Saturday, June 24, 2006

Having a Baby in Bangalore: Some Notes

Updated June 17, 2009 to add a link to this post - Complications during VBAC (Vaginal Birth After Cesarean) and a terrible tragedy.


For those of you considering having babies in Bangalore (especially those that have had babies in other countries and are wondering how your experience compares with that here), here are some quick notes:

1. We had our baby at one of the bigger, multi-speciality hospitals in Bangalore that offers "birthing suites". Unfortunately, the day little N was to be born, all the birthing suites were taken. We were repeatedly told in the days leading up to the due date that birthing suites could not be booked in advance, but on the day I was admitted to the hospital, we were told that one of the suites was booked by one of the head honchos at the hospital, for, get this, a non labor and delivery procedure!

So I got admitted to the general labor and delivery (L&D) ward, which had three beds in a row in a room and two other beds in the room next door. Adjoining the three-bed room was the delivery room with two beds on which the delivery would take place. There was one bathroom for the five beds, which, in my opinion, was inadequate, especially because the hospital, as a rule, administers enemas to all women who come to deliver babies. I leave the rest to your imagination.

The L&D ward also pipes in Indian classical music in the early hours of the morning which can be pretty irritating when you are going through pain and contractions.

There is one on-call doctor (I guess an intern or a resident, I'm not sure, but rather on the young side) manning the L&D ward, monitoring the progress of labor and assisting the OB/Gyns with the delivery with about two or three nurses administering drips, injections, hooking up the fetal and contraction monitors, etc.

2. Whether you like it or not, you will get a thorough shaving in preparation for the delivery. Most hospitals in the US have discontinued this practice.

3. Almost all OB/Gyn practices here are single-doctor practices. In the US, my OB/Gyn practice had five doctors, each of whom I had to consult during my pregnancy and each of whom was familiar with my case file. So on the day N was born, it did not matter to me which doctor was on call because I knew all of them and they all knew me, so we were all comfortable with each other.

With a single-doctor practice, there is always the danger that your doctor may not be available on the day you go into labor and that after nine months of seeing one doctor, you could, in all likelihood, get stuck with a doctor you haven't seen even once during the last nine months.

If little N had come a week later (i.e., the following weekend), I could have found myself in the delivery room with a doctor I had never visited before. My doctor had plans to be out of town that weekend. I had asked her in the initial months of the pregnancy what would happen if I went into labor and she was not around. She had said, quite simply, that she hadn't taken a vacation in 3 years so there was no likelihood of that.

4. There is a paediatrician ready and waiting to check the newborn in the delivery room itself (whereas N's paediatrician only showed up the following day to check on him).

5. Once you have your baby, you are moved to a ward (room) of your choice - private or semi-private, again depending on availability.

6. Private rooms are pretty comfortable. They have an extra bed for someone to sleep in with you during your stay. Babies room in with the moms.

7. The dietician visits you everyday to make sure you are getting what you need in terms of proper nutrition post-partum and to customize your menu to your tastes.

8. You are given full encouragement and support to breastfeed the baby, starting from nutrition to the floor nurses and nurses from the lactation department who will assist you all through the night and day in case you and the baby have problems with breastfeeding. The nursing staff, both in the L&D ward and those assigned to the rooms, was excellent - very helpful, efficient and knowledgeable.

9. Your OB/Gyn and the paediatrician will check in with you twice a day.

10. Hospital stays are for two days for normal deliveries and if everything is ok with the baby (we were home in less than 48 hours after little N was born).

11. One of the less welcome aspects of the stay in the hospital was the constant stream of hospital staff that visit your room - orderlies, janitors to clean your room (three of them, one after the other), admin staff, public relations staff, electricians, dietician, nurses, food service people, the list goes on. The visits start at 6 am and don't end until 10 pm.

12. Generally, fathers-to-be are not allowed in the L&D ward because there are other women in the room as well. Luckily for me, by the time my contractions came on strong, the two beds on either side of me were empty and there was no one else in the delivery room and so the doctor had not problem with V being there with me.

13. All in all, it was a very positive experience. Througout the duration of the pregnancy I was worried about the process, wondering how it would go.

I lucked out with a very good doctor who was willing to listen to all my concerns (I talked to her about not wanting a C-section, for example; I was pretty nervous that I would be pressured into having a C-section), explain to me why something was prescribed and generally make the birth a collaborative process. This was a pleasant surprise. I had heard that doctors stood on a pedestal and told patients what needed to be done, without any explanations.

As should be the case wherever you decide to have a baby, I suggest that you develop an open line of communication with your doctor, educate yourself about the process and your options. In the end, you will have to trust her to make the decisions that are right for you and your baby.

This is all I can think of right now. If I can recall any more usefull stuff, I'll update this list.

Thursday, June 22, 2006

Book Review: Hippo Eats Dwarf, A Field Guide to Hoaxes and Other B.S., Alex Boese

The best part of any non-fiction book is the index. In a reference manual, such as a baby care guide, the value of an index is obvious - it quickly helps you navigate the contents of the book to help you find what you are looking for. In other kinds of non-fiction books, the index, much more than the table of contents, is a very good indicator of the sorts of goodies that are on offer within the pages of the book.

And in this aspect, Hippo Eats Dwarf does not disappoint. How could it, with index entries such as "male pregnancy", "animals, condoms for", "supermodel eggs for sale", "hysterical pregnancy", "chewing gum, breast enhancing", and "frequent liar miles"?

Now, if these entries suspiciously sound like hoaxes to you, you would be right. Alex Boese's Hippo Eats Dwarf is all about hoaxes and how to survive them "... in an insane world in which the line between truth and fiction has completely blurred."
To say that we live in a fake or hoaxy age, or that "we live in fictitious times" (as the director Michael Moore put it), doesn't do justice to the full-blown weirdness of the pervasive phoniness that surrounds us. Our world isn't just fake or phony. Any society that produces Michael Jackson's nose, breast-enlarging mobile-phone ring tones, and human-flavored tofu has gone well beyond that. Our world is hippo-eats-dwarf.
The title comes from a news clipping that has apparently made the rounds regularly over the past decade about a dwarf in a circus act who was swallowed by a yawning hippo as the dwarf flew off sideways from a trampoline. This hippo-eats-dwarf story (because it's "bizarre, almost certainly fake and masquerading as real") serves as a metaphor for the kind of hoaxes, urban legends, "and other forms of b.s. that lurk in the modern world."

The book and the hoaxes it describes are organized category-wise into sixteen chapters covering various topics including birth, photography, war, romance, advertising, news, politics, and business. Each chapter provides general descriptions of scams in its respective category that have pervaded popular culture, and contains specific real-life examples of such scams.

For example, in the first chapter entitled "Birth", there are descriptions of scams related to fake pregnancies, male pregnancies, phony clones, miracle births, and reborn dolls. There are also real-life stories of a high-school girl faking her pregnancy for a school project and of a woman who gave birth to a frog (and whose story the BBC duly published on its website, complete with "a picture of a surprised-looking frog"!).

Each chapter is interspered with extremely handy "Reality Rules", just in case you are taken in by all the hoaxes. Rules such as "Just because a woman looks pregnant, doesn't mean she is", "Women give birth to children. Men don't. This rule is subject to future revision", "Just because someone bids doesn't mean they intend to pay", "Should a suitably dramatic picture of an event not exist, one will be created", "The world as it appears on the nightly news should not be confused with the world as it is in reality" and the disarmingly simple "Real food rots" all serve to ensure that you don't lose your sense of direction as you are reading the book.

Also working to preserve your sense of reality are the equally handy "Reality Checks" to "test your ability to distinguish the authentic from the bogus". Have researchers genetically engineered fruit trees that can grow meat? Can men really produce milk from their breasts by stimulating their nipples? Have surgeons in Holland really implanted small pieces of jewellery into people's eyeballs? These are fun to read, decide whether they are real or not and then go on to read the accompanying explanatory paragraphs to see how skewed your sense of reality is.

For anyone who is a news junkie or an avid internet surfer, many of the hoaxes explored in this book will seem familiar, whether or not it was appropriately recognized as a hoax at the time of reading it in the original source (the "Nigerian Bank Scam", anyone?). The sparks of recognition, however, will almost always be accompanied by a jaw drop or a shake of the head as you read the explanations behind those stories.

One such story is the famous surprise Thanksgiving visit that Bush paid to the American troops in Iraq in 2003. Newspapers splashed front-page photographs of a grinning President Bush carrying a plate laden with a juicy turkey with all the trimmings. Well, whaddya know? According to Hippo Eats Dwarf,
... the turkey wasn't real. It was a plastic prop known in the food service industry as a "trophy turkey." The food the soldiers actually got was served from cafeteria-style steam trays.
Another such story is that of the voice-over translation of Saddam Hussein's responses to Dan Rather's questions in the days preceding the start of the second Iraq war.
... although the translation was perfectly accurate, the voice-over's thick Arabic accent was not. The voice didn't belong to an Arabic speaker at all, but to Steve Winfield, an American actor who specializes in faking accents.... Apparently the network thought U.S. audiences would get confused if Hussein (as well as the person speaking his words) didn't sound foreign enough.
That certainly deserves a shake of the head.

Hippo Eats Dwarf is a well-researched book, written in a simple, easy to read style with a sense of humor and obvious love for the subject. It is the perfect companion on a long plane or train ride. Flip open any page in the book and you are sure to stumble upon something that tickles your brain or your funny bone. It is not the kind of book, however, that you would read at one sitting from end to end. It is the kind you savor over a long period, reading bits at a time, spreading the fun.

Wednesday, June 21, 2006

Labor of Love Redux: The Bangalore Childbirth Story

There was plenty of gushing warm liquid, but there was no muted sound of the champagne cork popping this time, probably because I was fast asleep as my water broke in the early hours of June 11.

A hesitant call into my doctor confirmed that this was no mere incontinence and that it warranted a visit to the labor and delivery (L&D) section of my hospital. So at 4 am we woke N up (who sat upright at the mention of "hospital" and "baby", scrambled down from his bunk bed and got ready in a jiffy), I called my parents who said they would be at the hospital by the time we got there, we said our quick prayers and piled into the car with a "hospital bag" (contents: change of clothes, toiletries, moisturizer, wallet, medical records) and a pillow for N in case he wanted to sleep during the long ride to the hospital.

During the last few weeks of the pregnancy, that was the major concern: the long ride to the hospital. All of our family, friends and anyone who noticed my condition and asked where I planned to deliver the baby would be worried about the distance and the condition of the roads to the hospital.

On a good day, with no traffic, we were a good one hour away. And on a bad day (which occurred often) the hospital was quite easily two hours away. The two major impediments were the two-lane Marathahalli bridge and the Madiwala market.

With all of the ITPL and Whitefield traffic having to pass through the Marathahalli bridge, it is the scene of miles-long backups every morning and evening. Although I love the Madiwala market, it is not much better for smooth flow of traffic.

On the left are fruit and flower sellers and on the right, vegetable sellers. The sheer amout of produce is mind-boggling. Mountains of cauliflowers, onions, coconuts, mangoes, tomatoes, cucumbers, greens, chillies, potatoes adorn the pavements under makeshift tents. Trucks are parked haphazardly on either side of the road offloading produce. There are men, women and children toiling away at arranging and selling the produce. It's a family affair. On any day that I have to pass through it, I don't mind being stuck in traffic and just looking at all the activity going on on either side of the wide road, but not a day went by without us wondering just how the ride would pan out on D-day.

As luck would have it, the "ride" ended up happening during the wee hours of a Sunday when all we had for company was a bright, full moon and lorries plying their trade on Outer Ring Road. And at that hour of the morning, there were only a few trucks offloading mounds and mounds of greens at the Madiwala market. One whole side of the road was free for moving traffic.

We made it to the hospital in about 35 minutes and walked in to a darkened lobby and corridors. All I knew was that the L&D section was on the 1st floor. Unlike in the US, we had not had a pre-admission tour of the L&D section. The 1st floor was equally dark. We walked around once, tried the second floor and were about to head back down to the first floor when we heard my parents' voices. We also ran into an orderly who finally took us through some back doors and down a flight of stairs to the L&D section which was tucked away into a non-decrepit corner of the hospital. All I kept thinking was, thank God I was not having any contractions!

The nurse at the L&D section checked me in and a showed me to the middle bed in a row of three beds. The beds on either side were unoccupied. A while later, the on-call resident walked in groggily, checked me up and confirmed that my water had indeed broken, called my OB/Gyn and reported the facts to her and received instructions on the next course of action.

Because my water had broken and I did not have any contractions, my labor had to be induced. So far, the script tracked N's birth pretty closely, down to the time my water broke in the morning. The various steps to induce labor (cervix effacing gel, pitocin drip plus two other injections) started around 7 am and continued until 3 pm.

The intervening period was eventful. The two beds on either side were occupied - one by a woman whose baby was pressing against her scar from a previous C-Section and so she was to go through another C-section that day to deliver her second baby as well, and the other by a woman who had started bleeding in her thirteenth week of pregnancy (a battery of tests later, she was told that everything was fine with the baby and she was ordered to stay in bed for a few days).

The C-Section lady and I shared my OB/Gyn. Her procedure was scheduled for 1 pm, right in the middle of my labor, which set off a mild panic - when would the doctor come out of the operating room? What if I wanted to push by then?

I asked the nurse and discovered that C-Sections take about 45 minutes and so the doctor would be back around 2 pm. I was surprised at how short the procedure was and for a moment, felt a twinge of self-pity - here I was, laboring since 7 in the morning with no end in sight. I did not have too much time to spend on that thought, fortunately, because the pitocin kicked in and I had dialated about 6cms by 2 pm.

The doctor walked in, saw my progress and debated whether she should go home and come back. Before I could start panicking again, she talked herself out of it on the thought that this was my second preganancy and that the last stages of labor might proceed at a fast clip and I might want to push all of a sudden.

So she sat down and waited.

Around 2:30, the doctor decided I was ready to go over to the delivery room (a room adjacent to where I had been for most of the day) and with the help of the nurse and V, I walked into a room with two delivery beds, one of which was prepared for me and the other was, thankfully, unoccupied. I was in excruciating pain and was screaming by then and I cannot imagine how it would have been with two of us doing that in that room.

The delivery room was bustling with activity. Two or three nurses prepped for the delivery, the doctor was robing herself, there were two paediatricians looking over a newborn over to my left, and an orderly was bustling about handing people whatever they needed. A fetal monitor was hooked up to me, V was feeding me water and generally getting his fingers crushed and pinched everytime I had a contraction.

The big clock on the wall in front of me was ticking away and by 3:30, it was time to push. With N, I had pushed for close to 30 minutes before he was born and I braced myself for another marathon pushing session. This time around, I pushed twice, each time feeling like the baby was never going to come out, but the second push did the trick.

At 3:46, the doctor announced that it was a girl. Of course, in India, by law, it is a surprise whether you're having a boy or a girl. And it certainly was a surprise, despite our many attempts to figure out body parts from grainy ultrasound pictures. V was leaning over to look. I think it took a minute for it to register that it was a girl, followed by relief because he so desperately wanted a girl that we had picked a girl's name and had not chosen a boy's name yet.

And so, little N came into this world.

Wednesday, June 07, 2006

One Month Later...

It's been almost a month since I last put up a post. Feeling mighty guilty, I assure you.

But, in my defense, I have a couple of excuses (ok, more than two) lined up. We moved to a different house and N is starting a new school (he was supposed to start today, but he developed an allergic reaction to something, so was stuck at home, the poor thing; quite a let down after all that build up).

I promise myself every so often that I will post something, anything, once a day, but things pile up and my attention gets diverted and that is that.

Plus, there is the question, What do I write about? There are so many things to read, so many magazines, blogs, websites, books, newspapers... by the time I take it all in, I have so many ideas I want to write about, I end up not writing about anything.

Well, hoping to rectify matters soon. I have a feeling I'll have plenty to say in the days, weeks, months to come....