Saturday, March 30, 2013

On the Eve of teaching him to sleep

As I write this my little baby is napping in his swing. This is an unusual day since he's been napping for an hour and 15 minutes so far. Sleep has not been my baby's thing. And it seems that sleep is not any baby's thing, unless you're really lucky. You need to teach your baby to sleep (if theyre not good sleepers already) and it's important for them so they can grow and develop. I have become obsessed with sleep for my little guy. He loves motion. Like you've never loved anything before. I'd go on epic 2 hour walks with him just to get a really good nap in.

There are countless resources on sleep, it makes your head swim. It makes you feel like a bad parent, a good parent, and it makes you not know how to feel as a parent. I am not writing this to recommend one way or another but I thought I'd write to describe how I am feeling on the eve (almost) of teaching our son to sleep. Aka, sleep training. We're using the Sleep Easy Approach and we'll see how it goes. Although I have been insanely sleep deprived, particularly so in the last month, I am suddenly sad. I guess this is the first 'letting go' of parenthood. I love having my little guy sleep next to me in his cradle and now his swing (motion junkie). I love looking over at him and just feeling blessed to have him in my life. But I do also like sleep and want to be a good mom and a good wife. Sleep helps me function in the day to do these things. I know it will be hard to have him cry, have him be in his own bed, in his own room and on a basic schedule of sleep but I need to be strong enough to do what's best for him which is teaching him to sleep well so he can grow and be happy. I definitely want to be a parent who lets go and gives my child space to grow, make mistakes, learn, be happy and create his own life. I want to give him the skills to do so. Knowing that it's just a few nights left of him in our room and getting up each hour sometimes (assuming this sleep teaching goes well), has actually freed me up to enjoy it more. I hope to remember this feeling through all of my parenting--letting go will allow me to enjoy the moments more because I know they will pass. And they will be replaced by new milestones and moments. Creating a happy life for baby and parents. Sending good vibes to all parents and their (non) sleeping babies.

Wednesday, March 27, 2013

Sleep: Cliff notes

I am lucky to have quite a few friends who have already embarked on the wild journey that is parenthood. The academic in me always wants to get the knowledge straight from the source. And it turns out my friend Jenny has the cliff notes for a lot of my parenting questions. Here's what she gave me on sleep: 

'So, the sleep thing.  First, here is some general sleep knowledge I have garnered over the years;
1.  Sleep begets sleep.  The more they sleep, the better they sleep.  So keeping a baby up so they sleep at night doesn't work.  
2.  They sleep in 40 minute cycles.  Deeper sleep at night, lighter during the day.
3.  For a nap to be good, it needs to last at least an hour.  This is when the chemicals in their bodies that make them cranky start to be removed.  
4.  At this age, three naps is standard.  Morning, early afternoon, late afternoon.  The first two should be a couple of hours each, and the last shorter to get them through until bedtime.  Awake time in between of 1.5 to 2hours.  Then, as wake time extends, they'll drop the late one around 8 months and down to one around 1.5 or two years.  
5.  An over tired baby is hard to get to sleep.  
6.  All babies give clues when they are tired.  Rubbing eyes, cranky, pulling ears.  You can try to figure out what Henry's are and then he will tell you when it is nap time.  M has just started rubbing her eyes as a clue. It is cute, though, because she doesn't have the coordination to always get her eyes, so rubs her nose or forehead on her way to the eyes.  
7.  Sleep will be interrupted more often during growth spurts, teething and around milestones like rolling, crawling and walking ( the brain is so busy processing these new things)
8. A baby who has had enough sleep will wake up cooing.'


And at 4 months and 3 weeks when my baby's night sleep and naps were both bad, Jenny first told me that this happened with her kids and her friend's kids. And when I told her I want to teach him how to sleep (aka sleep train) because his naps and night sleep is so bad, this is how she responded: 

'I won't lie to you--it [teaching how to sleep] is hard.  Here are a few things that may help:
-remember it is only a few days.
-it is okay if you can't get through it the first time.
-even as they cry, they will be happy to see you in the morning.
-good to get it done before things like teething and rolling start.
-figure out if it is helpful to do their recommended timed check-ins.  For me, I found they just made j and m much more angry, so I stopped.
-also figure out if it is helpful to have your husband around.  I discovered that it was easier when my husband wasn't there, so there were no witnesses.  He also had a tendency to ask questions (not questioning it, but just wondering things ) and that wasn't helpful.
-I didn't stick to a rigorous time schedule (same times every day), but used the wake up times to gauge when the naps would happen.  However I do try to stick to a similar bed time each night.  
-don't be afraid to use the emergency nap they recommend ( we went for a drive at the end of the first day).' 

Sleep has been so tough for my baby and consequently me. My husband sleeps pretty soundly and even through some of our baby's crying. I wake up some mornings so grumpy because he's had a good night sleep and I am the sleep keeper for our baby. And I am not a good keeper because I can't help him sleep better. And the sad thing, I have no idea what to do. I read books, ask friends, try different things (bath, book, etc, etc). That is the thing with parenting: you don't really know what you're doing, and no one can really tell you what to do. It is the ultimate in experimentation and doing what you think is right. Despite almost 5 months of bad sleep, somehow every night I have some optimism that this night will be better. He'll sleep longer. Go to sleep quicker. And I'll get more rest. This is hardly ever the case. I wake up in the morning with bags under my eyes, exhausted by the night. But when I start to hear my baby coo, I can't help it, I want to be up with him smiling at the world. Rinse and Repeat, every day. 

Tuesday, March 19, 2013

Oh breastfeeding!


As you may have read, we had a bit of a tough start with our first baby since he spent many days in the NICU. I was hell bent on breastfeeding my kid despite the rocky start and because of the rocky start!:) My background is in public health and I could go on and on and on about why breastfeeding is the best but one of the best things I find about it, not even considering the health benefits, is that it travels with you everywhere and can be ready at any moment. Once you get the hang of it, it's no muss, no fuss.

Hopefully your baby will latch right on. And because my baby did this even 6 days after he was born, I don't have too much advice there. However, there is tons of information on how to get a good latch out there. It's all about positioning and possibly repositioning.

Yes, breastfeeding can be tricky. Take it from a woman who sat up with her husband night after night, day after day for hours to breastfeed, then bottle feed their kid and then breast pump to improve production. I felt like a zombie. It was nuts. But like all things, this too shall/did pass.

We learned so many lessons that I don't know where to begin.
1. Make sure you're baby is actually drinking. Did you know that you should be able to hear a little swallow? You should also see him swallow. Imagine someone chugging a beer or big glass of milk or something, that's what it should look like.

2. Shoot! You just pumped and now your baby is hungry! Did you know that your baby can find more milk? Don't freak out and give him formula instead-that won't help production! Just put that baby on the boob so it helps you and helps him.

3. If you decide one day to pump just to see how much you're producing, don't be discouraged if you don't pump much! It doesn't indicate how much you're producing and how much your baby is getting. Remember, your baby is the best 'pump.' (and yes, I still have to convince myself of this). Best thing to judge this and one of the only things they are good for:) the dirty diapers! how many pee and poo ones has your baby had? and of course, if your baby is gaining weight.

4. Put that baby on the boob. Your baby is the best stimulation for milk production. You have those lovely feelings for your babe, the babe is stimulating the boob, nature is taking its course. You can do it!

5. Baby is fussy on the breast, change it up! Do the football hold, cradle hold, etc.  This really helped me. Also, learn how to get comfortable yourself. You can't hold your baby's head up for 30mins, have your husband help prop it up with a blanket or pillow. The whole experience will be better when you're relaxed.

6. Blocked ducts--ouch! They are horrible and feel like rocks in your breasts! Take a hot shower, massage the area in the shower. Put the baby on the boob and massage the area while he eats. It is suggested that his chin is facing the blocked duct but with me this was hard because most of mine were on the top of my boob. But it's just a tip to keep changing nursing positions to help release the duct and ease the pain. Also keep the baby eating (at least mostly) from the same boob. Keep at it and they will eventually go away. I even read that you can put an ultrasonic toothbrush on it  to help break it up. Know that you are not alone.

7. If you have breastfeeding issues or your baby had a stay in the hospital, do yourself a favor, go and buy the good pump. Not the okay pump but the really good one, preferably the one that does 2 boobs at once. It will make your life so much easier. Trust me, I know.

8. Try the champagne! Okay, it's not really champagne but it sounds like it: domperidone.  It is for nausea and actually carries a warning for heart palpitation in the elderly. This drug worked wonders for me. I tried pumping, baby to boob, taking fenugreek (yuck, tastes like swamp thing) and blessed thistle, etc. Domperidone really helped me and I know other women who it really helped also. If you want to breastfeed your baby and are having trouble look into this.

9. Buy a hooter hider. I thought I could get away with a big scarf/pashmina but really a hooter hider type design is the best. It has a little piece of metal on the top that keeps the fabric away from your baby a bit so you don't have to worry about smothering them and you can peek in at them. It's also big enough to cover you and them almost completely. Good for public places, like airplanes!

10. Lactation consultants will tell you 2 things: 'do you feel your breasts empty?' and 'just relax!' Ahhhh! This frustrated me so much. I never really knew if my breasts were emptied. Unless it had been several hours (like at night) and they were more noticeably full, I had no idea most times. My advice, again, go with those dirty diapers. If your baby is peeing and pooing and gaining weight, your breasts are being emptied.
Relax! How am I supposed to relax when I have a new baby, breastfeeding isn't coming naturally to me, and the baby is also having a hard time!? I hated this advice. Just do the best you can to get the hang of breastfeeding. It will happen. You breastfeed so much and so often that soon enough it will feel more relaxing for you. My advice, which a friend gave me, is to think about something else. Most people tell you to think about your baby when you are pumping or feeding but it was such a source of stress for me that it helped me to write an email, read a magazine, etc.

Again, if I can do it! So can you!


What we're learning along the way: many doctor visits

Our baby spent several days of his first days in the NICU. Intense and challenging. Not how anyone wants to spend their first days as a parent. It opened our eyes to a whole different world of little babes struggling in the world. So sad. Because of this we have a lot of follow up appointments. My husband and I celebrate when we have a week where we don't have to see a doctor or a nurse. But on the flip side, we learn a lot about baby development from a lot of experts.

Some lessons:
-Smiling: the neurologist told us our baby was not socially smiling in the first 2 weeks of life although he smiled all of the time. He said it was gas. However, we quickly learned that around week 3 or 4, those cute little grins are indeed social and they're smiling at you. We caught one of our babes very first smiles around week 5 when we were taking his passport photo.
-Sleeping: the NICU nurses and occupational therapists created a little cocoon for our baby with rolled up blankets on four sides and one fitted over it. This helps them feels secure and also keeps their shoulders and hips from falling too far back and straining. Our baby slept like this for at least 3 months. It helped him feel cozy.
-Babies develop from the head down. Work with your baby's head control first. Holding him, burping him, playing with him. Until he is confident and steady. Then work on tummy time which is also majorly about head control. Next, is sitting up--working on his trunk.  Combine head and trunk with learning to roll over. Then you work his legs and standing. All babies develop differently and like different things but this is the general order we've been working with our kid. We havent skipped to standing/jolly jumper before he can sit well.
-Tummy time. When you put your child on his tummy, it's good to place his arms underneath him/place him on his elbows to improve confidence and strength on his tummy. We've done this with our baby from the start and he loves tummy time. Later, when you work on rolling with him, he can then experiment with getting his arms out from underneath him.
-We learned a lot of lessons about breastfeeding, as you may have read, I saw 3 lactation consultants. I think I'll write a whole blog post just on that.


I am sure I'll think of more....

What's in your diaper bag?

I don't technically have a diaper bag. I have an old, black little back pack that has really good side pockets. In my diaper bag, with a son 4 months old, I carry:

A Skip and Hop changing pad (a hand-me-down luxury)
Blanket (to keep baby warm, put him down on, possibly change him on)
burp cloth
Hooter Hider for breastfeeding
Extra pacifier
small book
plastic rings
small stuffed animal
extra outfit for baby, usually footie pjs
Snack for parents
plastic grocery bag
hand sanitizer
diapers (obviously)
wipes
water bottle
Roll of dog poo bags (small, compact and ready for wet stuff, poopy stuff, etc)

what's in your diaper bag?

Tuesday, March 12, 2013

What every parent really needs

If you're a new parents you'll quickly discover that during pregnancy the mother and father really should've acquired a few things to help them with their new baby. These things should be, in no particular order:
-Another set or 2 of arms. One arm for holding the baby, the other arm for doing something else and that extra one or two arms for helping you do something else. This something else could be anything: making food, eating that food, getting dressed, walking your dog, changing a diaper, catching the pee stream before it hits his face or the wall, talking on the phone, breastfeeding....it's endless!
-These arms would be ambidextros. There are often time where I find I am holding the baby in my right arm and am using my left arm to do things it has never done before. I often end up wearing the milk from my cereal or the pasta from my dinner. And I definitely misspell much more often.

-One piece of equipment that doesn't include the evolution of the human body is: a smart device. This, gentlemen, is the perfect gift for your pregnant wife or the pregnant woman in your life. My husband's brother gave us the first I-pad out of the blue when it came out years ago. And when we moved to Canada I upgraded my phone to an I-phone so I could use Google Voice to text my American peeps (post on that coming soon). It turns out this is a godsend to anyone with a child.

Scenario One: you're breastfeeding and cannot flip pages to that huge book you've been dying to read and now have a few minutes to do so while your babe eats. Enter the Kindle. Turn pages with the flick of a wrist. Read your  favorite magazine.

Scenario Two: You have a new baby. You haven't left the house for a few days. You can't find the energy to call all of those friends and family to tell them how you're doing. Youre kind of winging this parents stuff and don't want anyone to know (although everyone does, I think!). Ah ha! I've got this smart device! I'll just snap a cute photo of the babe and send a quick email. Then I'll go back to trying to get some sleep or getting my child to sleep.

Scenario Three: You've just worked really hard to get your baby to sleep but shit! He's sleeping on me! I am not tired because it's the middle of the day and I know I have to get some stuff done. Or I am not tired because I have a minute of 'me time' even with this baby on me. Yes! I'll use my smart device to look up that thing I've been meaning to. Listen to some music. Catch up on email.

Scenario Four: the app. There are tons of parenting applications out there. May be I'll blog later about my favorite. But I definitely love the white noise app for when you're traveling. No need to bring that sound machine--this travels with you. And it even has a lovely woman who will hum lullabies to your baby!

So you don't know what to get your lady as a push present (even though the baby itself is enough of a gift), ta-da! A smart device of your choosing! Saves every woman's sanity!

Baby necessities: my list

The world of stuff to buy for babies is unreal. It is so consumer driven. So much of it is just so cute. And so unnecessary. My husband and I tried to make this as minimal as possible. And the best way to really do this is to use hand-me-downs. Think of it this way--these items have already been tests and approved!:)

Here are the things we've felt have been useful to have, so far. I'll expand on this list as I think of things.

For pregnancy: 
( All of my maternity clothes were on loan from my friend and it was awesome. I loved wearing them and thinking of her and she has great taste! Once my pregnancy was over, I promptly washed, boxed up and returned)
Good pair of maternity jeans
One cute dress
Maternity t-shirts
Comfy pants, I liked the baggy kind sort of like cargo pants
Maternity leggings, cute under dresses and long shirts
One jacket or long sleeves, unless you can get away wearing dad's


What not to buy:
-maternity underwear, not worth it as you don't really expand at your underwear line


For breastfeeding mamma: 
-Sleep bras
-Nursing bras and nursing tank tops (I prefer the tank tops because you can then nurse in front of people and not have your stomach hang out)
-Nursing pads
-A breast pump (we didn't initially have one but our tough introduction into parenthood which included a hospital stay for our baby meant we needed to have one, know how you'd get one just in case--where to rent, etc)
TIP: DIY make a hands free pumping bra by taking an old bra and cutting a vertical line wear the cups on the breast pump will go
-nipple cream (bc it hurts at first but dont worry, it gets better-and I went through a hard time and saw 3 different lactation consultants)
-pjs that have buttons down the front for each access when you're fumbling in the night
-luxury: nursing pillow

-Bottles, we like Dr Browns (so mamma can get out once in awhile)
-Rocking chair with padded arms for nursing and/or rocking
-What to expect in the first year, a good resource
-White noise machine or an application on your smart phone
-Baby monitor (we got the audio one first and then bought the video one...get the video one, it'll help you rest better to be able to see your baby and they are so cheap now).

For baby 7-10 months old
-it's nice to have some toys that make noise and light up, they seem to keep my baby occupied longer
-bath toys are fun now
-we have a exersaucer that is also a jumper which we got at a garage sale and now that he can crawl, it's nice to have him play in this while you do something you need to do

For baby 0-6 months
*Go for hand-me-downs! Babies grow so fast that there is no reason to get new stuff and put more stuff into the world. Sure, you'll want a few new, sweet items for your little babe but hand-me-downs will come from expert parents and will have already been loved. If you don't know someone with older kids, check out consignment shops

-PJs that are not snaps! All snap clothing for kids has a different configuration that can drive you nuts. Go with zippie pjs
-Baby hat to keep their head warm
-Baby slipper shoes, like this, to help keep their feet warm
-Lots of baby blankets for swaddling, laying on their back, changing the quick diaper
-Lots of burp cloths
-Baby bath, although we showered with our little guy for the first few months, once he was older we liked this Fisher Price one
-Baby rings, awesome for keeping him occupied-he can hold and put in his mouth
-Baby chair, somewhere to put the little guy when you're cooking, cleaning, etc. We have a hand me down like this (ours is a bit bigger)
-Play mat-awesome for when they grab, kick, roll
-Baby carrier, what ever kind you prefer. We have a Becco and a Moby. We loved the Moby when he was 0-3 months old. Then upgraded to the Becco.
-Stroller, nice for long walks or runs once they are old enough
-Pack n play, can be used as a side car bed for sleeping and for sleeping while out and about
-Books that are high contrast black and white
-Fabric books that baby can stick into this mouth, especially ones that have a crinkle sound to them
-A rattle or something that the baby can grab easily and hold (not too heavy) that makes noise
-Something with sound near the changing table so you can distract the baby if he's crying

Luxury items for 0-3 months
-Baby swing that plugs in  (while this is a luxury item, I have to stress that this has saved us during our baby's sleep regression at month 4)
-Towel with hood for baby after bath
-Large jacket to go around your baby in the carrier
-Mobile-I made a high contract black and white one with one of those picture mobiles that I happen to have (ha! they even use a baby mobile high contrast as an example) and printed high contrast images from this website
-changing pad-I first used a yoga mat folded up but as my baby moved more I wanted something more substantial and ended up buying a changing mat with the thought that I'll be changing many, many diapers on it. I read on some people's web posts that they just changed their baby on the floor. Sure, you can do this. But I have to say that I have some of my sweetest and most fun moments with my baby while he's on his changing mat. I have it on a dresser that is about waist high so we can look at each other in the face and giggle and coo. He loves to kick and gets pretty excited. I wouldn't trade those moments.

Sleep Regression

When our little guy turned 4 months it was like someone magically turned him into a horrible sleeper. From birth until about 3.5 months he was your normal newborn sleeper, mostly. Well, it turns out he was but I didn't know it at the time. Until I came across this great blog that made me feel better.  He would go to bed around 11pm after trying to put him down 3 times. He'd wake up after may be 3-5 hours and then wake up every 2 hours after that. I always thought 11pm was insanely late but according to this blog, it is kind of normal for new borns!

He was not a napper though. And it turns out that no matter what, even if you think your baby is just not tired or not a napper, like we did, he needs his naps and sleeps. We were wise enough to know he needed at least one good long nap a day but he had a lot of little intermittent cat naps (which this blog also says is pretty normal). I do think he may have been a bit sleep deprived but it's our first baby and I just didn't know. He had to sleep in the carrier basically. We could get him to sleep in a swing sometimes. And when Grandma was actually around she'd rock him. But it was tough. As I write this, he is strapped to my chest in a carrier napping.

We were making strides in sleeping as 4 months neared. We were getting him to sleep more around 9pm and sometimes even earlier. And although I thought those newborn months were tough sleep, they were not. Let me repeat: those were the easy days! Our little guy woke up to the world at 4 months. He was distracted eating. He was finally aware of that big hairy thing licking him so much: his dog! He wanted to look around, even behind him. And sleep suddenly became hard.

We could no longer rock him to sleep and put him down in his cradle. He would always wake up and cry and cry. We'd shush and pat for 30mins to an hour and those were good days. And the real kicker is that when he went down, he'd often wake up an hour later. Yes, one hour. And then each and every hour after that! It was with every sleep cycle. His little alert mind just couldn't get over the little wake up.

At first, when he was awaking from 1am until 6am every hour, I thought he was going through a growth spurt. And may be he was. So I was feeding him every hour. In bed. Laying down. Because man was I tired (yes, it took me awhile to master breastfeeding while lying down--you can do it too!). I think I was developing a terrible sleep association without even meaning to: my boob. This happened night after night.

About 6 nights in and a day time melt down from mama, we tried to let him cry, just a little to self soothe. It was incredibly sad for me and I hated it. Even though we were there telling him it was okay and patting him. But I was exhausted and didn't know what else to do. The next day our little guy was sick and there was no way we were going to continue with the crying and soothing from afar.

I was making myself dizzy reading about sleep and babies and what to do. We felt our little guy was a bit to young and also too small/not heavy enough to start real 'sleep training.' And we weren't sure we were completely ready either. But we had to do something. My zombie like fog was unreal.

Then someone in my playgroup recommended the Troublesome Tots blog. She suggested using a swing to help your baby to sleep. We had a baby swing that we used to keep little guy calm and try to get him to nap but we had never used it for night sleep. Alexis from the blog says it's particularly good for babies who love motion. That's our guy: he loves to sleep in the stroller, in the car, in the carrier. So we gave it a try. The idea is that the swing helps them self soothe a bit and then you slow the swing down more and more until it's still. Once they can do into a still swing, you move them to the crib (where he was sleeping before month 4).

The first night it worked brilliantly and he went down very easily--grumbling for 12 minutes. He slept 4 hours in a row that night! He still woke up every hour for soothing but it seemed to be a step in the right direction: sleep for all. The second night was about the same and even the third. But on the 4th day, it was much better! He cries a bit more going into the swing but he sleeps a 2-5 hour chunk. Yes, that's big variation but I'd take it! Why? Because he then sleeps another chunk of time 2-3 hours. And he has gotten up once with the sleep cycle the night before last night and last night and all I had to do was up the speed on the swing. I did not have to use the boob to help him at that sleep cycle awakening. I think the whole family feels better with this even little bit more of sleep! I really hope it continues in this positive direction and then hope weening him from the swing isn't too hard. Even if it is hard, it's been worth it just to get a few nights of sleep.

Finding a doctor in Quebec

We're American. And we had health insurance. So we were used to most of our healthcare experiences being available and efficient. We heard rumors about Quebec and how health care is good here as long as you don't get sick! Well, I wasn't 'sick' but I was very pregnant when I arrived in Quebec. We had a tip from a friend to start searching for a doctor 3 months before we even moved to Quebec. I had a small list of doctors and started calling while we still lived in the US. No one would take me as their patient despite the fact that I had been receiving excellent health care in the US, had an easy/health pregnancy and would have all of my records with me upon arriving.

I waited until I moved to Montreal to continue calling doctors in hopes of finding one. I think my list was 30 doctors long. I would call one doctor and then when they said they wouldn't take me, I would ask if they knew another doctor I could try. Someone needed to help me deliver this baby! After many, many attempts, I had one magic call one day where the secretary said 'Yes, she can take you'! Amazing! Of course, my appointment wasn't for another 3 or 4 weeks but I was thrilled to have a doctor.

Don't loose hope in finding a doctor in Quebec! But you should know it is nothing like the US system. You don't just see a doctor on your insurance site and call them up. Or hear from a friend that Dr. Johnny Begood is a good one. You seriously have to ask around. Ask everyone you know, even if you don't really know anyone. It's like a networking game. It can be daunting but it can be done. Someone has to help deliver your baby!

In the end, I had the best doctor and was really, really pleased with her. It was honestly shear luck though! Your American persistence will come in handy here!

Quebec and RAMQ

We decided we'd like to create a blog to help people who are moving to Canada but more specifically Quebec, as it's basically a different country than Canada.

We arrived in Canada with a baby on the way! One of first lessons learned: you have to wait 3 months to get into Regie de l'assurance maladie, RAMQ,  the Quebec medical system. I am not entirely sure of the different ways to get into the system but we came into Canada on a temporary work permit. We took our work permits to the RAMQ office in Montreal, took a number (like everything in Canada) and waited to submit our application.

2 tips about RAMQ:
1. If you are pregnant you do not have to wait 3 months and are able to get healthcare immediately.  In my case, I came to Quebec 27 weeks pregnant. You have to show all health care services your RAMQ letter which they give you on the day you sign up for RAMQ. Don't loose that letter!

2. And the major tip: If you can come to Quebec and sign up for RAMQ as close as possible to the end of a month, this counts as one of your 3 months to wait to receive care. For instance, if you sign up for RAMQ on the 25 of March, the month of March will count as one of your 3 months. So you will receive healthcare and a RAMQ card in June.