Fighting A Battle: Getting Your Birth Order Recognised By The State

Your dad and I were shocked when we realised that the State doesn’t consider your birth order to be 2nd when I asked about applying for the government-paid maternity leave (GPML) for your new brother or sister. And in doing so, I felt I had to fight for your rights, even if you aren’t physically around anymore. But that opened up more questions instead.

After checking with the GPML department, I was not satisfied with the officer’s too professional and sterile answers and decided to write to the Minister for MCYS instead and very promptly received a telephone call from one of the senior MCYS officers and email replies.

Email To Minister Chan (MCYS) dated 30 April 2012:
Dear Minister Chan
  I hope in the midst of your busy schedule, you will take some time to read through this email and understand the anguish and heartache that has been brought about after getting the replies from the GML(CPF) officer, Ms Cxxx Yxxx.
 
  We, as parents, would also like to find out what is the rationale behind pegging the confinement order to the current living child/children.
 
   To summarise, I had written to GML(CPF) to find out and confirm if I qualify for the Govt-Paid Maternity Leave that would be granted for 3rd and subsequent child. 
 
   The reason being, my 2nd child, Leia, was born but passed away four months after delivery. She has her birth registered as a Singaporean (both my husband and I are Singapore Citizens) and has her birth cert. Hence to us, she is our second child and we reckon the State recognises her as such since her birth has been registered.   
  
    From what I had read on the GML website, stillborns would not be considered in the confinement order, that I understand as much. But my situation is rare, since we don’t expect children to die this young but such things do happen. Hence I felt perhaps it will be better to check with the GML(CPF) as I am now expecting my 3rd child and planning to apply for maternity leave later in the year.

  I have included the email exchanges between Ms Yxxx and I below for your reference.

  Ms Yxxx has been professional in her replies and provided me with the link to the huge Child Development Co-Savings Act and highlighted that the confinement order is based on the number of current living child/children. Hence my current pregnancy, if successful, will be considered as my 2nd child.

   My husband and I feel very perplexed, hurt and disappointed by this. We feel that parents who had children who died unexpectedly at a young age, would feel that our child has been conveniently ignored. That her birth, recognised by the State at birth and registered, has been cancelled out. That the order of her birth is reduced to nothing just because she didn’t live on. We feel very unfair for Leia, that even though it is a fact she had died, but it is also a reality that she was born alive and lived, even if it was for a short four months.

   To me, to simply quote the CDCA document and tell me that is the reason why my current pregnancy will be considered the 2nd confinement, and not the 3rd, is a slap in the face and a pain in my heart. It may be a very technical reason behind it, but I feel it is very unfair to the parents and to those young children whose lives were snuffed out unexpectedly. And I sure don’t understand why.

   As it is, to lose a child that young is already a tragedy, something we live with each day, and to consider having another after the death of our daughter, is something my husband and I mulled over for a year and a half but still we decided to try for a 3rd. Not because of any baby bonus, GML or whatever extras the government will give us, but because we still feel we want to be parents. The joy of having another child outweighs the fear of losing another.

   So, Minister Chan, my hope is that my daughter, Leia, will be considered as my 2nd child, not just within my family, but recognised by the State, especially since her birth had already been recognised by the State.

   Thank you for taking the time to read this and hope to hear from you soon.

Email Reply From The Senior MCYS Officer dated 9 May 2012 (days after we had spoken over the phone on the 3 May) and this email was mysteriously retracted thrice, which didn’t work cos I had opened the email.

Dear Ms Christina Lim,

  We refer to your email to Minister (Community Development, Youth and Sports) on 30 Apr 2012 and our tele-conversation on 03 May 2012, requesting us to re-determine the birth order of your third child for the purpose of Government-Paid Maternity Leave (GPML).

 2.   We are sorry to know of the loss of your 2nd child, Leia Tan. Under the Baby Bonus Scheme, Leia’s birth order remains as 2 and your newborn will be considered as birth order 3 under the Child Development Co-savings Act (CDCA).

3.    However, for the purpose of GPML claim by your employer, your newborn will be considered as the 2nd child. This is because the provisions on GPML in the CDCA are related to the maternity leave provisions in the Employment Act. In particular, the maternity leave entitlement in the Employment Act is only for the first and second child.  As such, the birth order definition of ‘living children’ will protect working women who give birth to 3 or more children but had lost a child earlier whether as a still-born or through illness.

4.    We would like to assure you that the determination of birth order has in no way undermined your entitlement to Baby Bonus or GPML benefits (as an employee) under the CDCA.

5.     We wish you and your family well.

And this email from MCYS caused me to question point 3 (we don’t understand the legal, civil service mumbo jumbo language). And it felt like they were making a compromise, by recognising your birth order for the Babybonus application but not for GPML.

So I shot back another email to them, after giving them the morning to explain why they had retracted this email or even send me another “updated” one.

Email Reply To The Senior MCYS Officer dated 10 May 2012

Dear Mrs Pxxx-Pxxx 

  Thanks for the reply.

  I read through your email a few times and had also forwarded it to my husband. However as the information described is in the standard formal language, we would like to just clarify a few points so that we have fully understood MCYS’ stand.

   1. Babybonus
Am I right to interpret that when I put in the Babybonus application for my 3rd child, if delivered successfully, it will be ok to state that I have two preceding children, inclusive Leia.

   2. GPML
My husband and I do not understand the statement “maternity leave entitlement in the Employment Act is only for the first and second child.  As such, the birth order definition of ‘living children’ will protect working women who give birth to 3 or more children but had lost a child earlier whether as a still-born or through illness”

We are unable to see how the birth order definition of “living children” protects working women with 3 or more children but lost a child. Since we do not know about the details of the Employment Act, we are unable to understand the rationale behind it.

Over our conversation on the 3 May, you did mention that if I was interested, you could get the Legal Dept to write to me to explain why the CDCA has defined confinement order according to living children, and I had replied that although this would be useful in helping me understand, I would still find this to be an unfair definition in my case. Perhaps if you could provide me with a bit more explanation, that may help.

While there must be some good reason for protecting that group of mothers/working women, but since we don’t see the rationale at this point, I feel that the birth order definition of “living children” doesn’t “protect” or assure mothers/working women who had one less child. We are obviously in the minority, but yet this minority exists.

You had also pointed out the scenario that if I had applied for maternity for my first child, Tyler, and subsequently my 2nd, Leia, then when I do apply for maternity leave for my newborn, the child would be considered my 3rd child. This would have been straightforward, except I wouldn’t have expected how things would turn out and also because my family was staying and working in HK, and there wasn’t any need for me to apply for maternity in S’pore. But if this was all done, I guess this current issue would not have turned out to be so sticky and in a sad way, resulted in lots of questions being asked and us feeling emotionally drained at times.

  I would like to reiterate that it isn’t the babybonus. GPML or any other benefits that we are concerned with, but it is our hope to have our daughter, Leia’s birth order, recognised officially in all aspects.

  My husband and I would also like to thank Minister Chan, MCYS and of course, you, for the patience and time taken to look into our situation.

  Thank you and best regards

So the officer tried to contact me the last two days, but she caught me at the wrong time… when I was teaching. And finally did the smart thing by sending another email

Email Reply From The Senior MCYS Officer dated 14 May 2012

Dear Ms Lim,

I have tried contacting you on the mobile phone on 11 and 14 May 2012 but there was no answer.

 2.  As mentioned in our earlier reply, your newborn child is considered 3rd child for Babybonus application.

 3.  However, for the purpose of Government-Paid Maternity Leave (GPML), your newborn child’s birth order is considered as 2. We would like to highlight we recognised Leia’s birth.

 4.   As for your request for an explanation of the confinement order in CDCA, Paragraph 3 in our earlier reply is drafted with inputs from our policy colleagues and colleagues from the National Population Talent Dept, Prime Minister’s Office.

 5.   I would also like to clarify that in the scenario if you had applied for GPML for Tyler and Leia, your new born’s birth order would still be considered as 2, for the purpose of GPML. In our tele-conversation, I pointed out the scenario to highlight that it might have felt better if you have applied for GPML and have received GPML for Leia then. Apologies if I have confused you in any way.

6.   Thank you for taking time to understand our reply.

I still don’t understand the rationale for pegging birth order to the number of living children and while I know it is not possible to get what I want in life, but when it’s for you and your rights, I would want to fight. Just as you had fought.

Remembering Leia Kate

Our Angel. Our Feisty Fighter. Our Daughter.

Born 13 wks premature on 1 Aug 2010, 2051

Went Home To The Lord on 26 Dec 2010, 1448

We miss you terribly.

We still think you are in the hospital, just like previous times, but the reality is, you aren’t.

You have left us. You are taken from us.

I’m still angry with God for taking you so soon, but I know I can’t stay angry with Him for long. The pain and the void can be so crippling on some days that I can’t breathe or sleep, and have to run back to Him for comfort and strength.

Click here for Leia’s memorial page.

Thanks to Cara for getting this done for us thru’ Carly Marie Dudley’s websites.
(a) To Write Their Names In The Sand
(b) The Butterfly Beach

We Are Home – Nov 2010

A few days into being home haven’t been too bad. 

TJ has been a lovely brother, basically he is curious about his little sister, whom we have been reminding him that he has one and now that she is finally home, it is quite interesting to see his reactions (or lack of reactions) towards her. I try to remind myself to give him some attention throughout the day, but it can get a little tricky since I’m still trying to get into a routine that gives me time to do so.

Settling into a routine takes a while, and having two kids do make it more exciting.

Some of the tasks I need to do:

1. Leia’s medications which she takes at different times of the day
2. Her 60 ml  milk feeds (30 ml of EBM and 30 ml of Enfalac AR, the latter supposedly to keep her milk down in her stomach so as to lessen her reflux) every 3 hours
3. Watch her SPO2 levels on the pulse oximeter & listen for the alarm that goes off when the level dips below 85%
4. Check that the prongs on her nasal cannula are still in her nostrils
5. Change the tapes on her face (Leia absolutely hates this and makes sure we know that) every couple of days
6. The three-hourly pump

In between, I will hang out with TJ when he is awake and rest when he naps. So far, Leia’s been sleeping most of the time and it gives me time to rest too. I am still not comfortable letting my helper carry Leia or assist me with any of the above tasks since the only other person I trust, other than myself, is D.

 So she helps me out with TJ, making sure he has his proper meals and plays with him when I am unable to do so. I feel really bad that I haven’t been able to spend much time with my son.

On the other hand, TJ seems to be taking things quite well, plays independently and doesn’t cling to me as much. Perhaps we have done something right with bringing up a confident and self-assured kid. I guess TJ knows we love him as much as we love Leia and even now that our time is taken up by the Feisty Fighter, TJ doesn’t feel threatened by that and neither does he act up to get our attention. Thank God for this.

Dr Ong has been coming to our place to check on Leia since her discharge and we are very grateful that he doesn’t charge us for these regular visits. I update him regularly too with calls and messages.

Anyway home is the best and a lot more normal really, than being in the hospital or shuttling to and from it. I’m tired, but happy.

31 Oct 2010 – All 91 NICU Days

I haven’t updated this blog in a long time for many things had happened along the way. And now that there is a slight window of opportunity, I guess I should really put it down in words before my memory fails me again.

When we knew that my little one would be discharged at the end of October, there was much preparation to be done. Going to the hospital to feed her and learn from the nurses there, getting the necessary equipment like the O2 concentrator and just prepping up the apartment for the new arrival, except it was three months later.

Our helper had requested to come to S’pore on the 7 November (a couple of weeks later than expected) as she wanted to support her daughter in a competition. As a mum, I reckoned she should go and be there for her child as she wouldn’t be back home for at least 2 years. Hence my mum stepped in (thank God for that) to help me with TJ and stayed over for the week.

Unfortunately life has a habit of not going according to plan and my helper was delayed again and again, for up to a week plus. But that will be for another entry.

Dr Ong felt it would be wise to have me room in with my baby for 2 nights before the official discharge on the 31 October. I had a hard time saying bye to my son, since I have never liked being away from him for too long. Again, having my parents living within walking distance from us is a blessing, and I could just walk TJ to my mum’s place and be assured that he would be in good hands. Except I think my boy actually runs the place upside down inside out and “controls” his grandparents, who willingly allow for that to happen.

For this room-in exercise, the packing was a bit of a headache. At this time, my helper wasn’t around and thankfully, TJ was a good boy and didn’t interrupt me too frequently. The essentials were the bottle steriliser, my Medela breast pumps, the little basin that I use to keep the bottles in one place while I wash them in the sink and the small bottle of baby bottle washing liquid and everything else that was required by the Feisty Fighter. The room, which was just opposite the NICU ward, was comfortable and even though it’s a 2-bedded ward, I had the whole room to myself.

I was early that day and the NICU nurses told me to go to the room to rest instead since they couldn’t “hand over” my baby to the ward nurses till after 2pm. I actually went to meet D for lunch before returning to the hospital, napped a little before the nurses wheeled her into the room.

Besides learning to take care of a preemie in a controlled medical environment prior to discharge, I took these 2 days to try out the oxygen concentrator and the pulse oximeter on my own. Before this, these equipment had already been used for at least a week by the NICU nurses, but I just want to make sure that I know how to use these things properly.

 To a certain extent, I still had loads of help since the nurses were always around to check on my baby, warmed up the EBM before giving it to me just before each feed. I can’t say that I could rest since the whole objective for this room-in was for me to be “solely” in charge of my lil’ one, so I did the night feeds and comfort the Feisty Fighter when she started bawling for one reason or another. Still, I must add that during those 2 nights stay, I was very well fed.

My aunt, who does the night shifts as a NICU nurse at TMC, happened to be on duty during those nights that I was in the hospital with my baby. She would pop by during the late night feeds and keep me company, so that I wouldn’t fall asleep while feeding my baby. She has been a great help during the 91 days when my lil’ one was warded, in fact, my aunt was the one who wheeled my girl in the Globetrotter and prepped her in NICU shortly after she was born. I suppose there is a certain affinity between us now, somewhat.

There are these two colleagues of my aunt’s who do nights together with her and I had never gotten to meet them, and I was glad to have during those late night feeds. They encouraged me and told me that I would do just fine.

I am immensely grateful to all these angels who had been taking care of my baby girl from birth till now. All 91 days. And as much as I am so glad that I can finally have her home, 24/7, it does feel quite daunting since she has unique needs that are different from full-term babies. But Leia Kate Tan is mine, and I’m just glad she isn’t anyone else’s.

There must be a reason why she is here, even though she had a stormy beginning and will have quite a rough journey ahead. But God has been most gracious to us and He must have major plans for this little girl. I don’t know what He has in store for her, for us, but I do know that we aren’t alone on this ride of our lifetime. This adventure, for this family of four, has just begun.

18 to 22 Oct 10 – Days 79 to 83 (Relearn & Practise)

18 Oct: 2.61 kg

Every day (except for Sunday), Dr Ong will call and update me of my baby’s condition. Nowadays, I try to see that even the same old news is better than no news really, cos at least I know that my lil’ one is ok and not having other issues. It’s like one step forward, two steps back that would be really depressing.

At least she is constant, that’s why I like to find out about her weight each day. It makes me feel better knowing that she is taking my EBM well and putting on weight makes me happier.

Dr Ong also mentioned that I should be ready to go to the hospital more often to learn how to feed my lil’ one, especially spotting her little quirks during feeds and her colour changes when she is getting desats. I’m finally able to do something normal too.

Every little good news is a miracle.

19 Oct: 2.615 kg. My first try on feeding the Feisty Fighter.

When we first brought TJ home, I had tried direct latch on but it didn’t seem to work for both of us. He was a crying and fussy kid and I was crying in pain cos of incorrect latch on position. After two weeks, we came to a compromise. I expressed mostly, got him to latch on some of the feeds but in the end he had his breastmilk in a bottle. He, too, took forever to finish his milk (as long as 45 minutes) ‘cos he was so sleepy and we had to wake him up often and that dragged on the feeding time.

So with our lil’ one, we were told she needed more time as it takes a lot of effort and energy for her to suck, swallow and breathe ‘cos of her BPD. She will gag and choke ‘cos she would forget to do one of the steps or fall asleep. And when she can’t catch up with her breathing, desats set in and she turns grey. And I thought feeding TJ was a nightmare…

My “training” started at 4pm, with learning to use the nebuliser (Ventolin & Pulmicort, 4 times a day) and after that, the bottle. Before I put the mask over her nose & mouth, the nurse peeled off the surgical tape that held her cannula and my baby hated to have her skin dragged. And when the mask was over her face, the Feisty one stopped crying but had her eyes opened wide, seemingly wondering who the newbie was. According to the nurse, my lil’ one usually would close her eyes when getting the neb.

She has been back on the 3 hourly routine and she has been bottle-fed on alternate feeds. That is, she gets her milk through her feeding tube for one feed and the bottle for the next. Guess Dr Ong just want to minimise changes for her and introduces “new” things slowly. The nurses are able to complete the feeds within 30 minutes and I suppose that would be my “time to beat”.

And to prevent her reflux and milk from getting into her lungs, the nurses will add “Thick and Easy” to thicken her milk. This helps to keep her milk down in her gut and lessens the chances of her choking on the thin EBM.

So for this 4pm feed, my first time with her, she took 45 minutes to finish. In between, my lil’ one needed a number of rests, for her to catch her breaths and also to get her SPO2 back up again when she desats to below 80. I felt secured knowing the nurse was by my side helping me, but also knew that I would have to do this independently. Hence I tried to pay attention to everything, her colour changes (“dusky” is scary), pre-empt her gags & chokes when she starts to shake her head or push her head backwards, and learn to “entice” her to suck when she stops by stroking her chin and pushing/pulling the bottle upwards against her palate to stimulate the sucking motion.

It was quite an information overload, and I was so tired out at the end of this feeding session.

20 Oct: 2.67 kg

Fed her again at 4pm. And again, it took about 45 minutes. She gagged more often and fussed ‘cos she pooped during the feed.

21 Oct: 2.64 kg

Chubbs 21 Oct

My baby’s feeding tube apparently slipped out last night, not sure how that happened but since it is out, Dr Ong decided to introduce the bottle to all feeds, seeing that she had been doing well with the alternate bottle/feeding tube milk feeds.

Today, I went to the hospital twice to get more time with my lil’ girl, and fed her at 10am and 4pm.

At her 10 am feed, she gets Ferrum drops (to increase her iron level) in her milk and it turns her creamy white milk to orange. It is more difficult to feed her at this time, I believe it’s cos of the Ferrum. I’ve been wanting to taste it, wondering if it tastes like liver.

22 Oct: 2.73 kg

Doesn't look to chubbs here

It is harder to coordinate the timings of both my kids and both of them are equally important. I would love to go down more often to feed my baby girl, but at the same time, I have to spend time with my firstborn.

I supposed if she isn’t a preemie, it could be easier since I don’t have to factor in the travelling time to and from the hospital, taking TJ to my mum’s if I go to the hospital in the mornings etc.

And the re-learning process continues.

13 to 17 Oct 10 – Days 74 to 78 (Two Point Five)

13 Oct: Weight is 2.425 kg

She has been getting the bottle once every shift, i.e. three times in the 24 hour cycle. For a start… to see if her lungs and her lil’ body can take it or not. Her BPD makes it harder for her to coordinate breathing, sucking and swallowing, hence she gets breathless and tires out faster. For the rest of the feeds, she will be tube-fed.

14 Oct:  2.47 kg and milk amount has been increased to 45 ml every 3 hours.

15 Oct: Our Feisty Fighter is 2.51 kg today.

The original plan was to have our lil’ one back home with us when she reaches 2.5 kg, but due to her BPD and her need for O2, Dr Ong doesn’t think she is ready to be discharged. Well actually, I think he feels we aren’t ready to take care of her, given that she has certain needs that are different from a full-term baby.

For one, she has a number of medication and supplements that she has to take at different hours of the day. The second thing is her O2 requirement which is currently about 30-35% but she needs about 40-60% oxygen during her bottle feeds. And the last thing is her milk intake.

For the longest time, she has been tube-fed, but this week, Dr Ong has decided to first try bottle feeds once every shift and today, he has gotten the nurses to alternate between the bottle and the tube. However he did mention that this will also depends on our lil’ one, if she gets too tired out after a couple of bottle feeds, the nurses will revert to giving her milk via the tube instead to give her time to rest in between.

These are the lil’ things that we take for granted.

16 Oct: 2.53 kg today.

Ever since she started drinking from the bottle more often, her weight gain has kinda slowed down a little, but it’s apparently normal. Each day, I would ask the nurses what her weight is, it has just become a habit. The nurses would tell me that her weight is no longer an issue, it’s her feeds and her breathing. Both go hand in hand, and they have told me she takes abt 25 minutes to finish the bottle and requires higher O2 levels.

D & I attended the Infant First Aid (including CPR) course conducted by TMC ParentCraft in the morning and we are hoping we will not use the skills learnt.

I am appreciative of the care and concern the nurses have showered on us, and we are grateful that they had tried to help us by getting a second opinion and suggested ways to help us save costs during the two times when we were mulling over moving our baby to KK. I don’t think things happen by accident and in the grand scheme of things, I don’t understand why right now, but I know that God has put these nurses in the right places and at the right time.

I’ve enjoyed their friendship, in a professional sense, and I will make sure my lil’ one knows about these angels who had taken care of her in the first 78 days of her life, and counting.

17 Oct: 2.57 kg today.

TJ came to see his sister again. Somehow he knows that when both his papa and mama are at home, it’s the time of the week to visit his sister at the hospital. He would tell me about it during breakfast and I have a sneaky feeling that he enjoys this ‘cos he gets to take the bus, train and cab.

My Feisty Fighter feels a bit heavier in my arms today and she opened her eyes briefly to see who is carrying her before dropping off to La La Land. I suppose she knows she is safe and yes, my lil’ one, you take your time to recover. We aren’t going anywhere but here with you.