Engineering the Sleep Dynamic

It is true that having two kids (or more) changes the family dynamic immensely, starting with sleep. Four individuals with different sleep schedules can be overwhelming, but if you consider this an engineering problem that can be "solved", there is hope. And that's exactly how I decided to handle it: to find a way for everyone to get their sleep on without adversely affecting anyone else. We did this with Moses too, but it was simpler then.

The first dimension is the "how much" of sleep: Nelson is still on a 3-hour cycle all day long; Moses sleeps from 7-8pm to 5-6am (10 hours); Angelene needs 8 hours; and I need 4-5 hours. Night gives us only 12 hours, so the problem to solve is how overlaps will work.

The second dimension is the "when" of sleep: if Moses goes down at 7:30pm and is out for 10 hours, we won't see him again until 5:30am. For Angelene to have 8 hours of sleep, she'd have to hit the sack at 9:30pm and wake up when Moses awakes. But before she goes to sleep, she'd need to feed/change Nelson at 9pm, and set him asleep. I can get my 4-5 hours of sleep then if I go to bed at 7:30pm with Moses and wake up for Nelson's next feeding at midnight. I would do the two night feedings (midnight and 3am) with pumped milk, and he would resume normal breastfeeding at 6am.

Notice how Moses' sleep schedule is really the pivot of this whole plan, not Nelson's; if it's off, we suffer. The other key is the 9:30pm-midnight block when all 4 of us are asleep: if we miss this window, toss the plan out. But we have an advantage in the fact that I am a short-sleeper and night owl, which I can bring to bear for this plan to work.

The third dimension is the "quality" of sleep we each get, measured by how many times we are interrupted in our allotted blocks of sleep time. I reckon sleep interruption is practically worse than foregoing sleep altogether, so we want to limit that number. As parents though, we can hear our babies' squeals in our deepest sleep, and are bound to awaken thus. So our solution: Nelson care happens downstairs so that whoever is sleeping upstairs can have quiet (as in, forget the bedside bassinet). The only hiccup is the 9pm-midnight window, when Nelson is quietly brought upstairs to our bedroom (presumably already asleep). I normally do not hear much of that, although Nelson's been quite restless and loud some of the nights that I awake. Angelene then uses earplugs so she won't hear much of the midnight waking later. When I wake up a little while before midnight, I quietly take Nelson back downstairs.

The orchestration can be a hassle but it pays off when it all works. To help it work, Angelene must pump so we have reserve for the night feedings (or we'd need to use formula), and fixing two extra pumping sessions in a 3-hour cycle can be tricky. Sickness cannot happen because it throws the whole dynamic off. Outside commitments are foregone or limited to allow this orchestration to work. And we must stay on top of things at all times, including eating all meals of the day on time.

Surprisingly, this plan affords us unexpected opportunities: we can have breakfast and dinner together, since those are the junction points on which the night hinges (6pm and 7am). An early start allows me to be back home from work early enough and spend time with the family before night kicks in. The midnight-6am chunk of time (minus 3am Nelson feeding) turns out to be a great time for me to work on personal stuff, read, do some programming, etc. This is when you are likely to see responses to emails and other communication. I have sometimes taken another nap towards the morning, but I like that there is some predictability in the mayhem, that sleep depravation can be avoided with a little engineering creativity.

Meet Nelson Bwambale

We are pleased to announce the birth of our second born boy, Nelson Bwambale. He was born on Jan-19, 2016 in Colorado Springs, Colorado about 9 days ahead of his official due date. Even so, we was "fully baked", weighing in at 7lbs 13oz (3.5kg) and measuring 19in (48cm). Both baby and mother are doing well.

The Moz Weaning Plan

As sure as the sun rises in the east, the time has come for Moses to begin weaning. Really, the process started back when he was 6 months of age, with the introduction of solid foods. Weaning normally lasts about 2 years, when an infant's nutrition is entirely from the family menu (no breast milk or supplement formula). But at this point, the specific actions are to phase out breastfeeding and diversify his food profile.

The plan then is to supplement his nutrition with baby formula (we use Similac) and introduce more solid foods, sometimes letting him eat from our plates (not talking mastication here). He is no longer actively nursing anyway (more conversant with bottle feeding), and his mother has stopped pumping because of a naturally dwindling supply. There is, however, about 3 weeks worth of breast milk in refrigeration, and that will be it for him.

Enter the Baby Brezza Formula Pro, our main tool for this supplementation stage. In less than 10 seconds, you can have a bottle of warm consistent formula ready to use. We don't have to prepare his night-time bottle before we go to sleep anymore -- it can instead be done on demand whenever he needs it. Which is a good thing, because sometimes we don't need to: these days, he's been sleeping almost throughout the night (down at 7pm, up at 5am or so). The plan is to reduce the supplementation the more he eats regular food, perhaps in the next 7 months.

The original plan, discussed before he was born, was to breastfeed him about a year. Obviously nature has its own mind, and we must adapt. It's a poignant milestone, I think.

The Oxygen Experiment

Although Mozy was 9 days late, he was born with a condition called respiratory insufficiency, which is more common in premature babies than those who are full term (and late). He even spent a night in the NICU to stabilize the condition. Its causes range from high altitude (thin air) to insufficient surfactant, or inefficient surfactant conversion at birth (when the lungs switch from breathing amniotic fluid to breathing air. That first cry plays a huge role in the conversion, helping lungs expand and fill with air). Whatever the case, he needed oxygen for 3 weeks, a slow 1/16mLH administered by nasal tube.

At 2 weeks old, we did the first overnight test to see if the lungs had matured more. Basically the pediatrician puts in an order with a home oxygen supply company, who loan you a pulse oximeter. You are supposed to monitor over at least a 6-hour period with the subject off oxygen, then send in results. The pediatrician usually calls within a couple of days with her observations. Even though I thought the numbers looked good, we were crushed when the pediatrician told us Mozy's numbers were to borderline to get him off the oxygen. For the next test a week later, I really wanted to see the numbers myself, and ensure that the oxygen machine we had at home was working.

At 3 weeks old, we did the second test. This time, I sat for the first three hours (between feedings) and recorded the numbers every minute (180 readings). Either I'm a bad parent for conducting experiments on my kid, or I miss the lab environment at university, or I'm just a nerd. Either way, the first 60 readings were while he was on oxygen so I could see how efficiently his lungs were performing: 98% saturation on average. So the darn oxygen machine was doing its job; I couldn't blame that if this test failed.

Without oxygen, I took 120 readings and plotted them thus:

As can be seen, he had mostly 95% saturation (median and average are both 95%) over that period. The normal range is 94% and above, according to NIH. In fact, he was above the threshold 88% of the time! I would have been so surprised, or even reject the results, had the pediatrician called and said the second test was a failure too. I'd show her my numbers and demand to see hers. My first 3 hours would have had to match her set for me to accept her conclusion (which would mean that Mozy slowly deteriorates in lung function the longer he is off oxygen). But thank God the pediatrician confirmed our expectation: Mozy did not need to be on oxygen anymore, everything looked great.

You can't imagine the freedom: no more noisy oxygen maker or a slacking a line from it wherever the baby is taken. No more oxygen canisters when we travel, and irritation on his upper lip from the oxygen tube. He had grown strong enough to rip the tube off his face, and it worried us how hazardous that could be. Better sleep!

Two Weeks In, 9 Things

It's still unreal that we are actually parents. It still feels a little weird to hear my wife say "my son ..." on the phone or for people to refer to me as "his dad ...". A little undeserved, I think, because in many ways I am still the same old self. Not much has changed about me personally, or at least not as much as I thought would happen.

Change is full throttle nonetheless. It's been a tremendous advantage that I only need 4 hours of sleep a night, and thus have not felt depravation. The only change has been *when* I go to sleep (earlier than I like). For the mom, it's not only about how little sleep she gets and how often it is interrupted, but also when she gets it, and worse because 9-hour nights were the norm. So to help her get more sleep, we came up with a plan: after his midnight feeding, I bring him downstairs and will service the 3am feeding with formula or pumped breastmilk. This way, she can sleep from midnight to 6am when the next feeding would be due. It's worked well so far.

OTHERWISE:

(1) At 16 days old, he weighed in 16oz over his birth weight. Not sure whether that's good or bad. As of 3 days ago, he no longer needs supplemental oxygen. Definitely a good thing. Celebrate small victories.

(2) He has a good sleep/feed cycle of 2.5-3 hours for the time being. When he awakes, it's pretty much feeding, then diaper changing, then clothing, then holding, the off to sleep again. Quite predictable, we like that.

(3) We hate co-sleeping, but more times than not, he can only go to sleep in our arms or in our "space". So we got one of those co-sleepers that you put in bed. But we can't let his nursery go to waste, so we'll shove him out of our bed the soonest we can.

(4) If you want, you can worry all day long about the baby. How he breathes weird, what sounds like congestion after he eats or when hiccups rock his whole little body, his peeling skin, or his crossed eyes. It turns out it's all normal. Actually, you muse at how worrying started pre-conception and sustained throughout the pregnancy. So quit worrying, check!

(5) We haven't used his name around home very much. He's still pretty much "the baby" and "he" and "him". I thought we'd be all over it with every breath. But it should be known that his nickname is "Mozy".

(6) Swaddling does wonders, if done right. Our first few attempts we terrible, but we got better. It's almost a contradiction: I thought freedom (of arms and legs) meant peace, but it seems restriction is what calms babies down. It's the same theory with boundaries and happiness.

(7) Friends and family have been so gracious to bring us lots of food or come prepare meals at our house. We have not needed to go grocery shopping this month yet. I wasn't expecting much from this idea, but have been pleasantly surprised at the generosity.

(8) My paternal leave is 3 weeks long (except for a few days last week). Her maternity leave is 10 weeks long. No idea how it will look when we both return to work. But we got time to figure things out.

(9) Our plan to be by our lonesome selves for the first 3 weeks did not pan out. Just a couple of days after we returned home, we were open for family and close friends to come see Mozy. For those traveling out of town, we have a plan: choose 2-4 days out of a given week in September or later when you want to visit. We prefer you arrive at Colorado Springs airport (COS), but we can also pick you up from Denver International (DIA). We have a guest room, so you can stay with us.

The Moses Birth Story

An induction had been scheduled for 7 A.M. Saturday August 2nd, but early the day before (Friday), spontaneous labor started. The membranes had ruptured (water had broken), so we headed to the birth center only 9 minutes away, and were subsequently assigned a labor and delivery room by 7:30 A.M. that morning. Twelve hours later, our son Moses would be born. He was 9 days overdue, weighed 7lbs 14oz (3.5kg), and measured 20.5in (52cm) long.

Labor and delivery proceeded as best as we could have hoped for, without any pain medication. While the hospital requires a hydration IV, mom also needed antibiotics for Group B Strep (GBS), which she had tested positive for previously. There was talk about hooking up Pitocin (Oxytocin) when labor had seemed slow earlier, but it was never done because labor picked up and was progressing nicely on its own when a decision needed to be made. An epidural wasn't even discussed although we had asked to be notified at the last opportunity when it could be administered. Otherwise, the positions and breathing techniques we learned in baby classes were all that came handy, with the support of my sister Leanna and our friend Lydia. We couldn't have done it without them.

Because of the Group B Strep, the hospital requires a 48-hour stay for observation. We ended up staying 3 nights total because Moses showed a couple of concerns:

(1) respiratory insufficiency, for which he was put on oxygen. The nurses thought he was breathing faster than normal and did an oxygen saturation test from which they found out he was in the 70's range (normal is 90% or higher). The doctors blame the altitude and thin air here, and say it is almost always expected to give oxygen for summer babies born in Colorado, even for a few days.

(2) nutritional support, for which he received banked breast milk and a glucose IV when blood sugar levels did not improve. He was consistently borderline in the 30-40 mg/dL range (normal being 46 mg/dL+). We would need to supplement for a few days until mom started flowing. We didn't know that for a lot of women, milk production doesn't start 3-7 days after they give birth. For women that have had PCOS, it can take even longer to start flowing. Moses' blood sugar tests were getting worse because he wasn't getting anything from his feedings.

Because of these concerns, Moses was transferred to the NICU for 24 hours (Saturday overnight). After a car seat tolerance test early Monday morning, we were discharged later that afternoon. A home care company came and setup an oxygen unit at home, and we've since settled into a routine around Moses' sleep, feedings, and diaper changes. At his first pediatrician visit yesterday, he weighed in at 8lbs (3.6kg) already, so he's doing very well. He's still quite an easy baby, only screaming bloody murder during diaper changes.

We have plenty of time to get used to these changes. Mom's maternity leave ends early October, while my paternal leave will be almost 3 weeks long (minus 2-3 days to help out with a data center move at work). We have also been blessed with friends and family bringing us food and checking on our well-being. We don't have to do groceries for another week. We are looking forward to welcoming those who will travel from far and wide to come welcome Moses. Our guest room is ready.

Here I introduce Moses Baluku Miremba. All Ugandan, all Italian, and all American. We are smitten and can't wait to see what future God has for Him. Our job was to bring him on this earth and set him on a course, and guide him on his life journey wherever that will lead.

The Waiting Is Always Harder

It's not much of a game actually, waiting for a baby that is now a couple of days overdue (by our estimate). On average, first-time mothers give birth about 5 days later than the due date for normal pregnancies, so we are not feeling hasty yet. Besides, the doctor's estimated due date had always been today (Jul-25), so as far as she's concerned, we are still "term". Maybe she was right-er than our FAM calculation, as good as estimates go.

We are still intent on letting labor start naturally, but if it doesn't, the plan is to induce late next week. Meanwhile, at least the non-stress test (NST) will be done, possibly along with an amniotic fluid index (AFI), or simply a full biophysical profile (BPP). This is all standard procedure for overdue babies. At the last doctors visit 3 days ago, everything looked great. Technically, there is no additional benefit for the baby after 40 weeks (he won't be any more ready to be born), but there is a benefit to avoiding medications to get things going (Lamaze). So we'll just wait a little while longer.

Waiting is not as easy as we imagined, of course. I now understand why some people opt for scheduled induction or c-section as soon as the due date passes. It's about managing expectations and anxiety. Delays like this are also a reminder that a lot will not happen according to plan, that we should be ready to improvise without notice. But ready we are! The hospital bag now lives in the car, and our support people have our birth plan (already in danger of irrelevance). Anytime now.

The Baby Books We Shall Read

New parents have no idea what they are getting into, no matter how much they have seen or heard about it from others. Advice is abounding from every corner, but the truth is that you don't know what kind of parent you will become until you are one. Others' parenting styles might not work for you, but that's an opportunity: you get to come up with your own thing.

We know we want to be informed parents, among other thing, so we selected a few books to introduce us to the topic and get us started on the same page. Interestingly, I find that the more I read, the more it looks likely that we will end up improvising a whole lot. It seems that book knowledge plays a lesser role than experience (what really works in the end) and instinct. A friend recently told me: you'll know what to do when you have to do it. But I'd like those actions to be smart.

Since we won't remember all the advice we have received at this point, we decided to at least read up and bookmark what we think might be helpful.

We think our parenting will start with the ideas in "Babywise" (Bucknam), especially those about sleep and feeding schedules, if they will work for us. The other books are mostly supplemental and for reference, sources of other ideas we might find useful down the road. We are quite determined to not be "bookish" parents who follow book recipes to the tee, but more organic and with a high level of freedom in style. (I obviously don't know what that means!).

The Nursery Is Ready Too

For 2 days late June, we committed to setting up the nursery. For parents that do not want to co-sleep, the idea is that this baby will sleep in his own room at night from about 8 weeks old. Before that, he'll be in a bassinet right next to mom, and during the day, in a pack-n-play on the main floor. This nursery is more for those nights he will noisily resist sleeping.

Thanks for the Baby Gifts

Our thanks are long overdue, to everyone that sent or bought us stuff for the baby. There were two baby showers, some of you visited our baby registries, and a few personally delivered the gifts to us. A few brave ones made stuff for us! We appreciate it all, and we are grateful for friends and family like you. THANK YOU!

In addition to what we got, we went out one day in June and bought a whole bunch more stuff. In fact, $900 worth of stuff. Stuff we think we will need. Had we not received the baby gifts you all gave, we'd have spent about $1,750 to get them all. We've heard that it is expensive to have a kid, but now we know how much the start-up costs are. Blah.

Mobility Upgrades With 37 Days To Go

Preparations for the baby are now in high gear, with only 37 days remaining until his birth. As the anticipation builds, we finally start unboxing things and setting up the home proper for a baby.

We are told we will not be allowed to leave the hospital without a car seat and one that is properly installed in the vehicle. So our first order of business has been to install car seat bases in both our vehicles, test out the car seat transfers from home to car and back, and get used to the different harnesses and latches in this equipment. I believe I have not read equipment manuals as much as I did for this task.

While we were at it, we also assembled the jogging stroller, which can fit either of our car seats in rear-facing position. This coming week, we'll test the stroller (fully loaded) outdoors when we do our walks. But from now on, each of our vehicles will have a car seat, with practice taking it out when we go to work and bringing it in when we return home.

On left, Subaru installation of a BabyTrends Fixed car seat. Subarus don't do middle rear-seat installations, so the passenger-side rear seat will do. This car seat comes LATCH-ready though I wish there was another anchor on the front of the seat to control vertal bounce. The Nissan allows a middle rear-seat installation (statistically the safest spot in the car), and the Safety 1st car seat can only do belt installation. Perfect match. On right, our very fancy Expedition ELX jogging stroller. Luckily, it can fit either of our car seats.

In hindsight, we should have attended the safety class first, then inspected our vehicles before acquiring the car seats; we did it in reverse order instead. Car safety classes can seem pointless but they are good for laying out what you should consider in your particular situation. Then you must follow them with vehicle manuals and YouTube videos from the car seat manufacturer to get fully immersed.

Pregnancy Readership

I've met two kinds of expectant parents: those who live the pregnancy with more information than even the doctors, and those who get by with at least recognizing when things go wrong. The former research every little event they observe and may even know the biology and chemistry behind it all. The latter just know that cramping is not good and that drinking alcohol is bad. I read a study once that suggested the happiest pregnancies are more on the uninformed side, mostly because they don't know about everything that could go wrong or what should be happening, which can be overwhelming and discouraging. In other words, how much should you endeavor to know about your pregnancy without losing the joyful experience that it is?

We are middle-of-the-road: know enough about what's happening so you know what to expect, can comfortably explain what is happening to you, and won't be alarmed about normal pregnancy events. Since I am the researcher in our home, I took on the responsibility of being in the know, not only because it is my personality, but also because I wanted this to be one of the ways I remain actively involved in the pregnancy.

So every Thursday morning during breakfast, we have been reviewing baby progress: we talk about the baby's development, and what should be happening to the mother. We review any upcoming procedures and appointments or areas of concern. We give ourselves some tasks and educate ourselves about various pregnancy topics (since this is our first). But mostly, we sync up on how our lives are changing, and what we should be doing to ensure a successful pregnancy.

I have read the usual lot of books (as shown in the image), but I settled for weekly newsletters that deliver just the nugget of progress we need to focus on that week. The websites send additional advertisement and special articles from time to time, so beware of an increase in emails when you sign up. Also, each author may have a different understanding of, say, "30 weeks": do they mean you have finished 30 weeks, or that you are in your 30th week? Are they counting gestational or developmental weeks (which is off by 2 weeks)? Some use weeks that end on the day of the week when your due date is (like our weeks end on Wednesdays), others use the weekend. Some begin sending the weekly progress newsletter in the middle of your week, others wait until you have finished the week. There are a lot of pregnancy tracking websites, but they provide almost the same information. My list below has a few that have relatively in-depth articles, and a few that I use to confirm what other websites are saying.

Baby Center (http://www.babycenter.com/pregnancy).
What To Expect (http://www.whattoexpect.com/pregnancy/landing-page.aspx).
American Pregnancy (http://americanpregnancy.org/week-by-week).
Pregnancy Corner (http://www.pregnancycorner.com/being-pregnant/pregnancy-week-by-week.html).
Parenting (http://www.parenting.com/pregnancy/week-by-week).
The Bump (http://pregnant.thebump.com/pregnancy-week-by-week.aspx).
Baby Zone (http://www.babyzone.com/pregnancy-week-by-week/).
Pregnancy Symptoms Week By Week (http://www.pregnancysymptomsweekbyweek.org/).
BabyGaga (http://www.babygaga.com/calendar/pregnancy).
Countdown My Pregnancy (http://www.countdownmypregnancy.com/pregnancy/pregnancy-week-by-week.php).
Everyday Family (http://www.everydayfamily.com/pregnancy-calendar/).
Parents Connect (http://3dpregnancy.parentsconnect.com/calendar/1-week-pregnant/).
Lamaze International (http://www.lamaze.org/YourPregnancyWeekByWeek).
Netmums (http://www.netmums.com/pregnancy/pregnancy-week-by-week-guide).

I also like this one that's delivered everyday:
* Family Education (http://pregnancy.familyeducation.com/).

Baby List First 2 Months

Even before the baby registries were established, we had been wondering: "what must we have on hand at birth and for the first 8 weeks after our son is born?" We really do not know how much this baby's arrival will overturn our lives, but to cope, we make plans in spite of the uncertainty. It is more prudent to be somewhat prepared for an event such as this than resign yourself to improvisation when the time comes.

So we decided to make a list of "must-haves" that should see us through at least the first 8 weeks. We would start saving for those needs, as well as watch out for deals and sales online, in stores, or around town. Come the first week of July, we will go on a shopping spree to ensure that we have everything we deem necessary that we do not have on hand.

To compile the list, I initially did some internet research but ultimately decided to ask recent and new parents, to benefit from their experience. Then we looked up the prices on the internet to help with an estimate for our budget. The necessities are highlighted:

FEEDING
Nursing pillows (1)	$20 ea.
Bibs (4)	$15 (10pk)
Burp cloths (8)	$8 (4pk)
Breast pump	$250 ea.
Bottles and nipples	$20 (6pk)
Bottle brush	$5
Bottle warmer	$25
Sterilizer	$55
Milk storage system	$15 (100ct bags)
DIAPERING
Changing table and pad	$150
Regular diapers (16/day)	$40 (250ct. box)
Newborn diapers (2 bx)	$35 (150ct. box)
Diaper wipes (2 bx, 7th gen)	$12 (500ct box)
Diaper cream/jelly (organic coconut oil, Aquaphor lotion)	$12
Diaper disposal system (genie) and bags	$75
Diaper bag	$35
Diaper wipes warmer	$20
SLEEPING
In-bed sleeper	$45
Bassinet	$45
Crib	$200
Crib mattress with flex covering	$50
Bedding (3 sets of sheets, blanket)	$11 ea.
SIDS monitor	$80 attch.
Baby monitor system (audio/video)	$45+
Night lights (2)	$7 ea.
BATH TIME
Baby bath tub	$15
Hooded terrycloth towels (3)	$15 ea.
Baby wash kit (shampoo, sponges, etc)	$20
HEALTH
First aid kit (with acetamophine for fevers)	$20 av.
Bulb syringe (nasal aspirator)	$4 low.
Baby nail scissors and clippers	$7 pair.
Soft-bristled hair brush/comb	$7
Thermometer	$45
Humidifier	$40
Gas drops (Mother's Gripe)	$21
MOBILITY
Stroller (esp. jogging)	$150
Car seats/baby carriers (2)	$99 ea. +bs
Baby bjorn	$75
Baby backpack/carrier (hiking)	$99
Rockers and swings	$45 est.
SOOTHERS/ENTERTAINMENT
White noise machine	$25+
Bouncy ball or rocking chair	$12 / $90 dep.
Pacifiers (5)	$5 (2ct)
Pack-n-play	$75
Bouncy seat/jumper	$25 approx.
Infant toys
MOTHER
Nipple cream	$9 tube
Nursing bras	$20 ea.
Nursing pads	$8 (60ct)
Maxi pads and panty liners	$12 (20ct)
Hemorrhoid wipes and cream	$20 (48ct)
Ice packs	$15 (24ct)
Adult diapers	$15 (16ct)
Iron-rich diet/snacks
CLOTHING
Swaddling blankets (3)	$20 (3pk)
Receiving blankets (4)	$12 (4pk)
Sleepers (5)	$10 (2pk)
Scratch mittens (2)	$5 (3pk)
Onesies (6)	$15 (5pk)
Side-snap/tie tshirts (until umbilical cord falls off)	$11
Socks (6)	$10 (6pk)
Knit sweater and cap (2)	$20 ea.
Newborn hats (2)	$8 (5pk)
Stretchy pants (2)	$8 approx.
Hooded jackets (2)	$15 gen.
Special dress-up outfits (3)	$15 set
Car seat blanket (2)	$15

A good estimate for the necessities is about $2,000 if you are starting from scratch (have never had kids) and buying all new stuff. Most of the stuff can be reused for subsequent kids. Fortunately, there is an active community of parents exchanging or selling stuff for cheap, so you need not buy everything brand new. Friends and family often give away stuff they no longer need. In other words, your first baby expenses ought not break the bank.

Obviously the list above is not the complete compilation of what was suggested to us, nor is it our final list; we keep hearing of additional things that sound like they might be useful. Lists like this vary considerably depending on lifestyle and extravagance. I only listed what we (naively) think we might need. There are also things you cannot reasonably estimate at this time, such as baby formula (since we do not know whether we'll need it), and clothes. For these and few others, you just adaptive capacity. So the advice is to have additional reserve for the unexpected.

Baby Registries

In answer to: "when should we start buying baby stuff?", another question inevitably came up: "what should we buy?". We know most people start the baby purchases spree in the third trimester of pregnancy, so we decided June would be good for that and setting up the nursery. The first week of July is for ensuring any other necessities we won't already have, 2-3 weeks before this baby shows up.

Enter the fine American tradition of baby registries. For first-time parents, a steep increase in expenses is expected especially during the first few months. While we ideally should be prepared for these costs (savings?), we are not too proud to accept support from friends and family, also as a way for them to participate in welcoming this baby.

So we set up a couple of registries for our little boy. They all largely have the same stuff (cross-listed); you don't need to visit each one to see the whole list. The registries should allow you to ship whatever you buy directly to us, if you can't physically deliver it. We tried to not go berserk with the stuff we put there, but of course we wished out loud. Listed in order of preference:

BED BATH & BEYOND
http://is.gd/yLI1PQ (registry #10866968)

TARGET
http://www.target.com/baby/registry/jCH_SdFQOQrPx1_EaBIK4g

BABIES R US
http://is.gd/uKmMEl (registry #52399386)

Le Bébé, C'est Un Garçon

At the mid-pregnancy anomaly ultrasound scan, we had the option of finding out what gender our baby is. Instead, we decided to have the midwife call someone that would make us the delicious "gender cake" seen here.

In lieu of a full-blown gender-reveal party, we did the revelation with our Bible study small group. Blue cake means it is a boy! We have thought it might be so all along (from how easy it was to agree on boy names), until I switched votes over the last couple of weeks. I suppose you really cannot trust dreams; two about a baby girl using some names on our shortlist was enough to convince me. Either way, we are very excited to finally start using "him", "he", or "son" in reference to the baby.

His mother is in her 23rd week at this point and doing well. True to form, the 2nd trimester has been calm. In 125 days, we look forward to welcoming this little boy home. For my Ugandan family, I hereby present a Baluku (which will become his middle name). I know this was the expectation, par tradition.

We do not have any first/given name for him yet, but we have a shortlist of 6 boy names from which we will choose just before birth.

Place and Kind Of Birth

Like all brand new parents, the first decision you make right after the happy news of a pregnancy is about how it will end. The question of where and how the baby will be born must be settled ahead of all other decisions, sometimes cutting into the honeymoon glow of the good news. In our case, we had a difference of opinion on both subjects, although ultimately it is what she wants that will matter.

The difference in opinion arises from our attitude towards the role of medicine and interventions. I am for a natural or alternative approach to health care, and believe in the power of the body to heal and preserve itself given the opportunity. So medicines are a desperate last resort when I'm not feeling well, delayed until I have tried natural remedies.
When it comes to pregnancy and childbirth then, I believe the woman's body is designed specially to handle that challenge gracefully, albeit with lots of pain. Apart from emergencies and other serious risks, a pregnancy and childbirth should not be treated as a medical case, as if it were some kind of illness or anomaly. Before Obamacare, insurance companies used this excuse (pre-existing condition) to deny coverage. I think the practice of considering pregnancy a "health risk" is squarely misguided.

So obviously I voted for a natural birth in a birth center somewhere. Labor could start at home, and the birth setting would be quiet and private. A hospital would be close, and an obstetrician on hand in case of emergencies. I know it sounds idealistic, especially that I'll never experience these things, but I think that's what's best.
On the other hand is the Mrs., whose perspective of childbirth borders on traumatic. The stories she's heard about its mishaps have left her convinced that she needs the attention of an obstetrician during pregnancy, and must be in a hospital during labor and childbirth, in case of emergencies. This is the American default; it's not bad, but it could be better.

Colorado Springs doesn't have an alternative/natural birth center, but the two major hospitals have maternity wards designed to function as birth centers. The atmosphere though is still cold and sterile, and less than private. At Memorial Hospital and Penrose-St.Francis, the wards occupy their own floor. When we toured them, we also learned that they have adopted some practices advocated by midwives and doulas, specifically to empower women to experience labor confidently. Gone are the nurseries to which babies were carted right after birth. Most importantly, mothers have a whole hour right after birth for skin-to-skin contact with the new baby, and most post-natal procedures (except circumcision) are performed right there in the delivery room. Penrose-St.Francis has labor facilities and recovery rooms if the mother needs a few more days around the hospital. Also of note is the increasing role of certified midwives as primary care providers for pregnant women, with the backing of an obstetrician who has privileges in these birthing centers. This situation settles our first difference of opinion (the "where" part).

The non-compromise on the how the birth should happen: labor naturally as long as possible, knowing pain relief medicines are available when needed; avoid unnecessary medical interventions. Whatever the case is, the ultimate goal is for her to enjoy the pregnancy and get the support and relief she will need during labor and childbirth. We will do whatever she thinks is needed at the time, for her maximum comfort.

Forgive My Unbelief

Why is it that even when we have put our faith in God, we wince in doubt when our wildest prayers are answered? We consider the evidence but still wonder whether it is real that God showed up or delivered on His promises. Had we really believed in the first place that "all things are possible for him who believes"? (Mark.9:23).

I found myself in a moment of disbelief the day we first realized we might be pregnant. The FAM data I had told a different story -- that we had likely missed the current cycle. The doctor had already provided higher dosage prescriptions for the next round of fertility treatments, and so we were just awaiting the start of the next cycle. In fact, we also had a growing frustration with the cycle -- then approaching 60 days long -- that we thought we might ask the doctor about possibly terminating it and jumpstarting the next cycle. But before taking such adverse action, we decided to take a home pregnancy test (HPT) in order to avoid having the doctor do the same test for $200 (charged to insurance) at our next appointmrnt.

In EXHIBIT#1, I did not believe it was positive because the documentation (especially the images) indicated that the test line would be darker than the control line. My wife believed it was quite positive nonetheless. So the next day, we did another test (EXHIBIT#2); we expected to see a full "+" but it only looked like 2 parallel bars. Hmmmm! The next day I personally picked out a digital HPT hoping it would remove all ambiguity (EXHIBIT#3). But even after that, I was not fully convinced until we could see a sonogram at our next doctor's appointment.

In my disbelief, I wondered about how often HPTs reported false positives, and whether it was possible to have appreciably high Human chorionic gonadotropin (hCG) levels when you weren't really pregnant. Indeed, if a woman has an ectopic implantation, a "chemical" pregnancy, or has recently miscarried, hCG levels will be high enough to produce positive HPTs. If she has ovarian/cystic cancer, a thyroid problem, or a hydatidiform mole, the hCG levels will also be elevated. Beyond these possibilities, I came across reliability complaints against Clearblue and the high incidence of false positives in their HPTs. It was as if I really did not want to believe the current evidence ... until I could see an ultrasound.

In that moment, I was like the disciple Thomas who would not believe that Jesus had actually risen until he could touch the scars himself (John.20:24-27). I was like the father who needed to believe that his child could be healed (Mark.9:21-24). And like him, I needed help with my unbelief. It is not like I did not believe we would get pregnant, but that the timing seemed off. I was at the familiar crossroad of science and faith, with the science weighing more on my belief than my faith.

The issue is practical faith and its precedence in our lives. On this journey of pregnancy, I realize we will need more faith than science as we see God orchestrate a new life in our midst (Psa.139:13).

Attendre Un Bébé En Juillet

It is with great excitement that I introduce to you a Baluku or Masika, 

expected around July 23.

That means we just started the second trimester (currently in week 14). It also means God answers prayer, that hard work and diligence are worth the effort, and that some treatments for PCOS do work. Suddenly, we conclude our journey of infertility and prepare for parenthood with great expectation. You cannot imagine the excitement!

We found out back in November (funny story later) but decided that we would not announce publicly until after the first trimester when all manner of possible mishaps has passed. We also wanted my father-in-law (her dad) to have the honor of being the first family member to know, so we held the secret until Christmas when we visited Seattle. Other family members and close friends learned shortly thereafter. We deserve a medal for how well we kept the juicy secret; nobody had a clue.

"Baluku" and "Masika" are rank names traditionally given to first-born boys and girls, respectively, in the Konjo tribe of western Uganda (of which I am kin). They signify special responsibility and blessing on the first-born name-bearer, a vision for their life. The rank name becomes a middle name when their legal firstname is decided (although I know some who use it as a given or even a surname).

Speaking of traditions, our diverse backgrounds, ethnicities, and upbringing have suddenly swung into full focus as we begin making decisions about this baby (in a good way). I mean, who knew we would have different opinions about birthing? Our parenthood will definitely be unique, to say the least.

A PCOS Diagnosis

We pride ourselves in having self-diagnosed our infertility, but while FAM can point you a certain direction, it doesn't provide a diagnosis. We needed expert opinion on what kind of infertility we are facing so we visited a fertility specialist, who eventually informed us that from his initial observations it looks like Polycystic Ovarian Syndrom (PCOS). The thing with PCOS is that it is a spectrum of fertility issues that may or may not have anything to do with ovarian cysts. In fact for a lot of women, a hormonal imbalance perhaps due to a malfunctioning thyroid can be diagnosed as PCOS, as would a pre-cancerous cyst. So we needed to find the specific infertility affecting us.

From FAM, we can see the interplay of three reproductive hormones: estrogen (obviously), luteinizing hormone (LH), and progesterone. BBT charts show lower temps because estrogen rules pre-ovulation. The temps rise after ovulation because of progesterone. Ovulation tests work by detecting the presence of LH. But there is another important hormone is this interplay: Follicle-Stimulating Hormone (FSH). It is responsible for arbitrating follicle competition and nurturing an egg to maturation in ovarian follicles, and for releasing the egg during a so-called "LH surge" (what we collectively call ovulation). By a process of elimination, FSH became the culprit that was later confirmed by labs (blood panels). Ultrasounds around the time of ovulation revealed a pattern of anovulation (no mature follicles were observed 1-2 days before ovulation). So we moved from a general diagnosis of PCOS to a more specific "anovulation due to FSH deficiency". With that, two more questions arose: (1) what causes FSH deficiency? (2) How is this hormone imbalance treated?

The cause is not as easy to pin down because of the complexity of the endocrine system. We learned that a deficiency in some gland (say the thyroid or the pituitary glands) can affect the production of hormones elsewhere in the body, and this is what was likely happening in our case. The doctor thinks there is actually an estrogen imbalance that is affecting FSH. More specific blood panels and two possible causes emerge: vitamin D deficiency and insulin resistance. It is amazing how lifestyle and diet now tie into fertility, so we know treatment will not be singular.

The treatments start with Letrozole (as an alternative to Clomid) to help regulate estrogen and restore ovulation. Daily supplementation with vitamin D is recommended, and Metformin is prescribed for insulin resistance, even as diabetes is not diagnosed. We institute a low-sugar diet ("The Sugar Solution" is an excellent resource) and continue daily exercise. We also started seeing a doctor that specializes in PCOS treatment, who helped with the specification of said diet. We know the diet and exercise are working already just a couple of months in.

Even as we do infertility treatment, we are aware of the possibility that it may not work. After some heavy discussions, we decided that we would try any options (clinical or alternative) that are reasonably available, but would not do surrogacy or IUIs and beyond. At that point, we would take a break and eventually turn to adoption. But we do what we can while we still can (insurance, etc).

It is emotionally draining and stressful to deal with such a diagnosis, the medications, the doctor visits, and the numerous clinical procedures you undergo. I applaud my dear wife for the courage and strength she has shown in this journey. As long as there is visibility into the condition (we know what is going on), great chances are that there is a specific treatment plan for it. If you have been here, I encourage you to do your research and understand the condition yourself so that you can contribute to the doctor's prognosis. You know yourself better than a doctor does, and many doctors appreciate informed patients and working as a team. It is not an easy journey and it requires persistence and diligence.

I should also say that no one treatment plan works for everyone precisely because infertility is variable in different people, even under the same diagnosis. Fertility is one of the few areas where treatment must be quite specific and exact for a given degree of diagnosis.

Fertility Awareness, As It Were

It seems to me that fertility is a rarely-discussed subject even among couples, perhaps because it is a deeply personal matter or because it is taken for granted by most people as a fact of life. Or both. There is no species on this earth that does not reproduce somehow, so it is no surprise that for most of us, the question has always been "when" rather than "how". After all, the "how" was sufficiently covered in 6th grade and is the theme of many a television show. But I contend that what lies beyond the "when" is the most interesting part of the story.

Enter the book "Taking Charge of Your Fertility" (Toni Weschler) back in June, and we learn about the Fertility Awareness Method (FAM), the all-natural family planning method. We realized that conception is a carefully designed process but with lots of opportunities to fail. In fact, I am impressed at how simultaneously simple and intricate it is (engineering perspective) that I marveled at how awesome God works (still). I also realize that I knew very little about the physiology of conception, the avalanche of events that must happen predictably for anyone to get pregnant. It's actually quite a beautiful story, one short of a miracle.

So we become FAM converts and started the usual rituals: BBT charting and observation of other fertility signs. It is actually quite fun understanding how our particular situation works, but after 3 months the observations indicated possible fertility problems. This is how we initially discovered our infertility, and it prompted us to seek professional diagnosis right away. The clinical definition of infertility would have required us to wait a year before visiting a specialist for diagnosis, but we didn't see the point of that. Had we not been practicing FAM, I believe we would never have discovered that we will face infertility. From what we had learned, we also know that the majority of infertility causes are treatable. Hope!

Until you've experienced infertility, you won't know that 11% of women 15-44 are chronically infertile or not able to carry a pregnancy to term. You won't know that 1 in 8 couples struggle with fertility issues, according to Resolve. You won't know the personal and emotional toll it takes on a marriage. You might not even notice how many women out there are pregnant, or that there seems to be so many babies everywhere you go. An apparent prejudice will cross your mind: how is it that people who don't want kids get them (easily) anyway, and those who really want them must move mountains first?  You also won't know about the billion-dollar industry around infertility, complete with physician portals and big pharma, supplements and medications, various unmentionable aids and tests, websites and software, books and guides, and classes. There are numerous support and discussion communities for whatever your flavor of infertility is.

But it will expose you to three important topics: surrogacy, medical interventions (IVFs, etc) and adoption, should your treatments not work. These are perhaps the first big discussions we have had in our marriage, and I am glad we have had the opportunity to consider them.