My other blog

Before writing this post, I probably should have added a ‘follow me’ button to my new blog.

I have now – as I said, it is a work in progress. Look, here is a picture of not one, but two kittens to make up for it. Kittens win the internet.

Not the kind of kittens I was having.

Moving

I love blogging. I am someone who deals better with externalizing their thoughts (which is, FYI, not entirely an extrovert, although so often confused with). It also helps me keep in touch with the wake dear friends and surrogate family I have left strewn across three continents. And, while we are talking about the vagaries of academia – in that rejection filled world, I love the validation I get from my blog. I love it when people link to my blog to recommend help, when I get new followers, when people at academic conferences tell me that they follow my blog.

However, a few months ago I began to think about the effects of having people in study section read my blog. There is nothing in my blog that I wouldn’t openly discuss in person, and even openly discuss in a work setting. I am happy with, and quite vocal about: my feminism, my social liberalism but fiscal conservatism, that I am a Christian but that I find the decisions to make laws based on someone’s interpretation of the Bible borderline abhorrent, that I am a Mom and that I love being a Mom, that I run and bake and craft and that I suspect Pretty Little Liars may be one of the greatest TV achievements to date (<—- only slightly sarcastic). People who meet me, and invite these conversations will know this. However, they will also (hopefully) know me for my Science and engage with me in intellectual discussions. What is someone in study section thinks ‘Who is this Lekki?” and googles me? I am not sure that the search results I want are what is popping up. I am pretty sure that this (the third image in the search) is not I want associated with my (good?) name:

Professional.

 

So, yes, there is some Science and some professional shots, but there are also some very tempting personal stuff for the reviewer stuck on a long journey to NIH. It’s not that I am ashamed or secretive about anything here, it is more that I don’t want this blog forefront in Scientific reviews.

 

It put me off. But I didn’t know what to do; the idea of deleting my blog was emotionally really difficult. It is a record of my move to the US, the wedding, the birth of my first child. It is also a record of how I have grown and changed over the last years. And my followers! It is not great shakes in the blogging world, and it is not going to earn me any money (nor do I particularly want it to) but I have over 300 followers, which I kinda love. Especially when people I meet go ‘Oh! I read your blog’ (<— best feeling ever!).

But equally, suddenly feeling that my work could be affected by my blog was very paralyzing. It is hard to write when you picture the Chair of your Department scowling over your work (OK, my Chair does not know about this blog. But, you get the picture). So, in some way, the blog had to go. No point in having a blog you don’t write in. So, I have imported my blog to an anonymous blog here:

A Scientists Life

In a few days, I will delete all my personal posts from this page, and just leave up the work related ones. I decided to do this because I have a number of University websites that link to this blog, and I don’t want to mess up their links (or other with expensive wordpress redirects).

So, with some weird sadness, I will stop blogging here and move over to A Scientists Life. The goal is not to be anonymous there, just not to have direct links to my name so that if you google me, it is not high up in the links (I know it will take Google’s spiders a while to catch up with that, and that is OK).

The new blog is still a work in progress; I have not sorted out the background and pictures, and so on. I also have a long climb ahead of me to build up the same following, so please consider following me if you are interested in my personal stuff (Mum, I’m looking at you). Sam growing up, my fitness efforts, crafts, recipes, random thoughts etc. NB: I have no idea *who* follows me, just the number of people who do. Please continuing following here if you are interested in posts related to academia.

It’s kinda sad, but it is probably the smart thing to do.

An exit interview with the Dean

Tags

academia, academic life, changing job, Dean, faculty, mentorship, new faculty job, new job in academia

About one month ago I had my exit interview with the Dean. Although I have always enjoyed a good relationship with the Dean (who hired me directly, I was not hired through my Department), I found myself growing increasingly nervous. I tried to allay my fears by conducting a Google search on exit interviews, but I could not find much information. I tried to talk myself down, but my fears grew and grew. Thus my the time D-day came, I found myself almost speechless with fear.

I arrived 5 minutes early (it’s not like I was being productive at my desk) and the Dean was running a few minutes late, hurrying across campus from another meeting. The Dean had a new secretary who was in place – a cheerful, bright soul, which was not what I needed at the moment. Feeling sorry for a newbie, I then decided to engage her in friendly ‘how are you settling in chat’ at I sat on the very edge of my seat, feet jiggling 60 miles / hour. Big mistake. My mouth and throat were dry and swallowing was a task akin to getting your first R01 (i.e. something to be worked on for years and only achievable by this every experienced). The secretary offered me a drink – given my issues swallowing I politely declined. Where by ‘politely declined’ I meant screwed my eyes up, uttered a strangled ‘umf’ and shook my head wildly.

The Dean came. She also offered me tea. I probably should have declined (see previous difficulties swallowing) but (probably to delay the inevitable) I agreed. Off we went to the kitchen and the Dean smiled and said “look, I am even washing your cup”. Tricks! Tricks! I was not falling into this trap of false kindness. I pursed my lips and grabbed the cup with a superior air. OK, OK, I smiled and simpered and gently took the cup while feeling bad, but hey, it is the thought that counts.

We sojourned to the Dean’s office and so the ‘interview’ began AKA the ‘why is my school not good enough for you after all we have done for you?’ The Dean appraised me, she raised and eyebrow, and she said “So… I understand why you are leaving”.

I. Was.Not. Expecting. That.

The Dean must have seen my surprise, because she countered “You think there is a better environment for you elsewhere. It is human nature to look around, find the best environment and gravitate towards it. I can’t blame anyone for doing that”. I was really shocked at her kindness and maturity and well… grace. Although I was nothing (relatively) to the School – one small grant, one co-taught course, not many publications, it is still seen as a loss when faculty leave. But what followed with the Dean was an open, honest, and frank discussion of what had worked for me, and what had not. The Dean said many times (in so many words) ‘I am sorry to lose you, when I employed you, I thought you were a great Scientist, and I still think that you are. I wish you would stay at the School’ and it was interesting to hear all about what she was doing, her motives and movements, her plans.

One thing the Dean said which really stuck with me (again, slightly paraphrased) was: “If you think you can do better Science elsewhere, then we have to let you go. We are a Science Institution, we have to support Science”. It was a grounding moment. Something I have been thinking about a lot recently, and may write a post on, is the ‘ego’ in academics, the ‘I’, the ‘me’ and how destructive it is. It was grounding to hear the Dean take the ‘me’ out and just focus on the School’s mission: to do good Science.

Not all my goodbyes were that positive – some, in fact, highly destructive. But I’ll remember my exit interview with the Dean as a wonderful learning / mentorship experience for me, as someone very Junior. Often, when difficult or hurtful / reject-filled situations arise at work, I’ll try to think “what is best for the Science?’.

Happiness in academia

Tags

academia, changing job, job, mentorship, moving position

Pieces on the problems in academia seem to be endless. Forbes were hugely criticized as outdated after they claimed that University Professor was the least stressful job; and the difficulties of academia in the new funding climate were laid bare. Yours truly wondered whether it was unethical to bring the brightest and best students into such a harsh work climate. And now a well known academic blogger has joyfully kissed goodbye to academia and feels ‘liberated and happy’.

It is true that academia has become extremely challenging. For those not in the know, the financial crisis has reduced funding, and when your job relies on securing government funding there is increased uncertainty. The federal funding rate has decreased from 33% to less than 10%. That is, less than 1 in 10 grants gets funded (even less if you are lowly beginner like me), which means that you have to submit four times as many grants. So you spend your time writing unfunded grants, rather than say, doing the Science you love. Yet to stand out, you are supposed to be producing more Science than ever; which is somewhat of a challenge since the Earth, rather cruelly, has not decided to rotate on its axis just a little slower, and so give you more hours to the day.

It’s difficult. I had many comments on my last post (some in private) with people desperately grateful to feel heard and understood. People who spent much of their private time crying. But we’re not leaving now, right (or at least I am not)? So we have to find a way to make it work. Which is a roundabout way of saying that I have changed jobs. In early February, I handed in my resignation. It was a long (5 month), and very difficult decision. I have only been in my current position for 18 months, and I have many, many wonderful things to say about my Department. Clearly there is some fantastic research going on there. There is also a reasonable amount of money, a Chair with an open door, and a collection of kind-hearted people. Saying goodbye to the people who had thrown me a beautiful baby shower just 4  months after meeting me was not a trivial undertaking.

However. As much as there was somewhat of a personal fit, there was not a professional fit. After 18 months, I did not manage to establish a research team with any of my colleagues. Science no longer operates in a vacuum; the image of the mad Professor sitting alone in their laboratory at all hours awaiting their moment of genius does not apply to bad funding climates where one has to be collaborative, with fingers in many pies, conducting safe (fundable) Science.

I think I came in with the wrong attitude. I tried to give my time freely; I sat on committees, gave lectures, organized seminars, never turned a student away. In my work I never turned a project down; I offered myself as free statistical labor and Chaired working groups. I think it is hard to take that this did not work out.

It was actually a very difficult time for me; I take these things hard (too hard I think), and spent a lot of time crying and scared to do anything.

As it happens, I have been working with colleagues at Baylor School of Medicine. I guess it is a better fit there. They really like my Science, and have bent over backwards to try to make my ideas feasible and fundable. There were some amazing and exciting moments in which we would have a discussion about what I thought needed to be done in the behavioral genetics of obesity, but how I felt these ideas were just not practical. I vividly remember my colleague Sheryl coming into a meeting the week after such a Discussion and saying triumphantly ‘I can do it! I can design the study you need!’. And she did. I have written grants with the behavioral group and been blown away by how much support and feedback they have given me, and by how many doors they have opened (even when I was not ‘one of their own’). I loved that after submitting a grant I heard the words ‘So… what is the next project we will work on?’. I see their papers come out and am jealous I did not work on that project. (<- this is always my no. 1 tip for people looking for an academic institution – do you wish you were on the papers coming out of that place?).

So, when they invited me to interview last August (yes, that long ago). I agreed. I was quite surprised when they offered me the position, and even more surprised about their willingness to accommodate my concerns about funding, and the kind of start-up and support I would need. It took a lot of thinking about; the group at Baylor are very successful, well-known people. I really spent a lot of time thinking ‘ummm… why would they want me? And will I be a giant failure in comparison?’. Baylor require substantially more grant funding than UT, even than UAB (although no formal teaching) which, as outlined above, is a difficult thing in today’s financial world.

I discussed things with my School. Ultimately, and it hurts to say this, they did not make an effort to keep me. The words were there, but when I asked if we could have a meeting to discuss my 5-year goals, what I needed to do to get there, and how I could make this path happen I was told ‘No. Just stay if you want to, and go if you don’t’. So, I picked to go to the people who had laid out concrete ways to support to me.

It was phase 2 of a difficult time. My fear had been all along that it would be hard to live up to the academic credentials of the people at Baylor (they are really awesome), and there was some feeling that I would not however, I have been really spoiled in my training so far;  have always been told to push myself because I can achieve anything I put my mind to – that I am as capable as everyone as anyone else, and that success goes to the persistent: so persist! I was hugely respected by my PhD mentor Jonna, and given lots of analyses to lead at a young age. I was pushed by my postdoc mentor Donna to follow my dreams and by my postdoc mentor David to reach for the stars and keep trying. I was trusted with opportunities and made to feel good. And ultimately, I do best in an environment in which I have to strive to keep up – I do well if I feel I am not ‘making it’ and thrive in competition.

That is the environment I have chosen to gravitate back to – whether rightly or wrongly. The group at Baylor do demand high productivity, but they also love to see people follow new ideas and try new things. They love thinking about how they can push the boundaries of Science. I have a few collaborations there already and am enjoying working with people who make things happen – who turn ideas into projects.

So, from today, I was a member of The Children’s Nutrition Research Center, at Baylor College or Medicine. I promised myself that if I made the move, I was not going to live in fear of not living up to their standards or getting funding (that part of my life is over, right?). I am so excited to keep my epidemiology going (which is somewhat ‘safe’, and the result of an amazing mentor at UVA – where I would also move in a heartbeat) but also to explore new ways to bring epidemiological approaches to conceptualize and understand our eating behaviors.

Bad ass office

And I have a BAD-ASS office, which currently has two fish tanks  (one salt water, one freshwater) and a whole tray of plants.

I am excited because I can see productivity on the horizon, collaborations, and new Science. I feel valued and respected, even though these are people that I have so much to learn from. And coming full circle to the  title of this post: if you are in academia I encourage you to evaluate yourself and ask: do you have this? Are people excited for you to be a leader in Science? Do they recognize your unique needs and try to meet this? If you want independence: can you see that? if you want to be a part of team rather than a leader: do you have that? My old office mate Claire (very wise young lady) inadvertently prompted this move as well. She said that she and her husband were going to stay in Science until it was ‘wasn’t fun anymore’. Junior academics: are you having fun? I moved to have fun. Nothing is guaranteed anymore, so you might as well enjoy yourself on the way up or out.

The resolution to the problems in academia seems to me to be to find your happy place and stick it out as long as you can. I hope that this is what I have taken a step in this direction.

Image credits

http://www.phdcomics.com/comics/archive.php?comicid=1144

http://www.withlove-rachel.com/2013/02/i-may-be-geek-but-i-am-definitely-not.html

So Dr. Wood… should I do a PhD?

Tags

academia, Doctor of Philosophy, faculty life, getting grants, job security, life as a Scientist, life as faculty, mentoring, NIH funding rates, PhD, science, should I do a PhD, student life, work-life balance

I am sitting at my desk at 10 am, just 8 hours after I last left it. The pattern of 3 out of 4 nights this week. To my left, a venti latte. To my right, a picture of Sam from his hospital shoot, with his 1 month hand- and foot- prints immortalized in plaster of Paris. At the moment I see way more of that picture than I do of my actual son. Last week I traveled Tuesday -> Saturday. I was on the office Sunday. This week has been 9am-2am most nights. I made it home for dinner once. I am working late on Monday, and travelling Wednesday -> Saturday.

Every time I see my son he seems to have changed; his face is rounder. I am sure he got taller. I am starting to be glad he has a picture of me in his bedroom. His deeply excited cries of ‘Mama’ and his plentiful kisses when he sees me are simultaneously reassuring and devastating. How can my heart be warmed and broken at the same time?

I take a drag of coffee, and smile at my student. He looks nervous and says “I wanted to ask you a question… do you think I should do a PhD?”.

The worst question. It used to be an awful question to answer for sub-standard students. How do you dash their hopes and dreams? How do break the news to them that they are not who they think they are? How do you make it NOT sound like you (a PhD-level Scientist) are any better than them? That we are all just different? [Hint: I use “Great question! What skills do you think it takes to do a PhD? Do you think you have those skills? How do you think you would develop them? What sort of base would you need? What might you do to acquire them”]. But this student shows all the promise of being a great PhD student, so easy as pie, right? A quick yes, and a cheer, and high-five and a discussion of all the wonder that lies ahead.

Except, Science has changed. Science used to be known for being tough, and full of rejection, but ultimately a fun and rewarding enterprise. Intellectually demanding, often temporally demanding, but the reward of leading a research team to answer you own personal curiosities about the world was a goal no one could put a price on. Now? The funding situation has been terrible for the last 5 years. When I submitted my K award in 2010 the world was reeling from the shock of NIH dropping the pay line from a score of 10-40 (out of 90) to 10-30. It was absurd, people said. It must go higher! For my final cycle they dropped it to 19 (although eventually upped it to 25 which is how I got mine funded). Yes, 25 out of 90. Wonderful.

Shocking.

Terrible.

But these were the tough times that you had to ride out.

But it didn’t get better. The funding rate stayed at ~ 9%. That is, 9% of grant written get funded. Or, 91% do not. And then what happened? Senior people got their grants cut, they got the number of years on their funded grants cut, they lost their lab technicians and their postdocs… so they wrote more grants to get them back. Making the grant pool more competitive. So the 9% funding rate, became more like 4-6% for new investigators.

So what do new investigators do? They take on more work. They pick up the slack the funding mess left behind to try to make a name for themselves, to establish themselves so they could not be competitive against Chairs and even Deans. They write more grants than ever before, and they do more analysis than ever before, and they snap at the heels of anyone who can give them something to do that might bolster their CV.

But it’s OK because they are following their dreams, right? Except they are not. Funding uncertainly means that only the safest Science gets funded, in the areas currently identified as ‘priority’. Science is rife with tales of ‘I do what is fundable, not what is important’ (the two are obviously supposed to be interchangeable).

It’s along climb to faculty. And then you get there, and there is no relief. You are the 32 year old provider for your family, working endlessly, unsure if you’ll even keep your job (and watching your colleagues lose their).

So, what do you tell your promising student then? You are the role model. You have papers, and the awards, and the grants they put on the pedestal with you. Do bring them down? Or do you take the responsibility for the life ahead? Your job is really to continue academia and bring the brightest and the best in. But those are the ones you usually feel the most empathy for. They are the ones you most want to help.

If life is really about happiness, at the end of the day, what do you say when people say

“Dr. Wood, should I do a PhD?”.

OK, it’s not that bad. It’s really not. Not always. I have times when I just love my job. I come up with a new idea for a paper. I get work with an inspiring team. I lead a student to discover their passion. I travel to some cool places (although I am getting sick of Orlando, San Francisco and D.C., dear conference organizers). I get an interview with Good Housekeeping (yes! I did). I write a chapter for a medical student’s textbook, so I think I might actually reach some people (now there’s a thought). I like to think I will in some ways provide a good role model for my son (although there are many paths to doing that). But the Science we are in now, if very different than the one we got into just post PhD. And I think that we have a duty to prepare out students for that reality, so that they can make an informed choice.

And it has been different since the choice was work vs. Sam. Work has a lot to live up to.

For what’s it worth, with this student, I focused on the next step, not the bigger picture. I explained how rewarding, but how long, and how hard a PhD was. How I remember getting the night bus home from mine, and the night bus did not even start until 1 am. How I openly tell my PhD students that I expect them to work weekends, as well as evenings. How you are welcome to spend time with your family, and have every right to, but you have to understand you are in competition with people who do not – so make your choices accordingly. He still wants to do a PhD. I’ll leave the supervisor of THAT to deal with the longer term questions.

An Aside: I wrote this post in respect for 2 of my 3 blogging goals for 2014. One is to blog at least twice a week so that I can join a blogging network, and be more part of the blogging community (OK, so I am not achieving that one yet – but see the working until 2 am thing, mmmmkay?). The others are to (1) be brave enough to blog about something other than Sam – it can be hard to sit and write about things I do not feel so confident in; and (2) to be more honest about the ups and down of life. 2013 was really very hard for me, and I hardly ever wrote about it. I think there is that tendency in all of social media: facebook, blogs etc. We write about all the good, and very little of the bad. I think that sometimes people that showing that things are tough is a weakness.

Personally, as a reader, that makes me feel really shitty about myself sometimes – like I am the only one with hard times, or that I should just ‘buck up and be happy’ because everyone else is. I want to write more honestly about some of the things that are hard in life, while of course celebrating and sharing the good things. This was an attempt at that. And I am hoping that it will turn out to show strength of character, not the reverse.

Images credits (stolen from….)

http://ammamarfo.com/2013/02/20/highlight-reel-syndrome/

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Cutting through the BS and finding the Science

Tags

cortisol, cry it out, Ferber, Ferber method, Mom wars, popular Science, science, sleep training

I was slightly nervous posting about our sleep training. It’s a contentious topic, and I was worried about a backlash. Actually, I did not receive one; knowing that we had actually done it, and were not just considering it, my friends who do think sleep training via our method (some sort of cry-it-out-ish) is not good idea, kindly kept quiet. I appreciate their consideration. Others wrote with encouragement saying “we did that and it was awesome!” which helped me too. But a number of people responded to my comments about cortisol with relief: a ‘thank you for writing that, I had been worried about affecting my child and now I feel better’.

That got me thinking: as Mums (and Dads and Aunts and Uncles and pet cats… OK, not pet cats) we are bombarded with “information” (cough) about how to raise children. And what to eat. And how to have a successful marriage. And when to exercise. It goes on. The internet age has bought stacks of articles, stories and opinions to our fingertips (and many, many pictures of cats).

I am lucky: a large part of my job is to read scientific articles which argue that  they conclude X and to work out quite why they don’t actually quite conclude exactly X, so that I can go and do studies to help us actually conclude X with better data. Essentially, my job is to see through the bullshit and interpret actual data accurately. I spent the last semester teaching my student to do just that and she passed her qualifying exam in flying colors. I am not great at a a lot of this whole Science thing, but I am pretty good at that.

So, I think I have an advantage. I can see through all (well… some… I occasionally call my Mum in a panic) the guilt-trips and the misinformation and the scare stories Yes: scare stories. (check out the daily Mail’s list of things that can give you cancer http://www.anorak.co.uk/288298/scare-stories/the-daily-mails-list-of-things-that-give-you-cancer-from-a-to-z.html/).

Personally, I am never going to stop reading the interwebs (I’d have to do way too much work for a start), so I thought I would share some of my tactics for keeping a sane head.

First, I usually try to source the original scientific article. You can usually find them on PubMed or Google Scholar with some clever searches (can take some practice). You will find a link to the article (which you may need to subscribe to a journal to read), but I do the bulk of my assessment off the abstract. But you don’t need it really. Then I go through the following process, which I will illustrate using the ‘sleep it out causes anxiety disorders in children’ study. I use this study only because it was the subject of my most recent obsessive-research bout. You can do it equally with ‘diet coke causes your leg to fall off’ or whatever the latest ‘thing’ is.

So, back to the study. The abstract can be found here, and an article written about it on the internet can be found here.

Essentially, the study examined a small group of infants who had been left to cry-it-out as sleep training. After 5 days the infants would go to sleep without crying, but their cortisol levels were higher, while the cortisol levels of the mothers were not high. That is all the study says.

Response articles, however, said things like “But there is no doubt that repeated lack of responsiveness to a baby’s cries-even for only five minutes at a time-is potentially damaging to the baby’s mental health. Babies who are left to cry it out alone may fail to develop a basic sense of trust or an understanding of themselves as a causal agent, possibly leading to feelings of powerlessness, low self-esteem, and chronic anxiety later in life”.

I can’t find it now but I did also find an article that said that children left to cry-it-out would, within 5 minutes, “deduce that they are essentially unlovable”.

Holy Moly! Who wants to subject their kids to that?? So, what proces did I use to evaluate these data:

(1) OK, the biggest thing ever: what do the actual Scientists who wrote the study say it means? Not a blogger… not an author… not a media Science writer… not a random Physicist who someone got to comment on the study: what does a Scientist in the same subject say about the data? Preferably, what do the authors of the article say? They say:

“The findings are discussed in relation to understanding the determinants and implications of maternal–infant physiological synchrony in early childhood”

NOTHING about later life. NOTHING about disorders. Not even anything about anxiety. Not even implications for the development of the child. They simply say that mother and child cortisol levels are no longer in sync: they have a ‘physiological asynchrony’.

Already it’s less scary, right? I mean, if I said “do this and your hormones won’t rise and fall in the same rhythm as your child’s” you probably wouldn’t freak out too much.

(2) Then I look at the actual outcome: cortisol. Now let’s look at the claimed outcome: anxiety disorders in later life. Assuming the actual outcome was well measured in this study (and the cortisol was… it’s a good study) can we link the actual outcome with the claimed outcome? NO. Is there any scientific link between infant cortisol at bedtime and later anxiety disorders? Nope. OK, so how about infant cortisol and later anxiety disorders? Errr… nope. OK, we are getting tenuous here, but how about general cortisol (remembering that we have no proof that a temporary nighttime rise in cortisol leads to a general increase in cortisol) and anxiety disorders? Makes sense, right? Well, maybe, but sadly Science does not agree. Some studies support the hypothesis that cortisol (which is linked to acute stressful situations) is associated with anxiety disorders while others,show that within individuals suffering from anxiety “a lower cortisol awakening response… predicted an unfavorable course trajectory”.

So, you may not want your kid to experience cortisol rises. That’s fine. You may think that infant cortisol leads to adult anxiety. That’s also fine. But, know that that is not an evidence-based view.

(3) I check whether the outcome (here: cortisol) has been associated with ONLY the status variable (here cry-it-out training). Well… no. Cortisol is associated with any infant distress. We put our kids through distress all the time (last time I used the example of Sam howling in the car seat when I was on the interstate and couldn’t comfort him). So, cortisol at night is a question of adding something the kid already experiences, not bringing a whole new qualitiative experience.

More importantly: there is no evidence about whether cortisol is experienced by non-cry-it-out training. There is no control group. It is not only possible, but plausible to me, that if you have a kid like Sam who seems to hate the very concept of sleep, any form of sleep training is going to stress him out (this was highlighted to me when he would go ballistic at cuddling on the boppy pillow because it was used at night).

(4) I also look at the general methodology of the study: who was the data collected on? If it is not humans I treat conclusions pertaining to humans extremely skeptically. Is it on a large sample? This was on 25 infants – that is not a lot at all. It is probably what we would call a ‘pilot study’. But, that does not invalidate the conclusions of the study, it just means that we need to see it repeated. It is very possible that with such a small sample size there was some particular characteristic about either the mothers or the children that don’t pertain to you. Has the study been repeated by an independent group? In this case – not yet.

(5) I also consider the point that in most studies where we are looking at potential harm people are not randomized to a group. That is, people choose to follow a certain path / method and perhaps WHY they chose that actually explains the outcome. In the case of the sleep study, we have infants who could not sleep through the night, and mothers who responded to an advert for such (were they at the end of their tether?) and agreed to take part in the study. Would I follow a training plan for my kid at the direction of a Scientist to earn some bucks? No. Would I sleep in a sleep center with my kiddo when he was that young for 5 days? No. So maybe there is something about these mothers who consented to do such that leads to the rise in cortisol.

The clearer example is on breast vs. formula feeding. There are great breast and great formula feeding mothers (I was both, so clearly I am doubly great… that’s Science). But, if you ARE a negligent mother OR you suffer PPD or whatever, you are less likely to go through the hassle of breastfeeding. So, there will be more ‘struggling’ mothers in the formula feeding group. Or, even if you are super fabbie wonderful faultless mother (like moi, naturally) then there may be a reason you formula feed. I didn’t produce enough milk. Possibly because I was separated from my baby so much early on, or because I went back to work so quickly, or because I didn’t have a great post partum diet. Maybe THESE reasons – which aggregate more among formula feeders – and not the formula cause group differences between formula fed and breast milk fed babies (where they exist).

(6) I am wary of ‘evolution’ arguments. Yes: our environment is changing faster than our DNA can evolve (although note: much of who we are is not what the code of our DNA says, but how much it is turned on and off [i.e. are the genes doing anything in our body, or just lying dormant] and that can be changed in as little as 12 hours…). But regardless, our environment has changed, and we have to help our kids fit into it at some point. When and how is up to you.

(7) Sift out sensationalist language. Young Scientists, especially those in behavioral Science, learn early on not to say “we have shown that such and such is the case” but rather “our data support the idea that..” or “we have added to a body of evidence arguing that…”. Internet articles are sneaky-sneaky using a mix of both:

“But there is no doubt (oh no!) that repeated lack of responsiveness to a baby’s cries-even for only five minutes at a time-is potentially (oh… wait..) damaging to the baby’s mental health. Babies who are left to cry it out alone may (only may?) fail to develop” yada yada yada. Don’t focus on the first bit: focus on the uncertainty.

(8) You will KNOW if something is – for sure – bad for your kid. There are no Mummy-wars about whether one should smoke in pregnancy to stay relaxed, or teach your child to skip meals to keep body fat low and prevent child-onset obesity. Or if mothers should drink a butt load of delicious delicious wine to blank out the sound of their infants crying. We know some stuff. The rest? It’s not evidence based. It’s instinct and guesswork.

But yeah, I have my random opinions about my kid – some rational, some not. I am obsessed with the idea that Sam has homemade baby food only until he is 2 – even the organic-in-a-pouch stuff is not “good enough” (I am sure I will reassess when I see the work… but hey, Wes is a SAHD, he’s got to earn his keep 😉 ). I don’t really know why, although if I had to, I could bring out a heap load of scare stories showing you why he MUST have that if he is to be AT ALL healthy and functional later on in life. I would not have had him vaccinated had I been in the UK – even though Science really does not back that stance up. However, I don’t care too much about baby bath products (poison apparently), crying-it-out and disposable diapers. Go figure.

All vaccinated up

But look – you gotta read the stuff to know what you think about it. I certainly like my friends sending me articles that go contrary to my opinion so I can reevaluate my opinion. David (one of my UAB mentors) once said to me “Be who you are, but be it knowingly”. I say: “Raise your kid in your own way. but do it in an informed manner”. And do it without guilt.

My birthing coach Johanna put it best when I was fretting about sleep training: she asked if I really thought one thing could make up for all the days and nights of unconditional love.

Anyway, if Sam is anything like me, he’ll f- himself up more than I ever could anyway 🙂

Image credits

http://cheezburger.com/7281371648

http://tabloid-watch.blogspot.com/2010/04/mail-cancer-scare-is-fabrication-shock.html

6 months as Assistant Professor at UTSPH

Tags

American Heart Association, DP2, First year as faculty, getting grants, grants, K99, NIH Director's New Innovator Award, R21, teaching

Wow, that is very scary. I am 1/6 of the way through my first contract with UT. A good time to look back on what I have done, what I haven’t done, what worked and what did not.

Grants

This has got to be the biggie – the main concern, the main activity and the main source of waking up with cold sweats in the middle of the night. My paper record is reasonable for this stage of my career (32 papers; ~22 first-author), and I am tenure-track, which in my case means I have 3 years to get a grant. I have publishing expectations, but not contractual obligations. However, my ability to feed my son depends on grants (and to think I turned down a hard money job…).

It sounds like a long time… it is NOT a long time, especially as the lag between submitting and funding is generally at least 9 months. If you get revisions and decide to resubmit, you are looking at more like 15+ months. My K99 took nearly 2 years as I had to wait until the end of the funding cycle for a decision. Then I lost it… showing how precarious grants can be as well. So, if my next grant took as long to come as my K99, the ‘winning’ grant would have to be submitted within the next 2 months, to keep my contract. Scary.

My aim is to submit one NIH grant every cycle (3 cycles a year) and to hit as many alternatives as possible (foundations / internal UT funding / begging under a bridge). I have no qualms about my funding NOT being from NIH. I understand that that is most prestigious  and most beneficial for the departmental (huge indirect , but I am more concerned with just being able to get some Science done. I have the support of my Department Chair & Dean in this.

I got 2 NIH grants in – I actually aimed for 2 in case I missed the February deadline due to the arrival of young Samuel. I got in a K-12, which while using NIH funds, is administered through UT, so I already know that I did not get it. Boo. I also submitted a DP2 (stop sniggering Stella), the new NIH Director’s New Innovator Grant, which takes nearly a full year to review. In addition, I submitted one small pilot grant, through an institution (Baylor College of Medicine) with some colleagues I have made since arriving here (i.e. it is very new collaboration). Waiting to hear (hopefully very soon on this one).

Well… I am glad I was productive. I think 3 grants in a new place, all of which count as data collection grants (not secondary data analysis  which are somewhat easier to put together) counts as productive. 2 reflect new collaborations (the pilot grant with Baylor, the K-12 with UT Med school). And I will always believe that when you are junior, just the process of writing and submitting a grant is useful. But, I think I didn’t make the best choices.

My mistake was not going for grants which could be resubmitted. The K-12 I am not resubmitting because my teaching load starts soon, and is not compatible with the training and research demands of the K-12. The DP2 doesn’t have a revise and submit option. Given that last year the finding rate was under 3% for the DP2, and this year they are likely to have more applicants, but the usual NIH cuts, I have actually just written that one off. So, here is the thing: at the end of three rejected grants, I feel like I am back at square 1.

OK, not square 1, because all the benefits apply: I have shaped my intended research program somewhat, I have discovered my passions, improved my writing and learned how to make a budget (I had actually never done one of these before!). I can navigate fairly speedily through the vagaries of UT’s IRB, COI and IRiS (grant submission system) fairly smoothly. So, I guess I am ahead, but not where I would like to be, which is with some comments in hand and a grant ready to resubmit.

One of the problems with the DP2 is that it is an unusual grant format, and we have no templates for the submission, so it took a lot of time, for what I am anticipating being very little payback.

I actually find being 6 months in, and no grant on the horizon terrifying, but I try not to think about it to much, and try to act on it. So, a game plan:

*Keep submitting, submitting, submitting. Recall the American Heart Association at their Early Career Day:

“Grants Don’t Go The Smart” [we are all smart] “Grants Go To The Persistent”.

*Try to get into established groups, and work with established people. I think I was naive before: I thought that I could just come up with a great research idea and pursue it, solo. I am more and more pessimistic that that is possible: I think you have to grow your idea out of a secure base before you can run with it. You may have all the skills necessary, but NIH still want to see small steps in the progression to your idea. I look back and I have won lots of awards, but always, at about the end of a three-year study period. And I always struggled at the beginning. I see getting a grant as less like drawing a picture, and more like growing an orange: you have to plant the seeds in well fertilized soil, nurture them, water them, tend them, watch them grow, and then, then all that is done and the tree is strong, you will get your orange.

I have not given up on some of my grander plans, but I am focussing on smaller more logical research steps and building my other plans more slowly: as I built my behavioral genetics reputation (sadly going – sob – it is my favorite thing) over a 3 year PhD, then I built my lipoprotein work over 3 years. For both of areas, I didn’t feel respected until the end of that period (and nor, looking back, was I remotely competent). So, as I move back into BG and move into cognition and obesity, I am planning to fund myself on other projects, and slowly ‘work-for-free’ producing papers and building a research base.

It’s still scary.

Papers

Eh. I really miss writing papers. With 3 grants, networking, having a baby, learning how to be a mentor and so on, I have not done the Science that I loved doing before. My mentor Donna was wise: when I asked to leave UAB she asked for three papers in the three months before I went. She got them 🙂 It left me with a strong and recent publication record on my CV and gave me some wiggle room.

I am running out of wiggle room. I have some ideas, and some manuscript proposals in, and I need to get better at arranging my time.

Teaching

One of my proudest and most enjoyable achievements at UTSPH has been becoming a mentor. I have had the benefit of wonderful, selfless mentors and I am honored to be able to pass on their gifts to me, to my student. I have spoken to a lot of people, both inside and outside, of UT, about how to be an effective mentor. I am working hard at focusing on the needs and dreams of my student, not just *my* needs. I.e. really working with my student on what she wants, where she wants to be, and what she finds fulfilling, without just giving her the work I need done (in her name, of course). But then I am trying to balance this with keeping her productive. I invested a lot of time with my student identifying her weaknesses and working an individualized program to fulfill them. I hope to always have the time and freedom to do this for people.

Looking forward

I love my Department at UTSPH. I chose a job fairly naively (impulsively? Hastily?). I guess for a first faculty position, I didn’t really know what I was looking for. I guess I also didn’t know that (1) I would be a mum and (2) a Mum-Lekki might be looking for something different to a non-Mum Lekki. These are the things I value about my department:

*It is very egalitarian. I don’t see ‘ranks’ among the faculty. Everyone treats everyone else equally and with respect.

*Our Chair cares deeply about his Department. And it shows.

*It is a ‘healthy’ organization to me: everyone seems very happy to help and guide. There is no evidence of backstabbing or competitiveness between members of the Department. People pull together and are kind to each other.

*Many in my Department really value family. And have made (small) allowances for me having a baby. It’s not that they value me less, or expect less of me, just that I have been given some space. I have to hit the same benchmarks, by the same time, but the road there is a bit more flexible.

*Most importantly of all: I have fabulous female role models: women who are enormously successful, but are mothers first-and-foremost. I have loved seeing this.

I write this in the hope that it might inspire people who are job hunting to think beyond pay scale, teaching hours and tenure clocks, and think more about the type of place they want to be, and the type of place and people that would make them happy.

I always wondered what it would be like being faculty, and I think this post sums up the early months: highs and lows, panic, a juggling act, a steep (but wonderful) learning curve, responsibility (so much responsibility!), freedom.

So now… I am looking forward. I have 3 grants this month: An AHA Beginning-Grant-In-Aid and an R21 (familiar mechanisms, good funding rates, and based on my previous work – come on!!) and an internal pilot funding application.  I am already working on one R01 to be submitted in June (not sure if I will go as CO-I or CO-PI) and planning another (this time in the area I want to move into, but based within a team). I am also teaching (!) Team teaching (phew) in Summer, and building my own course in – of course – Behavioral Genetics, for the academic year 2013-14. Very exciting.

I am still scared nothing will come of anything, and I’ll be out of a job in June 2015. But hey, that just encourages me to keep trying so that I can say “At least I gave it my all”.

Academics: how do you feel? What do you feel about leaps from postdoc to faculty? What do you think your chances of a grant are.

Everyone: What do you look for in a job?

I’d love to hear your thoughts.

Being a working Mum (part 1)

Tags

evening routine newborn, marriage after a baby, maternity leave, milk supply when returning to work, morning routine newborn, pumping at work, returning to work after a baby, returning to work at 8 weeks, working mom

Ready for work

Well, this was the week that I returned to the office full time. Sam turned 8 weeks on Sunday, and I returned on Wednesday 2nd January.  I was dreading it. Full on dreading it. I grew up expecting, witnessing and delightedly anticipating 6-8 months of maternity leave. And, I got 5 days off followed by 5 weeks working from home (popping into the office ~3 times a week) and then 2 weeks off for Christmas. I loved being off completely – Sam is a delight, and was wonderful to be at home with. I reveled in full-on Mum-hood and it was enormous fun, and vastly rewarding to slip into the ‘Mum’ role: being there with him, making curtains, nesting at home.

Being a Mum

What I didn’t like so much was trying to work from home, and feeling unproductive and slow. I felt I was not being a great Mum (I was with Sam, but not doing lots of ‘Mum’ things) and I wasn’t being a great Scientist (I just kept my projects rolling along, I didn’t do anything new). Still, I often cried at the thought of returning to work and being away form Sam.

But that was it: I cried at the thought of being away from Sam. The big return happened at the end of a UT-sponsored 11 day Christmas break. No work, no trips to the office, often: no getting dressed 🙂 It was great, but it was not ‘me’. I like structure and progress and achievement. Come the dreaded January 2nd, I actually looked forward to getting dressed up, getting out of the house on time, and being totally focused on something for me – until that point everything was either done with Sam, or with the consciousness that Sam was nearby, and the unavoidable tendency to run to him at to his every wail.

Both of us at about 3 pm one day. It was time to get out of PJs 🙂

Yes, I actually looked forward to leaving my son. I looked forward to being productive. I looked forward to achieving. I looked forward to talking about things that didn’t involve spit or poop. I looked forward to doing Science – I truly love and believe in the value of what I do.   So, I journeyed off to work with some trepidation, but mainly, excitement.

And it was good. So much fell into place – so much of me came back. Like healthy eating. I knew my breakfast had to sustain me so I made something wholesome and nourishing (I won’t reveal the number of McDonald’s egg biscuits I ate for breakfast on my 11 day break, but it rhymes with schmeleven). I had to take lunch in, so I was motivated to make something healthy. I washed my hair and I did my make up. I felt like I got back to being me.

That’s better

And I had a ball at work. Partly because of the long break, partly because I knew I had much less time than before, and partly (mainly) because I was there instead of with my son – I worked my butt off. It was like I had to justify being away from him, by doing something equally as valuable. Facebook was off, except for lunch / tea breaks, and personal emails were largely filed away under ‘to be answered at the weekend’. Every day 1 pm arrived before I even noticed.

Sam shopping without his mama 😦

Granted, about then, I start to really miss Sam. By 2 pm, I miss him enough that it hurts. But I demand some extra pictures / updates from Wes. I see how happy Sam is and I just count down the hours until 4.

One pretty happy little monkey

I am not saying it is ideal. I am not saying that given the choice, I would not have a more UK-style maternity leave. I am not saying that I don’t think an extended maternity leave would in fact be better for Sam (as suggested by the bulk of Scientific evidence, which also shows that it would be better for me). I am just saying that there are advantages.

*My milk supply is better because I pump at a scheduled time each day, and pump past empty.

Pumping. It’s a love-hate thing.

*I have now spent time investing in proper morning and evening routines. That time does not pass by now without every second being valued. In the morning Sam and I wake up at 7 (Sam would like to sleep until 8.30 – not happening buddy!).We play and cuddle for 20 mins then I change and dress him. We go downstairs and I make / eat breakfast (Wes holds him while I nip upstairs and dress like lightening) and then I breastfeed Sam, and pump. He goes to his Dad, full and sleepy and I go to work.

Monkey is actually awake here… he is just pretending to sleep. Seriously.

In the evening, I get home and breastfeed when I walk in the door (usually I top up with pumped milk). Sam and I play (or I might go for a short run, followed by play) until 6, and then we have serious bath-time. He and I climb in together and laze in the bath for up to 30 mins 🙂 Then it is PJ time, story time and feeding time, and down for bed. I make every second of that time count. It is wonderful time that otherwise was rushed through, or passed off to Wes.

Bath time of awesomeness.

*Wes is happier as it helps him have a routine, and be productive himself. It makes us more of a partnership as we are a real team in this, and also gives me something interesting to talk to him about. I don’t watch much news, don’t really follow any sports anymore, and now I have something in my conversation other than babies. And it puts me in a better mood (unless I have had a bad day at work, but hey, you can’t have everything).

Husband and wife 🙂

It is certainly not easy. It may not be what I would choose. But, I am happier than I was when staying at home (more content? Probably not). When it does get hard (Friday was hard, after 2 pm is REALLY hard) I remind myself of these advantages. I remind myself that Sam still responds in a really special way to me: he has a special calmness for me, and an amazing smile which he refuses to give to anyone but me or his Dad.

Oh that smile

I also remind myself that when I pictured my family I didn’t picture something as dependent or as needy as an infant. I pictured a more independent child – running about, exploring, socializing and sharing his / her view of the world with me. I pictured three or more people, each having their own experiences, and sharing that, so that they could learn from and grow with each other. I looked forward to us all giving equally and contributing to the family dynamic.

It’s an unusual set-up, and I am surprised it works so well. I wouldn’t wish it on anyone, but I might choose it for me. In a way, it is also sad. We have all grown-up. Being at home was like being in a lovely cocoon of Mummyhood. And it kept Sam so young: he didn’t have to have bottles, he didn’t have to have a routine, and everything could be deliciously focused on him.

But, ultimately, my contribution to my family, to the world and to myself lies in my work. My Science. My teaching. It makes me me and I am glad to have it back. In essence, I remind myself that I have been gifted the very dream I wanted all along – just a little earlier in Sam’s life than planned 🙂

Academic Awards

Tags

academia, awards, etiology, genetics, lipoproteins, public health, success, type II diabetes, winning awards

Yee-ha. 3.5 weeks’ in to IT, life must be slowly returning to normal (the new normal, to be cliched) as I actually have something about academia to say. My mind must be emerging from its previous state where it basically went “How is Sam?…. is Sam OK…? Do I need to feed Sam?… Maybe I’ll just look at Sam for a while… Awwww… look at Sam! [repeat ad infinitum]”. I have even managed some work. It is good to be back 🙂

That being said… there is always room for a picture of Sam.

So, I recently won an award. The Scott Grundy Fellowship Award for Excellence in Metabolism Research, given by the American Heart Association (AHA). I am ridiculously excited (hey – I have been in with a baby for nearly a month, it doesn’t take much!). But… I feel a bit guilty because I don’t think my research is any better than many of the other applicants (and I know this because I graded the abstracts for the conference, and saw some of the abstracts which applied for this award, although obviously I had no say in the actual award). I have felt like this before… I have won a few awards in my time (and even had some taken away :-O ), and really, I am not sure I ‘deserve’ any of them. So as a way to assuage my guilt here are my ‘hot tips ‘n’ tricks’ for winning academic awards at a junior level:

1. Make your submission a culmination of a body of work. Random projects may be very good, but IME, they rarely win awards. At the junior level at least, it is better to have had a clear path to the current the piece. Notice how many people win at the end of their PhD.

2. Make it clear how you are going to further this work. A lot of awarding bodies want to give the award to someone whose work will become well-known. So, it is best to make it clear that you – and others – think this work has real longevity (for epidemiologists read: clinical implications). Spell out how these conclusions will lead to work that will eventually help people and how YOU will use it to do so.

3. Apply for everything. Seriously. To an extent: it is a numbers game. No one knows what you didn’t get, they only know what you did. Any competition, any award, any conference with a ‘prize’, anything: I’ll apply for. Kind of the infinite monkeys theorem approach . Yes, it is awkward to nominate yourself for an award. Read this for inspiration to do so.

To be or not to be… that is the snigleplonk.

4. Know the awarding body you are applying to, and know their mission. Use phrases from their website / literature / position statements for how your research fits their mission.

5. Know the ‘hot trends’ in your fields, and try to submit a paper on that (without ignoring point 1). Ah… yes, my paper is on ethnic disparities.

My early postdoc work… and the starting point for the winning abstract. Yes, it was a long research road.

6. Know the politics of your awarding body. Do they like certain studies more than others? I’ll be honest: I had heard that certain data-sets were more popular with the AHA than others… so I shamelessly planned to submit an abstract from one of those data-sets (although it is also true that this data-set was the best – and maybe only – way to answer the question I was interested in). Cold.

7. Think carefully about your letters of support and don’t brush over them. Choose your referee(s) wisely: I had an extremely gifted referee who was very respected by the AHA. He also wrote a wonderful – and personal – letter. This was really what did it, I suspect. I have seen people at other conferences ‘win’ or be a ‘Young Investigator Finalist’ and, especially with people finishing their PhDs, am sure that it is partially because their mentor is extremely popular in the society. Do not be afraid to ‘help’ your referee see the value and place of your work, either 🙂

First place! Woo-hoo!

8. Be involved in the awarding body, if you can. Go to their conferences, publish in their journals (er… I am failing at this one…) and help their society if you can.

So, I write this out, and it all sounds horrible. Clearly I decided I wanted an award and went for it, well before the submission date. I know I would love to think that awards were won solely because a brilliant young Scientist did some ground breaking research in a moment of inspiration that wowed the conference / society. But, realistically I don’t see this to be the case all the time (or even much?). So, I invite people to play the game others are playing: it only seems fair.

Also, of course, following all the above to the letter is NOT going to let bad research win. It is just going to help the very good research stand out a little.

My work:

Oh, what work won this award? Well, I have this hunch that patterns of lipoprotein sizes can be used to detect early diabetes: that is small LDL, in conjunction with large VLDL and small HDL may help us better identify who is at risk for Type 2 diabetes. I would like to develop this as a diagnostic, or at least, clinically predictive, test. I don’t know if it will work, or be better than our current clinical measures, but for some time, I have been interested in this pattern of lipoproteins, and interested in whether etiology (i.e. the causes – genetic and otherwise) are the same for small LDL as for small HDL as for large VLDL. This is primarily what I worked on during my postdoc. I am now interested in ethnic disparities in lipoprotein patterns: my work was previously all in Caucasian-Americans: is the same pattern predictive in non-Caucasian Americans? I need to know this because if I want to develop a diagnostic test, I need to know who it applies to, of course, I aim to develop a test that applies to all populations.

And then the topic of the ‘winning’ abstract,which has been the subject of my faculty research thus far: is the etiology of lipoproteins different by race / ethnicity? And if so: why? Does it speak to gene-environment interactions and so does it point to more modifiable risk factors (e.g. diet and exercise, but maybe something more exciting) in helping to prevent incident Type II Diabetes?

 

Image credit

http://en.wikipedia.org/wiki/Infinite_monkey_theorem

Samuel’s Birth Story

Tags

birth story, Bradley, cervadil, epidural, foley balloon, induction, pitocin, Texas Children's Hospital, Women's Specialists of Houston

This is the story of how Samuel Clarke Frazier came into the world 🙂 It ends at that joyous moment, so there is no dwelling or rehashing of the difficult time that followed – just a history of the moments leading up to one of the happiest points in my life. However, it is a birth story. It is graphic. On other blogs I have seen the authors put up birth stories and readers complain that words like ‘cervix’ and ‘discharge’ spoiled their breakfast. Well… expect that and more, if you stick with this post, you may know me VERY well by the end (although note: it is safe for work, and suitable for my students to read and still respect me afterwards).

We left off when the hospital had called. I had been merrily distracted by an awesome ‘shower in a box’ but as soon as the phone rang, all the emotions hit me: fear (perhaps terror), panic, excitement. At that moment, all I could think was ‘I am not ready… I just need another day…’. I answered the call, and the nurse told me that the hospital was not sure they could fit me in that day after all – but she would call and let me know later if it was a possibility. She could call us, but if we had not heard by 9, we could call her.

Ugh. Talk about a mood changer. OK, I might not have felt ‘ready’ but I did not want to delay this. I cried, so Wes got me out of the house to a gorgeous little Italian in Bellaire (where I ate about 3 bites of pizza and boxed the rest) and we got ‘Rock of Ages’ on DVD to distract ourselves. 9 came… no phone call, and at 9.00 and 1 second I dialed the hospital. Come on in they said! Come in for 11. Woo-hoo. That was a difficult hour to kill, but we changed and packed and tidied and faffed and left ridiculously early.

We got to the hospital at 10.50 and were not turned away! This was it… it was happening! Then began wait after wait… waiting for a room, waiting for a nurse, waiting for the cervadil (I am not complaining, I utterly accept that on a labor ward, the woman NOT in labor is the least of their priorities)… the upshot was, it was 2 am (yawn) before the induction began.

Induction part 1: Friday night: Cervadil.

Waiting for the first stage

Cervadil is a gel they put on your cervix overnight, to ‘ripen’ it (nice terminology, always reminded of ‘the reaping’ in The Hunger Games). Hopefully it thins the cervix and dilates it, meaning the pitocin has less to do – some women respond so well they go into labor, but that is not the purpose per se. The cervadil basically looks like a long tampon, but a doctor has to insert it (boo). Unfortunately, my doctor (the resident for that night) was very heavy handed – placing it and then pushing, and shoving more. I did get quite bruised, from the heavy-handed insertion, otherwise it would have been utterly painless. Once it was in, it was painless (I couldn’t feel it at all) and time for lights out.

Cervadil in, and no discomfort

Many hospitals give a sleeping pill at this stage, but I was not offered one (I don’t know if this is because my OB practice is as hands-off / anti-interference as possible, or because I had told them that minimal intervention was my choice) and I did not want one. Slept like a log anyway, until I was woken up at about 6 to see how it had worked.

Wes’ cot

I was pleased to see my OB, Dr. Boswell, in the morning. We love her, and she did the examination to see how the cervadil had worked. The result? No effacement, no dilation. Nothing. No change. Boo. I was disheartened, but Dr. Boswell was upbeat and said it was just time to start phase 2: round 1 of pitocin.

Stage 2: Saturday morning: Round 1 of pitocin

IV line for the pitocin

The turned the pitocin on at about 9. As I had wanted to try to labor without an epidural (even on pitocin) they started, as promised, at the very lowest dose: a 2. I waited, with some fear, for the hugely painful contractions pitocin is supposed to give, but… nothing. So after 30 mins, they upped it to a 4. And I waited… and nothing… this carried on all day, until at 2 pm Dr Boswell came back. She asked how I was feeling, and I gave a very merry “Wonderful! I feel great!” but her response was “Rats. I was hoping you would be in a lot of pain by now”. She didn’t think the pitocin was working – we could see my uterus contracting on the monitor, but no nice rhythmic contractions, nothing that seemed productive. And no pain meant that clearly, nothing was really happening. I asked if getting up and walking would help, but she said, not at this stage. I was welcome to, but resting for actual labor might be better.

So… I waited… and waited.. and we upped the dose every 30-60 mins. When the dose was at a 12 (not very high, it goes up to 20), at about 7 pm, Dr Boswell recommended the pitocin be turned off. You could see that my uterus was contracting constantly, with no break in between, but I could not feel it. I was still spending my time reading, watching TV, texting, Skyping my Mum. Basically: completely ineffective contractions. They checked my cervix: no effacement, maybe a fingertip dilation. Again: basically zilch.

Here, I am very grateful to have been with The Women’s Specialists of Houston. Not only did the doctor leave me alone all day (very few internal examinations… in fact, just one, with an intern who again was extremely heavy handed until she bought tears to my eyes) but many doctor’s would have just upped and upped the pitocin, labelled it a ‘failed induction’ and gone for the C-section. Dr Boswell said that this can occur for a number of reasons and that the game was not up yet. She said that nerves / tiredness / stress / hunger (I had not been allowed to eat before being admitted) can cause pitocin to fail: she wanted me to have a relaxing evening, with a big meal, and a good sleep. She also said that pitocin causes the cells that trigger contractions in response to pitocin to be expressed on the wall of the uterus, therefore they can work better on a second attempt, but you need a rest so your uterus doesn’t get ‘exhausted’ (yes… really). So, feeling doomed to failure I agreed to take a break. At this stage, I began to feel quite depressed about the whole thing: I had really wanted as natural of a labor as possible, and this felt anything but. My body just felt like a passive vessel for medical intervention: I felt nothing, I felt my body was doing nothing. Still, when Dr. Boswell suggested one last intervention to help tomorrow’s pitocin: a foley balloon, I agreed to try it to help avoid a C-section.

Stage 3: Saturday pm: Foley Balloon

A foley balloon is another method of helping dilation, but it is mechanical rather than pharmaceutical. Basically, they insert two balloons into you, one in your uterus between the baby’s head and your cervix, one just outside the uterus resting on the cervix. They fill the balloons with water and hope the pressure mimics the pressure of a baby’s head descending in labor, and so causes your cervix to dilate. Bleugh. I will say, Dr Boswell absolutely gave me the choice of having the balloon or not. She also sad that she would stop at any point when it was uncomfortable, and if we could not fill the balloons with the recommended amount of water without discomfort – we just wouldn’t. She saw no point in discomfort, nor wearing me out more. She is awesome.

The insertion was about as pleasant as it sounds – luckily Dr Boswell is a wonder at doing these procedures and it was just unpleasant / uncomfortable more than anything. At least, that was the physical side, emotionally I felt a bit like I was sick of being prodded and poked and my body not being my own. But hey ho. Dr Boswell saw all my bruising from the heavy handed intern examinations and offered me ice, which was nice, and sympathy, which I think was nicer 🙂

But once it was in, actually, no problem. I could not feel it at all, and ended up like this moments later:

Foley Balloon not hindering sleep.

It was weird getting up and going to the bathroom with it in… but otherwise, it really didn’t bother me.

At 6 am (why so early?? Why??) Dr Boswell (phew) came to remove the foley balloon. It was simple and painless – she drained the water and it kinda slipped out. Moment of truth time: had it done anything? Had it made any difference?? YES! I was 4 cm dilated! This is the stage they will often admit you to hospital (if you are not being induced), and evidence that my body might actually respond to something.

Stage 4: Saturday am, Pitocin round 2

Nice day to have a baby?

So, we were all go on the pitocin. They worked the same way as before: starting low and increasing the dose until it was effective, but not letting it get so high my uterus got exhausted (for real… they actually said this… hence the need for an overnight break and some food). Dr. Boswell came to wish us goodbye 😦 So sad to see her go, but she handed us over to her colleague Dr. Dryden with promises that she was ‘wonderful’ and ‘very experienced’ and had delivered both of Dr. Boswell’s babies. Dr Boswell said not to start the pitocin until the change of nurses shift at 9, so that the nurse can monitor the whole reaction of my uterus, and see it’s responses and patterns. She warned me that the time was probably coming to break my waters, she emphasized that given all the excess fluid, no one, but no one was to break my water except Dr. Dryden, in case of a prolapse. Then Dr. Boswell left for some much needed sleep (she had been at the hospital all Saturday and on call all Saturday night).

Waiting… waiting… by the time the nurses had switched and done their rounds, the pitocin was started at 10… again, I could not feel much, although it did feel a little bit more like rhythmic menstrual cramps. Dr. Dryden came in at 10.30 and determined it was time to break the water. I liked Dr Dryden (and she did a wonderful, wonderful job at the birth and after) but she was quite different to Dr. Boswell – I felt everything was an option and my choice with Dr B.; with Dr. Dryden felt more that things were going to be done her way. But I did like her and felt quite comfortable around her – plus she did the most wonderful job of the actual delivery so am eternally grateful for that. I got a bit antsy when she mentioned breaking my waters – we had been taught in Bradley that this increases the risk of C-section because once your water is broken, if the baby was not out in 24 hours, it was an automatic C-section. Wes asked if this was the case and Dr. D said ‘No, you are absolutely not on any clock’ so we agreed – again, I have a feeling that was going to happen anyway 😉

Dr. D. pronounced me still 4 centimeters and broke my waters. It took all of 2 seconds, I didn’t feel it at all, and then there was just a horrible hot gush. Ugh. Dr. D left, the nurse upped the pit and left Wes and I were left to our own devices. Before the nurse left she mentioned again that she could give me wireless monitoring so I could get up and walk – AS REQUESTED IN MY BIRTH PLAN – but you know when you are in pain and all you want to do is curl up and laze around? Yeah, I was there. All I will say is that breaking the waters is darn effective. Immediately, I began to feel contractions. Painful, but spaced out. I practiced my Bradley relaxation techniques to get through them – they came about every 2 minutes. Whether they are more painful than non-pit contractions I will never know, but I will say that you do get thrown straight into later stages of labor – for example, straight into 2 mins apart, painful contractions, which is often not the case with natural labor.

At about 11, the nurse came in and told me that she had read my birth plan and was here to get me walking. I wasn’t really given a choice, but in a good way. I had given them detailed reasons why I wanted to walk and use the birthing ball (pain relief, good positioning, speeding up labor) so the nurse played hard ball and made Wes walk me up and down the corridors. Again, a highly effective way to get labor kicked up a notch. The contractions got more painful and about a minute apart. Again, although painful, it was bearable as I could get a complete pain-break as these photos taken 30 sec apart show:

Contraction

Break from contraction 😉

I tried the birthing ball, which pre-labor I was convinced would be the best place for me. It hurt more, hurt my tailbone and I practically kicked the thing out of the room. I also, with Wes’ help, tried squatting, which was equally as miserable. Walking it was.

Then I needed the loo. No. 2. Wes told me I would have to buzz for a nurse, but I didn’t see why. I buzzed and the nurse said “wait! Wait for me’ which I tried to do, but she was ages coming. Ages. I was in pain, in labor and I needed to go. I tried to wait, but eventually, I figured I would either go on the floor or in the loo, so I might as well use the loo.

Waiting for the nurse so I could use the loo! Gave up and used it anyway, much to her chagrin.

The nurse busted in while I was going (see? Labor is just so not dignified – and yes, I was with it enough to be horribly embarrassed) and chastized me. She told me that needing the loo was often a sign that the baby was coming and she was cross I might have had the baby in the loo. What was I supposed to do? Holding it was not an option!! She had to come quicker if she wanted me to wait! So, she wanted an exam afterwards to see if the baby was coming. So – at 11.15 what amazing progress had I made? 4 cm, maybe 4.5. UGH. Back to labor.

When the nurse left, the contractions got really bad. They just didn’t stop one on top of another. The pain was bad (but I could cope with it):

Ow. Ow. Ow.

Then I needed the loo again. Really, like upset tummy needed to go. I buzzed for the nurse and waited and waited and buzzed and begged them to come (I was close to going anyway, but torn between my discomfort and being told off again!), when she came she wanted me to use a bedpan! No freakin’ way! Gross. So, I pointed out that just a few minutes ago I had been 4.5 at most and so really, no baby was going to be falling out of me. She agreed and let me use the bathroom (although she insisted on being in there with me! When I had an upset tummy! Told you: labor is not dignified).

While in there, I had a mental breakdown. The pain was horrific, and I was not progressing. I could deal with this pain, but given that I was dilating 1 cm every 2 hours, and had 5.5 cm to go – not for another 11 hours. Plus, if this was early labor, how bad would transition be? F that, I’ll take the pain relief. So, I asked for the epidural.

It was administered quickly (within 5 mins) and within 10 I had gone from this:

Ow. Ow. Ow.

To this:

Bliss.

As soon as the epidural had kicked in – about 11.45 the nurse wanted an exam, so they could ascertain in the future whether the epi had caused me to stall. I was annoyed: what was the point? I had been at 4.5 forever, and so finding out I was 5 was not going to help. I acquiesced, a resident Dr was called, and I grumpily let her announce that I was “9.5, maybe more, there was just a lip, and the baby was coming NOW”.

What? What the F-ing F? Some 40 hours to get get 4 cm, then to 9.5 in 40 minutes? So looking back, this:

Ow. Ow. Ow.

was transition. We had been taught in Bradley that transition was the most painful time, and the time the women find it most emotionally difficult and cry for the epidural. Our plan had been for Wes to step in at that stage and talk me out of it.. however, we just had no idea we were in transition. We thought it was too soon. I was annoyed that I had an epidural so late: I was moments away from giving birth when I got it, and most of the hard stuff had been done. I could have had a non-epidural (one can hardly call all the cervadil, balloons and pit natural…) birth, but hey ho. While I was annoyed that we had managed this slightly wrong, I was also pleased that I was enjoying this last stage. Plus, most of my fears about an epidural were unfounded: I could feel my legs, I could use my legs and I could certainly feel the contractions.

The nurse took a picture of us as a 2-some, promising to take the same picture but with the baby between us, when he was out (we never got this latter picture as everything went a bit Pete Tong, but hey ho)

Last picture as a 2-some

Doctors were called, and it was time to push. I declined the mirror and pushed – again, the epidural did not affect my ability to push as I could certainly feel quite a lot. I could tell the nurse when my contractions were coming, and she often had to help me hold off on pushing the urge was so strong, so that I could let the pressure build. Pushing went pretty well, Firework moved quickly – so quickly, they had to chase him with the little monitors.

After about 30-40 mins we could see the head, then poor old FW got stuck 😦 I had been warned about a very narrow pelvis and nothing seemed to get him past it. We tried squat bars, different positions, breaks, laboring down, I even let them get the dratted mirror. After 2 hours of pushing, they called Dr. D. She watched a few contractions and coached me. I actually said “It is OK to use forceps if you need, or cut me” but she didn’t think we needed that yet. She put her hands inside me (owww… just owwww… the epidural seemed to be doing F all at this stage) and said that FW was a slight transverse – he was facing the wrong way (up, not down – ah back labor also explains the yell for the epidural earlier) and slightly sideways. Again, I am grateful I was with the Women’s Specialists, many OB’s would have gone for an emergency C-section at this stage. Not Dr. D. Mindful of my ‘no C-section if possible’ [and now it does seem silly I was so adamant about that] scrawled all over my birth plan, she just turned him manually while he was inside me.

That. Is. The. Most. Pain. I. Have. Ever. Experienced. I swore violently – then apologized. But Dr. D was doing absolutely the right thing, using each contraction and push to slowly stretch me and rotate FW. I began to worry that FW was in danger as his heart rate was dropping, but Dr. D was wonderfully calm. I even said “if you need to do a C-section, do it!” but she said “I don’t need to see him now. I do need to see him soon, but he is OK now” and quietly called some extra pediatricians in. Once Dr D had figured out he was the wrong way and stuck in my weird pelvis it was all quick quick. Another 30 mins or so of pushing, with her help, and my beautiful boy was born:

He was handed straight to me:

and taken off for some checks as he had been stuck for quite a while. All the checks were done in the room, and Wes got to help, although he mostly took photos:

FW had become Sam! The long pushing didn’t affect him at all. He took a while to cry which freaked me out (I got slightly panicked over that) but his apgar scores were 8 and 9 and his lungs, when he decided to use them, were certainly powerful enough 🙂

Sam was little enough that I only had a minor second degree tear which Dr D and an intern stitched up, while Sam was assessed. Sadly, as I was quite ill, I didn’t get Sam back after that 😦 But, that is not this story. This is the story of how the lovely Samuel Clarke Frazier came into the world at 16.32 on November 4th 2012, weighing 6 lb and 15 oz. A wonderful, wonderful day: