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A Gynaecologist’s Complete Guide to Pregnancy in Singapore (2020)

So you’re pregnant or have decided to start a family with your significant other — whichever it is, congratulations! Pregnancy is a beautiful journey, and while you should definitely enjoy every moment of it, there are a few measures to be mindful of to ensure you and your baby remain healthy.

As a gynaecologist in Singapore, I often receive questions from mothers-to-be and couples who are trying to conceive. Hence, I’ve decided to put together this comprehensive guide on the most frequently asked questions as well as some tips to hopefully ease the worries of every couple, no matter which stage of their pregnancy journey they’re at.

In my complete guide to pregnancy below, I cover all you need to know pre, during and post-pregnancy in Singapore.

What are some good habits to practice for pregnancy in Singapore?

Many think that all precautions are only practiced during pregnancy; however, if you’re trying to conceive, there are some measures that are good to take even before the pregnancy. As a general rule of thumb, here are some tips when trying for pregnancy:

  • Don’t start too late
    While education and career advancements have provided many opportunities for young individuals in Singapore, more couples are pushing back family planning. In Singapore, the age-specific fertility rate has been rising for females aged 30-34 years, as compared to years ago when fertility rates were highest among females aged 25-29 years. Age-specific fertility rate refers to the number of live-births born to females of a specific age group. The older you get, the harder it is to conceive; fertility declines immensely from 35 years old. Furthermore, chances of pregnancy complications and genetic abnormalities also increase. The ideal age to try for pregnancy is between 20-24 years of age.
  • Quit activities that carry high risks
    Men and women who smoke are more likely to have fertility problems compared to non-smokers, due to the chemicals in cigarettes that can cause damage to eggs and sperm. This damage also greatly impacts the child’s well-being; babies born to smokers tend to have slower growth, lower weight and a higher risk of breathing problems. This applies to passive smoking as well. Thus, it’s important that you and/or your partner quit smoking at least three months before trying for a baby to make sure the sperm and eggs are healthy when the baby is conceived.
  • Go for a pre-pregnancy checkup
    To ensure a healthy pregnancy, it’s important to check for any prior medical conditions like hypertension, diabetes and anaemia and keep them under control. If anything, see a gynaecologist early to discuss your chance of pregnancy and assess any pregnancy risks.

While there are many factors that determine a couple’s fertility, the above points should be the bare minimum.

Vaccinations to take

The right vaccinations are crucial in ensuring you have a smooth pregnancy ahead. It is recommended to get vaccinated at least three months before you get pregnant. I usually recommend vaccines for these illnesses for my patients:

  • Rubella (German measles)
    Rubella is a contagious virus that can be passed on to your baby. If contracted, your foetus might be at risk of hearing loss and heart damage, resulting in a miscarriage or stillbirth.
  • Chicken Pox
    Chickenpox does not really happen during pregnancy and even so, does not cause serious harm. However, it can result in scarring, skin blisters and organ damage in your foetus.
  • Hepatitis B
    A Hepatitis B infection can be chronic or acute. If chronic, you can pass hepatitis B to your foetus, which increases their chance of liver-related diseases and infections like liver cancer and cirrhosis later in life.

There is no evidence that vaccinating pregnant women, breastfeeding women or women who intend to conceive will cause harm to the baby.

What’s the most effective way to test for pregnancy in Singapore?

Missing your period is usually one of the most obvious signs of pregnancy, together with other early symptoms of pregnancy including:

  • Fatigue
  • Headaches and dizziness
  • Lower back pain
  • Raised basal body temperature
  • Food cravings
  • Mood swings 
  • Sensitivity to smell
  • Nausea and vomiting
  • Bloatedness

However, these symptoms are not unique to pregnancy and could be due to hormonal changes in women. In fact, some women do not experience symptoms early in their pregnancy at all! Thus, if you suspect that you are pregnant, you can purchase a pregnancy test kit available at most major retail pharmacies in Singapore. The cost of a pregnancy test kit in Singapore ranges from $6-$25.

It’s advisable to take a pregnancy test one week after your missed period — try to perform the test first thing in the morning as that’s when your urine is the most concentrated. A pregnancy test kit is more than 99% accurate and works by detecting human chorionic gonadotropin (hCG), a hormone produced during pregnancy. However, if the test is administered too early in the pregnancy when hCG levels are too low to be detected, the result may be a false-negative. Take the test again a few days later.

Confirming your pregnancy with a gynae

After testing positive for pregnancy with a pregnancy test kit, the next step is to confirm your pregnancy with a gynaecologist in Singapore. At your first checkup, your gynaecologist may repeat the pregnancy test and conduct an ultrasound to scan for the foetus.

Once your pregnancy is confirmed, your obstetrician will start you on a course of supplements and advise you on things like your diet and lifestyle changes to prepare your body for a healthy pregnancy.

Can I choose my baby’s gender?

This is a common question I receive from patients, notably because of a certain method they’ve come across that offers a 70-90% chance of conceiving a baby of the preferred gender. They’re referring to the Shettles Method, a procedure developed by American biologist Dr. Shettles in the 1960s. Shettles posited that factors such as timing, position and frequency of sex can influence whether couples have a girl or boy.

While some couples swear by this method, I must emphasise that the Shettles Method is not based on hard scientific evidence. Statistically, every couple has an almost 50% chance of conceiving a boy or girl with every pregnancy. It is also always the father who determines the sex of the baby; the mother will always provide an X (female) chromosme and the father either an X or Y (male).

Choosing an obstetrician

Choosing an OB-GYN is usually influenced by choosing which hospital you want to give birth at and vice versa. This includes whether you wish to receive pregnancy care and give birth at a public or private hospital. While maternity care in Singapore is of elite standard at both public and private hospitals, there are significant differences in factors like options and costs.

Generally, seeing an OB-GYN in a private hospital tends to be costlier due to more luxurious surroundings and private rooms. The waiting time is shorter, and your OB-GYN of choice is also guaranteed. However, in the event of an emergency, you and your baby might need to be transferred to a public hospital with a larger neonatal intensive care unit (NICU).

On the flipside, public hospitals are cheaper but admin and waiting times tend to be longer. This includes waiting longer for pain relief. Public hospitals also have stricter visiting hours. But if you wish to have a midwife-led birth, then a public hospital is where you want to be.

The different trimesters in pregnancy

A pregnancy has three trimesters that span around 40 weeks. In each trimester, both mother and foetus will go through specific milestones.

First Trimester (0-13 weeks)

The first trimester is most crucial for the baby’s development. During this time, your baby’s body structure and organ systems start to develop. It’s also the period where most miscarriages and birth defects occur, so it’s paramount to be extra careful.

During the first trimester, most women undergo the most changes. These changes include the onset of nausea and vomiting (or morning sickness) at 6-8 weeks, fatigue, breast tenderness and frequent urination. Mood swings and a stronger sense of smell may also occur. I should add that despite its name, morning sickness can happen at night or all day depending on the woman.

Second Trimester (14-26 weeks)

The second trimester of pregnancy is usually called the “golden period” because most of the unpleasant effects experienced from the first trimester of the pregnancy disappear or reduce. However, you’re likely to develop a new set of symptoms, including back pain, abdominal pain, leg cramps, constipation and heartburn. Additionally, somewhere between 16 to 20 weeks, you may feel your baby’s first movements.

Your baby will go through a lot of changes during this period. Other important parts of the body like the skeleton, muscle tissue and blood cells start to form. For males, the testes begin to drop into the scrotum and for females, the ovaries begin to form eggs.

Third Trimester (27-40 weeks)

You are now in your final stretch of pregnancy. During this stage, some of the symptoms you’ll experience include shortness of breath, back pain from carrying a heavy belly, varicose veins and sleeping problems. By now, most of your baby’s organs and body systems have formed and would continue to grow and mature during this third trimester. You should also feel your baby’s movements regularly as kicks and rolls become stronger.

Two weeks before or after your estimated delivery date, you will undergo a process known as labor, which is a series of progressive and continuous contractions that enable the cervix to open and thin.

Can I exercise during pregnancy?

Yes, exercising during pregnancy can help you stay fitter and stronger, prevent excess weight gain and help you mentally. Always adjust your activity and intensity to your fitness level — if you were not active before the pregnancy, 15-30 minutes of moderate-intensity exercises is a good start. If you were already active, then continue with your regular exercises unless they’re activities that should be avoided during pregnancy, such as scuba diving or sports that require a lot of sudden movements and jumping.

Some pregnancy-safe exercises I recommend to my patients include walking, swimming, cycling on a stationary bike, yoga, pilates, low-impact aerobics and even strength training. The key is to maintain a moderate level of intensity and avoid exercising to the point of exhaustion. A rule of thumb is to still be able to hold a conversation as you exercise — if you feel breathless, you’re exercising too strenuously.

What are some lifestyle and dietary changes I have to make?

You are what you eat — in this case, your baby is what you eat. During pregnancy, make sure you eat food with high nutritional value to nourish your body and baby’s development. Ensure to include in food rich in folate, iron, calcium, vitamin C, fiber and fortified grains. Tuna is fine, but make sure to go for light tuna and not albacore. If you find it hard to eat due to your nausea, split your calories into 5-6 small meals a day. Also, make sure to drink plenty of water. During pregnancy, your blood volume increases to 50 percent, so extra water intake is needed to help your body adjust to increased functions.

I recommend taking prenatal vitamins to meet your iron and folic acid needs. Your doctor should be able to advise you on a prenatal vitamin that works best for you.

You probably already know this, but I will repeat it again for reminder’s sake: cut out alcohol, smoking and caffeine. These things are detrimental to the baby’s development. At the very least, caffeine should be reduced. Current guidelines recommend no more than 200mg a day. If you need help quitting, speak to a professional and find a good support system. Lastly, manage your stress well. I understand that pregnancy can be filled with stress and anxiety especially for first time mothers, but try your best to reduce this stress through yoga, meditation, essential oils or even therapy.

Can I still have sex during pregnancy?

It’s perfectly safe to have sex during pregnancy and doing so won’t hurt your baby. Your baby cannot tell what is going on too. However, your sex drive may change during pregnancy. During the later stages of pregnancy, an orgasm or even sex itself can set off mild contractions. This is normal and there’s no need for alarm. Some couples might find that sex can be difficult during pregnancy, so this can be a time to explore and experiment together.

Preparing for labour and delivery

Labour is traditionally divided into three stages:

Stage 1: Latent phase

Duration: Few hours to few days depending on the woman

This is often the easiest stage of labour. During this phase, your cervix begins to dilate and you may experience symptoms like abdominal cramps, a mild backache or passing of the mucous plug. Once the contractions get worse or if your water bag bursts, you may start to head to the hospital.

Stage 1.2: Active phase

Duration: 8-12 hours

During this stage, your cervix will dilate 1cm more with every passing hour of dilation. Expect an increase in the frequency and intensity of contractions, each lasting up to 45 seconds. By this time, you should already be admitted into the hospital for an internal vaginal check and into the delivery suite.

To manage the pain, your doctor and delivery team would administer labour pain relief, which includes:

  1. Narcotic injections. Narcotic injections can be given intravenously every hour during labour. It’s typically given a few hours before delivery so the effects will wear off before the baby is born. For some women, narcotics help take the edge off and allow for some rest and relaxation between contractions.
  2. Nitrous oxide gas. Nitrous oxide gas can lessen but not eliminate the pain of labour. It’s the same gas used at the dentist, and is usually inhaled during contractions through a mask you hold. The effects of nitrous oxide only take effect while the gas is inhaled and disappears when the mask is removed. It can be used throughout delivery.
  3. Epidural anesthesia. An epidural provides the most pain relief during labour and birth. A tiny tube or catheter is inserted through a needle into a space outside the spinal cord sac in the lower back. The needle is then removed with the tubing taped in place. Throughout labour and birth, medication is given continuously through the tube to block the pain of contractions. Due to the numbness caused by the epidural, a woman with an epidural cannot get out of bed. Most take this opportunity to get some rest. A “walking epidural” or spinal-combined epidural can be given instead to allow the woman to still move around.

Speak to your doctor about your preferred pain relief.

Stage 2: Delivery

Duration: 30-120 minutes

During this stage, you have to work the most to push the baby out. But don’t worry, your doctor and medical team will be there to guide you through this. You may experience an urge to bear down due to the pressure of the baby’s head on your back passage and perineum. This may be accompanied by the passing of faeces, but it is normal so do not feel shy. To allow better access to your birth canal, your legs may be raised up and an episiotomy may be also made for the delivery.

Stage 3: Delivery of the placenta

Duration: 5-30 minutes

After the baby is delivered, your uterus will squeeze out your placenta in order to separate from the wall of the uterus. This separation process is usually followed by a sudden gush of blood from the vagina. Rarely, cases of a retained placenta occur. This happens when separation of the placenta from the uterus wall does not occur. In such instances, the doctor may remove the placenta manually by inserting his hand into the vagina to reach the womb. Some patients may choose to keep their placenta for personal or religious reasons; otherwise the hospital will dispose it.

Vaginal delivery vs Caesarean: Which is better?

While most women would have a vaginal delivery, where the risk of this delivery method is high, I would recommend such patients to opt for a Cesarean or C-section instead. A C-section is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. Most C-sections are done under regional anaesthesia, where only the lower part of the body is numbed. A C-section is usually performed if:

  • Your cervix isn’t opening enough despite strong contractions
  • Your baby is in an abnormal position
  • You’re carrying twins
  • Your placenta covers the opening of your cervix
  • You have a sexually transmitted disease at time of labour
  • You have health conditions like a heart or brain condition

Many patients often ask which is a better delivery method. The truth is, there is no one ‘better’ delivery method, only the safest delivery method for you and your baby. What matters is that you raise your child with love after he/she enters the world.

Dealing with postnatal depression

It’s normal to experience postnatal blues or baby blues after giving birth due to a change in hormone levels. Baby blues are usually characterised by mood swings, anxiety, irritability and sadness for about a week or two. However, about 1 in 10 women develop postnatal or postpartum depression. Postpartum depression is an illness that requires professional help and does not go away as quickly as postnatal blues.

Women who were depressed before or during pregnancy are more likely to develop postpartum depression. They often experience feelings of guilt, hopelessness and/or worthlessness, thoughts about self-harm, difficulties with controlling their worries and panic attacks.

While it’s normal for many new mothers to experience negative feelings at some time, repeated occurrences of these symptoms with no sign of recovery might be a sign of postpartum depression.

To recover from postpartum depression, the first step is to tell yourself that it’s not your fault. Your doctor may refer you to a support group, therapist or psychiatrist.

How soon can I resume regular activities after giving birth?

Recovering from childbirth can vary from weeks to months. Most women feel fully recovered after 6-8 weeks, but it may take longer to return to how your body was pre-pregnancy. During this time, remember to eat and rest well and give yourself a break occasionally.

If you’ve had a C-section, you’ll have more restrictions on what you cannot do, including driving and lifting anything heavier than your baby.

Regardless of delivery method, you will experience vaginal bleeding and discharge. The flow will be heaviest during the first 10 days. This is your body’s way of eliminating the extra blood and tissue that was used to nourish and grow your baby. It is important to only use sanitary pads, as tampons can introduce bacteria and lead to infection.

To sum up, pregnancy is a journey that comes with its own ups and downs, but it’s only the beginning of a long and fulfilling journey to motherhood!

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