Laparoscopic Tubal Ligation, A Solution For Women Who Don’t Want To Have Children

Laparoscopic Tubal Ligation, A Solution For Women Who Don’t Want To Have Children

May 8, 2022   Return

WORDS LIM TECK CHOON

DrAgilan

WOMEN’S HEALTH AND FERTILITY WITH

Dr Agilan Arjunan Consultant Gynaecologist & Fertility Specialist

KL Fertility Centre

 

This month, Dr Agilan Arjunan gives us a closer glimpse of a method that allows a woman to stop worrying about becoming pregnant. It’s a relatively simple and safe method but be warned: the result is practically irreversible!

WHAT’S LAPAROSCOPIC TUBAL LIGATION?

Pregnancy is the result of a sperm cell meeting and fertilizing an egg cell after sexual intercourse. The egg cell is released by the ovary and travels outwards towards the uterus (see Figure A), and along the way, it may encounter sperm cells.

Cutting and tying, cauterizing, or banding the fallopian tube prevents the egg cell and the sperm cell from ever meeting. Hence, there is no worry about pregnancy.

Such a procedure is called tubal ligation. ‘Ligate’ means ‘tie up’, hence this procedure is sometimes also called ‘getting the tubes tied.’

WHAT HAPPENS DURING A LAPAROSCOPIC TUBAL LIGATION?

Dr Agilan Arjunan explains that this is currently the most widely used method of tubal ligation. The surgery involves making small cuts or incisions through the skin.

  1. The patient is given anaesthesia and a drip in the vein of an arm or hand.
  2. A device will be gently inserted into the vagina to move the uterus.
  3. The surgeon makes a small incision near the navel.
  4. A thin, flexible pencil-wide tube with a camera and light source at the end (laparoscope) is inserted through the incision.
  5. The abdomen is inflated with gas (don’t worry, it’s safe) to make it easier for the surgeon to view tissues and organs via the laparoscope.
  6. A second small incision is made at the pubic hairline.
  7. Through this second incision, the surgeon uses a special device to hold the fallopian tubes in place.
  8. The fallopian tubes are then sealed either by cutting them, passing an electric current that causes blood to clot in the tube opening (electrocoagulation) or by using a band or clip over the tubes.
  9. The laparoscope and other devices are removed, and the incisions are stitched up.

The entire procedure takes about 30 minutes, provided there are no complications.

ovary

WHAT HAPPENS AFTER THE SURGERY?

The patient will rest awhile in the hospital for observation. If all is well, she usually will be allowed to leave on the same day.

The patient can resume working a few days after the surgery, but it’s best to resume daily activities gradually as one heals.

Normally, sexual activity can resume a week after coming back from the hospital, but it’s best to get clearance from the doctor first.

WHAT ELSE CAN A WOMAN EXPECT AFTER THE SURGERY?

There may be some vaginal bleeding for a few days after the procedure, and this is usually normal.

Menses may resume 4 to 6 weeks later, and during the first two or three cycles, one may experience heavier bleeding and slightly more discomfort than usual.

The surgery does not affect one’s ability to enjoy sexual activities.

IS THIS PROCEDURE EFFECTIVE? WHAT ARE POSSIBLE RISKS INVOLVED IN GOING FOR THE SURGERY?

Laparoscopic tubal ligation has a chance to fail, although statistically it’s a small chance—fewer than 1-in-100 women.

Dr Agilan adds that there is also a risk of ectopic pregnancy, which sees an egg cell still being fertilized by a sperm cell and developing into a foetus in an abnormal location—usually in the fallopian tube itself. According to some studies, this risk is very low, lower in fact than the risk of ectopic pregnancy in women whose fallopian tubes are not ligated.

Other risks are those usually associated with any form of surgery: bleeding, infection and anaesthesia-related side effects.

Don’t worry too much about the risks for now, as a good surgeon will explain the risks before one agrees to go for the surgery. Dr Agilan recommends taking this opportunity to have any doubts and concerns cleared by the surgeon.

WHAT ARE THE ADVANTAGES OF THIS PROCEDURE OVER OTHER FORMS OF TUBAL LIGATION?

Dr Agilan shares that the chief advantage is that one recovers more quickly from surgery due to only a few small incisions being made on the body.

Some studies suggest that this procedure can also reduce one’s risk of ovarian cancer and pelvic inflammatory disease, although we still don’t know the exact reasons for this.

The biggest advantage of this procedure, perhaps, is that it is the best contraception available for a woman. “If the woman is absolutely sure that she doesn’t want to have children,” says Dr Agilan, “then this is the best method available. It’s effective and, unlike other female contraception methods such as the Pill, doesn’t affect the woman’s hormone levels.”

If the woman is 100% sure, that is, which is important as once it is performed, laparoscopic tubal ligation is practically irreversible.

While this surgery prevents pregnancy, it offers no protection against sexually transmitted diseases—other precautions such as the use of condoms will still be needed to avoid catching these diseases.

IT’S REALLY IRREVERSIBLE?

Reversing a tubal ligation is a very complicated procedure with a small chance of success.

“Once the fallopian tube is clipped, banded, or cauterized,” explains Dr Agilan, “scar tissues can form around the affected area. These scar tissues can grow over time until they eventually obstruct the tubes permanently.”

Even if the reversal is a success, there is still no guarantee that the woman can successfully conceive.

Therefore, Dr Agilan reiterates that a woman should be absolutely, positively sure that she doesn’t want children for the rest of her life before she undergoes this surgery.

CONSIDER OTHER OPTIONS IF ONE IS UNSURE

“This surgery is not the only option available,” Dr Agilan says. “For women who believe that they may want children some time in the future, there are other forms of contraception that can be considered.”

This includes the Pill, contraceptive patch and more. Alternatively, her partner can opt for vasectomy, which can be more easily reversed should the couple change their mind about having children in the future. Dr Agilan recommends discussing this matter further with one’s doctor to explore options that best suit one’s needs. HT

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LADIES, WATCH OUT FOR THE SYMPTOMS OF THESE COMMON CANCERS Edit

LADIES, WATCH OUT FOR THE SYMPTOMS OF THESE COMMON CANCERS

May 8, 2022   Return

DR-HAFIZAH-ZAHARAH

 

WORDS HANNAH MAY-LEE WONG

 

Early detection of cancer may lead to better treatment outcome and higher chances of recovery. Hence, it is important that women go for their regular health screenings and know the early signs and symptoms of cancer.

 

Consultant oncologist Dr Hafizah Zaharah says, “Women should be aware of their body changes at all times, even when they are still at a younger age—in their 20’s and 30’s. Recently, we have an increasing number of patients in the younger age group.”

 

GET SCREENED REGULARLY

 

Women over the age of 40 go for health screenings once a year.

 

Women younger than 40 should go every two years.

 

The recommended screenings include:

  • Mammograms and breast ultrasounds for breast cancer
  • Colonoscopy for colorectal cancer
  • Blood test and tumour marker test for ovarian cancer
  • Pap smear for cervical cancer.

 

POTENTIAL SYMPTOMS OF COMMON CANCERS

BREAST CANCER

  • A lump in the breast or armpit.
  • Changes in breast size, skin, and shape. For example, swelling, dimpling, irritation, thickening, or redness of the skin in the breast.
  • Nipple changes, such as spontaneous discharge, scaly appearance, or retraction of the nipple.

COLORECTAL CANCER

  • Diarrhoea, constipation, or narrowing of the stool for more than a few days. 
  • Rectal bleeding with bright or dark red blood.
  • Blood in the stool; stool appears dark brown or black.
  • Constant cramping or abdominal pain.
  • Anaemia.

OVARIAN CANCER

  • Abdominal bloating or swelling.
  • Poor appetite and feeling full quickly.
  • Pelvic or abdominal pain.

CERVICAL CANCER

  • Abnormal vaginal bleeding. For example, bleeding after intercourse, or bleeding and spotting between periods.
  • Unusual vaginal discharge.
  • Pain during intercourse.
  • Vaginal bleeding after menopause.
  • Pain in the pelvic region.

SARIMAH SPEAKS HER MIND: THE TRUTH ABOUT MOTHERHOOD

SARIMAH SPEAKS HER MIND: THE TRUTH ABOUT MOTHERHOOD

May 8, 2022   Return

WORDS HANNAH MAY-LEE WONG

As Malaysians, most of us recognize the gorgeously charismatic Che Puan Sarimah Ibrahim. We watched her on NTV7, Astro, TV3, we heard her on Red FM and Mix FM, some of us even had the chance of attending events where she was the emcee; it’s clear that this half-Irish Malaysian beauty has been around and is here to stay. But something about her has changed lately: she’s become a mother. In this intimate and exclusive interview, Sarimah chats with us about life, motherhood and how taking care of her mental health plays a big role in helping her stay grounded.

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An Introduction: Che Puan Sarimah binti Ibrahim is a Malaysian-Irish television host, actress, singer and radio announcer. With more than 20 years’ experience, her career highlights include: being a host on the Disney channel, hosting The Biggest Loser Asia on Hallmark ,Akademi Fantasia and The Sarimah Show.

Staying true to herself, Che Puan Sarimah doesn’t sugar coat when sharing her experience of being a new mother. Unexpectedly, when asked if she’s always wanted to be a mother, the answer was: no. Sarimah reveals, “I’ve got three younger brothers. Mum didn’t have a helper or anything, so I was the second in charge. I fed them, changed nappies, did everything you had to do as a mother since young. I guess from that experience I felt like I’d already done the mothering role.”

“In my 20s and 30s, I didn’t think I wanted to be a mum. I care so much about my brothers, I see them like my own kids until today … But when I hit 35, I met my husband and that’s when things started to shift. I think when you meet the right person, it changes your perception about the future. It was delayed, but my maternal instincts only started kicking in then.” At the heart of it, Sarimah tells it like it is: Every mother’s journey is unique, and the process is never easy. She elaborates on the joys of motherhood, her struggles and finding herself again through it all.

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At the beginning

At 42 this year, Sarimah acknowledges that getting pregnant with baby Tunku Sofia Najihah was a miracle in itself. What may surprise some is that she did not even need the help of IVF (in vitro fertilization). “Just to clarify, I’m not against IVF at all. Everybody has their own way of doing things and IVF helps so many people,” Sarimah assures. “For me and my husband, the experience was just a little bit pushy. I was told: ‘You’re 40, your eggs are going to run out, you need to do this now!’ … I was also told that even though I was perfectly healthy, there’s no reason why I can’t get pregnant, but if I wanted to speed things up, then I should try IVF.”

After some deliberation, Sarimah paid a visit to her gynaecologist. A quick checkup was done, and her gynaecologist concluded that she was perfectly healthy and able to get pregnant naturally. He recommended a D&C (dilation and curettage) procedure for Sarimah. “They cleaned out my womb to make sure the conditions in my womb were suitable for implantation. A lot of women don’t realize they’ve got fibroids or other factors that hinders them from getting pregnant.”

A day after the procedure, Sarimah’s gynaecologist was very confident that she should have no trouble getting pregnant naturally. “Two months after that, it happened, I got pregnant,” Sarimah beamed with joy.WhatsAppImage2020-01...

Tunku Sofia at 6 months, on a daily walk with mummy and daddy.

Working out through pregnancy

“In the beginning, I had morning, afternoon and night sickness (I don’t know why they call it morning sickness, it was all the time!). I felt quite sick for 7 weeks,” Sarimah said.

“I was little bit worried because I am quite a fitness fanatic. My gynaecologist kept telling me to slow down since this was my first precious baby. But I’ve been working out for 15 years with cardio and weights every day: pilates twice a week, having a personal trainer for weights once a week … I thought I would still do the same but perhaps just cut the intensity.”

Upon consulting her doctor, she was advised to stick to what she felt comfortable doing. “I tried to lie down and do nothing, but I felt sicker. When I went to the gym for workouts, I felt better. Everyone’s an individual and you can’t say what works for you works for everyone. For me, stopping exercise would have been worse.”

Sarimah worked with her doctor and trainer to come up with a suitable programme for pregnancy. “I didn’t do weight training until after 3 and a half months of pregnancy. For cardio, I also waited after my second month of pregnancy before I did anything past 15 minutes. By my eighth month, I slowed again to prevent back pains. But the day before I gave birth, I was still doing my cardio workouts, fast walking uphill!”

“During my pregnancy, I did light walks, squats, lunges, weights … My trainer adjusted my workouts. I also went for pregnancy group workouts where they have professional trainers for pregnant women,” Sarimah adds.

Speaking up about postpartum depression

When it comes to motherhood, out of “mom-guilt,” many choose to only talk about the positives of parenting. But having studied psychology in depth, Sarimah knows that this isn’t the healthiest way of going about it.

“For someone in my position, it could be seen as me being in the limelight, having help, having financial ease, what’s there to complain about? But it’s not about having 10 nannies or how much money you have in the bank.” Sarimah emphasizes that a mother’s journey has physical, spiritual and mental aspects to it—wellbeing in all those areas matter.

“I had slight postpartum depression. It’s common but no one really talks about it. A lot of people think that this is like a phantom condition that can be dismissed. People think it’s just because of the hormones, but it’s not.”

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The highs and lows of motherhood

In life, Sarimah strongly believes that for every high, there naturally will be a low. “A holistic way to look at what happens to you after you give birth, is that when you give birth, you get so excited. Your adrenaline is pumped up. Your expectations for yourself, your husband, your baby, and your life are so heightened that days after (mentally and physically), there will naturally be a drop. The shock and change to your system (not just your body, but your whole life system) can just hit you.”

“It was quite challenging in terms of my emotions. I couldn’t understand why all the tears were flowing. I didn’t know why I was going through the dips, I thought you should stay perpetually high like the day you gave birth … In that process, luckily I had my supportive husband and my close friends, and I got help—I went for therapy.”

Getting therapy

Like so many women hit with postpartum depression, Sarimah inexplicably experienced waves of sadness, guilt, and confusion between the new-found happiness of being a new mom. “I knew I needed to ask for help. I didn’t know what was going on, why I was feeling like that. I was exercising, eating well, but I knew this up and down was a bit too much.”

“So, I got some therapy, and it helped. I talked it out, had my catharsis; then you find out you’re normal, then you feel safe. You find out other women are going through the same things and it takes away the shame and the taboo. I started feeling more myself.”

“If I hadn’t gone for that therapy, I think I would have still been in that foggy headspace between ‘what’s wrong with me’ or ‘I’m not good enough’ or ‘Oh my God, where is my future going to go?’”

Sarimah still continues to go to therapy to this day. “Therapy is like working out. You don’t just go, and then stop. For me, I go for my therapy every month just like I make sure I go to the gym. You can’t just take care of your body without taking care of your mind. It needs to be a holistic approach.”

Igniting the conversation

Sarimah voices her concern that people don’t talk enough about postpartum depression. “Nobody knows that suffering feeling when you don’t even know yourself after you give birth—your body and your mind has changed; your hormones have gone wonky, you’ve got all these questions like ‘Who am I? What am I doing?’”

She elaborates that the way postpartum depression presents itself to every mother is very different, and it stems from a cumulation of each individual’s history. “What you’ve been through, what you saw your mother go through, plus your own chemicals in your mind—there’s no way to prepare for it, it (postpartum depression) hits you in a way that’s customized to you.”

“The only thing you can do is: If you feel it’s too much, that’s when you should go talk to somebody. It’s just one hour of your life. Talking to a therapist can lead you to feel better or find out if you need further help.”

Mentally preparing for the future Sarimah is very much a career driven woman. Up until she had gotten married, she had 22 years’ experience being a host and public figure. She made a conscious decision to slow down after she tied the knot, but she reveals that there are many things up her sleeve at the moment. “Now that Sofia’s 6 months old, I’m looking more into how I can work in the mental health field. I want to help women, and it’s a journey. As I have helped myself, I’d like to help others.”

In closing, we also asked Sarimah what she’s looking forward to most in her life. She replied, “None of us know what the future holds. Every day I look forward to what Sofia would do and what her next words will be—those are my thrills nowadays. I look forward to finding more about myself, seeing who I am in this process and I still love entertaining people, so I don’t see myself saying good bye to that anytime soon, I’d love to combine mental health and entertainment somehow.”

To top it all off, Sarimah has her own cosmetic line named Thrill by Sarimah Ibrahim. “It’s health focused and uses natural ingredients. We sell our products (compact powders and cushion foundations) on Shopee and it’s doing quite well. That’s something I really enjoy doing. We have ingredients that help with acne and sensitive skin.”

While the multi-talented entertainer continues to work on many things that are currently in the pipeline, we wish her all the best in her future endeavours and hope to keep in touch. Speaking of exciting events, Sarimah and her husband, Tunku Nadzimuddin Tunku Mudzaffar will be at our Health in the City (HITC) Move Run 2020 event as guests of honour. Make sure to join our run to get a glimpse of the lovely couple.

Lastly, we would like to extend a special thank you, to Che Puan Sarimah Ibrahim and her husband for this interview, and graciously agreeing to be part of our event. HT

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Useful Tips for Pregnant Moms during the Covid-19 Pandemic

Useful Tips for Pregnant Moms during the Covid-19 Pandemic

May 8, 2022   Return

WORDS HANNAH MAY-LEE WONG

As we unravel more information about the COVID-19 virus that’s taking the world by storm, we now know that people of all ages can be infected.

However, there are groups of people that may be more vulnerable to the virus due to having a lower immunity. These include the elderly, those with pre-existing medical conditions (such as diabetes or heart disease) and pregnant women.

No evidence that baby is at risk when the mother has COVID-19

Consultant obstetrician and gynaecologist Dr Ramesh Marimuthu assures us that currently, there is also no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19.

He adds, “There is also limited evidence to show if a pregnant woman with COVID-19 can transmit the virus to her foetus during pregnancy or delivery.”

Thus far, in Malaysia and globally, no infants born to mothers with COVID-19 have been tested for the virus. In these cases, there were no traces of the virus found in samples of amniotic fluid or breast milk.

“That said, for the best outcome, the recommendation is emergency admission through Caesarean for infected mothers. Their babies are isolated from the infected mothers and shall not be breast fed until the mothers are tested and proven negative from the virus,” Dr Ramesh explains.

Staying safe during the pandemic

  1. Rest at home and spend this time meaningfully by preparing for your baby’s arrival.
  2. Stay positive.
  3. Keep yourself well-hydrated.
  4. Eat home cooked food as much as possible.
  5. Wash your hands or use a sanitizer before you open your gate/doors or touch any doorknobs when you arrive home.
  6. Regularly use a disinfectant to clean doorknobs and surfaces which are frequently touched.
  7. Reschedule all hospital appointments unless for emergencies.
  8. Avoid going out unnecessarily. But if you do, wear a mask.
  9. Keep a hand sanitizer handy to disinfect your hands as often as possible, when you must go out.
  10. Most importantly, if you detect symptoms of Covid-19, such as difficulty in breathing, severe cough or high-grade fever, go to the nearest hospital for screening immediately.

“Let’s take every care to stay safe. Wash our hands as often as possible, wear a mask if we must leave home for any essential tasks, disinfect our homes regularly. Let’s protect our babies and our loved ones!” Dr Ramesh says in closing. HT

HPV DNA TESTING FOR MORE ACCURATE DETECTION OF CERVICAL CANCER

HPV DNA TESTING FOR MORE ACCURATE DETECTION OF CERVICAL CANCER

May 8, 2022   Return

WORDS LIM TECK CHOON

 

According to the Human Papillomavirus and Related Diseases Report on Malaysia 2019, cervical cancer ranks as the third leading cause of female cancer in Malaysia and the second most common female cancer in women aged 15 to 44 years. Approximately 1,682 new cervical cancer cases are diagnosed annually in Malaysia.

Human papillomavirus (HPV) infection is a well-established cause of cervical cancer and there is growing evidence of HPV being a relevant factor in other anogenital cancers (vulva, vagina, anus and penis) as well as head and neck cancers. “Any woman who is sexually active or used to be sexually active may be at risk of contracting cervical cancer,” says Dr Kavitha Nagandla, a consultant obstetrician and gynaecologist at IMU Healthcare.

Cervical cancer is usually found in women who are in their 30s to 40s. To mitigate the risk of cervical cancer in the female population, the Ministry of Health Malaysia has since 2010 introduced through schools, the Human Papilloma Virus (HPV) vaccination program for girls aged 13.

 

Regular screening are still necessary even after being vaccinated against HPV

“Women need to understand that the vaccine does not offer 100% protection,” says Dr Kavitha. “Although the vaccine is very effective, we still need more data and until then, women regardless of whether or not they are vaccinated are strongly advised to undergo regular screening.”

“The purpose of screening is to catch abnormalities in the cells early so there can be early intervention,” she further explains, adding that HPV not only causes cancer but also non-cancerous conditions like warts on the hands, feet, eye lids, lips and genital area but these conditions are highly treatable.

A Pap smear would usually be recommended by the specialist. This is a procedure in which a small brush or spatula is used to gently remove cells from the cervix to be checked for cell abnormalities that may lead to cervical cancer. It is essentially a test that detects pre-cancerous cells and is done as part of a pelvic exam.

In general, women aged 21 to 50 should get a Pap smear done annually. If the results are normal 2 years in a row, then they should do it every 3 years.

Women aged 50 to 65 should have it done every 5 years, while women aged 65 and above should get checked if they have signs and symptoms such as post-menopausal bleeding.

A Pap smear is not required for women who have never had any sexual intercourse as there is practically no risk of contracting HPVs nor cervical cancer. Women that used to be sexually active but currently aren’t, on the other hand, should still continue getting a Pap smear, as they are still at risk of developing cervical cancer from their past relationships.

 

HPV screening for added security and peace of mind

It is highly recommended to combine HPV DNA testing alongside the Pap smear test.

Although Pap Smear is the most common form of screening for cervical cancer, its sensitivity is only 50%. That’s why doctors are now advocating that along with the Pap smear, patients should also do HPV testing. HPV testing is 99% sensitive.

“If there is an option for HPV screening, we would advise the patient to do it as Pap Smear alone is not sufficient to identify potential issues with the cervix,” Dr Kavitha says.

“There needs to be more awareness on the HPV test and how it is a more accurate form of screening. The sensitivity is so high, you can repeat the HPV test every 5 years if confirmed negative,” she adds.

PROTECT YOURSELF AGAINST CERVICAL CANCER!

PROTECT YOURSELF AGAINST CERVICAL CANCER!

May 8, 2022   Return

Dr-Ganesh-Ramachandr...

 

WORDS HANNAH MAY-LEE WONG

 

Cervical cancer is a type of cancer that grows on the cervix—the lower part of the uterus which connects the uterus to the vagina. Most cases of cervical cancer are caused by the human papilloma virus (HPV). 

Associate Professor Dr Ganesh Ramachandran notes that there are almost 100 subtypes of HPV. That said, not all HPV cause cancer.

He explains that cervical cancer does not occur immediately after exposure to HPV. In fact, about 90% of women recover after a HPV infection.

However, some types of HPV infections can progress to pre-cancerous lesions and subsequently may cause cancer. “Generally, this takes about 15 to 20 years in otherwise healthy women. In women with a weakened immune system, this may take up to 5 to 10 years,” Dr Ramachandran says.

 

Get vaccinated

Vaccination against HPV is an effective way of preventing cervical cancer. “It has been reported that the number of HPV infections and pre-cancerous lesions has dropped in countries with a vaccination programme, and in time this should lead to a drop in new cervical cancer cases,” Dr Ramachandran adds.

Adopting a healthy lifestyle, going for regular pap smears, and using self-testing kits for HPV also play an important role in preventing cervical cancer.

The Breastfeeding Adventures of a Modern Day Mommy

The Breastfeeding Adventures of a Modern Day Mommy

May 8, 2022   Return

Dr Tan Sue Yee is a lecturer at the International Medical University – she specialises in matters related to healthy diets and good nutrition – and an active member of the Nutrition Society of Malaysia. She is also the mother of Yong En, who will turn 4 this August, and Yong Hui, who just turned 5 months old in April. Dr Tan exclusively breastfed Yong En – this means offering her daughter only breast milk and not other kinds of milk for the first 6 months of life – and continued breastfeeding for nearly 2 years (even after her daughter started on complementary food at 6 months onwards), and she is currently doing the same with Yong Hui.

When HealthToday caught up with her recently, it was a perfect opportunity to ask her, “You’re a mother who breastfeeds both her darlings, so what was the experience really like?”

Mommy’s getting ready

Experts always tell mothers who are expecting their first baby to research as much as they can on breastfeeding. This helps to clear any doubt or confusion.

Dr Tan says, “I am on the panel of a programme called MyNutriBaby, which is spearheaded by the Nutrition Society of Malaysia to provide information and resources for mothers who wish to optimise their children’s nutrition. In this programme, I have the opportunity to work with Pn Fatimah Salim, a lactation specialist.

“I was carrying Yong En when we first met, so I peppered Pn Fatimah with so many questions! What was it like? What can go wrong, and how can I overcome the problem? What if the baby cries? How do I know when baby is hungry or full?

“Pn Fatimah was patient and kind enough to answer my questions, so when Yong En finally arrived in this world, I had a good idea on how to do things right.”

The experts are right: it is good to look up breastfeeding or discuss the matter with lactation specialists, mothers who have breastfed, etc. However, Dr Tan points out that it is important to get the correct information from reputable sources. Like everything else, breastfeeding has its share of misconceptions and urban legends! Interested or curious moms (and dads) can start with www.mynutribaby.org,my, the website of the programme Dr Tan participates in.

The first time

Welcome the baby with the best food Mom can provide: breast milk. So say the experts, who advise moms to breastfeed as soon as possible. Cradle the baby close – bare skin contact is preferred – and, if the baby does not instinctively reach for the nipple, gently guide the baby’s mouth to the right place.

“With my eldest, Yong En, everything went smoothly. Yong Hui, however, needs some guidance in getting the first time right – it took about 40 minutes before she could breastfeed properly,” says Dr Tan. “Believe it or not, I wasn’t too upset. I guided her and I was actually overjoyed when Yong Hui finally succeeded in latching on to my breast!”

Babies are just like their parents, they are born with their own personalities and quirks. Some learn fast, while others need a little nudge and guidance in the right direction. Therefore, if your baby takes some time to latch properly, Dr Tan advises patience. Relax to the calming sound of your little one’s heart beating against your skin. Your baby will get the hang of it soon. If you need any help, contact the nurse. Many baby-friendly maternity wards have nurses and lactation specialists who are always willing to lend a helping hand.

Breastfeeding on demand

The baby will probably get hungry every few hours, so mothers should observe for hunger cues – such as tears, grasping movements reaching towards the mother’s nipple, etc – and breastfeed when the cues are present. This practice is called “breastfeeding on demand”.

Many new mothers may find it challenging to switch from a past routine, in which they were always on the move, into one where they are now – as some mothers smilingly put it – their baby’s amazing milk factory. They will find themselves breastfeeding often – not surprising, as Dr Tan explains that a baby’s stomach has a small volume, so the baby will get hungry quickly.

She adds, “To many mothers, breastfeeding on demand may seem tiring or confining, but in my experience with both my kids, it is not so bad! Breastfeeding is an opportunity to bond with the little ones, an experience that is both emotionally rewarding and satisfying.”                               

Dr Tan’s tips for a less stressful breastfeeding on demand experience:

  • Rest, even sleep, while breastfeeding. Babies tend to cuddle up for a nap after filling their tummies, so why not join them in dreamland?
  • Play your favourite calming music or catch up on your favourite shows or books while breastfeeding. Make the experience more enjoyable by having drinks and snacks within easy reach.
  • Breastfeed on a comfortable chair with good back support.
  • Stay positive. Instead of groaning and focusing on the stress and exhaustion, think of the feelings of calm and joy you experience when you breastfeed your baby. If it makes you feel better, think also of the benefits you are getting. Breastfeeding helps new mothers lose those post-pregnancy kilos!
  • Give and take a little. Because you are now breastfeeding on demand, you may not be able to keep the house as tidy as you used to, and sometimes you may not have the time or energy to cook or do housework. This is fine; don’t get worked up over it. Just ask your partner and other family members to help. You may be surprised at how willing they can be to give the new mother a helping hand as well as lots of emotional support!

Night feeding

Babies get hungry at night too, so experts advise mothers to be prepared to breastfeed at night too.

The bane of every mother contemplating breastfeeding: having to wake up at ungodly hours of the night to the cries of a hungry baby, not to mention feeling a considerable degree of resentment for the slumbering hubby… especially if he is the one who wakes up the mother and tells her to go feed the baby as the baby’s crying is interrupting his sleep!

“It’s not easy,” said Dr Tan with a laugh, “but it’s not impossible either. For me, when I choose to breastfeed, it is a commitment I have made to myself and my babies. It is my choice, to do something that I know is best for my children, so I always try to focus on the positive aspects of what I am doing.”

Furthermore, night feeding is also important for a mother to have a more successful breastfeeding experience, as mothers produce more milk at night.

Night parenting tips for new moms:

  • Have realistic expectations. Some babies may need more feeding throughout the night, others less. If your baby falls into the first group, make adjustments to accommodate night feeding. For example, you can try catching more naps during the day.   
  • You can wake the baby for a breastfeeding session before you go to sleep. That way, your baby will feel hungry a bit later, thus giving you some decent amount of sleep before your night feeding sessions start.                                                
  • Try to offer both breasts, so that your baby will have a full tummy each time. 
  • Check your baby’s diapers each time before a feed, and change them if necessary. Babies sleep easier when their diapers are dry and comfortable.
  • Have the baby sleep in the same room so he or she is closer to you, to make night feedings more convenient.
  • When things get tough, remember why you wanted to breastfeed, and revisit your goals if you need some extra motivation. Also, if you approach night feedings with a positive attitude, you may begin to appreciate how each session is a peaceful moment for just the two of you – magical moments that you will cherish for life.

The importance of support

Experts point out that a breastfeeding mom’s chances of success improve significantly if she receives support from the people around her, especially her spouse and close family members.

Dr Tan agrees. “My husband was – is! – fantastic when it comes to supporting me,” she gushes. “My mother and mother-in-law are fabulous too. They help me around the house, as well as encouraging me and keeping my spirits high!”

If your husband, parents or in-laws do not share your views on breastfeeding, Dr Tan recommends involving them in your medical appointments, antenatal/parenting classes, etc. She frequently gives talks on child nutrition, and she has seen doubtful attendees eventually becoming interested in breastfeeding once the topic is discussed. “Often, their doubts or reluctance come from having incomplete or inaccurate information,” she says. “But when they learn of the benefits of breastfeeding, they often come around!”

Milk supply woes

Experts say that the more you breastfeed on demand, the more milk your body will produce, so there should not be any supply shortage problem.

Dr Tan never encountered any milk supply issues while breastfeeding both her daughters.

First, she addresses some common misconceptions. Women can breastfeed even if they have small breasts, flat nipples or inverted nipples. Breast milk production is regulated by hormones, and is not affected by breast size or nipple shape.

“If a mother is unable to produce breast milk, often it is not an issue of inadequate breast milk; usually it’s due to stress or the baby not latching properly to initiate the ‘let down’ which releases milk,” explains Dr Tan. A family member once found that she could not produce enough milk for her baby, but once the other family members cared for the baby to give her some time to compose herself and relax, she could breastfeed the next time she tried. “Some mothers, especially first-time mothers, can become anxious or worried when they try to breastfeed, and the stress affects the hormones and hence breast milk flow.”

She recommends relaxation methods such as listening to music or even getting some “me time” to calm one’s nerves before trying again.

On the other hand, hormone imbalance could affect breast milk production (although this is not a very common occurrence). If all efforts to calm down still fail to resolve the milk supply issue, it may be worthwhile to see a doctor to investigate the matter further. For issues of baby latching, seek the help of a lactation specialist.

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When a Breastfeeding Mommy Goes Back to Work

When a Breastfeeding Mommy Goes Back to Work

May 8, 2022   Return

Time can pass very quickly when one is a mother. It seemed like it was only yesterday when one’s child was just an adorable baby, and she seems to be growing up so quickly with every day!

Also, just around the corner is the end of the mothers’ maternity leave. While some mothers may welcome a return to a familiar routine, most may experience a twinge of concern about how they can continue to breastfeed their little ones when they return to work.

It’s best to get prepared early

“Getting everything in place early helps the mother resume work knowing that her baby is in good hands,” Dr Tan Sue Yee says. “It also allows the mother and her baby to transition smoothly into a new routine that allows the baby to continue to receive the goodness of breast milk.”

What is the new routine like?

Generally, life on a working day for Mom and her baby can go about like this:

  • Mom breastfeeds her baby before she goes to work.
  • When she drops off her baby at the babysitter, she also drops off a day’s supply of expressed breast milk for her baby. Moms have a good idea by then how much milk their baby needs in a day, but it is good to leave some extra in case Mom is late in picking up her baby due to traffic jams, etc.
  • The babysitter cares for the baby. She stores the expressed breast milk properly in the fridge, thaws and warms the breast milk to give to the baby.
  • Mom comes home after a day’s work and breastfeeds the baby.

There are a few things Mom (and Dad) should look into before it is time to go to work.

#1 Decide how to express breast milk.

A breast pump is a popular option, as it allows Mom to collect and store her breast milk, which can then be fed to the baby by the caregiver while Mom is at work. The other option is to express breast milk by hand. Moms prefer breast pumps due to the convenience offered by these devices.

Dr Tan explains that there are two main types of breast pumps available: manual (that requires Mom to keep squeezing a handle to collect breast milk) and electric-powered ones. These breast pumps have either a single pump, which collects milk from one breast at a time) or double pumps, which collect milk from both breasts at the same time. Prices may vary depending on the brand and the features of the breast pump, but it is not always necessary to get the most expensive one. Many Moms have gotten by just fine with manual pumps or more inexpensive electric-powered ones.

There are many breast pumps available in the market, so how does one choose? Dr Tan advises Moms to ask family members or friends who have breastfed for recommendations. They can even borrow breast pumps from these people for ‘test runs’.

Some criteria to consider when choosing a breast pump are:

  • Is it comfortable to use?
  • Do you find it easy to use?
  • Do you find it easy to clean and sterilize?
  • Are you comfortable with the amount of noise it produces?
  • And, of course, is its price within your budget?

Note that it is a good practice to sterilize breast pumps before use. This can be done by using a sterilizer or just immersing the breast pump in boiling water for 10-15 minutes. After use, wash the breast pump immediately. Doing all this helps reduce the risk of germs contaminating expressed breast milk.

#2 Learn how to store and prepare expressed breast milk for your baby.

Dr Tan Sue Yee explains that there is a simple art to storing breast milk: label the date of collection (and the baby’s name too, if the baby’s caregiver has more than one young charge to care for) on the container. When storing breast milk in the fridge, place the newest ones at the back. This way, Moms will always use the older milk first and there is less chance of milk still being kept after it has spoiled.

Breast milk should be kept in the coldest part of the fridge or freezer. The table below shows how long breast milk can keep at certain temperatures.

  • Room temperature – 4 hours
  • The regular space in the fridge (2-4°C) – 8 days
  • The freezer (0°C and below) – 2 weeks

“This is why labeling the date of collection properly and accurately is important,” Dr Tan says. “We don’t want to store spoiled milk and accidentally give it to the baby.”

When it comes to preparing the breast milk for the baby, it is pretty simple.

  • Thaw and warm the milk by placing the container in a bowl of warm water.
  • Moms may find fatty blob-like globules in the milk. This is normal, as they are just milk fat that has become separated from the rest of the milk. Just shake the milk gently and the appearance of the milk will be back to normal.
  • If the milk has a soapy or metallic smell, it is still fine to be consumed. On the other hand, do not use breast milk that smells sour or rancid – such a smell is a sign that it has spoiled.
  • Moms can test whether the milk is ready to drink by tipping a few drops onto the inside of their wrist. If the milk feels lukewarm, it is ready for the baby’s tummy.
  • A word of caution: do not use a microwave to thaw or warm the milk! Doing so creates pockets of heat in the milk which can scald the baby’s tongue and mouth. Also, discard any leftover milk.

#3 Prepare your baby for this new way of feeding.

Babies need some time to get used to new things – sometimes even longer than adults! – so about 2 weeks before Mom goes back to work, she can introduce feeding expressed breast milk to her baby. Dr Tan recommends, if possible, to get someone else to feed the baby during these sessions,  so that she would be comfortable being fed by another person once Mom goes back to work.

Dr Tan explains that, to do this, Moms can start by replacing one breastfeeding session with expressed breast milk, and slowly replace more breastfeeding sessions as the days pass.

#4 Find the right person to care for your baby.

The right person isn’t just someone who is good with the baby – she must also understand how to store and prepare breast milk. “A friend of mine once placed her daughter under this babysitter’s care,” Dr Tan recalls, “only to discover, when she went back to retrieve something she left behind, that the babysitter boiled the expressed milk directly in a pot!”

Therefore, Moms should take time to talk with a prospective babysitter or the family relative who will care for the baby. Feel free to demonstrate on how to store and prepare expressed breast milk, if that will help them understand better. If the babysitter is not working out, they should not hesitate to look for one that is more understanding about their baby’s needs.

#5 Other things to do

Moms should also check to make sure that they can comfortably express breast milk back at their workplace.

  • It won’t hurt for the Mom to let the employer or her immediate colleagues know that she wants to take some time out every day at work to express breast milk. This may sound daunting, but Dr Tan assures Moms that there are many women today who express breast milk while at work, so there is usually strong support for such Moms at the workplace.
  • Some workplaces have special rooms for Moms to do this. If the Mom’s workplace does not have this facility, however, she can make enquiries in advance. Are there any places that she can use, such as an unoccupied meeting room? (Storerooms are not recommended, but they are an option if the employer does not provide any other option.)
  • Does the pantry have a refrigerator that the Mom can use to keep her expressed breast milk, and will her colleagues be comfortable if she does this? Is the temperature of the fridge right? Moms can bring cooler bags containing ice packs to store their breast milk if there is no available storage at work.
  • Last but not least, take plenty of pictures of the baby on the phone. Looking at them will make the temporary separation from the baby much easier to bear! “And stimulation the production and flow of breast milk too!” adds Dr Tan.

#6 And, of course, breastfeed when you’re back from work.

Even when the baby is comfortable with being fed expressed breast milk, there is always time and place for breastfeeding. After all, breastfeeding also provides emotional benefits for both Mom and her baby, and many Moms find that breastfeeding their precious little darling is a great way to de-stress after a hard day’s work.

E_TSY1

 

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Screening the Baby Bump

Screening the Baby Bump

May 8, 2022   Return

The longer a couple wait to have a child, their risk of having a baby that carries a genetic disease (Down syndrome, Patau syndrome, etc) increases. This is because the egg and the sperm both have a higher chance of becoming defective as one ages. This is especially documented in women. Table 1 shows the risk of a woman bearing a child with Down syndrome as she ages.

Table 1. A woman’s risk of bearing a child with Down syndrome

Maternal ageRisk of Down Syndrome
251 in 1,300
301 in 850
351 in 340
401 in 100

Many fertility centres offer genetic screening service as an add-on to various fertility treatment packages. While it is not compulsory, it may be worth considering in the following situations:

  • Parents-to-be with a family history of genetic disorders and birth defects.
  • Parents-to-be who are aged 40 years or older, especially the mother-to-be.
  • Mothers-to-be with a history of miscarriages or have previous children with birth defects, mental handicap or genetic disorders.

The cost varies. Screening for rare genetic mutations usually cost more, as the specimen may have to be sent to laboratories overseas for analysis.

Types of genetic screening

  • Pre-conception genetic screening. This checks whether the parents are carrying genes that put any child they conceive at risk of developing a genetic disorder.
  • Pre-implantation genetic screening. A sample of cells is carefully extracted from the foetus at the early stage of pregnancy to determine whether there is any genetic abnormality present.
  • Prenatal genetic screening. This is to test whether the baby has genetic disorders. More recent methods such as non-invasive prenatal diagnosis (NIPD) allow for less invasive screening with lower risk to the child one is carrying.

Each type of screening is not 100% accurate, so there is a possibility that a baby is born with a genetic disorder despite having negative results, or vice-versa. Depending on the risk, the fertility specialist may encourage the parents to take one or more, maybe even all three types of screening.

The benefits of screening

Knowledge is power, as the saying goes. Indeed, knowing that there is a possibility of the child having a genetic disorder allows the parents to be emotionally prepared to raise a special needs child when the time arrives. The parents have time to consult in advance specialists on the needs of the child, make arrangements for the child’s education and caregiving needs, and even make necessary financial arrangements. By having the time to consult necessary experts and advisors, parents will not be caught unaware when the child arrives into their lives.

Also, by being emotionally prepared to raise the special needs child, the parents would be less likely to face conflicts and challenges that could come in the way of their relationship. 

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Taking a Shot for Two

Taking a Shot for Two

May 7, 2022   Return

For every mother-to-be, she will do all in her power to ensure the safety and well-being of the little one she is carrying. However, many often overlook one important aspect of protection: immunization. 

Women are generally encouraged to get immunized before pregnancy, as not all vaccines are safe during pregnancy. Doing so allows her to build up a store of antibodies and strengthen her immune system before pregnancy (which is when the immune system is naturally weaker than normal). If she has not been able to get herself immunized prior to pregnancy, it is advisable to do so post-pregnancy, as most vaccines are safe during breast-feeding. However, healthcare practitioners will ultimately decide if the benefits of getting immunized outweigh the risks to the mother and baby.

The following few vaccines are considered safe for pregnant women who may have a risk of infection:

  • Hepatitis B – Hepatitis B is a serious infectious disease commonly transmitted from an infected mother to her child during childbirth. It affects the liver, and can be potentially life-threatening. Women who yet to receive this shot when they were younger, and are found to be at high risk of contracting this disease while  testing negative for the virus can receive this vaccine.
  • Influenza – A bout of serious influenza infection can cause severe complications during pregnancy. The influenza quadrivalent vaccine can protect the mother from a serious infection during pregnancy. It can be received before pregnancy, or at any stage of pregnancy, or after pregnancy. It is quite safe for both the mother and her baby.
  • Tetanus/ Diphtheria/ Pertussis – This combination vaccination, also referred to as the adult DTaP (diphtheria, tetanus, acellular pertussis) vaccine is recommended in the third trimester of pregnancy, ideally between 27 and 32 weeks of gestation. Newborns are too young to receive vaccinations against these three potentially life-threatening diseases, so it is up to the mother and the other adults around the newborn child to protect him or her from these diseases. Women who have not received this shot should consult the doctor on the possibility of getting it.

For most of the other adult vaccines, their safety during pregnancy has yet to be established. It is best to discuss them with your doctor, so your doctor can then assess the benefits against the risks of these shots for you.

References:

1. BabyCenter. Available at www.babycenter.com

2. Centers for Disease Control and Prevention. Available at www.cdc.gov

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