The first 201 days of Oliver Shan Yu Hanson’s life were spent away from his parents’ embrace, inside an incubator at a hospital’s neonatal intensive care unit, with tubes and tapes all over his tiny body.
He needed help to breathe, stay warm and receive nutrients.
Outside, the apprehension was equally stark.
Mr Brendan Hanson, 46, and his wife, Ms Tan Soo Lin, 41, had to grapple with the most difficult question that any parent could face: When do you let your child go?
The boy was born in November 2015 – 15 weeks too early and weighing a mere 580g, which is less than the weight of two soft drink cans.
Doctors said Oliver could have severe brain damage and may end up a vegetable, never to wake up.
“When do we not save him? When he loses two or four limbs? I almost went ballistic,” said Mr Hanson. “We decided that two limbs is OK, but not four, and blindness is OK. If he becomes a vegetable, we would let him go.”
But all that logic disappeared the moment Mr Hanson reached a hand into the incubator, and Oliver’s tiny fingers curled around his father’s finger. “We were like, ‘Save him no matter what’,” he said.
Mr Hanson, a Singaporean scientist who is originally from Australia, and Ms Tan, a junior college teacher, had tried for three years to have a second baby.
“We were planning for IVF (in-vitro fertilisation) but (Oliver) happened spontaneously,” said Ms Tan, whose daughter is 12 years old.
However, the joy was short-lived.
“By the time I was 20 weeks pregnant, my blood pressure was going up. I was in and out of hospital.”
Ms Tan had preeclampsia, a serious pregnancy complication characterised by high blood pressure.
When she went for a scan at 23 weeks of pregnancy, her doctor’s face turned pale and he asked her to go to the emergency department of a hospital. Her blood pressure was at a dangerously high level but she was unfazed. “I felt fine and I still went for breakfast as there were no symptoms,” recalled Ms Tan.
“But the moment I arrived at NUH (National University Hospital), I wasn’t allowed out of the labour ward. They put me on lots of medication to try to bring down my blood pressure.”
That was a Friday. By Sunday, Ms Tan had been told that she had to get the baby out or both of them will die. But she resisted.
“I still said, ‘OK, I will leave the hospital’. I just wanted him to live… I was aiming for 28 weeks as the chance of survival is better.”
Mr Hanson said he had to threaten her. “I told her if you don’t let Oli come out now, you’re a bad mum. It was a very hard conversation.”
Premature births on the rise
A premature baby or preemie is one who is below 37 weeks old, as a normal pregnancy lasts for around 40 weeks. Globally, around one in 10 babies is premature.
The vast majority of preemies do not need high intensity care as many are born at 35 to 36 weeks, said Associate Professor Zubair Amin, the head of and senior consultant at NUH’s department of neonatology. The most vulnerable, he said, would be the babies who weigh less than 1.5kg.
An average of 50 babies weighing 1.5kg and less are born each year at NUH and most of them would be around 29 weeks old, he said.
Those who are born around 24 to 25 weeks stay the longest – possibly four to six months – in the hospital.
“If the baby is below 24 weeks old, we would discourage the family because the outcome is very poor. The lung maturity is not there. Most will die,” said Prof Zubair.
Some 75 per cent of babies aged 24 weeks and above who are born at NUH will survive. The rate goes up to 90 per cent if they are at 27 weeks old or more.
Premature births make up around 13.5 per cent of total births at KK Women’s and Children’s Hospital (KKH), compared with 11 per cent a decade ago.
The rise has mostly to do with lifestyle changes such as more stress, and women getting pregnant at an older age, as well as the use of assisted conception which carries a risk of prematurity with multiple births, said Dr Nirmal Kavalloor Visruthan, a consultant at the department of neonatology at KKH.
“It’s also because obstetric monitoring has improved. When we identify difficulties, we get them out earlier so that we can treat them. So, more babies are born prematurely.”
About 90 per cent of premature babies at KKH will survive. Dr Nirmal said those who are less than 26 weeks old are the most challenging to care for, but the survival rate is still good, at some 70 per cent to 75 per cent.
However, a third of this group of preemies would have complications, such as developmental delays, serious lung problems, blindness and hearing issues.
With more babies requiring intensive support and care, KKH this year expanded its neonatal intensive care unit (Nicu) to 40 beds, from 28 in 2013, while NUH increased the number of its beds from 18 to 24 around two months ago.
Singapore General Hospital is the other public hospital with a Nicu. Some private hospitals also have intensive care units for babies.
Racked with guilt
Even as medical advancements mean that hospitals are better-placed to save these tiny babies, the guilt lingers for parents.
“When I first saw him, what struck me was not his smallness but the flatness of his head, and there were tubes coming out of him. He looked like a lizard,” said Ms Tan, adding that humour was sometimes the only way to cope with the difficult situation.
“It’s very easy to give in to your madness, to your depression, after you have just given birth,” she said.
“We thought about whether this was an exercise in selfishness as we wanted a baby… If I didn’t have the illness, this wouldn’t have happened. I felt I created all this. The guilt was horrifying.”
Oliver spent 201 days in the Nicu, during which he had 15 blood transfusions, a heart operation and three episodes where he stopped breathing and had to be resuscitated.
“Honestly, we were in despair. After drinking our Milo every night, we would be crying. Is our baby going to live? Are we going to have a son?” said Ms Tan.
“For 201 days, every night, we had the same conversation, we trembled. It was not easy.
“We were so consumed with fear that the next phone call would be to tell us that our son was dead.”
Mr Hanson felt helpless. “The thing I felt when I first saw him was that I couldn’t help him,” he said.
“When I first went to Nicu and touched him, his skin was sticky. I was worried (it) was going to come off.”
In intensive care, Oliver fought infections, grew and put on weight. He was also fed breast milk.
Ms Tan would be at the hospital from 10am to 9pm while Mr Hanson would visit before work, during lunchtime and after work.
Oliver finally went home in October last year, weighing 2.8kg. He had to be put on oxygen round the clock for a year.
He is now two years old and starting to walk. He has chronic lung disease but is otherwise healthy.
“We are not the best parents but we are very deliberate parents,” said Mr Hanson. “If I can’t help him physically, we have to show him why he chose us, we have to show him that life goes on even when you are struggling.”
A version of this article first appeared in The Straits Times
(Photo: The Straits Times)