Preparing for a Newborn

✏️ Draft: This page is a draft and is likely to be incomplete. You can help write it if you like.

These are the things we're doing to prepare for a newborn. This was made much more easier by the fact that we received an extraordinary number of things from our friends and family:

• Anne and Charles gave us the majority of what we have
• Isha and Rishabh offered us a large number of things, of which we took all that didn't overlap
• Julie's sister Jaja and her husband John gave us a bunch
• Many of her coworkers and our friends bought us things from our Baby Registry

The entire list is quite large and not quite suited to this format so once we've bought the remainder and covered it all, I'll post it as a Google Sheet and post that here.

Choosing A Paediatrician

This was harder than I expected. While our obstetrician's clinic provided us with a large set of recommendations, there were a couple of surprises:

• Meet and Greets are not common in SF
• Some doctors are DOs

Meet and Greet

Many of my friends reported going to a meet-and-greet with a paediatrician before picking them. However, when I called various practices here in San Francisco, they told me that if I decided to go with them what I should do is notify the obstetrician who I'm going with and they'd send a doctor over to see the newborn post-birth.

Some of our friends told us it was very valuable:

We picked out and met ours beforehand with Kaiser.

I was glad to have gotten to know her a little bit before coming into our first appointment when my brain was fried.

Pediatricians can also have some good insight about pregnancy and the birth process and choices during labor because OBGYNs are focused on the birth while pediatricians are focused on the baby afterwards. I asked one of my friends who is a pediatrician a bunch of questions about amniocentesis, fetal monitoring, vacuum, etc.

— Anne, SMS, 16 months after first child

Others told us that the first time was useful but also that we shouldn't worry too much about it because changing your paediatrician is easy:

We had one for [our first child] and that was useful, but perhaps they were only doing that because it was during COVID. No idea, but we didn't have one for the second, but I suppose that's because we were experienced by then.

I can put your mind at ease about this. 8 months after [our first child] was born we had to move because we bought a home and we had to change paediatricians anyway. While we did go through the research process again, it wasn't like a good one was hard to find.

I would just copy and paste what you were looking into for an obstetrician. Yelp has some reviews, but Google Reviews have a lot more.

— Avinash & Anisha, Phone call, 18 months after second child, 3.5 y after first

Overall, I would be happy to place myself at the mercy of fate to start with, but the other thing I found out did make me a little nervous, especially since the concierge paediatricians in SF do offer meet-and-greets.

DO

This was the second thing I discovered in the process that I had no idea of before: in the US a doctor who practises medicine need not be an MD. They could also be a DO, a Doctor of Osteopathic Medicine. Osteopathy in most of the world is a complete joke science: it is full of woo. Many of my friends were quick to tell me that most of what a DO studies is the same as an MD and that they have some added garbage on top. In general, I am very pro-medical-access and so having a slightly less capable person provide a bit of garbage along with medicine at a lower cost is better than not having a doctor. But it turns out that half of DOs perform their stuff on some 5% of their patients and so there is quite a high risk that you will be given some bogus advice. I'm not a doctor myself, and this is all new to me so I'm unlikely to be able to identify it unless I shove everything into Claude.

Opinions of these DO doctors was mixed among the doctors I know or to whom I am connected to, but not inspiring in their ability. Here are some quotes, anonymized:

[My wife, who is a doctor,] also thinks they are able to perform reasonable medicine for what it's worth

what your forgetting Roshan is that people like the doesn't-work shit

so if they MD but also do some bone manipulation juju their patients are happier

if they are worse, it's because their schools are less selective/best students get MDs

— Partner of a Doctor in Family Medicine, Private conversation

Personally I'd stick with the MDs the DO degree is very variable and program dependent from my limited understanding of it

— Family Doctor, Private conversation

In primary care DOs are worthless. It’s Ayurvedic medicine people that passed a residency. Bottom of the barrel.

— Cardiovascular Surgeon, Private conversation

Though another of my friends had a good experience with one.

my obgyn is one that my pediatric emergency MD friend found and has seen for her 3 pregnancies, and the obgyn is a DO

— Patient, Private conversation

My parents are both surgeons so I usually go to them for this information, but they were not familiar with the qualification and said that they had asked their friends before on encountering authors on papers with a DO qualification but did not get a particularly concrete answer.

Single vs. Multiple Practitioners vs. Concierge

We also had the choice to go to a single-practitioner practice or a multiple-practitioner service or a concierge service. The highest ratings were for the concierge service, with whom nearly everyone was pleased. However, the costs involved ($12000+) were substantial. Considering one of my parents would be present most of the time while we had an infant, we would always have a doctor in the home.

Single-practitioner services have the problem that when the doctor is out for whatever reason, you're out of luck. This is just a queueing theory problem and the reviews on the web reflect that, with fewer practitioners correlating heavily with greater complaints about queues, waiting times, and delayed appointments.

Multiple-practitioner services seem to mostly be the place to go to if you don't have special requirements, which to start with we don't anticipate having. You may be scheduled onto a different practitioner but that is fine. The downside is that m-p services frequently have some who are DOs.

Big Ticket Items

Some items are crucial to raising a baby. An obvious one is a car seat - but this effectively constrains other choices. Here's what we chose.

Travel System

The term for a car seat + stroller + bassinet + stroller seat is "travel system". In practice, what you can do is buy separate things and then get adapters for most popular devices. Some of the popular brands in this are Clek, Diono, Graco, Uppababy. Clek seats need adapters, Diono's just sit in the car, and the other two have travel systems.

The things that we were looking for were:

1. As few moving parts as possible
2. As light as possible
3. Comfortable ride handling
4. Ideally single-handed operation

In the end, we decided on an Uppababy travel system. The standard ones you probably want are:

1. Uppababy Mesa Car Seat
2. Uppababy Cruz Stroller
3. Uppababy Bassinet

Picking a travel system from a single brand has the primary advantage that everything works with everything else without adapters, and if you have trouble then you only need to contact a single manufacturer. A friend of ours expressed that a thing they would have appreciated is the ability to pick up their child from the car seat and transfer them to the stroller to transport them without needing to explicitly wake them. The Uppababy Mesa is one such car seat.

You'll ultimately need the bassinet because infants are meant to be on their backs for them to grow properly.

The Cruz stroller isn't the only one that Uppababy offers. There is a slightly more expensive Vista stroller that has a tandem mode where you can transport two children: one lower to the ground and one above. In our case we decided to save the extra weight and figured that we'd just repeat the research process at child #2 when we need to, but we do know of another couple who has just given birth who chose the Vista.

Each Uppababy device has a version number and there's never a reason to choose anything but the highest number version currently available. As of this time, they all correctly interoperate.

For car seats, the crucial thing to know is that you want to use the LATCH system in your car if you can. It's much simpler than running the seat belts around. These are rear seat metal loops that are hidden near the point where the backrest meets the part where you sit. You usually undo a velcro or button cover where you sit and it's there.

When we first picked up the Mesa, I set it down on a coffee table and it promptly fell to the floor. If you Google what this means for the car seat, there are lots of people who will tell you that this ruins the car seat. When we contacted Uppababy about this they asked us to check if anything was broken on the seat, and that if nothing was, then it's fine to use because the device is meant to withstand a lot more force.

One of the big advantages we had was that many people in our network had children just before us. This meant that when Julie's sister visited us with her daughter we were able to put the stroller, car seat, and bassinet to the test. The bassinet attaches to the stroller but we also parked it in the bedroom for them to use as a stationary bassinet. So far, we feel quite good about the travel system we've chosen. Our niece never slept through a car seat disengage and transfer to stroller but she also did fall right back to sleep post transfer.