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ALLISON BEHRINGER: Having a baby must be incredible. It must also be terrifying. You have to care for every detail - details that can mean life or death. You have this immense responsibility to do the best thing. But there are ​so many ways​ to be a parent! How do you know what’s ​best​? One thing does seem clear to me: no matter how much you prepare, no matter how much you know, motherhood is often nothing like what you expect. 

I’m Allison Behringer and this is Bodies, a show about people solving mysteries about their bodies.

From a young age, Vivian Chen knew that she wanted to help people-- she knew that she wanted to be a doctor. And when she was 13, her parents moved the family from Taiwan to England, in the suburbs just outside of London.

VIVIAN CHEN: Back then, if you’re in Asia you kind of really look up to western living and you know everybody's trying to get an education in the West. And they thought that if they moved us when we’re younger that would give us a better start.

ALLISON: That start was not easy. She didn’t know any English when they arrived. And at school, the kids would make fun of her.

VIVIAN: Why are you here? You don't even understand a word that the teacher is saying. You must be really stupid if you can’t speak our language. 

ALLISON: Her dad was away working and her mom couldn’t drive in the UK yet, so every day Vivian would walk 30 minutes to school and 30 minutes home, all alone.

VIVIAN: I just remember thinking very clearly to myself --Am I going to be able to survive in this country?

ALLISON: Vivian was determined to show that she wasn’t stupid. And her resolve to become a doctor got even stronger. But in the beginning, she couldn’t understand what the teacher was saying during class.

VIVIAN: So I would go to my teacher and borrow the textbooks. I would go home and use a dictionary to translate the text and understand it and they would say, you can’t take it home every day.

ALLISON: She and her dad came up with a plan. One Friday, Vivian borrowed all her textbooks and took them home.

VIVIAN: Over one weekend we basically photocopied the books for like 10 hours. So while everybody was kind of going home and chilling out and maybe doing like one to two hours of homework, I would be getting home at three thirty. I would have a snack and I would basically be working all the way through until 9:00. And at the weekends I did maybe four to five hours of studying as well. My parents would be like okay you need to stop now, this is just ridiculous. you can't be in your room, you can’t be studying all the time.

But I didn't even feel like I was working. Because that was my main goal, to prove to the bullies wrong.

ALLISON: Vivian was, quite literally, educated by the book. And pretty soon, she was translating for her mom at the bank and doctor’s appointments.

VIVIAN: Two years after we moved they bought a house, and when she was buying a house, I had to go get the mortgage for her and I was 15.

ALLISON: In the UK, you go right from high school to medical school. Vivian got into one of the top med schools in the UK.

During her last year of school, Vivian went to a Chinese New Years party. There she met Todd. The two of them talked all night. And at the end of the evening, Todd asked for her number.

They got engaged two years later. It was a long engagement--Vivian was working towards her board exams and didn’t want the distraction of planning a wedding.

Vivian graduated 2nd in her class in medical school. She was licensed in internal medicine, and started her rotations. 

VIVIAN: Before I went into clinical practice I actually wanted to be a cardiologist. So I would finish my training, have kids. That was the plan.

ALLISON: But during her cardiology rotations, she realized that these two plans were not gonna work together.

VIVIAN: Even before I had kids I knew that kids would be my number one priority and I wouldn't want to send them to childcare for five days, 12 hours, just so I can complete my cardiology training.

ALLISON: And so she decided to switch to family practice. Vivian became board certified in a second speciality of medicine.

VIVIAN: So during my workday I could see anyone from a baby to a 90 year old. But if I didn’t have the immediate answer to their questions, I would feel inadequate. I put on myself this pressure to know everything that I could possibly know about the human body.

ALLISON: One day, a woman came in with severe fatigue and joint pain. Vivian checked her for the usual things and found that she had low vitamin D so she gave her a supplement.

VIVIAN: I was really kind of congratulating myself and thinking well you made the diagnosis there and you know, well done, and she was happy because she wanted a label. Because before that she had seen two other doctors and they didn't run the vitamin D test and so they just told her everything was normal. And that it was just stress, you know, busy lifestyle.

ALLISON: But after three months on the supplement, the patient came back and still had severe fatigue and by that point her Vitamin D was normal. That was a challenge for Vivian – she thought she had made the right diagnosis. So why isn't she getting better?

VIVIAN: I then started telling her the things that the other doctors were telling her. Which is just – you are stressed out. You have a busy lifestyle.

It made me feel very uncomfortable every time I saw her because it reminded me that I wasn't able to help her. But then I needed to give her something because she came to me for help

ALLISON: A few months later, the woman came back again. But this time she was healthy. She told Vivian that she had gone to a naturopathic doctor who gave her a diagnosis and treatment. She asked Vivian if she wanted to know what she did to get better.

VIVIAN: And to my absolute embarrassment now, I had actually said, “No.” I don't know what stopped me from opening up to that but I wasn't interested in what she had  to tell me.

ALLISON: Vivian was 30, a few years into family practice, living in London when she got pregnant. Right away she started reading everything there was to know about having a baby.

VIVIAN: I was trying to prevent the issues that I had come across as a physician that I witnessed with other mums. So the postnatal depression, lactation problems, so a lot of mums are not able to breastfeed their children. So I had contacted a lactation consultant beforehand and I found out everything there was to know about how to breast feed.

From a human science point of view I knew that breast milk was the best food for babies. so it changes in consistency through the time with the age of your infant. So I know that it's designed to be optimal nutrition for babies.

ALLISON: She also joined a pregnant mom’s group in the neighborhood. They were all due around the same time. They took parenting lessons together and they planned what they’d do once they had their babies: fitness in the park, baby yoga, and coffee meet ups.

Vivian had a pretty unremarkable pregnancy. Three weeks before her due date, she started her maternity leave. She bought the first toys, cleaned everything. Met up with the new mom’s group a bunch. She planned to have her baby in a natural birthing center at the hospital--she wanted to do a vaginal delivery and without any drugs.

Vivian was past her due date and they had to induce. But the baby was in the wrong position, so her cervix wasn’t dilating. It took 36 hours to fully dilate. But then the baby wouldn’t come out because the umbilical cord was around her neck. They would need to do a ventouse, which is a suction device that pulls the baby out.

VIVIAN: They offered me local anesthetic when they were doing the suction and I was like no, because I just wanted to have her out of my body. So she sucked her out and handed her straight to me.

ALLISON: They named her Sarah. Vivian had been in labor for two days.

VIVIAN: I remember feeling like this absolute joy. That she was there and that she was healthy and looking at her and thinking oh my gosh she's so perfect. But then that kind of – you know that the bonding feeling I had read about in books like that you feel this connection with your baby. I didn’t feel that.

We know that you have to feed the baby as soon as possible and that’s kind of part of the bonding process as well.

Babies are born with an instinct to root. If you lay a baby flat on Mum's chest, they can slowly bob their head towards the nipple and start feeding and that's the normal instinct of a human baby.

But, Sarah just didn't want to feed, she wasn’t interested. I was actually physically kind of latching her onto my breast and she just she wouldn't suck. So there was just no latch at all and without the latch you can't feed her.

ALLISON: By this point, they were still at the hospital, still trying to get Sarah to feed. 

VIVIAN: I went into complete panic because you know, I wasn't doing the thing that I thought I should be doing. You go into this mode of “Oh my God, what is happening…” Like they need to eat.

ALLISON: Lying in the hospital bed, she got her cell phone and called the lactation specialist, no answer. She left a voicemail. She sent an email.The nurse started to bring in formula--it was a formula made from cow’s milk.

Vivian did not want to give Sarah formula. She knew the saying – she had preached the saying to her patients – “breast is best”.

The milk that the mom produces right after birth is especially precious – it’s thick, sticky, highly concentrated milk – Liquid gold for the baby. It’s called colostrum and it contains the antibodies to fight disease and the correct bacteria to populate the gut of the ​baby​. Vivian knew that Sarah should get as much of this as possible.

ALLISON: Finally, 8 hours after Sarah was born, the lactation specialist called her back and told her what to do. 

VIVIAN: I basically would massage my breast and squeeze out the first milk. So squeeze out maybe a few milliliters into a container and then pour that onto a very small spoon and then drip that into her mouth.

ALLISON: Meanwhile, nurses kept coming in, insisting Vivian give her formula.

VIVIAN: I was at first able to kind of fend them off by saying oh no no I squeezed out my colostrum I gave it to her she's fed... and then they kept coming and saying well colostrum is not enough.

ALLISON: She wanted to leave the hospital. Todd was worried.

VIVIAN: And he was kind of like, you’re so sleep deprived, are you sure you know what you're doing. you thinking clearly? But I was so insistent, I literally just ordered him to go pull the car and my mom and I packed the bag and then we just left.

ALLISON: The lactation specialist came to Vivian’s parents’ house where she would be spending the first week. She put her finger in Sarah's mouth and just started poking around, which stimulated a sucking reflex. Sarah learned how to latch and started to feed. It felt like the feeding problem had been solved.

But she cried a lot.

VIVIAN: Babies would get home from hospital, they would sleep a lot. She didn't sleep. she would nap for 15 minutes and then wake up. And in the night, she woke up every hour or so. And sometimes it was because she was hungry and wanted to feed and other times she was just crying.

ALLISON: A baby cries to communicate: I’m hungry, I need to be changed. And parents learn to interpret what cry means what. But Sarah’s cries were indecipherable. She was fed and clean – what was she trying to say? She’d arch her back and wail for hours. It was relentless.

A nurse and midwife both told Vivian it was colic – which is a label for a baby who cries a lot, like a lot. There are many factors that could cause colic and all you can really do is try to soothe and comfort your baby.

VIVIAN: When a baby cries non-stop and you have no way of consoling her, it's probably one of the most soul destroying experiences. And when it is your own baby. It is heartbreaking and when I had no one to kind of hand her over to, I would just hold her and cry with her.

ALLISON: Then, when Sarah was around 4 weeks old, she stopped feeding.

She’d latch on to Vivian’s breast, but then before she was finished, she would come off, arch her back and cry. Vivian’s body was supposed to be this source of nourishment and comfort. Instead, it seems to be a source of her pain. 

VIVIAN: Seeing her turn away from my body was an experience of total failure. And I really didn't know what was going on – how to help her. 

ALLISON: Vivian went into doctor mode. She started calling EVERYONE she knew. She’s making 5, 10 calls a day. And going back through all her textbooks and reading online. All on just a few hours of sleep.

Two different doctors said it could be acid reflux and wrote a prescription for Sarah to take an antacid medicine. That didn’t work.

A lactation specialist said it might have to do with her let down--in other words, her flow of milk. So Vivian tried pumping and feeding Sarah through bottle.

She bought 10 different brands, trying different shapes and sizes and flows of bottle nipple. Vivian tried different feeding positions. No luck.

She called another pediatrician who said that this sounds like a cow’s milk allergy. Essentially, mom eats milk product. That gets absorbed into breast milk. Breast milk contains content of cow’s milk, which upsets baby. But Vivian knew from her training what an allergy looked like.

VIVIAN: I was like “What do you mean?" Like how can it be a milk allergy? I said to her she doesn’t have a rash, doesn't – she's not wheezing, she doesn’t have hives.

ALLISON: Vivian’s mind was a swirl of the dozens of things it could be. All the while, Sarah was not getting enough food. And they weren’t closer to an answer. Then Vivian came across an article online about this technique called dream feeding, which is a nice term for what is essentially tricking your baby into eating.

VIVIAN: I would use a pacifier so I would put the pacifier into Sarah's mouth and then I would just literally stand there and rock her until she was kind of in a drowsy stay about to fall asleep. But it can’t be when she is in deep sleep because when she is in deep sleep it won’t work.

So I literally have to spot just the right moment of that kind of unconsciousness where I would quickly whip out the pacifier and then stick my breast in her mouth. And she would mistake the breast for the pacifier and just keep sucking and that's how she was fed.

But at some point, she would fall into that deep sleep where she would just kind of come off and not suck enough. It stopped working because the volume just wasn't there like she would fall into a deep sleep before she could drink enough milk.

I am sure I kept her alive doing that for a while because I would ensure that she had three or four good feeds like that during the day. But it also meant that I could never go anywhere.

I couldn’t take her out to those lovely strolls around the neighborhood because I had to wait for her nap time to feed her. Sometimes it would happen, sometimes it won't and which means that I have to, you know, find another opportunity to dream feed her.

My life basically revolved around feeding her.

ALLISON: It was Vivian alone in the house all day. Just her and Sarah. Todd had to be at work.

VIVIAN: I kept thinking how lucky he was that he got to go to work and away from this nightmare situation I was in. So whenever she would cry incessantly, inconsolably, and I wasn't able to calm her down, I would kind of come out of myself, almost like an out of body experience where my thoughts just weren't clear anymore and I would be jealous of him. Not having to be in my shoes.

ALLISON: She knew she needed some adult company, that she and the baby needed to get out of the house. So one day Vivian packed up all the baby stuff, packed up Sarah’s antacid medication. And she went to the mom’s group for the first time since Sarah was born.

VIVIAN: I pulled out the antacid medication. I was kind of holding a syringe injecting that into Sarah's mouth. And the mums are like oh my God what are you doing. And so I kind of was telling them the story of how Sarah wasn’t feeding. And they were supportive but none of them had issues with their babies. It was just kind of like, “Oh poor you and poor Sarah.”

I remember sitting there with Sarah and feeling like I was on call as a doctor like when is my beeper going to go off? When was she going to need a feed? When is she going to start crying?

Are these mums going to think that I can't cope with my baby? 

Seeing other mums so relaxed and doing what I thought I would be doing really added salt to the wound.

I never went back.

VIVIAN: I think it's very lonely to become a mom in the Western society. In Asia, your aunt would come, your mom would come, and it wouldn’t be abnormal for you to be living at home for a few months after giving birth. Someone is always popping in.

Here, you’re normally by yourself. You have to make an effort to go to these mom groups to connect with moms. And you have to make an effort to call on help. The onus is on you. Whereas I think he had the support network you would just have to say a word like oh my baby's not feeding and then like tons of people come and give you advice and help you.

ALLISON: She was exhausted. She didn’t have enough hands to care for Sarah and make all these phone calls and do all this research. She and Todd decided to move back into her parents house.

VIVIAN: It was another confirmation of, “Oh, you have failed, like you can’t even take care of your own child that you need your mom to help you.”

But I think I was so grateful for their help and just any suggestion that I might be able to get some sleep was like okay, I am doing it here it doesn't matter what other people think, I am doing it.

ALLISON: Having her mom’s help during the day was a huge relief. But in the nighttime, it was just her and Sarah.

VIVIAN: In the night when she was in pain. It was just kind of me holding her in a really dark room. Trying to get her back to sleep. And the way I consoled her was just rubbing her back. In circular motions or patting her on the bum. But I would have to be pacing around the room in order to console her because the movement distracted her. So I would be pacing like that three or four times a night.

It almost felt to me like torture. You know like how if you just fall into sleep and then you’re so sleepy. You really can’t gather enough energy to do anything and then you have to do that because otherwise she would just scream the house down and then everybody will be awake.

ALLISON: And in this tortured state, Vivian was getting to the point where she was ready to try anything. Like even though she didn’t think it could be an allergy, she had started cutting out gluten, dairy, soy and nuts, just in case.

VIVIAN: I wasn’t taught that at medical school and I had never come across it. So if you imagine I actually done board exams in internal medicine and family practice. Those are postgraduate very intense exams. You kind of think, well I must know – I must know how to diagnose allergy. I must know everything there is to know about allergy.

But I had never come across this particular set of symptoms as a manifestation of allergy. Refusal to feed – I had never come across that and that never came up in pediatric textbooks that I studied.

ALLISON: But then the allergy thing started making more sense. She started uncovering scientific literature about refusal to feed being linked to allergy. She started seeing more and more things about cow’s milk protein allergy. Not​ lactose intolerance, but an allergy to protein in the milk.

She called a dietician.

Vivian described Sarah’s symptoms. And the dietician was like, this sounds like cow’s milk protein allergy to me! She told her how even though Vivian had been on the elimination diet, it can take up to 4 weeks for the milk proteins to get it out of your system and out of the breast milk. They didn’t have time for that. Sarah was starting to lose weight. She was getting lethargic and her diapers weren’t as wet – a sign of dehydration.

You need to take her to the hospital, the dietician told Vivian.

At the hospital, they put a probe down her throat to test the pH to check for acid reflux. The pH was normal. It for sure wasn’t acid reflux.

Then they needed to put in a feeding tube to get Sarah some liquids and nutrition.

Vivian was firm with the doctors. She told them, look, we’ve ruled everything else out. I think it has to be a cow’s milk protein allergy. She asked them to use a hypoallergenic formula. They agreed.

At this point Sarah is only 8 weeks old. And this feeding tube needs to go into her tiny nose, down her throat, into her stomach.

VIVIAN: The moment they put the feeding tube down Sarah's throat is probably one of the worst moments of my life. It basically made me feel like I had failed her as a mom. And made me question, “What the hell was I doing as a physician when I couldn't even prevent my own daughter going through the suffering of needing a tube being passed down her throat?”

It was something that you can’t even put--I cannot even put it into words. And we watched her struggle with that tube. It was momentary, I think, once the tube was passed through. She was fine.

It was the pain of watching your own child suffer. And that you have spent your whole pregnancy and your whole life learning how to help people.

And nothing was going according to plan. And it made me question what I was taught at medical school.

You know what was I missing that I can't even help my own child? It was a complete turning point for me professionally and on a personal level because up to that point everything in my life had basically happened exactly how I had planned it because I knew that hard work equals results.

So if I couldn't help my own child, who else have I not been able to help in my years of practicing as a doctor? Who else had suffered because I didn't know what I should know.

ALLISON: At the hospital, they pumped the special, dairy-free hypoallergenic formula down into Sarah’s stomach. One day, two days, three days. On her third day at the hospital, Sarah started to get better. They gave Vivan a bottle to try feeding the formula to Sarah that way. Sarah didn’t turn away. It was at that moment that Vivian knew, without a doubt, this is a cow’s milk allergy.

In the coming months, Vivian would learn all about cow’s milk protein allergy.

So there are two types of allergies: the acute type, which happens right away and is easier for doctors to spot, like swelling, wheezing, and rash. The second type – which doctors aren’t always trained to recognize – is a ​delayed​ allergy, with symptoms like abdominal pain, diarrhea and eczema. This was the kind of allergy that Sarah had, and it was from cow’s milk – so it was a good thing that Vivian refused the cow’s milk formula when Sarah was first born. It’s estimated that anywhere from 2-10% of infants have cow’s milk allergy. And sometimes – but not always – milk proteins from the mother’s diet get absorbed by the intestines and then transmitted into breast milk. This is why a supervised elimination diet is often recommended for mothers who suspect a milk allergy.

Because so many of the symptoms are similar to colic and reflux, it’s possible that a baby could have a mild to moderate milk allergy and the parents might not know.

By the end of the third day, Sarah was strong enough to leave the hospital. They returned to Vivian’s parents’ house.

VIVIAN: So I was then in my old room that I grew up in--my old bedroom. I was sitting on my single bed And I had her in my arms, just kind of propped up on pillows. We looked at each other – she was looking at me – and to not have her pull away in pain was such a new experience for me at that time, even though she was already, you know, over two months old.
That's normally what you would experience with babies when they're first born. They would feed and then they would be content afterwards.

But she was never content. I never had that moment with her. I remember thinking oh wow she's never looked at me for this long. She let me know that she was content. We really kind of looked at each other and bonded at that moment.

ALLISON: Vivian told me how bonding isn’t just a nice word. It’s part of our evolutionary design – a primal, survival instinct to understand what the baby needs. It is the bond that sets a parent up to help their baby survive. At the end of the day, there is no universal “best” way to parent. You can read books and blogs and attend classes, but it won’t tell you how to harmonize with the unique animal language of your baby.

That ancient type of listening remains a mystery that each parent must figure out on their own wild journey of parenthood.

Today, Sarah is healthy and has grown out of her allergies, though the family doesn’t drink cow’s milk. And when Vivian returned to work after maternity leave, she changed. She became the kind of doctor who listened to her patients and took their suggestions seriously.

And when the family moved from London to the United States a few years ago, Vivian decided she wouldn’t get licensed in the States as a physician.

And instead, she’s shifted to a more preventative, integrative approach to the body. She coaches people on improving their health through lifestyle changes like sleep, exercise and nutrition.

This week in the Bodies Facebook group, we’ll be posting resources about breastfeeding and allergies. We’ll also link to Vivian’s website. You can find a link to the Bodies facebook group in the show notes or by going to KCRW.com/bodies. Nothing is off the table, and everyone is welcome. You can also find episode transcripts and resources at bodiespodcast.com. Thanks to Sarah Schoengold for your help with the website. You can follow the show on Twitter at @bodiespodcast and me at @albtweetin. A L B T W E E T I N. If you like Bodies, please leave a review on Apple Podcasts.

This episode was produced and edited by me, Allison Behringer. It was also produced by Elysabeth Alfano. Editorial advising by Sharon Mashihi and Camila Kerwin. Original score and sound design by Dara Hirsch. Kristen Lepore is our managing editor. Abigail Keel provided additional feedback. Cover artwork by Sarah Bachman. Episode art by Kathy Farthing. Bodies is made with support from KCRW’s Independent Producer Project. Special thanks to Nick White and the whole KCRW team. I’m Allison Behringer and this is Bodies. See you in two weeks.