2014 to Mar 2016

First Visit to KKH

I finally went for my first official antenatal appointment at KKH Private Suite.  I did not expect to stay there from 10am to almost 2pm.  Most of it was playing the waiting game.

First, I registered with the main desk.  The nurse at the desk asked me if I wanted Dr. June Tan to eventually deliver my baby.  I said I am not sure if I can afford the private ward rates of the Private Suite and she said you can have the option of B1 wards too, and I said, that’s still difficult.  She was a bit confused because I did choose to see a gynae from the Private Suite.  So I told her you see, I am carrying triplets.  She was a bit shocked and she asked, natural? I said, yes.  She took my hand and congratulated me. This proved to be something I keep getting the whole day at the different departments.  I continue to be surprised that no one really thinks how difficult a multiple pregnancy is. She understood my dilemma that I needed to see a specialist like Dr. June Tan from the Private Suite but when delivery day comes and the triplets might be premature, I will need to downgrade to a cheaper ward. So she said I can discuss it with Dr. June Tan.

After registering, they did a routine check-up (take weight, urine test and blood pressure). Then they sent me to AMC (Antenatal Monitoring Clinic) for my ultrasound.  AMC told me it will take an hour before it was my turn.  I was like you must be kidding.  So my friend and I decided to head down to the food court to have a light bite, until Livia decided to throw a tantrum and that was impossible to do.  We returned to AMC after 45 minutes and I waited a while more and it was soon my turn.  There were 2 ultrasound technicians and they were both speaking to each other in Chinese.  When they performed the ultrasound and found triplets, the female technician started getting flustered.  They spoke very quickly in Chinese and all I could hear was, “this one MC…this one singleton.”  After they were done, they told me to wait somemore.  I waited another 15 minutes more as the female technician kept shuffling between rooms consulting other technicians on her triplets case.  I have no idea what they were talking about.  Then they returned my papers to me and said you need to go ADC (Antenatal Diagnostic Center) to confirm the triplets. I was like what we just saw it was triplets, still need to confirm?  So off we went to ADC where I waited yet another hour until I got fed up and asked how long before my turn. After I asked, it seemed it was already my turn.  A lady technician called me in and performed another ultrasound.  I expected some fancier machine, but it looked exactly like the one at AMC.  The difference perhaps was at ADC, they could see a membrane separating my identical twins.  I felt a bit relieved inside because that reduced complications.   She took a snapshot of all 3 babies because she knew all the snapshots I’ve been getting were just of the babies itself, but not all 3 together.

After ADC, I finally got to see Dr. June Tan.  I only saw her a total of 5 minutes.  I guess because I had researched thoroughly, I could understand what she was saying without asking for a detailed explanation.  The only thing she brought up that was of concern was the possibility of TTTS for the identical twins.  I understood what she meant and I knew that meant I had to come in every 2 weeks for foetal screening.  I did tell her I couldn’t eat very well and losing weight, and she said I don’t have to worry too much about that yet since its the first trimester.  Although I continue to get scans every 2 weeks, she will only see me monthly unless there were problems to be discussed. And that was it. Then I waited some more to pay for my first consultation at the main desk, and they gave me my next 3 appointments.  It turned out to be 6 appointments, if you combine the other appointments at AMC and ADC.  Mothers who do not have high-risk pregnancy can really reduce their waiting times by seeing a private gynae, because rather than shuffling between departments, they would see the gynae and have the ultrasound done by the gynae and it will be all over within 15-20 minutes.

I am so used to the personable Geraldine Tan and her intimate clinic at Katong that I wasn’t prepared for the big hospital experience.  But only big hospitals can give the detailed kind of screenings multiple pregnancies need and have doctors and nurses experienced in handling complicated pregnancies.

I started reading a book, What to Expect with Twins, Triplets, or Quads by Dr. Barbara Luke. And before I even read the book, I fulfilled most of the criterions Dr. Luke recommended for triplet pregnancies.  What the book, however, enlightened me on was:

  • Triplets mature faster than singletons.  This will prepare them to survive premature birth despite their potentially low birth weight.
  • Because triplets mature faster, they reach their peak growth at 24 weeks and slow down thereafter.  So I have to gain most of my weight in the first 24 weeks.  That means almost 1.5-2kg per week for 14 weeks (that’s all I have left until 24 weeks).
  • If you are underweight, you are at a disadvantage because you need time to put on extra weight to reach normal weight.   But unlike singleton and twin pregnancies, if you are of normal weight or overweight and have triplets, you still have to gain the same amount of weight which is optimally 1.5kg-2kg per week until 24 weeks.
  • Since I had given birth before and it was a smooth delivery and Livia was at a good birth weight, I stand a higher chance of delivering triplets with heavier birth weights than compared to a first time mother.  This was the best piece of news I’ve received the entire pregnancy because I am really so worried about the triplets staying in NICU for too long. But if I am to give my triplets better odds, I need to eat, eat and eat.
  • Nutrition and gaining weight steadily will help the triplets have a longer gestation period. Eating too little in fact can trigger preterm labor.

Just from these little pieces of information and a lot more others I researched prior to reading to book, means that one cannot treat multiple pregnancies the same way as singleton pregnancies. And it starts with choosing the right OBGYN.  In Singapore, you have the option of going to KKH, NUH or SGH, since all these hospitals have lots of experience with multiple pregnancies.  If money isn’t an issue, then Gleneagles is also a good hospital for multiples antenatal care.

So it looks like many antenatal appointments for me the next 7 months.  Its made difficult by the fact that my husband might be overseas like he was during my first appointment.  I feel he is missing out on the first trimester again because the last time I was pregnant with Livia, I was overseas.  I still keep him updated as much as possible over the phone so he’s always clued in.  I hope he’ll be there the next scan.

(Postscript:  Changed antenatal care to NUH after a bad experience at KKH)

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