Milkonomics (i)

the law of supply and demand applies quite well to breastfeeding

Lyor is currently 10 months old and he’s now eating more solids but still drinking formula for much of his nutritional intake¹. I stopped breastfeeding while he was 7 months old and I wanted to share some of our learnings, because for the first half-year of his life, it felt like my entire 24-hour schedule was catered to producing more nutritious breast milk for him.

We did a mix of breastfeeding and formula-feeding, and while I’m glad that Lyor is a healthy baby, I wouldn’t necessarily recommend our approach for everyone since it was a crazy, demanding experience. Neither

Jack An

nor I were working full-time during those months, in order to prioritize caring for Lyor, and since every family is different, what I write below isn’t to recommend what to do; it’s mostly just to share what we learned for those that are curious hearing from a first-hand account.

Along with Lyor’s eating habits, I will share a number of other topics listed below. Each topic will be split out into separate published posts so that it’s not too long for one reading, and it’ll be a better read to read them in order:

1. The last month of the pregnancy and giving birth (part i);

2. The first week of recovery and learning to breastfeed (part ii);

3. Taking care of Lyor and each month’s new challenges (part iii);

4. Some additional learnings plus the resources we found helpful (part iv).

I hope this either helps you on your parenthood journey or helps you have a better understanding towards modern-day parents in general ~

---

For part i, I will be talking about what happened in the last month of the pregnancy and my experience giving birth:

1. Going through an induced labor;

2. Experiencing postpartum hemorrhage² right after the birth;

3. What was good and not-so-good about Taipei’s most popular maternity & pediatric clinic 禾馨 Dianthus³;

---

1. The last trimester of pregnancy was physically taxing 🫄

I previously wrote about getting ready to have a baby and what I experienced during pregnancy, but since those were published a few months before I actually gave birth, I wanted to update my last few months of my pregnancy and getting ready to give birth.

The last month was physically tough:

• I couldn’t really sleep well, and I started experiencing sleep apnea where I would stop breathing while I was sleeping, which is also dangerous for the baby because they rely on a mother’s oxygen while in the belly;

• My feet did swell a bit from the water gain, but luckily I could still fit in most of my shoes, though I do know some friends who had to buy new ones just for the pregnancy⁴;

• I went for a pregnancy massage which was a nice, temporary relief.

Overall though, I was getting really heavy and my back hurt, no matter if I was sitting or standing or lying down. Because of these physical issues, my doctor recommended I come into the hospital a few days before my due date and get induced (start the labor earlier through medication):

• I don’t think it’s very common in the West, but I know many women in Taiwan who got induced so I felt okay about it;

• It saved me the stress of not knowing when my water would break and not having to rush to the hospital, especially if Jack wasn’t around to drive me⁵ since I don’t drive⁶;

• Some people I know chose to be induced because they want their specific doctor to help them deliver the baby, so they schedule the check-in times when their preferred doctor is on call.

I know it’s a bad angle but I got really big compared to my pre-pregnancy physique

1a. Getting induced, giving birth, and a whole lotta chaos 💉

I checked in to the Xinsheng branch of Dianthus on the evening of May 25 and to start the induced labor, they were inserting these pills into my vagina at 4-hour intervals that were supposed to start contractions.

They also scheduled the epidural doctor to come, which I had requested and paid for in advance⁷:

• My doctor had mentioned that the pain experienced during the birth without an epidural doesn’t really make a positive difference in the overall experience of giving birth so I might as well get it⁸;

• The epidural doctor first injected a local anesthetic in my back near the spine to numb the area, and then injected the epidural into my spine (the only place to do it), with a pipe leading to a button that I can press to release more pain relief whenever I wanted⁹.

looks scary but it’s a small price to pay for my peace of mind and for less pain

After 24 hours in the clinic, my contractions still didn’t start, so they brought in a drip bag of oxytocin. Very soon after, I started feeling the contractions as well as the pain, which felt more like a really bad ache and sourness in my lower back. It was nighttime already and one of the nurses told me that I need to stay in bed until the contractions start happening more frequently (about 5-10 minutes in between). Eventually, I couldn’t stand the discomfort and told the nurse that I was going to get up and walk around to ease the ache, but she was adamant about me staying in bed. We went back and forth for a bit until I told her I was getting up no matter what she says, so she told me to lay on my side and start pushing to see if the baby was ready to come out.

Once Lyor’s head was crowning, I went into the delivery room. It was a chaotic scene and I didn’t have my glasses on so I really couldn’t see much, perhaps a blessing in disguise. The overnight nurses seemed to have difficulties knowing what the right procedures were¹⁰, and I could tell my doctor was getting frustrated telling them what they needed to do while trying to help me deliver the baby and stitching me up after the delivery.

When Lyor was born, he didn’t make a sound and the whole room was quiet, which really freaked me out because I’m basically blind without my glasses or contact lenses and I couldn’t see or hear anything. My doctor sucked out the liquid from Lyor’s mouth which let him breathe (and cry out loud), and he was announced as being born on May 27, 2024 at 3.3kg¹¹.

1b. How to lose a lot of blood in 10 seconds (through postpartum hemorrhaging) 🩸

~2 hours after giving birth, I suddenly felt really nauseous and I told Jack to bring me a plastic bag because I wanted to throw up. I ended up projectile-vomiting my dinner¹² onto Jack’s shirt and we both heard some gushing sounds under my blanket. Jack lifted up the sheet and between my legs, there was a huge blood stain and what looked like pieces of raw chicken liver.

yum? ew.

I was really dizzy and lightheaded, probably from losing so much blood in one go, and Jack rushed out to get a nurse who came in, took one look, and ran out to get the rest of the medical team. My doctor acted very quickly and ordered two blood bags, and she stuck her arm up my vagina to manually pump my uterus with her hand, mimicking contractions. Once I was in a more stable state, the team had to leave very quickly to take care of another woman in labor.

Postpartum hemorrhage is the #1 cause of maternal death worldwide because when you lose that much blood in one go, your body goes into shock:

• It only affects 1-5% of deliveries and if caught quickly, it’s not life-threatening;

• What happened in my case was that my contractions stopped soon after giving birth, so my uterus wasn’t as strong and sort of floated to the side inside my body;

• Usually, contractions will continue for a few hours which helps strengthen the uterus (this is why my doctor had to pump it with her hand manually), and over the next few weeks, the excess blood is supposed to be released from the body incrementally, but since my uterus wasn’t in place, the blood came out in one go.

After the medical team left, they told Jack he had to mimic contractions for my uterus by massaging my stomach every 15 minutes. We both had not slept for over 30 hours, so while I was able to pass out and get some rest, Jack was really tired and it was an early Monday morning (around 5 am) so he was a trooper until my aunt was able to come take over around 9 am¹³. He still had to get up later for his Monday meetings at work¹⁴, so this wasn’t the easiest time for either of us.

1c. My honest review of 禾馨 Dianthus maternity & pediatric clinic (3/5 stars) 😶‍🌫️

Usually in Taiwan, you’re allowed to stay in the hospital for up to 3 days when giving birth, which was our initial plan as well. However, since I had complications with postpartum hemorrhaging, I couldn’t really walk due to the pain and body weakness so we decided to pay for a private room at the hospital to stay for an entire week. That way, just in case there are any side effects or other unexpected situations, there would be doctors and nurses on call and ready to help.

Understandably because Dianthus is a medical clinic and not a 月子中心 postpartum center¹⁵, there’s not much customer service as they are busy dealing with patients, but I found that the nurses’ knowledge and experience were wide-ranging, from very professional to very amateur, and the overall treatment of patients felt wanting. I did like my doctor but that’s probably the biggest upside to going to Dianthus. It’s surprising to me because it’s a private clinic, which means it’s not covered by Taiwan’s national health insurance and it’s very expensive, so I’m not sure what exactly I was paying so much money for. Let me share some examples of the things that confused me:

• Some nurses were knowledgeable and others were clueless: When I was still pregnant and going in for my checkups, we noticed that the nurses at the registration desk vs the nurses inside doing body checkups vs the nurses giving injections and taking blood had vastly different knowledge about how to help. Some of the nurses at the registration desk were just following an SOP, filing documents, and couldn’t give clear answers when we had questions. On the other hand, the nurses who gave injections were confident and helpful when talking to us. Different levels have different responsibilities, which makes sense, but it really makes you wonder how they all have the same license but have such different levels of knowledge.

• The overnight team seem understaffed and VIP mothers are prioritized: I mentioned earlier how I was in a lot of pain due to the contractions before I gave birth and I wanted to stand up and walk around but the nurse kept discouraging me from it. When I argued with her and asked her why, she gave a few strange answers, such as the baby could slip out and hit his head on the ground??? I think the real reason was that maybe there was only 1 medical team on call, and they were probably busy helping other women in labor and wanted me to hold off as long as possible before delivering my baby. I’ve also heard from friends that if there are VIP customers in labor (e.g. extremely wealthy or celebrities), they will prioritize them and give them the best service, at the expense of all the other mothers. One of my friends was a VIP mother and she got a ton of attention and service, so I guess it must have some truth to it.

• Inexperienced nurses focus on following a process rather than understanding a mother’s concerns: When I woke up from my long sleep after postpartum hemorrhaging and was ready to breastfeed Lyor for the first time, one of the nurses advised against it and I had to argue with her for a good 15 mins before she called in another nurse who I also had to argue with, and finally, a third nurse came in to talk to me and she was much more reasonable and said she’d bring Lyor in to be breastfed. I understand that they might have been concerned because I experienced postpartum hemorrhage, but it had been almost 24 hours since I gave birth and I was feeling much better. I don’t think I should have had to argue for 20+ minutes just to breastfeed my own baby.

• Inexperienced nurses give bad advice: On the first day of breastfeeding, I asked one of the nurses when I could start pumping milk and she told me I had to wait till breast milk was squirting out, which is misleading advice. I didn’t end up pumping that first week because my milk was only dripping out (and not “squirting” out), which led me to experience the pain of breast engorgement within the first few days, and I only found out that I could have started pumping much earlier once I got to the 月子中心 postpartum center a week later. I guess I shouldn’t have relied on her advice and looked it up myself, but I was still recovering and in a lot of pain, so I just took her word for it.

• Inexperienced nurses don’t really know how to help: Because of the postpartum hemorrhaging, it was extremely painful to move around and use the bathroom since I couldn’t sit or put pressure on my vaginal area. One of the nurses recommended this portable toilet seat insert and we paid for it from her / Dianthus, but she didn’t know how to use it and taught it to us wrong. We thought I couldn’t use it and Jack went to several pharmacies and bought some other equipment to see if it could help. Finally on the last day of the week, another nurse taught us how to use the original one properly and it worked really well! A lot of unnecessary pain for a week because of the initial nurse’s misguidance.

• It’s too popular of a clinic so it’s always crowded: Since Dianthus is both a maternity and a pediatric clinic, we took Lyor for his checkups there as well (at the Neihu branch). We had to go ~1x / month for different shots, and each time we had to wait for almost 2 hours. There were always 30+ babies and their families around too, some standing because there weren’t enough seats, and you could hear the babies crying when they got their shots, causing other babies to start crying too. The whole environment was really stressful. The last time we went, which was Lyor’s 6th visit when he was almost 6 months old, we waited for almost 4 hours, which I thought was ridiculous, and after that I decided to switch to a nearby general hospital, and it has been so much better for all of us since.

Overall, while I do think my doctor was great, there were some questionable moments that made me reconsider if I’d want to go back to Dianthus if I decide to have another baby again. Probably not though…

---

Thanks for reading so far! Hopefully this was an interesting intro and helped you get a different perspective on the process of giving birth.

If you’re curious about the first week of breastfeeding while recovering from postpartum hemorrhaging, check out part (ii)

1. It’s recommended by a number of resources that babies should be fed breast milk or formula as their main nutrition intake until they are 1 years old.

2. I liked my Dianthus doctor but some of the nurses seemed very inexperienced, and after we went a few times with Lyor for his check-ups, we ended up switching to the general hospital Chang Gung because the care and service is much better there. This is a common thing I noticed at the postpartum clinic

3. Postpartum hemorrhage is when there’s excessive bleeding after giving birth and it’s the #1 cause of maternal death worldwide.

4. This is an under-discussed, annoying expense that all women have to experience through pregnancy — the clothes and shoes we have to buy just for this short period of our lives. It’s wasteful! Just like pads and tampons; absolutely necessary for girls and women but with little innovation these past few decades to help save on cost or improve their environmental impact.

5. During my last month of being pregnant, a few taxis wouldn’t take me when they saw up close how pregnant I was. Although they made up other excuses, the fact that it happened multiple times during just this one month while it has rarely happened in my lifetime when waving down taxis in Taiwan, meant they were likely discriminating against me because they didn’t want my water to break or for me to give birth in their car. It’s the same reason why you can’t enter a country like the US or Canada while extremely pregnant because they don’t want you giving birth there just to collect the citizenship.

6. I have a driving license in Taiwan that I got when I was 18 years old but I only tried driving out on the road once and decided it was not for me, as my hand-eye coordination and spatial awareness are severely lacking 😬

7. I had a foreigner friend who gave birth at a general hospital in Taipei, Taiwan Adventist Hospital, who didn’t schedule the epidural earlier but requested it once she checked in, and because there’s only 1 doctor administering it in the entire hospital, it took him over 20 hours to get to her, and by then it was already too late!

8. I heard from a friend that in France, epidurals are not as encouraged and you have to specifically request it since it’s not offered directly.

9. This feature of manually pressing the epidural cost more than the automated insertion at a 20-minute intervals.

10. I think the overnight weekend nurses were probably newbies, and Jack and I guessed that the more experienced nurses are able to choose their schedules so they won’t pick overnight weekend shifts.

11. This is the global average weight for a newborn baby boy.

12. We ate Whoppers from Burger King right before they put me on the oxytocin drip bag, which was still good then, but we tried it again recently and they changed the bread and meat — it’s not as good anymore 😢

13. My family was in Hainan for a longtime family friend’s wedding. I was initially a bridesmaid for it when she asked me the year before, alongside my sisters, but once I found out I was pregnant and my due date coincided with her wedding, I didn’t end up going. Jack’s parents had just come back from a trip to Europe and were both sick, so they couldn’t help out either.

14. Jack had initially asked for 3 months off for paternity leave, which he was granted, so we had planned to be fully focused on learning how to be parents after Lyor was born. However, 1 month before Lyor was due, Jack’s manager changed her mind and cut it short to 1 month max. Although we were pretty angry about it, and Jack left the job soon after so he could focus on Lyor, Taiwan actually doesn’t have many supportive laws for new fathers. Although Taiwan is progressive in some ways, it’s quite traditional when it comes to gender roles regarding family matters.

15. Dianthus does have a 月子中心 postpartum center but only at their Shilin branch.