Summer Holidays

Chubbocks summer holidays just got over this morning, and Puddi goes back to playschool tomorrow. This time around, my parents were away in the US with my sister and we had charge of the family dogs, so we couldn't go out of town till my parents came back, not to mention that A has a new job and I was in some job-related turmoil so we were kind of stuck in situ.

My kids do have cousins - one in the US, the other in Canada, and will have one more, when my sister has a baby in October this year. But sadly, they hardly get to meet them, since they live so far away. Once in two years is the best that can be managed. My sister and I did have a plan to meet up in different corners of the world every year so we could fulfil both wanderlust and family togetherness, but at least for the present, the recession has put paid to that. She made a visit here for three weeks in December which was great, and the kids had a blast, but all in all, it seems too little.

Of course, it's not like she and I met our various assorted cousins too often. We lived in Delhi and most of them down South in Bangalore or thereabouts, so we met them annually, at best. But I always think of cousins and family reunions when it comes to summer vacations. I don't know if those were merely simpler or poorer times, when people didn't have the money to go stay in fancy locations in fancy hotels, and so visiting relatives was the default option for vacations.

We used to make an annual trip to the South, without fail. I still remember the lo-ong journey through Madras on the GT express. There used to be an 8 hour or so stop at Madras before we shunted off to Bangalore. Madras station would be stiflingly hot and humid, and reeking of fish. I used to loll around in a petticoat ( slip) and jump from berth to berth during the wait. Sometimes mom and I would get out and she'd souse me under the station pump to cool off.

Then later the KK express was introduced and we could go direct to Bangalore, and it seemed like the time was magically 'cut short' to some 40 hours. By the time we crossed Jolarpettai, I'd start wheezing. We'd pull in to Bangalore and one of mom's brothers or sometimes Thatha would be there to receive us and take us home. Enormous amounts of luggage would have to be managed - a brass tiffin carrier, a holdall, a big water jar and assorted suitcases.

Bangalore was a somewhat boring destination for me because there were no kids my age near ajji-thatha's house. I spent most of my time reading through thatha's extensive book collection and had waded through the unabridged Oliver Twist by age 6, out of sheer lack of alternatives. Thatha also had back issues of Reader's Digest dating back to the 50s and 60s, and I loved reading all the humour columns. There was a lovely club with a swimming pool just opposite their house, with a beautifulyl landscaped garden but I was not allowed to swim thanks to the asthma so I had to content myself by wandering around the lawns and making up stories.

We would do a round of visits to various relatives, including my aunts. My elder aunt, Vasanthi, loved to cook and would get so excited at seeing us she'd cook up a storm, But she was also absent minded. once when we were over, she was so busy chatting while we had lunch that she kept grating coconut for salad to go with lunch right until we were through with our food! She always had some interesting new food for us to try - like a Banana dosa - and always, but always had a stock of gulab jamuns on hand, because she loved them and knew I adored them.

My other aunt too was an enthusiastic cook, but more prone to making health food, so various kinds of leafy greens and salads would parade themselves before us at their place. Born with a green thumb, she had an awesome collection of Bonsais. Various relatives would offer that particularly Bangalorean beverage both to us and our parents - Bournvita/ Horlicks, in lieu of tea/ coffee.

But the real high point of summer holidays was going to Mysore where my paternal relatives stayed, including my cousins Nirupama and Kalyani. Nippu, as she's referred to, is just three months older than me and Kalyani was 6 years older than the two of us. We used to love the train ride to Mysore, especially the Maddur vadas that we stopped for enroute. My sister and I always used to pester to go home by horse cart rather than autos because they were so much more novel. The cart would trundle along to the clip-clop of the hooves down roads carpeted with bright red gulmohur flowers.

As soon as we reached my uncle's house, there would be a glad pandemonium, as everyone rushed to greet everyone else. The grownups would make as much noise as we kids. One aunt or other, or a cousin or uncle was always visiting. In the evenings, any one of a number of relatives would drop by as usual and spread the word that we had arrived. Then every day someone or other would land up, and there would be a spate of conversations, with old family skeletons and anecdotes being trotted out. At night, there would be sessions of '28', a strategy based card gamne, for penny points, interspersed by family gossip. Nippu used to curl up and go off to sleep at her usual hour but I used to stay up as late as possible, to be part of the action.

There would be a mandatory trip to the famous covered market. We usually had at least one expedition to Brindavan gardens, where we'd all pile into a rented van and go off for the day, and one outing to Chamundi Hills. A satyanarayana puje at the Raghavendra Swamy Matha was also a must, and we kids would dress up in our finery and keep making aimless trips from home to temple until the puje was over and we could relish the truly awesome food served there.

We kids had any amount of freedom to wander around by ourselves - something that I look back upon with envy, from the perspective of my poor city kids. We went off for picnics, including a mandatory outing to Kukkarahalli kere, followed by a meal at Ramya restaurant. We once went to a temple garden for a picnic and were chased by a bull - that was a famous incident where I fell under a moving car. We'd go to Jagan Mohan Palace to see the paintings, and to the Mysore Palace to look around. We'd go down 100 feet road to buy all manner of little knickknacks, and to the Technical Institute.

We were usually taken out by my cousins' next door neighbours, as their kids and we and my cousins all played together through the summer. They would take us in their Fiat, which made us feel very rich, to Lalit Mahal Palace grounds which were quite overgrown and had a wonderful view of Chamundi Hills, and then on to a meal at a restaurant where for some reason I always had Chhole Bhature.

My cousins and we spent the summer in all sorts of games, either in the temple opposite our house, or on the rooftop, concocting plays and dance performances that never saw the light of day. I'm not really sure what we did but the television was something that was never ever turned on. At mealtimes, the adults would eat first and then leave the table to us because they knew that given our habit of chattering and playing about, we'd be at it for hours.

They were wonderful summers, something we still reminisce about when we get together - so carefree, so aimless, so devoid of any structure or purpose nand yet so full. We used to weep when the train pulled away from Mysore station, and my uncle and cousins would also have brimming eyes. We looked forward to those summers every year and they never disappointed.

My kids had a rather sacked out summer this time. They went briefly to a summer camp of yoga and art, and then basically lazed around at home. A and I were at work and without ajji thatha to keep them busy, they had to find amusement for themselves - from drawing on doors and windows ( Puddi), to being prodded to complete summer homework( Chubbocks), to fighting with each other. We went swimming as often as we could, and all our weekends were spent in a pleasantly aimless manner.

I was happy for them to have an aimless summer sans any structure. I think it's so important for people to learn how to use their leisure time and to cherish it and it's best to begin when they are young. Chubbocks has now learned how to keep himself occupied, especially with his favourite occupation of reading, and I think it's been a fun summer for them.

Snippets from a mini-Break

Puddi, recalling a recent nosebleed she had had: "Chubbocks was really scared when I was blooden"

Puddi, regarding Bojjandi: "Bojjandi is a cu-uute baby. He's ho-oorrible cute"

Chubbocks, on me pressing him to try bacon: "What if I get swine flu?"

Puddi, after watching a performance by Banjaras: "When I grow up and become a man, I'll become a fire eater"

Puddi, in tears, observing A and me arguing: "Why are you scolding Abba? He's my favourite abba!"

Staycations

I have been pretty stressed out at work for a while, so it was nice to get away for a couple of weeks. Not too far, though. I took a staycation, as much due to the recession as to the stress of traveling with three kids.

Two whole weeks. Pretty long time for me to chill out, right? Wrong. It turns out three kids have a way of fast-forwarding time faster than any time machine yet discovered. I can't say I got much done. I did have some hazy plans for finishing the mural on their playroom wall...buying some sequins for the blue front wall...getting our modern chandelier repaired...putting up some of the paintings we've been too lazy to put up since december...being a little more active on my blogs...

Well, I achieved none of the above. I did manage to take them swimming almost daily for 3 days, and then I fell ill with a septic bad throat. I recovered by Friday, and we went swimming twice on Saturday, then chubbocks fell ill. He passed it on to Puddi who then passed it on to Bojjandi and so it went. A welter of impatient, cranky kids and cranky and impatient mum, glued together in one room with the AC perpetually on thanks to the heat.

A big chunk of my day went in yelling at them to behave/ eat/ wear their slippers. A tiny but blissful chunk went in curling up for a siesta in the afternoons. A small chunk went in helping Chubbocks have fun with his holiday homework - a concept new to me since I went to school in the dino era when there was no such thing. I spent a teeny tiney amount of time reading - was too tired to read most of the time. Don't really know where the rest went, but I can tell you I found no window aimless and big enough to persuade me to put away the pile of ironed clothes.

I got back to work today, and it feels tough to give up that aimless, rambling, snapping, yelling existence and come back to the relative sanity of a workplace. To not have little bodies hurling themselves at me precisely when I'm painstakingly painting a toe nail or updating my facebook status, to say, "I lou you mumma" or "Fimming pool". To not watch puddacious hurl herself at the furniture in a frenzy of joy at sheer existence twenty times a day. To not applaud Bojjandi carefully drool and crawl his way through an obstacle course of cushions set up by his big brother to cushion his fall. To not be around to answer Chubbocks' twenty million existential questions. "What if there was a number bigger than infinity?" "Are you older than infinity?"

On the other hand, I don't pay for the air conditioning bills at work!

One little life…

I read this harrowing account of a VBAC gone wrong some time ago. I hadn't posted on it until now as I wanted to be sure it was a true story and not an urban legend. But I have recently read the full account on Madmomma's blog and she says she's in touch with the poor mom who underwent this tragedy so I am posting it here for those of you who haven't as yet come across this outrageous incident.

You know, when you are pregnant, you read all the baby books anyone's ever written, talk to every woman you've ever known who's ever had a baby…And yet ultimately, you know you know nothing and you put yourself in the hands of your doctor, professionally qualified, experienced and, hopefully, with your best interests at heart. Any of us who've had a complication during pregnancy would remember the feelings of panic and the reassurance you feel when your doctor seems to be competent and advises you calmly and yet sympathetically on your options. What do you say when a doctor, whose negligence seems to have caused you to lose your baby, advises you to take up 'Japa and tapa' and says you can always have another one? Does that replace the baby you have lost? Do you ever forget how old the baby would have been and stop crying for the 'it might have beens'? Especially when you realize it was a matter of minutes, and sheer medical negligence, do you ever stop regretting and not counting the 'what-if's?

I wept unashamedly the first time I read this story, in my office. I don't have the strength to read it again. But I'm putting it in here to hopefully forewarn any expectant young mother about the risks and the kind of things to watch out for. As for Rashmi, my heart goes out to her and I hope she somehow finds the strength to cope with this. God help her.

Rashmi's story

My name is Rashmi B.T. I am 35 years old, married to an air force officer, Vivek, and have a four year old son, Dhruv, delivered by emergency Caeserean section in 2004. On March 4th, 2009, my life was changed unalterably. I lost a baby that I had carried inside me, completely healthy, for a full 41 weeks.

I understand that doctors are human, that mistakes happen. However, I have come to believe that what happened to me could have been prevented if the doctor and the hospital had provided the most basic level of care and expertise. What's worse, they refuse to take steps to prevent someone else going through the same nightmare, simply because they want to protect themselves from the possibility of litigation – something I am not interested in unless it is the only way to force them to change their protocols.

The Beginning

In June 2008, Vivek and I learnt that we were expecting our second child. The pregnancy was uneventful. I was healthy and fit. Every prenatal visit and test showed that the baby was healthy and developing well. During my 35th week, I decided to consult Dr. Latha Venkataraman at The Nest, Wockhardt's Bannerghatta Road maternity facility to see me through the rest of my pregnancy.

Despite the fact that I had already undergone a C-section, she urged me to opt for a V-BAC (Vaginal Birth After Cesarean Section) or in layman's terms, a normal delivery. She brushed aside my concerns, telling me that a second C-section would be six times more risky and assuring me that a V-BAC would be less risky and almost pain-free.

My due date was estimated as 26 Feb 2009. I visited Dr. Latha on 28 Feb. She wrote on my record: "delivery will be attended by Dr. Latha/Dr. Prabha." Since I had neither met, heard of, nor been examined by Dr. Prabha before, I was concerned. Dr. Latha explained that Dr. Prabha Ramakrishna is another consultant at Wockhardt, and that it was a hospital requirement for her to write both their names down as possible attending doctors for my labor/delivery. However, she assured me that it was just a formality, and that she would be the one to attend to me when I went into labor.

On 3 March, I visited Dr. Latha again. Since I was so far past my due date, I requested that a scan be done to check on the baby. When I called her to read out the results of the report, she did not want to know anything other than the liquor content, though I specifically asked her if there was any other information she would require from the scan. She told me I could either wait for labor to start or choose a day to come in and have my labor induced.

The Nightmare Begins
I went into labor at 2am on 4 March, and got admitted to the hospital at 5.15am. By 7.45 am, I was experiencing contractions less than a minute apart. Dr. Latha came and did a quick examination. I was shifted to the labor ward at 8am where I remained until 1.50p.m., under the sole care of nurse Savitha. Dr. Latha was not present at all.

A junior doctor, Dr. Shirley, was available intermittently. She spent most of the time on her cell phone, talking to her husband. She was keen to see him before he left on an 11-day vacation. A Dr. Chetna substituted for her while when she went to see her husband off. There was no other doctor present. Dr. Prabha was called each time the fetal heart rate fell (this happened a couple of times). She was seeing outpatients and attending two other deliveries simultaneously, so she was only able to come to the labor ward to see me four times, for less than 5 minutes each time.

At 10am, I was given Syntocinon, a drug used to enhance labor; the dosage was increased at 10.45am. At 12.30, there was vaginal bleeding, and the nurse phoned Dr. Prabha, who advised her to "keep a watch". The bleeding reduced, but I began to feel pain of increasing intensity during contractions. Dr. Shirley reappeared at 1.00 p.m., examined me vaginally and announced that I was almost fully dilated and would deliver by 1.30pm. I complained several times of excruciating pain but was told that it was normal. At 1.30pm, Dr. Prabha came in and was told by Dr. Shirley that I was fully dilated and would deliver any minute. Despite that, Dr. Prabha breezed off to visit another patient in the OPD.

I felt no urge whatsoever to push, yet was asked to do so. The stirrup on the delivery table kept breaking off – I was told that this is a recurring problem that "needed attention". At 1.50 pm, the fetal heart rate dropped to 80 beats per minute. Dr. Prabha was called again. She checked the fetal heart rate on the CTG, explained that this was normal when the baby was passing through the birth canal, and asked me to hold my breath and push hard. I felt no sensation in my cervical area, but felt intense pain tearing my stomach apart. I felt like my baby had rolled into my stomach and could see its body pushing up against my ribcage. I was screaming, pointing at my stomach, and telling them that my stomach was hurting, and there was no urge to push. But she told me to "push, push harder". I then heard Dr. Prabha saying "Get the OT ready". She told my husband that she was going to attempt to deliver by forceps – if that was unsuccessful, she'd have to do a Caesarian.

The OT wasn't on standby, wasn't ready. I was numb with pain. They wanted me to get up and move to the operation table. I couldn't move. They eventually slid something under my back and I pushed myself on to the OT table, as there was no transfer stretcher available. I complained of severe shoulder and chest pain. No one paid me any attention; everyone was busy preparing the OT, and the anesthetist was attempting to top up my epidural. The fetal heart rate was never monitored in the OT. Dr. Prabha unsuccessfully attempted a forceps delivery at 2.20 p.m., and then cut me open. I heard a deafening sucking sound, after which I must have passed out.
Later, I learnt that my uterus had ruptured along the scar of my previous Caeserian section. My baby was found floating in my abdomen. He had no heartbeat and he wasn't breathing. He had been deprived of oxygen for a long time – 43 minutes. They "resuscitated" my son and put him on a ventilator.

When I opened my eyes I saw Dr. Latha leave, followed by Dr. Prabha. Dr. Shirley was suturing me while laughing and talking with another nurse. I felt reassured that my baby was okay, even though I had neither seen nor heard him.
"Don't Worry, You Can Conceive Again"
At 3.30pm, a nurse struggled to take my BP reading; the BP apparatus wasn't working and had to be replaced. Dr. Latha met Vivek at the NICU and told him that the baby was doing fine and had to be kept under observation. She also told him that my scar had ruptured, but said that I was okay. At 4.30 pm, my husband repeatedly begged the nurses to give me pain relief. I was then shifted to the ward.

At 9.30 pm the neonatologist told Vivek that the baby had been deprived of oxygen for over 40 minutes, possibly resulting in "some extent" of brain damage. This was the first inkling we had that something had gone wrong.

The next morning, I was given a sponge bath at 6am. I then lay unattended until 2.30 p.m., when Dr. Prabha, Dr. Latha, and Dr. Prakash (the neonatologist) saw me for the first time after the operation. Dr. Latha unceremoniously ripped the dressing off my wound without using any gel or spirit, and pronounced the wound clean.

We were told that our baby would be kept under observation for another 24 hours. Later that night Dr. Latha came in at 9.50pm. Her only words to me: "Don't worry, you can conceive again. Your uterus is intact."
"Do Japa and Tapa To Get Better"
None of the consultants saw me on 6 March. That night, my milk came in, and my breasts became swollen and painful. I asked in vain for assistance. After repeatedly begging for help, I sent Dr. Latha a text message at noon on 7 March. At 4pm, a nurse told me that the doctor had instructed them to use a breast pump to relieve my pain – however, since the hospital didn't have one, I would have to go and buy one.

Dr. Latha finally visited me at 7.30 pm. She confessed that she was unaware that there had been a 43 minute delay in performing my C-section. She also admitted that instructions delivered over the phone could never substitute for personal supervision. She said, and again I quote, "Do some pranayama, japa, and tapa to help you get better."

Throughout my stay, nurses didn't know what medication I had been prescribed. They kept asking me what medication I was to be given. They had to be repeatedly reminded to give me medication.

For the next 13 days, Arnav was in the NICU on a ventilator. Throughout that time, he was completely reliant on ventilator support, his eyes were dilated and non-responsive to light, and there was no sign of movement. After a week, the neonatologist asked me to express milk and said they would feed the baby with a pipe inserted from his nose to the stomach. I did this for the next six days.

On 16 March, we decided to let Arnav go. We requested that he be removed from life support.

"We Would Do Exactly The Same For The Next Patient Who Walks In"
Vivek and I wanted to learn what had gone wrong with such a healthy pregnancy. Basic reading indicated that scar rupture is a well-known risk when you attempt to deliver vaginally after a first C-section, and must therefore be monitored very closely by a doctor if attempted at all. We met with the hospital administration and the doctors. All we wanted was an explanation. To hear the words, "I made an error in judgment". Instead, we were met with a wall of defensiveness. Dr. Latha said that despite knowing the outcome, she would take exactly the same steps with the next patient who walked through her door.

I decided to get a second opinion. And then a third, and a fourth, and a fifth. Three of Bangalore's best-known gynaecologists (and other doctors too) categorically stated that given my age (35), the estimated weight of the baby (> 4 kilos), and the duration of gestation (>40 weeks), a vaginal birth should never have been attempted, and scar rupture was a logical, obvious outcome.

All reading I have done has backed this up. Even a layperson's book like "What to expect when you are expecting" (pages 363-364) says that abdominal pain during a V-BAC indicates a scar rupture and outlines the procedure for safe delivery of the baby. Given that I was complaining of excruciating abdominal pain, shoulder pain and chest pain, the doctor should have known my scar was rupturing. I should never have been asked to push; it exacerbated the rupture. Nor should I have been given a drug that intensified my contractions. By Dr. Prabha's own admission, she did not know about the rupture until she opened me up.

Several doctors have also told us that keeping Arnav on the ventilator for 13 days was an exercise in futility from the first. At no point were we told that he would never survive if taken off the ventilator – had we known that, we would never have subjected him, or ourselves to two weeks of anguish. All we were told was that he "might be" brain damaged to "some extent" but they couldn't predict how bad it would be.

A Brick Wall of Defensiveness; Discrepancies Galore

When I attempted to engage with the hospital to ask them to change their protocol of treatment based on an unbiased review conducted with the inputs of external gynecologists, I was met with a brick wall of defensiveness. They refused to conduct a fair, transparent investigation, claiming that their internal investigation showed that they had done everything right and that losing the baby was "my destiny". Dr. Latha went so far as to say that since I am educated, I should have been better informed about the procedure.

I don't want to sue them for money. I just want them to change their policies and protocols so that this doesn't happen to someone else. I have been hitting a brick wall for two months, and feel that the only way to make them pay attention is to tell my story to people.

There are many discrepancies and attempts to cover up the hospital's inefficiency (to name a few: baby's weight recorded as 3Kg despite the fact that he was never weighed; post-facto note of fetal heart rate as 180bpm despite the fact that the heart rate was never monitored in the OT; discharge summary says "live term baby extracted" even though Arnav had no heartbeat or respiration at birth; half-hour discrepancy between CTG trace and labor room clock). I asked questions to which I was given ludicrous answers (Eg: Our pediatrician is very experienced, so he can guess the weight of any baby just by looking at it).

We were charged approximately Rs. 2,20,000 by Wockhardt. Of this, we found over Rs. 7000 billed for things that had never been done (spinal anesthetic, an extra day of room rent, food not consumed). We subsequently found more extraneous charges, amongst them an amount billed for tests that were performed on 18 March, two days after Arnav's death.

My Story Has Just Begun…
My uterus is still healing. My back still hurts from the trauma. And my heart aches for Arnav, the baby I will never hold.

More than that, I am filled with the fear that this will happen again. After all, Dr. Latha says she would "do exactly the same again" even though she knows the outcome. And the hospital agrees that she – and they – did everything right.

Wockhardt delivers approximately 80 babies each month. With BP machines that don't work, a delivery room stirrup that's falling off and that has "needed to be fixed for a while", nurses who don't know what medication they are supposed to administer, and one (yes ONE) OT dedicated to emergency deliveries. That OT wasn't ready when I needed it. What guarantee do you have that it will be ready when you need it? Sure, they claim to have nine other OTs in the hospital – but if they are all as woefully unprepared as the one I was in, my story could be yours.

I want them to change their policies, and I won't give up until they do.

Thank you for reading.

Wockhardt's side of the story

1. Reputations take a lifetime to build, is it right to destroy them without understanding true facts and make a hospital and its doctors look inhuman? The true facts of Ms Rashmi BT's case
   

   Ms. Rashmi B.T. was under the care of a senior gynaecologist in Bangalore for her second pregnancy. She had a breech presentation (where the legs of the baby present itself first instead of the head during the time of delivery) in the earlier pregnancy which required a C-Section. She made a conscious decision to shift under Dr. Latha Venkatram's care at Wockhardt Hospitals, Bangalore in the 35th week of her pregnancy largely because she was aware that Vaginal Birth after Caesarian Section (VBAC) was an option and wanted to select that option for her second delivery. She had collected information that Dr. Latha Venkatram was one of the senior gynecologists in the city who offered this option to her patients. From the OPD records filed by Dr Latha Venkatram it is evident that Rashmi was counseled and given ample information about the procedure and the risks associated with it and she took an informed choice to select this procedure.
   Vaginal Birth after Caesarian Section (VBAC) is the term used when a woman gives birth vaginally, having had a caesarian delivery in the past. Worldwide VBAC, if possible, is being recommended and preferred over repeat C-Sections as its advantages substantially outweigh the disadvantages. According to the Royal College of Obstetricians and Gynaecologists patient information guideline 2008 "Birth after previous Caesarian Section", overall three out of four women with an uncomplicated pregnancy would give birth vaginally following one caesarian section delivery. The short-term and long term complications inherent in a C-Section make it preferable that a woman is offered the choice of a VBAC. The American College of Obstetricians and Gynecologists and have set a goal of 37% VBAC deliveries by 2010
   Repeat Caesarian sections are associated with:
   o A possibly more difficult operation
   o Longer recovery period
   o Possibility of injury to bladder or bowel
   o Possibility of blood clots developing in legs and pulmonary thrombosis
   o Breathing problems for the baby. Higher in C-Section than in VBAC
   o Serious risks increase with every Caesarian delivery
   o Higher chance of infection
   o Future complications for the mother who has had repeated opening of the abdomen
   o Higher costs
   VBAC has a shorter stay in the hospital, faster recovery as well as lower cost for the patient. There is a risk of uterine rupture but this risk is approximately 0.5%. In spite of this risk the benefits of VBAC far outweigh the risks. As in all medical procedures there is no way to predict which patient would fall under the 0.5% risk of uterine rupture or any way by which this rupture can be prevented. A VBAC delivery is more demanding of the gynaecologist, as it takes 6-8 hours as compared to a C-Section, which in a planned fashion would be over in less than 40-45 minutes. Also the mother and child need close monitoring it is estimated that one will have to do as many as 200+ unnecessary C-Sections to prevent the occurrence of 1 uterine rupture. In most cases a uterine rupture is not fatal. However in the best interest of Ms Rashmi, Latha Venkatram gave her both the choices and Ms Rashmi chose to opt for the VBAC option.
   

   Ms. Rashmi B.T. was a fit candidate for a VBAC. She had a breech presentation in the earlier pregnancy which required a C-Section. A breech presentation in the earlier pregnancy which necessitated a C-Section is in fact an indication to offer a VBAC to the patient in the subsequent pregnancies. An age of 35 is not a contraindication to a VBAC. The fact that she was 5 days past her due date was also not a contraindication to a VBAC because less than 5% of patients deliver on their due date.
   During her antenatal visits to Dr. Latha Venkatram, Ms Rashmi B.T. was explained in detail about the pros and cons of VBAC and she agreed to undergo the procedure. The OPD case records have these notations. She was also clearly informed by Dr. Latha Venkatraman that she works along with Dr. Prabha Ramakrishna as a team and either of them would be present during her delivery. Doctors particularly in the area of obstetrics frequently prefer to work as a team since many times an emergency may hold one of them which would make it possible for the other team member to attend to the delivery as the date and time of delivery cannot be predicted. In a VBAC considering that a consultant needs to be around for most of the labor period it is prudent that a team takes care of the patient. Both Consultants of the team Dr. Latha Venkatram and Dr. Prabha Ramakrishna are Fellows and Members of the Royal College of Obstetricians UK.
   

   Ms Rashmi B.T was admitted to the hospital early morning on the 4th of March 2009 in spontaneous labour. She was connected to monitors for a close monitoring of both maternal and fetal parameters. She was visited by Dr. Latha Venkatram soon after admission. An experienced nurse and a fully qualified gynaecology registrar were monitoring her constantly. The Consultant Dr. Prabha Ramakrishna was also available on the same floor and repeatedly examined her. She was kept informed about the progress of the labour.
   The labour progressed normally until 1.50 p.m when a sudden decrease in the fetal heart rate was noted (fetal bradycardia). The tracings before 1.50 p.m were normal. The moment fetal bradycardia occurred, the consultant Dr. Prabha Ramakrishna who was on the same floor was called in by the gynecology registrar. When Dr. Prabha Ramkrishna examined Ms Rashmi, the baby's head position was a little high. She was asked to push to see if the baby's head would come to +2 position in which case she could do a forceps in the labor room itself and deliver the child. When the baby's head did not descend as required she asked for the patient to be shifted to the Operating room. After this Ms.Rashmi was not asked to bear down any further.
   

   Shift to the OT was rapid since the dedicated Operation Theatre for Caesarian sections is situated within the labour room complex and this theatre is not used for any other procedure. Within 7-8 mins the patient was in the theatre. The anesthetist had a choice of going in for an emergency general anesthesia which has inherent risks for a pregnant woman or to go in for epidural anesthesia. Since the patient was already receiving pain medication (epidural analgesia) it was decided that for the safety of the mother increasing this analgesia to achieve anesthesia was the preferred option. In the OT the fetal heart rate was recorded as 180 b.p.m on the Doppler. On the OT table an examination was done and it was found that the head had receded and a forceps delivery was not attempted. An immediate emergency C-section was then performed.
   The anesthetists, Neo-Natologists and the surgical nursing team had assembled in the theatre within a few minutes of the emergency being declared. The hospital has full- time anesthetists, Neo-Natologists and a surgical nursing team working round the clock to attend to all kinds of medical emergencies.
   At the time of birth the baby did not have a heart beat or respiration. Resuscitation was started and the heart beat started about half a minute later. The child was immediately shifted to the Neonatal ICU and put on the ventilator. The baby's weight at birth has been recorded in the NICU as about 3 Kg. The only reason an exact weight could not be taken in the NICU was that the child was already attached to various lifesaving equipments and the neonatologist had to make the closest estimate. However it must be noted here that a birth weight of 4 KG is not a contraindication for a VBAC.
   

   In the neonatal ICU the clinical team met the family on a daily basis and kept them informed about the status of the baby and the prognosis. The poor prognosis was explained to the parents on the 2nd day itself. An opinion from an external eminent neonatologist was also sought who concurred with the poor prognosis. All decisions regarding further care were made only after extensive discussions with the parents of the baby. Dr.Prakash Vemgal our Neo-Natologist is not only highly experienced but has also gone through some of the highest training in Neo- Natology in high patient volume and reputed international centres.
   The doctors and the management (including senior management personnel) of the Wockhardt Hospitals group spent long hours with the parents understanding and trying to address their concerns. As is the normal practice in such a case a complete internal review was done. The family sent to us a detailed list of areas they wanted us to look into during our investigation. We did go into each of these areas and sent them a detailed reply addressing most of these issues including taking the opinion of two leading and senior external gynecologists of the city who do substantial VBAC work. It is unfortunate to note that inspite of providing her all clarifications Ms Rashmi has been projecting an extremely poor image of Dr. Latha Venkatram and the hospital.
   Our internal review involved discussions with our own team of gynaecologists, meetings with two external gynaecologists who practice VBAC and the entire clinical care team. Our findings after this detailed internal review are summarized below.
   a. Ms Rashmi BT was a fit candidate for a VBAC. She would have been offered this procedure as a first choice by any gynecologist or hospital which practices advanced obstetrics anywhere in the world. Her age or the week of pregnancy were not contraindications to go in for a VBAC.
   b. She had made a conscious and informed decision about going in for a VBAC. She had changed her senior gynecologist whom she was consulting until the 35th week of her pregnancy primarily because that gynaecologist was not in a position to offer VBAC.
   c. The OPD case notes of which she was given the duplicate copy recorded that she was willing for VBAC and she was informed about all risks of her decision.
   d. Both the mother and the child had been monitored carefully right through the labour
   e. All medications used for progressing labor were prescribed agents and safe for use in VBAC
   f. She did have a uterine rupture which in VBAC carries a risk of 0.5%. This rupture could in no way be predicted or prevented. In spite of the rupture the gynecology team was able to save the uterus for future child bearing.
   g. The Operation theatre was ready at the time it was required.
   h. All the staff were present in the Operation Theatre within a few minutes of the emergency being declared
   i. While the baby was in the NICU Dr.Prakash Vemgal the head of Neo-Natology met up with the parents at regular intervals and kept the family clearly informed about the status and prognosis. All major decisions were taken only after discussion with the parents.
   j. Senior management of the organization met up with the family on multiple occasions to understand and address their concerns
   A minute by minute account of her story as is being spread through the various emails circulated by various people who were neither physically present during her admission to the hospital nor were involved in her care process exhibits to us a determined effort to harm the reputation of the gynecologist and the hospital without having any understanding of the clinical facts of the case.
   Is medicine now going to be judged through the lens of only opinions running across chain mails or through the untiring efforts of institutions and doctors which toil endlessly to save lives but remain spectators to their actions being judged by emotive outbursts?
   We do understand the pain and suffering of Ms Rashmi BT. As a hospital every life is precious to us but we are also are in the world of medicine where unfortunate rare complications can be counteracted but every procedure cannot be made risk free. There are many lives which we save each day when all has been given up and each such case teaches us that to pursue medicine is to pursue the limits of the unknown but does that mean that we become victims of public misinformation
   We have taken all necessary care and followed every medical protocol that any reputed institution across the globe would have followed. However it is unfortunate that even though Ms Rashmi has not been a victim of any medical negligence she has chosen by this random spread of irrational mails to use a redressal system that is purposely harming the reputation of Dr Latha Venkatram, Dr.Prabha Ramakrisha and our institution.
   

   The case can be subjected to analysis by any competent authority.

I am not a medical authority but I can see some discrepancies in the hospital's story right way. For one thing, a 4 kg baby is big in any geography especially India where women are much smaller built. So it should have rung alarm bells in the doctor's mind, given a previous CSec.

Moreover, how can the hospital wash its hands off saying the mother was fully infomed? Did the doctor tell her what could be a potential outcome while Rashmi was in labour? We all know things change in, literally, a heartbeat in medical situations. What the doctor may have told Rashmi earlier would be negated given the dynamic situation in the labour room, so it really is up to the doctor to take a competent medical decision, backed by experience and training, rather than to say the patient was educated and informed and to pin the blame on the patient.

TO OUR CLOWN PRINCESS ON HER 3RD BIRTHDAY

Well, I started out to blog about Puddi, my puddacious daughter, for her upcoming third birthday. But words, my constant companions in everything I do failed me this time. I just couldn't find the right words to encapsulate what she means to me, how she lights up our lives, to describe her kooky personality and the things she does...So I decided to hand over my pen ( keyboard in this case) to my better 1/3rd, as he is far more gifted with words than I am, to tell our dear daughter how we feel about her.

All I can bring myself to say is that if I could have imagined a daughter and brought her to life, she would have been such a pale, insipid thing compared to my beautiful butterfly of a Puddi. You fill up my heart, darling. Happy birthday!

Love, Mama

Guest post by A

My dearest Puddi,

What can I say about you which words can capture adequately?

Let me try comparisons. There was Lucille Ball. There was Sridevi. And now there’s you. The same impish personality, and the same ability to make everyone laugh by doing something completely kooky, even as they’re gasping over how pretty you are. The same gift of just walking into a room and stealing a scene, simply by ensuring that no one can take their eyes off your face.

How about food metaphors? You’re like an ice-cream rolled into a lemon meringue pie, to which lots of cream has been added, with some spice on top for taste. And all that’s actually just in the first spoonful.

Hmm – let’s try just talking about life with you. I never cease to be amazed by how you can look like a tomboy in T-shirt and shorts, and transform into a little lady the moment you’re in a frock or a dress. I love how you wake up frowning with your wild hair all mussed, and then suddenly make the morning good by switching on that dazzling smile. Your thirst for adventure and desire for new experiences (inherited in spades from your mom) lift my spirits and remind me just how full of possibilities life can be. It’s a joy to watch you playing with your two brothers - I hope they’ll always appreciate what a loving, fun sister they have. It breaks my heart to see your small face crumple and tears roll down your soft cheeks if your mom or I scold you – it feels as if we’ve violated a sacred vow. I can’t bear the thought of anything so much as scratching you (that’s my alibi for being the exceptionally protective father that you’ll soon discover I am – your boyfriends better watch out!).

Nah. You know what, there’s no point in trying to describe you – it’s like chasing a rainbow with a butterfly net.

So let me just say that you’re a big chunk of my heart, that I didn’t know what having a daughter would change my life in so many ways, and that I already choke up when I think of you going away one day.

So have a very happy birthday sweetheart, and here’s hoping each of your birthdays celebrates a year which was better than the last.

You make us feel truly blessed. Thank you for being our daughter.


With all my love
Abba

Loving all of me

Madmomma asked me a while ago, for an article she was writing, whether there was any body part that I hated. I thought about it and replied, "My feet".

It's true - I always hated my feet. They're really really huge, for one thing. It's as if they were in training to carry a much taller person, or they had some prescience that I would grow up and become the hulking figure I am today and they'd have to support that entire roll of lard all by themselves.

My toes are fat, podgy things, quite shapeless, even back when I was slim with a Monroe-esque figure ( 34, 24, 35!!!). My little toes clearly got squished right from when I was in the womb - they have a curled-in toe nail that's very hard to cut and impossible to get nail polish on. The rest of my toe nails are thick and a natural beige, so they can't really look sparkling clean. When I was growing up, dad used to joke that I had iron feet, since nothing but the thickest, most boring footwear lasted longer than a couple of weeks. I remember when I'd started working, I had a pair of sandals that looked like they were made from recycled tyres, which I bought only for the longevity factor.

Well, over time everyone developes their own coping strategies. Mine are: in summer at least, to get french pedicures done as often as possible ( once a month is the limit of my endurance of trips to a beauty salon). The rest of the year, I do my best to deck out my feet in the most stylish footwear I can find. In fact, after MM asked me this question, I realised I don't hate my feet any more - because they give me a good reason to splurge on stylish shoes and keep building up my collection. If I'd had beautiful feet, I'd probably have wanted to live in strappy sandals and kohlapuris and never explored the world of boots, pumps and sandals that cover up the toes. And if a pair of shoes conks off, as they will, why that's just an excuse to buy one new pair, no?

Quite apart from that, which is a fun reason, I realise my feet have kept me active, helped me see the world and explore new places. They've made it possible to run after and rescue my son when he fell into the pool, to play cricket and field the ball for my kids, take romantic walks with boyfriends/ husband...Like me, they may not be beauties but they get the job done!

The other day I was critically looking at my lumpy shape and thinking that though I'm overweight, except for my belly which is hanging out to the next room and often sees new places before the rest of me does, I'm pretty well-proportioned. For a couple of minutes I looked down resentfully at the belly. Then I realised that this was the home of my three most precious gifts, my kids, for nine ( more or less, usually less) months. This was where my body nurtured them and gave them comfort, gave them a safe environment to thrive and grow big enough to face the outside world on their own.

Yes, I could do with a smaller belly and am and will be taking steps ( literally, as in restarting my running program) to reduce its size, but there's no way that I could resent it having become this big or sticking out. Now when I go to the swimming pool with the kids, I don't feel embarrassed or feel the need to cover it up or hide it. It's perfect because it's an indication of the natural process I went through to get my children. It's part of my life process.

Weaning Baby off

It's that time of year. Time when I have to start thinking about weaning Bojjandi off mother's milk and put him completely on formula and food. Time when I have to wean myself off from feeling the warmth of his plump little body as he nuzzles in for a meal. Time when I have to wean myself off the excuse to drop everything and just sit down quietly and concentrate on being with my baby. It's too soon, I feel, and wonder if I can prolong it.

For me, I haven't once resented having to sit up/ wake up and feed my baby at odd hours of late night or early morning, or in the middle of a party. Because I am so happy and - yes, proud – at being able to do it. I know, it's something millions of women all over the world are able to do, it takes little more than a healthy body and hormones, and that being able to do it or not is no reflection of my ability or caring as a mom. But here's the back story.

I always, but always took it for granted that this was something I would do with my babies, the most natural thing in the world for a mother to do. To feed her babies. You see it in Hindi movies all the time. Even in serials and sitcoms – a woman gives birth in a bizarre circumstance, e.g. a taxi, and about five minutes after the baby is born, baby is suckling away and mother is happily watching it. You see at every street crossing, poor beggar women sitting and nonchalantly nursing their babies till the age of two or three or more.

So after Chubbocks was born unexpectedly early (3 weeks), it hit me hard that I couldn't do it – that was something I wasn't prepared for. The first day after surgery, I was knocked out with the General anaesthetic. I could barely make out what the baby looked like when I came to briefly, and he was in the nursery that night as I slept off the worst hangover of my life! The next day they moved him into my room, and the nurse asked me to start feeding him. Mom was there to help, but it was an awkward business figuring out how to hold this teeny-tiny, fragile little thing and positioning him. Worse, he fell asleep a few seconds into the process. Then the nurse asked if I could express some milk so the baby could be fed later. I tried, manually, but all that emerged was about a teaspoon of rich, yellow stuff.

"Is that all?" Mom and the nurse exclaimed.

I thought to myself that I had always read that colostrum only came out in minute quantities, but obviously these were two experienced women, so clearly something was not working right. After that it was an endless cycle of trying to position baby and get him to latch on, him falling asleep at the breast and me struggling to express what looked like a reasonable quantity – which, I now know was much more than anyone could expect, but hey, no one told me how much milk I should expect so in hindsight I think I expected to produce about a bottle full at the get-go. Meanwhile, the hospital nurses passed comments about how sad my productivity was and continued feeding Chubbocks formula out of a bottle, since 'he shouldn't starve meanwhile'.

After we went home the situation didn't improve. Chubbocks kept falling asleep, I kept struggling, feeling more and more inadequate as a mother. How was it that I could fail at something so basic, so natural, something the poorest of women was able to do with ease? I looked up the internet, asked around, my mom soaked quantities of fenugreek seeds, I ate fennel seeds after each meal…It didn't help that Chubbocks was born a fairly light baby and lost weight in his first ten days. I panicked. It didn't help that my in-laws would ask A every single day when he called, as to whether Chubbocks had gained weight. It didn't help when, any time he cried when they had come over, even right after a feed, my mom-in-law would say, "He's hungry". It didn't help when my mom asked, out of concern, "Are you sure you're producing enough?"

What was enough anyway? How could I check what was happening? How come my baby, even on formula, was thin and gangly, and lizard-ey looking? I got A to buy me a pump. Naturally, it would turn out to be a mal-functioning one, and the first time I used it I was in agonizing pain and convinced my nipple was going to come off. It was only after 3-4 sessions that I realized that no one could have designed a product to hurt like this. Otherwise, in my irrational state of mind, it was almost a form of penance for me for failing at this. I went back to the store, fought with the manager and got it replaced. So now at least I knew there was some milk, but Chubbocks continued to fall asleep each time I tried to feed him. I'd sneak formula milk into him after I had had an unsuccessful feeding session, not wanting to admit that I had had a failed session again. I'd sterilize his bottles and pretend to mom that that was 'just in case'. I'd cry and agonize late into the night about why this was happening and what I could do about it, and I'm sure that stress didn't help my cause.

Eventually, after four months of struggle, I gave up and put him on formula. I decided it was better for his health that he should get a decent feed, rather than me and my ego struggling along. But the guilt didn't go away, and along with all the challenges of being a new mother, it became a deciding factor in how I reacted to everything, for a while. Each time he cried, be it for a wet diaper, or change of scene, I took it as a judgement on my poor parenting skills. It was almost like I had to make up for not being able to feed him by making him the happiest and (bizarrely) the non-cryingest baby in the world.

Thankfully, despite my idiocies, he didn't seem affected and has turned into a happy, intelligent, secure child. But the guilt factor stayed with me until I had Puddi and was able to feed her. Even in her case, after starting out extremely well with milk coming in a day after she was born, somehow the supply began to falter. I tried all sorts of remedies from herbs and vegetables to homoeopathy. Eventually I turned to Domperidone which is prescribed for this in the US though here no doctor seems to have heard of the solution, and would up being able to feed her, though with artificial aid, until she was 9 months old. In a way, having a third baby and being able to keep him purely on my milk for six months has finally vindicated that sense of guilt.

More than that, I feel the experience of breast-feeding my second and third children gave me the ability to bond with them at a visceral level, and much faster than with Chubbocks. It could also be because when Chubbocks was born, we were both new at our jobs – me as mother, he as baby. By the time Puddi came along, I had job experience and with Bojjandi, I'm a veteran. So I love and cherish that feeling of holding your baby so close, of being the one to unfailingly comfort him, of importance, perhaps, at being the only one who can nourish him. Once I wean him off, I'm going to have to earn my place!

Dessert Baby

Little Bojjandi,

You are eight months old already! How time flies. By now I can barely remember a time when you spent most of your day sleeping or feeding. I can't remember a time when you weren't alert and responsive, looking back at us, eyes twinkling with an intelligent gleam in them. I can't remember a time when you used to lie flat on your back, unable to do more than flail those chubby arms and legs about, instead of turning turtle in the twinkling of your eye J as soon as you're put down, and crawling backward. I can't remember a time when you used to bawl for no reason, instead of having built up your own repertoire of very different sounds to express what you want – that cute little humming sound when you're sleepy, angry grunts when you want your food RIGHT NOW, plaintive bawls as soon as you discover you're all alone in a room. I can't remember a time when mother's milk was all you craved, seeing you eagerly react to the taste of each new food, from mangoes to parathas with sabzi. I can't remember a time when you quietly lay against my heart as I rocked you to sleep, instead of bouncing up and down on those sturdy legs, butting my chin with your teak head.

Your didi gets very upset when she takes you for your evening walk and the neighbor comments on how you're so tiny for your age, and how shocked she is that you still can't sit up though her grandson was sitting up at the age of five months. But you know what, I don't care. That's one of the gifts you and Puddi gave me – the ability to just enjoy what your child is and forget about the so-called milestones. They'll happen when they will, and meantime, I can share your wonder at discovering a brand new world.

Even as I feel time's flying past and I wish I could press pause and enjoy each phase for a while longer, you come up with something even cuter and more heart-warming and I forget all about "time's a fleeting" in sheer enjoyment of every lovely moment. I'm so glad we had you – you're our icing on the cake, our sweet, cuddlesome, chubby little Bojji – and you just complete our family so beautifully. Here's looking forward to more antics from you.

Love,

Mama

A Matter of Interpretation

Puddi: Mama, I wanttosee sussideez barr!

Mama: Eh? Errr…what's that?

Puddi (tearfully): Sussideez barr, mama!

Mama: silent, scratching head

Puddi: Mama, you know – the barr sussideez, the shimpul barr sussideez…

Mama: Oh, The Jungle Book?

Puddi: Yes, mama, sussideez barr!

Nature Nurture

I always wonder how kids born in the same house, from the same gene pool can be so different. Take my sister and I, for example – she's tidy and organized, I'm completely the opposite. She's very good at crafts and packing presents neatly. I'm a klutz at both, not to mention sadly lacking in patience. As our elder two are growing up, it's become clear that they are also quite disparate.

When Chubbocks was little, we had an infestation of ants in some of the woodwork. Every day hordes of big black ants would swarm through the house, which was quite disgusting. But I never wanted to kill them since I have a fondness for the industrious creatures, as opposed to cockroaches or flies. My mother-in-law started a game with Chubbocks of stomping on them and I found it extremely distressing so I told Chubbocks that at best we should sweep them away gently. I taught him to watch how each ant would manfully hoik 10 times its own body weight in a food item and laboriously wend its way home. We used to sit and watch as a group of ants, in a great display of teamwork, would pick up a bougainvillea leaf and wander off with it for some mysterious purpose.

Last night an unwary ant happened to wander onto the dining table. Puddi the boisterous unthinkingly reached out and crushed it before anyone could say anything. I got pretty upset with her and rebuked her that the poor thing must have been looking for food to take home to its family. She of course listened for about two minutes and promptly returned to her primary occupation of playing with her food. Chubbocks, meanwhile, sat silently. A couple of minutes later I looked across at him to find his eyes swimming with tears. He got so upset about the ant, that eventually he just broke down and sobbed inconsolably, distraught at the thought of the ant and the ant's family who would wait and wonder and worry. He was eventually so upset that not even the bribe of ice cream or chocolate worked. He just couldn't get any food down and finally had to be put to bed early.

His dad and I tenderly took the ant outside and laid it down in our garden, at his behest and A had to come up with a complicated story of how the ant had just become unconscious and had woken up later with a big headache, gone home and was now being looked after by his family. This morning as soon as he came down, Chubbocks wanted to go and look for his ant. He went out into the garden and came back beaming. "I saw it. It's fine!" "How do you know it's the same one?" we asked."I saw its face".

I don't know how many kids today are that tender-hearted. I hope Chubbocks remains like this…

7th heaven

Can’t believe my youngest child is already 7 months old and more…almost enough to make me long for another baby! He’s come on in the most amazing way, too. Perhaps it’s a result of how blasé the parents get with a growing brood. With the first child, everything is an event. Each time the baby cries, you question your credentials as parent, you question your paediatrician’s degree and you’re pretty much happy promising him anything to stop crying. I thought we’d be a bit more blasé the second time around and of course, by the third time, pretty much ask to be woken only when someone saw blood. Well, guess what. It’s as thrilling each time, because each baby is so different, despite the same two sets of genes blending and a similar upbringing.

Bojjandi’s growing up and has a definite personality now and it’s a thrill to uncover a little more of that with every day and each interaction. He seems to have a lovely nature, his smiles are so completely guileless and open. Touch wood, like my other two babies, this one too is usually commented on as, “What a happy baby!” He loves greeting us with a beaming smile right from the time he wakes up in the morning, and throughout the day, it seems like he just wants to catch our eye so he can let loose one of those beams of pure joy.

He’s turning out to be a pretty good communicator – or maybe the other two trained us well. He rarely cries but when he does, we can usually tell what’s causing it – gas versus code brown, boredom versus hunger…And he’s already multilingual – he can not only make French-like cooing sounds but also Germanic guttural sounds though we haven’t yet figured out what language the grunts are.

An active baby, he now hates lying down because he can’t see what’s going on around him. He starts yelling loudly until he’s propped up on someone’s lap. He even hates being in his bouncer because it’s too constricting. Like his siblings, he seems to prefer making his own amusements rather than play with toys. He can be endlessly amused by me turning my fingers round and round over his head. He also spends hours making his plump hands turn in circles and sucking at those fat fists. He’s just learned to clap and finds considerable amusement in trying to make one palm strike the other. He also seems quite amused by the mayhem caused by the rest of us and looks on with a goodnatured grin on his face.

He’s taken pretty well to changes so far. I recently had to travel on work and was out of town for 6 days. The poor baby went cold turkey on everything from breastfeeding to hugs from mommy but seems to have not troubled his dad at all. He’s enjoying his solid meals tremendously and as soon as he spots his meal on his little silver thali, starts yelling as if to tell us to hurry up and feed him. He loves a banana for breakfast and now not only finishes a full banana but usually winds up the meal by howling for more. He’s also transitioned quite smoothly from the steel Aladdin’s lamp feeder to sippy cups for milk, and moved from his cloth sling to Puddi’s old cot with ease.

All in all, he’s made third-time parenthood seem like a complete breeze and lots of fun. It’s hard to believe that this time last year he was the size of a zygote and that we ever even had a second thought about not welcoming this blessing into our lives and hearts. If ever there was an indulgence baby made for the pure purpose of enjoying every step of the way, that’s Bojjandi. I’m not so serious about my role as parent anymore – I’ve learnt that a light touch is better than a heavy one. It’s better to enjoy every moment of it – the scoldings, the banter, the tantrums and the topsy-turvy house, because it all goes onto the next phase all too soon and while each phase has its moments, there’s nothing that fills a home and a heart as much as really young children and their perfect imperfections. And I’m savouring each and every moment of Bojjandi’s each phase, drawing it out and hoping the growing up slows down a bit.

Having Bojjandi’s like having a really calorie-packed, chocolatey, sinful dessert after having a great meal. You’re not sure you need it or indeed can manage to have it but you just want to indulge yourself and when you do, it feels so good…7th heaven!

Not This Mother’s Day

This, I think, is going to be my post for Mother's Day. We went through a harrowing experience yesterday and it just brought home to me what all lies in store. Makes me wish I could hug my kids close and curl up under a blanket for aeons…

Chubbocks, as you know, is a very gentle, sensitive type of fellow. His one experience of sleeping over at a friend's house seems to have left him scarred, and each time he goes for a playdate, he is at pains to confirm that he's going to be fetched back that evening. And, now that he's ;earned to use a telephone and dial his dad's or my mobile number, he's on the phone at the dot of whatever time we said we'll fetch him – Where are you? You said 4 o'clock, it's 4:02 now! Why haven't you come? In fact he comes up with the most hilarious reasons for leaving and starts hinting to his friends' moms from about 2 in the afternoon – I have a piano class to attend ( he's not enrolled in any class as of now)…we're going to my cousins' house (his only cousins live in Canada and the US)…and so on.

Last night we had some old friends over for dinner after ages. They have 2 kids, one around 8 or 9 and one who's just a month and a half younger to Puddi. Our kids got to stay up and chill with theirs, which is a rare happening since my brood is usually in bed and asleep by 8, so naturally the kids were very excited, They got along well together and had a good time, Puddi and the friend's son communication in some pidgin toddler-ese together. When they got up to leave, we all stepped out till the gate to say bye. Puddi was holding hands with their son by then and chattering away. As they started walking to where their car was parked, she began walking along with them. "Puddi, you're going to stay in their house", we sais in jest. Puddi nodded, didn't even bother to turn her head back to look at us and kept walking along with them.

A and I waited, with an apprehensive Chubbocks beside us, big smiles on our faces, waiting for the moment when realization would dawn that she'd miss us and when she'd turn and come running back to us. Only to be completely dumbfounded when this pint-sized Puddi kept on marching on and on and down the road out of our sight. Then came the sound of a loud blubbing. It was Chubbocks, waling to think his sister was going off! He wept and wept while I ran after the looney Puddi and grabbed her. I picked her up and turned to get back home, only to find that she had burst into tears, because she wanted to go off with her newfound friend!

Somehow we marched her back home and got her and Chubbocks into bed. She was still sobbing to go ages later, while Chubbocks was telling us that if Puddi ever goes for a sleepover, he'll really miss her and give her one of HIS toys when she comes back home. Much later A and I finally got a chance to deal with our own emotions on this occurrence. And we both realized we were feeling shattered. I mean, of course we want them to eventually become independent little beings and to take their own decisions but this was way too soon. Not to mention the total lack of any looking back on her part. It gave us a tiny inkling of just how it would feel the day our little chicklings finally leave the nest, and left us devastated…

Weaning food

Way back when Chubbocks was a baby, one of my friends mentioned that her sister used to make this traditional form of weaning food for her child. It sounded so healthy I decided to make it as well, and just adapt it in case I found any food allergies or such. It's a very simple recipe, you have to make it maybe once a month and it's easily customized to the child's taste. I must admit Chubbocks is one of the skinniest kids around so that may not be an advertisement for its properties but at least he's very healthy and full of beans, so I guess it did do some good J

Ingredients:

Plain uncooked Rice: 1 cup ( ps. Not basmati but a softer type of rice, like parmal is better for infants)

Moong dal without the skin: 1 cup

Ragi flour: 1 cup

Almonds (blanched): 1 cup

Sooji: 1 cup

Wheat flour: 1 cup

Roast all the ingredients one by one on a low flame in an iron kadhai until well roasted and aromatic. Cool and grind to a fine powder. Mix well and store in an airtight container. To cook this, just steam 2-3 tablespoons in the pressure cooker with some water (1.5 times amount of water should do fine). Add any vegetables or fruit that the baby is fond of, well-mashed, and serve. I used to add mashed steamed spinach, mashed bananas, mashed pumpkin, potatoes, onions, garlic…pretty much anything that the baby enjoyed and top off with a spoonful of home made ghee.