, because it really is nobody's fault.

I'm sorry for the answers we can't provide today. I'm sorry for the pain we can't take away. But here's what we can do. And it is my mission to do my best in this endeavour.

1.     Allow the woman space to feel her emotions

Often, the myriad of emotions a woman may go through, disappointment, guilt, anger, loss, bereavement, grief, get shoved under the carpet. "It's only a miscarriage! People go through much worse!” she is told. Though it is true, much worse horrors are possible and do happen in this miraculous world of making babies, the experience of 'pain' is very individual. Only the wearer knows where the shoe hurts.

2.     Accept her state of mind

Non-judgemental acceptance of the waves of emotions she's going through is paramount to healing. Just when we allow ourselves to feel an emotion rather than resist it, does it flow through us and pass. It resolves, leaving us cleansed. The gynaecologist's chamber should be the one place where the woman can bring up any issue and any doubts around it, any number of times. We will answer them calmly, repeatedly, with the best possible explanation of the current scenario.

3.     Reassurance

Often, the event of losing a pregnancy haunts the woman all through the next one. As gynaecologists, we are happy to repeatedly offer you very encouraging statistical and medical evidence and research, all through the next pregnancy to reassure you. We are in this journey together and our aim of delivering to you a healthy mother and a healthy baby is an oath. We will go the extra mile to ensure your peace of mind, that comes from a qualified professional's true reassurance.

4.     Precautions

Any precautions (physical or otherwise) and medication that may help in reducing the chance of a mishap the next time around – we will discuss in detail to help you make informed choices. Of course, needless medication and restrictions would certainly be discouraged.

5.     Hope

We hope that when the cries and laughter of your magical bundle of joy fills up your home, it drowns the silence of grief you felt for the pregnancy lost.

Life goes on and brings with it a multitude of experiences. Some we're able to make sense of, some just flow through us with a higher meaning, as yet unrevealed.