Touching my daughter-in-law Carrie’s beautiful belly – we’re expecting our second granddaughter around the middle of this month – I’m reminded what a miracle birth is. On one hand, it’s the most robust expression of human life, as basic as taking breath. On the other, it’s an ineffably spiritual phenomenon that binds us all together as partners, families and communities.
Those who are able to take it for granted are the lucky ones; many others struggle to become pregnant or to stay pregnant. For them, modern medical advances can be the wonderful boon that enables them to realise the family they long for.
It’s difficult to over-estimate the importance of choosing the right support during pregnancy and birth. Your decisions about where and how to give birth are deeply personal ones, but they will also be influenced by your doctor’s professional opinion and advice.
However natural these processes may be, difficulties of various kinds are not unusual. And here’s the good news: Whether you’re in need of help with fertility issues, doctors to support you through the challenges of pregnancy and later to advise on and manage the birth of your baby, Singapore is a good place to be. One, you have a plethora of highly qualified and experienced doctors and specialists to choose from. Two, this little red dot boasts some of the world’s most advanced medical facilities.
To all the mothers of expat babies that will arrive in 2014, we wish you the “Happy Birthday” that you deserve.
#1 Make it Happen
For would-be parents who struggling to conceive because of fertility problems, Dr Kelly Loi answers our questions on IVF, or in-vitro fertilisation.
Who should consider IVF?
Because it is a fairly complex and stressful process with some risks involved, IVF is usually recommended only if simpler fertility treatment procedures have not worked. These simpler treatment procedures include ovulation induction with the help of fertility drugs, as well as intra-uterine insemination where sperm is placed directly into the womb by artificial means.
For some couples, however, IVF may be recommended earlier. This might happen in the case of severe male factor infertility due to abnormal sperm count or quality; or gynaecological conditions such as endometriosis, or disease or obstruction of the fallopian tubes. In endometriosis, tissue similar to the lining of the womb is deposited outside the womb, leading to painful periods and ovarian cysts.
Pregnancy success rates fall markedly after 40, so a woman who is approaching that age may also be recommended to try IVF earlier.
How do you decide whether to recommend IVF to a couple?
I perform a thorough assessment. For the man, a sperm analysis is needed. For the woman, investigations include: an ultrasound evaluation of the uterus and ovaries blood tests to assess her hormonal profile and ovarian reserve a test of tubal patency (absence of obstruction in the Fallopian tubes), either by means of an X-ray and dye test called a hysterosalpingogram, or during a diagnostic laparoscopy, which entails surgery under anaesthetic.
What does IVF entail?
A typical cycle starts from Day 2 or Day 3 of the menstrual cycle. Daily injections are given for 10 to 12 days to stimulate the growth of the eggs. During this stimulation phase, ultrasound scans are done to monitor the growth of the eggs. Once the eggs have reached a good size and are ready for harvesting, the eggs are retrieved through the vagina using a vaginal probe. As this procedure is performed under sedation, there is minimal discomfort. After four to five days, the best embryos are selected for transfer back into the uterus.
What is the success rate of IVF?
Pregnancy rates range from 30 to 40 percent, depending on age; success rates fall with increasing age.
What does it cost?
Generally speaking, around $12,000 to $15,000.
What is your message for couples who are struggling to become pregnant?
Investigations and treatment take time, so seek consultation early.
Dr Kelly Loi: Health & Fertility Centre for Women, 390 Orchard Road, #18-06 Paragon Medical Suites, 6235 5066
#2 Enjoy the Journey
According to Dr Jasmine Mohamed, the best thing you can do is to relax and enjoy your pregnancy. Calm mums-to-be tend to have smoother labours, she adds.
How should a woman choose her obstetrician?
Choose someone whom you can communicate with effectively and feel comfortable with. Some obs have a more traditional, “doctor-directed” approach, while others are more flexible. Find someone who has enough time to address your concerns fully.
What is your approach to the various birthing options?
If the pregnancy is uneventful and the woman is well, it only makes sense to go for a natural vaginal birth. Recovery is faster than after a Caesarean section, and it makes any subsequent births very easy: they are likely to be vaginal deliveries too.
An epidural is safe for both baby and mum. It does reduce the sensation to push at the end, though, so there’s a higher chance of the birth needing to be assisted with vacuum or forceps.
The use of an epidural doesn’t mean it isn’t a natural delivery, and it can be a handy option, especially where the labour is longer than expected. A mum isn’t any less of a mum if she had an epidural. That said, I see plenty of women who sail through delivery with just gas and air, or no pain relief at all.
What would you advise someone who wants a completely natural birth, with as little intervention as possible?
I would support this if she is fit and healthy, and the baby is not too large. There are factors that make certain labours harder and longer than others, however, such as a first delivery, a larger baby, high maternal BMI (Body Mass Index), or complications like gestational diabetes – some of which may not be within one’s control.
One tip that I would give women to increase their chances for a smooth natural birth is to come into the hospital only when in active labour and to avoid induction of labour unless necessary.
When is a caesarean birth the best option? What are the drawbacks, if any?
Planned caesarean deliveries are indicated in certain situations, for example placenta previa, where the placenta is overlying the cervical opening and labour progress would result in severe haemorrhage; or breech presentations that could not be turned. Emergency caesareans are also sometimes performed during labour. Recovery from a caesarean will invariably be a little longer than that from natural birth, but most mums do well.
Where do you practise, and how many babies have you brought into the world?
I deliver mostly at Thomson Medical Centre, where my clinic is located, but also at Mount Alvernia, Gleneagles and Mount Elizabeth hospitals.
For the past five years, until recently, I have been delivering between 25 and 30 babies every month. In my new practice, I focus on a smaller number. This allows me to spend much more time with my patients in the antenatal period, as well as during their labour.
How important is the support of one’s husband or partner?
Very important! The presence of a birth support partner has been shown in many studies to improve birth outcomes. Secondly, if the partner isn’t there, he might never hear the end of it!
Dr Jasmine Mohammed: W C Cheng and Associates, 339 Thomson Road, #01-01Thomson Medical Centre, 6235 4122
#3 Double Luck
Soon after Australian Deanne Cowl moved to Singapore from Melbourne in mid-2012 with her husband Simon and their son, she found she was expecting – twins! Obstetrician and gynaecologist Dr Chris Ng and his team supported her through her pregnancy and caesarean delivery.
How did you feel during your pregnancy?
For a twin pregnancy I was pretty lucky. Initially, I had awful morning sickness, but when that passed the main objective was to carry the twins as close to term as possible. I must admit I struggled quite a lot with the heat and humidity and spent a good portion of my last trimester walking up and down our condo pool. It was also one of the few ways I could get to cuddle and hold my two-year-old son – in the weightlessness of the water.
Tell us about the birth of your twin girls.
They were born on August 20, 2013 at Gleneagles Hospital. I’ve never been readier for anything in my life – or more scared. It wasn’t my first delivery, of course, but twins! That was going to be a new journey.
Millie Ann Cowl was born first weighing 2.8kg, followed by Lucy Laura Ellis Cowl at 2.64kg. Millie was the more active twin in utero and Lucy the quieter one; that hasn’t changed.
They are thriving so well, and we are all loving getting to know each other. My son doesn’t seem too fazed by the chaos of twins and has taken to his role of “big brudda” (as he would say it) amazingly well.
How was your experience of caesarean birth?
I was quite nervous beforehand, as my son had been delivered naturally and I was worried about the recovery and how I would manage with both the twins and my son. In the end, it was a positive experience overall, and I completely trusted Dr Chris Ng and his team. He talked me through the surgery and recovery process step by step, and answered my many questions.
When the girls were first born I was both thrilled and amazed by them – in awe of the miracle they are. It was quite an overwhelming and surreal moment and it took a little while to process it all.
The total experience in Singapore has really been wonderful. Even though we’ve been away from home and family and friends, we’ve felt so supported here by our doctors, our wonderful friends and the mum and twin support groups.
Dr Ng, GynaeMD Women’s and Rejuvenation Clinic, #04-03A Camden Medical Centre, 1 Orchard Boulevard, 6733 8810