Margaret Jane, or Maggie as we all call her now, was born in an emergency c-section on November 17, 2011 at National University Hospital. She weighed 1,512 grams and measured just under 40cm long. She was a 30 weeks and 2 day preemie and spent fifty-one days in the NICU.

In a few days, it will be a year since she was born. Right now, she is wandering around our flat, a board book in one hand and a puzzle piece in the other. She can’t quite decide which is more delicious for chewing, so she is carrying them along with her as she  ambles around after her big brothers and sisters. She has round cheeks and chubby thighs, developmentally all caught up with no signs of damage, and when she gets sick, an ordinary childhood cough, I now only imagine she’s going to die every other minute.

It’s hard to break the habit when all through my pregnancy and then for the first months of her life, we prepared for the worst. Maggie is the exception.

I had had nine early miscarriages and we were fairly sure that we couldn’t and wouldn’t have another child. We had four wonderful teenagers, adopted siblings from Cambodia, and we were starting to think of Life After Kids, going as far as buying guidebooks to Paris and New York and making plans.

Surprise, you’re pregnant

Instead, we found ourselves referred to a high-risk obstetrician at Gleneagles who prescribed weekly progesterone shots, asprin and daily self-administered heparin shots. The shots left bruises over my stomach, but they also let me feel like I was doing something. For some women with unexplained early miscarriages, blood thinners seem to prevent miscarriages. There are far more theories about early miscarriages than solutions, so doctors pretty much rely on what has proven to work: frequent visits to a doctor and interventions that probably don’t hurt. Somehow, that combination of attention and placebos produces a statistically significant decrease in miscarriages.

I had ultrasounds so often I lost count of them. We bought a fetal doppler kit and every day I would sit and listen to that heartbeat. Was it the asprin, the fish oil tablets (yuck), the injections of what turned out to be extremely expensive cow snot – heparin, or just a random genetic match that worked this time?

Early rupture

Maggie grew. I scheduled my last work trip to Cambodia, and a few days before tried to carry some heavy packages on my own. Something hurt sharply but I decided it was just a pulled muscle. In Cambodia, I felt idiotic to complain about my weird symptoms when I was talking with women who worked on the streets as prostitutes right up to the day they delivered, who hauled construction materials and buckets of laundry through crowded slums and didn’t have any access to medical care except if they were lucky a midwife who washed her hands.

But back in Singapore, I mentioned my symptoms to my doctor who put me immediately on his table for a scan. He was a friendly warm man who liked to chat, full of endearments for all the babies he had helped bring into the world, the wall behind his desk covered in their photographs. This time he was quiet.

“You’ll need to get a referral,” he said and started making phone calls to NUH.

I was leaking amniotic fluid. I was just coming to 23 weeks and the biggest surprise was that she still had a chance, even as tiny as she was. Bedrest was prescribed, plenty of fluids and regular scans. Wait and watch.

There was likely a small tear high up on the amniotic sac. When I moved, I leaked more so I ended up lying in bed. At each scan, they would measure how much fluid was left. It’s not an exact science because the baby moves around, but an experienced doctor or technician can get a good estimate by measuring several different pockets of amniotic fluid around the baby’s limb. When it’s low, the medical term is oligohydramnios. Too much fluid, polyhydramnios, can be a danger too.

Amniotic fluid cushions the growing baby. The baby drinks the fluid and pees it out, and eventually starts practicing breathing in it. Without enough amniotic fluid, the baby’s growth can be restricted and harmed, and during delivery the umbilical cord can get fatally compressed. There’s a wide range of how much fluid is needed though, and most women diagnosed with low amniotic fluid have normal deliveries.

I had detailed ultrasounds to make sure the problem wasn’t Maggie’s kidneys or other congenital issues that can cause low amniotic fluid. She seemed healthy, just small. Then the ultrasounds were simply to check if there was any fluid. The Amniotic Fluid Index number became the most important number in the world. Could I get past 2 again? Climb up to 4? Would I make it all the way to 5 if I just spent the whole day drinking?

There have been theoretical attempts to seal tears or to ‘top-up’ the amniotic fluid, but they were all risky and only theoretical in Singapore. Instead, I just drank endless cups of water and milk, hoping to replace what was steadily leaking out.

I hadn’t planned to start maternity leave for another three months, and we were in the middle of renovations and moving house which somehow had to be managed along with our other four kids while I was in bed. I remember being either incredibly bored or incredibly busy, and insisting that we should have evolved from birds and laid eggs like civilized creatures.

I had to start taking my temperature and was put on a round of antibiotics. Inside the womb, the placenta and the amniotic sac form a nearly perfect protective shield over the developing baby against infections. The tear made her vulnerable.


Eventually I was admitted to the hospital for monitoring because of irregular contractions. I checked out for two days, missing my other kids so badly, and then had to check back in. I was put on tiny blue pills, nifedipine, to slow down the contractions. They turned my brain into a cabbage and the world narrowed down to a hospital bed and the eight hours between each pill.

The doctor in charge of my case had set 32 weeks for delivery. If I could get there and I was stable, I would try for more time, but that turned out to be optimistic. I made it to 30 weeks and 2 days, developing gestational diabetes on the way as well.

I woke up feverish and with a terrible backache and by the afternoon, I had been wheeled into L&D where I declared everything to be very pretty and sparkly when I was on the nitrous oxide, and that I would kill my husband when it wore off.  There was no question of a vaginal delivery – Maggie was breech, her growth had slowed down recently and they were concerned about the umbilical cord. I was relieved almost to have all those decisions taken away by sheer medical necessity. I was just so grateful that she might live through this.

The gurney paused outside the operating theatre, and I turned to my husband, scrubbed up to accompany me, and said at last what I had lain in the hospital at night worrying silently about: “If I die, don’t blame the baby. Make sure the kids don’t blame the baby.” It felt stupidly dramatic, but I had spent so long preparing for Maggie’s death that I felt almost as if her safe delivery would require some other price.

The epidural was a beautiful warm relief and a few minutes later, the surgeons wrestled Maggie out. She was taken to a table where she was wrapped in plastic film to keep her warm and a team of doctors and nurses checked her and whisked her off to the NICU. Then I lay back and happily chatted with my shell-shocked husband while the surgeons stitched me up. Queen Victoria was right – childbirth drugs are brilliant.

Nothing prepares you for the NICU

I had read about premature babies and NICUs for months. It was still surreal to be wheeled down to that room with its hushed chorus of beeps and chimes from machines, and to see near the door where a kind nurse had written in bright pink letters our daughter’s name above a plastic crib and inside, so small she looked like a funny doll, not pink or plump enough, Maggie.

The very tiniest preemies don’t wear diapers – they get a little scrap of muslin that won’t hurt their delicate skin. Maggie wore a newborn size diaper folded over that her bony legs stuck out from. Plastic wrap was stretched over her crib instead of a blanket because of all the wires attached to her. Tubes that seemed impossibly big but turned out to be the thinnest available ran down her throat to gently breathe air into her still developing lungs. I had had steroid shots a few weeks earlier to help her lungs develop faster and Maggie had been given artificial surfactant, a fairly recent treatment that has saved hundreds of thousands of preemies thanks to Dr Avery.

Maggie had been born before all her organs had fully developed. She had no fat stores to draw on. She didn’t even have eyelashes.

Machines helped – a heat lamp to keep her warm, the monitors that warned when she struggled to breathe or her temperature fluctuated, the x-ray machines and ultrasounds that showed the hole in her heart that refused to close, that her brain had no serious bleeds, the slow drip of nourishment and medication through her IV lines fattening her up until she could digest breastmilk, the blue lights to treat her jaundice, and the ventilator that breathed for her when she was too weak.

But it was people who kept Maggie alive in the NICU. Older nurses told us about the days when the ventilators needed to be worked by hand, a nurse at the bedside patiently and steadily helping a sick baby breathe. They were able to save younger and younger babies now, babies with illnesses that would have been impossible a few years ago.


I don’t remember much of the NICU stay because it was like stepping through the cupboard to Narnia. Time passed differently. Things happened in the world outside, but our lives narrowed down to going back and forth from the NICU and home. Our kids came along although they were too nervous at first to touch the new baby.

She became strong enough for kangaroo care, when a parent carries a baby skin-to-skin. The baby’s temperature and heartrate settle, and babies in kangaroo care gain weight faster and are discharged earlier. We learned to run the cords from her bubble ventilator over a shoulder and balance just-so in the uncomfortable plastic chairs by her crib so that we could hold her, a tiny froglike creature that seemed not-quite human, against us. She would make tiny mewing sounds at first, then settle into a deep long sleep on our chests.

I had problems making enough breastmilk, so there was the pumping every three hours and racing to the hospital at 2am with a bottle of fresh breastmilk so she wouldn’t have to take formula. I envied the other mothers who pumped so much they had problems storing it in the freezer. The preemies started with just a few drops, fed through a thin green tube that ran down their nose or mouth. Breastmilk protected against necrotizing enterocolitis, an infection that destroyed their delicate intestines so although I hated my breastpump, formula was a failure.

Heart surgery

Maggie grew slowly. They gave her three rounds of medication to encourage the hole in her heart to close. All babies are born with this open, even healthy full-term babies. The ductus arteriosus connects two of the arteries in the heart which works beautifully in the fluid-filled world of the womb but not so well when the baby needs to use those new lungs to breathe air. Normally, it will close on its own within hours or days from birth. Most preemies will see their PDA close as they approach the day they should have been born. If it’s small enough, it can be left for years.

Maggie’s didn’t. She struggled to breathe and had to be reintubated once. The hole was large and surgery went from an option to scheduled.

She’d tested positive for MRSA, the hospital superbug, and was shifted to an isolation room with just one nurse assigned to her. She was getting close to 2kg but she was still elegantly strange for a baby, all slender limbs and pale skin. She had no hair and her eyes were an odd grey.

Just before surgery, we had an emergency baptism. The priest at our church was overseas, so a Russian priest we knew well came and did the baptism without candles or immersion, only words and the faintest trace of holy oil on her. Her godmother and her parents sang softly over the sleeping baby.

Surgery was fast. There were problems with intubating her, then with her blood pressure at the start of surgery, moments when we stood in the corridor of the NICU ward while nurses and doctors strode past us into her room, refusing to answer questions or even look at us until it was all over.

In the NICUs in Singapore, parents are distant thirds to the nurses and doctors. There is so much happening, complicated difficult decisions that need to be made quickly, and the parents, even with the best intentions of the hospital, end up in the way. They aren’t trained in how to bathe a baby so small their skin can peel off, how to feed a child through a tube, to know when this beep can be safely ignored but that beep brings a team rushing to an incubator.

I read with envy about NICUs in other countries where there were comfortable chairs next to the incubators, even rooms with beds. Where parents could come in all the time, where parents were encouraged to do the basic care for their preemies. But I was so intensely utterly grateful to the doctors and nurses who took care of Maggie – and too exhausted – to ask for more.

Only once when a nurse scolded me for breastfeeding Maggie while she was on the bubble CPAP, something I had figured out how to do with great difficulty, did I get mad enough to speak up and ask that she not be assigned to our daughter again.

Going home at last

I was scared that they would close the doors on us, that they would shake their heads and say “I’m sorry, but you simply aren’t fit to take care of her.” All the parents knew we had to pass a test to take our babies home when they were healthy enough. We had to wash and feed the baby and demonstrate infant CPR. It was well-intentioned but terrifying.

A few days after surgery, Maggie passed her final tests and so did we. We brought her home on the 6th of January.

We had never left the NICU with our baby, and suddenly we were strapping this tiny squirmy bundle into a carseat on a stroller and wheeling her out past the doors. Without thinking consciously about it I started walking quickly, leaving my husband behind because a part of me was still certain that this was all a paperwork mistake and they would come running after us and take Maggie back.

That first night, like most preemie parents, we watched her sleep. There were no monitors now and we discussed half-seriously renting one so that we could go to sleep without worrying about her heartrate. Within a few days though Maggie made it clear that she would decide when to sleep and eat and that she preferred above all to be cuddled. Pretty soon her older siblings discovered that Maggie did not mind being dressed up in doll clothes and would reward them with a gummy smile for every cuddle.


In February, we wound up back in hospital when Maggie – tiny and pale and quiet still – developed aspiration pneumonia, probably from coughing the wrong way and just being small and weak. She had been to the doctor who said it was a cold, and then in the evening she got quieter and colder. We went to the ER and one of the NICU doctors was on duty and the world dissolved back into hospital time.

Her lungs had partially collapsed so she was admitted to the pediatric ICU and intubated. They only had regular sized beds, and Maggie was a tiny thing in the middle, tubes draped all over, and at the foot of the bed, one of her siblings or me curled up asleep.

She had two weeks, first recovering from the pneumonia and then figuring out what had caused it. She was diagnosed with reflux eventually, and went home with different formula and more medicines. We knew she was spitting up, but didn’t all babies spit up? Not as much as Maggie did apparently. We got more bibs.


And then she decided to grow. Like most preemies, she wasn’t even on the growth charts at first. We weighed her daily, tracking her growth on a spreadsheet with charts, something we found that other preemie parents also did. Then she crept up to the 5th percentile and got round cheeks. She began to reach out for toys and howling when they rolled away. She stopped throwing up. She pulled herself up on furniture and took her first steps.

We went from weekly pediatrician appointments to monthly to “Call us if something happens” at her last appointment.

Everytime she gets sick, I wait for worse to happen. Maybe it will. But the time we’ve had with her, seeing how much she is loved by her older brothers and sisters and how much she enjoys every day, it doesn’t matter how long her life is, just how good it is.

Another child?

But the big question now is: what about another child?

Another pregnancy is likely to be high-risk. The treatments during the pregnancy were expensive, and between my hospitalization and Maggie’s NICU stay, we had to clear out our cash savings and close to half of our medisave. We missed weeks of work and lost income as well.

The baby bonus for Maggie as our fifth child is a matching grant of up to $18,000 in a special account for medical and educational costs. We’re lucky that as a lower middle-class family we will be able to save up the $18,000 in the account and eventually make use of it. We’re even luckier that Maggie doesn’t require more surgeries and therapy treatment like most preemies.

We want another child. The age gap between Maggie and her next sibling is twelve years, and we’d like her to have a sibling close in age. But another NICU stay would wipe out all our healthcare savings entirely.

Most of all, I think of two families I met in the NICU and the pediatric ICU.

The smallest boy

He was the size of a kitten, with dark hair and reddened skin. His mother didn’t come to visit at all at first and then we saw her still in her hospital gown, weeping by his incubator. She would return simply to stand near him and pray silently. He was too small for her to touch.

The nurses and doctors don’t discuss other patients, but the NICU is small and the parents talked to each other quietly. The little boy would not make it. I saw them one more time, their older daughter leaning against her father, chattering away while her parents stared at nothing, frozen in grief. Then the next day, his incubator was gone and another baby in a crib was wheeled into the empty place.

I think of how they went home empty handed and a few days or weeks later, a letter was sent to them with their bill.

The much-loved daughter

In the pediatric ICU, there was a disabled ten year old girl who could not speak or move very much. Her parents took turns to care for her with the ease of long practice. One would turn to the two younger children that tagged along after school to visit their big sister and help them with homework, while the other soothed their ill daughter, adjusting the tubes and cables around her and understanding all the little sounds she made. Then they would swap places so a parent could get a cup of tea and talk to the nurses about the next day’s treatments.

They loved her. They loved all their children, that kind of practical quiet love you hope for in good parents, love that helps with homework and kisses hurt knees and shows in kindness and easy affection. The younger brother and sister showed the same gentleness to their sister as their parents.

I wondered how they managed. There were children in the pediatric ward who went almost the whole day without anyone visiting. There was a frightened little boy admitted whose mother couldn’t find a babysitter for the younger sibling so he crept out and went bed to bed looking for a parent or nurse to comfort him. There was another severely disabled boy whose father came every evening after his shift, still in his work uniform, to lean over his bed and whisper to his son.

Why we need free healthcare for our children

Increasingly, many Singaporeans don’t want to have children. We marry late, we plan on one or two children at most. Some of us decide to stay single or if we get married, to skip having children for careers, travel and other passions. Our birthrate is plunging.

In the pediatric ICU, I saw people who wanted children, who had proven themselves through some of the hardest experiences to be devoted and loving parents.

And they couldn’t afford to have more children because a sick child in Singapore will wipe out a family’s savings.

I am so grateful for the excellent medical care that saved my daughter’s life over and over. But our experience made me aware how much of that was luck – luck that we both had flexible jobs, that our other four children were old enough to cope, that we had enough cash and medisave, that Maggie was “only” in the NICU for fifty-one days, and most of all that she survived and does not yet have any conditions that will wipe out my family’s financial future.

But we can do better as a country.