A thyroid patient with concerns about her on-going hypothyroidism and possible effects on the unborn child, Juleen Lim tells us the story about the eventful pregnancy and birth of her first child. (All pictures courtesy of Juleen Lim).
- Name: Choy Sher Yi (a girl)
- Date of Birth: May, 2018 (Born: Week 38 Day 4)
- Weight: 3.06kg
- Height: 49cm
- Parents: Choy Choon Wei & Lim Juleen
Complicating the matter is that I have been a thyroid patient since 2000 but that did not deter us from trying for a baby. To get myself ready, I consulted my endocrinologist Prof Dr SP Chan of Ramsay Sime Darby who adjusted my Tyroxine dosage slightly from 450ug per week (a dosage that has been my stable dose for many years) to 500ug per week.
(For those who have a thyroid problem like me, those scary stories in the internet about a thyroid link to baby’s brain development should not be taken too seriously. As long as the thyroid patient is under the care of an endocrinologist, having a normal and healthy baby should not be an issue).
Conception During Stressful Period
Sher Yi was conceived amidst a very busy period. At the time, we were packing to shift from our rented apartment to our newly-bought subsale home. With both of us holding fulltime jobs and rushing to get the renovations completed so that we could move in on time, it was especially stressful. On top of that, I also went for a one week Taiwan business trip within that period.
During the trip, however, I had unusual bad flu where I had a lot of phlegm and had to wear a face mask throughout my stay. The illness coupled with a missed period made me suspect I had conceived.
So, curious and excited, I bought a pregnancy test kit from the pharmacy and the next morning, discovered that the text was positive. Hurray! I thought. I immediately woke my husband and broke the news. He said, “Wow, so fertile ah.”
Immediately after, when I was just nine weeks in, I went for my first ultrasound scan. There, I could see the fetus but for some reason, could not detect the heartbeat. I immediately thought about my previous pregnancy when there was no heartbeat detected at all but I kept those thoughts at bay and told myself not to worry so much.
After all, the present fetus showed healthy movement. Perhaps the ultrasound was too early and besides, I was experiencing all the pregnancy symptoms.
For example, I suffered the full brunt of morning sickness from the second month on. I had recurrent acid reflux and vomiting issues and could only eat very small amounts every two hours. To manage my nausea, I stayed away from strong-smelling and strong tasting foods. Regular lower chest massage in the middle below the rib cage was also helpful in expelling gas from my bloated stomach.
In between that time, I went to Klinik Kesihatan TTDI Klinik Ibu dan Kanak-Kanak to register and attend ante-natal checkups. They didn’t have an ultrasound machine though so I also went to a separate gynae for ultrasound scans.
Moving House In Spite Of Pantang
Meanwhile, our house was ready for moving in. Despite the “pantang” about shifting while pregnant that the older folks warned us about, we still moved. Admittedly, there is basis behind the “pantang” because it was extremely tiring what with the hands-on work of arranging and rearranging a house full of things. We hadn’t even made our kitchen cabinets and clothes wardrobe at the time. Without these built-ins, most of our stuff was placed on the floor which made things even more confusing. I realized how messy it would be if we didn’t have cupboards when the baby arrived so despite the taboos against drilling holes and banging in nails lest the baby gets a cleft palate, I still proceeded to put up cabinets.
Specialist Care and Tests
That being done, I proceeded to take my cousin’s (who is a doctor) advice about seeing a proper maternal-fetal medicine specialist especially since I was an older mother with a history of a previous miscarriage. Before my third month, I made an appointment to see Prof Dr Tan Peng Chiong, UM Specialist Centre (UMSC) and decided he would be my gynecologist for care and delivery.
He prescribed taking low dose aspirin daily to avoid the risk of pregnancy hypertension explaining that high blood pressure can strike anytime during pregnancy regardless of baseline blood pressure. The appropriate dose would be 100mg. He also recommended that I take Obical twice a day and Obimin once a day. Additionally, he recommended the NICC (Non-Invasive Chromosomes Check) which takes 10ml of maternal blood to test for Down Syndrome, other genetic risks and also the baby’s gender.
The results came out within two weeks and it showed low risk. Phew.
Attack Of Shingles
Despite the good news, it wasn’t smooth sailing all the way. I was about 13 weeks into the pregnancy when I suddenly felt persistent tingly itchiness coming from the back of my right waist. Using a mirror, I saw that I had a patch of redness with dots. The first thing that came to my mind was insect bites. I even asked my husband if he too had insect bites, like from bed bugs? He said no.
After a few days, I noticed that the itch did not improve. In fact, from the mirror, I could see that the red patch had increased in size and was growing horizontally, from seven dots to 11. The new dots had an ominous look ─ they were like blisters with liquid inside.
I quickly called my husband and told him I could be having shingles. He panicked and immediately asked advice from a doctor friend. I was really afraid that the shingles might affect the baby and I panicked as well. The next day, when I was only at 14 weeks, we rushed to Selayang hospital contagious disease department for treatment. It was confirmed that I had shingles and I was given a week of antiviral medication called Aciclvir Tablets 800mg which I had to take. I had to take one tablet five times a day after food for one week in order to get rid of the viral infection. I was on two weeks Medical Leave as I had to stay away from other people or I could cause them to get chicken pox.
Another disaster struck when I was about 17 weeks in. Going for my usual antenatal check-ups at TTDI Klink Ibu dan Kanak-kanak, I did a Glucose Tolerance test and the results showed that I had developed Gestational diabetes.
My fasting sugar was 4.5, and after two hours, the reading was 8.9. The nurses advised me on my diet and I had to do self blood test with a home kit twice a week to monitor my sugar levels. I had to prick my own finger four times a day ─ before breakfast, two hours after breakfast, two hours after lunch and two hours after dinner to check. After controlling my diet for a while, the readings became less serious. However, they were still high and the doctor advised me to take Metformin tablets to get a better control of the situation.
By Week 31, I was taking two tablets of 500mg Metformin daily. By Week 35, I was taking four tablets of 500mg Metformin daily. Due to the unrelenting Gestational diabetes, the gynae advised that I should deliver no later than 38 weeks.
With the appointment made for delivery day, I checked in to Dahlia Ward, UMSC on Week 38 Day 3. My husband was there with me throughout the whole process. I was not in labour at the time so my cervix was not open.
To induce labour, they proceeded with overnight ballooning of the cervix in the first stage. By the next morning, there was blood show. The ob-gyn checked and the cervix was open. Then the water bag burst.
The second stage was through inserting a drip via a needle and tube to my arm to initiate contraction. Laughing gas was prepared on stand by but I didn’t need to use it. I just took deep breaths every time contraction was felt.
The contractions increased in force and frequency and when the time came, the epidural doctor inserted the tube into my spine. I felt some numbness. Both my legs had a tingling feeling but I could still move them slowly. The edipural reduced the pain and contractions then became bearable.
Drama in the Labour Room
Soon came the time for pushing. I could not feel much but my obstetrician instructed me to push hard every time there was a contraction. I pushed for about half an hour as the ob-gyn monitored the baby’s heart rate. Midway, he said there was a slight sign of distress. He asked me if I needed assistance using tools or would I like another 15 minutes to push? I requested to push for the last 15 minutes. But after pushing as hard as I could, the baby still would not come out.
He then gave me an episiotomy to open the birth canal further. I felt no pain as I was on epidural but still, the baby would not come out. He then tried the vacuum extractor. He did it twice but each time, it got disconnected. It seemed the baby was stuck too tight inside.
Immediately, he called for an ultrasound to check the baby’s head position and there they found out that she was facing sideways. So the doctor manually turned the baby’s head to the correct position and this time, he used forceps to take the baby out.
It was a success! Finally, she was out! I was so relieved and overjoyed. The doctor put her on my chest and I saw my little Sher Yi for the first time. She was slightly purplish and covered in slimy liquid and blood but it was the most precious sight of my life. In a short while, she was whisked away for cleaning. I heard her cry. It was as loud as a siren.
My husband quickly snapped a photo and showed her to me. My first reaction was, “Oh, she looks like you!” I said to my husband.
In hindsight, despite the complicated delivery, I am glad that it was a normal birth. I had always insisted that I did not want a caesarian section as I wanted the experience of natural childbirth.
Effects Of Epidural
All was not over however. The next morning I had difficulty getting up to go to toilet due to the temporary effect of the epidural. My legs and body still felt numb and weak. But later in the day, as my sensations came back and I could walk and pass motion normally, I had permission to check out, although the sensitivity of detecting a full bladder was still lesser than normal. It took me a few weeks to regain the normal sensitivity level which my gynae said was normal.
From Hospital to Confinement Centre
My next 28 days was spent at a confinement center. It was a good experience in that I had a good rest because nannies helped me to look after my baby and prepare my food. But earlier, when deciding on a confinement centre, I did not check on breast feeding support. I assumed confinement centres supported breast feeding but the center I went to discouraged me from breastfeeding. I was really disappointed and angry because I really wanted to breastfeed. The nannies said that I should not breastfeed as the wine and ginger in the food I was given to eat would worsen my baby’s jaundice. Of course I did not believe in all this traditional thinking.
But on her fourth day, even when she was not being breastfed, we noticed that Sher Yi’s eyes and skin had turned yellow. We rushed her to the emergency paediatrics at Pusat Perubatan Universiti Malaya (PPUM) where we found that her bilirubin level was 320. Sher Yi was admitted to PPUM for two days for ultraviolet light treatment. I stayed with her to take care of her. After she was discharged, Sher Yi took some time to recover from jaundice and we went back to PPUM for regular check-ups.
The second month of my confinement was spent with my mum. I was fortunate that my mum is a fantastic cook. I always enjoyed her Penang Nyonya style of cooking. I took care of my baby myself while my mum helped to cook for me. When Sher Yi was two months old, I did two glucose tolerance tests at the Clinic Kesihatan and the results showed I had fully recovered from diabetes.
By the third month, I was back home with my husband. Now it was team work all the way to this day with my husband and I taking turns to help each other with Sher Yi . We look forward to Sher Yi’s first birthday in May.