Ethan Tsai

I had never known about babies’ gastrointestinal quirks. I think passing gas will always be funny to mankind. I was going to make a video, but quickly realized that it has already been done many many many times.

Full Term!

After almost two months, Ethan is finally a full-term baby.

The expected due date according to various cyclical “wheel” tools based on thousands of years of finely-tuned human evolution was May 21, but the obstetricians somehow came up with May 23. So for the next 2 to 3 years, we will have two answers for “how old is he?”, depending on what kind of doctor or person is asking the question:

• Age (chronological age): Age outside of the womb.
• Adjusted Age: Age from expected due date. Because Ethan was about 2 months early, his adjusted age will be less than his chronological age. So when he is 6 months old, he might appear to be 4 months old in various developmental metrics.

He was so tiny when he first came out. He seems so huge now, but he is actually simply within the normal range of weight for children at his gestational age:

The primitive reflexes on an infant can be interesting to play with. Here we have the “fencing reflex,” named for its resemblence to a fencing posture:

En Garde!

It is pretty crazy to read about the swimming reflex – somebody discovered that placing a baby face down in water would evoke paddling and kicking motions …

The current anti-SIDS thinking is that infants should sleep on their backs. However, supine sleep (sleeping on back) is associated with temporarily lower social- and motor-skills development (through 18 months). Infants are to be given “tummy time” to avoid developing into a socially-inept, fumbling person, and to practice learning to lift their heads and crawl around.

Today was Ethan’s first “tummy time”:

Ready!

Set!

No!

Ethan enjoyed his first Mother’s Day with his mom and our moms:

Ethan and Grandmother

Ethan and Mom

Ethan and Grandmother

UCSF states they take a more “holistic” approach to deciding when a baby is fit to leave the Intensive Care Nursery to go home. It means there are no hard metrics such as minimum weight. It also means it is difficult for parents to plan (“he’ll probably be ready in a few days”). We had to scramble to buy the car seat, install the base into the car, and practice fiddling with all the buckles and straps. Given the lack of preparation time, we had to conscript some unwilling test subjects that happened to be about the same size as Ethan:

Monkeying Around

Curious George

On the big day, his final exam was the ominous-sounding CAR SEAT TEST. The nurse sticks him in our car seat and makes sure he can survive being in it for at least an hour (a typical ride home from the hospital to suburbia). Here is Ethan in his sporty red (“Lotus”) SnugRide car seat, ready for a day at the track:

Ready to Race

Ready!

After the hour was up, the baby in the racing-red car seat was painstakingly strolled into the station wagon.

I normally weave my way home all the way down Oak, but today I drove extremely conservatively in the right-hand “slow” traffic lane (except for right-turn-only lanes).

First recorded smile!

Smile!

Real social smiles aren’t supposed to happen until 2 months of age; anything before that is considered to be facial grunts associated with expelling gas. But we’ll take it :).

One piece of baby-related paperwork involved the following checkbox:

[X] I plan to breastfeed the baby.

I marked the “X” and moved on.

Ethan required gavage-feeding (fed via tube inserted through nose and esophagus) his first few days. It doesn’t sound pleasant, but is necessary and typical for premature infants that have not yet developed the ability to suck and swallow food on their own.

The Intensive Care Nursery nurses tested him every day for a suck/swallow reflex until they decided he was able to bottle feed. At that point, the tube came out, and I was allowed to bottle-feed him.

Gavage

When Patrika recovered a little, we saw a lactation consultant for some advice. Later that day, we saw that Ethan had had a tube inserted again. It appeared our feeding preferences had been changed from:

1. Breast (first choice)
2. Bottle (if mother unavailable)
3. Gavage (if unable to feed from bottle)

to:

1. Breast (first choice)
2. Gavage (if mother unavailable)
3. Bottle (if unable to Gavage; never the case)

No tubes

Some extremely zealous lactation consultants (less-politely referred to by others as “breastfeeding Nazis”) would rather see a baby have a feeding tube than see them suffer the confusion of a bottle.

It is a point of view people are entitled to have, but the transformation of our preference from “we plan to breastfeed” to “we do not want a bottle at all costs” was not communicated clearly to us. We got this cleared up, and the tube removed again.

Ethan arrived 7 weeks early, on April 4 2009, 2:22pm, at 1.55kg, 42.5cm (3 lbs. 6oz., 16.7 in.).

Ethan in incubator.

We used to joke that when “it” happened, Patrika would be in her office working. She’d finish up e-mails and phone calls in between contractions, then finally calmly and slowly walk across to the street for admission to Labor and Delivery.

Of course, things did not happen as planned.

Last weekend, Patrika decided we should clean the apartment and pack our bags, even though the big day wasn’t for almost two months (May 21). During our various pre-parenting classes, and in some stuff I had read, expecting mothers will have a “nesting” instinct that will motivate them to do lots of cleaning (or tell their spouse to do lots of cleaning), so I thought:

No big deal, I’ve read about this.

Today at 4 in the morning, Patrika woke me up and said:

We need to go.

With all the joking about mid-phone-call and mid-e-mail contractions, I had never really considered the possibility of a midnight run to the hospital, so I was not really feeling very prepared. We got in the car; Patrika using her cell phone to call ahead to the hospital to let them know we were coming.

We had been having some complications during the pregnancy, so I wasn’t completely alarmed at everything I was hearing, but some things did stand out:

… there was a basketball-sized amount of blood.

I would later realize this was a two-dimensional description (area of spotting), as opposed to my initial three-dimensional interpretation (a big gushing volume), but it was not good to hear that as I attempted to continue calmly driving to the hospital. We were admitted to Labor and Delivery, and Patrika requested monitoring to confirm the baby was still OK (he was).

We received medication to try to control the bleeding and to try to buy time for the baby to come out on his own. However, after about 8 hours, around 1:30pm, it was decided that the risks of continued blood loss outweighed the benefits (and decreasing likelihood) of a natural birth, and Patrika was wheeled away to the operating room. I was told to don a set of scrubs and wait; after a very long 15 or so minutes, I was brought to the head of the operating table to sit next to Patrika during the procedure.

At 2:22pm, a baby, crying with eyes open, was delivered via unplanned Cesarean section, and we proudly announced his name:

Ethan

At UCSF, one makes the transition from obstetric-fetus patient to pediatric-baby patient by being literally passed through a deli-style window counter; I had to go out in the hall to walk next door to perform my first fatherly duty of cutting the umbilical cord:

• The umbilical cord is tough. I felt like I had to saw through that thing with the small scissors they gave me.
• We had planned to donate our cord blood; we were going to fill out that kind of paperwork next week. Since we never got to do so, I think our cord blood ended up getting disposed of (the default course of action).

I think every new parent feels extremely blessed. I feel doubly-blessed, because both Patrika and Ethan had to overcome a placental abruption (suspected, but not confirmed, until the Cesarean section was actually performed). Fortunately, mother and baby are both well, and Ethan appears healthy for a minus-7-week-old.

April 4 is the designated Children’s Day in Taiwan and Hong Kong.