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Childbirth 101

Consultant Obstetrician & Gynaecologist Dr Kenneth Edward Lee addresses some of the common questions women have about pregnancy and childbirth.

One of the biggest fears of women about childbirth is pain. What sort of pain relief is available today?

The common ones are Entonox, which is a mixture of oxygen and nitrous oxide; Pethidine, which is administered intramuscularly; and Epidural, sometimes called ‘Happy Dural’ because it provides very good pain relief, is very safe, and even helps with dilation of the cervix. However, mothers should consider the various pain relief options well in advance and not wait until the pain becomes unbearable before deciding. An epidural, for example, must be done by an anaesthetist and is most effective if administered during the early stages of labour.

Are more women opting for Caesarean deliveries today? Why?

Caesarean delivery is recommended when there are medical indications, for example, a low lying placenta. Increasingly more women are asking for it and the procedure has become safer than it used to be. Some women opt for a Caesarean delivery for horoscopic reasons. Some are fearful of the pain of childbirth. Some worry about the loosening of the vaginal walls after childbirth. It is also getting more common as more women delay marriage and childbirth till a later age, by which time there are more risks and chance of complications in childbirth, which then lead to medical indications and the need for delivery via surgery.

Do you recommend women who have delivered via Caesarean section to limit the number of babies they have?

In the old days, most doctors would recommend up to three babies via C-section but the procedure is much safer now so even 4-5 babies delivered this way should not be a problem. The surgical cut is now made at a lower segment resulting in better wound healing and lower chance of uterine rupture.

What is post-partum hemorrhage and why does it happen?

Post-partum hemorrhage is when there is excessive bleeding following the delivery of the baby. It may be due to uterine atony, which means the uterus cannot contract properly after delivery or the placenta is retained instead of being properly expelled after delivery. It is not very common but women at risk are mothers with multiple pregnancies (carrying more than one baby), women who have had many babies (fourth or subsequent pregnancy), or women with uterine abnormalities like fibroids or low lying placenta.

Is it true that women who get pregnant at an older age face a higher risk of pregnancy complications?

Yes, women past the age of 35 tend to face a higher risk of their child getting Down’s Syndrome. Staying healthy and exercising regularly may reduce the chance of infertility or the risks of facing pregnancy complications but it does not entirely eliminate the possibility of such complications occurring. Still, there are many tests that can be done to increase the chances of a good outcome for mother and baby.

What are some of the more common pregnancy complications?

High blood pressure and diabetes which can become very serious if not treated. Women with pre-existing high blood pressure are more likely to face certain complications during pregnancy. However, some women can develop high blood pressure when they are pregnant and this is called gestational hypertension. This may result in pre-eclampsia, which is a more severe form of pregnancy-induced hypertension. This condition can potentially harm the mother’s vital organs and even cause stillbirth. Close monitoring and vigilance is the key.

How regularly should an expectant mother visit her doctor?

Within the first trimester, mothers should visit the doctor every two to three weeks in case there are any problems with the baby at the initial stages. From week 12 to 28, consultation should be done once every four weeks and subsequently every fortnight between week 28 to 36. From week 37-40, mothers see the doctor once a week.

How common are miscarriages today? Why do they happen?

Miscarriages occur in about 10-20% of all pregnancies. Although we cannot explain why they happen, there are several possible causes. It could be nature’s way of dealing with an abnormal foetus. It could be due to maternal illness or uterine abnormality – for example cervical incompetence (the inability of the cervix to hold a baby). It could also be due to trauma suffered during a pregnancy. If a couple experiences more than three recurrent miscarriages, I recommend further investigations for both partners to see if there are any underlying conditions affecting their ability to keep their pregnancy.

Post delivery ‘dos’ and ‘don’ts’

Despite the old wives’ tale of not showering for a month after delivery, a definite ‘do’ is to take a shower when medically stable as better hygiene will help to boost your own morale. Mothers should also get as much rest as possible after giving birth and avoid over strenuous activities that will tire themselves out. Massage, three to four weeks after delivery, is also good as it helps you to stay relaxed.

Dr Kenneth Edward Lee is based at the Maternity & Gynaecological Clinic, #B1-01 Blk A, Mount Alvernia Medical Centre, Tel: (+65) 6252 5360, (+65) 6252 5778.