Labour seems like a daunting process when you’re a first-time mum. Yet, this is the final — and all important — push that will make the past 9 months well worth your sweat, pain and effort!
Every pregnancy and birth experience is unique to a mother, even for women who have given birth before. So don’t take a one-size-fits-all approach to your baby’s arrival. Make informed decisions based on what your doctor says will work for you. Here is Dr Tan Toh Lick’s, a Consultant Obstetrician-Gynaecologist at Thomson Women’s Clinic, labour advice:
1) What is a “normal” pregnancy?
A normal pregnancy lasts for about 40 weeks. This day which is given as the estimated due date (EDD). Deliveries from 37 to 42 weeks are considered within the normal range ― this period is known as term. Most pregnancies either go into labour at term, or have a planned Caesarean section for delivery. About one in five pregnancies will require labour to be to be induced because of medical indication or by maternal choice. Induction at or beyond 37 weeks is associated with fewer foetal deaths, fewer Caesarean sections and fewer infant illnesses such as meconium aspiration syndrome — a process when baby passes his first stools while he is still in the womb. As the absolute risk of foetal death is small, the mum-to-be can opt to induce labour at term, or be monitored until about 42 weeks, with appropriate counselling.
“There is the risk of drowning, and umbilical cord avulsion — a process where the umbilical cord snaps — associated with water births.”
2) What delivery options do I have?
Most women will choose to have a vaginal delivery. A number will have a Caesarean section because of medical indication, or by maternal choice. Overall, one in four to one in five pregnancies will be delivered by Caesarean section.
Some women may also choose to have a water births. Water births can reduce the need of pain-relief during cervical dilatation to full dilatation. However, there is the risk of drowning, and umbilical cord avulsion — a process where the umbilical cord snaps.
Less than 1 per cent of women have a home birth by choice or it’s unplanned. The Singapore College of Obstetrics and Gynaecologists issued a statement in 2012 stating that “unassisted home births to be unsafe, and advises women to avoid having unassisted home births where possible”.
Click to learn what you should do when you are in labour…
3) What should I do if I’m in labour?
Some women may experience cramps progressing to increasingly frequent and painful uterine contractions. For others, they may experience a show and typically a blood tinged mucus discharge ― or broken waters.
If you experience vaginal bleeding, broken waters, or regular contractions every 10 minutes, then you should make your way to your maternity hospital for assessment. In a complicated pregnancy — for instance, one with previous Caesarean section or myomectomy, placenta praevia or poor obstetric history — or if you are at less than 37 weeks gestation, it would be prudent to be assessed by your doctor even if you do not experience any pain or contractions.
There is a wide range of analgesia — pain-relief methods — available for women in labour. Breathing exercises, massages, music, positioning, even a birthing ball can ease labour pain. Medication commonly offered for pain relief include Entonox and opioids such as pethidine. Where these are inadequate to control the pain, epidural or spinal anaesthesia can be employed for pain management.
“If you experience vaginal bleeding, broken waters, or regular contractions every 10 minutes, then you should make your way to your maternity hospital for assessment.”
4) How long will I need to push?
The time needed to push varies. In first-time mothers, this can be as long as two to three hours. In women with previous vaginal deliveries, the pushing is more efficient and duration can be reduced to less than one or two hours.
Where there is no urgency to deliver the baby and the woman is comfortable, the midwife or obstetrician may allow the foetal head to descend further before pushing commences. Delayed pushing results in less time pushing with increase spontaneous vaginal delivery. However, the waiting increases the overall duration of being fully dilated to deliver the baby. As the duration is increased, the oxygen level of the baby is also lowered. Monitoring and timely intervention is prudent in this second stage of labour.
In the third stage of labour, some couples may choose to delay their umbilical cord clamping. This method has been found to give rise to higher birthweight babies with higher transient haemoglobin levels and iron stores. However, this may increase the risk of phototherapy for jaundice. Cord blood collection or donation may be performed at this stage for storage of stem cells.
The partner may also wish to cut the umbilical cord to play an active part in the labour and delivery.
Following delivery of the baby, active management to contract the uterus is implemented. This will reduce blood loss, but may lead to after pains, vomiting and raised blood pressure.
What is an episiotomy? Read on to find out…
5) Who can be with me during the delivery?
In hospital delivery, you may have your husband with you during labour. It can also be someone reliable and not squeamish whom you feel will provide support during labour. You also have to be comfortable with the person seeing you without clothes and/or being emotional. If you’ve engaged a doula, the doula may be permitted as an additional companion in the room.
In a planned elective Caesarean section performed under regional anaesthesia, a birth partner is generally allowed in the operating theatre. You will be prepared and covered before your birth partner is invited into theatre to sit next to you. In an emergency Caesarean section, the priority is the mother’s and baby’s well-being, and there may not be enough time to prepare the birth partner for the theatre.
“The decision for an episiotomy is generally made at the time of delivery by the obstetrician with the woman’s agreement.”
6) Will I need an episiotomy?
About four in five vaginal deliveries will sustain vaginal tears as the baby’s head passes through. This is more common in first-time mothers compared to women with previous vaginal deliveries.
An episiotomy is a cut in the perineum — the area between the anus and vulva — and lower vagina, generally made just before the baby’s head is delivered. The main aim is to prevent multiple or severe tears. However, there is no benefit in routinely performing an episiotomy.
Restrictive episiotomy results in less trauma, less stitching and fewer healing complications, with no significant difference in pain and severe perineal trauma. An episiotomy should be considered in instrumental deliveries — deliveries where instruments like forceps are used — as recent evidence suggests it has a protective effect on severe perineal tears.
The decision for an episiotomy is generally made at the time of delivery by the obstetrician with the woman’s agreement. This is to: Facilitate delivery where the perineal tissue is very rigid and likely to tear; reduce the risk of severe perineal trauma during instrumental delivery; and to facilitate delivery and manoeuvres in cases of shoulder dystocia (when a baby’s head passes through the birth canal and the shoulders become stuck during labour).
Article contributed by Thomson Medical Centre.
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