Mission breastmilk: Bits and pieces

On the Montreal – Amsterdam flight, there were only 12 seats at the section that I was sitting and all the seats were full. I didn't inform the crew that I would be occupying the toilet for a long time so when I made a disappearing act to express in the toilet, my absence of conspicuous. One of them came knocking at the door when I was half-way expressing to make sure that I was OK, and not fainted in the toilet :-)

~~~OOO~~~

My breastpump broke while I was expressing at the lounge in Amsterdam airport while on transit home. The pump can still be used but it takes a lot more effort to balance the broken part and work the pump. I have to thank my lucky star it didn't break any earlier, as it would have made my expression sessions much more difficult.

~~~OOO~~~

What's my record output in one single expression session?
13oz!
This was achieved when I had a gap of eight hours between expressions, instead of the usual 5 – 6 hours.

~~~OOO~~~

Yan Yan has no problems at all with nipple confusion or breast rejection. When I offered her the breast upon my return, she didn't hesitate one bit and suckled like a pro, as if I hadn't been away at all. And I'm thankful for this - one less thing to worry about in my next trip - Bangkok for a couple of days at the end of the month. Now that we (Yan Yan and I) survived Montreal, I'm sure Bangkok will be easier.

Mission breastmilk: Accomplished, but not quite

How did my breastmilk mission go? Well, I managed to cart home 203oz of frozen breastmilk from halfway round the world, though not in optimal condition.

I thought I had it all figured out – I'd freeze my breastmilk at the hotel's freezer for the first part of my trip, and for the second part where I extended my stay for two days, I had booked a hotel which has a full refrigerator.

The hotel apartment with a bedroom, living room and a kitchenette

And I had my dry ice supply arranged for packing home the frozen breastmilk. I neglected one very important detail though - that is I'd be flying home on a Sunday. The dry ice supplier that the hotel contacted would only deliver on Friday as they don't work weekends but that would be two days earlier than my scheduled departure. I finally managed to find another supplier who would deliver on Saturday. Taking into account the time lag between delivery and my departure from Montreal, I ordered two bags of 12kg dry ice in the form of small pellets (for small quantities like this, all the suppliers only supply in small pellet form). I was hoping against hope that there would be enough dry ice left for me to pack on Sunday but alas, when I opened the bags on Sunday afternoon, almost all had sublimated, leaving only less than 1kg in each bag. The guy who delivered the dry ice had suggested putting them into the fridge but I read that it may shut off the fridge's thermostat due to the extreme cold so I dared not try, just in case I would cause the fridge to break down.

Nevertheless, I packed the frozen breastmilk tightly into my Fridge2Go bags, threw in whatever dry ice I had left, and added in extra layers of Techni Ice sheets on top, before covering them up with a towel to minimize air space. I wasn't optimistic that the milk would survive the 31 hours from the point of checking out to reaching home, but at that point, I could only hope for the best. I was really disappointed, and the thought of all the wasted effort and $$$ to buy the dry ice (they didn't come cheap – I paid CAD 57 including delivery and taxes) left me feeling down all the way back.

My expression schedule across three time zones - Malaysian, Amsterdam and Montreal times. Luckily my effort was not in vain.

The first thing when I got home was to check on the milk. There was no more dry ice left but the Techni Ice sheets were still frozen solid. Almost all the milk packets had started to thaw – some only slightly at the edges and felt soft to touch (not rock solid), while some had started to liquefy. The bags with liquid (about 70oz) were left to thaw in fridge completely. I kept about 45oz for Yan Yan's feed for the next two days, and gave about 25oz to mum to give to Xiaoyu (my 2-year old niece). I refreeze those that were thawing only at the edges as I don't have the heart to toss them all away. I sms this frequent traveler mummy, who assured me that it would be alright to refreeze them, as she had done so herself in the past. I also called up Dr. K, a lactation consultant and she said that as long as the milk packets were still cold, it was OK to refreeze. And so I did.

Here's my breastmilk tally:
Total stock in freezer/fridge before I left: 388oz
Balance stock in freezer when I returned: 146oz (so Yan Yan consumed about 242oz while I was away)
Carted home from Montreal: 204oz (refreeze 134oz, 70oz consumed by Yan Yan and Xiaoyu)
Total stock left in freezer: 280oz*
Discarded: 43oz (on flights to Montreal), 43oz (on flights back from Montreal)
So in fact, what I managed to express in total (290oz, including those discarded) was more than what Yan Yan consumed throughout my entire trip :-)
*There's more now as I'm still adding to the stock whenever my daily output exceeds the amount Yan Yan consumes :-)

On hindsight, these are some of my thoughts:

- if I had enough dry ice, I'm pretty sure everything will still be rock solid by the time I reached home. I should have stayed one more night in Montreal and leave on Monday, so that the dry ice could be delivered to me just in time for check-out. And if I did stay an extra day, I would even have time to make a side trip to Mont Tremblant, a famous ski resort in the Laurentian Mountains 1.5 hours from Montreal :-)
- I should have bought the styrofoam container that the guy brought along to store the dry ice. I declined coz it would have cost me another CAD 15. Had I bought the styrofoam container, probably the dry ice wouldn't have sublimated that rapidly.
- the dry ice was in the form of small pellets (smaller than ice cubes), hence the rate of sublimation was much swifter compared to dry ice blocks. Unfortunately for small quantities like this, all the suppliers I contacted only supplies in pellet form.
- I think the Fridge2Go bags probably helped to keep the milk frozen for longer. If I had used a normal cooler box, more could have thawed out.

Another valuable lesson learnt in my breastfeeding journey.

Yiu Yiu's 4th birthday

Yiu Yiu turned four on Sunday, November 1. We celebrated her birthday with a small luncheon party at home with family members, babysitter's family and several friends, including two of her classmates.

This time around, she asked for a Snow White cake instead of Barney, which she had for two years in a row. I contacted the baker who baked her beautiful Barney cake last year, and Yan Yan's fullmoon cuppies but as I had left it till too late, she couldn't fulfill my order this time. So we settled for a simple Oreo chocolate cake from Bread Story, with a printout of Disney princesses on what seemed to me like sugar paper.

So how did Snow White evolved to Disney princesses? Well, we know the owner of Bread Story in SS2 and she sent us some photos for us to choose for the cake. When we showed them to Yiu Yiu, she chose this one. The kids at the party loved the cake and polished off almost the whole cake. Thank goodness for that, coz otherwise, I'd end up having to finish the leftover cake.

After having filled our tummies, the girls gathered around Yiu Yiu for some photos with the cake but the boys were more interested to continue playing with each other. Everyone gathered around the table nevertheless, when we started singing the birthday song.

With Faythe and Chloe, her kindy buddies

Cutting the birthday cake...

...and savouring it

I was busy serving and mingling with the guests, and forgotten to take a family photo before the cake was cut. This was the only one we managed to take.

Everyone left by about 2.30pm, leaving hubby and I to clean up the house while the girls slept. We managed to put the house back in order in time for me to bathe the girls and took a shower myself before going to Hilton Kuala Lumpur for an evening lecture. Yeah, I had to work on my girl's birthday.

Pressies galore - thank you so much for coming uncles, aunties and friends

Of travelling, exams and birthday

I touched down at KLIA early on Tuesday morning , and less than 60 hours later, I was on the plane again. Luckily it was only a short trip to Singapore for a meeting on Friday. I had initially planned to make a day trip, but since the meeting was scheduled to start at 8.30am, the only flight that could take me there that early is an Air Asia flight departing LCCT at 6am, and I would have had to wake up at the ungodly hour of 4am. Not wanting to torture myself, I flew in on Thursday evening. Alas, I still didn't get much rest as I stayed up till 4am that morning rushing off some urgent documents for work.

~~~~~OOOOO~~~~~

While I was in Montreal, hubby was informed that Yiu Yiu's end-of-term exams will be held in the week of November 2. Yiu Yiu was bugging me to do revision with her at home (I guess the teacher must have reinforced this to them) when I was home between the Montreal Singapore trips but I was just too darn tired, as well as didn't have the time to prepare any revision worksheets for her, like what I did for her mid-term exams.

This week was revision week at the kindy and from my experience with the mid-term exams, I knew the kindy would return the revision worksheets to the parents for the weekend. I took the short-cut and erased all the answers from the kindy revision worksheets, photocopied them, and walah, I've got my revision sheets :-)



I had planned to space out the revision for Maths, English and Chinese over the weekend but the moment she saw me pulling out the worksheets, she took them from me and finished them all in one marathon session, despite me trying to coax her to space them out. Rajin or not my daughter?

~~~~~OOOOO~~~~~

Yiu Yiu will turn four tomorrow. Hubby and I had agreed that we won't be celebrating her birthday in a big way this time, unlike the last two years. When I was away in Montreal, I also didn't give much thought to her big day. We finally decided to still have a small celebration at home. So on my way to the airport on Thursday, I was frantically short messaging everyone, making arrangements for the last minute do.

We went shopping this afternoon – for the party packs, disposable cutleries, food and beverages.


Yiu Yiu is very excited, and can't stop saying that tomorrow is her birthday, and she's gonna have a party :-)

Yiu Yiu's birth story – Part 2

The days after
On the second and third day, my blood pressure was still elevated so I couldn't be discharged. On the fourth day when I was fit to go home, Yiu Yiu developed jaundice and had to undergo phototherapy. I decided to stay on at the hospital as I was breastfeeding, and we only finally went home on the sixth day.

The few days at the hospital were really tough. I was a naïve new mother who didn't quite know how to handle a baby, especially such a tiny and fragile-looking baby. She couldn't latch on for the longest time, and I was truly struggling to breastfeed her. It didn't help that she kept on crying out in hunger and frustration at each breastfeeding attempt. And when she developed jaundice, I was repeatedly told by the nurses to keep on feeding her, that fluid intake would help to flush out the bilirubin, but she just couldn't latch on properly. Many a times, when she cried out in hunger, I broke down too.

One night, I succumbed to one of the nurses' suggestion to feed her some formula. I insisted though that they used a feeding cup and not bottle, as I didn't want her latching problem to be compounded by nipple confusion. The very next morning, I was reprimanded by my obstetrician. He said babies can survive with minimal breastmilk for the first few days, as they have enough body fat stores to sustain them. He further added that her blood glucose level is monitored daily and if there's any indication that she needed supplemental feeding, they would not starve her. So that was Yiu Yiu's one and only formula feed, until she reached 15 months, when we started to introduce formula to her.

Yiu Yiu's birth story – Part 1

Another birth story? Yeah, but this one is almost 4 years too late. I started this blog when Yiu Yiu was eight months old, so I don't have any entries on details of her birth and early months. It just struck me that perhaps I should also pen down Yiu Yiu's birth, whatever little that I still remember, to mark her upcoming 4th birthday.

So here goes…

October 24, 2005
Hubby and I went to see my obstetrician, Dr. G for my 37th week check-up, and when he checked my blood pressure, he said that it was elevated. It was the first time in my whole pregnancy that my blood pressure actually went up. Anyway, he sent us home and asked us to come again next week. The next week, my blood pressure was still elevated and there were traces of protein in my urine too. He also checked my cervix but I don't remember him telling us if it had already softened. He told us that my placenta was probably matured and calcified, and thus, would not be able to provide much sustenance for baby. He wanted to check the baby's heartbeat with the CTG machine, and hence asked us to be at the hospital early the next morning.

November 1, 2005
It was the morning of Deepavali, and when we arrived at the hospital at about 8am, I was promptly hooked to the CTG machine. At the end of the observation, we were told that baby's heartbeat was fine. He checked my cervix, but again, he didn't offer any information as to its dilation. Anyhow, he advised that we should schedule for an induction of labour, since I was already 38+ weeks. Being the ignorant first-time parents, it didn't occur to us to question the rationale behind his advice, but I guessed it had to do with my less-than-efficient placenta. Since it was already past 10am by the time we were done, he was reluctant to induce me on that day itself, as he was worried that there might not be an anaesthesiologist around should I had needed an emergency C-sect. So he sent us home and asked us to be at the hospital early the next morning.

Hubby proceeded to settle the bill and just as we were about to leave the hospital, hubby got a call from his nurse, telling us that Dr. G changed his mind, and decided to induce me then instead of waiting another day. Okay, so we went to the labour ward and by the time I changed into the hospital gown, it was just past 11am. I was put on a drip and I settled down with some newspapers and magazines. There wasn't much progress in the first three hours, and if I'm not mistaken, I was only 2cm dilated at 2pm. I remember thinking to myself that at this rate, I'd probably deliver only at 10pm, assuming my cervix dilates at the rate of 1cm per hour. The midwife then increased the dose of the medicine and I started feeling some contractions soon after. Somewhere along the way, I was given pethidine injection, which caused me to drift in and out of consciousness. From that point on, I couldn't really recall much. I remember trying to get some sleep, only to be awakened by each wave of contraction that got progressively stronger. I remember Dr. G rupturing the membrane, probably when I was about 5cm dilated. I remember hubby got really anxious with each progressively louder groan I made, and several times, he rushed out to get the midwife to check on me. And he told me later that at one point, the nurses got a little irritated and even reprimanded him, telling him that labour pain is like that, and I had to just bear with it.

When I felt the urge to bear down, I asked hubby to inform the midwife. She was half expecting that hubby is crying wolf again, but she frantically got into action getting all the things ready when she found out that I was already fully dilated. I was asked to hold and not push since the obstetrician was not there yet. I thought those few minutes were the worst throughout the whole process, having to fight the extremely strong urge to push. Looking back, I should have just gone ahead and push without waiting for my obstetrician, as I'm quite sure the midwife and nurses were capable enough to help me birth the baby. Anyway, when my obstetrician arrived, I started pushing and thank goodness, Yiu Yiu was out at 5.58pm, with just two pushes, as she was just a tiny (weighing 2.5kg and measuring 46cm) baby. Hubby was rather emotional towards the end and he actually shed some tears when Yiu Yiu was finally out.

She was immediately taken away for cleaning and I didn't even have a chance to lay my eyes on her. As I was still very sedated from the pethidine, I wasn't quite aware of what else was happening after the birth – I didn’t feel my placenta being delivered, neither did I feel anything while my obstetrician was stitching me up. I remember falling asleep after all that action, and being pushed to the maternity ward thereafter. My family came to visit at about 8pm but I was still feeling very groggy then. Mum cooked some ginger fried rice and though I was ravenous, I couldn't eat as I was nauseous, again no thanks to the pethidine. Which is why for my second birth, I told myself that I'd try to go without pethidine.

The Down Syndrome scare

The obstetrician who delivered Yan Yan was the second obstetrician we consulted during my pregnancy. What happened to the first? Well, we ditched him after he gave us a nasty scare about carrying a Down Syndrome (DS) baby.

At my 12th week check-up with the first obstetrician, Dr. T, he performed the nuchal translucency scan, and mine measured about 1mm, which is within the normal range of up to 2mm. At the 16th week, he performed the triple test. I got a call from him the very next day, informing me that the test came back positive, showing that I had an increased risk of carrying a DS baby. I was calm when I received the news, as I knew that the sensitivity of the test is only about 60%, and there's quite a high false positive rate. Nevertheless, I promptly trawled the Net for more information and the more I read about it, the more worried I became. I called him back the next day to discuss further, and found out that the results came back that my risk was approximately 1/200, while the normal risk for my age is approximately 1/350. He suggested that I do an amniocentesis, which I wasn't really keen on doing, due to the risk of miscarriage. All this happened just before our trip to Yogyakarta, so that totally spoilt my mood for the trip. But my gut feeling told me that my baby was fine, and interestingly, hubby had the same feeling too.

Upon our return from Yogyakarta, we seeked a second opinion from Dr. R, a former professor who specializes in problematic pregnancies. In our first consultation, he told us that his method of screening for DS was slightly different. He would perform a different blood test in the first trimester, and if the blood test indicated an increased risk, then only would he measure the nuchal translucency. He questioned the wisdom of doing the triple test, which is less sensitive compared to the nuchal translucency scan with 80% accuracy – it's like taking a step backwards. But since my triple test results came back as such, he couldn't refute the results.

Anyway, he offered to perform a thorough anomaly scan to look for structural abnormalities associated with DS - primarily the head, heart and kidneys. After looking at the scan, he told us that all the major organs looked perfect to him. He also said the distance between the thumb and index finger for a DS baby is normally far apart, and the thumb is normally very small (if I'm not mistaken). But my baby didn’t show any of these characteristics. In a nutshell, he reassured us that the baby should be fine and the chances of her being a DS baby is <1%. He didn't think we should bother with doing an amniocentesis. But he did caution us that two of his patients (28yo and 30yo) who had all normal test results and scans, turned out to be DS baby. But to us, as long as he opined that our baby was fine, we were reassured. After all, he's seen enough complicated pregnancies, and has the experience to predict with reasonable certainty whether the baby was normal or otherwise. And after his good prognosis, had our baby really turned out to be a DS baby, then I suppose it's really God's will.

I didn't have the courage to share this earlier, lest the worst really happened. Now that all's well, I thought perhaps it's a story worth sharing and preserving.

I should also add that I'm truly blessed that Dr. R agreed to take me in as his patient, as he normally doesn't accept new patients planning a normal delivery. His new patients are mainly complicated pregnancies, or those planning a C-sect birth. He had told me upfront that he would follow me through to 20+ weeks, after which he would pass me on to either of his two partners. As he was still seeing me by my 30th week, I asked him if I should start following-up with his partners. I was pleasantly surprised when he said that since he had been seeing me thus far, he'd follow through with my delivery. I guess I've to thank my lucky star, and THANK YOU Dr. R, for being such a patient, kind and gentle doctor.