Thursday, November 11, 2010

Heavy Workload!

Dear Readers,

Due to very heavy workload in the hospital, I could only occasionally update the blog.

The readers can refer to my earlier postings which are still useful and relevant.

I will try my best to find time to update the blog and reply to your email.

Dr Jason




Blockage of Fallopian tubes (输卵管堵塞)

Dear Dr Jason,
My name is B and I am a friend of E.
She has given to me your contact, hoping to get your advise on the side effects of laproscopi surgery.
I had gone through this HSG test few weeks ago and the result from the X-Ray was not so good.
My gynae suspect that both sides of my tube fallopion are blocked, and thus advise me for a laproscopi surgery to further confirm.
Pls advise if laproscopi is only useful to find out the root cause of the blockage or is it useful to unblock the blocked tube as well.
What is the side effects of doing the laproscopi ?
Will there be any damage (permenant) if laproscopi is not well done.
Need to hear your comment and expert advise before to proceed further.
TQ.
Confused,
Bonnie


........................................................................................

Hi, B,

1) It is very unfortunate to hear that you have blockage of fallopian tubes from HSG.

2) You need further investigation to determine the reason of blockage.

3) I agree with your doctor that the next step of investigation is laparascopic surgery.

4) The result of HSG is not 100% reliable. Sometimes, the dye that used in HSG to flush the fallopian tubes could not flow through the tubes due to muscle constriction of the fallopian tubes. In this situation, your tubes are perfectly normal and the laparoscopic surgery will double confirmed this situation.

5) Laparoscopic surgery will further investigate for the underlying reason of blockage and treat accordingly.

6) Just like any other surgery, laparoscopy carries a small risk of complications, such as bowel injury, bladder injury and wound infection. However, the risk of complication is actually low.

7) If laparoscopy confirmed blockage of both tubes, you need to undergo test tube baby treatment if you keen to pregnant.


Dr Jason Ong

Thursday, July 29, 2010

Risks for Preterm Births May Be Higher Among Overweight Mothers





July 28, 2010 — Risks for preterm births may be higher among overweight and obese mothers, according to the results of a systematic review and meta-analyses reported in the July 20 issue of the BMJ.

Compared with normal-weight women, very obese women were at 70% greater risk for induced preterm birth before 37 weeks and at 82% greater risk for early preterm birth (before 32 or 33 weeks).

"Overweight and obese women have increased risks of preterm birth and induced preterm birth and, after accounting for publication bias, appeared to have increased risks of preterm birth overall," the study authors write. "The beneficial effects of maternal overweight and obesity on low birth weight were greater in developing countries and disappeared after accounting for publication bias."

"Future research is needed to try to determine why overweight and obese women are at risk of preterm birth, and to determine effective methods of weight loss in women of childbearing age before pregnancy," the study authors conclude. " ...Clinicians need to be aware that overweight or obesity in women is not protective against having infants of low birth weight and should consider surveillance when indicated. Ideally, overweight or obese women should have prepregnancy counselling so that they are informed of their perinatal risks and can try to optimise their weight before pregnancy."


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Personal advices :

1) Achieve an ideal body weight before pregnant. The ideal body weight should be between BMI 20 to 24.

2) Control your weight gain during pregnancy. The ideal weight gain during pregnancy is between 10kg to 15kg.


Tuesday, July 27, 2010

Some Caffeine Is Okay During Pregnancy


By Genevra Pittman

NEW YORK (Reuters Health) Jul 21 - A cup of coffee a day during pregnancy probably won't increase a woman's risk of miscarriage or premature birth, The American College of Obstetricians and Gynecologists said today.

Until recently, studies have had conflicting findings about the effect of moderate caffeine consumption on pregnancy complications.

But, "I think it's time to comfortably say that it's okay to have a cup of coffee during pregnancy," Dr. William Barth, the chair of a College committee which reviewed the evidence, told Reuters Health.

In a statement published online today in Obstetrics & Gynecology, the College's Committee on Obstetric Practice said that 200 mg of caffeine a day, about the amount in a 12-ounce cup of coffee, doesn't significantly contribute to miscarriages or premature births. That definition of "moderate caffeine consumption" would also include drinking about four 8-ounce cups of tea or more than five 12-ounce cans of soda a day, or eating six or seven dark chocolate bars.

The committee said the evidence was not clear on whether consuming more than 200 mg of caffeine a day might increase pregnancy risks.



Wednesday, July 21, 2010

Anti Tetanus Injection


Dear Dr,

I am currently pregnancy at 7 months. I followed up my pregnancy in the government clinic and also in the private hospital. This week, the nurse in government clinic gave me an injection for Anti Tetanus and another injection will be given next month.
But my gynae doctor in the private hospital said the injection is not necessary. May I know what is the purpose for the injection?

C.L
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Hi, CL,

Tetanus (破伤风) is an infection of the wound, particularly the dirty wound. For example if your hand is cut by a sharp object, the doctor usually will clean the wound with antiseptic and then routinely they will give you an anti tetanus injection.

After delivery, you will have an episiotomy wound in your private part. The purpose of this injection is to reduce the possibility of the tetanus infection in your episiotomy wound.

About 50 years ago, there were not many hospitals available in the country. Many pregnant mothers had to deliver their baby at home by using the traditional midwifes service. These midwife carried a bag of scissors and knife to the house and conduct the delivery in a not cleaned and hygienic environment. Some of the scissors may contain bacterias because they were not cleaned and aseptic.

After delivery, many mothers developed wound infection in the episiotomy part and some of them complicated by serious tetanus infection.

As a result, all the pregnant ladies during that time need to receive anti Tetanus injection before the delivery to prevent wound infection.

However, this injection is not compulsory any more nowaday if you decide to deliver your baby in the hospital setting. The instruments in the hospital are properly cleaned and aseptic. Some of the instruments like needle, blade and suture are disposable. They are used once only before throwing away. So the risk of wound infection is very low.

This anti tetanus injection may cause fever, muscle pain and allergic reaction. For these reasons most of the private gynaecologist have stopped giving this injection.

However, the government clinic still continue to give the injection until today to every pregnant mothers, because some of them still prefer to deliver at home by the traditional midwifes, especially those stay in the rural kampung, Sabah, Sarawak and the Orang Asli.


So, CL, I agree with your gynae doctor that this injection is not important as far as you deliver your baby in the hospital setting.

Thursday, July 8, 2010


Some news to share.


龙凤胎早夭 伤心外婆申诉:护士叫我

女儿自己生

二零一零年七月七日 下午五时四十三分

(槟城7日讯)一名伤心外婆带着失去龙凤双胞胎的女儿向郭庭恺申诉,声称其女儿在槟城医院早产时,护士只顾着聊天,把她女儿留在产房独自待产,还告诉她“是这样的,给她自己生啦!”

这名伤心外婆是55岁的黄秀菁,她周三早上带着刚失去一对5个月大龙凤胎的女儿沈咪咪(34岁)到玻璃池滑区州议员郭庭恺服务中心,在郭庭恺陪同下向媒体申诉其女儿的不幸遭遇,并对医护人员当时的态度不满。

沈咪咪表示,当她怀孕4个多月时,发现自己来红,并于上个月2日前往私人医院做检查。经过检查后,医生告诉她说其下体宽度太大,必须马上进行缝针手术,而手术后必须留院一段时间接受观察。

为了胎儿安全,她答应进行手术,并在私人医院住一周。由于私人医院医药费昂贵,她于上月9日向院方申请转至槟城中央医院。当天下午,她和母亲拿着医生的转院通知书,到中央医院柜台准备办理手续,才被告知必须到中央医院对面的妇产科医院做检查。

医护人员态度不友善

她和母亲不熟悉中央医院运作,想要问清楚时却遭一名医护人员无礼对待,以不友善口气告诉她说说,“因为怀孕不足5个月,她必须直接到妇产医院接受检查。”

当她和母亲到妇产医院办理入院手续后,当值护士表示要为她抽血检查,但她当时体质衰弱,被护士抽了2次血后即晕倒和出现抽搐情况。她休息一阵后,该名护士表示,之前被抽的血量不够,又向她抽2次血。

羊胎水破 当时怀胎5个月

在住院期间,她于19日发现来红和肚子痛,于是告诉病房当值医生,该名医生向主管医生请示后,向她表示她的睡姿错误,给她调整正确姿势。至于她肚子痛,医生说可能是尿道发炎。直到6月20日凌晨2时许,她突然羊胎水破,当值护士前后找来2个医生为她检查。不过,医生告诉她胎儿只有5个月大,即使出世后也会夭折,因此叫她要有心理准备。

女儿一人在产房

之后,医生帮她打了一支针后,便由护士推她到产房,留下她一人在产房里待产。当时,她知道一对儿女将会夭折而非常伤心,在产房内只有她一人,她觉得非常害怕,于是拨电通知母亲。黄秀菁接获女儿电话后,在凌晨4时许和丈夫抵达意愿,苦苦哀求后才获得院方通融让她进入产房陪伴女儿。当她进入产房后惊见只有女儿一人,便到病房外向正在聊天的护士查问:为什么没有医生或护士接生。岂知,一名护士告诉她说,“是这样的,给她自己生啦!”母亲听到这话后,无可奈何地在外陪着。

没人接生 独自产下2婴

沈咪咪说,当天凌晨5时50分,她独自在产房内产下第一个胎儿,36分钟后才产下第二个,这段时间内都没人跟她接生,当她生产完后,才有护士为她处理伤口,而其夭折的双胞胎儿也只是被护士马虎处理。

由于她当时流血不止,医生和护士用一把塑胶支撑钳撑开她下体,支撑钳突然断掉。当护士为她输血时,把针筒刺入她手臂后,才发现血包上的身份证号码有异,于是该名护士马上拔出针筒后,向其他护士查询。所幸,血包上的身份证号码只是书写错误,而不是拿错血包。

医生称须切除子宫保命

到中午,黄秀菁见女儿还未从产房出来,而且看到很多医生在产房内,便问一医生女儿情况。“当时医生说她下体流血未止,若情况没改善,须切除子宫保命。”

她担心女儿情况有变,致电女儿之前在私人医院主诊医生咨询,并在该医生建议下,向槟城医院申请转院回到私人医院接受治疗。她说,当时中央医院执勤医生以需要主管医生批准为理由,拒绝让其女儿转院,经过一段时间交涉后,她才成功为女儿转院。

当私人医院的医生为女儿检查后,告诉她女儿的情况良好,没有切除子宫的必要。对此,她不满当时中央医院的医生把女儿的实际情况“恶化”。黄秀菁和沈咪咪母女针对槟城医院医护人员的疏忽和恶劣态度表不满,并对政府医院服务失信心。沈咪咪透露,其8岁大儿子当时是在槟城妇产医院生产,但当时没这情况。

投诉医院无下文 郭庭恺促卫生部关注

玻璃池滑州议员郭庭恺表示会针对这起事件,修书向卫生部、卫生局、槟城医院等相关单位作出投诉。他说,他本身已接获不少关于中央医院的服务和医护人员恶劣态度的投诉,他也向院方和各相关单位作出反映,但都没下文,槟城医院总监更不曾给他任何回复。

他认为,卫生部应重视这些投诉,同时也对目前医院的体系制度进行改革和实行问责制。因为,过去有很多医院疏忽事件中,都没有人需要负责。他希望院方提升医护人员的服务态度和跟病人或家属说话的技巧。

看着婴儿衣 伤心妈妈红了眼眶

(槟岛西南区7日讯)伤心妈妈看着新生婴儿的衣服,不禁眼眶红了,她似在拼命眨眼忍住眼泪!

虽然沈咪咪还未为新生儿购买新衣服及用品,不过,他和母亲一早已收拾好长子黄俊彬(8岁)小时所穿过的衣服,准备在迎接第二个小生命时,让双胞胎穿。

有关的衣物包括了精巧可爱的鞋子、尿布等,还有一套俊彬之前从未穿过的新衣,由于婴儿衣服收藏已久,咪咪和母亲原本准备再过不久,就将有关衣服重新拿去清洗,岂料,衣服还没洗,孩子就这样没了,怎不教一家人伤心?

身子看起来还很虚弱的咪咪指出,长子的衣物和用品是在她怀胎7、8个月时才买。因此,她目前未想过这么早为新生儿添购衣物。

相关照片

■ 黄秀菁和沈咪咪母女在郭庭恺的陪同下,向媒体申诉她的悲惨遭遇。

■ 黄秀菁表示不满值班护士告诉她给女儿自己生。

■ 沈咪咪提及她一对夭折的双胞胎时数度流泪。

■ 望着这些暂时派不上场的婴儿用品,咪咪不禁悲从中来,眼眶泛红。

■ 如宝宝穿上这可爱的小鞋子,小脚丫显得更活泼可爱。

■ 这套崭新的婴儿衣物,是亲戚赠送大儿子,但从未拆开过,咪咪打算留给即将诞生的宝宝。

Placenta Previa (前置胎盘)


Hi Dr Jason,
thank you for creating a informative blog to share with all of us.
Im 16 weeks pregnant at the age of 34. this is my 2nd pregnancy after 4 years. My eldest daughter was a C-section baby due to low lying placenta.
I just wonder for this 2nd pregnancy, will I bear the same risk of this kind of complication?
thank you
best regards

Lim


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Diagram on the left : A normal placental location

Diagram on the right : Placenta previa where the cervix is fully covered by the placenta.



Hi, Lim,

Placenta previa is caused by abnormal placenta implantation into the lower part of the uterus where the cervix is completely or partially covered by the placenta tissue.

This situation is dangerous as the baby is unable to go through the birth channel due to the placenta obstruction at the cervix.
Sometimes, it may cause heavy bleeding during pregnancy and potentially risky to both the mother and baby.

The risk of recurrence of placenta previa in the subsequent pregnancy is around 20 percent.
It means you stand a high risk for this problem to happen again.

To make thing worse, a recurrent placenta previa with a previous caesarean delivery will significantly increase the risk of placenta accreta.

Placenta accreta is referred to a condition where the wall of uterus is infiltrated by the placenta tissue, particularly the wall around your surgical site in uterus.

The placenta issue may invade the uterine wall and as a result the placenta tissue is unable to separate from the uterus after delivery.

If this situation happens, it will cause heavy bleeding after delivery and sometimes the doctor need to remove the uterus in order to save life.

Your doctor should be able to determine the early placenta location after 3 months of pregnancy. If after seven months of pregnancy the location remained low lying, then the placenta previa is confirmed.

Dr Jason Ong


Wednesday, June 30, 2010

Money! Money! Money!


In this era of hyperinflation, our spending power is limited due to increasing cost of living and stagnant economy growth.

It is very common to hear the young couples complain of high cost of maintaining a family, particularly after having a baby.

Many of my young patients complained of high cost of having a baby due to expensive private medical care and high expenditure during confinement. To make thing worse, their salary is stagnant for years........

I could feel that many of them are under financial distress and personally I have a strong empathy to them.

Pregnancy should be a joyful moment in your lifetime because a newborn baby will bring happiness to your family. However, high cost of pregnancy and delivery may deter many of you from taking up this responsibility.

The delivery package in most of the private hospitals is getting expensive over the years. Generally, private hospitals in Klang Valley charge around RM 3000 for a normal birth package and between RM6,000 to RM 8,000 for caesarean delivery.
In Penang, the normal birth package is around RM 2,000 to RM 3,000 and caesarean delivery is around RM 4,000 to RM 5,000.

The hospitals are under pressure to increase the charges due to expensive medical instruments and medicine with most of them are imported from overseas and the cost will be passed down to the patients.

In my subsequent blog, I will give you a few tips to reduce your financial burden during pregnancy...so just stay tune!

Meanwhile, I would like to hear from you. Are you spending too much to have a baby ?

Please leave a comment.


Tuesday, June 29, 2010

Less Active Baby !

Dr Jason,

Recently my baby will move certain time per day include morning. But today since morning he is not moving, even i call him or touch on my stomach also he never move. What can I do? Is it consider normal situation? Thank you.


Regards,

S J


..................................................................................................

Hi, S J

Normally your baby needs to move more than ten times from 9am to 7 pm. If you feel that your baby' movement is less than ten times, you need to immediately take your meal and count again. Sometimes, baby has less movement because of low blood sugar, particularly after 7 months when your baby's demand for food is higher.

Occasionally, baby has less movement because after 7 months the space inside your womb is limited. Your baby is clamped inside the womb due to his own body size.

However, extra precaution should be taken if you still sense less movement despite after taking your food. You need to consult me as soon as possible if the problem persist.

You can give me a call if the movement is still not improved.

Dr jason

Thursday, June 10, 2010

Tiger vs Dragon

This year 2010 is the year of tiger


Due to the Chinese traditional belief, the year of tiger is not suitable for pregnancy and delivery.
Generally people believe the tiger babies are not auspicious and may bring bad luck to the family.
Because of that, this year most of the hospitals registered a decline in the number of newborn babies and most of the gynae doctors have more time to 'lepak' because of less patients.


2012 is the year of dragon

2 years later will be the year of dragon. Many people believe the dragon babies will bring luck and prosperity to the family.
I have many patients come to see me specifically asking for the best time to pregnant if they want a dragon baby.During the last dragon year 10 years ago, most of the hospitals registered a sudden increased in delivery by 10% to 20%.

However in real life, is it good to have your baby delivered in the dragon year?

A sudden increase in the number of babies may bring unexpected problems to your family and society:

1) You need to wait longer to see a gynaecologist due to increase in the number of patients. But it is good for doctors who can get better income : )

2) You may face problem to employ a confinement lady. The confinement lady may take the opportunity to increase the charges.

3) By the time your child start schooling, he/she needs to study in a crowded classroom. The teachers may not able to give individual attention to your child because of big classes.

4) Your child need to compete with more students to gain entrance to the university or scholarship awards. The univerisity will not offer more places for the dragon babies. At the same time, the number of scholarship will not increase to accomodate more top scorers.

In conclusion, It is not sure our traditional belief of auspicious dragon babies is true.
But one thing for sure, the dragon babies really bring more prosperity to the gynae doctors due to more business :)

Monday, May 31, 2010

Ugly Caesarean Scar



Dear Dr. Jason,

您好。我是YL.

我在去年十二月剖腹后至现在已差不多六个月了。外表伤口从起初密得蛮漂亮,但这两个月伤口处就凸出小小的小肉块。我听别人说这肉会随着时间越长越多。请问这消息是真的吗?我需要回去你哪儿再复诊吗? 您的回复我感激不尽。


谢谢


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One of the common problems faced by the patients with caesarean delivery is scar keloid formation.

Keloid is referred to the thickening of the surgical scar and formation of a layer of thick tissue on top of the scar.

Because of keloid, the surgical scar looks very prominent and ugly.






Thickened and ugly caesarean scar due to keloid


Not all the patients develop keloid after the surgery.

Your body genetic composition is the main factor in developing this problem. You are inherited with the gene that promote keloid formation.

Many patients mistakenly blame the doctors for poor surgical skills, but in fact the problem is primarily caused by your skin condition.


A better surgical scar with less keloid




A good skin healing without keloid




For my past 13 years of practice as a doctor in Malaysia, I noticed that the Indian patients generally recovered better with less keloid problem.
Malay and Chinese patients tend to face more keloid problem after the caesarean delivery.

Typically, the keloid will appear after 3 months of the surgery and it will progressively worsen until about 1 year after the surgery.

Luckily, many of them the keloid will slowly disappear and become less prominent after 2 to 3 years.

There are many preventive steps you can take to prevent this problem :

1) Avoid unneccessary ceasarean delivery if you know that keloid is a family inheritance problem within your family, or your past surgical experience which left a prominent keloid.

2) Apply tight compression to the surgical wound 1 month after the surgery. Wearing a tight body bandage or tight underwear to compress the scar may prevent the keloid.

3) DON"T scratch the scar eventhough you feel itchy. The more you scratch, the worse it becomes.

4) Applying silicone gel or steroid scream to top of the scar 1 month after the surgery may reduce the severity.

5) Steroid injection into the scar after 1 month of the surgery may prevent and treat this problem. Monthly steroid injection into the scar will make the keloid slowly disappear.


Steroid injection into the keloid scar


6) Laser treatment is also effective and useful in this situation.



Wednesday, May 19, 2010

Bad Experience in The Confinement Centre


Anonymous said:

Good Day Doctor

i agree with u based on my own experience.during my 1st pregnancy,due to both of our parents are not able to take care of me n baby during my confinement, my husband and i hv decided to stay at confinement centre after delivery of the baby. i agreed to do so because is convenience to everyone.

finally,is time for my delivery.after discharge, i was sent to centre. i started feel sad as i was away from my husband. i can't control myself and keep crying when i m alone.i discussed with my husband and luckily we managed to employ a confinement lady who is my mum in law's friend in short notice. i was sent back to my own house after staying at centre for few days and my deposit are forfeited.

i feel so lucky that i hv make a right decision during that moment eventhough i hv lost some money.if not i will suffer with depression and no one will know what is the impact....

i m jz sharing my experience. different ppl will hv different opinion on this new trend. anyway home care will be my only choice in my next pregnancy.

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Hi, Anonymous,

Thank you for sharing your bad experience with all the readers.

I usually advise my patients to think twice before making the decision to stay in the confinement home.
I have seen many bad experiences from my patients who stayed in the confinement centre.

For Examples :

1) About 2 years ago, one of my patient successfully delivered a baby boy and after being discharged from the hospital, she was transferred to a confinement centre nearby my hospital. After staying there for 2 days, she noticed that the baby's head was swollen. The baby was crying persistently and refused breast milk.
She felt something went wrong and the baby was brought back to the hospital for further examination. After the X ray examination, we found that the baby had a fracture in the skull.
Upon further investigation, the confinement lady in the confinement centre said that the baby fell down from the sleeping cot with the head hitting the floor. The sleeping cot was about 1 meter in height from the floor !!
As a result, the baby suffered from head injury and skull fractured.
Apparently, the confinement centre employed mainly the Indonesian maids to take care of the babies.

2) About 1 year ago, there was an outbreak of infection to the newborn babies and one of the newborn baby was infected with the germs after delivery. The baby was admitted to hospital for treatment.
Upon discharged from hospital, the baby was transferred to a confinement centre because the mother was staying there.
Unfortunately, this sick baby brought the germs to the confinement centre and all the healthy babies in the confinement centre were subsequently transmitted with the disease.

3) I need to treat more cases of post partum blue ( Depression ) from the confinement centre.
You need to have plenty of family support during the confinement period to avoid the risk of depression.
Staying away from the family members is not a good idea !

4) Few of my patients were admitted to hospital because of food poisoning in the confinement centre.

The above mentioned examples are based on my personal experience and it is not my intention to run down the service in the confinement centre.




Tuesday, May 11, 2010

Reply To HooiHooi


Dr,
HooiHooi again. :D
A lot thanks for my safe delivery process!

I decided to breastfeed my baby since pregnant. And I manage to do so after came back from hospital. But during baby 13th days old, his jaundice level, bilirubin reading still 13+mg/dl. Paediatrician suggested I admitted baby for phototherapy and stop breastmilk for 2 days. And my baby bilirubin level drop to 9+mg/dl and discharged yesterday. BUT, paediatrician suggests me to only give baby breastmilk twice a day, others meal give formula milk for 1 week untill next follow-up. I am not so agree with this decision. May I know your opinion on the point of a gynae?

My baby can drink well, pee and poo well, awake and play 2-3 intervals a day, for me, is consider quite active.

.......................................................................................

Hi, HooiHooi,

It is quite unusual for a doctor to make recommendation of stop breastfeeding because of jaundice.

There are many reasons a newborn baby developing jaundice. Although breastfeeding itself is a contributing factor, the jaundice caused by breastfeeding is usually mild and not serious.

Personally, I advise you to continue for the reasons as stated below:

1) By now your baby should be more than 2 weeks old now. It is very rare for the jaundice to persist beyond 2 weeks.

2) Your baby had received phototherapy and jaundice was subsiding. Once the level went down, it is very rare for it to go up again, except if the baby has other hidden causes.

3) Your baby is a full termed baby. The jaundice level of 13 mg/dl is not considered seriously high.

4) Reducing frequency of breastfeeding will cause reduction in breast milk production.

5) Breast engorgement is also a problem if you don't feed the baby frequently. Breast engorgement may cause fever to you.

6) Exclusive breastfeeding means you only supply breast milk to your baby. By adding formula milk will defeat the purpose of exclusive breastfeeding. The baby may refuse your breast milk later due to formula milk.

7) This is probably your last pregnancy. Breastfeeding is good to you to reduce risk of breast cancer.

Anyway, it is not my purpose to criticise your paediatrician, who is also my colleague. Maybe you should discuss with him to know why he made this recommendation.


Monday, May 10, 2010

Reply to Kellyy



Kellyy said :

Hi Dr Jason,

FYI, I'm currently on my 2nd pregnancy and about to deliver in 3weeks time. I'm planning to breast feed my baby as what i have done for my 1st one. The problem that I have previously is very low milk supply although I breastfeeded my son oftenly and right after birth. After a friend introduce fenugreek, my milk supply had slightly increased. My question is can i have the fenugreek right after labour? Will there be any side effect? I have constipation and piles problem. Will fenugreek worsen that?

Thanks,

Kellyy.


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Low breast milk production is a common problem faced by some of the new mothers who keen to breastfeed their babies.


Among the reasons contributing to low breast milk production :

1) Infrequent feeding resulting in low breast milk production. A regular 2 to 3 hours feeding interval is important to maintain the breastmilk production.

2) Delay in latching after the delivery to stimulate the breast milk production. This problem is commonly happened among the mothers with complicated labour and require caesarean delivery.

3) Inverted nipples which causes poor latching during feeding.

4) Poor suction from the baby to stimulate the breastmilk production.


There are few steps can be taken to help the production of breast milk:

1) Drink adequate amount of water during confinement period. The chinese traditional taboo believe that you should restrict the water intake during confinement. This practice is harmful and you are not encouaged to practice.

2) Increase the protein and calcium diet.

3) Learn a proper technique in breastfeeding. Improper feeding technique will cause poor suction from the baby. Please refer to this link to learn the proper techniques of breastfeeding.

http://drjasonong.blogspot.com/2009/12/breastfeeding-positions.html


4) Breast pump is helpful to extract and stimulate the breast mlik production.


If the above mentioned steps are still not helpful to increase the breast milk production, you need to consider medications:


1) Fenugeek is a traditional herbal medicine which may be helpful to stimulate the production. While Fenugreek is generally considered to be safe when used moderately, there have been reports of a few minor side-effects. Nausea is one common side effect, while other people have reported diarrhoea and stomach gastric pain. Apparently Fenugeek is safe to the baby as well.

2) Maxolon ( metochlorpromide ) can be used to increase the milk production. You need to see a doctor for consultation before taking this medicine.

You need to have a lot of determination and preseverance in order to succeed in breastfeeding. However, this sacrifice is worth taking because both mother and baby will eventually enjoy a lot of benefits from the breastfeeding.

Tuesday, April 27, 2010

Confinement Centre (陪月中心)


It is a new trend to stay in the confinement centre during your confinement period.
There are many confinement centres in Butterworth and Bukit Mertajam.
Some of the centres are operated by the experienced nurses and some of them are operated by traditional confinement ladies.

Despite of these confinement centre service, some of the new mothers still prefer to stay at home and employed a confinement lady to take care of them.

Today, I want to make some comparisons between confinement centre care and home care.


The advantages of Confinement Centre care :

1) More cost effective compared to home care. The confinement centre usually provide package of services which include food, lodging, herbal treatment, massage service and baby formula milk powder. The cost to employ a confinement lady to your house for 1 month is quite expensive nowadays.
2) Some of the confinement centres even equipped with medical facilities such as Infrared lamp, photo light for the jaundiced baby.


The disadvantages of Confinement Centre care :

1) The quality of the service is depent on the operator.
2) The risk of infection to your baby is higher in the confinement centre compared with home care. In the confinement centre, many babies stay together within the same room. If one baby is sick, your baby maybe infected as well.
3) The chance of depression is higher. You feel sad because you stay away from your family for 1 month. You may have problem to adjust yourself to the new environment in the confinement centre.

Well, the choice is yours. From the medical point of view, my opinion is home care is still better than confinement centre care.

What is your opinion? Leave some comments please!

Reply To Jess


Jess Said,

Dr. Jason, I am quite confused with my expected due date calculation. My last menses is on 25th july 2009 and thus my EDD should be on the 1st may 2010. but according to my gynea calculation my EDD is on 18th may 2010. He did the calculation by depending on the fetus size through ultrasound scanning. which calculation is more reliable? Please advise.

......................................................................


Hi, Jess,

Since the first day of your last menses was on 25/7/2009, so it was correct to say that your expected date of delivery was on 1/5/2010, based on Naegeles’ s calculation formula.

However, Naegeles’s calculation formula is only useful and accurate if your menses is regular and the menses interval is 28 days apart.

If your menses is not regular, or the menses interval is not 28 days apart, this calculation formula is not inaccurate.

In your first 3 months ( 1st trimester ) of the pregnancy, ultrasound scan is very reliable to accurately calculate the actual date of expected date of delivery.

If your expected date of delivery (EDD) based on Naegeles’ formula is within 1 week from the ultrasound scan date, the doctor will usually refer your EDD to the Naegeles’ calculation.

However, if the calculation date is more than 1 week compared with the first trimester ultrasound scan date, the doctor will usually follow the ultrasound scan date.

Since your delivery date is approaching, I wish you a safe labour and happy motherhood.

Cheers!



Wednesday, April 21, 2010

Reply To Hooi Hooi




Dr, I am HooiHooi. I search frm internet, knowing that got a thing call 耻骨联合分离症 (Diastasis of Symphysis Pubis). Read through the symptoms, quite similar to those I faced these few months. I know as you mentioned, it is due to our pregnancy hormone and baby's weight. What else can we do during natural birth process to minimize the pain? The pain will still continue after give birth?


-------------------------------------------------------


Hi, Hooi Hooi,

As the doctor taking care of your pregnancy, I am glad that you have taken extra effort to read and learn more about your pregnancy. A better informed pregnant mother usually has a better pregnancy outcome and I would like to share with you my own experience.


Diastasis of Symphysis Pubis is a common problem during pregnancy. It is estimated about 30% to 40% of pregnant mothers suffer from this condition. Luckily, most of them only troubled by mild pain and usually it will recover within 2 weeks after the delivery.


Symphysis pubis is located just above your private part, about 3 cm above your clitoris. Symphysis pubis is a joint to merge the two pelvic bones from both side.

During the pregnancy period, your body produces a hormone (relaxin hormone). The function of this relaxin hormone is to soften your skin and muscle. Your skin must be softened so that it can be stretched to accommodate the growing baby. This relaxin hormone also soften your vaginal muscle so that the birth tunnel can be stretched to allow the baby to go through during normal delivery.


Unfortunately, this relaxin hormone not only soften your tummy skin and vagina tunnel, it also causes other structure in your body to soften as well. For examples:

1) The gum in your mouth is softened. As a result, some pregnant mothers complain of toothache and gum bleeding while brushing the teeth.

2) The skin inside the nose. Some of you may experience bleeding from the nose during pregnancy.

3) Diastasis of symphysis pubis as mentioned by you. This condition is caused by softening of the symphysis pubis joint. Due to the joint softening, it can’t hold your pelvic bones probably. As a result, every time when you walk or exercise, you will experience pain above your private part. To make the problem worse, your baby will grow in weight as pregnancy advance. The weight of the baby will compress downward and worsen the pain in symphysis pubis.

There are few things you can do to reduce the pain :

  • Use a pillow between your legs when sleeping; body pillows are a great investment!
  • Use a pillow under your 'bump' (pregnancy tummy) when sleeping
  • Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed
  • Some women also find it helpful to have their partners stabilize their hips and hold them 'together' when rolling over in bed or otherwise adjusting position
  • Some women report a waterbed mattress to be helpful
  • Silk/satin sheets and nighties may make it easier to turn over in bed
  • Swimming may help relieve pressure on the joint
  • Keep your legs close together and move symmetrically (other sources recommend a very small gap between the legs with symmetrical movement)
  • When standing, stand symmetrically, with your weight evenly distributed through both legs
  • Sit down to get dressed, especially when putting on underwear or pants
  • Avoid 'straddle' movements
  • Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a garbage bag) on the car seat to help you enter car backwards and then turn your legs as a unit
  • An ice pack may feel soothing and help reduce inflammation in the pubic area; painkillers may also help
  • Move slowly and without sudden movements
  • If bending over to pick up objects is difficult, there are devices available that can help with this
  • Really severe cases may need crutches, although these should probably only be used as a last resort
  • Some women report that pelvic binders/maternity support belts are helpful for pelvic pain
  • In severe cases, pain relief medicine may be helpful.

Friday, April 16, 2010

Sex During Pregnancy



IT IS common for women who are pregnant for the first time, to wonder whether sexual intercourse will affect the developing baby.

The common questions asked by the concerned pregnant mothers include :

1) Whether sexual intercourse will harm the baby ?

Routine sexual intercourse is safe during pregnancy because the baby is protected by surrounding waterbag.

Orgasm may cause some uterine activity which, however, does not harm the foetus.

It is safe for women with a normal pregnancy to have sexual intercourse during pregnancy even right up to the time when labour starts for a normal healthy pregnancy.

2) Will it causes infection ?

The labour door is tightly sealed by mucus plug to prevent any bacterias from infecting the baby. It is unlikely for the bacterias from vaginal to ascend into the worm. Furthermore, the waterbag provides necessary protection to the baby from infection.

However, certain sexualy transmitted diseases, eg : HIV, Hepatits B, Syphilis and Herpes may potentially infecting the baby if your spouse is carrying the disease.


The Mucus Plug in the cervix

3) Can sexual intercourse leads to miscarriage or premature labour?

Orgasm may induce some uterine activity, but the contraction is not strong enough to cause miscarriage or premature labour.


4) What is the ideal position for sexual activity during pregnancy ?

As the abdomen increases in size with advancing pregnancy, the woman may be uncomfortable with the traditional man on top position.

It is advisable to find alternative positions. By trying out various other positions, the couple will find one that they are both comfortable with.


5) In what conditions sexual intercourse is not encouraged?

1) Women who have recurrent bleeding during pregnancy. The cause of bleeding may be due to placenta located too near to the cervix ( Placenta Previa ).

2) Women who have prematured ruptured of waterbag.

3) Women with high risk of premature labour with history of weakness in the cervix

Sex during pregnancy may enhance the relationship with the spouse or partner during the pregnancy and after childbirth.

However, It is important to confirm with your doctor on a regular basis that there are no pregnancy problems and that the pregnancy is normal before engaging in intimacy.

Tuesday, April 6, 2010

Reply To Jeannette


Hi Dr Jason,

I found your email from your blog. I'm writing to you in regards of my ovulate period. My period was overdue by 3 weeks ago. But, pregnancy test is negative. However, i'm currently have popping in the ear.

I have history of delay of ovulation due to stress but no more than 3 weeks. Please advise.

Thank You.

Yours sincerely


----------------------------------------------------------------------

Hi, Jeannette,

3 weeks delay is definitely a long duration, particular for a person with regular menses period.

You need to repeat your urine pregnancy test if the earlier test is more than 1 week now. Sometimes, in a very early pregnancy, urine pregnancy test may not be accurate. Just purchase from pharmacy the urine test and do again.

If the urine test is still negative, most of the time your problem is due to hormonal imbalance. Women menses are controlled by a group of hormone. In certain situation, the hormone production ratio is imbalanced. As a result, your menses cycles will be affected.

There are many conditions that cause hormonal imbalance :

1) Stress in your daily life

2) Travelling to other country with different climate and weather.

3) Sickness ; eg: Flu, diarrhoea, bladder infection

4) Lack of sleep

If the urine pregnancy is still negative and you hope to get your menses soon, you can consult a doctor to perform a detailed checking, including an ultrasound scan.

Some hormone pills may help to induce your menses to come early.

Cheers!



Monday, March 29, 2010

Reply To Kathy


Dear Dr. Jason,

I'm into 6th week of my first pregnancy. I'm losing my appetite and this often cause gastric pain. I do drink liquid food but sometimes i still get gastric. May i know what should i eat and can i take actal when i have gastric pain? Thank you

Kathy

.......................................................................................


Hi, Kathy,

You are suffering from morning sickness due to your pregnancy. During early stage of your pregnancy, your body hormone suddenly increased. This pregnancy hormone will lead to a few changes in your body :

1) Dizziness and vomiting, particularly during early morning when you wake up from sleep
2) Indigestion or commonly we know as " Stomach wind "
3) Breast distension and pain
4) White discharge from your private part.

The presence of these pregnancy symtoms indicates that your baby is fine and in good condition.
In an unhealthy pregnancy, the mother will not suffer from these symptoms due to lack of hormone production.
So, actually it is a good thing to happen, Kathy.

There are a few things you can do to reduce your suffering :

1) Take small and frequent meals. Avoid over-eating to reduce gastric distension.
2) Since your appetite is poor and you can't eat a lot, try to eat in small portion, but always choose high nutritious diet, eg: egg, formula milk, protein based food, fruits and veges

3) Go for liquid diet if you can't swallow solid food eg: porridge, glucose based drinks

4) Reduce oily and deep-fried food.

5) Avoid the food that leave a strong smell in your mouth, eg: belacan, spices. Rinse your mouth with water after eating.

If the problem is not improving after modifying your eating habit, you need to consult your doctor. The doctor will prescribe some medicines which are safe to take during pregnancy.

It is safe to take Actal during pregnancy.



Wednesday, March 17, 2010

Baby Weight


The estimated weight of the baby according to the month of pregnancy:

16 weeks ( 4th month)

Average Weight : 140g

Normal range : 80g to 200g

20 weeks ( 5th month )

Average weight : 310g

Normal Range : 230g to 460g

24 weeks ( 6th month)

Average weight : 560g

Normal Range : 445g to 970g

28 weeks ( 7th month )

Average weight : 1140g

Normal range : 800g to 1540g

32 weeks (8th month)

Average weight : 1750g

Normal range : 1300g to 2200g

36 weeks (9th month)

Average weight : 2240g

Normal range : 1880g to 3100g

40 weeks (10th month)

Average weight : 2900g

Normal range : 2300g to 3500g