Dr Jasmine Mohd

Yes you can. Do refer to The Essential Guide To Abortions In Singapore (2019) for further information.

No, there isn’t any such prenatal screening test available. Autism spectrum disorder is a neurodevelopmental disorder characterised by persistent deficits in communication and interaction, and certain repeated patterns of behaviour or activities. ASD is more common amongst children with certain genetic conditions than in the general population. These include conditions lsuch as fragile X and Angelman syndrome for which there is screening available. However, the vast majority of children with autism spectrum disorder may not have any clear identifiable genetic condition.

In general, abortions are safe with low complication rates when performed by a gynaecologist in a MOH-approved clinic or hospital. Common complications would include small amount of placental tissue remaining in the uterus (generally in the order of less than 5%). This is usually due to perhaps a small bit stuck in corner of the uterus and it would be unsafe to continue scraping at the area. This usually may pass out on its own or the gynaecologist may suggest some medication to expel it. Rarely it may require a second procedure.

For women in whom it's their first labour (primigravida) there will usually be some degree of tearing. Some first time mums are lucky and have no tear. For multipara (second time mums and above) tearing is usually minimal and some do not tear at all. This is because the soft tissue resistance is less in women have delivered before and secondly the perineum tends to stretch out better in these women as well. Likelihood of tearing is related to a few factors.

Technically the term natural vaginal delivery in obstetrics refers to the spontaneous birth of a fetus as opposed to an assisted vaginal birth, which means being assisted with forceps or vacuum. However in common usage these days, a natural birth generally refers to an unmedicated birth, or at least a birth with as minimal intervention as possible. Women who are keen on “natural birth” also tend to decline pain relief options in labour.

Medisave claim for natural delivery is up to $2550, assisted delivery up to $3050, Caesarean section up to $4400. These are inclusive of a claim of $900 for pre-delivery expenses. Please refer to the Ministry of Health website for further details.

Generally the consensus is that a natural tear is preferable to an episiotomy. In my practice most multiparae do not need an episiotomy. Quite a number of first time mums do not need one if they push well. However natural tears can also be irregular and extensive. In general, with episiotomies, the likelihood of tears around the urethra or clitoris is less. The overall recommendation is for restricted use of episiotomies. For example it can be useful in women who tend to be very oedematous and swollen at the perineum after prolonged pushing.

Please do not worry. If you are afraid of pain, there are many good pain relief options that are available to women in labour. The contraction forces in labour can be very intense. Some mums are able to manage this well without pain relief with breathing techniques and keeping calm during labour. Some other pain relief options that my patients use include walking around, water immersion or shower or massage, and working with a birth support person (doulas).

Bearing down in the second stage will result in you pooping if your rectum is full. To prevent this from happening you can consider having a enema. This is often administered by the nurses when you do present in early labour at the hospital. An enema is safe and it doesn't hurt.

There are a myriad of complications that can occur. Generally the more common ones include Slow or arrested labour due to the cephalo-pelvic disproportion. This is usually in turn due to relatively large baby compared to the size of the bony maternal pelvis, and/or occiput posterior position where the presenting diameter for the fetal head is larger compared to when the baby is in a more favourable occiput anterior position. Fetal distress -this is usually manifested by an abnormal fetal heart rate trace on the CTG.

I would recommend birth classes for first-time mums as they would help you be more aware of what to expect doing labour. Secondly, some preparation is of value, as it might help you make better choices during labour.

The other pain relief options include gaseous nitrous oxide (Entonox) and intramuscular opioid injection. Entonox will make you feel a bit high and takes the edge of the contractions but you will still feel the contractions distinctly. The injection is more effective than Entonox and is sedating. It lasts for about 3-4 hours. If given too close to the point of delivery it might cause some respiratory depression in the newborn but this is generally rare. Epidural is the most effective method of pain relief.

Most women give birth lying down in a supine position (on their back). This is particularly the case if they are on epidural as they will not be able to manage alternative positions well. Some also give birth lying their sides. Alternative birthing positions include squatting and on all fours. These are an option if you are not on epidural as you will be able to maintain your position well. I suggest to explore options with your obstetrician and doing the labour to see what suits you best.

Generally, I tell my patients to come in should they develop regular intense contractions that last for approximately one minute and at a frequency of every five minutes or so; secondly if they develop any significant large amount of bleeding or if their waters break in particular if they have tested positive for group B Streptococcus colonisation.

Not at all. This is a commonly held misconception. Epidurals are safe and do not result in any long-term or short term risk to mother or child. Sometimes with an epidural you may not have much sensation or urge to push when it comes to the second stage of labour. If this is the case I usually encourage the mum not to bear down until the fetal head has descended passively down the birth canal. Sometimes I may also reduce the epidural infusion rate a little so that the mum can push better.