Being the Mom of a Preemie... How's it like?

Introduction
One of the commonest questions I get from my friends nowadays is "how's your son?".  And it suddenly made me realize that unlike most mothers who share a lot about their children, I seldom do so. 

Thanks to the dedicated pediatric team at Hospital Ampang, and thank God for the miracle, I'm grateful that Alvin is generally growing and learning like other babies.

However, I shall be glad to share this journey of being a mom to a premature baby here.

Expect many differences
Compared to healthy full-term babies who get to go home together with mommy upon her discharge post-natal, babies who are very preterm don't.  They have to live in "the NICU that never sleeps" for a significant amount of time until they are at least 1.7-1.8 kg or when they are well enough to discharge.  Therefore, if a prem baby seems very unadjusted and "stubborn" compared to a full-term counterpart when they first go home, the differences endured during his/her early days, and immature brain, may have a connexion.

How does NICU look like?
As photography is not allowed at the NICU in Hospital Ampang, I abided by the rule.

Briefly, it's very noisy with the sounds of ventilators and various alarms.  It's brightly-lit 24 hours a day.

In Hospital Ampang, only parents of patients are allowed into the NICU.  Grandparents aren't allowed, with the exception of critical cases with the permission of the pediatrician in-charge.

Of course I do not know the reason for that, but I personally think it's a good idea (why?  I'll explain in a while...).

I know about the general functions of each device attached to a premature baby in the NICU, yet I dread going there each day because I was afraid of seeing deterioration instead of improvement.  It's only until my child's completely off from CPAP that my confidence began to grow.  Even then, I was still worried about other things like hospital-acquired infection, the risks of ROP and hearing problem, PDA, and a host of other dangers that a preterm baby faces. 

The image above from Mayo is a simple and precise illustration of the gadgets used on a very preterm baby in the NICU.  Scary, isn't it?

In the event where grandparents are allowed into the NICU, perhaps many will burst into tears.  Especially among those who have seen their elderly friends who're ill and battling for life in the hospital with various life support and monitoring devices attached to the latter.  And when they see their grandchildren on similar setup, it will not be surprising for grandparents to end up thinking "will my grandchild make it?".    

Various follow-up appointments to keep
In comparison to full-term babies, premature babies are known to face higher risks for quite a number of conditions.  As a result, it's crucial for there to be continuous monitoring and check-ups to make sure that everything is OK and for early interventions to be initiated if any anomaly is detected.

After all, premature babies are born before they are supposed to, and thus their bodies may not be fully-prepared to cope with life outside the womb.

Let us know divulge into some of the things that we check for, post-discharge from NICU and ward 4A (ordinary neonatal ward).  Being a layperson who shares for the sake of sharing, please bear with my usage of possibly crude-sounding words (my apologies...).

ROP Check
ROP stands for Retinopathy of Prematurity (please click to view the factsheet of ROP). 

The check was conducted for a few times over a period of 3 months.  Eye drops are administered to dilate the pupils, the eye is wide-opened using a special device (like the one used to keep the wide-eye opened during eye surgery), and a bright light is "flashed" into the eye to check if any abnormal blood vessel is present.

Anyway, the panic button shouldn't be on outright... firstly because not every premature baby has ROP, and secondly, if there is ROP but detected early, treatment can be initiated a.s.a.p.

Having gone through 3 tests, I am relieved that my kid is free from ROP.  But there will be an appointment in a year after the last test, this time to test for visual acuity just to make sure that everything is 100% okay. 

Hearing Assessment for Preterm Babies - the BAER test
Premature babies have higher risks in terms of facing problems with their ears and hearing.  And thus, an appointment with the audiologist needs to be scheduled.

The audiologist will check the eardrums, and then proceed to do a full hearing assessment.  During the test, the baby is orally-sedated. This is one test which you'll see the usage of headphone with colourful wires adhered to the forehead. 

Pediatric Check-up
Appointments at the Pediatric Clinic are scheduled once quarterly or once in 3 months for the purpose of monitoring growth, development milestones and the general health of the baby.

The development of premature babies is tracked based on their corrected age (i.e. age based on EDD) as opposed to the conventional age.

Speaking of corrected age, I find myself frequently reminding folks around me that they should measure Alvin as if he's born in August, not May.  This is because I often hear "at this age, his so-and-so is already drinking 6 oz of milk", and "at this age, his so-and-so is already eating this-and-that".

The advice for extra vaccination
During the first pediatric check-up, pediatrician at Hospital Ampang, Dr Rahimah had recommended that my child gets the PCV (pneumococcal conjugate vaccination).  As PCV is currently not in the list of compulsory vaccination in our country, we're advised to seek the vaccination in a private clinic.

I do not know which clinic offers the best deal, but I take convenience into consideration and had decided to seek it from a private pediatrician's clinic (Dr Chia) near where I live.  The Prevenar 13 is to be administered in 3 doses during infancy, and 1 dose at 18 months of age. 

Different Feeding Pattern

When my child was first discharged, he's only 1.78 kg and one can imagine how his appetite is.  We started off with about 30 ml of milk per every 2 hours, and now it's approx. 100 ml per every 3 hours.

100 ml is a small portion, but then what's most important is that as long as growth rate is proportionate to the corrected age, then I shouldn't worry much.

At first, I saw that folks were quite surprised to see this strange feeding pattern which is very different from full-term babies.  Of course, since both children of my parents-in-law are full-term babies weighing well beyond 3 kg at birth, they're already consuming 4oz per feed (120 ml) right from very young.

When to Start Solids?
At 3 1/2 months corrected age (6 months conventional age), there were two occasions when people, including nurses asked me why have I not started solid food on my child. 

Taking my parents' experience with me into account, my parents started me with solid food when I was about 6 months old (corrected age: 5 months old).  Although I was able to swallow my food and did not vomit, I became extremely constipated that enema became an essential tool on a daily basis.  Only upon attaining a more matured digestion that I began to be no longer dependent on the enema as an infant.

I do not want my child to go through my nightmare (as if I remember anything from 6 months old when I don't, hahaha...), so I shall stick to the plan to start semi-solid food at 6 months corrected age rather than now.  I have a feeling that he may be the same as me in this regard, so do trust a mother's instinct and don't fall for pressure from others!

"Do you bring your baby out?"
Besides the above, I have also been frequently asked if I ever take my baby out to public places because I hardly tell anyone of me going anywhere with my child, be it verbally or via the Net such as social network and blog.

Yes, I do.  But to somewhere that's not too crowded until he's at least 2.

"Why doesn't he nap longer?"
This is a question I frequently receive from the present caretakers of my babies i.e. my parents-in-law.

I'm not an expert in babies, but from what I have gathered, some premature babies have sleeping pattern that differs from full-term babies.  Those under this category sleep longer hours, but shorter intervals.

Such phenomena stems from the reason that premature babies tend to have brains less matured than their full-term counterparts.  When "state control" is still lacking, this is when some preemies find difficulties falling asleep despite being tired, and more easily upset by over-stimulation.

People like to say "sleep like a baby" to describe a person who sleeps soundly.  But contrary to that, I'm quite afraid of my baby sleeping too soundly.  To sleep well is okay, but please don't get too sound.

SIDS is one of the things that I'm a little scared of.  If you talk about the risks, I guess I see them all the time.  Low birth weight, being male, not breastfeeding, and sleeping tummy down.  Although I always put my child to sleep on his back, 99% of the time, he'll flip over soon after I put him down.  I'd repeatedly turn him onto his back, and he'd flip again.

In the end, I had to settle with the notion that it's okay to sleep tummy down provided there's nothing to obstruct the nose, and that I'll check on him frequently at night.  At times, I become paranoid and end up rousing him sometimes if I think he sleeps too soundly for more than 5 hours (call me silly and cruel for disturbing a sleeping child!).   

Hernia
Premature babies, especially boys, are known to be at greater risk of having inguinal hernia.

Speaking of Government hospitals in the Klang Valley, only the Pediatric Institute of HKL has pediatric surgeons.  Generally, babies with hernia from Government Hospitals are put into a waiting list until they're 2 years old before they get operated on, except for emergency cases e.g. if the hernia is incarcerated
Additional note: We first went to the surgical clinic of Hospital Ampang as advised by the Dr at KKIA, together with our referral letter.  Dr at the surgical clinic of Hosp Ampang examined Alvin and confirmed he had inguinal as well as umbilical hernia.  We were advised to return for a follow-up in 3 months' time, and dr at the surgical clinic had informed us that Alvin will be referred to Institut Pediatrik HKL when he turns 2.  

Thanks to a commenter to this post who is paed surgeon at a Govt hospital for his/her clarification (at the comment column), and for the benefit of whoever happen to face similar issue with their infants: Accordingly, Govt paed surgeons will take in your case as soon as they receive it - without any postponement.  That being the case, thus I think it's better to go directly to HKL (or the General Hospital of your home state) with the referral letter because that would have saved the hassle and risk of waiting for 2 years to be referred for another time i.e. KKIA --> Hosp Ampang (for e.g.) --> HKL... 

Considering that my child's caretakers get very anxious about him whenever he cries, and considering that I will likely not be able to detect an incarcerated hernia (if it happens) with my untrained hands, I thought that rather than to wait for 2 years, it's best to get it repaired quickly, privately if the budget from my humble savings permits. 

Hernia repair is a minor surgery.  Ours took about half an hour, done in September 2012 at Sime Darby Medical Centre Subang Jaya (popularly called SJMC) by pediatric surgeon Dr Ahmad Zulkiflee. Forcing a baby to "fast" for 6 hours pre-op was a nightmare indeed (note: breastfed babies fast for 4 hours, FM-fed babies fast for 6 hours).  Thankfully, recovery was smooth and speedy,  Alvin appeared comfortable and didn't require analgesics.

Conclusion
In short, I'm grateful that everything had gone beyond my expectation so far.  Thanks to the good people at Hospital Ampang, and thank you my dear family members and friends for your kind prayers and words of encouragement.  

There's only one more thing left to be seen now... arghhhhh, I'm still stressed.  Anyway, I shall update more later on. 

The Rules of Living with Extended Family

In the midst of a rainy evening coupled with a bout of post-nasal drip-induced coughing because I'm allergic to the humidity of a rainy weather, a few things came into my mind.  How can I be so mean as to be away from my kid even though just 2 doors away, even though I'm not at work today because of this unwellness?

I appreciate people's help.  But I complaint when I am taken for granted or when people don't think that I am capable of caring for a child and hence no need to let me know anything about their plans. No matter how well-intended an act is, executing something involving my child without my knowledge is a clear hint that I am not important at all.

In reality
In life, no one can tell what's going to happen next.  Let's look at the hypothetical example of X and Y.  X may be perfectly independent, capable and does not need Y today.  To X, Y may be just a helpless soul.   But who knows if there comes a day when X needs Y?  Therefore, does it justify X taking Y for granted now?

TTD - Tolerance, Tact, Diplomacy 
TTD is my basic principle of survivorship with extended family.  TTD surely keeps you harmonious with everyone at home, but it leaves you stressed and taken for granted at times.  Within a very short time, I realised that it takes much more than TTD in order to be happy.

Traditions from the imperial days
Many people opine that inter-racial marriages are more challenging than marriages between the same race.  It's partly true, but even marriage between the same race is just as challenging in the case where both are brought up under different cultures.

Let's divulge into the filial piety concept traditionally-practised by the Chinese from ancient times. Generally, parents are deemed to be the head of the family no matter how old or powerful the children have become.  For instance, the Dowager-Empress during the Chinese imperial days held more powers than the Emperor to the extent that a Dowager-Empress was even empowered to spank the Emperor (in private of course!) for disobedience towards her.

The Chinese today have generally evolved into variety of cultures, depending on the type of education received, location, and their own preference.

Neither this nor that
I am brought up under a little of everything.  Both my parents went to English schools, and they're therefore a little of both.  Not extremely Chinese and not extremely westernised either, but a hybrid from the Gen-X.

Anyway, suffices that we know each others' differences, the challenges involved in making sense and integrating the differences, and my efforts not to win over my child... but instead to enable him enough opportunity to experience a mother's love. 

Conclusion
Having said that, it doesn't follow that I want to be possessive or anything of that sort.  Instead, if blessed with the opportunity to be in the shoes of an elderly mother, I will not want to be involved in my children's family affairs unless sought to give advice, not by one party but both. I'm sure that if you're old enough to have a baby, you should be independent enough to be able to take care of your affairs.  Otherwise, don't bother having any.  

Chinese or western?  I don't think one is superior/inferior to the other.  We need to choose wisely between the two, pick only the good points from each culture to emulate, and leave behind the practices that are already redundant today.   

Just my 2 cents...

The Breastfeeding Talk

The perfect diet

General rule:  Human's milk is naturally-tailored for human babies and thus, it explains why mother's breast milk is best for baby.  But what about in situations when the ideal is challenged?

A history so brief?

Experience-sharing

There are many good resources on the benefits of breastfeeding available online, so I shall not discuss them here.  Instead, I'll go specifically into my recent experience.

I'm not a lactation consultant and therefore only wish to share my humble experience as someone who'd gone through it at one point of my life, and in a different manner from the majority. It's a brief, yet valuable experience.  It's something that I wish I'm able to do as planned, but alas!  There are many things that we humans can only plan, but the ultimate outcome is beyond our control.

An advocator of breastfeeding who uses formula - a treachery, or not?

Just in case if you're curious as to who that person is, I'm referring to no one but myself.  Ahaxxx.... why and how on Earth did I betray myself?

Long ago, I used to wonder why does infant formula sell so well despite breast milk being superior to formula.  Surely there are many reasons to it, but why?  

I used to pledge to myself that I'll try my best to breastfeed and express my milk for as long as possible. 

Mother's milk is not only highly-economical, but it provides all the necessary nutrients for a baby in the right proportion, crucial antibodies, and there's generally no need to worry about intolerance or constipation when it comes to mother's milk.

So what forced me to suddenly change in just 2 months' time?  Here's the story:

Ensuring continuity

In order to sustain lactation for a long duration, say 6 months, 1 year or more, there are some practices that need to be done.

Apart from a nutritionally-balanced diet and enough rest, a mother needs sufficient stimulation in order to lactate smoothly.  The more frequently you breastfeed, the longer you get to continue lactating. Direct latching is best, followed by pump.  As for the latter, if you're pumping exclusively, then you must be very consistent to pump once in every 2, 3 or max 4 hours round the clock.

The challenges that arise when you deliver very prematurely 

When a baby is delivered very prematurely, he/she is thus very small in size and physically not strong enough to suckle from the breast.  Or else why do NICUs resort to OG tube to feed our "mini babies", whether slightly bigger, as small, or smaller than Alvin?  

In my case, by the time my Alvin is strong enough to suck reasonably (when he's around 1.6 kg), my milk production had decreased by 80%, despite expressing milk religiously. 

If it had been the case of a baby who's much bigger and developed, and thus able to start breastfeeding sooner (say 1 week after birth), then perhaps lactation may not be as greatly affected as in the case of a baby who's only able to start breastfeeding more than a month after birth.  In the case of the latter, who knows if my body started giving wrong signals for it to stop lactating and resume fertility because "after so long, there's no baby around to feed, maybe the baby didn't survive, and so we need to start reproducing soon".   Well, I do not know. 

Babies of other people keep quiet and turn serene upon being offered to feed directly from their moms.  But my baby screamed at me when I tried to do the same with him, because I do not have sufficient milk to satisfy him. And his appetite isn't even tremendous, though considered OK for his size and age.

That's right before our discharge from Ward 4A.  And so, I had resorted to using my final resources, namely frozen EBM (expressed breast milk) to feed him until we're home and out of "stock".

 

Hard work but low yield

Relactation is not easy but I just gave it a try without much positive expectation.  Medication didn't work out for me.  Attempts to stimulate production by ways of letting the baby suck and expressing milk did not result in any difference, with a maximum yield of only a few cc per 30 minutes session.  That's a lot of hard work, but the result is negligible.

And thus, breastfeeding is only a sort of comfort or snack in between meals for Alvin as opposed to other babies who receive their full meals via the same.   Although having a few drops of milk is almost useless, a little is arguably better than none.  And of course, it comes with a string of screaming from the angry baby, unless he's falling asleep or if I bring in formula.   

So many reasons for using the formula

Having looked into the goodness of breastfeeding and some of the challenges in this case, let's divulge now into the pros and cons of formula-feeding.

 

The good and bad

Infant formula is costly because it's highly-taxed, it may or may not suit the baby, and is never the same as breast milk no matter how much fortification is added to it.   

Trying out infant formula is somewhat similar to trying out contact lenses; what's good for one person may be lousy for another, and vice versa.  Not surprising, this is why sometimes we see why a number of families (who use formula) use different brand for each child.  What's well-tolerated by Child A may not be the case for Child B.   

Formula-feeding requires stringent practice of hygiene, and any neglect in doing so puts the baby at risk for serious food-poisoning.  Bottle-feeding causes a lot more gas to be gulped in compared to direct breastfeeding.  But of course not many of us have the privilege to breastfeed directly due to work and thus the second best option is to express milk to be bottle-fed to the baby.  

Some babies become constipated as a result of formula-consumption.  As a result, special formula has to be resorted to, which costs a lot more than ordinary infant formula. 

Apply not the blanket rule

Before we outwardly criticise or condemn mothers who formula-feed their babies, we have to first ascertain the reasons why they do it.  

Is formula-feeding done for convenience reason per se, or with the belief that it's better than breastfeeding, or is it due to the body's inability to produce sufficient milk for its baby due to unavoidable circumstances?  What about the case of mothers who are prevented from breastfeeding due to genuine medical reasons that do not allow them to?

Is this kiasu attitude?

Contrary from people's impression that I'd "go private", I let Alvin receive his vaccinations at the Government clinic (Klinik Kesihatan Ibu dan Anak, or KKIA).  Ever since the shocking delivery incident, I'm have no qualms going to some Government clinic/hospital because they're actually much better than what most of us expect.

Despite the long waiting time as there are many other babies going there, and despite having to go on-leave for that purpose, because it's free.  And since the nurses and doctors at the local KKIA near my place are generally nice, I don't mind the waiting time.  

I don't mind anything, except when it comes to going into the "Bilik Penyusuan" (feeding room) at the KKIA to feed Alvin or to change his diapers in the midst of our queue.  Wait........... didn't I praise the availability of such a facility in the past? 

During the first time I went into the room, I saw many mothers breastfeeding their babies there.  I seldom see anyone who bottle-feed babies as small as mine in that room.  It made me feel "paiseh"  (or embarassed in Hokkien dialect) when I wasn't doing the same, and yes, I was bothered by what others may possibly think of me. 

Conclusion

Having said the above, if anyone were to ask me about my opinion on breastfeeding, I'd still maintain my stand, that breastfeeding is the best for your baby and you should thus do it for as long as your body permits.  It's even beneficial for the mother herself, because breastfeeding may help (note: I say may, because everyone is different) in shedding extra pounds, and in the prevention of breast-cancer (speaking of estrogen levels and stuff hormone-related).

P/S (26.09.2014):  After going through extensive reading up (books, articles and TBAN group), and in analysing where did I go wrong, I am of the opinion that my early cessation of lactation after Alvin's delivery was due to - 1) Not using a good pump; 2) I should have pumped milk once in every 3 hours instead of 4 and above; 3) I shouldn't have skipped midnight and early AM pumping because prolactin is high during these hours; and 4) I should have bought and brought a more silent pump along with me when rooming in at the NICU because the queue to use the only breast pump at the NICU was long most of the time.  I regret my past ignorance, so please do not commit the same mistake as mine.

A review on coconut oil

Coconut oil is traditionally-akin to the "Jack of all trades" when it comes to usage. Its uses range from culinary to beauty, and remains as useful even in this modern day.

The cold press virgin coconut oil from Tanamera

Introduction
Long ago, I used to hear a lot of stories about coconut oil; good and otherwise... The good - it works wonders for the skin and hair, while the not-so-good thing I heard about coconut oil is that it has a peculiar smell.  I didn't know because I've not use it then.  So, what does experience tell me now?

The attracting factor
My first encounter with coconut oil came when I tried the Tanamera facial for the first time.  Part of the facial treatment involves facial massage using coconut oil.  Upon application, I immediately fell in love with the sweet scent of coconut oil.  I always associate its fragrance with the coconut candies that I used to encounter in my childhood (remember those brown candies in transparent wrappers?).

Good for....
Here's sharing a few things about coconut oil which I think worked as claimed.

Being a non-professional in cooking, I do not know why the oil is called "virgin", just like olive oil that comes with the "virgin" and "extra virgin" categories.

1. Make-up removal
Voila...  Since most make-ups are oil-based, coconut oil thus works effectively yet gently in removing make-ups.  Just dab a few drops of the oil onto the palm (or fingers if you prefer), massage onto the face in a circular motion, and wipe with cotton pads.  Then, wash your face with your regular cleanser.  You'll notice that your skin feels clean, yet fresh after that.

2. Pre-wash hair conditioner and hot oil
In order to use the coconut oil as pre-wash conditioner, simply apply the desired amount onto the strands of your hair (small amount should be sufficient in order not to cause excess greasiness), leave for 5 minutes and shampoo as usual.

Another use that's indicated on the label of Tanamera's coconut oil is as an alternative to hot oil, where you apply some oil to the hair after wash, leave for a few minutes, and rinse.

As I have naturally-oily scalp that warrants daily washing, I prefer to use the coconut oil at pre-wash rather than afterwards.

Having said the above i.e. the benefit of coconut oil for hair, it doesn't mean that I have the most perfect hair, although I have to admit that this coconut oil pre-conditioner helps tame my treases to some extent.  I'm currently battling with bad-hair days because my hair is occasionally frizzy and not straight by nature, and I have not done any sort of hairdo to rectify it since many months ago as I wasn't sure if chemical treatment goes well with pregnancy.

So if time permits now, I should really do something a.s.a.p. because to me, bad hair day = a compromised mood.   I'm not into super-straight hair because it doesn't suit me, but only desire something that looks neat and easy to manage. 

3. Massage oil
Tanamera spa uses coconut oil in many of its massage packages.

Miscellaneous
If I'm not mistaken, MCT Oil (MCT stands for Medium Chain Triglyceride) that's being used as one of the fortifications in breast milk for premature babies is made of coconut oil.  The smell is very familiar indeed.

Last but not least

If you like the scent of coconut oil, then this is a product worth consideration, bearing in mind the multiple uses and goodness of coconut oil.    :)

The Mentari Spa at Tanamera

Craving a self-reward after working hard in looking after the kid for the past few months, I have decided to head to Tanamera Spa for some pampering.   
 

View of the floor from above the bench ~ rose petals and chrysanthemum floating on water

Mentari Spa for the "night-owl"
After moments of consideration, I have decided to try the "Mentari Spa", a mini package comprising body massage, scrub and mask that takes about 2 hours.

There are a selection of plant-based massage oil to choose from - basil, coconut, ginger, coffee and mixed herbs.  The mixed herbs oil has a sharp but pleasant fragrance that's supposed to be stress-soothing.  Well, I am stressed because I have many new challenges to face nowadays, and sleep-deprived because my kid is a night-owl (and therefore I'm forced to be one too ).

For scrub and mask, I have chosen coconut-based selection.  The scrub and mask smell heavenly-sweet.  Upon application, I was reminded of kuih made of coconut milk, as if I'm in a kuih-making kitchen.  Yum... reminds me of  kuih lapis.  The coconut scrub and mask work wonders, where the skin feels much smoother in the aftermath.

A review
Overall, I'm happy with the 2-hours session.  The massage was professionally-done, and I feel fresher after that.   I really miss feeling fresh after not being able to sleep soundly uninterrupted.  Anyway, I don't mind the interruption because at least it shows the kid is more active compared to last time, although the timing (i.e. late at night) isn't ideal .

The scrub and mask were done after massage.  I noticed that it feels a little chilly in the spa room when mask is applied to the body.  But not to worry, the chill felt is only very mild.

After everything is done, you'll be shown to the shower room for a warm shower.  Bathing robe and towel are provided.