Most of obstetrics (labour and delivery) is usually uneventful, but when a problem arises, things can go downhill in the blink of an eye.
The role of your attending obstetrician and midwives is to react quickly in these situations to ensure the safety of you and your baby.
Here are my top tips for your pregnancy journey and giving birth, based on my personal experience helping mummies deliver babies in Singapore over the last 13 years!
(Also read: How Do Gynaecologists Have Babies?)
1. How important is it for you to have a birth plan?
Birth plans are super popular in Singapore these days. By my estimation, at least 50% of expectant mums have one. The majority of birth plans in Singapore are generally geared towards having a minimal intervention, “natural” birth approach.
In a sense, the popularity of birth plans is a good thing, as it means that mums are more engaged in their pregnancies.
However, do note that birth plans can only be your wish for what your labour will be like - it can’t be a contract as such, because it isn’t.
Moreover, a birth plan isn't absolutely necessary. What I suggest instead, is a good honest discussion with your obstetrician with regard to your understanding and thoughts about giving birth.
If your desire is for a natural birth, read on to my next few tips!
2. Start fighting those extra kilos early
Ideally, you should begin pregnancy at a healthy BMI of < 23. Many obstetricians would concur with me that slim, lanky, young women tend to have the smoothest birth outcomes. It's just how biology works!
If you're packing a few extra kilos, start shedding them before pregnancy. We don't necessarily advice an active weight loss program during pregnancy if you're overweight, but please avoid putting on excessive weight. Which brings us to..
3. This is how much weight you should gain throughout your pregnancy
You should definitely avoid putting on excess weight during your pregnancy. Try to keep your total weight gain to 11 - 15 kg or less if you're of normal BMI, and under 10 kg if you're overweight.
It's always a good idea to watch your diet (no need to "eat for two"), and keep as active as possible throughout your pregnancy.
4. Inducing labour? Bad idea, if you're a first time mom!
If it's your first pregnancy, try to avoid an induction of labour unless necessary. In first time mums, the likelihood of an unsuccessful induction is much greater due to an unfavourable cervix (poor Bishops score), unless you are truly well into labour.
Having said that, inductions aren't as dreadful as they're often made out to be. With proper planning, a favourable cervix, and a prior membrane sweep, inductions can go well.
5. When is an emergency C-Section required?
Occasionally, an emergency C-section is necessary, usually when fetal heart rate abnormalities reflect hypoxic stress (lack of adequate oxygen at the tissue level).
Obstetricians and midwives are trained to recognise severely abnormal fetal heart rate traces. The most common factors for this are:
- If the amniotic fluid is reduced and no longer acts as a buffer around your baby
- And/or a bit of cord is wrapped tightly around a part of your baby's body
- And/or if your baby is compromised to begin with eg. slightly growth restricted
- And if this is all compounded by a protracted labour with repeated uterine contraction
The renowned Professor Robert Winston once said: “The most dangerous journey one takes is down that four inches through the birth canal”. This may seem a grossly alarmist statement, but as obstetricians we've "seen it all", including severe unfortunate outcomes like cerebral palsy.
6. This is the best position of your baby for delivery
A little bit of mechanics will help you to understand this point better - your baby’s head (“the presenting part”) is not a ball, and the birth canal (the bony pelvis, curve of sacrum and the angle of the pubic rami) is not a chute if you will. The fetal head has different measurements in certain dimensions, and everyone’s bony pelvis (“the passageway”) is different.
Accordingly, the most favourable position for delivery is when your baby is occiput anterior (OA) - this means that your baby is looking inwards towards your spine, and at delivery, your baby’s face is looking backwards towards your perineum.
Conversely, occiput posterior (OP) means your baby is looking outward towards your tummy, and at delivery its face is facing your pubis.
7. How long will your labour be?
Your baby's position in the birth canal typically determines how quick or slow your labour will be.
First time mums are more likely to have your baby in an occiput posterior (OP) position, rather than the ideal occiput anterior (OA) position, compared to mums who have delivered before.
A persistent OP position tends to result in:
- A longer labour
- A higher chance of C-section
- A higher chance of an assisted delivery with vacuum or forceps
This is because your baby's presenting diameter is greater in an OP position...just pure mechanics again!
8. If you were wondering why second time moms have it easier...
If you've delivered vaginally before, your contractions are more efficient, and your baby can turn more easily from an OP to OA position.
There are various claims made for certain delivery positions that allow this turn to occur more easily during labour, but there's no strong evidence that these methods are effective.
9. Requesting for pain relief isn't "giving in"
As covered in my earlier post about how gynaes have babies in Singapore, gynae mommies almost ALWAYS request for epidurals.
Some of my expectant mums choose to go without any pain relief, which is well and good if you're fortunate enough to have a fast labour. These mummies tend to be naturally calm, or have had some practice at breathing and mental techniques to cope with the contractions.
However, if your labour is slow or prolonged, there's nothing wrong with having an epidural. Quite often, first time mums are distressed and can’t cope well with the contractions, which means they get tense and exhausted. Consequently, they may be unable to push well at the point of delivery, especially if the baby is large.
10. A few popular old wives tales about epidurals in Singapore debunked..
Epidural is safe. There's no evidence that it causes long term backache. To those mums who claim it gives them backache when old, I say all old people including men have backache!
There's also no evidence that epidural “passes to the baby”.
11. Should you have an episiotomy?
If it's NOT your first delivery, usually the (natural) tear is minimal and heals quickly. However, a natural tear can also be irregular and extensive, if not more so than having your obstetrician perform an episiotomy.
Your obstetrician may suggest having one to assist in the vacuum or forceps delivery, or if it otherwise looks like your perineum is not stretching out well. Do discuss this with your doctor.
12. This is when should you check yourself into hospital
The best way to have a smooth labour is to present to hospital in the active phase, when you're having strong and intense contractions about 5 - 10 minutes apart. Once you're in active phase (more than about 5 - 6 cm dilated), you should deliver generally within the next 6 - 8 hours.
The latent phase of labour (when contractions are infrequent and mild) can last for a day or more.
Again this advice is well and good only if you're calm, and can cope well at home. Sometimes there are other issues eg. anxious other half rushing to hospital at the slightest sign, well-meaning mum-in-law flapping around..etc etc
I hope that you found all these tips helpful! My final 2 cents is for you to work with an obstetrician whom you can communicate well with, and have all these issues discussed well before you go into labour!
Dr Jasmine Mohd practices as a obstetrician and gynaecologist at WC Cheng & Associates. She holds a joint appointment as Adjunct Assistant Professor at NUS. Dr Jasmine remains dedicated to surgical teaching of residents in her role as Visiting Consultant to the Department of Minimally Invasive Surgery in KKH.