Child Development Chapter I - So, You Want to Have a Baby?

So, something is stirring inside of you. Your thoughts are turning towards the possibility of bringing a child into the world, of having a baby. Now, let me establish a point right here at the beginning. Many people might think that it is mainly or even only women that have these thoughts. I think sometimes men do as well. However, for the sake of clarity of discussion, as I do believe it is mostly those who have the potential to be a mother that first face the questions that follow, I will write this as though I am speaking to a member of the female sex. If the situation arises where there is something that needs to be addressed by the male, the father, I will make that clear at that point.

Another clarification that I want to make right here also is that this chapter is written for those who are thinking about having a baby. In other words, they are thinking about or making plans. As you can well imagine, particularly if you are in that situation, it is entirely different if you realize that you are pregnant and had not planned it. That is going to be dealt with in the next chapter. Having said that, it doesn't mean that if you are in that ‘boat,’ you can't read this chapter too. There could be something of value here as well.

So, potential mother-to-be - how does the idea of having a baby make you feel? Excited? Warm and fuzzy? Maybe your feelings are mixed? There might be some anxiety there?

First of all though, when you think of having a child, what comes to mind when you look into the future? What do you see for this child? What do you want for this child?

I am sure one of the first answers to those questions for most if not all of you would be that you want the best for this child. But what does that mean? Wonderful, warm, loving home with two parents? A fully decked-out baby room? Or are you thinking more of you and the baby, what it would be like to have a baby? Are you thinking about what you can give to the baby and what your relationship will be with this child? Do you think you can give it your best? Is your dream of "best" an ideal or is it realistic? What determines that?

Perhaps we need to, as is sometimes said, go back to the drawing board. What is it that is stirring inside you that makes you think you want a baby, that now is the time? Do you feel you have grown up and matured to the point where you believe you know what a baby needs? Do you believe that you can provide that?

Are you looking for that little person on whom you can lavish all your love? That is not a bad dream. Some would say that is why The Creator made this world and told the first man and woman that what he/she wanted of them was to reproduce and fill the earth. The Creator who is often described as Love has so much love to give that he wants more people to share it with and to experience it.

However, we are not The Creator. Our love is not perfect. Sometimes what we think of as love doesn't totally come from the right place. Our intentions might be right. However, sometimes, if we are honest with ourselves and know ourselves, we might have to admit that we "want somebody to love" because we have had problems receiving from and giving love to everyone else. It seems to us that if we had a baby, with whom we could start a relationship from square one, we could end up with something mutually satisfying that would fill those unmet needs stirring within us. Do we need to honestly ask ourselves whether this is starting off on the best foot? Whose needs are we talking about here? Ours or the baby’s? I would humbly suggest that we need to look at what needs to we have and make sure they are satisfactorily met before we get to think that we are capable of meeting the needs of a baby.

Let's look at another question. Not ‘what,’ as we began to discuss above, but ‘who’ does a baby need to be able to provided the best? Is one parent enough? Are two parents better? Nowadays, the question also arises, are two parents of the same gender good enough?

Should we stop there? What about grandparents? Uncles? Aunts? Cousins? Even great grandparents. We have all heard the phrase, "it takes a village to raise a child." Do you believe that? Are you in such a village? Or do you believe you are quite capable of raising a child on your own? What about support beyond yourself and your partner, if you have one? Even more important, if you do not have a partner and are still considering motherhood. Do you have parent(s) or other relatives who can be counted on for support? What about friends? Are you part a reliable social circle in your community, even in your church?

Are you thinking about taking pre-natal classes? Indeed, do you have a Family Physician to help you get started on this journey in the right way? Or are you thinking about using the services of the midwife? If so, will you still have a physician as a backup? Not everyone needs a specialist though. Are you prepared to accept the help a Community Health Nurse could provide?

Others of you are coming at this from a different angle yet. If you are a woman, you might be thinking, "I am getting into my 30s; if I am going to have a child, that is as healthy as possible, and raise him when I am most capable of, I had better start now." Again I ask, are you prepared and confident to do this on your own? Just decades ago, that would have been unthinkable. However, now we have the means of having a child without being in relationship with a father, thanks to artificial insemination and in vitro fertilization. Indeed, if you can't or don't want to go through the whole process of pregnancy and delivery yourself, you can have your egg, fertilized by one of these methods, implanted in someone else's womb or uterus and have them bear the child as a surrogate mother. The options are so much more broad than they were a couple of generations ago.

Or are you saying this because you have a partner? You may or may not be in a traditional marriage. However, you feel that you are in a relationship that has reached a point where it is time to think about having a child. But have you really discussed this with your partner? Does he or she share those thoughts? What anxieties might you have? What anxieties might they have?

What other factors do you have to consider? Do you have the financial means to add another person to your life? Do you live in a place where there is room for a baby? If you are not living in a single-family dwelling, are families allowed in your building? Are you living with your parents, or the parents of your partner? Are they going to be prepared to have a baby in the home? Or will that mean having to plan for moving out with all that that entails?

If you are working, how will that affect your pregnancy? Does your employer cover you for any "sick time" that might occur because of your pregnancy or do you have private insurance that could cover that? Will you be able to take maternity leave, and how much, if you can? Can you afford to take some time off at the beginning of being a parent even without paid maternity leave?

What about your health or that of the baby's father? Is there anything in your own health or in your family history that you might want to know about in making plans in this area? Are there some conditions that could be passed on genetically? Is there anything in your health history that might preclude you from being a mother?

And if there is something genetic that does not have a good prognosis, that would not bode well for the future of a child, are you prepared to bring such a child into the world? What are your beliefs about life? What degree of testing are you willing to consider to find out what kind of a baby you're going to have? Ultrasound? X-rays? Scans? Amniocentesis, which involves inserting a large needle into your uterus to withdraw fluid and cells for testing?

Are you prepared to consider termination of pregnancy if it is learned that the child developing within you is affected in some way that means it will not have what some would consider a meaningful life? Or does it depend on the situation is? Would you, for example, have a child with Down's Syndrome, but draw the line at anencephaly, a child with no brain, or at least a very limited one? Or is all of life sacred for you, from conception to death?

This last paragraph dealt with biological or physical concerns that can lead to ethical questions. But what are you bringing to this arena of parenthood from your own personal, family and life experience background? Are there issues in your life and relationships that are unresolved? Perhaps you think you are doing all right now. However, even though you might want to be a parent, there is still a stress involved and stresses have a way of bringing up past unresolved problems and turning them into present difficulties.

How did your parents treat you? How is your partner treating you now? Do you have misgivings about how your partner has treated you in the past? Have you ever been physically, emotionally or sexually abused? Have you resolved that? Are you still in such a situation? Does it involve your partner?

What about drugs and alcohol? How do they fit into your current lifestyle? If you use so-called illicit drugs or even take medication, even if it is prescribed, or drink alcoholic beverages fairly regularly, socially, do you think having a baby calls for any changes in that area? I am sure most of you would agree that to give the baby its best chances, one should be free of all of that. Are you prepared to make that a reality before you plan to become pregnant?

Let's look back again at your partner. I did raise the issue a few paragraphs back about whether your relationship involved abusive behavior from your partner. Or, are you abusing your partner? Is your partner excessively using drugs or alcohol? Do you think any of those situations is an optimal environment into which to bring a child?

Are you and your partner prepared to make the changes in life that having a baby will necessitate? Are are either or both of you all about going out with your friends? Pursuing your sport pursuits? Spending money on your hobbies? Having a baby will call for some changes in those areas. You are not going to have the time you once had.

Well, I hope all of the above has not unnecessarily dampen your enthusiasm for having a baby. Probably one of the reasons for your thinking about having a baby is because you have seen what having a baby can do to a person's life in a positive sense. It can indeed be one of the most wonderful experiences of life! I am not trying to talk you out of it!

However, at the same time, one has to be realistic and acknowledge that in our modern, often excessively self-centered, noisy, fast-paced and technologically-oriented society, bringing a child into the world is not is easy in some ways as it was. Some may hesitate because of concerns about where the world and the environment are heading. I really don't think most of us are in an acute situation now that should cause us to forestall fulfilling these dreams. It is obviously different if you are reading this on the run in some war zone, but that is not very likely. Then it would naturally be better to postpone any such thoughts. 

On the other hand, because of the availability of good water, nutrition and health care services for most of us, and the fact that I expect most of my readers are living in our relatively peaceful and stable developed, Western environment, the North versus the South, the possibilities of having a healthy and happy child have never been better. The questions that I raised don't all have to be answered before you embark on this path. Some of them can be addressed along the way. So, if after considering the above, you feel you are ready, perhaps even more confident, go for it! See you after you are pregnant!

Retirement II Post Retirement - Sunny Ways

Post Retirement - Sunny Ways

Just finished listening to a part of the local Noon Show on CBC about retirement and it got me to thinking again about my writing on my experience. I had been thinking about doing so for some time. Readers of this blog might remember that I had written in August of last year on "Pre-retirement Blues" but I have not written on the subject since.

As for my title - apologies to Wilfred Laurier, who first popularized the phrase, and Justin Trudeau, who borrowed it towards the end of his recent election campaign. It just came to mind when I sat down to write and thought about a title, as that is a phrase we have heard a few times since October 2015, and it works for me so far.

Now, let me begin by making clear I am talking about voluntary retirement. I think that is an important distinction to be made at the outset as involuntary retirement can be, I imagine, an altogether different 'kettle of fish.' I am not going to write about that further here though, as it is not my experience. This is not to say that I have not had acquaintance with this phenomenon from others I have known and who have been my patients back a few years when I did see adults.

Let me backtrack a little to some issues that need to be dealt with before retirement. One of the most obvious ones that might come to mind is financial, particularly financial readiness. My wife and I have definitely not lived the most frugal of lifestyles by any means, but neither have we been extravagant or really at any time lived beyond our means. I think the background for that in her case was the traditional Chinese cultural value of saving. This was not dissimilar to my own experience as a child of parents and grandparents who had gone through the Great Depression that hit Canada in the 1930s. It prompted my father to seriously talk to us about saving, and even tithing, the religious giving practice, when our parents first decided to give us a serious allowance when I was already 14. From that point forward, I kept scrupulous records of my income and expenditures until after we had been married long enough for me to realize that my wife could do a better job even than I in terms of helping us make sure we live within our means, both from a moral and bookkeeping point of view. She became my "office manager," and has continued to be the person in our household who helps keep and organize the records both for our personal tax and other purposes as well as for the corporation that we had for the last 10 years here in BC and the private practice I had in Manitoba before that.

We began our savings and investment in earnest within the first three or four years of my career, when I was still in my 30s and we were just beginning our family. Apart from some forays into other investment funds, some of which we still have, some - well, one at least - of which were rather disastrous, particularly the one instance of a Multi Unit Residential Holding investment in Calgary in the 1980s, we have entrusted our funds to our Canadian Medical Association financial arm. As a young investor, reading publications like Financial Times, it was always gratifying to see that it performed very well.  We have been very happy with both of the service and the results over the last 30+ years. This applies to both our portfolios in mutual funds and RRSPS. I highly recommend this approach to my medical colleagues. Naturally, there were times when we winced as we saw the paper numbers drop sometimes by tens of thousands. However, saving for retirement is a long-term process and the drops are generally followed by restoration. A key strategy also, unless you are a real risk-taker, is to gradually switch your investments to so-called safer funds as you approach your retirement. This means the returns are generally lower, but the possibilities of great fluctuations and with that, losses, are also less. One certainly doesn't want to arrive at retirement when your funds have just suffered because the market has undergone a significant downturn.

So, we were certainly prepared for retirement from a financial perspective. If anything, my wife and I wanting to enjoy our retirement years together, that knowledge added to the ledger side in favor of retirement sooner rather than later. However, for me, there was another ethical side to this.

As I may have mentioned earlier, in other writings, I had intended to retire two years ago, when I was already 67 years old. However, even before that occurred, it was already apparent that no one was going to come and take my place. My Department Head and Medical Team Leader really wanted me to stay on. I proposed coming back two days a week to the team that had less medical coverage. However, these two individuals really felt that the other team also needed help and so I ended up coming back 1.5 days to the team I had identified and one day to the other team. I really did not feel I wanted to retire and leave our teams with less than adequate medical coverage.

This brings me to another aspect of retirement that is often discussed - do you do it abruptly or gradually? I would have to say that for me, looking forward to retirement, as much as I enjoyed my work, got satisfaction and good pay from it, and worked with good teams, I wanted to retire and so began to "test the waters." Two years earlier, when I was 65, I had cut my working week down to four days. At the same time, I had asked our Department Head about the policy for being "on call" at that age. When I discovered it was an option, after “paying those dues” for nearly 40 years, it was a no-brainer. I quit being on call. Then, as just discussed in the paragraph above, I took a further step in the pathway of gradual retirement by going from four days a week to 2.5 days weekly when I agreed to postpone my retirement. Technically, my stopping work in June 2013 was regarded as retirement and my coming back to work towards the end of September, after a long nice break, further testing the waters of retirement, was regarded as a locum, from which I could withdraw at any time.

I might also have written elsewhere about the spiritual side to my retirement. I refer here to the fact that I felt I had really had a spiritual or religious calling to medicine. I therefore then also wondered if I should not receive a similar signal with respect to retirement. Now, those who are familiar with these things will understand that sometimes these messages seem to come, as it were, out of the blue. At other times, we accept that we hear the divine voice leading us through a series of events or changes.

In my case, in the end, and I don't believe I was just reading things this way to justify a desire to retire, I believe it was the latter situation. I had already downsized my work involvement and that seemed to be going well. Then, a few months before I did take retirement at the end of December, 2015, word came that someone had been found who would take my place on the Child and Adolescent Mental Health teams in Richmond. I took that as a second motion of affirmation to proceed. As I stated above, if one wanted to include that as a third, we were already financially ready. Fourthly, the timing coincided with when a number of my longer term patients, whom I had gotten to know quite well, practically becoming friends with some of them, were, as is said in the field, "aging out." This meant that they, turning 19, would no longer be eligible for the services I offered within the program constraints of our team, and would be turning to the adult equivalents for follow-up if necessary. If they were leaving, it seemed like a good time for me to go.

One other component that was addressed on that noon show today was where your spouse might be act with their thoughts about when you retire. Of course, in many instances nowadays, there might be two partners in a marriage whose retirements need to be considered. According to the guest on the show who had done some surveying and research and then written a book about retirement, many couples never talked with each other about their dreams and plans. That was not the case for my wife and myself. The whole issue was made somewhat easier by the fact that she did not have a career outside the home other than whatever business might have ensued from looking after our personal and corporate financial affairs.

Another factor that has a bearing on retirement is one's health. As the saying often goes, without good health, you have nothing, or at least possibly a lot less to look forward to. Here too, I have been fortunate in that I have no major issues that had a significant bearing on retirement planning or thoughts about what I would do after. I have never been one to consistently be physically active, particularly not aerobically, in my adult years. I was certainly active and did considerable physical work as a child and young man. I did play soccer, volleyball, softball, some cross-country and even downhill skiing and curling. In my last secondary school year and through much of my college years and into medicine I did quite keep up with the Canadian military exercise program called 5BX. I have done things like jogging and exercising for periods of time at various intervals. In more recent years, the latter was often more necessitated by some physical complaints that surfaced and needed to be dealt with. Both my wife and I continue to walk actively and I did as much of this to and from work as I could as well, like as not carrying a backpack with 10 pounds of paperwork in it, a necessity for me of working in two offices. So, one needs to look at one's health and certainly assess where it is at and try and optimize it as one approaches retirement.

I think the final element, and in many cases the most important issue in considering retirement, is what one is going to replace one's career with. Here is where many with remaining financial liabilities choose to work part-time or at some other job. Others who do not want to stop "working" for various reasons also find different types of employment. Of course, there might be volunteering possibilities related to one's career or even in other areas that one might want to pursue but never really had the opportunity to when working. Finally, of course, there might be interests, passions and hobbies that one may have not been able to give the time to when carrying out one's vocation that one would have wanted to, but that one looks forward to getting into more after retirement. In many cases, this whole last area is the biggest stumbling block for a happy and successful retirement. There are too many individuals who have made their careers/work such a key component of their lives that they have nothing else to turn to when they retire. Therefore, it follows that a key component of retirement planning is looking at what other interests a person might have that one might wish to pursue after retirement if it is not going to be work of another kind, and not all volunteering. Again, for myself, this has not been a big issue. That no doubt also stems in part from the fact that I did not go into my career until beginning training for it eight years after post-secondary school. By that time I had already pursued some of the interests that I would have to say I had been gifted with to the point where I never wanted to entirely give them up. I also always looked forward to when I would be able to put more time and effort into them again. This all brings us back to the issue of balance in life, about which much has been written. The obvious message with that is that this is something that again needs to be looked at, preferably throughout one's career, but particularly as one nears retirement.

So, for me, some five weeks after my retirement, I have no regrets. There has only been one moment when I thought to myself, what do I do next? That was really a momentary mood, as there is always something to do, so far. Now, without external pressure, it all boils down to self-discipline. However, at least for me at this point, there is sometimes also still a considerable tug towards a number of pursuits that I just want to do. In that I am fortunate and for that I am most thankful. Indeed, contentment and thankfulness are other important variables at this time of life, which indeed they are throughout all of life.