571 of you joined us in the Singapore Parenting Festival's first webinar: The New Norms - Pregnancy & Safe Childbirth Guide. We've received an overwhelming number of questions during the webinar, and we apologize that we could not answer them all due to time limitation. Fret not! We've compiled the questions below, and got our experts to answer them. You can also watch the replay of this webinar here.
Q: My wife is 31 week Pregnant and now she has tailbone pain frequently. Is there anything that can help with the tailbone pain issue? Tks!
A: Tailbone pain is often caused by the pelvic ligaments loosening and shifting. During pregnancy, your body releases a hormone called relaxin. The hormone makes your pelvic ligaments looser and more flexible to make room for the baby to grow and enable you to give birth.
Some suggested stretches you can try:
- Cat-cow
- Standing cat-cow
- Child’s pose
- Downward facing dog
- Bridge
Do consult a professional if you are unsure or need advice regarding these stretches and do not over-exert!
Q: Is it necessary to prepare a birth plan?
A: A birth plan is a list of your preferences for your baby's birth and his/her first few days of life. You don't need to have a birth plan to give birth but it can be useful to help you think about and to communicate your wishes for your baby's birth with your partner and your healthcare team.
Q: What is the oldest safe age for pregnancy?
A: There is really no cut-off in terms of a safe age for pregnancy but do be aware that older mothers may have a pre-existing medical condition (e.g. diabetes or high blood pressure) that may increase the risk of pregnancy. Older mothers are also at high risk for miscarriage and for developing complications in pregnancy including gestational diabetes and high blood pressure conditions. Women above the age of 40 are also at a much higher risk of experiencing a stillbirth. Affected mothers may need closer antenatal attention and follow-up to ensure a healthy pregnancy. Rest assured however, that most healthy women have healthy babies even if their age is a risk factor.
Q: I've heard a lot of negative side effects of using epidural. would you recommend it? why or why not?
Epidural anaesthesia remains one of the most effective ways of providing pain-relief to labouring women particularly for first-time mothers who tend to experience longer labours. By making the mother comfortable throughout most of labour, she can conserve her energies to concentrate on pushing the baby more efficiently when the conditions are right.
Most of the side effects of epidural anaesthesia are usually temporary and short-lived. These may include:
- Low blood pressure. It can be normal for your blood pressure to fall a little when you have an epidural. In a small number of cases, the drop in blood pressure may affect the heart rate of the baby and medications may have to be given quickly to correct the blood pressure.
- Temporary loss of bladder control. Usually, a urinary catheter (tube) is placed in the bladder throughout the duration of the epidural anaesthesia to help drain urine from the bladder. This catheter is removed 6-8 hours after the epidural is taken off.
- Itchy skin.
- Feeling sick.
- Slow breathing.
Inadequate pain-relief can happen in a small number of cases. The doctor in charge of prescribing the epidural (an anaethestist) can adjust the medications or if required rarely, re-insert the epidural. Nerve damage has been described as a possible complication but remains generally rare. If you are concerned with the complications and side-effects, you may need to discuss this with your doctor and healthcare team.
Q: Can I exercise while pregnant? To what extent would it become dangerous?
A: If you are healthy and your pregnancy is normal, it is safe to continue or start regular physical activity. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. Exercise helps to maintain a sense of well-being, keeps energy levels up and conditions the mother for the physical requirements of labour. During the later trimesters, adjustments may need to be made in order to reduce the risks of losing balance or to avoid falls or impact on the tummy. A mother who is at least 20 weeks pregnant should also avoid lying completely flat on her back during exercise as this may severely impair the normal flow of blood in her body due to compression of large blood vessels by the enlarged womb.
Q: Should you avoid the flu vaccination during the FIRST trimester?
A: Getting the flu shot during any trimester of pregnancy is reasonable and safe, and being vaccinated against the flu in the first trimester will not put your baby at risk.
Q. Can i take this 2 vaccines (flu and whooping cough) if I got severe drug allergy?
It really depends on the type of drug allergy and the type of allergic reaction experienced previously. I would suggest consulting your doctor for further advice. Sometimes, the expertise of a specialist in allergies may need to be obtained.
Q. I heard that whopping cough vaccine should be re-taken before getting pregnant even if the mother had already gotten the vaccine before when she was a child?
The whooping cough vaccination is recommended for all mummies between 16-32 weeks gestation of each pregnancy she goes through regardless of any previous childhood vaccination.
Q. How to apply for the baby support grant?
A: As part of parenthood incentives to encourage more couples to have children, the Singapore Government will provide a one-off Baby Support Grant (BSG) of $3,000, for children born from 1 Oct 2020 to 30 Sep 2022. With the new BSG, parents will now receive up to $21,000 in cash and cash-like benefits on the birth of their first child, in addition to parental leave, and subsidised preschool and healthcare. More details on all the measures in the Package can be found at go.gov.sg/mpbooklet. You can also use the Family Support Calculator in the LifeSG app to find out how much benefits you can receive.
Q: Do antibodies passed through milk protect babies from infection?
A: Breast milk antibodies can offer many benefits to babies which include protection from various infections. The WHO and UNICEF recommend that “children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first 6 months of life – meaning no other foods or liquids are provided, including water. Infants should be breastfed on demand – that is as often as the child wants, day and night.”
Q: Will birth partners continue being able to be with the mummy whilst in the labour suite and staying in if the covid restrictions get any worse
A: The situation is evolving daily. Currently, most hospitals will require birth partners to be COVID-19 swab/test negative before they are allowed to accompany mummies in labour. Visitor restrictions including restrictions on the time of each visit may also be imposed. Some hospitals may offer complimentary swabs for birth partners while others may impose a fee. The policies do vary from hospital to hospital so it might be good for enquiries to be made in advance.
Q: so Covid19 will not spread to baby through breastfeeding, only through saliva or other fluids?
A: The Royal College of Obstetricians & Gynaecologists in the UK suggests that for mothers who have suspected or confirmed COVID-19, a discussion about the benefits and risks of infant feeding, including breastfeeding should take place. The RCOG further suggests that “there is no strong evidence to show that the virus can be carried or passed on in breastmilk and that “the well-recognised benefits of breastfeeding and the protection it offers to babies outweigh any potential risks of the transmission of COVID-19 through breastmilk.”
The main risk of breastfeeding is close contact between mummy and baby. Should the mother cough or sneeze, the baby may be infected by droplets containing the virus after birth. Wearing a mask and maintaining proper hand hygiene may help to reduce the risk of infection.
Q: During delivery, does the pregnant mum need to wear a mask?
A: Similar to the question on the presence of birth partners, the situation is evolving daily. Depending on the infection control policy of the hospital involved, masks may or may not be required. It is important to check with your hospital and healthcare team in advance if this is a concern.
Q: What makes a good candidate to do VBAC?
A: About 75% of women experience a successful VBAC. The success rate may be even as high as 90% if the mother has had a previous successful VBAC. The main risk of a VBAC is that of womb rupture which can put the baby and mother’s lives in danger. This can happen in 1 out of 200 women. Induction of labour can increase the risk of a rupture to 1 out of 40. As such, mothers choosing VBAC should go into labour on their own. Medications that regulate womb contractions in labour (oxytocin) should be avoided to further minimise the risk of a rupture. Additional monitoring may be required in labour to avoid a rupture and it would be sensible to deliver at a facility with easy access to operating theatre in case a emergency C-section is required. A good candidate for VBAC should have a relatively complication-free pregnancy that does not require induction of labour for delivery. She must be able to accept the risks of a possible uterine rupture which can potentially put herself and her baby at risk.
Q: My first birth is c-sec, Can I have a natural birth for my 2nd one?
A: The option of a VBAC should be discussed with your doctor (please see the above answer).
Q: Hello Dr, how high should the placenta be for natural delivery and by which week? Thanks.
A: Generally, the placenta should be at least 2cm away from the cervix by 36 weeks in order for a natural delivery to be considered. There is always a possibility of bleeding from a low-lying placenta during labour. Should this happen, an emergency C-section may be required. A mother with a placenta that is at least 4cm away from the cervix at 36 weeks should generally experience no issues with natural delivery. A planned C-section is generally recommened for a mother with a placenta that is less than 2 cm from the cervical opening because of the likely risk of severe bleeding in labour.
Q: Do I need to get a doula? is it necessary?
A: A doula's most important role is to provide continuous support during labour and delivery. Although research is limited, some studies have suggested that labour companionship during childbirth might be associated with benefits including a decreased use of pain relief medication during labour, and a lowered risk of experiencing a forceps/vacuum-assisted delivery. At present, engaging a doula is a very personal option and I would encourage you to speak with your doctor to find out more.
Q: Are there any exercises or preparation work to be done in advance to recommend to help easier vaginal delivery?
A: See the answer to the earlier question on exercise in pregnancy. In order to prepare your body for labour and delivery, exercises such as Kegel, squats and back stretches can also be helpful. Kegel exercise is a type of pelvic floor exercise that helps strengthen your vaginal, uterus, bladder and bowel muscles.
Q. Are there pregnant mothers that did not take the flu, whooping cough vaccination and give birth with healthy baby?
Certainly. The idea of pregnancy vaccinations is to lower the risks of maternal flu and infant whooping cough and their possible complications. Some mothers may however, choose not to receive the vaccinations as they may have experienced unpleasant side-effects previously, or if they are allergic to components of the vaccine.
Q: what would your recommendation be for long labours - to take a c-sect or not? what would be some events that would lead u to conclude on getting an "emergency" c-sect?
Long labour can be influenced by three important factors, the so-called 3 Ps – Passenger (the size of the baby), Passage (the size of the mother’s birth passage) and Power (the frequency and intensity of the womb contractions). The former two cannot be changed unfortunately. Only “power” can be adjusted by the use of an intravenous medication/hormone known as oxytocin. Instances of long labour may result despite adequate “power”, either because the “passenger” is too big and/or the “passage” is too small. In these cases, a C-section may be necessary. The decision for a C-section is ultimately a professional judgement that is made by the obstetrician taking into account these various factors in order to achieve safe outcomes for both the mother and baby.
Q: How difficult is VBAC and why do some doctors prefer not to do it?
See the answer to the earlier question. Doctors may advise a mother not to try VBAC is there is concern about an increased risk of uterine rupture, or if there are concerns that an emergency C-section cannot be arranged expediently in such an event. It is best to discuss in detail with your doctor so that you fully understand the risks and benefits of VBAC versus a repeat C-section.
Q: I'm 16 weeks and I'm still currently experiencing some lower abdominal cramps once in a blue moon. Should I be concerned?
A: As pregnancy progresses, these ligaments stretch, which can cause aches and cramps or sharp pain that occurs on one or both sides of the lower abdomen. This can happen at any point during the pregnancy. Do seek professional opinion if these get increasingly frequent, or if there is associated bleeding or leakage of fluid from the vagina.
Q: I have read that posture matters while giving birth and perhaps lying on the back might not be the best especially if you have tailbone pain. Any advice?
A: Many women experience lower back pain during pregnancy. For approximately one-third of pregnant patients, the aching annoyance becomes a significant pain in the rear – or more precisely, the tailbone. The tailbone, or coccyx, sits at the bottom of your spine, above your tush and behind your uterus. It helps stabilize you when sitting and serves as an attachment point for the pelvic floor muscles that support your bladder, bowel, and uterus. While approximately 70% of women experience low-back pain at some point in their lives, 50% - 80% report back pain in pregnancy. For nearly 10% of them, the pain can be debilitating.
Tailbone pain is often caused by the pelvic ligaments loosening and shifting. During pregnancy, your body releases a hormone called relaxin. The hormone makes your pelvic ligaments looser and more flexible to make room for the baby to grow and enable you to give birth.
If you are concernred about tailbone pain during labour, speak with your doctor and healthcare team. There are many ways of positioning a mother in labour. A position that does not aggravate the tailbone pain may be helpful.
Q: I had wanted to walk around during my earlier labours before, but the nurses said they needed to keep me strapped to this fetal monitoring device so disallowed that. how come?
A: In some societies, midwives monitor the baby’s heartbeat by listening-in at regular intervals during labour. This is however labour intensive and requires training and experience. In cases where the pregnancy may be high-risk, doctors would generally advise monitoring throughout labour (continuous). A high-risk pregnancy is one where complications such as pre-eclampsia (high blood pressure in pregnancy) or diabetes have occurred. Sometimes, a pregnancy may be deemed high-risk during labour such as when the baby is suspected to have passed stools (meconium) into the amniotic fluid (a sign of fetal distress). Mothers who choose to have epidural pain relief will also require continuous monitoring of their baby’s heartbeat.
Your doctor's preference can affect what type of monitoring you have. Talk with your doctor about what he or she usually uses. Most labour wards in Singapore would err on the side of safety and would recommened continuous fetal heart monitoring as a default.
Q: I always have a need to use the toilet when I have anxiety. Can I move around and go to the loo?
A: I am assuming that this is a general question about urinary frequency in pregnancy. Many women experience frequent urination and constipation during pregnancy due to the hormones and physical effects of pregnancy. Moving around and going to the loo should generally pose no problems. Do seek professional advice however if the urine appears cloudy or is foul-smelling as this may be a sign of urinary tract infection (UTI). UTIs are associated with an increased risk of pre-term labour and should be treated with a course of antibiotics.
Q: What kind of complications does natural birth lower?
A: Generally, a successful natural birth confers the following advantages:
- Faster recovery
- Shorter hospital stay
- Less requirement for readmissions to hospital
- Less risk for baby to be admitted to intensive care
- Lower complications such as bleeding and wound infection compared to C-section
Q: Is there a template for a birth plan?
A: There are many birth plan templates available on the internet. You can check this link for an example for what you might want to include in yours: https://bit.ly/2QGYUOb . You may also like to ask your doctor to check if he/she has one planned for you!
Q: I'm currently 7 weeks pregnant and have bleeding on and off. Do I go to my gynae immediately? or should i wait and see?
A: Bleeding in the first trimester is common but medical attention should be sought early to rule out the possibility of miscarriage or ectopic pregnancy, especially if you have yet to see your doctor for your booking visit. Please see your doctor for advice.
Q: Can you elaborate on the oxytocin mentioned to help in labour pain?
Oxytocin is a hormone that helps to regulate uterine contractions during labour. It can also trigger the release of breastmilk after delivery. Commonly referred to as a “happy hormone”, it is also believed to promote a sense of love and attachment. Oxytocin may be given to a labouring mother to regulate womb contractions so that the cervix dilates efficiently. It is not routinely used for pain relief during labour.
Q: How about stem cell banking?
I presume the question is referring to cord blood banking.
Cord blood banking is a process of collecting potentially life-saving stem cells from the umbilical cord and placenta and storing them for future use. Stem cells are immature cells that can assume the form of other cells.
After the doctor cuts and clamps the umbilical cord at delivery, cord blood is collected from the remaining umbilical cord still attached to the placenta. The blood is sealed in a bag and sent to a lab or cord blood bank for testing and storage. The process only takes a couple of minutes and is painless for mother and baby.
The cord blood bank may also send tubes so that the mother’s blood can be taken, too. If so, the banking kit will have instructions along with blood collection tubes.
Q: Can you also share your view on Public cord banking? Would donors get priority in future should he/she require it?
Public cord blood banking is strictly voluntary and involves donating the baby’s cord blood for anyone who may need it for treatment.The bank may also use the donated cord blood for research. It is best to check with the Singapore Cord Blood Bank for further details.
Q: I just found out I am 5 weeks pregnant and I am worried about Ectopic pregnancy. Can this be spotted early and is it preventive?
An ectopic pregnancy is a pregnancy that has implanted into a location other than the womb, frequently inside the Fallopian tubes (in such a case, called a tubal pregnancy). Ectopic pregnancies cannot progress and develop normally because of their location and can be life-threatening because of the risk of rupture and bleeding. Risk factors for ectopic pregnancy include previous ectopic pregnancies and a history of pelvic inflammatory disease. Some ectopic pregnancies may also occur by chance. The signs of an ectopic pregnancy include lower tummy pain and vaginal bleeding occurring in the context of a missed period. If you are concerned that you might be having an ectopic pregnancy, it is best to see your doctor early. A scan may be performed to verify the location of the pregnancy. A blood test may also be taken at the same time. The scan and blood test may need to repeated at regular intervals (usually once every two days) before the diagnosis of an ectopic pregnancy can be confirmed. Depending on the results, surgery may be recommened to remove the ectopic pregnancy. In selected cases where the ectopic pregnancy is detected very early, injections can be given for treatment. For further details, it may be best to consult your doctor early.
Q: Is delayed clamping more beneficial or cord blood banking? Do we have to choose one or can we have both?
A: Growing evidence supports the fact that parents can both delay clamping and bank their cord blood, without choosing one over the other.
Q: Does too much blood in delayed clamping be a problem?
It was believed that neonatal jaundice (yellowing of the skin in newborn babies) was more common in term babies in which delayed cord clamping was practiced. This belief has fallen out of favour.
Q: What are the side effects / risks of induced labour?
A: An induction of labour may be recommended for women with pregnancy risk factors such as high blood pressure in pregnancy (pre-eclampsia), gestational diabetes or in instances where there is concern that the baby is too small. An induction may also be recommended if the baby is past the estimated due date.
The aim of induction of labour is to achieve a vaginal birth. Medications may be given to cause the cervix to dilate and when appropriate, the waters may be broken by your doctor. Oxytocin may also be given through a drip to regulate the womb contractions to achieve a vaginal delivery.
The main risk of induction of labour is the possibility of requiring a C-section for delivery should induction be unsuccessful. This can be due to inability of the baby to tolerate the stress of induction (seen on the baby’s heart tracing), failure of induction (the cervix does not open or labour does not progress), and rarely womb rupture (for women who have had previous fibroid removals, previous C-sections or who have had 5 previous deliveries or more) and cord prolapse (where the umbilical cord of the baby slips out through the cervix during labour).
Q: Does stress during labour affect the blood pressure of mom?
A: Anxiety causes the release of stress hormones in the body. These hormones trigger an increase in the heart rate and a narrowing of the blood vessels. So yes, stress during labour affects the blood pressure of mom. Do try to relax!
Q: For GD (Gestational Diabetes) but well controlled with diet, would you recommend induction at week 38? Or there isn't a need to?
Mothers with gestational diabetes mellitus (GDM) are recommended to deliver their babies from 38 weeks and frequently, not beyond 40 weeks. This is due to the increased risk of experiencing a stillbirth in women with GDM. Other factors that may influence when an induction is recommended include the estimated size of the baby, the degree of GDM control as well as other concurrent risk factors such as high blood pressure (pre-eclampsia). I would suggest having a detailed discussion with your doctor to determine the best time for an induction of labour.
Q: Hi Dr Tan, for mummies with low lying placenta, is it better to deliver at government hospitals?
A: Unfortunately the answer is not a strict yes or no. It depends on how comfortable you are with your current gynae as well as the level of care that can be provided by the hospital you decide to deliver in. Deliveries for mummies with low-lying placenta are at higher risk for bleeding, so it is important to make sure that your doctor is comfortable delivering you, and that he or she has the healthcare support and resource to deal with unexpected heavy bleeding that may occur, including accessibility to blood for transfusion, if required.
Q: Im 31 wks with 2 episodes of threatened preterm labour. Due to that, my cervix became short to 17cm & head presented very low and engaged. What’s your advice to delay the birth of baby?
It may not be appropriate for me to advise on your questions as the history appears to be complex and much more details would be required. I would suggest seeing your doctor for a full discussion on the options available.
Q: I'm currently 33 weeks into my pregnancy, but my baby is still in the breech position. What can I do to help my baby turn?
A: 1 out of 4 babies are bottoms-first (breech) at 28 weeks of pregnancy. By the time, a pregnancy reaches 32 weeks, 7 out of 100 babies remain in a breech position. Only 3-4% of babies remain breech when a pregnancy reaches term (37 weeks or more). There is very little research into techniques to help the baby turn. The Royal College of Obstetricians & Gynaecologists (RCOG) in the UK suggests in its guidelines that moxibustion (a form of traditional Chinese medicine) has been used between 33-35 weeks with limited success when combined with postural management techniques. Unfortunately, the quality of data from the research on moxibustion remains poor.
C-section is safer for breech babies at term and is recommended over vaginal breech delivery. External cephalic version (ECV) is an alternative option for pregnant mothers with breech babies at term who are not keen for C-section. During an ECV, gentle pressure is applied to the mother’s tummy to help ease the baby into a head-first (cephalic) position. 1 out of 2 ECV procedures succeed. In successful cases, the mother is discharged to await natural labour. If you have a baby that remains in a breech position by 36-37 weeks, you may want to discuss with your doctor to see if you might be suitable for ECV.
Q: Are there any complications for natural birth for those with severe bleeding haemorrhoids?
Generally, haemorrhoids should not pose a problem during natural birth although they may sometimes bleed during the delivery process. Most haemorrhoids go away after pregnancy. If they do persist, they may be treated with medications or in more severe cases, by surgery.
Special thanks to Dr. Tan Eng Loy, Obstetrician & Gynaecologist, E K and E L Women’s Clinic