Ava's Gift of Life

It took us more than a year to conceive our first-born.  Like most couples who plan to have a baby, the unwanted visitor that comes month after month translates to a growing anxiety.  As time ticks by - pressure overrules passion, and schedule takes over spontaneity.  The whole thing starts to feel like a chore, more than anything else.  So when we finally got pregnant with Ava, we wanted to give back as a sign of our gratitude.

The opportunity presented itself when we attended a childbirth education class sponsored by the hospital.  One of the topics was the option to save the cord blood of the baby (extracted from the umbilical cord right after birth), which is currently being used to treat certain cancers and blood disorders.  Mothers can either deposit it in a private bank for family’s exclusive use, or donate it in a public bank where a match recipient can avail of the “gift of life”.

So we quickly got in touch with Singapore Cord Blood Bank (SCBB), the only public bank in Singapore and in the Southeast Asia Region.  To our surprise, donating wasn’t so easy after all!  To start with, not everyone can donate.  My husband and I had to go through a rigorous “interrogation”, detailing our health and lifestyle background, including that of our parents.    Furthermore, I had to sign a disclosure that in the event genetic or infectious diseases are found in my blood, this has to be brought to medical attention and deportation is a possibility.

Unfortunately, the saga didn’t stop there. They had to extract at least 30ml of blood while I was on active labor!  I was already at my wits end riding through contraction after contraction and the nurse, for some reason, had to poke me thrice just to get it right! But that’s just me.  I found out belatedly that baby Ava had her share of sacrifice too.  Because a sufficient amount of cord blood had to be collected, her cord was clamped immediately after birth and at least 1/3 of her blood was instead taken away. This was the heartbreaking part for me.

A thank you (or sorry) card for poking me thrice while on active labor?

According to a study published in the Journal of Cellular and Molecular Medicine, delaying cord clamping for at least 30 seconds reduced incidences of intraventricular haemorrhage, late on-set sepsis, anaemia, and decreased the need for blood transfusions.  Moreover, it could reduce the infant's risk of many illnesses, including respiratory distress, chronic lung disease, brain haemorrhages, anaemia, inflammatory condition sepsis and eye disease.

I find comfort with a Cochrane study which shows that although there is a significant increase in newborn haemoglobin levels in the late cord clamping and cutting group compared with early cord clamping and cutting group, this effect did not persist past 6 months.

Also, the American Academy of Pediatrics actually recommends public cord blood banking over private, if the parents do opt to store the cord blood.  The likelihood that they can use their own cord blood is slim, since whatever condition that will afflict them is already inherent in their cord blood cells.  Secondly, by increasing the pool of cord blood available to public, this gives a higher chance of a match with a recipient who is in need of transplant.  

However, this policy has been greatly contested arising from the recent development on stem cells research. Researchers around the world are unlocking the autologous (the patient’s own) use of cord blood stem cells for cellular therapy to help repair failing organs and tissues. In fact, in 2009 a first successful treatment of cerebral palsy was performed in Singapore by infusing the little girl's own cord blood. Her condition has greatly improved post-treatment.  Indeed, positive results on regenerative cell research offer such promising possibilities.

Going through these salient points from various angles have only raised more questions than answers. Do we then go for delayed clamping and avail upfront the benefits it offers or do we clamped it early to extract valuable cord blood and store it in a private bank this time and be assured that our family has the insurance of health?

After much thought and discussion, we decided that prevention is always better than cure. To begin with, the baby ought to benefit from what is rightfully hers.  We cannot compromise the present of what might and could happen in the future.  My husband, bless him for having a big heart, also feels that if we do have to extract the cord blood, it still has to go to the public bank for we cannot store it exclusively when a match recipient might have a dire need for it.

AFTERNOTE: It is with great pride that a year after, Singapore Cord Blood Bank called me to say that Ava’s cord blood and my blood sample passed all stringent requirements.  After confirming that Ava is in great health, I consented to use it for a possible match with a baby who needed it. Her donation, after all, was all worth it. A precious life was gifted to us, and we can only pass it on.

My Birth Plan

My first birth was great albeit with extra pain brought about by early artificial rupture of amniotic membrane (which happened without my consent), I believe it could be greatly improved.  After countless hours of research and 12.5 hours worth of hypno-birthing classes, I am now more prepared mentally and physically to give natural birth the second time around.  Now that I know better, I want to do better. 

Having a birth plan is not so straightforward.  Firstly, some doctors are not so keen on it because it deviates from their routine procedure.  But that is exactly the point, every mom gives birth differently so one mold does not fit all.  Secondly, the care providers and hospital policies are, if not oblivious, unreceptive to such requests.  Third, keeping the birth plan short is a challenge.  The more you know, the more you realize that much of the processes and procedures greatly affect the quality of birthing and most importantly the baby’s first experience earthbound. 

I will be absolutely thrilled if all goes to plan. My husband and I, however, have discussed on how we would handle the unexpected, when it does happen.   Thanks to our hypno-birthing class, we come prepared and have an acronym for it - BRAND.  Remembering what the acronym stands for is very helpful when medical intervention becomes an option: to ask 1) the BENEFITS of the solution being offered, 2) what are the RISKS of the provided solution, 3) are there any other ALTERNATIVE solutions, 4) what happens if we do NOTHING and stick with the birth plan and 5) how much time do we have to make a DECISION.

At the end of the day, it is about making an informed decision.  I am of course not against medical intervention.  In fact, we are very fortunate to live in a time when such interventions are readily available in order to save a mother or baby’s life.  What we don’t want is treating an otherwise normal physiological event into a medical procedure, when labor inducement is introduced even when mom and baby are doing great or caesarean is automatically performed because of breech position without even exploring options - when everything is done so routinely. 

This is the purpose of the birth plan – to give mothers the “voice”.  It is a conviction that giving gentle births to our babies is a step towards a more compassionate world. 

ADMISSION STAGE

• To be assigned a nurse who is partial to natural birthing.
• To self-hydrate and decline routine IV prep upon admission.
• To have intermittent monitoring (EFM) of FHR after the mandatory twenty-minute strip at admission.
• To be provided a labor room equipped with water tub.

DURING FIRST STAGE LABOR

• The patience and understanding of care providers to support our wish for natural birth as much as possible.
• To continue with intermittent monitoring (as agreed with doctor every 30minutes to 1 hour) only.
• To be allowed to walk around or move during labor.
• To be allowed to eat and drink, without the use of IV drip unless medically necessary.
• To be fully consulted before any medical procedure is to be done (e.g. amniotomy, augmentation, membrane stripping).

DURING BIRTHING

• To be allowed freedom of labor positions of choice (as discussed with my doctor, my pain tolerance and stamina is higher when I am on all fours).
• To be allowed the use of HypnoBirth breathing techniques.  Mother-directed pushing.
• Episiotomy only if necessary and only after discussion.
• To allow the gentle descent of the baby – no pulling.  If possible, dim the bright lights temporarily at moment of birth and until baby is moved to mother’s chest.

FOLLOWING BIRTHING

• To refrain from suctioning baby’s nose unless medically necessary.
• Immediate skin-to-skin contact, with baby placed on mom’s lower chest.  Dad joins in this bonding by placing hand on baby’s back under warming blanket.
• To be allowed mom-baby bonding as long as possible and delay measurements of weight, height, etc… and other procedures.
• Delayed cord cutting.  Dad will only cut cord after it stops pulsating.
• To allow vernix to be absorbed into baby’s skin; delay “cleaning”.
• To refrain giving the baby glucose water.  Mom to breastfeed exclusively.
• In the event of C-section, the Dad to be allowed to remain with mom in the operating and recovery room.
• Dad will hold the baby after C-section and bring baby to Mom for viewing and eye contact.  In the absence of urgency, Dad continues to hold baby for bonding.

On Raising Babies and Buildings

It’s been over 2 weeks since my last post and I’ve been itching to write, if not for my extended mileage in the office.  It’s one of the many endless overtimes that architecture is infamous for.  I’d say the more developed the city is, the more impossible the deadlines are. Whoever starts a 17-block condominium from scratch and targets to launch in 4 months time?  It does not come as a surprise that repeated visitors to Singapore are constantly amazed to see the city transform overnight!  The construction industry here gives the hard-working ants a run for their money.

When my supposedly half-day work stretched to whole day for two weeks running, I feel guilty that my little girl has been spending all these time alone in the house with her ‘yaya’ (the most difficult part of living abroad – non-existent extended family to help look after her).  However, when I reach home, I also feel guilty knowing my colleagues will be spending the night AGAIN in the office and I know so well how an extra head and pair of hands make a huge difference.  Not that they mind, on the contrary, they are actually very supportive.  I am also pregnant, after all.

I realized after reading the book, “What Happy Working Mothers Know” a New York Times Bestseller by Cathy L. Greenberg, Ph.D. and Barrett S. Avigdor J.D., a working mom is synonymous with being a guilty mom.  It inevitably goes with the territory.  The gist is to find the elusive ‘balance’ of work and home and most importantly to stay happy.   The mother sets the emotional climate in the family and activities at home mainly revolve around her.  Thus, it is imperative that the mother does what is in line with her values.  If she finds contentment and feels her work, to a large extent, defines who she is, then she should do it.  No point in forcing the issue of being a full-time mom just because society expects this of her and is unhappy while taking care of the baby.  I think it does more harm than good. 

Having said this, I made a self-assessment to find out what truly makes me happy.  Without a doubt, being with Ava and seeing her grow more beautiful each day - inside and out, and knowing that I am an active participant, is what truly makes me happy.  But in all honesty, I also realized that I could not do it the whole day.  I need to go out there – design buildings and see them built.  It gives me renewed energy which I believe benefits Ava too.  This is mainly the reason why I opted to go for a part-time job.  It is an attempt to bridge the gap between two ends of the spectrum – the career-oriented working mom and the full-time homemaker.  It is the perfect compromise.

How do we deal with feeling guilty then?  The book emphasizes on prioritizing what matters most, on setting a simpler goal each day and acknowledging achievements no matter how small.  If it means putting my career on a backseat for the meantime, so be it. When I was pregnant with Ava, I had to give up a project I designed from scratch and oversaw the construction for 2 years.  With the pending birth of my second, I am slowly turning over my current project too.  It frustrates me not seeing it to completion.  It also means a stall in my career path.  But still at the end of the day, nothing compares to the milestones Ava achieves everyday and BEING THERE to witness it.  Priceless.

Construction of 30-Storey Residential Building before turning over to my colleague.

Ava helping Mommy with Grocery

This brings me to another point why being there for her at her early years is very important.  It is her formative years – when the window of opportunity to influence character and experience is greatest. The American Academy of Pediatrics defines early childhood as the ages between one and five years.  According to The National Scientific Council on the Developing Child, Harvard University, critical aspects of brain architecture begin to be shaped by experience before and soon after birth, and many fundamental aspects of that architecture are established well before a child enters school. 

The science of early brain development, established over decades of neuroscience and behavioral research, is sufficiently mature to support a number of evidence-based implications.  Central to this conclusion are the three core concepts: First, both brain development and behavior are shaped by experience over time.  Second, both the architecture of the brain and established patterns of behavior are increasingly difficult to change as individuals get older.  Lastly, it is more effective and more efficient to get things right the first time than to try to fix them later.

So spending plenty of bonding moments with Ava not only gives me joy and contentment, it’s practically sound too.  I want to get it right the first time and I have that big chance now.   This is the chance to instill the values that is important to our family - during the years she’s most receptive.  Jacky Kennedy Onassis once said, “If you bungle raising your children, I don't think whatever else you do well matters very much”.  Ava’s development in her formative years is definitely one of the constructions I don’t want to miss.