Pregnancy, Childbirth & Labour
Ask Dr Jasmine Mohd about:
- Birth plans
- How to have a healthy pregnancy
- Dos and do nots during your pregnancy
- Who can be with you at childbirth
- Recommended labouring positions
- When to head to the hospital
- When is labour induced
- When do doctors decide on using interventions
Dr. Jasmine Mohd practices at WC Cheng & Associates at Thomson Medical Centre, the largest private women’s hospital in Singapore. She is wholly supportive of breastfeeding efforts, and a natural approach to childbirth, including hypnotherapy techniques. Dr Jasmine’s subspecialty is advanced laparoscopy (keyhole surgery), hysteroscopy and robotic surgery. She underwent advanced surgical training in robotic gynaecological surgery at the Mayo Clinic Arizona and spearheaded the implementation of the Robotic Surgery Program in KKH.
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.
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.
Forceps delivery is sometimes necessary during the second stage when the mum gets too exhausted to push further or if there is significant concern about the baby for example fetal distress which requires the baby to be delivered immediately. I tend to choose forceps when I feel the mum is not pushing well enough or baby is big. If mum is pushing well and there is good descent of the baby but mum still need helps eg with rotation of the foetal head, that's when I decide to use a vacuum extractor instead.
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).
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.
Of course. you can change your mind anytime! Should you feel you need pain relief at any point in labour, it can and will be offered to you. The pain relief options in labour include nitrous oxide gas, intramuscular opioid injections as well as an epidural. They are all safe and do not result in any significant risk to the baby and mum unlike what is commonly perceived.
Possible is one thing, but the risk of rupture is higher than for one previous CSection. Uterine rupture is generally rare, but unpredictable and catastrophic. The likelihood of successful VBAC would increase if you were in labour and dilated to a significant degree in the earlier pregnancy.
Hi! I suggest to have it looked at by your obstetrician, just to make sure that there is no abnormal healing or scarring. For some women post first delivery, there is a bit of discomfort after the first few attempts at intercourse. This should generally resolve with time. I suggest to go slowly, and use plenty of lubricant.
It is not possible to comment accurately on your sister’s labour as we will not be privy to the exact circumstances of what happened. In general though, the nurses in all labour wards will help the patient arrange for pain relief if it is required, whether it is in the form of epidural, entonox gas or painkiller injections. All nurses in labour wards are also highly trained to assess patients in labour and their progress (degree of dilation and descent down the birth canal).
In general the risk of pregnancy loss increases when maternal age approaches her late 30s and beyond. Without knowing the details of your circumstances, general advice would be to maintain an normal BMI as maternal obesity or being significantly underweight is associated with obstetric complications. Also avoid excessive alcohol consumption and exposure to cigarette smoke. For the male partner, watch issues like smoking, alcohol consumption , exercise habits and body weight as these can affect sperm quality.