Dr Wong Pak Seng
MD (UKM), MRCOG (London), MMed O&G (Malaya),
Fellow in Infertility & Reproductive Medicine (London)
Consultant Obstetrician, Gynaecologist and Fertility Specialist,
Clinical Director of Sunfert International Fertility Centre, a comprehensive one stop fertility centre, Sunway Medical Centre
The prospect of giving birth may be daunting, but it will help if you prepare yourself well. The following are some important considerations to help you plan for the arrival of your little one:
How do you choose the right doctor and birth place?
This is a very personal decision. First and foremost, you should be comfortable with the doctor that you choose. Most patients would agree that the doctor should be approachable, competent and experienced. You should consider both the paediatrician and the obstetrician. Other practical factors would include the proximity of the doctor’s clinic to your home, as it would certainly be less stressful to travel a shorter distance to see a doctor, especially if you or the baby is not well.
The birth place that you choose should be comfortable and have all the basic facilities including blood bank support and neonatal intensive care unit. Budgetary concerns also plan a role in deciding where to deliver.
What are the things to bring when admitting to hospital?
The most important thing is to pack early. Essential items include your personal items, baby’s clothing and admission documents. If you have signed up for cord blood banking, remember to bring the cord blood collection kit. However, most hospitals provide everything from toiletries to both you and baby’s clothing, so all you need to do is to just turn up.
What do I need to do to prepare for labour?
Both you and your partner can learn more about the birth process by attending parentcraft classes, so that you are both aware about the options available in order to be able to make informed decisions. Also, there are many good books or websites that can help you create a birth plan which will include, among others, options of labour position, pain medication, who your birth partner is and how the baby is cared for after delivery. A word of caution is you should not try to achieve a “perfect birth”. Childbirth is unpredictable and your doctor will advise you accordingly if things do not go as planned.
Can I achieve a vaginal birth?
Every woman has about 80% chance of vaginal delivery, unless there is a preventing factor like a low lying placenta (placenta praevia), breech or a narrow pelvis (birth canal). Most doctors would perform an internal check at about 37 weeks to decide whether you are suitable for vaginal delivery.
Sometimes, a decision for caesarean section is made during labour due to unforeseen circumstances like a distressed baby or failure to progress in labour.
What are the signs and symptoms of labour?
The commonest symptom is regular womb contractions that are painful and occur frequently. These are different from the intermittent tightening (Braxton Hicks) that occurs towards the later part of pregnancy. If you are unsure, you can always call up the labour room and ask for advice.
Some women may have a burst water bag with clear yellowish fluid draining copiously. This may or may not be accompanied by contractions. Labour is usually imminent and it is best to make your way to the hospital.Some women may have slight vaginal bleeding that comes together with sticky mucous. This is called show, which may indicate that the cervix is partly open. It is best to wait for some contractions to come on first before going to hospital. This may take up to several days.
Can my partner be with me during labour or caesarean section?
Most hospitals now allow the partner to be present during vaginal birth. This has been shown to improve outcome and impart a greater sense of satisfaction to both parents. Most hospitals also allow the partner to be present during caesarean section, provided it is done under regional anaesthesia (spinal or epidural). However, different hospitals have different policies and it is best to check with your obstetrician first. In addition, most hospitals would only allow the husband to accompany the wife, and not anybody else.
Would I require pain relief during labour and what is the best option?
Labour pain is the second most painful condition in humans after kidney stones. Hence, it is advisable to get some form of pain relief during labour. The commonest pain relief is usually the pethidine injection. This injection is given on the buttock and is fairly effective. However, it does not take the labour pains completely away, and may make both the baby and mother sedated. If the pain relief is inadequate, you may top it up with entonox (laughing gas) inhalation.
The most effective pain relief is an epidural anaesthesia. This is an injection that is administered via the backbone (spine) and is given continuously until labour ends. It is a very safe and effective pain relief, and the risk of complication is very low. However, as the bearing down urge is absent during the child birth, you may require some assistance to deliver the baby, usually with a vacuum.
Why do some women need assisted delivery?
Sometimes despite your best efforts, labour does not progress in the second stage. In addition, the baby’s heartbeat may also slow down during the second stage due to head compression or fetal distress. Most doctors will then recommend an instrumental delivery, usually with vacuum or forceps. However, sometimes instrumental delivery may not be suitable or possible due, for example, to acute fetal distress or a large baby, and a caesarean section may be recommended.
How many days do I need to stay in the hospital?
If you delivered vaginally, you would only be required to be hospitalised for a day or two. Occasionally, your baby may need to stay longer due to jaundice, and most women would room in with their babies. You may also be required to stay longer if you have high blood pressure or other medical conditions that require close observation.
If you had a caesarean section, you may be required to stay at least two or three days for adequate post-operative recovery.
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