Younger vs older first-time mum

Posted by: Brigitte Rozario Post(s) by this blogger

Is it better for women to have children when they're younger or older? A younger mother will have all the energy to run after her small children and yet watch them graduate from college before retirement. An older mother will be more settled in her life and career when she has her children.

Lily Chua (not her real name), 42, mother of two aged 18 and 19 years old:

I got married at 21 and at 23 I had my first child. The next year, I had my second child.

At first my family was rather shocked because they expected me to do well in my studies, get a degree and have a good career. Instead, I got married at 21 and then I was pregnant. So I had to stop working and help my husband in his shop, which is what I have been doing until now.

My husband was of course happy when I got pregnant. I was scared (because I was still young) but I had a lot of help from my mum. She helped me look after my first child from birth until she was three years old although I did take my daughter home on weekends.

I had to consult my mother and mother-in-law when raising my children.

My mother also had her children at a young age but it was different during my mother's time - everybody was expected to marry young then.

In my time we were expected to study, have a good education and a career.

Instead I got married and had children. Although I have no regrets I do see my friends with good careers now and I am a bit envious of them.

Looking back I think I was too young then to have children. I missed out on a lot of things that others have/had - like a career and travelling.

My children are now 18 and 19 and I'm just 42.

On the plus side, my children are grown up now and can take care of themselves meanwhile some of my friends' children are still small. At least if anything happens to me now I know my children can take care of themselves, unlike my friends whose children are still small.

The good thing about having them when I was young is that I had more energy to run after them then.

But I think it's better if women only have babies when they're 27, 28 or even 30, not too young and not when they're too old either. By that age you would have graduated from university and have a stable job, you would've travelled a bit so then you settle down and have children.

So you would be more mature and know how to take care of your children but you wouldn't be too tired at that age.

My advice to my children now is to study hard and have a good career, don't get married early and have children too early; don't even have boyfriends or girlfriends yet.

If you have children early you'll be tied down. In everything you do, your priority will always be your children and you would have to make certain sacrifices.

If you have children when you're older your career would be established by then and you wouldn't have to worry so much about your financial situation then.

Shanthini Venugopal who had her son when she was 39:

Shanthini with her son

I have one son who turns 12 in October. I was told that I couldn't have children and then at age 39 I found out I was pregnant. There were concerns about the risks because of my age. In fact my doctor said I could do an amniocentesis to find out if there were any birth defects but he also told me there were risks involved in doing an amniocentesis. He asked me a simple question: 'If you did find out there was something wrong with the child, what would you do?' I said after 39 years I finally have a child, I don't think I'd abort the child; I would deal with whatever I'm faced with. He said, 'If that's how you feel then I would say don't do the amniocentesis and I will guide you in every way.'

So, I went for my checkups every month.

Today, my son is like any other healthy 11-year-old boy.

Age was never an issue for me. I never thought about how old I would be when he graduates. I am a fairly healthy person. I am a lot older than all his friends' parents but that kind of worry never even entered my mind.

I just thought it's better because I've done so much in my life and now I could actually tone down. All the parties and 'hoo-ha-ing' were over. In fact I thought it was better because sometimes when you're young and you have a child you feel the child holds you back - not everybody feels like that but there are some who feel that way. I've done a lot of things in my life and I don't think it would've been possible if I'd had a child earlier.

I was not tired running after my son when he was small because for the kind of work I do I have to be extremely energetic. I do shows for children and I have to have that kind of energy when I'm doing performances and teaching children. I've never lacked energy. That was never a concern for me and I never got tired of running after him.

For me, I was ready at that point in my life when I had a child. I was ready for it and I wanted it so it was something that I took on as another challenge in my life.

Having a child at a later age I feel is just as wonderful as having a child when you're younger. It is up to each individual. I think the experience of having a child at whatever age - if it's something you have been looking forward to - is going to be a beautiful experience. It really doesn't matter whether you're younger or older.

I have absolutely no regrets. It's been a learning process for me. It doesn't matter if you're younger or older when you have a child. You are never prepared for any of it because there is no parenting course and nobody can tell you what's going to happen. It doesn't matter if you're older or younger - you still don't know. You can hear of other people's experiences but it's never the same. No two children are the same. You just learn as you are experiencing it. That doesn't matter whatever age you are. It's a very level playing field.

Junk/Fast food - yes or no?

Posted by: Brigitte Rozario Post(s) by this blogger

Is it okay to have junk food and fast food? Is it a complete no-no or okay for now and then? Do parents really watch their children's diet?

Dr Koh Chu-Sing, the Scientific & Regulatory Affairs Director of Danone Dumex Malaysia, has had a career in nutrition for over 30 years. He says:

Fast food is just food that is delivered fast. Not all fast food is junk food. You can get some nutritious fast food - for example, the economic rice.

Junk food is defined as food with empty calories. That means for the amount of food you eat it only has calories and doesn't have much nutrients. The other definition of junk food is that if you take it regularly over a long period of time, it is unhealthy. It might promote obesity and a deficiency in some nutrients.

Examples of junk food are potato crisps, burgers and deep fried chicken. Taken daily over a long period of time they can cause obesity and they have a high salt content that can promote hypertension. They can also promote malnutrition, which basically means abnormal nutrition.

Is it okay for kids to take junk food? If they take it occasionally it's all right because junk food is normally enjoyable but they should not be encouraged to take it every day. Having junk food regularly will encourage children to get used to high salt and sugar content in their food and as a result they will tend to take food with high sugar and high salt content.

This is not to be encouraged as a daily form of snacking or diet for a child. Occasionally as a form of reward it is all right; by occasionally I mean once a week or once a fortnight.

You should start getting concerned when a child puts on excessive weight or if he or she loses a lot of weight. That means that the child is not taking a proper diet. If the child avoids eating meals and would prefer to take some other things, either very sweet or very salty food, this is also when you should be concerned.

If a child wants to replace his normal meals with junk food then I think that is cause for concern. But the best way to know exactly if the child is doing well nutritionally is to have his weight measured, that means being compared with the growth chart. Or you can calculate the BMI (Body Mass Index). From there you will know if the child is getting good nutrition or not.

Another indicator is the child's activities. If the child always looks tired and sleepy, wanting to just sit down and do nothing much, that is an indicator of nutritional deficiency or some nutritional problems.

I always tell parents that if children have some nutritional deficiency you'll find they are lethargic, slow, don't participate in activities and they easily fall ill the minute they are exposed to rain. That is an indicator that a child is not doing well.

When I was working with the Government we used to see children who didn't eat anything except junk food. They replaced their normal meals with junk food. They would have anaemia, vitamin deficiency problems and stunted growth. Even in school they wouldn't perform well because they would always be tired. Good nutrition for children is very important. Having wholesome snacks is very important to support the child's nutrition.

Sometimes we make the error of classifying food as bad food or good food. There's no such thing as bad or good food, just bad nutrition because even junk food can be turned into good food if you only have it once in a while. It becomes bad when you have it every day.

Mazwin Mokhtar, mother of two aged six and eight:

I seldom give my children sweets and they don't ask for it. They like the crisps though but they don't have it every day. We try not to give it to them every day.

I let them have it because they want it and even if I say 'No' they will buy it in school. They see their friends eating crisps and they also want to eat it.

I usually ask them to eat their meal first before they have the crisps and not to have it on an empty stomach.

I have told them that if they want crisps I will take them after school to go and buy it. In school, I want them to have proper meals. They don't always listen to me but so far they have no health problems, either.

My children would love to have fast food every day, especially the younger one. Usually I buy them fast food about three times a week. They go for the fried chicken, fries and ice-cream.

My younger child doesn't like to eat rice at night. He will always ask for fast food but when we go to the fast food restaurant he won't eat much. He'll want the fries and the ice-cream. I am more worried that my children are not eating at night.

Shalina Shukri, 40, mother of four children aged four to 20 years of age:

I have lost count on the number of times the children have fast food in a month. As a working mother with little domestic help (who can't/won't/don't cook), we had to resort to fast food home delivery service or drive-through. Due to such conveniences, fast food is becoming a staple diet in my home. With the help of excellent advertisements as well as toys which are being packaged together with the meals, it has become THE kind of food that they prefer and love.

To me instant noodles is also a fast food and it has become the meals that my domestic help prefers to cook - because its fast, involves less cooking time and is less hassle regardless of whether we've bought meat, chicken and vegetables from the market. The fresh food are usually left frozen in the freezer until I have the time and strength to cook them during weekends.

As for junk food like crisps, only my youngest child is adamant on having it daily. She's only four years old and can be very persistent. No matter how strongly we insist that she takes her cereal or rice first - she would be bawling very, very loudly for the crisps. I cannot remember how this started for her or who encouraged her but I'm a bit worried, and I might make her give it up 'cold turkey' soon.

Healthwise she is okay and the doctors confirm this too - she's active and her physical as well as mental growth development is okay. Although she is not reading yet, she recognises alphabets and numbers and she's great with the Sony PlayStation 2 as well as Internet games - I cannot challenge her when it comes the mastering the small mouse and the arrow keys on the laptop.

Thankfully all my kids are healthy and none of them are obese or overweight.

I do worry about their eating habits as I do not want the junk food situation to continue excessively because anything excessive will be bad in the long run. Another thing I do not like is the probability that sometimes this habit develops because it's less work for the domestic helper.

As adults, we should know better and inculcate all the good things such as good nutritious food, knowledge and influence about good food and good eating habits, good social skills and good habits overall.

I think that having good support from the whole environment - domestic help, school/daycare and most of all parents - can help to curb the problem of bad eating habits.

Thankfully, my older kids seem to have outgrown junk food and fast food. I think this is due to their own awareness, the philosophy of 'you are what you eat' and the need to look good.

During the school holidays and if we're not travelling anywhere, the children would prefer to go to nenek and atuk's house in the kampung where my mum will fuss and cook for them. These are times that my kids and parents look forward to and I would envy them because then I would be stuck at work in KL salivating over the delicious home cooked meals that I would be missing.

To quit or not to quit

Posted by: Brigitte Rozario Post(s) by this blogger

While women in the past fought to have a career and to join the workforce, some women today are opting for the reverse - giving up careers to stay at home and raise the children.

Should a woman give up her career to stay home with the children?

Says Anna Ch'ng, mother of a nine-year-old girl:

My daughter is now in Year Three. I stopped working when she was in Year One. I had been working all this while as a secretary.

When I was working my daughter was going to the babysitter who is also my good friend and lives next door to us. I knew she would be in good hands. That's why I didn't think of quitting.

I told my husband that when she started primary school I would stop because I have always felt that when children start primary school, the time spent in school is almost half a day and a lot of things happen there. My daughter has always been very attached to me even when I was working because she is quite vocal so she likes to talk a lot. That's why I feel it's high time I stopped working to be with her especially when she comes home from school and has a lot of stories to tell me. As I told my husband, I want to be the one who takes her to school and give her encouragement, especially when it comes to exams.

I know I didn't make the wrong decision because the minute I pick her up from school she starts talking about what happened in school. I feel it's important that you get to know first hand what goes on in your child's life. If I were still working she would have to wait till I came home to tell me her stories and sometimes we just wouldn't have the time.

I asked her if I should quit my job before I quit. She answered, 'Yeah, mum, you should have stopped a long time ago.' I started to feel guilty and I asked her about it further. She answered, 'No, mum. It's okay. What I'm trying to tell you is I only feel your absence during the school holidays.'

Quitting my job was always the plan coupled with the fact that as she grew up I saw that she liked to chat with me and I felt that if I didn't quit she wouldn't have the chance to talk to me.

Financially we are affected a bit by my quitting but I have learnt not to spend as much. When I was working whatever I felt like buying I would just buy because I had my own salary. Now, if I buy anything it is just items for my daughter and I no longer do any impulse buys.

Because of my age, I don't think I will be going back to work. I am 49 now.

I have no regrets about quitting my job to stay home with my daughter.

Zanita Anuar, mother of two boys and two girls aged four to 15, works as the director of research and exhibition at the National Art Gallery:

I did not think of quitting when I had my first three children. I only started to think about it when I had my fourth child because by then I felt that I had gained enough clout in my career that if I were to work from home I could survive. I thought I had reached the top of the glass ceiling at my workplace and being home I could be with my fourth child and watch her grow.

But then I got promoted to head of a department. I've had to become the No. 2 and on occasion the acting director-general of the art gallery. Then I felt that I couldn't just leave because too many people depend on this institution. So I was in two minds - leave, don't leave, leave, don't leave.

I decided to stay on.

I'm missing out on cooking for my kids. I missed out on some of the children's first change from diaper to being toilet trained. Sometimes I didn't get to follow that because there's a maid.

However, I try to spend the holidays with them and when I have to work on weekends I bring them with me to conferences or courses. I'm glad my husband is around to spend time with them while I have to be at a course or conference.

I think it's better for my family that I keep working because they begin to appreciate who I am because of what I do. They even ask about art and my work.

Sometimes when we're having too much fun they ask me to stay home instead of going to work. So, now I begin to actively take holidays. I actually plan my holidays into the calendar instead of just taking leave only when there are school holidays. Now I take leave during all the children's birthdays. I spend one day with that child on their birthday no matter where we celebrate it, even if it's just walking in the mall. We just spend time together as I think I should make up for lost time.

I would be a completely different person if I did not continue working but then the question is working where? I could work from home. Sometimes when I take leave then I work from home. So, it's just a matter of adjusting the work.

I learnt a lot having taken this path. You just have to take the path and then you'll know and the path will continue; it's just going to be designed to certain convenient distractions when required. Because, in the end, it's all by design. You can really take control of it. You cannot say that you don't have control over your career or that you don't have control over your life at home. You can. It's just excuses. Your negotiations may not work. But you cannot use that as an excuse.

I don't think people have to quit. Why do people see it as either you work or you stay home? It doesn't have to be one or the other. My family is very much into my work.

Confinement practices - practical or irrational?

Posted by: Brigitte Rozario Post(s) by this blogger

Confinement practices range from the practical (having ginger in your food to rid the body of gas) to the downright unhygienic (not having a bath for a month). Should they be strictly adhered to or are they just a bunch of old wives' tales?

Dave Teoh, group president and CEO of the Daveleen group of companies (including the Peiling Postnatal Care Services & Consultancy):

Dave Teoh

There were a lot of confinement practices in the past which may not apply today. For example, mothers were told not to sit in an air-conditioned room. But if you think about it even the labour room is air-conditioned. What about the people living in Cameron Highlands or Beijing in the winter? Does it mean they have to move to a hotter country or location?

These are some of the things that you have to think about - whether they are true or just myths.

If you ask me I would say most of them are just myths.

The most important aspects of the confinement period are your lifestyle and your rejuvenation. The first seven to 10 days is the crucial period.

The confinement period is the time for the mother to rest and rejuvenate. In fact confinement practices don't just cover rest and nutrition; it also covers your lifestyle.

In the old days most women worked on the farm, perhaps planting padi or working in the orchard. During confinement they actually had the time to rest. And those days you needed somebody to help you boil the water for your bath and also to bathe the baby. That's why they had a confinement nanny (pui yuet).

In the past women needed a confinement nanny to help them do things like boil the water and do the washing but now you have a water heater, a washing machine and disposable diapers. So you don't need a confinement nanny anymore.

Importantly, the confinement period has to be relaxing and a wonderful experience for the mother. It cannot be a matter of hiding yourself in the room and not being able to go out. That is not the right way to do it. Of course it's better to stay indoors but there is no solid evidence that if you go out there will be adverse effects. Look at the westerners - they go out after delivering their babies!

One of the confinement practices that may conflict with the doctor's advice is the consumption of alcohol. When you talk about Chinese confinement one of the main ingredients in food preparation is wine. I don't believe the woman in confinement should take alcohol but she can take rice wine which has been boiled till the alcohol content is completely evaporated. Only then do you use it in food preparation.

Drinking rice wine (without the alcohol) or what is sometimes called "confinement water" will help reduce the water retention in the woman. However, these days you don't even have to drink all this because there is R/O (Reverse Osmosis) water and you also have good filtration systems - so you don't need to have the confinement water, you can just take the R/O water.

Another thing we don't encourage (which used to be done in the past) is the practice of buying raw herbs and boiling them because herbs by nature are toxic. So it is better to get processed herbs.

Herbs are still important for rejuvenation but make sure you get the processed type in capsule or extract form.

Dr Wong Pak Seng, consultant obstetrician, gynaecologist and fertility specialist

Dr Wong Pak Seng

One cannot dismiss age-old practices totally, even in the modern era with advances in medical care and evidence-based medicine. A lot of the confinement practices (more than 60%) are related to foods and food directly contributes to nutrition, which is important to everyone, more so after childbirth.

After childbirth, a woman may feel weak, and this is likely to be due to a sudden withdrawal of "feel good" hormones as well as anaemia due to the blood lost during labour. Also, the stomach and bowels which were initially compressed by the pregnant womb, now suddenly expands because of the sudden decrease in the size of the womb. These organs swell up with air and fluid, hence the sensation of bloatedness or "wind". If we can understand this, we can appreciate why the foods that are prepared (containing ginger or black pepper) for the mother in confinement appears to correct the problem.

Confinement food and herbal food are also medication. They try to replace the hormones so that the woman feels better. But too much hormones is not good either. When you have just delivered, your womb is very big, your ovaries are very big, everything is large and if you take too much hormones sometimes it can result in problems like bleeding or if there are fibroids they can start to grow. My advice is that you can take everything that is prescribed but take it in moderation.

I don't think there is any effect to the baby if the mother is still breastfeeding while taking the herbal medications. I don't think they will be toxic to the baby.

Even the alcohol with a lot of herbs in it - it's fine to drink as well but the way to minimise the transfer to the baby is by drinking it late at night after you're done breastfeeding baby for the day. Then you sleep till morning and say about six hours later when it's time to feed baby again, the alcohol would have washed out of your system.

If you are very concerned and baby is not yet sleeping for six hours then give one feed by the bottle.

But I usually tell my patients not to worry, they can have the herbal preparation because the actual amount of alcohol that is released in the breast milk is very little.

I believe one should be selective about confinement practices. Practices that are outright irrational cannot possibly be beneficial to the woman.

For example, the prohibition on having a bath and washing the hair. It is illogical not to put hygiene as the top priority. Keeping one's body clean by having regular showers is more likely to contribute to a quick recovery.

The other irrational practice is the avoidance of fruits or vegetables. These foods are a good source of vitamins and fibre which would help ensure good bowel habits and faster recovery.

As for the advice not to touch water, if you are immersing yourself in iced water, then yes, it will cause temperature changes in you but if you are just washing your hands with cold water it wouldn't make much difference. So I think this belief that the woman shouldn't touch water is just an old wives' tale.

There's another irrational practice that prohibits a woman from drinking water. There's no problem with drinking water. It may not be so appropriate to drink soft drinks because your tummy is already gassy. But if you drink plain water or warm water I don't see how there's anything wrong with that.

When a woman tells me that she can't drink water and she's very dehydrated and constipated, I tell her to drink a lot of red dates water because red dates has a high iron content. Or she can drink milk. Otherwise (if she is not drinking water or milk) she would be constipated and then the milk won't come if she's trying to nurse baby.

There's some rationale behind some of the confinement practices. For example, if you take ginger and black pepper to get rid of the wind - yes, it's very logical. But to restrict your fluid, to believe that you cannot drink water and cannot shower - those, I think, are not appropriate in this age.

There's no truth to these unusual confinement practices.

Should a woman opt for caesarean?

Posted by: Brigitte Rozario Post(s) by this blogger

In the past natural childbirth was the norm. Caesarean section was only done when the mother or baby was not doing well and only as a last resort.

Today, women are choosing to go for caesarean section for various different reasons - fear of the pain, fear of risks to their child, beauty, convenience, timing baby's birth for good luck.

Should a woman opt for elective caesarean?

Jennifer Hor

Jennifer Hor, parenting educator, nurse and midwife with Jenlia Maternal Services:

We have to acknowledge that caesarean section rates have gone up a lot. I don't think that's just in Malaysia. It is something that has been happening in a lot of developing and developed countries. The way I look at it is how couples have been given information.

In developing as well as developed countries where people are getting more affluent, I think a lot of people have actually started to look at childbirth not as a natural or normal process of being a parent. The moment they get pregnant they think of looking for a doctor and looking for a hospital - it's very "medicalised". It is almost like pregnancy is a medical condition.

If you don't look at childbirth as a natural process then you would think of how to get out of it very quickly, so people want it to be very fast and obviously quite easy. That's why I say the information given to parents should be accurate so that parents can actually make better choices. A lot of people actually think, if I can get my baby out fast (via a caesarean) why do I have to go through labour?

Caesarean section should only be used as the last choice and it should only be done when recommended by the doctor or under certain medical conditions.

You will find there are people choosing to do a caesarean section. If you talk to a lot of mothers they will tell you they are just worried and frightened about the pain and they haven't got any proper preparation on how to manage the pain. So, a lot of them think that if they have a caesarean section it is a lot less painful.

A lot of times when I conduct parenting classes, women ask me about the side effects of the drugs (painkillers) but they don't ask about the side effects of a caesarean section.

If they have been given proper information they will know that it is a major operation and that you don't choose to have a caesarean section.

To sum up, couples should be given the proper information, and they should be properly prepared to manage the pain, because fear of labour pains is a genuine fear. It's not a perceived fear. And the pain is there but women have to realise that it is a normal and natural process and that means that they can do it. It would help if they can think positively that this is how they will manage the pain and that their body is built for it.

Vicky, a mother who chose to go for C-section:

One of the main reasons I opted for a C-section was because of fears of complications. I know a few people who actually had complications during delivery and they ended up with emergency C-sections anyway.

I have a friend who had complications when she was giving birth and her child turned out to be a blue baby who is now permanently brain damaged.

I also know of a few people who went for normal birth but ended up doing a C-section. For one person, the doctor found that the umbilical cord was around the baby's neck.

All these stories just frightened me.

Actually my husband and I went for all the ante-natal classes and learnt the breathing exercises for normal birth. I was so torn about whether to go for a normal birth or a C-section because with a C-section the husband is not allowed into the room. That was the saddest thing for me. That was why I was so torn. I knew my husband wanted to participate in the birth. In the end the baby's safety was our priority when it came to choosing.

I wasn't worried about myself; I was more worried about the baby.

One of the questions I asked the doctor was whether I would be able to go for normal childbirth for my second child if I had a C-section for the first. He said yes and that kind of convinced me to go ahead. Hopefully I will be more courageous with my second child and have more faith.

Dr Wong Pak Seng

Dr Wong Pak Seng, consultant obstetrician, gynaecologist and fertility specialist:

C-Section is a very safe procedure, normally performed if it is evident that a vaginal birth cannot be optimally performed. The reasons for this can be related to the following factors:

Baby factors:

* Baby is in an unfavourable position such as breech or transverse;

* Large baby, usually in excess of 4kg;

* A compromised baby, such as a growth retarded baby or a baby who has passed motion (meconium), fetal distress during labour; or

* Multiple pregnancy (twins or triplets).

Mother factors:

* Medical illness such as severe hypertension, heart disease etc;

* Certain obstetric conditions such as placenta praevia;

* Slow progress of labour; or

* Maternal request or "horoscope baby" when the couple want the baby's birth to be on a certain date and at a certain time.

Nowadays, there are more and more women, because of education or lifestyle and the desire for a small family, who want to have a caesarean section. This is partly because they feel that if they go through normal birth, the female anatomy is distorted or they may suffer the risk of a prolapsed uterine.

Nowadays caesarean section is very safe compared to previously when there was a high risk of death, infection and bleeding. Nowadays, a caesarean section is quite straightforward.

But it is still an operation and there are still risks involved.

What are the short and long-term risks?

Short term:

* Wound infection;

* Bleeding leading to blood transfusion; and

* Pain.

Long term:

* Scarring; and

* Scar rupture especially during normal delivery for subsequent pregnancy.

Most doctors would allow caesarean on demand. However, the couple should be well counselled with regards to the risk-benefit ratio. They must also be aware that her next delivery should she get pregnant again could very likely be a caesarean.

The doctor's role is to provide the patient with the information and based on that they make an informed decision. So if they want to have an elective caesarean section then I tell them it's fine but it's a surgery after all so there's always the risk of bleeding and wound infection; if you try normal birth then it's part and parcel of a natural process, you see the baby immediately, you recover well, you breastfeed and the next day you go home. So if, despite that, they still want to go for the C-section then we will do it.

Out of a hundred women, 80 would have a normal delivery and 20 would have a caesarean. This is the usual number everywhere in the world. But in private hospitals, it's about 30-40 going for caesarean. Out of this number maybe about 10 would request for elective caesarean. The rest end up having to undergo caesarean for one reason or another.

If you have a normal birth, four or five hours later you can get up and walk to the toilet and the next day you go home. For a caesarean section, the same day you won't be able to move much because of all the tubes attached to you but the next day the doctor will remove all the tubes and you are encouraged to walk. The following day you can go home. That means you stay two nights. The third day is the earliest you can go home.

It will take two weeks for the external wound to heal and you can do some light chores. But a full recovery takes two months.

If the first caesarean was done for reasons that we don't think can recur then the chances of her achieving the second delivery naturally is good. But certain criteria are necessary such as she must go into labour spontaneously, the baby must not be too big, and the progress must be good.

If for the first delivery she tried to deliver normally but the progress was slow or the doctor checked and found that her pelvic bones are very narrow - these reasons will likely be there for the second delivery. In such cases the doctor will recommend she go ahead and do a caesarean instead of trying naturally for subsequent deliveries.

The more caesareans you do the more internal scarring occurs, particularly from the womb to the bladder. You can do up to three caesarean sections but beyond that it gets worse.

But because today more and more women are opting for caesarean it's not unusual to see women who are in their fifth caesarean. If the hospital takes all the necessary precautions, and there is a surgeon on standby in case there are any complications with the internal organs, if you prepare the patient, have blood on standby, then it is still okay to do it.

The greatest risk in going for so many caesareans is that the scar is going to be very thin now and there may be a risk of rupture.

Is it bad to give your child a pacifier?

Posted by: Brigitte Rozario Post(s) by this blogger

Using a pacifier used to be a non-issue. Today, a larger number of parents think it's a bad idea because of the effects of prolonged use. Is it okay to give your child a pacifier?

Maureen Nagle, mother of a 21-month toddler, says pacifiers are a big NO:

Before we even became parents we decided that we would not give our daughter the pacifier. We knew what we wanted and how we were going to bring up our child. So there was a whole lot of planning and a whole lot of research done. It's worked out quite well. We've kept to what we wanted to do.

We decided not to give her the pacifier based on a lot of articles we read written by paediatricians. Pacifiers are an outdated thing. First of all pacifiers are not good for the child's teeth. They can deform the mouth. Secondly, we did see some documentaries about this saying that pacifiers make a child lazy in the sense that the child's speech would be delayed. Because they have the pacifier in their mouth all the time there is no motivation to do anything.

My husband and I have seen many times where the child has a pacifier and the minute you remove it, the child cries. Even for a simple trip to the bank the parent needs the pacifier for the child just so the child keeps quiet and doesn't throw a tantrum. I think the pacifier is more to comfort the child.

We decided that if you bring up a child without giving her the pacifier from the start she's not going to know what she missed out on. Our daughter has never had a pacifier so she doesn't know that she's missed out on it and the same goes for sugar. We didn't want to give her sugar because it's not good - it makes a child hyper active. Again, because we never gave her sugar she doesn't crave for sugar or chocolates.

The first time I took her to a paediatrician, he gave her a jab. She was just a baby and she started crying, of course. Which child won't cry when you give them a jab? And, the doctor said get her a pacifier. I later related this to a cousin who is training to be a paediatrician and she was just as horrified. She said a pacifier is a no-no. I was also quite horrified and so I dropped him as a paediatrician.

My daughter doesn't cry continuously. As a baby when she used to fall, she would cry but she wouldn't go on and on. When she would start to cry, we would carry her, comfort her, tell her it's okay and distract her. So much so even if she slips now she will not cry. The only times she cries is if it's really painful and even that it's not forever and ever. You can reason with her and tell her it's fine, it's okay. At most it will last a minute.

Dr Chin

Dr Chin Wai Seong, consultant paediatrician

I don't think it is right or wrong to give a baby a pacifier. If you ask me I would say giving a baby a pacifier is fine but try to understand all the advantages and disadvantages and also the practical tips you need to know when offering a pacifier to a baby and also when you want to wean the baby off the pacifier and how to wean the baby.

The advantages: Sucking the pacifier is self-comforting for the baby. If you don't give the pacifier they're going to suck their thumb. In view of that if you give the baby the pacifier which is disposable it'll be easier to wean the baby off the pacifier rather than getting baby to stop sucking their thumb. If they start sucking their thumb, there is also the tendency to overbite their finger when they start to develop teeth. The pacifier is softer than the finger so if they're overbiting their finger they will have injury and the formation of hardened skin on the thumb.

Also studies show that if you give the pacifier the risk of sudden infant death syndrome is reduced. The cause of sudden infant death syndrome is unknown - some from choking or the tongue falling backwards. So using the pacifier seems to reduce the risk of sudden infant death syndrome.

The disadvantages: If you give the baby the pacifier too early it will interfere with the development of the breastfeeding technique because the way the baby sucks on the pacifier is different from the way the baby sucks on the mother's nipple.

Sucking on the pacifier might also result in some wind production and indigestion. Because of this the milk might not be digested completely if the child sucks on a pacifier all the time.

When you introduce anything foreign to the body there's a risk of contamination and gastro-intestinal infection.

There is also the risk of choking because the material on some pacifiers is not good - they have very soft rings and the diameter is very small. The baby might accidentally suck the whole piece into their mouth and choke on it.

Studies also show that when the child gets addicted to the pacifier they are lazy to open their mouth to talk so there will be the risk of speech delay.

Some babies might develop a dependency and they may want to suck the pacifier all the time even when they're playing and during their daily activities.

Prolonged use of the pacifier, especially after one year old, when their teeth start developing, will impair the development of the teeth and the alignment will become slanting upwards especially the upper and lower incisor teeth. In more severe cases they have a misalignment of the jaw.

Tips: Firstly, you must establish the breastfeeding skill first which will take one or two weeks. Once they have the skill to suck the milk directly from the breast, then you can introduce the pacifier.

Don't rush for the pacifier to console one fussy baby. It is not the first line of management. As a parent you have to look for the cause of the crying.

As for buying a pacifier, you should buy the type that comes as a whole piece and not the kind where the nipple can be separated because the nipple might get separated and swallowed accidentally and there's the risk of choking. You want the type that is one piece and the plate must be hard. Also, look for the pacifier with a small hole at the nipple. This is for good ventilation when the baby is sucking.

Don't tie a string or strap around the pacifier and hang it on the baby's neck. The one with the clip and a short length of strap is okay because there's no risk of strangulation.

If you drop the pacifier on the floor, clean it with warm water.

Check the pacifier for damage as any cracks on the nipple may hurt the baby's gum and lips.

Try to limit the use of the pacifier during the sleeping hours. Once the baby has fallen asleep you can remove the pacifier.

When the child is awake and busy with activities or playing, don't offer the pacifier.

This will prepare the child to stop sucking the pacifier after the child turns one year old so they won't get addicted to it.

Parents must know when to wean the child off the pacifier. Try to do so after the child turns one year old once the child starts developing teeth. Don't let the child use the pacifier for more than two to three years old.

Parents shouldn't be overly anxious or worried if their child prefers to suck a pacifier at less than one year old. As long as they are aware of the disadvantages and know how to prevent the disadvantages from occurring, it is okay.

Handphones vs no handphones

Posted by: Brigitte Rozario Post(s) by this blogger

Should children be given a handphone? On one hand it is great for convenience if they need to contact their parents or for parents to know where they are in any emergency. On the other hand, giving your child a handphone exposes the child to a whole host of risks.

Here are two opposing opinions to the question of whether a child should be given a handphone:

Noor Nirwandy Mat Nordin, project director of Muslim Consumers Association of Malaysia, deputy chairman of the Communications & Multimedia Consumer Forum of Malaysia (CFM)

Noor Nirwandy

I don't think that children should be given handphones until after the age of 16. It exposes them to too many risks.

During our time we could only talk to boys and girls on the phone under our parents' observation. We could never send SMSes to our girlfriends or boyfriends. So if we did anything wrong, we would get caught and punished on the spot.

The initial intention (for giving the handphone) is to provide facilities for us to know where our kids are but we must think twice before doing so. I advice parents to know how to adopt the technology before giving a mobile phone to their child. For instance, you must know if the phone given to your child only has the basics or if it's more than that.

But I still oppose just giving a basic phone. For me, not giving a phone is the best solution.

Secondly, you must impose regulations and an audit system. You must audit your child's behaviour. For instance, every night take the phone and browse through it. You should also have stricter guidelines such as using a prepaid number and giving them maybe RM10 of credit for one week or give the child a phone that is registered under the parent's name for better control.

There are no boundaries in communications these days – children can communicate through their phones, e-mail, chat. While you may not be able to stop them, you can minimise the communication.

We (CFM) have had complaints where parents say it is very easy for strangers to ask their underaged girl out for lunch or dinner. Having a phone opens up the opportunity for others to do bad things.

We want to minimise the risk factors. Problems in school with not doing the homework because of the handphone – that is secondary. We are more concerned about the bigger consequences of having a handphone like social problems – rape and having sexual intercourse at a young age.

For parents, if there are risks involved and you have calculated and you know that the risks won't benefit you, why take the risk? Better not to have the risk at all by not giving them a handphone.

Lim Fun Jin, technical director at ISA Technologies, father of two boys aged four and 15 months

Lim Fun Jin

I think it is inevitable that we give them handphones. I guess the key question is when is the right time. My personal experience from having a handphone and using it is that my social life is much more enhanced with a handphone in terms of connecting with my peers. I think for kids it's the same.

Parents buy their children phones for security reasons or for them to contact the kids but from the kids' point of view I believe it's to connect with their friends. As we know, today, social networking is part of our lives – from Facebook to simple things like using the phone for SMS.

But I guess the question for me is when is the right time and what is the purpose – is it part of the experience process or part of the IQ-EQ development to develop things beyond the academic side. Getting them to network and having a social life and friends – I think it's a good thing but obviously there's also abuse in terms of chalking up crazy amounts of bills and things like that. Those I think are the main concerns of parents.

Getting them a handphone is about educating them and teaching them to be responsible – what are you going to use it for, what are the guidelines. Yes, definitely there'll be elements of social networking but how far do you go? Kids have lots of friends but up till what age and what are their intentions? Nowadays you can pass a lot of multimedia messages over and some of the content may not be suitable for kids. So you're always exposed to these kinds of concerns.

But I think if the kid has been groomed to be responsible then by all means. I feel it's a good thing to have that responsibility than not to have it. We can always take the view that we will always shield them so that they don't have to face these kinds of difficult decisions and responsibility but in a lot of ways I find that the grounding is more important.

You need to ground them right and from there give them the responsibility and see where it goes. If it gets abused then withdraw the benefit.

My peers and I actually made some observations at a recent reunion. What we found was that you can be very good academically but the social element in terms of overall career development is actually a very important factor. And when does it start?

Social networking actually starts when we're young. But you must make sure the academic part is never missed out in lieu of the social part. I feel that things like phones, exposure to computers, even experiences with technology devices is a very good thing. It's a good experience to expand your social network.

National school vs vernacular school vs international school

Posted by: Brigitte Rozario Post(s) by this blogger

How do you choose the school that's right for your child? Do you enrol them in the regular national school, the national type school also known as the vernacular school (Chinese or Tamil school) or how about the international school? All three options offer their benefits and drawbacks.

Here are three people we spoke to who respectively offered good reasons for sending your child to each option.

Raymond Liew, board president at SMJK Yak Chee in Puchong

Basically I think parents want to send their children to Chinese school so that they will learn and be able to speak in Mandarin. Secondly, the Chinese schools offer more languages – Bahasa Malaysia, Mandarin and English. With these three languages you can work anywhere in the world, even though you might not be an expert in the languages.

Personally I don't believe that only one language can unite the people. I think that the more languages the children learn the better it is. In Chinese schools you learn everything. In our Chinese schools we have Chinese students as well as Indians and Malays. When the children mingle they learn from each other the different cultures.

From what I can see the national schools' way of teaching is different from our way of teaching. We have more emphasis on practical and not just on theory; we make sure the students do their homework; and discipline is very important to us. We also place emphasis on activities and sports.

It is true that students have a lot of homework in Chinese schools but it's because we have a lot of subjects. This doesn't mean that the child will grow up to be studious and not so well-rounded as we also have a lot of activities and sports in the Chinese schools. This is to build up both their IQ and EQ at the same time.

Whether the Chinese school students emerge with a good command of the English and Bahasa Malaysia languages depends on the individual. I don't think you can say that someone who goes to a Chinese school will emerge with a poor command of both these languages. 

I can see that the teachers in the Chinese schools are more responsible and more concerned about the students' development.

I think the best thing about the Chinese school is that it offers unity. The children are brought up to not be so divided. It is easier for the children of different races and religions to bond. Personally, I believe that the more you learn, the better to unite.

Margaret A. Kaloo, principal of ELC International School and chairman of the Association of International Malaysian Schools (AIMS)

Why do Malaysian parents queue up to go to international schools? They want English. They want smaller class sizes. They want more attention paid to their children; they want their children to be able to think, analyse and apply information, and not to keep quiet and not ask questions.

In today's world it has never been as important as it is now to be articulate. It's not enough to have it in your head; you must be able to articulate it; you must be able to ask; you must be able to apply it. That's where our students in government schools are missing out. They may get 14As, but can they think, can they analyse, can they apply information?

At the international school we have much smaller classes, much better student-teacher interaction, excellent extra curricular activities; we take the children out of the school and into the community and we even teach several languages like French, Bahasa Malaysia and Mandarin.

Being educated in English doesn't mean that the command of other languages suffers.

We can have anything from 20 to 60 different nationalities at an international school. Hence the students find out about each others' cultures and views, they learn to develop tolerance, they are encouraged to have a healthy international outlook, they form friendships which transcend traditional barriers and differences and they even learn a range of languages.

In addition, graduates of international schools have lifelong access to their school's international network of social and business contacts.

There is definitely a better chance of raising a well-rounded child at the international school and the middle class parents see that. They want their child to have the option to do all the other things like sports, music and drama.

An international education offers the opportunity to celebrate diversity in a spirit of understanding and tolerance and to develop a positive regard and awareness of other people.

Associate Prof Datuk Mohd Ali Hasan, National Parent-Teacher Association Collaborative Council president

I think that parents, or whoever takes care of the children, must consider who we are. We are Malaysians. We want our children to be grow up with the national spirit, a sense of integration, unity and belonging to Malaysia.

Where else can we send our children in order to achieve this?

Are we going to send our child to an international school considering that its reputation, image, status, even the curriculum is not to our mould. Secondly, we have to consider the cost and thirdly, the eliteness.

The school would consist of the upper echelons of society, perhaps the children of diplomats and high commissioners. I'm sure the general population in Malaysia cannot afford it.

So definitely, the international school is out of the question for the general population.

I can say that the Chinese school does have its strong points. For example, the teachers are very professional and hardworking compared to those in the national school. In addition, the Chinese schools excel in terms of discipline and infrastructure. These are the advantages of the Chinese school compared to the national school.

As for the Tamil schools, there are many in the estates where the facilities, teachers and infrastructure are still lacking and not on par with the national and Chinese schools.

I think for Malaysian parents, or whoever takes care of the children, currently it is a choice between the Chinese school and the national school. I think, we need to consider that we want to develop future Malaysian leaders who live in a proper Malaysian environment.

I would advise parents to send their children to the national school because I think we need to instil integration, unity, feelings of diversity in unity which I think is more prevalent in national schools.

Unity, integration and a sense of belonging to Malaysia is of prime importance rather than being compartmentalised, being with one race and not mixing with others.

For me, that is of prime importance. We want our children to be leaders of their own race as well as Malaysia and the global race, I think the national schools have a bit of an advantage here over the present national type school or even the international school.

Religion vs no religion

Posted by: Brigitte Rozario Post(s) by this blogger

Should you give your child a religion of your choice from the time they are born? Or should you wait until the child is old enough to decide for themselves?

Nadia (not her real name) prefers to leave it up to her children, aged 7 and 3, to decide when they are old enough.

My husband and I were raised with a religion but I disagree with certain things in that religion. I can't teach my kids to believe in something which I don't believe in.

We don't fastidiously practice the religion when it comes to certain conventions. To me these are just rituals.

We are very free at home. My son is too small to understand but my daughter asks me about religion. We just talk about it. Her cousins are quite religious and they teach her how to pray. And when she comes home she always discusses it with me. Usually I tell her that if she feels like praying it's okay, she can go ahead. I don't stop her and at the same time I give her freedom.

When my mother-in-law passed away, we went for the funeral. I told my daughter that her grandmother died and I explained to her that certain people believe that everyone has a 'spirit' and that the spirit goes to heaven and certain people believe in reincarnation. So far she has not asked me what I believe in.

She has asked me why I don't pray the way her cousins pray, why sometimes we join in the prayers and certain times we don't. So I explain to her that prayer is between you and God and if you want to talk to God. I don't believe it has to be at certain times and at the same time I don't believe that we have to do it every day, if we don't want to. This is how I feel. I always stress that this is my opinion and if you feel like it you can just pray at any time. Not giving her a religion and exposing her to all religions involves a lot of explanations.

My daughter knows about God. She believes in God. But I don't associate God with punishment in raising my children and disciplining them. Instead I tell my daughter what are the consequences of her doing certain things. But sometimes she decides to do it anyway. Then she has to bear the consequences for it. That's what I tell her.

My kids are exposed to other religions, too. So my daughter understands that Muslims pray in the mosque, Hindus pray in the temple and Christians pray in a church.

I teach her that people are different so they behave differently and there is no right or wrong. I hope she will understand.

Rev Dr Hermen Shastri, general secretary of the Council of Churches of Malaysia

Rev Dr Hermen Shastri

A child growing up would need a moral formation and values. Religion helps to give life a certain direction and perspective. If you don't give a child a religion from small then the child grows up with values inculcated from experiences in the context in which he lives.

If the child is still under the care of the parents and the parents belong to one religion then you cannot expect the parents to expose the child to other religions because the parents have a vested interest in the upbringing of the child.

I think the most important thing is the initial upbringing. If a child is inculcated with godly virtues connected to a certain religious belief system then that child will have that in mind. He will always have it in the background and perhaps dwell on it and perhaps then choose to practise that religion in a more fervent way.

I think it is important today to have that belief and connect it to life and the things around. Belief can come in many forms. Of course if it's the religious system that the family practices it brings the family closer together, helps bring meaning to important occasions like religious festivals, the birth of a brother or sister, maybe the death of a grandparent. The religious system helps the child cope with that and find its connection within the family.

When you're talking about a child you're not talking about doctrines and all that because a child won't be able to understand that but a child will be able to understand why Christians are Christians and why Hindus are Hindus and be able to see that kind of conviction lived out in the family. And then the child will appreciate and pay attention and it will never leave the child for the rest of his life.

Midwife vs doctor

Posted by: Brigitte Rozario Post(s) by this blogger

Almost all women in the Malaysian urban areas see a gynaecologist when they think they are pregnant. This gynaecologist sees them through the pregnancy, guiding their health and development until they go into labour and then the delivery.

However, in countries like the United States and England, the choice of having a midwife or a doctor as your primary caregiver is up to the patient.

What are the benefits of having a midwife or a doctor as your primary caregiver?

Datuk Dr Nor Ashikin Mokhtar is the founder and executive chairman of the Primanora Medical Centre. She has looked after more than 10,000 women and has delivered no less than 3,000 babies.

Dr Nor Ashikin

Dr Nor Ashikin says:

The advantage of seeing one doctor throughout a pregnancy is that the progress is being monitored, and the wellbeing of the pregnancy for the mother and child is also monitored. In Malaysia, to deliver their baby most women will see an obstetrician or gynaecologist.

These are doctors who are highly trained or specialise in women's reproductive health and also in pregnancy.

In such a situation the other advantage is that the doctor will be able to pick up any abnormalities early and to also be able to prescribe the medication that a midwife may not be able to prescribe.

Should the woman go into labour and if there are any emergencies, the doctor is there. It would be easier to anticipate problems, prevent them and intervene immediately if she has been seen by a doctor from the very beginning.

Definitely, a midwife is not encouraged for all pregnancies and certainly not for high-risk pregnancies.

Especially when you want to diagnose your pregnancy you need to see a gynaecologist. Again there are a lot of myths about testing yourself at home or even going to a GP (general practitioner) but that's not the ideal way to ascertain if your pregnancy is going to be a healthy pregnancy or not. Ideally, all women after they miss their period and they've had a urine test to check if they're pregnant should confirm it with an ultrasound check.

The midwife can't do these tests and not all GPs can do the test as well. Particularly if it's a high-risk pregnancy you should immediately see a gynaecologist because when you do an ultrasound even as early as six weeks you can see whether the baby is alive or not, you can see the heartbeat and you can see if you have one or two babies and if the pregnancy is inside or outside the uterus.

Cecilia Koh is a British-trained nurse and midwife with special interests in babycare with over 30 years of working with mothers and babies in England and Malaysia.

Cecilia Koh

Koh says:

When I worked in Britain, the midwife was a recognised professional – we were trained to look after normal pregnancies. We handled the pregnancy, the delivery and the post-natal care.

If at any time during the pregnancy or during the labour, a problem arises, then we call the doctor. They would also have a doctor assigned to them. So we worked with the doctor in that sense. In fact, most of the normal deliveries were conducted by midwives and the abnormal deliveries were conducted by the doctor.

One of the benefits of having a midwife is that she is trained to conduct the delivery by aiming for non-intervention. We try to take the more natural path. We have a lower episiotomy (a surgical incision made to enlarge the vagina and assist childbirth) rate. Without an episiotomy, even if you have a small tear, it will heal very fast. With an episiotomy there is the risk of it getting infected if you do not take care of the wound.

The delivery technique is different. Midwives have to be very, very patient.

During the delivery if the midwife is looking after you she's there the whole time. So there is a relationship even though you only meet the midwife in the labour room.

Doctors do not have the time nor the patience. They are not there to look after the patient, just the delivery. We spend more time with the patient with less interference. We try to get them to do things as naturally as possible.