今早為Asian Medical Students Association Hong Kong (AMSAHK)的新一屆執行委員會就職典禮作致詞分享嘉賓,題目為「疫情中的健康不公平」。
感謝他們的熱情款待以及為整段致詞拍了影片。以下我附上致詞的英文原稿:
It's been my honor to be invited to give the closing remarks for the Inauguration Ceremony for the incoming executive committee of the Asian Medical Students' Association Hong Kong (AMSAHK) this morning. A video has been taken for the remarks I made regarding health inequalities during the COVID-19 pandemic (big thanks to the student who withstood the soreness of her arm for holding the camera up for 15 minutes straight), and here's the transcript of the main body of the speech that goes with this video:
//The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, continues to be rampant around the world since early 2020, resulting in more than 55 million cases and 1.3 million deaths worldwide as of today. (So no! It’s not a hoax for those conspiracy theorists out there!) A higher rate of incidence and deaths, as well as worse health-related quality of life have been widely observed in the socially disadvantaged groups, including people of lower socioeconomic position, older persons, migrants, ethnic minority and communities of color, etc. While epidemiologists and scientists around the world are dedicated in gathering scientific evidence on the specific causes and determinants of the health inequalities observed in different countries and regions, we can apply the Social Determinants of Health Conceptual Framework developed by the World Health Organization team led by the eminent Prof Sir Michael Marmot, world’s leading social epidemiologist, to understand and delineate these social determinants of health inequalities related to the COVID-19 pandemic.
According to this framework, social determinants of health can be largely categorized into two types – 1) the lower stream, intermediary determinants, and 2) the upper stream, structural and macro-environmental determinants. For the COVID-19 pandemic, we realized that the lower stream factors may include material circumstances, such as people’s living and working conditions. For instance, the nature of the occupations of these people of lower socioeconomic position tends to require them to travel outside to work, i.e., they cannot work from home, which is a luxury for people who can afford to do it. This lack of choice in the location of occupation may expose them to greater risk of infection through more transportation and interactions with strangers. We have also seen infection clusters among crowded places like elderly homes, public housing estates, and boarding houses for foreign domestic helpers. Moreover, these socially disadvantaged people tend to have lower financial and social capital – it can be observed that they were more likely to be deprived of personal protective equipment like face masks and hand sanitizers, especially during the earlier days of the pandemic. On the other hand, the upper stream, structural determinants of health may include policies related to public health, education, macroeconomics, social protection and welfare, as well as our governance… and last, but not least, our culture and values. If the socioeconomic and political contexts are not favorable to the socially disadvantaged, their health and well-being will be disproportionately affected by the pandemic. Therefore, if we, as a society, espouse to address and reduce the problem of health inequalities, social determinants of health cannot be overlooked in devising and designing any public health-related strategies, measures and policies.
Although a higher rate of incidence and deaths have been widely observed in the socially disadvantaged groups, especially in countries with severe COVID-19 outbreaks, this phenomenon seems to be less discussed and less covered by media in Hong Kong, where the disease incidence is relatively low when compared with other countries around the world. Before the resurgence of local cases in early July, local spread of COVID-19 was sporadic and most cases were imported. In the earlier days of the pandemic, most cases were primarily imported by travelers and return-students studying overseas, leading to a minor surge between mid-March and mid-April of 874 new cases. Most of these cases during Spring were people who could afford to travel and study abroad, and thus tended to be more well-off. Therefore, some would say the expected social gradient in health impact did not seem to exist in Hong Kong, but may I remind you that, it is only the case when we focus on COVID-19-specific incidence and mortality alone. But can we really deduce from this that COVID-19-related health inequality does not exist in Hong Kong? According to the Social Determinants of Health Framework mentioned earlier, the obvious answer is “No, of course not.” And here’s why…
In addition to the direct disease burden, the COVID-19 outbreak and its associated containment measures (such as economic lockdown, mandatory social distancing, and change of work arrangements) could have unequal wider socioeconomic impacts on the general population, especially in regions with pervasive existing social inequalities. Given the limited resources and capacity of the socioeconomically disadvantaged to respond to emergency and adverse events, their general health and well-being are likely to be unduly and inordinately affected by the abrupt changes in their daily economic and social conditions, like job loss and insecurity, brought about by the COVID-19 outbreak and the corresponding containment and mitigation measures of which the main purpose was supposedly disease prevention and health protection at the first place. As such, focusing only on COVID-19 incidence or mortality as the outcomes of concern to address health inequalities may leave out important aspects of life that contributes significantly to people’s health. Recently, my research team and I collaborated with Sir Michael Marmot in a Hong Kong study, and found that the poor people in Hong Kong fared worse in every aspects of life than their richer counterparts in terms of economic activity, personal protective equipment, personal hygiene practice, as well as well-being and health after the COVID-19 outbreak. We also found that part of the observed health inequality can be attributed to the pandemic and its related containment measures via people’s concerns over their own and their families’ livelihood and economic activity. In other words, health inequalities were contributed by the pandemic even in a city where incidence is relatively low through other social determinants of health that directly concerned the livelihood and economic activity of the people. So in this study, we confirmed that focusing only on the incident and death cases as the outcomes of concern to address health inequalities is like a story half-told, and would severely truncate and distort the reality.
Truth be told, health inequality does not only appear after the pandemic outbreak of COVID-19, it is a pre-existing condition in countries and regions around the world, including Hong Kong. My research over the years have consistently shown that people in lower socioeconomic position tend to have worse physical and mental health status. Nevertheless, precisely because health inequality is nothing new, there are always voices in our society trying to dismiss the problem, arguing that it is only natural to have wealth inequality in any capitalistic society. However, in reckoning with health inequalities, we need to go beyond just figuring out the disparities or differences in health status between the poor and the rich, and we need to raise an ethically relevant question: are these inequalities, disparities and differences remediable? Can they be fixed? Can we do something about them? If they are remediable, and we can do something about them but we haven’t, then we’d say these inequalities are ultimately unjust and unfair. In other words, a society that prides itself in pursuing justice must, and I say must, strive to address and reduce these unfair health inequalities. Borrowing the words from famed sociologist Judith Butler, “the virus alone does not discriminate,” but “social and economic inequality will make sure that it does.” With COVID-19, we learn that it is not only the individuals who are sick, but our society. And it’s time we do something about it.
Thank you very much!//
Please join me in congratulating the incoming executive committee of AMSAHK and giving them the best wishes for their future endeavor!
Roger Chung, PhD
Assistant Professor, CUHK JC School of Public Health and Primary Care, @CUHK Medicine, The Chinese University of Hong Kong 香港中文大學 - CUHK
Associate Director, CUHK Institute of Health Equity
student mental health research 在 Roger Chung 鍾一諾 Facebook 的精選貼文
【最新學術論文發佈】貧窮匱乏與焦慮及壓力有時間性的關係
在這全香港調查(時間點一的樣本 n=1970; 時間點二的樣本 n=1224),我們發現匱乏(即對物質及社會必須品負擔能低)對同時間點的焦慮及壓力有顯著的數據關係;而增加及持續的匱乏情況亦會增加焦慮及壓力的徵狀及程度。但相反地,匱乏程度的減少並沒有為焦慮及壓力的徵狀及程度帶來顯著的減少。這令人擔憂的結果對政策制定有深遠的意義 -- 我們必須要在制定社會政策時考慮到會影響精神健康及導致健康不公平情況的社會因素,尤其是因為焦慮及壓力是其他更嚴重的精神健康問題的前因。
非常榮幸能夠與健康不公平研究範疇的世界級大師Michael Marmot爵士、英國貧窮研究頂尖專家David Gordon、中大公共衛生及基層醫療學院院長Samuel Wong、香港貧窮研究專家黃洪、我的博士研究生及研究助理一起合著了這篇論文,是我其中一篇最滿意的論文。
【My latest academic publication on JECH 】Our territory-wide longitudinal survey in Hong Kong, with sample sizes of n=1,970 and n=1,224 for baseline and follow-up, provided another piece of important epidemiological evidence on the association between being deprived and two specific mental health-related conditions - anxiety and stress. There is a longitudinal and not only cross-sectional association. However, the findings of significant associations of persistent deprivation with worse anxiety and stress, and increased risk of incident anxiety, suggested that it is also insufficient to not aggravate the circumstances of deprivation alone; deprived individuals who stayed deprived over time also had generally worse mental health-related outcomes. Furthermore, reduction in deprivation level across time was linked to less anxiety and stress; however, the results were not significant, implying that poverty may have a long-lasting effect on health that does not wane after the circumstances have improved. This is alarming because it is essentially saying that reduction of deprivation may not have any immediate positive effect on subsequent mental health. Nevertheless, we should not conclude that efforts to reduce deprivation are futile as there may be longer lag effect on mental health that cannot be picked up by the current analyses. Greater attention should be paid to deprivation in policymaking to tackle the inequalities of mental health problems, especially since stress and anxiety are precursors to more severe forms of mental illness and other comorbidities.
I'd like to thank my stellar team, which include my PhD student, research assistants, School Director Prof Samuel Wong, HK poverty expert Wong Hung, British poverty expert David Gordon (of the Peter Townsend School), and the venerable Sir Michael Marmot.
#healthequity #socialdeterminantsofhealth #epidemiology #hongkong #inequality #research #mentalhealth #anxiety #stress
student mental health research 在 Daphne Iking Facebook 的精選貼文
My sister, Michelle-Ann Iking's 3% chance of conceiving naturally was a success! Here's her story:
(My apologies as I've been overwhelmed with personal matters. I've only managed to get to my desk. So finally got around posting this).
This is the story behind my sister's pregnancy struggle and how she shared her journey over her Facebook page.
Because some may have not caught her LIVE session chat with me (https://www.facebook.com/daphneiking/videos/687743128744960/) , or read her lengthy post (as it's a private page);
she's allowed me to copy and paste it over my wall, in case you need to know more about her thought process on how AND why she focused on the 3% success probability. Read on.
-------------------------------------------
Posted 10th May 2020.
FB Credit: Michelle-Ann Iking
A week ago today I celebrated becoming a mother to our second, long awaited child.
Please forgive this mother's LONG (self-indulgent) post, journalling what this significant milestone has meant for her personally, for her own fallible memory's sake as well as maybe to share one day with her son.
If all you were wondering was whether I had delivered and if mum and bub are OK, please be assured the whole KkLM family are thriving tremendously, and continue scrolling right along your Newsfeed 😁.
OUR 3% MIRACLE
All babies are miracles... and none more so than our precious Kiaen Aaryan (pronounced KEY-n AR-yen), whose name derives from Sanskrit origins meaning:
Grace of God
Spiritual
Kind
Benevolent
...words espousing the gratitude Kishore and I feel for Kiaen's arrival as our "3% miracle".
He was conceived, naturally, after 3 years of Kishore and I hoping, praying and 'endeavoring'... and only couples for whom the objective switches from pure recreation to (elusive) procreation will understand how this is less fun than it sounds ...
3 years during which time we had consensus from 3 different doctors that we, particularly I (with my advancing age etc etc) had only a 3% chance of natural conception and that our best hope for a sibling for our firstborn, Lara Anoushka, was via IVF.
Lara herself was an 'intervention baby', being one of the 20% of babies successfully conceived through the less intrusive IUI process, after a year and a half of trying naturally and already being told then my age was a debilitating factor.
We had tried another round of IUI for her sibling in 2017 when Lara was a year old. And that time we fell into the ranks of the 80% of would-be parents for whom it would be an exercise in futility... who would go home, comfort each other as best they could, while individually masking their own personal disappointment... hoping for the best, 'the next time around'...
So the improbability ratio of 97% against natural conception of our second baby, as concurred by the combined opinion of 3 medical professionals, was a very real, very daunting figure for us to have to mentally deal with.
Deep, DEEP, down in my heart however, though I had many a day of doubt... I kept a core kernel of faith that somehow, I would again experience the privilege of pregnancy, and again, have a chance at childbirth.
And so, the optimist in me would tell myself, "Well, there have to be people who fall in the 3% bucket... why shouldn't WE be part of the 3%?"
Those who know me well, understand my belief in the Law of Attraction, the philosophy of focusing your mind only on what you want to attract, not on what you don't want, and so even as Kishore and I prepared to go into significant personal debt to attempt IVF in the 2nd half of 2019, I marshalled a last ditch effort to hone in on that 3% chance of natural conception... through research coming across fertility supplements that I ordered from the US and sent to a friend in Singapore to redirect to me because the supplier would not deliver to Malaysia.
I made us as a couple take the supplements in the 3 month 'priming period' in the lead up to the IVF procedure - preconditioning our bodies for optimum results, if you will.
At the same time, I had invested in a sophisticated fertility monitor, with probes and digital sensors for daily tracking of saliva and other unmentionable fluid samples, designed to pinpoint with chemical accuracy my state of fertility on any given day.
(UPDATE: For those interested - I obtained the supplements and Ovacue Fertility Monitor from https://www.fairhavenhealth.com/. Though I had my supplies delivered to a friend in Singapore, and redirected to me here since the US site does not deliver to Malaysia, there are local distributors for these products, you will just have to research the trustworthiness of the vendors yourself...)
I had set an intention - in the 3 months of pre-IVF priming, I would consume what seemed like a pharmacy's worth of supplements, and track fertility religiously... in hopes that somehow, within the 3 month priming period, we would conceive naturally and potentially save ourselves a down payment on a new property... and this was just a projection on financial costs of IVF, not even considering the physical, emotional and mental toll it involves, with no guarantee of a baby at the end of it all...
It was a continuation of an intention embedded even with my first pregnancy, where all the big ticket baby items were consciously purchased for use by a future sibling, in gender neutral colours, in hopes that sibling would be a brother "for a balanced pair", though of course any healthy child would be a welcome blessing.
It was a very conscious determination to always skew my thoughts in service of what the end objective was. For example, when 3+year old Lara would innocently express impatience at not yet having a sibling, at one point suggesting that since we were "taking too long to give her a baby brother/sister", perhaps we should just "go buy a baby from a shop", instead of getting defensive or berating the baby that she herself was, we enlisted Lara's help to pray for her sibling... so in any place of worship, or sacred ground of any kind that we passed thereon, Lara would stop, close her eyes, bow her small head and place her tiny hands together in prayer, reciting earnestly, "Please God, please give me a baby brother or baby sister."
After months and months of watching Lara do this, in the constancy of her childlike chant, Kishore started feeling the pressure of possibly disappointing Lara if her prayer was not answered. Whereas for me, Lara's recitation of her simple wish became like a strengthening mantra, our collective intention imbued with greater power with each repetition, and the goal of a sibling kept very much in the forefront of our minds (hence our calling Lara our 'project manager' in this endeavour).
And somehow in the 2nd month of that 3 month period, a positive + sign appeared on one of the home pregnancy tests I had grown accustomed to taking - my version of the lottery tickets others keep buying in hopes of hitting the jackpot, with all the cyclical anticipation and more often than not, disappointment, that entails...
This time however I was not disappointed.
With God's Grace, (hence 'Kiaen', a variation of 'Kiaan' which means 'Grace of God'), my focus on our joining the ranks of the 3% had materialised.
It seems poetic then, that Kiaen chose to make his appearance on the 3rd May, ironically the same date that his paternal great-grandfather departed this world for the next... such that in the combined words of Kishore and his father Kai Vello Suppiah,
"The 1st generation Suppiah left on 3rd May and the 4th generation Suppiah arrived on 3rd May after 41yrs...
One leaves, another comes, the legacy lives on..."
***
KIAEN AARYAN SUPPIAH'S BIRTH STORY
On Sunday 3rd May, I was 40 weeks and 5 days pregnant.
The baby was, in my mind, very UN-fashionably late past his due date of 29th April, so as much as I had willed and 'manifested' the privilege of pregnancy, to say I was keen to be done with it all was an understatement.
In the weeks leading to up to my full term, I had experienced increasingly intense Braxton-Hicks 'practice contractions' - annoying for me for the discomfort involved, stressful for Kishore who was on tenterhooks with the false alarms, on constant alert for when we would actually need to leave home for the hospital.
Having become a Hypnobirthing student and advocate from my first pregnancy with Lara, and thus being equipped with
(1) a lack of fear about childbirth in general and
(2) a basic understanding of how all the sensations I would experience fit into the big picture of my body bringing our baby closer to us,
I was less stressed - content to wait for the baby to be "fully cooked" and come out whenever he was ready... though I wouldn't have minded at all if the cooking time ended sooner, rather than later.
With Lara, I had been somewhat 'forced' into an induced labour, even though she was not yet due, and that had resulted in a 5 DAY LABOUR, a Birth Story for another post, so I was not inclined to chemically induce labour, even though I was assured that for second time mothers, it would be 'much faster and easier'...
That morning, I had a hunch *maybe* that day was the day, because in contrast to previous weeks' sensations of tightening, pressure and even spasms that were concentrated in the front of my abdomen and occasionally shot through my sides and legs, I felt period - like cramping in my lower back which I had not felt before throughout the pregnancy.
It was about 8am in the morning then, and my 'surges' were still relatively mild ('surges' being Hypnobirthing - speak for 'contractions', designed to frame them with the more positive connotations needed to counteract common language in which childbirth is presented as something that is unequivocally painful and traumatic, instead of the miraculous, powerful and natural phenomenon it actually is).
I recall (masochistically?) entertaining the thought of opting NOT to have an epidural JUST TO SEE WHAT IT WOULD BE LIKE...
I figured this would be the last time I would be pregnant and so it would be my 'last chance' to experience 'drug free labour' which, apart from the health benefits for baby and mother, might be *interesting* in a way that people who are curious about what getting a tattoo and skydiving and bungee jumping are like, might find these *interesting*...even knowing there will be pain and risk involved...
Since I have tried tattoos and skydiving (unfortunately not being able to squeeze in bungee-jumping while my life was purely my own to risk at no dependents' possible detriment) a similar curiousity about a no-epidural labour was on my mind...
In the absence of other signs of the onset of labour (like 'bloody show' or my waters breaking), I wanted to wait until the surges were coming every few minutes before we actually left the house for the hospital, not wanting to be one of those couples who rushed in too early and had interminable waits for the next stage in unfamiliar, clinical surroundings and/or were made to go home in an anti-climatic manner.
I was even calm enough through my surges to have the presence of mind to wash and blowdry my hair, knowing if I did deliver soon I would not be allowed this luxury for a while.
Around 9am I asked Kishore to prep for Lara and himself to be dressed and breakfasted so we could head to hospital soon, while I sent messages to family members on both sides informing them 'today might be the day.'
My mother, who had briefly served as a midwife before going back into general nursing and then becoming a nursing tutor, prophetically stated that if what I was experiencing was true labour, "the baby would be out by noon".
The pace in which my surges grew closer together was surprisingly quicker than I expected; and while I asked Lara to "Hurry up with breakfast" with only a tad more urgency than we normally tell her to do, little Missy being prone to dilly-dallying at meals, I probably freaked Kishore out when about 930am onwards, I had to instinctively get on my hands and knees a couple of times, eyes closed, trying to practice the Hypnobirthing breathing techniques I had revised to help along the process of my body birthing our child into the world.
I recall him saying a bit frantically as I knelt at our front door, doubled over as he waited for Lara to complete something or other, "Lara hurry up! Can't you see Mama is in so much pain and you are taking your own sweet time??!!"
SIDETRACK: Just the night before, Lara and I had watched a TV show in which a woman gave birth with the usual histrionics accompanying pop culture depictions of labour.
Lara watched the scene, transfixed.
I told her, simply and matter-of-factly, "That's what Mama has to do to get baby brother out Lara, and that's what I had to do for you also."
In most of interactions with my daughter, I have sought to equip her to face life's situations with calmness, truthful common sense, and ideally a minimum of drama.
Those who know the dramatic diva that Lara can be will know that this is a work-in-progress, but her response to me that night showed me some of my 'teachings' were sinking in:
She looked at me unfazed, "But Mama," she said. "You won't cry and scream like that lady, right? You will be BRAVE and stay calm, right?"
#nopressure.
So as we prepped to leave for the hospital I did indeed attempt to be that role model of calm for her, asking her only for her help in keeping very quiet,
"Because Mama needs to focus on bringing baby brother out and she needs quiet to concentrate...".
As we left the house at 10.11am, I texted Kishore's sister Geetha to please prep to pick up Lara from the hospital, and was grateful Kishore had the foresight to ask our gynae to prepare a letter for Geetha to show any police roadblocks between my in-laws' home in Subang Jaya and the hospital in Bangsar, this all happening under the Movement Control Order (MCO).
To Lara's credit, in the journey over to the hospital, she - probably sensing the gravity of the situation, sat very quietly in her seat at the back, and the silence was punctuated only by my occasional deep intakes of breath and some variation of my Ohmmm-like moans when the sensations were at their height.
By the time we got to Pantai Hospital at around 10.30am, my surges were strong enough I requested a wheelchair to assist me in getting to the labour ward, as I did not trust my own legs to support me... and Kishore would have to wait until Geetha had arrived to take Lara back to my in-laws' house before he himself could go up.
I slumped in the wheelchair and was wheeled up to the labour room with my eyes closed the whole time, trying to handle my surges.
I didn't even look up to see the attendant who pushed me... but did make the effort to thank him sincerely when he handed me over, with what seemed like a palpable sense of relief on his part, to the labour ward nurses.
The nurse attending me at Pantai was calm, steady and efficient. I answered some questions and changed into my labour gown while waiting for Kishore to come up, all the while managing the increasingly intense surges with my rusty Hypnobirthing breathing techniques.
By the time Kishore joined me at around 11am (I know these timings based on the timestamps of the 'WhatsApp live feed' of messages Kishore sent to his family), I was asking the nurse on duty, "How soon can I get an epidural??" thinking what crazy woman thought she could do this without drugs???!!!
The nurse checked my cervix dilation, I saw her bloodied glove indicating my mucous plug had dislodged, and she told me, "Well you are already at 7cm (which, for the uninitiated, is 70% of the way to the 10cm dilation needed for birthing), you are really doing well, if you made it this far without any drugs, if can you try and manage without it... I suspect within 2 hours or less you will deliver your baby and since it will take about that time for the anaesthesiologist to be called, epidural to be administered and kick in... it might all be for nothing... but of course the decision is completely up to you... "
So there I was, super torn, should I risk the sensations becoming worse... or risk the epidural becoming a waste?? And of course I was trying to decide this as my labour surges were coming at me stronger and stronger...
I was in such a dilemma...because as a 'recovering approval junkie' there was also a silly element of approval-seeking involved, ("The nurse thinks I can do this without drugs... maybe I CAN do this without drugs... Yay me!") mixed with that element of curiosity I mentioned earlier ("What if I actually CAN do this without drugs... plenty of other women have done it all over the world since time immemorial.. no big deal, how bad can it be...??") so then I thought I would use the financial aspect to be the 'tiebreaker' in my decision making...
I asked the nurse how much an epidural would cost and when she replied "Around MYR1.5k", I still remember Kishore's incredulous face as I asked the question, i.e."Seriously babe, you are gonna think about money right now? If you need the epidural TAKE IT, don't worry about the money!!!"... and while we are not rich by any stretch of the imagination, thankfully RM1.5k is not a quantum that made me swing towards a decision to "better save the money"...
So in the end, I guess my curiosity won out, and I turned down the epidural "just to see what it would be like and if I had it in me" (in addition of course to avoiding the side effects of any drugs introduced into my and the baby's body).
My labour occuring in the time of coronavirus, it was protocol for me to have a COVID19 test done, so the medical staff could apply the necessary precautions. I had heard from a friend Sharon Ruba that the test procedure was uncomfortable, so when the nurse came with the test kit as I was starting another surge, I asked, "Please can I just finish this surge before I do the test?" as I really didn't think I could multitask tackling multiple uncomfortable sensations in one go.
The COVID19 test involved what felt like a looong, skinny cotton bud being inserted into one nostril... I definitely felt more than a tickle as it went in and up, being told to take deep breaths by the nurse. Then she asked me to "Try to swallow" and I felt it go into my nasal cavities where I didn't think anything could go any further, but was proven wrong when she asked me to swallow again and the swab was probed even deeper. Then she warned me there would be some slight discomfort as she prepared to collect a sample... but at that point all I could think about was:
(i) I really don't have much of a choice
(ii) please let this be over before my next surge kicks in
(iii) if all the people breaking the MCO rules knew what it feels like to do this test maybe they won't put themselves at risk of the need to perform one...
In full disclosure as I was transferred into the actual delivery room at some point after 11am, another nurse offered me 'laughing gas' to ostensibly take some of the edge off... I took the self-operated breathing nozzle passed to me but don't recall it making any difference to my sensations..so didn't use it much as it seemed pretty pointless.
I recall some measure of relief when I heard my gynae Dr. Paul entering the room, greeting Kishore and me, and telling us it was going well and it wouldn't be long now and he would see us again shortly.
From my previous labour with Lara I knew the midwives pretty much take you 90% of the way through the labour and when the Dr is called in you are really at the home stretch, so was very relieved to hear his voice though knowing he would leave and come back later meant it wasn't quite over yet.
I do remember realising when I had crossed the Thinning and Opening Phase of labour to the Birthing Phase, by the change in sensations... it is still amazing to me that as the Hypnobirthing book mentioned, having this knowledge I was instinctively able to switch breathing techniques for the next stage of labour .
Was my opting against epidural the right choice for me?
Overall? Yes.
Don't get me wrong.
I *almost* regretted the decision several times during active labour... especially when I felt my body being taken over by an overwhelming compulsion to push that did not seem conscious and was accompanied by involuntary gutteral moans where I literally just thought to myself, "I surrender, God do with me what you will..." (super dramatic I know but VERY real at the time...).
I think I experienced 3-4 such natural explusive reflexes (?), rhythmically pushing the baby down the birth path, one of which was accompanied by what felt like a swoosh of water coming out of a hose with a diameter the size of a golf ball... this was when I realised my water had finally broken...
The nurses kept instructing me to do different things, to keep breathing, to move to my side, then to move to the middle, to raise my feet... and when I didn't comply, Kishore (who was with me throughout both my labours) tried to help them by repeating the instructions prefaced with "Sayang..." but I basically ignored all the intructions because I felt I had no capacity to direct any part of my body to do anything and someone else would have to physically manoeuvre that body part themselves.
When I heard Dr. Paul's voice again and the flurry of commotion surrounding his presence, I knew the time was close... and when I heard the nurse say to Kishore, "Sir, these are your gloves, for when you cut the baby's cord", it was music to my ears...
I'm very, VERY grateful Kiaen slid out after maybe the 4th of those involuntary pushes... the wave of RELIEF when he came out so quickly... it still boggles my mind that my mother was essentially right and as his birth time was 12.02pm, it was *only* about 1.5 hours between our arrival at the hospital and his arrival into the world.
Kiaen was placed on my chest for skin to skin bonding and remained there for a considerable time.
For our short stay in the hospital he would be with us in my maternity ward number C327... another trivially serendipitous sign for me because he was born on the 3rd (May) and our wedding anniversary is 27th (July).
I was discharged the following day 4th May at about 5.30pm, after I got an all clear on COVID19 and a paediatric surgeon did a small procedure on Kiaen to address a tongue-tie that would affect his breastfeeding latch... making the entire duration of our stay about 31 hours.
I have taken the time and effort to record all this down so that whenever life's challenges threaten to get me down I can remind myself, "Ignore the 97% failure probability, focus on the 3% success probability".
Also that the human condition is miraculous and it is such a privilege to experience it.
To our son Kiaen Aaryan, thank you for coming into our lives and choosing us as your parents.
Even though Papa and I are both zombies trying to settle into a night time feeding routine with you, I look forward to spending not only all future Mother's Days, but every day, with you and your Akka...
And last but not least, to my husband Kishore...without whom none of this would be possible - we did it sayang, I love you ❤️
Photo credit: Stayhome session with Samantha Yong Photography (http://samanthayong.com/)