…I was concerned if the gynae will be there for me during
labour to ensure my baby is safely delivered…
by Ms Eunice Goei
As your baby’s due date gets nearer and nearer, you should be prepared and know what to expect during this period.
Labour is a delicate process and it is important that both you and your husband are prepared in welcoming your little one to the world.
The top three things you should look out for are:
When you experience any of these three symptoms of labour, you should call and report to the hospital immediately.
The abdomen becomes hard during contractions, while in between these contractions the abdomen becomes soft as the uterus relaxes.
These contractions feel like muscles being pulled and the pain is described as feeling similar to period cramps.
False Labour (Braxton Hicks)
Don’t panic when you start feeling contractions. These might be Braxton Hicks contractions, often called “false” labour pains.
These contractions are perfectly normal and are described as irregular and unpredictable. These contractions fade away and disappear after some period. They are also usually only felt in the front of the abdomen or pelvic region.
If you feel your contractions start to get less intense and frequent, then they are most likely Braxton Hicks.
These can start to occur in your second trimester, but more often start in the third trimester. These happen as a way of your body to get you ready for “true” labour.
Braxton Hicks contractions can be alleviated by changing positions, taking a warm bath or by drinking a few glasses of water.
Unlike Braxton Hicks contractions, “true” labour contractions have a regular pattern to them – first, there’s a rising intensity of the contractions, which then peaks and fades then repeats the process after some time.
These contractions do not disappear and gradually become stronger and more frequent as time passes.
When you feel that your contractions intensify every 4 to 8 minutes, it is time to report to the hospital as your baby is about to arrive.
To prevent infection during pregnancy, the cervix is protected by a mucus plug (called an operculum) that fills and seals the cervical canal.
It serves as a protective wall that prevents bacteria from getting into the uterus.
Just before labour, the cervix thins and causes blood to be released into it. This causes the mucus plug to become bloody and will dislodge when you get closer to labour.
The mucus plug will stain your underwear and may have a brownish or reddish color.
During pregnancy, the baby is surrounded by the amniotic sac, which is filled with amniotic fluid. This cushions the baby during pregnancy and protects it from small impacts or vibrations.
During labour (or just before it), the amniotic sac bursts – also known as your water breaking. You might experience some wetness in your vagina after this, followed by a constant leaking or gush of a clear or yellowish fluid.
The fluid discharge when your water breaks can sometimes be confused with urine and if you feel unsure or uneasy, it is advised to call your doctor or report to the hospital immediately.
If your water breaks before labour, it might be a premature rupture of membranes (known as PROM), which can cause complications such as infection.
Your doctor will be able to advise you on the proper steps to handle PROM and minimize the risks.
Labour during pregnancy is a long process and for a first-time mother may last from 10 to 24 hours. This time gets shorter for subsequent births.
Labour is divided into three stages:
First Stage of Labour
This is the longest stage of labour and can last for up to 20 hours on average. This is the stage where your cervix begins its preparation for giving birth.
Your cervix begins to dilate and labour contractions start during this stage. Your cervix will also change its position so that it points more towards your front for easier delivery.
There are three phases in this first stage of labour:
During this phase, contractions are infrequent, usually 15 to 20 minutes apart. Your cervix starts to open to about 3cm.
You may not notice these contractions as they feel like menstrual cramps.
During this phase, your contractions increase in intensity and frequency, happening every 3 to 4 minutes and last up to 90 seconds each.
Your cervix continues to open until it becomes fully dilated at 10cm.
You will need to focus on breathing and relaxing during this phase.
You might experience a loss of appetite and nausea as your body prepares for delivery by clearing out your digestive system.
You should move to the hospital during this phase so that doctors can monitor you and your baby.
Second Stage of Labour (Delivery)
This stage occurs when your cervix is fully dilated to accommodate the delivery of the baby.
There will be an urge to push and your midwife or doctor will assist you in finding the best position for you to deliver in – whether it’s sitting or leaning over a birthing ball.
The baby’s head will lower down in your pelvis and the contractions will help push the baby through your birth canal.
Each time you push and have a contraction, your baby will move slightly until your baby is delivered. This stage may last from a few minutes for experience mothers or up to 1.5 hours for first-timers.
During this stage, you may need assisted delivery if it lasts too long, you become too tired or your baby shows signs of distress.
If needed, your doctor might do an episiotomy (a small incision between your anus and vagina) to enlarge the vaginal opening. Depending on the situation, your doctor or midwife may opt to use forceps or a suction cup (Assisted Delivery) to assist and maneuver the baby through the birth canal.
Third Stage of Labour
The last stage of labour is the delivery of the placenta or afterbirth.
A few minutes after delivery, your contractions restart, and you feel the urge to push again. The placenta separates from the uterine wall after the baby is delivered and your body starts to eject it.
Once the placenta and membrances are out, your doctor will examine it to ensure it has been fully ejected.
Your doctor will also stitch any tears or if you had an episiotomy. This stage lasts the shortest and is usually over after a few minutes.
If you or your baby are at risk during the labour, your doctor may recommend a C-section to deliver the baby.
A C-section may also be performed if the mother has a serious medical condition or if the baby is in a position that makes it difficult or dangerous for a vaginal delivery.
Here’s a list of situations where a C-section is recommended over traditional vaginal delivery:
The mother may opt to deliver her first twin/multiple child through traditional vaginal delivery then get a C-section for the others.
A single vaginal delivery of a baby is hard, and the mother may be too tired for the subsequent deliveries.
The baby should be positioned with his/her head down and facing the mother’s back during proper pregnancy. If there are some abnormalities to the baby’s position, a C-section may be performed.
The normal heart rate of the baby during delivery should be between 120 to 160 beats per minute. If the baby’s heart rate is abnormal, a C-section may be needed.
If the baby is too large and you are having difficulties pushing him/her through your birth canal, you may need to undergo a caesarian section.
In cases where the mother is sick, a C-section may be done to minimize the risks.
Some complications include the placenta blocking the cervix, or if there is a premature detachment.
The procedure is usually performed under spinal or epidural anesthesia, where you will be awake. You will not feel any pain and you can hug your baby immediately after delivery.
In some rare cases, you will be asleep as general anesthesia is used. This happens when the C-section has to be done quickly or when the spinal or epidural anesthesia is not very effective.
The doctor makes an incision on your skin below your bikini line, which allows the subsequent scar to be hidden. The doctor then makes a subsequent incision into the uterus and the amniotic sac will be opened. The baby is delivered through the opening and you may feel a pulling sensation.
The umbilical cord is cut, and the placenta is removed, after which your doctor examines the uterus for any tears. The incisions are closed with sutures and a sterile bandage or dressing is applied.
Depending on the reason for your previous C-section, your chances of giving birth vaginally may increase or decrease. This situation is called a vaginal birth after a caesarian (VBAC).
For example, if during your previous pregnancy a C-section was needed because of a serious condition you had, then chances may decrease as the condition may still be an issue in the new pregnancy.
These chances are impossible to predict accurately, and you will need expert opinion for your doctor if you can go through with it safely or not.
An attempt of VBAC is called a trial of labor after caesarean. About 60 to 75% of women who attempt a VBAC can deliver vaginally.
Not all hospitals offer a VBAC and some avoid it altogether because of controversy. VBAC’s are a sensitive topic and it may take some time before you find a doctor or clinic that is willing to do one.
by Ms Eunice Goei
I felt reassured that my baby is in good hands knowing that Dr Tan is committed to his professional duties throughout my gestation and ensured my baby is safe when I experienced complications during pregnancy. I was pleased to engage his professional services because my baby is closely monitored and safely delivered.
My third pregnancy was a difficult one. During 12th week and 32nd week of gestation, when I experienced pregnancy complications, Dr Tan responded quickly, even after office hours. Under Dr Tan’s professional care during those difficult times, which required me to stay at home to have ample rest, my baby developed well and was delivered safely.
Unlike seeing a gynae in public hospital, seeing Dr Tan allows me to have more more time to discuss my condition with him. He also conscientiously prescribed good health supplements (eg DHA pills) and better-quality medication to ensure my baby developed heathily.
Approachable and Friendly Service.
Dr Tan and his staff, Gina are both approachable and friendly. They provide personalised and pleasant service to their patients.
I would definitely recommend Dr Tan to anyone who needs his professional services. Since he specialises in both gynaecology and female urology, this saves the trouble of any patient having to see two different specialists should the need arises.