Tuesday, July 30, 2013

Initial Impressions of My New Care Provider

I had been seeing a nurse-midwife at Kaiser for my prenatal care until last month, when we moved from southern California to the Bay Area. I had to find a new provider and hospital to go with my new location and insurance. Switching care providers mid-pregnancy, especially when you've been happy with your care and been with the same provider for two previous pregnancies, is difficult. I didn't know anyone in my new location whom I could ask for a recommendation. To some extent, I felt like I was basically (figuratively) letting the phone book fall open and calling whoever was on the page it landed on.

While I think I might have preferred to stick with the nurse-midwife route, I did take the step of asking on a parenting group I frequent if anyone was from the area and could help me choose someone and someplace. One of the hospitals here was highly recommended, and a perusal of the hospital's website made it look quite inviting. I looked at the hospital's list of OB providers and chose a group of nine OB's located just across the street from the hospital. Their office staff was friendly and helpful and sounded on the ball and competent. They explained that they assign each provider a certain number of patients who are due within the same month, and you stick with that provider throughout your prenatal care, and there's a very good chance she will be the one to deliver your baby. I liked the sound of that, as my previous experience with group practices was that you needed to meet everyone in the practice because they rotated call duty. She gave me the option of three of the doctors and I said I really didn't know any of them or have a way to choose, so she suggested one and made me an appointment.

I had that appointment a few weeks ago. The office was easy to find, right next to the hospital. A few things I was immediately on alert for. First of all, how busy was the office? It looked busy but not crowded. I saw no formula advertisements or paraphernalia (but no breastfeeding posters, either). They didn't seem to be running behind (I had a 10:15 appointment and was seen on time), and no one seemed to wait long in the waiting room before being called back. The billing office was very helpful in confirming my insurance and payment responsibilities.

The medical assistant who took me back was competent in taking my weight and blood pressure. The office used a regular doctor's scale and a hand-pumped and manually read blood pressure cuff. Kaiser always had fancy new digital equipment, and there was something charming and hands-on about doing it the "old fashioned" way. The MA wasn't sure if I'd need a gynecological exam, since I was farther along in my pregnancy and transferring care, but she had me undress from the waist down just in case. The stirrups on the table were covered with oven mitts, which I found very funny. I appreciated that they were covered - it showed respect for the patient's comfort - and I appreciated that they were not branded. (I've seen formula-company branded stirrups in other OB offices!)

The doctor herself came in promptly and was a sweet and personable woman. She checked the baby's heart beat and did a quick external ultrasound to take a measurement of his head, for her own records, since I had not yet obtained my records from Kaiser. She measured my fundal height and said I was measuring right on track. There was no mention of my weight gain (about 17 pounds so far), so I figured there was no concern there. She said she definitely wanted to hear about my history, but that we could do that in her office where we'd be comfortable (and I'd be dressed!), rather than sitting in the exam room. I really appreciated that!

I met her in her office, where she listened to my three previous birth stories and my concerns. She said I was obviously a good candidate for VBAC (this being my fourth baby and potentially third VBAC), and that her office and the hospital, and the nurses at the hospital, were very supportive of natural birth. She said she was on call mostly during the weekdays because she has two kids at home (in fact, she had just returned from maternity leave after having her second), and that there was probably a 75% chance that I'd get her as my delivery doctor. If she wasn't available, then one of the other doctors from the practice would be on call, and she of course trusted them fully to take good care of her patients.

Overall, I feel good about this doctor. I'll see what happens in the weeks to come (my next appointment is in about two weeks). She seems like she'll listen to me and respects that, hey, this is my fourth; I may know a little something about this process. She seemed to be willing to listen to my assertion that Pitocin and I don't get along, and that I really don't need it anyway! She was pleased and a bit surprised to hear that though I had blood pressure issues with my first two, I did not with my third.

Of course, I'll have a much fuller report once I actually deliver this baby! (Three months to go...)

Saturday, July 27, 2013

Nursing During Pregnancy: Can I Continue to Nurse My Older Child after the Baby is Born?

Let's talk about breastfeeding and pregnancy! There are several issues at work here, and I'll be talking about a few of them over the course of this week. 

The questions I'll be covering are:
Can I Continue to Nurse My Older Child after the Baby is Born?

Today's Question: Can I Continue to Nurse My Older Child after the Baby is Born?

If you're planning to nurse through your pregnancy, which we've established is safe and possible for most women, the next question that will logically arise is, What happens once the baby is born? Can and should I continue to nurse my toddler?

The short answer is, Yes! You absolutely can nurse more than one child at a time. Women with twins (and even triplets) do so successfully, and women also successfully and happily nurse a toddler and a newborn at the same time. Your body will make as much milk as your nurslings demand, so if two babies (or a baby and a toddler) are demanding milk, your body will increase production to meet that demand.

Nursing more than one child at a time is called "tandem nursing." You can nurse at literally the same time, with one child on each breast, or you can have them take turns.

Most women who have tandem nursed a toddler and a newborn have reported it to be a positive experience. It enables them to maintain that closeness with their toddler and continue to supply breastmilk to him or her, and it helps them to foster a bond between the toddler and the baby, as the toddler gets to "share" milk with the new baby brother or sister.

A few things to note if you decide to try tandem nursing:

1.  Feed the baby first.
Toddlers can eat solid foods, drink other milks and water, and should not need to nurse as much or as often as a newborn. Make sure you are meeting your newborn's nursing needs over those of your toddler, since nursing is your newborn's only source of nutrition. If your toddler is jealous of the time the baby has at the breast, you can make that time special for your toddler as well. Create a special "nursing basket" of activities you two can do together while the baby nurses, such as books to read or videos to watch, and bring those things out only when you sit down to nurse the baby.

2. Colostrum and newborn milk have laxative properties.
Breastmilk changes as your baby grows. The milk your body was making for your toddler was different from the milk your body will now make for your newborn. Colostrum and early milk have laxative properties, which means your toddler's stools may become looser when he starts getting that sweet, runny newborn milk. Just as a word of warning!

3. Your toddler will likely want to nurse more.
It's very likely that the increased flow of milk your toddler gets now that your body is back to making milk for a full-time nursing newborn will make him want to nurse more often. He will enjoy the flavor and volume of the milk. It is up to you to set limits on his nursing so that your newborn still gets "first dibs" on your milk.

What if I don't want to tandem nurse?
If you decide you don't want to try tandem nursing, you should wean your toddler at least six weeks before you expect the baby to be born. You want to establish the habit of not nursing before he sees a baby brother or sister nursing regularly. Some toddlers will be curious about nursing even if they've been weaned for a long time, and some will even ask to try it. This did not happen with my sons, but I have heard of this from other mothers. Some choose to allow the toddler to try nursing. Most toddlers who have been weaned for more than a month or two (or even a week or two) don't remember how to latch and cannot draw out any milk and quickly lose interest. If they do manage to get milk, many are no longer accustomed to the taste and find their usual foods more interesting.

If you have any questions about nursing during pregnancy, feel free to ask in the comments or on the Facebook page.

Did you nurse through your pregnancy? What issues, if any, did you encounter? Have you tandem nursed? Would you encourage another mother to try tandem nursing if she is unsure? What additional advice do you have for nursing through pregnancy or tandem nursing?

<< Previous: What are Some Other Concerns about Nursing through Pregnancy?

Friday, July 26, 2013

Nursing During Pregnancy: What are Some Other Concerns about Nursing through Pregnancy?

Let's talk about breastfeeding and pregnancy! There are several issues at work here, and I'll be talking about a few of them over the course of this week. 

The questions I'll be covering are:
What are Some Other Concerns about Nursing through Pregnancy?

Today's Question: What are Some Other Concerns about Nursing through Pregnancy?

Now that we've addressed the efficacy of breastfeeding as contraceptive and of some of the safety concerns related to breastfeeding and pregnancy, let's look at some of the other issues some women have with nursing during pregnancy.

1. Sore breasts/nipples

Pregnancy can cause your breasts to be tender and your nipples to be sore whether you're breastfeeding or not. Many women report that nursing becomes very painful during pregnancy because of extremely sensitive nipples or nipple/breast tenderness. Not everyone will experience this, just as not everyone will experience other hormonal side effects of pregnancy. Some women find the pain bearable while others decide to wean or cut back on nursing because the pain is intolerable. Sometimes this pain can be helped a bit by ensuring that your toddler's latch is as good as possible. Toddlers can tend to become lazy about latching properly, and often we as mothers don't worry too much about correcting them because it no longer bothers us. However, a bad latch can make already existing nipple pain that much worse. If you suddenly notice sore nipples even if you've been nursing pain-free through your pregnancy so far, check for thrush. The hormonal disruptions of pregnancy can make some women more prone to yeast infections. It may also be that the nipple soreness is hormonal but is beginning later in the pregnancy. My nipples did not become appreciably sore until the second trimester.

2. Nausea

If you experience morning sickness, it can be that much harder to deal with a baby or toddler climbing you and demanding your attention. For some women, the act of nursing also increases the nausea. If your morning sickness generally goes away after the first trimester, you may find that you can stick it out knowing it will probably get better in a few weeks. Also, make sure you are sufficiently hydrated. I've found that dehydration can make the nausea much worse, and breastfeeding can add to the dehydration, especially in summer.

3. Physical discomfort

Pregnancy can cause pain in your lower back, ribs, and hips, and your growing belly may make it difficult to find a comfortable position in which to nurse. Fortunately, toddlers can be very creative about how and where they nurse, so your child may solve this problem for you! Experiment with different positions and try nursing in different places to find a tolerable and workable position.

4. Feeling "touched out"

The hormones of pregnancy make some women not want to be touched intimately, especially if they are also feeling ill from morning sickness or experiencing other bodily discomfort. The demands of a nursing toddler can compound these feelings of simply not wanting to be touched. Some women talk about how nursing makes their skin crawl. I found that occasionally I get "restless legs" while nursing. Unfortunately, there's not much to be done about this "touched out"-ness, except to try to find time for yourself if you can to settle your nerves.

5. Guilt

If you lose your milk or find you need to wean because of the pain or discomfort, you may feel guilty that you were not able to nurse your child as long as you'd hoped to. I had planned to nurse my third son until he was two, but my milk dried up about two months ago, when he was only 19 or 20 months old. I still allow him to "dry nurse" (nurse even though there's no milk) once a day for his nap for two reasons. One is so that he is not deprived of that closeness, and the other is so that he doesn't forget how to nurse, so that I can make the decision later whether to allow him to continue nursing after his brother is born. (This is called tandem nursing and will be addressed in the next section of this article.) Remember that even if you do have to wean completely before you had planned, you still gave your child as much as you could, you still love your child, and there are many other ways that you will continue to express that love. Remember, also, that when you begin nursing your new baby, you will find new ways to connect with your older child, and, if you want, you can even share some expressed breastmilk with your older child.

<< Previous: Is It Safe to Breastfeed while Pregnant | Next: Can I Continue to Nurse My Older Child after the Baby is Born? >>

Wednesday, July 24, 2013

Nursing During Pregnancy: Is It Safe to Breastfeed while Pregnant?

Let's talk about breastfeeding and pregnancy! There are several issues at work here, and I'll be talking about a few of them over the course of this week. 

The questions I'll be covering are:
Is It Safe to Breastfeed while Pregnant?

Today's question: Is It Safe to Breastfeed while Pregnant?

The short answer is: Yes! For most women, it is perfectly fine to continue to breastfeed throughout pregnancy.

There are generally three concerns raised about breastfeeding during pregnancy. These are:

1.  Breastfeeding releases oxytocin, which also causes uterine contractions.
2.  Making breastmilk requires quite a lot of the mother's resources.
3.  Pregnancy will cause your milk to dry up.

Let's take a look at each of these concerns.

1. Breastfeeding releases oxytocin, which also causes uterine contractions. 

This is true. Oxytocin is the main hormone that stimulates the uterus to contract during labor. Oxytocin is also released during orgasm and breastfeeding and is called the "love" hormone, because it encourages the bond between mother and baby or between partners.

Some women are concerned that the oxytocin released during breastfeeding may cause her to go into labor prematurely. Indeed, nipple stimulation (which is what causes the release of oxytocin) is one method of "natural" labor induction for women near or beyond their due dates. It is important to remember that your uterus is contracting occasionally throughout your pregnancy whether you are breastfeeding or not. These are not as strong or as regular as labor contractions, but they are normal and expected and are thought to "warm up" the uterus for labor. 

As mentioned, oxytocin is also released during orgasm, and sexual intercourse is considered safe for most women during pregnancy. Breastfeeding, as well, can continue through pregnancy.

Uterine contractions brought on by breastfeeding may become a concern if you have any complications, including a history of preterm labor. Please check with your care provider if you have reason to think breastfeeding during pregnancy may not be safe in your situation.

2. Making breastmilk requires a lot of the mother's resources.

This is also true. Making breastmilk requires nutrients and calories from the mother, just as pregnancy does. Some women may be concerned that they cannot take in enough to handle this doubled demand. 

However, unless you are already malnourished, there is no reason that you cannot eat and drink enough to provide for your nursling and your developing baby. Eat to your hunger and drink to your thirst. You will probably notice an increase in appetite and thirst, but that is reasonable given the amount of calories your pregnancy and breastfeeding combined will require. This will also depend greatly on the age of your nursling and how much he or she still nurses. An older toddler who is only nursing a couple of times a day will not require many additional calories from you. If your baby is still under a year old and mostly relies upon your milk for sustenance, you may find it more difficult to keep up. If he or she is old enough, you can try offering more solid foods if you need to cut back on nursing.

3. Pregnancy will cause your milk to dry up.

This may be true in some cases. For some women, the hormones of pregnancy will cause a supply drop in preparation for the switch back to colostrum when the new baby is born, while others continue to nurse regularly and comfortably all the way through their pregnancies. For some, supply problems begin almost immediately, while for others, the supply dip or drying up occurs during the second trimester. There's no way to know in advance whether you are one of these women, and an ample supply pre-pregnancy is not a predictor. I had plenty of milk before I became pregnant and did not expect pregnancy to affect my supply. Instead, I found my supply quickly dwindled to nothing despite my toddler's continuing to nurse. I could tell that he was eating considerably more solid foods and receiving very little breastmilk. I had trouble expressing even a couple of drops of milk by the middle of the second trimester. Some women are able to combat this supply dip by using foods and herbs that can increase milk supply, but this will not work for everyone.

You need to be aware of this possibility, because if you do become pregnant while your baby is still under a year old, it may be difficult to continue to meet his needs if your milk does dry up. You should take this into consideration if you're considering allowing breastfeeding to be your only form of birth control. (See the previous post for more on breastfeeding as contraception.)

Remember that this possibility doesn't mean you shouldn't at least try to continue breastfeeding during your pregnancy, if that is your desire.

<< Previous: Can I Get Pregnant while Breastfeeding? | Next: What are Some Other Concerns about Nursing through Pregnancy?

Tuesday, July 23, 2013

Nursing During Pregnancy: Can I Get Pregnant While Breastfeeding?

Let's talk about breastfeeding and pregnancy! There are several issues at work here, and I'll be talking about a few of them over the course of this week.

The questions I'll be covering are:
Can I Get Pregnant while Breastfeeding?


Today's question: Can I get pregnant while breastfeeding?

The short answer is: Yes! It is certainly possible to get pregnant while you're still nursing. 

Let's break it down, though. 

Breastfeeding is a natural contraceptive, given to us by nature to assist with child spacing to encourage safer and more viable pregnancies and childbirth and to ensure that there would be adequate resources for the existing child before another was born. However, the advent of agriculture, the addition of regular complex carbohydrates to our diets, our ample food supply, and the disruption of natural breastfeeding rhythms in favor of a more "scheduled" life have all weakened breastfeeding's ability to suppress ovulation.

Breastfeeding is as effective (over 99%) as the Pill for contraception provided you meet all of the following criteria:
1. Your baby is under six months old.
2. Your baby breastfeeds at night as well as during the day and sleeps in close proximity to you.
3. You use no artificial nipples (no bottles, no pumping, no pacifiers - all feedings and comforting are at-breast).
4. Your period has not returned.

This means that some women can get pregnant even while breastfeeding and meeting these conditions, just as some women can get pregnant while taking hormonal birth control correctly. However, most women will find exclusive breastfeeding to be very effective as contraception during the first six months. If a new pregnancy is absolutely not an option for you, consider using a backup method as well, such as condoms, hormonal birth control*, or an IUD.

*A note about the Pill: There are several forms of oral hormonal birth control (the Pill). There is evidence that the estrogen in the combination pill may have an effect on milk supply. It is recommended that nursing mothers who wish to use hormonal birth control try the "minipill," which contains only progesterone. The minipill is very effective, but only if used exactly as directed, which means that you must take it at exactly the same time every day. If you don't feel that this is realistic for you, talk with your OB or midwife about other birth control options.

After six months, you cannot rely upon breastfeeding alone for contraception. Some women find they are unable to get pregnant when they are breastfeeding at all, while others begin ovulating as soon as their babies start going longer between feedings, start sleeping through the night, or begin eating solid foods in addition to breastmilk.

Also, remember that you ovulate before you have a period, meaning that it is possible to become pregnant the first time you ovulate after giving birth, even if you haven't had a period yet.

I did not use any birth control after the birth of my third child, and breastfeeding alone prevented the return of my period until my baby was 12 months old. I got pregnant when G was about 16 months old, meaning I had about four periods before conceiving. G was still nursing pretty often, including at least three or four times at night, but he was also eating solid foods. My cycles were very irregular, ranging from 33 days to 57 days, and it was quite nerve-wracking when my period was so unpredictable. I took many, many pregnancy tests during that time! That's just my experience, but I think it's a fairly common one. If you decide to go the "let's let nature take its course route," be aware that you may not know you're pregnant until you finally decide to take a test!

Next: Is It Safe to Breastfeed while Pregnant? >>

Tuesday, July 16, 2013

Moving Mountains and the Stress of the Endless "To-Dos"

I'm slogging through in that place where you have so much to do, it seems much easier to simply ignore everything and do nothing than to get any of it done. It feels like doing any of it is just a drop in the bucket, and I don't know where to start. It's getting better. There are lots of people helping (the advantage of being relocated by a major company instead of trying to do your whole move on your own), but the fact remains that we still have a lot to deal with ourselves, including a lot of the financial side of things regarding the house we left behind in trying to get it rented out.

I don't handle this kind of stress well. I'm not good at breaking down a project into pieces, making a to-do list and crossing things off, taking things one step at a time. I'm the kind of person who walks into a messy room, looks around, picks up a piece of trash, can't figure out where to put it, and lies down on the bed to play Candy Crush instead. I admire greatly people who can, instead, walk into a messy room, pick a starting point, and make sense of the chaos one pair of jeans at a time.

I have accomplished a few things. I set up our water, trash, and power accounts today. I canceled our old internet account. I'm working with a contractor and property manager to get our house into renting-out shape (on my end, it's mostly trying to figure out how to pay for it all than actually making the calls). Things are moving forward, and I know that we'll be settled into our new place soon and things will make more sense.

Entertaining the kids, doing my own work, maintaining some semblance of routine (ha!), and finding time to relax are all challenges right now. These would be challenging anyway in the summer, with all three home and me pregnant to boot, but not having a "home base," as it were, a place to feel comfortable and have a set of rules to keep us (yes, even me) in line, a backyard in which to play safely, and rooms where we can be more than 10 feet apart if needed for breathing space and quiet, magnifies every problem.

I have a few more moving-related tasks to accomplish in the coming week or two, and then we can hopefully settle into the usual routines of meals and naps and sleep, activities and work, laundry and dishes. The seemingly unending mountain of "things to deal with" is shrinking, bit by bit, and will eventually plateau out into the normal cycle of chores.

How do you deal with massive projects or extensive lists of to-dos? What's your strategy for cutting through the clutter and making sense of the piles? What do you do when it just seems like too much?

Monday, July 15, 2013

In-Between and without Routine: Moving and Living in Temporary Housing

We're spending a couple of weeks in a hotel apartment while we wait for our new home to be available for move-in. We made it safely and successfully to the Bay Area, but we're in a weird state of in-between, almost like a vacation, except we have to work. The kids are terribly bored but have made some friends at the hotel, which is nice. There are quite a few families here in a similar situation to ours, and it's nice to have some kinship with them.

Thus, blog posts and videos have unfortunately fallen by the wayside until we're more settled and our schedule is more regular.

Briefly, though, I can say that our experience here is very different from our life in San Diego, but in positive way. This area is very diverse and multicultural. There's so much more variety of food, language, and nationality here. We loved living in San Diego, but I'm already seeing why people love the Bay Area so much, and I can see that we will find a happy and fulfilling life here as well.

I am looking forward to getting settled in, finding a routine, and making our lives normal again. I also have my first appointment with a new doctor this Friday, which I hope to fill you in about when I can.

Remember, if you have a question for me that you'd like to see answered in a future Ask-Me Monday video, or if there's a blog topic you'd like me to address, feel free to comment on the Facebook page or to send a private message to me there!

Tuesday, July 2, 2013

Parents' Responsibilities to Others Versus Others' Responsibility to Parents

I was musing about this while I "supervise" my house being packed up, and I thought it might make a good quick little blog post.

I took the kids out for breakfast this morning to Coco's, a family restaurant similar to Denny's or IHOP in terms of ambiance and food. It was quite empty, given that it was after 9:00 on a weekday morning, except for a few older couples enjoying some coffee and a mature woman with a calendar and iPhone doing...something. The hostess showed us to a section and told us to sit anywhere and that she would be right back with a high chair for the toddler.

My two older kids immediately sat down in the first booth, on a bench back-to-back with the lone woman tapping away on her iPhone. I monitored G while we waited for the hostess to bring a high chair for him, keeping him from either running off or climbing into another booth. iPhone lady shot me a look and I realized that N was kicking the bench, which had to be annoying to her. I told N to stop kicking, figuring that would be that. N did stop kicking, and then woman said, "Actually, could you sit somewhere else? Or should I move?" not in the politest of tones. I hesitated, then asked my kids to move to a booth farther back (two tables away), which they did, cheerfully (and noisily). I felt like the woman's eyes were drilling into my back. I didn't glance back to see if they actually were. I then spent the first half of breakfast diligently trying to keep my kids to "indoor voices." They were behaving very well, and if there had been any other families there at that moment, I would have been happy to let my kids keep on how they were, but I felt like I didn't dare disturb iPhone lady. It really put me on edge, and I found myself fighting tears for no good reason. I'm very stressed right now, preparing to move 500 miles north and waiting for my house to get packed up and taking care of my kids by myself. And being pregnant.

I calmed down as my coffee arrived, and the kids set to their food very nicely, and I turned around to see that iPhone lady was gone. The rest of breakfast was very pleasant and relaxed, and we left happy.

The incident made me think about the balance of "give me a break here; I'm alone with three kids" to "I'm sorry my kids are annoying you; I'll do my best to keep them quiet."

As parents, we have a job to do: We have to prepare our kids to function in society. That means teaching them manners, how to act in different arenas (home versus store versus restaurant, for example), and to be sensitive to how their actions affect others (i.e., empathy). As a result, we parents spend a lot of time trying to be tuned in to how are kids are acting and to how others around us are reacting to us. It can be exhausting. I find myself watching the faces of those around me, trying to judge whether they are charmed or irritated by my kids. I find in large part that people don't mind when my kids are just being kids, as long as they're not being destructive or unreasonably loud or exuberant. If I see an amused or nostalgic smile on the face of a grandmotherly woman, I don't try to rein my kids in as much as if I see the pursed lips and pointed looks of someone less open to "kids being kids." I try not to be too entitled. Just because I have kids and am stressed and sometimes they're hard to control doesn't mean my kids have the right to run rampant around a quiet restaurant and disturb other diners (which they weren't doing, but just for arguments' sake). I don't think I deserve special treatment because I decided to have kids, like I'm somehow unique among the women of the world.

As members of society, though, isn't it right for us to be aware that parents with kids sometimes need a little leeway? I know that for people who don't have kids, or haven't been around kids in a long time, or aren't usually around kids at all, it can be hard to understand or be forgiving of even normal kid behavior, and every noise or accidental shout of excitement can be irritating. But if you're in a family restaurant, one that regularly serves, and even caters to, parents and children, it shouldn't be overly surprising if a family comes in for a meal. And if that family is a mom alone with three young boys, it shouldn't come as too much of a shock if those boys are a little excited or hyper, and the mom looks a little exhausted. Where does that balance point fall? How much is it my responsibility to keep my kids from annoying you (yes, kicking the bench was not okay, and I stopped him as soon as I saw it), and how much is it your responsibility to realize that I also have a right to sit there and eat (my kids weren't doing anything unreasonable or unpleasant), and just because you had until then been in a quiet restaurant working quietly on whatever-it-was you were doing, doesn't mean you could expect it to remain quiet. It's a restaurant, not a library.

Frankly, if I had gotten there first (instead of having to corral the toddler), I probably would have chosen a table farther from her anyway, as, just like anywhere else, if there's room to sit farther away from people, I generally choose to do so (movie theaters, restrooms, the DMV). It wasn't that I minded moving to a farther table, it was more the sour look and the obvious annoyance at the audacity I had to bring my family to a family diner for a family breakfast. And that's all it was. There was no confrontation, no complaint, and no further incident with her. I didn't otherwise feel unwelcome, and a couple that came in after us did watch my kids with the welcome amused smile and eye twinkle that I usually associate with older people. I didn't worry that we had disturbed their meal at all.

So what balance do we need to strike? It's obviously different depending on where you are and what the demographic there is like. Behavioral expectations vary with venue for adults as much as for kids. I sometimes struggle with my need to please everyone. I don't want to annoy people or disturb their meals or interrupt their work or reading. At the same time, kids are kids and I can't always control every noise or every action. I can tell them when they're being inappropriate and work with them on it so that next time they'll know better. That's my job, and I take it seriously. I want to raise responsible, empathetic, and pleasant human beings. But can I enlist the rest of society to help me with that a little bit, and maybe give me a little bit of empathy and patience themselves when they see I'm doing the best I can?