Thursday, February 21, 2013

Wait! Don’t Wash That Newborn!


Do you ever watch a television show where a baby is born and laugh as they hand the new mom a clean, approximately 8-week old baby? Most people are well-aware that babies are born with a slimy mucus-like covering on them. For years, I just assumed it was from being inside the mom’s uterus—leftover amniotic fluid or something that surrounded the baby while in the uterus. Well, it has a name—vernix. And by definition, it’s “a white cheeselike protective material that covers the skin of a fetus.” But, what is it, and why do babies have it?
Vernix is produced during the third trimester and it provides a temporary skin barrier for the watery environment babies live in while in utero. According to Cosmetics & Toiletries Sciences Applied, the prenatal functions of vernix include:” waterproofing, since due to the low surface energy, vernix caseosa is highly unwettable; the facilitation of the skin formation in utero; and protection of the fetus from acute or sub-acute chorioamnionitis (an inflammation of the outer (chorion) and inner (amnion) fetal membranes due to a bacterial infection). During delivery, vernix caseosa acts as a lubricant while postnatally, it exhibits antioxidant, skin cleansing, temperature-regulating and antibacterial properties.”
Since we have no control over vernix during pregnancy and delivery, it’s important to discuss its postnatal significance where we do have control. Proven to have such great benefits postnatally, it makes you wonder why we are in such a rush to give newborns their first bath—removing vernix. When I had my children, I think the excitement of giving birth made me oblivious to much of what was going on in the delivery room. But, after reviewing paperwork given to me at the hospital detailing the stay of each of my children, I confirmed neither of them received their first baths immediately after birth (phew!). The blood and meconium was immediately wiped away, but I think the vernix was “allowed” to stay on their bodies and was quickly absorbed, as vernix does.
Modern science and Western Medicine recognizes the benefits of vernix. A study regarding the significance of vernix was published in the American Journal of Obstetrics and Gynecology, 191 (6), 2090-2096, titled: Antimocrobial Properties of Amniotic Fluid and Vernix Caseosa are Similar to Those Found in Breast Milk. This study revealed that a number of immune substances were present in both amniotic fluid and vernix samples. Tests using antimicrobial growth inhibition essays showed these substances were effective at deterring  the growth of common perinatal pathogens— group B. Streptococcus, K. pneumoniae, L. monocytogenes, C. albicans and E. coli.
Results from this study brought into question the practices commonly used when treating newborns. The study suggests that baby’s first bath should be delayed until at least twenty-four hours after birth. The Department of Health in conjunction with the World Health Association has set-forth a protocol for newborns, and in the section regarding thorough immediate drying of the baby (0-3 minutes after birth), it says “Do not wipe off vernix,” and “Do not bathe the newborn.”  The protocol later states that you should wait at least six hours to wash the baby.
When you have a baby, it’s important to discuss your wishes with not only your physician, but also your entire care staff at the hospital where you deliver your baby. Make sure your partner is aware of your wishes, because if you’re like I was, you will be so caught up in pushing out a baby and the excitement that goes along with it, that postponing the first bath could easily slip your mind. If I were to have another child, I would inquire as to what the hospital’s protocol is. Some hospitals do wait longer than others to bathe your baby, so this could be a non-issue for you. If not, I’ve seen people who have sayings printed on a onesie customized for their newborns. You could do this and have it read “Please do not bathe me.” Whatever you do, make sure your wishes are known by everyone who will come into contact with your little one.
So, next time you have a baby, let the hospital staff know you’d like to “Keep the vernix now, clean the baby later!”

Bayi dilahirkan dengan vernix


Rethinking Vernix

Many people view vernix, like blood, meconium, or amniotic fluid, as one of the soils of the birth process that should be removed as thoroughly as possible after birth. Some babies have an abundance of vernix -- in every crack and crevice -- and quite a lot of energy is expended to present the parents with a clean newborn baby. The myth about why babies have vernix -- as a sort of "grease" to facilitate the birth process -- doesn't really make sense, given that the largest, term infants seem to have the least amount of the stuff.
Dr. Hoath and his colleagues at the Skin Sciences Institute, Cincinnati Children's Hospital Medical Center, have been studying the composition and properties of vernix and its role in adaptation of the neonate to the extrauterine, or dry, environment. Their research suggests that rather than being a soil, vernix is a natural skin cleanser. It may also be an anti-infective, an anti-oxidant, a moisturizer, and a wound-healing agent. Perhaps instead of rubbing vernix off of the newborn infant's skin, we should be rubbing it in![2]

The Biology of Vernix

Vernix caseosa is unique to humans. Structurally, it is similar to the outermost layer of the epidermis, the stratum corneum. Vernix is made up of hydrated fetal corneocytes embedded in a rich lipid matrix. It is the ability of these corneocytes to hold a large volume of water that gives vernix its water-retentive properties.
Vernix is synthesized during the last trimester of pregnancy. At that time, a surge in sebaceous gland activity and increased desquamation of fetal corneocytes combine to create a proteolipid film that covers the fetal skin surface during the critical period of adaptation before birth.[3]
Vernix is believed to interact with the developing epidermis and facilitate the in utero formation of the stratum corneum.[4] By covering the developing stratum corneum and waterproofing its surface, vernix allows cornification of the skin to occur. With advancing gestational age, vernix on the skin surface detaches into the surrounding amniotic fluid.[3] Evidence suggests that pulmonary surfactant produced by the fetal lung has a role in detaching vernix from the skin surface.[3] The detached vernix mixes with the amniotic fluid, causing turbidity of the fluid, a recognized marker of lung maturity.

Figure 1. External variables affecting newborn skin.

Tuesday, February 19, 2013

Bagaimana Kontraksi bersalin berlaku

Kalau sebelum ni ibu bersalin, tapi tak pernah tahu pun macam mana kontraksi berlaku. Dari segi medical memang kita susah nak faham sebab kita tak belajar perubatan. Tapi dari segi fahaman, mungkin kita perlu tahu untuk memudahkan proses bersalin.

Sangat kagum, sebenarnya kontraksi dikawal oleh hormon.

The hormonal formula is: oxytocin (love) + beta-endorphin (dependency) + prolactin (mothering) = mother-baby-bond.

Badan kita bekerja bergantung kepada love, dependency dan prolactin. Owh rupanya mudah jer. Tiadala urat saraf vena ke sel darah ke apa...

Kalau rajin boleh baca ni :

How a contraction works (overview)
Physical component:
The hormone oxytocin regulates contractions and it is released from the hypothalamus (primitive brain). The uterus has oxytocin receptors which respond to oxytocin by initiating a contraction. Contractions start in the top of the uterus and ‘wave’ downwards. The cervix must be ready (ie. ripe) before it will respond to contractions by opening. This is why induction usually involves preparation of the cervix with prostaglandins before starting a syntocinon (pitocin) drip to create contractions. When the uterus contracts the placental circulation is reduced (more so if the waters have broken), slightly decreasing the oxygen supply to the baby. This is why there are breaks in between contractions – to allow babies to rebalance their oxygen levels before the next contraction. If you’re wanting a reference for the above, any midwifery A&P text book will cover this basic physiology eg. Coad 2005, Stables & Rankin 2010.
Note: Oxytocin (syntocinon/pitocin) administered via a drip is not released in waves and an individual woman’s oxytocin receptor response is unpredictable. This may result in contractions that are too powerful without an adequate gap between them leading to a hypoxic baby – similar to what happens during directed pushing.
The psychological / emotional component:
oxytocin release and therefore contractions are influenced by external factors
Oxytocin is influenced by, and influences feelings and behaviour. There is a growing body of research exploring this aspect of oxytocin and it’s potential uses from treating autism to persuading us to buy products in shops. For real oxytocin nerds like myself, Moberg has written an entire book on how this hormone works. Michel Odent and Sarah Buckley are gurus when it comes to the function of oxytocin in birth, mothering and breastfeeding and I would recommend anything written by them. Basically oxytocin is part of the hormonal cocktail that prepares a mother and baby for bonding and attachment. The hormonal formula is: oxytocin (love) + beta-endorphin (dependency) + prolactin (mothering) = mother-baby-bond.
Note: Oxytocin does not cross the blood brain barrier. Therefore, only oxytocin produced in the brain has these psychological/emotional effects. Syntocinon/pitocin administered via a drip into the blood stream only effects the uterus ie. contractions.
Contraction pattern
Contractions are measured according to how often they occur in a 10 minute period and are recorded as 2:10, 3:10, 4:10 etc. To be considered ‘effective’ contractions need to occur 3:10 or more and last for 45 seconds or more. From a mechanistic perspective it would be impossible to progress through labour with 2 contractions or less every 10mins. I actually believed this for a some time (again sorry to those women).
What I now know is that a woman’s contraction pattern is unique. I have witnessed women birth babies perfectly well with very ‘ineffective’ contraction patterns. The recent ones that stand out in my mind are: A woman with an OP baby whose contractions never got closer than 5 minutes apart and were mostly 7-10 minutes apart. And a first time mother who birth her baby with mostly 10 minute spaces between contractions. When left to birth physiologically women’s labour patterns are as unique as they are. Unfortunately many midwives are unable to witness a variety of contraction patterns because individuality is not tolerated in the hospital setting.

Monday, February 18, 2013

Review Hotspring utk sembuh selsema

Semalam pagi saya bawa Yusuf ke air panas setapak. Alhamdulilah, selsema yusuf dah tak meleleh lepas balik terus tidur dalam 3 jam. Tapi malam tadi Yusuf batuk2 dan termuntah dengan banyaknya. Not sure sebab Yusuf makan banyak sbelum tdo or memang nak buang kahak. Tapi lepas muntah tu nyenyak terus tido. Harap Yusuf sembuhlah selsema nya. Dah sebulan lebih semenjak masuk tadika. Sekarang dh bagi scot emulsion pada Yusuf. Nanti nak try bagi olivenal plus. Ramai cakap bagus utk tingkatkan immunity anak.

Sunday, February 17, 2013

Mandi air panas setapak

Pagi tadi first time mandi air panas setapak. Sebab yusuf selsrma lama sangat. So cubalah kot2 boleh sembuh. Ingat nk g sungkai tapi suami cakap jauh bazir duit jer. So air panas area kl ni bolehla mandi kat setapak.

Ramai cina yg mandi sini. Siap bawa sabun mandi n berus gigi lg. Cebok n baldi pun diaorg bawa. Tempatnya kecik jer. Pagi ahad ok, tak ramai org. Pak cik klate yg mandi kat situ cakap hari kerja ramai org tua cina berkumpul. Kalu hari cuti tak rmai sangat.

Mcm2 penyakit ada, tapi tengok badan fiaorang tinggal parut jerla. Not sure sakit apa, yg perasan macam eczema, macam chicken pox, baby ruam lampin, org tua sakit kaki dll. Kitaorg rendam kaki dlm kolam kecik. Ada cina situ cakap lain kali selepas rendam kene bilas dekat air yg mengalir sebab kolam tu org mcm2 penyakit. Kalau tak bilas, blk rumah mandi. Hehe .... Td kita org x bilas pun.

Kalau nk tgk gambar leh klik blog di bawah ni:

Sy tadi tak ambik gambar pun. Huhu cam segan sebab banyak cina pakai seksi hehe.

Kat selayang pun ada air panas tapi macam tak terjaga sgt. Tapi kalau nk lebih natutal lehla g mandi air panas slayang.

Thursday, February 14, 2013

Bersalin di mana?

Ini adalah dilema semua ibu2 mengandung. Kalau duit banyak maka tak perlulah risau dah tentulah Hospital Pantai, boleh beranak dalam air. Tapi bagi kakitangan kerajaan dan duit tidaklah banyak sangat ni nak beranak di swasta itu tersangatlah risau kalau duit tak cukup. In Shaa Allah, saya mampu tapi.... kenelah menabung.

Dulu saya beranak di Hospital Selayang, Alhamdulilah takdelah masalah sangat cuma tak tahan dengan mulut nurse jela. Bukanla saya ni jenis yang biadap pun, eventhough kita cakap elok2 pun kene marah jugak. Malam masa dekat wad dapat nurse yg baik, tp bila masuk Labour room mulut nurse takde insurans. Rasa nak sepak ajer semasa sedang menahan sakit contraction. Nasib baik dh kene cucuk dengan dadah. khayal je tdo hehe

Kalini saya seboleh-bolehnya nak beranak di rumah. Tapi masih belum cukup keyakinan sebabnya menumpang rumah mak kan. Karang bila menjerit contraction of course kene paksa g hospital punya. And kalau berjaya beranak di rumah pun, of coursela family sibuk bawa anak g hospital untuk check up. So sekarang dilema sy adalah Hospital Kerajaan Atau Hospital Swasta?

Kalau gov, sy akan pilih FPP Hospital selayang tapi kalau swasta mungkin GMC atau DBM di Batu Caves. Tapi orang kata kalau beranak di swasta cepat jer kene czer ek? huhu tak mauuuuuu

Sekarang tengah google pengalaman org yg bersalin di tempat pilihan saya. Hmmmm... mungkin kene tengok keadaan masa 7 bulan baru boleh buat decision. Kalau tiada sebarang komplikasi bolehla bersalin di pusat perubatan. Tapi kalau ada masalah perlulah ambik FPP Hosp Selayang.

Harap2 beranak kali ni dipermudahkan dan dikelilingi nurse dan doktor yang terbaik. In Shaa Allah.

Penjaga Pantang/ Confinement Lady

Hari tu ada officemate bertanyakan mengenai penjaga pantang. Lepastu sambil google sy pun cari jugalah utk diri saya. Alhamdulilah saya berjaya booking Jemari Tradisional. Orang kata best penjaga pantang ni.
Saya ambik utk 2 minggu RM1900 tinggal bersama di rumah.

Dulu untuk anak pertama saya ambik Shadira. Alhamdulilah, sangat berpuas hati. Sehari saya terlalu sibuk dengan menyusu anak dan rutin berpantang. Sehingga apabila penjaga pantang pulang rasa nak nangis sebab dh takde orang nak menjaga pantang saya huhuhuhuhu

Tapi kali ni shadira mahal giler. 2 minggu RM3000. Dulu saya kene RM1800 jer. So terpaksala berubah angin. Lagi pun Kak Nor head of CL tu dah berenti dari situ. So kenelah berubah angin. Mujur saya book awal, baru pregnan 2 bulan dh booking penjaga pantang. Sebabnya bulan 7 punya dah full, saya beranak bulan 8. So, korang yang nak cari penjaga panatan leh survey cepat2. Saya ada jumpa blog yang senaraikan syarikat penjaga pantang ni. boleh tengok kat bawah.


Yang ni sikit jer yang sy ambik. Nak senarai lebih banyak boleh tengok kat blog idzerqqy

Ummie - Tradisional Confinement Lady Consultant :-

Urut Bersalin - Shah Alam & Lembah Klang :-

Cintasari Postnatal Packages : -

Jemari Tradisional :-

Kak Ina Confinement :-

Tanamera Postnatal :-

Kak Mek Urut : -

Siti Postnatal : -

Shadira Postnatal :-

BBIM Sri Hartamas

Alhamdulilah, dah sebulan Yusuf ke BBIM Sri Hartamas. Sekarang Yusuf dah gembira. Dah tak nangis2 nak hantar masuk tadika. Cuma bila dah cuti lama nangis la jugak. Rupanya bukannya Yusuf terlalu kecil utk masuk tadika, tetapi Yusuf merasa sedih ditinggalkan oleh ibu or ayah. Yelah, kalau kita pun ditinggalkan di tempat asing mestila kita menangis.

Tq to Maszurina the teacher of Yusuf, sudi jengah ke blog sy n concern about his progress. In Shaa Allah, today i will chit chat with u in FB. Sebab hari ni baru ada masa tengok blog yg dh bersawang ni. Saya tiada niat pun nak memburukkan BBIM hanya meluahkan perasaan risau saya terhadap Yusuf yang menangis. Maaf jika post sy yg lalu telah membawa kontroversi. Yela 2 tahun Yusuf duduk di rumah dengan maid, tetiba hantar ke tadika pada umur 2 tahun 2 bulan. Jadinya saya bimbang jika Yusuf stress dan ada masalah jika ke tadika pada umur masih muda.

But after a month, eventhough only half day Yusuf had develop conversation with us. Yusuf memang sangat pendiam, dan kurang bergaul dengan kanak2 lain. Saya pun tak tau kenapa. Orang kata sebab ibu bapa nya pendiam. hehehehehe "pendiamla" sangat aku nih. Tapi saya rasa mungkin kerana Yusuf seorang sahaja budak dlm rumah and get full attention from parent, maid, grandparents and pak su yang membuatkan Yusuf tidak perlu bercakap dan bergaul dengan budak lain.

Sorry teachers in BBIM Hartamas, i know it's hard to handle my child but i'm proud with ur work because my son had improve his conversation and now he seem to join playing with other kids. I hope all teachers could motivate Yusuf and support him because he is a little bit manja hehe.

BBIM Sri Hartamas baru je buka pada tahun ini. Melalui emel, banyak parent yang complain dan ada sedikit pertikaian apabila emel tidak dibalas dan tidak mendapat respon yang baik. Tetapi apabila CEO BBIM reply email, barula parent start to give a chance to BBIM. Saya juga sama seperti parent lain yang concern dengan kualiti BBIM. Yerla bayar mahal tu. 1/4 daripada gaji bulanan huhu. So it is good for parent and CEO to communicate supaya both parties got benefit.

Kepada ibu bapa yang sedang mencari tadika utk anak, yes i highly recommended because BBIM is Islamic and Montessori. Kaedah Montessori ni sangat bagus utk budak. Kebiasaannya mereka lebih mahir matematik dan mempunyai sistem bekerja.

Cuma kelemahan bila hantar ke tadika mana2 pun, anak mudah berjangkit penyakit. Minggu pertama hantar anak sy kene demam, selsema n batuk. Bila dah bercuti n sembuh, hantar masuk tadika selsema balik. cuti sabtu ahad dah kering selsema isnin anta tadika selsema balik huhu....
So sekarang ni dah sebulan la Yusuf selsema tak baik2 huhu. Habis berjangkit 1 rumah. Sekarang nak cuba Olivenal Plus untuk tingkatkan imunity Yusuf. Harap Yusuf lebih sihat selepas ni.