My confinement notes

Experts:
Jin Jinhua: a consultant acupuncturist at Raffles Chinese Medicine.
Dr Lee Le Ye: a neonatologist at NUH.
Motherhood September 2006 magazine.

Childbirth results in deficiency of QI and BLOOD in the mother’s body.
Solutions:
1. consume tonics and nutritious food. Note: Caesarean mother should refrain from too much nutritious food and tonics in the 1st week because the open wounds from surgery are still healing and infection could set it if body is too "heaty". Tips by Jin.
2. consume iron supplements. Tips by Lee.

Adapt to mother’s "body type".
A mother who is naturally "heatier": do not eat too much nutritious food and tonics. Do not wear too much / too warm. If body is too heated up, will increase risk of infection of open wounds.
A mother who is naturally "cool" should consume more nutritious food and tonics. Dress more warmly.

FOOD
Drink fish papaya soup to boost breastmilk supply.
Avoid too salty food to prevent water retention.
Avoid "cold" food. Why? can weaken stomach / digestive system, result in coagulation of lochia.
e.g. of "cold" food : cold drinks, cucumber, cabbage, pineapple, citrus fruit
Avoid food that cause wind, e.g. sweet potatoes, jackfruit, pumpkin, cucumber, nuts, legumes. Tips by Motherhood.
Avoid food that make you sweat because sweating expands the pores and expanded pores will allow wind to enter the new mother’s body. Tips by Motherhood.
If sweating, must change clothes. Tips by Mum S.

DO NOT OVEREAT.
A breastfeeding mother needs only ~600-800 calories more / day mothers who bottle-feed their babies. Tips by Motherhood.

DRINK
drink lots of nutritious fluids, e.g. red date tea.
can also drink chicken essence, other healthy soups.
water is allowed (Jin).
lochia = the normal uterine discharge of blood, tissue, mucus from vagina after childbirth.

WEAR SLIPPERS. Do not let soles of feet to touch the floor.

Must maintain a normal temperature to prevent heatstroke.
Can use air-con or fan.
Room must have fresh air and allow mother to cool down.

BATHE?
In tropical climate, Keep your body clean by wiping with warm / herbal water.

WASH HAIR?
In tropical climate, If you need to wash hair, dry it immediately to avoid catching a cold.

Note: the rule of not to wash hair and bathe during the entire confinement period probably originated in China during olden times when water facilities were scarce and contain bacteria.

Causes of rheumatism (Motherhood): wear & tear resulting in the inflammation / degeneration of muscles / bones.
Causes of headaches (Motherhood): high blood pressure, stress, insufficient rest.

How to prevent backache (Motherhood)?
1. sleep on a firm mattress.
2. exercise regularly.
3. do not slouch when waking / sitting on the couch.
4. do not allow ourselves to become overweight.

If reading helps us to RELAX, try reading aloud to our baby.
Nothing soothes a baby more than feeling the closeness of his mother & hearing her voice. Tips by Motherhood.

AVOID PHYSICAL TASKs.
because new mother’s joints are weak and loose.
You need not lie in bed all the time.
Do not be sedentary to prevent blood clots in the legs.
Steer clear of water.
Do not mop the floor.
Do not do laundry.
Get more rest.
Stay at home.

BIND YOUR BELLY
Binding your belly only prevents the muscles from sagging.
To trim your tummy, exercise and eat sensibly.

Related:
Confinement meal

Confinement meal

Confinement meal delivery usually comes with 2 dishes and 1 soup.

Here are some dishes that I think I will need to eat:
@~@ green papaya fish soup: to enrich milk glands
@~@ black chicken herbal soup
@~@ SOUPS with pork rib
@~@ FISH

Here are some dishes that I think I will like:
@~@ SOUPS. In one of my challenging years overseas, I treated myself once in a while after exhausting 7 days work by having double boiled soups, so I always love nutritious Chinese soups.
@~@ any VEGETABLES stir fried with SESAME OIL plus shredded MUSHROOM / minced meat / silver anchovies (I am not sure how I will like the additional shredded ginger).
@~@ any VEGETABLES or SOUPS with FISH MAW cut into small pieces.
@~@ dishes containing SEA CUCUMBER, e.g. stir fried asparagus with sea cucumber.

Food that I need to do further study on:
liver and kidney. Honestly, I do not like to eat organs. I avoid liver and kidney in pregnancy despite of being anemic because of the undesired effect of vitamin A from liver, for the developing fetus.

List of companies providing confinement meal delivery in Singapore as of 2012:
www.newbaby.com.sg SGD 1,588; no delivery during public holiday.
Natal Essentials SGD 1,588; service disruption 1st Two Days of Chinese New Year; I find some of the menu contains fried items and cooling items like lotus root.
Chili Padi SGD 1,568 (NA for my case); no meal for 1st Day & 2nd Day of Chinese New Year.
www.richfoodsg.com/menus/confinement-meal-packages SGD 1379; No service during Chinese Lunar New Year period (4 Days).
www.ihostfood.com
Florence’s Gourmet 6292-9188 or e-mail flgourmt
www.confinementfood.com SGD 1,588
www.iprettymommy.com: We have recently moved to Malaysia, we are not open for Singapore market before June 2013.

Note:
1. I have not taken any of their services, so I cannot guarantee on the quality, but the list is a good start for mothers to be who need confinement food.
2. The price is for 2 meals / day for 28 days.

Some useful knowledge:
Breastfeed baby before consuming their meals. By the next meal, the ginger and wine contents in mummy’s body would have been excreted through urination.
Alternatively, you may like to extract the breast milk before eating and feed the baby at a later time.

Black vinegar purifies the blood, the old ginger drives out the wind. If take black vinegar, glutinous ligaments and collagen of the pig’s trotters can reduce its acidity.
Duzhong / Eucommia Bark strengthens the kidneys, helps to lower blood pressure.
Fish maw contains collagen to strengthen limbs & joints, can improve QI and beautify complexion.
Kai Lan is beneficial to veins and bones, improvies joints and lypmh.
Black fungus is rich in iron and drives out stale blood from the body.

Useful URLs to learn about Chinese herbs used for confinenment:
http://www.newbaby.com.sg/index_files/NewbabyconfinementfoodHerbUsed.htm

Below is an image of Chinese herbals useful for confinement, from Chili Padi.
I love LILY FLOWER, once a good friend of mine cooked for me after a completion of a big project in UK.
I also like dishes with black fungus, ginseng, and wolfberries. Just think of Korean ginseng chicken!

Where else besides restaurants and hawker centers can we eat in Singapore? Someone’s home through PlateCulture

I used to be adventurous in my food consumption: gulping everything edible (though I am not highly carnivorous) until my pregnancy, confinement and breastfeeding restrict my choices of food. Please don’t get me wrong.

These experiences (that I am grateful of) have widen my horizons and allowed me to embrace a new passion in food, its benefits on health, and simple cooking. I even take a course on cooking for children from Coursera.

These days, I love home-cooked meals.
I also try to minimize eating MSG-infested food served in restaurants and (some) hawker centers.
Sometimes, I feel thirsty after dining in some restaurants / food courts / hawker centers. Have I become so sensitive to MSG and excess salt?

Now, I choose to savor (instead of hastily consume like in the past) my food and constantly learn creative ways related to food and health.

Recently, I learned about PlateCulture through Anh-Minh Do of Tech in Asia. PlateCulture, a Malalysian-based start-up (founded by Audra Pakalnyte and Reda Štarė of Lithuania), is like Homedine in US and Cookening in Europe.

So, I started browsing the hosts listed by PlateCulture.

I am particularly interested by Healthy Chinese Food with Herbs hosted by Sara K of Damansara, Kuala Lumpur. Like Sara, I love pandan leaves and ginger.

Here are 4 inspirations from her (mixed with my past experience):
(1) I plan to incorporate traditional Chinese medicine principles into my cooking.
For example,
On a hot day, have a bowl of green bean soup.
On a cold day, have a bowl of red / azuki bean soup.
(2) Freshly squeezed orange juice with no water or sugar added, is indeed a simple pleasure of life.

(3) I often cook steamed fish (salmon with sesame oil or white fish with ginger), perhaps I should also try cooking foil-wrapped steam herbal chicken.

(4) Sara wrote "Dinner at home is often accompanied with relaxing traditional/new-age music with aromatherapy". Sometimes I do listen to classical music while enjoying my simple home cooked dinner, perhaps I should try traditional / new-age music too.

For PlateCulture-listed kitchens in Singapore (as of October 2013), the cost ranges from SGD 30-70 per person, which is quite expensive for our standard.

Normally, we will only spend around $15-$20 per person on our once-a-week restaurant dining. Sometimes, we are pretty happy eating at shop houses without air conditioner, and it costs us only $5++ (less than $10) per person. Many times, my husband and I will share a cup of coffee.
I do not care if people say that I am cheapskate, we do so simply because I could not take too much caffeine (but I love coffee!);
it is more about one of my values of being frugal and sustainable (environmentally friendly and not wasteful).

Of course, I understand that home kitchens (like those promoted by PlateCulture) are not professionally run restaurants. It is the interactions with the hosts and the newly formed relationships that matters, which are absence from dining in restaurants.

I really look forward to more affordable home dining experience in Singapore offered by PlateCulture!

The power of positive thinking that we could never underestimate

Positive thinking

# allows us to treasure, enjoy, embrace our lives

# gives us a reason to continue living as illustrated by a story of Viktor Frankl

# makes learning easy for us
# can be inherited (sounds like our genes) to the future generation as suggested by a reader S

@~@

When Viktor Frankl was imprisoned in the Nazi camp,
suffered torture and the loss of his family (parents, brother, wife),
he miraculously realized that
between what happened to him (the stimulus) and his response to him,
he still has the power / the freedom to choose his own response.

Viktor Frankl chose to think positively, to imagine positively.
He imagined that he would lecture to his students after being released from the camp.
He imagined a positive future that gives hope and strength to his present.
He survived,
founded logotherapy and
wrote Man’s Search for Meaning,
which highlight the importance of finding meaning in all forms of existence,
even the most sordid ones, and hence a reason to continue living.

@~@

Learning is a part and parcel of living.

As my saying goes "Live, Learn, Earn"

How can we effortlessly learn difficult subjects and skills using positive thinking?

Think positive.
Do not think that it is difficult.

Simplify.

The best in the world simplify the complex (e.g. complex subjects);
the most common make the simple complex.

@~@

A reader S sent me a warm email about her experience with positive thinking.

She wrote:
Although my pregnancy was relatively physically challenging,
I suffered from acid reflux, nausea, and backache that made sleeping flat uncomfortable,
yet I was very happy.

Pregnancy seems to be a long holiday when I was pampered by my family member, tolerated by my colleagues, and showered with kindness by strangers.


I spent many hours reading self-help positive psychology books.
Probably, I read over a hundred books,
making my own notes that I can review later,
they are like short-cuts to happiness for me,
or an instant side-effect-free ‘aspirin’ when I am stress.

As a result, I delivered a healthy baby who is naturally happy.
He smiles within 24 hours in his sleep,
and he smiles the first thing in the morning when he wakes up after a good night sleep and being fed with breast milk.
He smiles often, even to strangers.
People loves him.

God must have given him to us to also let us learn from him.
His natural ability to be happy with himself, with life, and to bring happiness to others through his smiles.

On the other hand,
looking back at my post-delivery experience,
there are things that I wish can be better.

Sometimes it seems that the more people (including grandparents, in-laws, the so-called experts, and well meaning friends giving advices)
are involved in the process,
the more different wants and rules to be met,
which made my life tougher.
What I did not realize that I do not have to live my life to other people’s expectation!

What works for others, may not work for us (my baby & me).
What works for us, may not works for others.
For example,
his grandmother insisted that we do not buy a breast pump,
but the breast pump turned out to be highly useful!
I just have to keep on experimenting and finding ways that work for us.
It is ok to be different & imperfect.

Finally, the most important lesson that I learned,
while I diligently gulped down all the nutritious confinement meals and red date tea,
I forget to consume my positive thinking nourishment.

Everyday, it seems that there are new problems.
Things that I must buy and do.
Grandparents will tell me to do this, to do that, and the list goes on.

To make it worse,
my mother nagged at me,
she told me to sleep more,
not to breastfeed baby at night,
because that was her experience,
but she did not know that by doing so would result in drop of breastmilk supply,
and I would wake up at night worrying for my baby,
because I was not allowed to sleep with him in the same room or same bed.

Moreover, I need to write as it is therapeutic for me.
In recent years, I have been writing using my laptop
but my mother disallowed me to use IT gadgets (including my laptop, mobile phones) because she is worried that they are bad for my eyes.

I sincerely want to forgive my mother,
she just wants the best for me.
Although she does not realize that children are not necessarily inherit the same likings / ways of feeling goods as parents,
she just wants the best for me.

Perhaps, my mother is also learning from this experience,
after all my baby was her first grandchild.
She appears to be more patient with her grandchild than to me or our siblings when we were young.
Oops! I am comparing again.

Well … I am trying to be more mindful when I compare things.
Some comparisons are fruitless.

After all, all those have become the past.
I choose to cherish the happy and positive things from the past,
and live in the present.

Blueroselady says:
Congratulations S for becoming a new mother!
You are doing well and great!

To summarise S’ points:
Cultivate intrinsic happiness daily.
Live in the present.
Live not for others’ expectation.
It is OK to be unique / different.
It is OK to be imperfect.

@~@

Bonus: voice note dated 2013 Aug 20th

Recipe of Chinese soups: SiShen, LiuWei, BaZhen

I first learned how to cook these Chinese soups from a Chinese lady of TeoChew dialect.

Sometimes, I wonder what the SiShen / 四神汤 / Four Divinity Soup, LiuWei / 六味汤 / Six Flavor Soup, BaZhen are.

Contents of SiShen:
Dioscorea opposita (淮山 / 山藥) : an exception to the rule that yams must be cooked before consumption.
Lotus seed (Nelumbo nucifera)(蓮子)
Fu Ling (茯苓) : a wood decay fungus.
Euryale ferox seeds (芡实) : a fox nut of water lily family.

SiShen is almost a subset of LiuWei.

Contents of LiuWei:
Dioscorea opposita (淮山/山藥)
Lilium lancifolium bulb (百合)
Polygonatum odoratum (玉竹)
Lotus seed (Nelumbo nucifera)(蓮子)
Euryale ferox seeds (芡实)
either Dimocarpus longan fruit (龍眼) or Ziziphus zizyphus / red date / jujube.
Longan can give internal heat / 上火 & relax.
Red dates can alleviate stress, for antifungal, antibacterial, antiulcer, anti-inflammatory, sedative, antispastic, antifertility/contraception, hypotensive and antinephritic, cardiotonic, antioxidant, immunostimulant, and wound healing.

Contents of SiJunZi / 四君子湯 / Four Noble Soup:
Panax ginseng (人參)
Atractylodes macrocephala (白朮)
Fu Ling (茯苓)
Glycyrrhiza uralensis (甘草)

Contents of Siwu / 四物湯 / Four Substance soup :
Angelica sinensis (当归)
Paeonia lactiflora (芍药)
Ligusticum wallichii (川芎)
Rehmannia glutinosa (地黄)

Contents of BaZhen = SiJunZi + Siwu.
Tips:
1. LiuWei can clear heat.
2. BaZhen is heaty, good for confinement.
3. Stir the SiShen, LiuWei soups before drinking as the nutritious substances tend to sediment at the bottom.

Here is the picture of some of the ingredients:

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Mom is the Best

A friend of mine shared with me how her husband and her confinement nanny walked out their home,
to see firework next door.

My friend thought that
both her husband and her confinement nanny
are selfish and irresponsible.

For the sake of their pleasure of seeing 15-minute of firework,
they abandoned my friend and the baby.

At that time,
my friend suffered from illness,
and doctor adviced my friend not to get close to her baby.

However,
after the firework had been shot,
she heard the baby’s cry,
getting louder and louder.

She thought that the confinement nanny was trying to console the baby,
to prevent the baby from being scared,
but when she went to the baby’s room,
nobody was there.

She was upset,
and took the risk to carry her baby in her chest,
so that the baby would not be over-scared,
in spite of what the doctor said.

I could understand my friend’s unahppiness.
Her experience reminds me on
世上只有妈妈好,
which means Mom is the Best.

If I were her,
I would be disappointed with her husband and confinement nanny too.
But I tried to console my friend,
her husband was still unused to having a baby,
he has not fully developed his protective and nurturing instinct,
please give him some time.
Well, about the confinement nanny,
I do not know what to say.
Any suggestion?

Talking about Mom is the Best,
here is a song,

The lyrics:

1.
世 上 只有 妈妈 好
Shì shàng zhǐyǒu māma hǎo
Earth above only mom great (Only mom is great in the world)

有 妈 的 孩子 像 *块 宝
Yǒu mā de háizi xiàng *kuài bǎo
Has mom kid like a gem (A kid who has a mom is like a gem)
*块 kuài, classifier for objects like cake, soap…

投 进 妈妈的 怀抱
Tóu jìn māma de huáibào
Casts into mom’s arms

幸福 享 不 了
Xìngfú xiǎng bù liǎo
Happiness enjoy without end (Enjoys the happiness without end)

2.
世 上 只有 妈妈 好
Shì shàng zhǐyǒu māma hǎo
Earth above only mom great (Only mom is great in the world)

没 妈 的 孩子 像 *根 草
Méi mā de háizi xiàng *gēn cǎo
Without mom kid like a grass (A kid who has no mom is like grass)
*根 gēn, classifier for long slender objects.

离开 妈妈的 怀抱
Líkāi māma de huáibào
Leave mom’s arms

幸福 那里 找
Xìngfú nǎlǐ zhǎo
Happiness where find (Where to find the happiness)

3.
世 上 只有 妈妈 好
Shì shàng zhǐyǒu māma hǎo
Earth above only mom great (Only mom is great in the world)

有 妈 的 孩子 像 块 宝
Yǒu mā de háizi xiàng kuài bǎo
Has mom kid like a gem (A kid who has a mom is like a gem)

投 进 妈妈的 怀抱
Tóu jìn māma de huáibào
Cast into mom’s arms

梦 里 也 会 笑
Mèng lǐ yě huì xiào
Dream inside also will smile (Will also smile in the dreams)

Do not compare our boss, especially in front of him / her. A lesson from different breast milk colors

This is a sharing by a good friend of mine KW, with a permission (to share) from KW as long as I do not write her name.

She recently hired a confinement lady (called auntie in Singapore) recommended by her good friend RT, to help taking care of her baby.

In the first week of work,
Auntie seemed very nice,
especially to baby.
This made KW very satisfied.
Then,
in the second week,
Auntie started to compare KW (the current boss) with RT (the previous boss).

RT has a maid at home, whereas KW (the current boss) had no maid at home.
So Auntie has to help her with washing dish / baby bottles, washing baby clothes.
Auntie does not have to help with sweeping / mopping etc because KW hires a weekly cleaning lady.
Of course,
by default,
the working environment is more comfortable with RT than with KW (the current boss).

KW slightly complained to me that Auntie is relatively lazy.
KW does not mind cooking rice and soup for Auntie, because KW also eat the rice and the soup.
Initially before hiring, Auntie agreed to help cooking 1 soup / day,
soups are good for lactating mothers.
Auntie does not have to cook dishes, because KW orders tingkat for both KW and Auntie.

KW told me that she tried placing carrots & potatoes near the cooking pot.
But Auntie does not seem to take the signal (it is her duty to help peeling).
Then, next day KW tried more direct method:
writing a post-it note for e.g.
"Auntie, please help wash the vegetables, I will prepare the meat ball."
"Auntie, please do not stack up the bottles while sterilizing" (KW told me that her Avent bottle was damaged because Auntie stack an Avent cup on its inverted bottom, now both are sticking together, the plastic seems melted, and cannot be used).

Actually, Auntie is not very busy.
KW also takes care of her baby.
When Auntie is free and has enough rest,
Auntie will read books.
Few times, KW caught Auntie playing mobile phone and then pretended to play with baby when Auntie realizes that KW is around.
KW told me that she does not mind Auntie plays mobile phone when baby is not crying.
Auntie also locks the baby room.
Auntie does not open the door soon after knocking.
If I were KW, I will be worried.
My wise friend KW asked Auntie for the reason,
Auntie said she is afraid,
because KW rents a room to a (female) tenant.
Then, KW asked if Auntie locks the room,
can KW open with the key after knocking?

Personally, I think KW is a nice boss to work with.
She is polite and respectful.
She also treats Auntie well, give her welcome gifts.
She even told Auntie that it was her fault that the Avent bottle & cup were sterilized until sticking to each other, in fact it was Auntie fault.
Often, KW’s husband helps washing dishes, so Auntie does not need to do this.

Auntie also compares KW’s husband with RT’s husband.
No car vs has car (in the complain that KW does not go outing (kai-kai) as much as RT*).
No automatic light at KW’s home vs better condominium lighting system.
No maid vs has maid (to prepare breakfast, lunch, dinner for Auntie, to wash dishes, to wash baby clothes).

*KW told me that in her first outing to a shopping center, once they get down of taxi, Auntie immediately rushed to see clothes on sale, forgetting baby and KW.

Auntie compared KW’s baby with RT’s baby.
KW was telling Auntie to burp baby for longer period, because KW knows her baby needs burping to be comfortable, or else baby will cry.
Auntie insisted no need to do because RT’s baby no need burping.
Every baby is unique.

However, Auntie made a comparison about breast milk that upset KW.
KW’s breast milk is white in color & according to Auntie is not as yellow & creamy as RT’s breast milk.
Auntie told KW, "Your breast milk is not good in quality, unlike RT’s breast milk".

KW is particularly sensitive over breast milk.
Her first confinement lady threw away her breast milk so that she can feed baby with formula, until KW decided to confiscate the formula (previously KW has to supplement breast milk with formula).
I remember KW crying while telling me that she expressed her breast milk drops by drops every 2-3 hour,
enduring post-delivery pain and the lack of sleep.
She asked me to help her praying to God for giving her sufficient breast milk for her baby.
She said "every drop of breast milk counts",
reminds me on "谁知盘中餐,粒粒皆辛苦", and
inspires me to coin "谁知母亲奶,滴滴皆辛苦" for her .

Though unhappy and did not reveal it, KW was worried because of Auntie said about the color of breast milk.
So KW asked me to search about breast milk info over the internet.
KW also shared with me that she called Joyful Parenting and Breastfeeding 6488 0286,
and learned that
her white color breast milk (like the color of boxed cow milk for adults sold in supermarket fridge e.g. Farmhouse) is normal.
The staff also told her that if breast milk color is like barley is normal (though this contains mostly foremilk).

It is important to remember that breast milk colors may be different for different mothers.
Breast milk can be yellow (like RT’s breast milk) because of possible intake of multi vitamin (e.g. vitamin B, also present in whole grains, potatoes, bananas, lentils, chili peppers, tempeh, beans).

Breast milk colors may also change with the growth of the baby, to suit the baby’s need.

KW is a smart woman.
She tries to reason (with herself) that her baby is not crying due to hunger,
so her breast milk (though white in color) should be meeting the need of her baby.
She asked me for help.
She called a breastfeeding resource.
She did not directly confront and argue with Auntie.

I like KW,
she is not easily affected by others’ opinion,
though she takes input from others,
check them herself,
and make a decision for herself.

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How to increase breast milk production? 10 recipe of Asian soup that also benefits lactating mothers

Category A

1. LiuWei 六味汤 + pork rib (排骨).

2. BaZhen 八珍汤 + pork rib / chicken bones*

3. SiShen 四神汤 + pork rib.

4. double-boiled chicken bones* / pork rib soup with wolfberries, red dates, xigui.

Category B

5. pork rib + overnight soaked peanut (add the soaked water to the soup) + carrots.

6. pork rib + beet root + carrots / corn.

7. pork rib / pre-boiled chicken bone (for 1 hour) + 2 potatoes + 1 carrot + 1 tomato.

8. meat ball + caixin (must finish per meal). To make meat ball, you can mix minced meat, tapioca flour, sesame oil, pepper, soy sauce.

9. pork rib / chicken bones* / pork tenderloin (腰部嫩肉) + red yeast rice (红曲米 / ang-kak)

10. fish bone + fish maw (must soak, squeeze out oil for 3x).

* use the bones of village chicken, not meaty chicken.

If you have no access to chicken bones, you can use pork rib / pork tenderloin.

Do not drink soups in Category A on consecutive days, because they may be too heaty, especially BaZhen soup.

The soups in the Category A are often consumed during confinement.
The soups in the Category B are also good for pregnancy.

The soups are easy to cook.
When mothers take good care of their health, they can give their best to their babies / children.

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Do-not-eat food list (up to 100 days after giving birth)

No prawn.
No shrimps / no dishes cooked with shrimps-based chili.
No shrimps-based chili (aka belacan).
No sashimi.
No cockles.
No cuttlefish / squid / sotong.
No crab.
No mackerel.

No unknown mixed meat^ including dim sum siu mai, har gow, mixed meat, bakwa.
No outside noodle-based food (concern about the type of oil being used for cooking).

No cabbage (because it will wash away the Chinese medicine).
No napa cabbage 大白菜.
No kimchi*.
No radish 白萝卜.
No kangkong (Ipomoea aquatica) / water spinach / water morning glory.

No watermelon.

* After 100 days, the chili in kimchi can balance the cold white cabbage, tentatively add ginger reduce the cold of white cabbage.

^ mixed meat may have neck part of pork. The old says 有毒.

Note: The list is a subset of do-not-eat food for confinement, which has more food that one should not eat according to the Eastern tradition and knowledge.

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My Elective Caesarean section, birth plan and FAQs

I wrote this post some times ago, and have revised it for few times when I acquired new tips. Hope that the sharing is useful to expecting mothers with similar experience like me.

Thank you to the advance of medicinal sciences and technology, pregnant women like me have a tremendously increasing chance of survival. However, it is also possible that because of the advance ultrasound, we got the prediction that our baby was too big for natural vaginal birth, that resulted in me ending up for an elective C-section.

Good bye my birth plan for natural birth!
Initially, I wanted to have a natural vaginal birth without epidural. My paternal grandmother, maternal grandmother, and mother have delivered nine, four, and four babies, respectively, through natural birth and without epidural. I have prepared my mind to have no fear in enduring labor pain. However, since I am going for a C-section, the birth plan can be put aside for the time being.

Since my pregnancy was considered not to require C-section, no maternal obesity, no high blood pressure, no gestational diabetes, no pre-eclampsia, our baby is not in breech position, I have prepared for the best. I only read up about natural birth, we watched videos about natural birth but not Caesarean at all. OK, I read a little bit about Caesarean.

Our baby was underweight all the way, then he started to have normal weight. That’s good. Then, in the last 2 weeks, he gained about 0.5 kg per week. Well, our baby is a late boomer.

On my 39th week 3rd day (in the evening), the ob-gyn recommended me to go for an elective Caesarean the next day or the day after. We did not have any mental preparation.

The C-section was scheduled 2 days before our baby’s EDD (expected due date). Until the day before the C-section, I had no major contraction, no bloody show. I only suffered from back pain from growing tummy, and could only sleep on left side, with a little pillow to support my belly (with baby inside).

Since the operating theaters were not available the next day after we saw the ob-gyn, I had a day extra to find out more about C-section.

To quote Marie Curie, "nothing is to be feared, only to be understood." I think and feel that the more I understand, the more prepared I will in facing challenges in lives. That is what happened when I prepared myself mentally and physically for tandem skydiving, paragliding, many academic examinations in the past, delivering talks, and venturing into the foreign countries on my own. In addition to my birth country where my parents took care of me, I have lived and survived on my own in five foreign countries, learning the systems from the scratch, making new friends, finding ways to my accommodation. To learn about making peace, I have also traveled to war torn site where soldiers with gun pointed at our bus. I have nothing to be fearful of except God.

In the evening we saw the ob-gyn, we decided to follow the ob-gyn’s advice. He told us that he was worried that the baby may have shoulder dystocia or injured nerves as he might be too big to pass through my birth canal. The ob-gyn even did not bother to check if my cervix was dilated. Shoulder dystocia affects less than 1% of birth, but our baby might have an increased risk.

As of the 39th week 3rd day, our baby has not reached the criteria of macrosomia (big baby syndrome). Note that fetal weight estimations late in pregnancy are pretty imprecise.
Perhaps, the ob-gyn thinks that our baby is big, I am small (though not small by Asian standard). I still remember my Spanish girlfriend remarked that I looked slim while pregnant, without a big belly. She teased me "I hate you". Well, now my belly looks big, I agree with the ob-gyn that our baby is likely to be a big size but I was hopeful that I can deliver him naturally.

The ob-gyn prefers the election C-section instead of an attempt of natural labor followed by emergency C-section with high risk in between. Emergency C-section has increased risk of surgical and anaesthetic complications. Post-surgical remark : I think my anesthetist was cool! He estimated the right birth weight of our baby with a difference of 0.002 kg. I may consider anesthetist as a career, if I had a chance to go to a medical school.

For the safety of our baby, we consented for an elective C-section. It was difficult to book an operating theater at our hospital of choice, they seemed to be unwilling to give us a slot, until the ob-gyn personally spoke to the hospital staff. The latter thought that we chose an elective C-section for horoscopic purpose. Actually, we did not care about the timing, as long as our ob-gyn feels comfortable and not in rush, of course we understand that he wants to see patients at his clinic at particular time slots. The most important thing is the safety of our baby. When I tried to think positively about the hospital, I come out with a positive explanation (as advocated by Martin E. Seligman): they perhaps reserve the operating theater for emergency C-section for mothers who have not succeeded to try to deliver naturally.

"My attitude is Que sera sera. Accept things that I cannot change. Now, we can only make decisions based on our limited knowledge."

Our baby was still moving happily in my womb on the day -1 of C-section. Soon, I will be able to see and hug the little one whose tiny feet and knee often protrude on my belly. However, I was concerned with the slower recovery from C-section, how I was going to take care of our baby. Post-delivery note: it turned out to be a huge challenge! Since my left hand was poked with medication, I have no strength to bring my baby to my side to breastfeed him.

FAQs (note: you should always consult your healthcare provider):

Q Why did our baby suddenly grow so much?
1. Since I complained about abdominal pain and my cervix was relatively short as compared to normal, I was prescribed 200 mg of Utrogestan daily to prevent premature delivery, for a period of 2 weeks (until the safe date for our baby’s birth). I did not took it for the last 2 days of prescriptions. I was also asked to rest more, which I enjoyed as I love reading, gazing at the park nearby, and freed me from the need to commute to work. I love to work, but I find that fighting for a space in public transport is like a daily battle and I had to be extremely careful of irresponsible people who run to rush for the train.
2. Honestly, I ate some chocolate cakes, though I do not think that I ate excessively based on my normal weight gain. The ob-gyn told me that my baby weight has nothing to do with my diet.

Q: How do I know if our baby is really big?
A: A friend had a baby measured using ultrasound for 3.5 kg, but the baby girl arrived weighting only 2.8 kg. That is why they said that the ultrasound weight prediction is imprecise. Both father and mother of our baby are not fat genetically, how can our baby be so big? Perhaps he is lengthy, and the weight measurement of ultrasound is based on the length.

Q. If I have a short cervix, will it be a shorter path for our baby to pass through, then why I cannot attempt a natural vaginal birth?
A. In my consent form, the reason for elective C-section is Cervical dystocia.
What is cervical dystocia? difficult labor and delivery caused by mechanical obstruction at the cervix.
I also read that "In preparation for childbirth, the woman’s cervix shortens."
I am confused.
No matter what, we are grateful that our baby did not end up as a premature baby.

Q: How do I know my cervix is dilating?
A: " if my cervix was in fact dilated, then I’d be able to feel something hard on the other side of it"
www.babycenter.com said that a pelvic exam can result in too much stimulation and more dilation of cervix.
Self-check may be dangerous / unhygienic, risk of breaking water bag, feel for the "hole in the donut".
"you could go 3 weeks more without going into labor after you have become effaced or started dilating"

Q: Does short cervix cause cervix dystocia?
A: I cannot find answers to this.

Q: Is C-section less painful than natural birth?
A: No, this is a misconception. The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense nerve block. It seems that I was going to endure more pain but the effect was minimized through anesthesia, but for the subsequent days I had to endure more pain as compared to natural birth.
It seems to me that
natural birth: short-term severe pain, long-term mild pain.
C-section: short-term mild pain, long-term severe pain (with the risk of longer recovery).

Post-surgical note : I heard that some women opt for elective C-section to preserve their vagina, in order to keep their husband happy.

Q: What are the risks of C-sections?
A:
postoperative adhesions.
incisional hernias: may require surgical correction.
wound infections.
placenta accreta.
emergency hysterectomies.
postnatal depression.
newborn mortality before 39 weeks.
C-sections for subsequent pregnancies & deliveries.
Emergency C-sections have additional risks:
anaesthesia risk: due to stomach not empty.
severe blood loss.
postdural-puncture spinal headaches.

Q: Will C-section reduce the chance to conceive / have the subsequent baby?
A: There will be an increase risk of
1. placenta accreta (only 0.13% after two Caesarean sections, but increases to 2.13% after four and then to 6.74% after six or more surgeries).
2. emergency hysterectomies.
40% or more of women having three or more C-sections will experience the complications of heavy bleeding and needing hysterectomy.
"By the time a woman gets to her third cesarean, she’s at serious risk for life-changing and even life-threatening complications," says Bernstein.

Q: Can one have a vaginal birth after a previous C-section?
A: Yes, but there will be a risk of uterine rupture which is catastrophic. We had a heart-to-heart discussion and decided that we are happy with 2-3 children, even if just 2 children.

Q: Should I choose between GA (general anaesthesia) or epidural?
A: Regional anaesthesia (e.g. using epidural) is preferred as it allows the mother to be awake and interact immediately with her baby.
You may still feel some pressure or a tugging sensation at some point during the surgery.
A catheter is then inserted into your urethra to drain urine during the procedure, and an IV is started (for fluids and medications including antibiotics) if you don’t have one already.

Q: Does one have to shave for C-section?
A: The top section of your pubic hair may be shaved (http://www.babycenter.com). My ob-gyn prefers full shave.

Q: What are the types of C-section, their pros and cons?
A:
1. VERTICAL / Longitudinal incision. Con: more complication. Pro: more space to deliver baby. Used in emergency C-section to allow a quicker access to baby.
2. HORIZONTAL / lower uterine segment section / a transverse cut just above the edge of the bladder. Pro: less blood loss.
The procedure involves an incision through the skin, abdomen, muscle, and then into the uterus. From start to finish, including pre- and post-op, a typical C-section lasts 3-4 hours.

Q: Should I request for antacid medication?
A: You may be given an antacid medication to drink before the surgery as a precautionary measure. If an emergency arises, you may need general anesthesia, which puts you at risk for vomiting while you’re unconscious and inhaling your stomach contents into your lungs. The antacid neutralizes your stomach acid so it won’t damage your lung tissue.
For me, since I suffered from gastric pain in the past, I would prefer to request for an antacid.

Q: Can my birth partner attend C-section?
A: Your partner, freshly attired in operating room garb, may take a seat by your head.
Sometimes no for emergency C-section, in which GA is used.

Q: What Bible verses can help to prepare Christian mothers for C-section?
A:
2 Corinthians 12:9,10 "My grace is sufficient for you for my power is made perfect in weakness. … For when I am weak, then I am strong."
Psalm 103:1-5 "… who forgives all your sins and heals all your diseases, who redeems your life from the pit and crowns you with love and compassion, …"
Proverbs 31:10-31 "A mother’s love is like a beacon burning bright with faith and prayer. Through the changing scenes of life, we can find a haven here. A mother’s love is something that no one can explain — it is made of deep devotion and of sacrifice and pain."

Q: How expensive is C-section?
A: Caesarian is $500 + $925 = ~ $1,500 more expensive than normal delivery.
Note that this calculation has not included:
room charges.
equipment usage fee.
medication fee.
anesthetist fee.
baby’s stay.
pediatrician fee.
doctor’s daily visits (even just to ask "are you ok?").
Eventually, several thousands $ are required.
Personally, I try to save money by sharing a room. I can still have privacy of view thanks to the curtain, but patients have limited privacy of sound. My first night roommate heard my family’s and relative’s conversations, and by default I have to listen (& get to know my second and third night roommates because some (I think many of) their relatives speak loudly). An ear plug is a rescue.

Q: How is placenta removed during C-section?
A: The ob-gyn will do it.

Q: How is the suture done?
A: The stitches used for your uterus will dissolve in the body. The final layer – the skin – may be closed with stitches or staples, which are usually removed three days to a week later (or your doctor may choose to use stitches that dissolve on their own). Closing your uterus and belly will take a lot longer than opening you up, usually about 30 minutes.

Q: How to breastfeed after C-section?
A:
1. you and your newborn lie on your sides facing each other.
2. football / rugby position.
To minimize discomfort, place a pillow over the incision while holding your baby.

Q: How is lochia removed after C-section?
A: According to Mayo Clinic, “Expect a bright red, heavy flow of blood for the first few days after the C-section. It might contain a few small clots. The discharge will gradually taper off, becoming more watery and changing from pink or brown to yellow or white. To reduce the risk of infection, use sanitary napkins rather than tampons. Contact your health care provider if your bleeding soaks a sanitary pad each hour for two hours, you pass a clot larger than a golf ball, the discharge has a foul odor, or you have a fever of 100.4 F (38 C) or higher.”

Q: How to recover from C-section?
A:
As soon as the anesthesia wears off, your doctor will encourage you to get up and walk around, which reduces the risk of a dangerous blood clot (pulmonary embolism) forming. Post-surgery note: I only remember a voice telling me to move my legs after the surgery, even though I was immobile.
Avoid strenuous work (e.g., lifting objects over 4.5 kg, running, walking up stairs, or athletics) for up to six months.
Rest as much as you can.
Talk less.
Wait ~ 18 months before attempting to conceive another baby.
According to babycenter, pee often, even if you don’t feel the urge to go. In the first few days after you give birth, your bladder may be less sensitive than usual, so you may not feel the need to urinate even when your bladder is quite full. In addition to causing urinary problems, a full bladder makes it harder for your uterus to contract, leading to more after pains and bleeding.

Q: What are food precaution after C-section?
A: My mother: do not eat hard food (e.g. rice) immediately after surgery, but drink something warm or eat porridge. If the porridge is cold, do not eat.
Do not eat TianZiWang.
Do not eat fried food.
My mother in law: do not to eat poultry within 12 days after C-section because today poultry is heavily injected with hormones.
My confinement lady: Do not eat ginger and wine within 12 days after C-section.
My confinement lady: Do not do post-natal abdomen massage, but hand, foot, back massage are ok after 12 days of delivery. A friend A of CW who also delivered via emergency C-section went for the post-natal abdomen massage, and felt uncomfortable after it. Personally, I think foot massage has risks too because of the linkage of acupressure points.
See also my notes on confinement.

More details:
www.webmd.com
www.mayoclinic.com
www.babycenter.com

Things I did on day -1 of my elective LSCS:
Read, watched, learned about C-section.
Drank a lot of water because I felt so thirsty.
Drank red date tea.
Paid all my outstanding credit card bills. I did not know how long it would take me to recover.
Requested the father of our baby to help us take photos of my tummy with the baby at the park.
Trimmed my eyebrow and fringe.
Clipped my nails to prevent scratching our baby.

New birth plan for my elective lower segment C-section (LSCS):
To ask healthcare provider:
Will my IV contain antibiotic?
Will I be given antacid? to request.

Before I head into the operating room, let my doctor know that I would like to see our baby as soon as possible after the delivery (as long as he is healthy).
Tips: if you have myopia, you will not be allowed to wear your soft lens, so bring your spectacles with you (and do not let any nurse to take them away). If they insist, pass it to your birth partner. Like me, you want to see your baby clearly.

If the ob-gyn allows, ask the father of our baby to play soothing music. Post-surgical note: I forgot to request. Then, I tried to console myself that music may distract my ob-gyn.

After C-section, to confirm with the ob-gyn if I do not have vertical incision.
If there was vertical incision, uterus is more likely (8 – 10%) to rupture during a vaginal birth after cesarean (VBAC).
Note: outside incision may be horizontal, but invisible inside incision may be vertical.
My ob-gyn said I have horizontal incision.

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