From getting pregnant and fertility struggles to pregnancy and postpartum recovery, here’s what you can anticipate as an expectant or new mum here in Singapore – and the specialists who can help you at every step of the way.
Prepping for pregnancy
Your current health plays a major role in your chances of getting pregnant and having a healthy pregnancy. It also lays the groundwork for your child’s health later on, says DR REBECCA DALY of International Medical Clinic (IMC). So, if you’re thinking about getting pregnant or are currently trying, you’ll want to consider optimising your health in any way you can.
You can start by going for a preconception health check. This usually involves a detailed discussion with your doctor about your periods, past pregnancies, any gynaecological concerns, genetic conditions in the family, long-term medical issues, medications you’re taking, and anything else that could impact fertility and pregnancy outcomes.
“A preconception check is an opportunity to identify key steps you can both take to help your fertility, reduce your risk of problems in pregnancy and protect your baby’s health, giving them the best start in life,” says Dr Daly. “Medical, psychological, behavioural and environmental factors should all be addressed before getting pregnant.”
How to increase your chances of getting pregnant
In addition to visiting your doctor for a preconception check, there are other key things you can do to support a safer and healthier pregnancy, for both mother and child. Here are six way to get your body ready and increase your chances of getting pregnant.
#1 Keep physically active and eat well
“The best foods for getting pregnant are the same as those for general wellbeing: whole grains, healthy fats and proteins,” says Dr Daly.
#2 Maintain a healthy weight
Being under- or overweight can affect a woman’s fertility by suppressing ovulation, thus affecting her chances of getting pregnant. Obesity in pregnancy can lead to a higher risk of gestational diabetes, high blood pressure in pregnancy, preterm delivery, miscarriage and stillbirth. Being overly thin, on the other hand, can cause preterm delivery, low birth weight and miscarriage, says Dr Daly.
#3 Quit smoking
Smoking can have significant impact on your chances of getting pregnant. It reduces fertility for both men and women, and is harmful to the unborn child. That’s why quitting is strongly advised, says Dr Daly. “While it can be challenging to quit, there are several options to help you kick the habit. Speak to your GP if you or your partner need help to stop smoking before getting pregnant.”
#4 Limit alcohol consumption
“For men, drinking over the recommended units of alcohol can affect sperm quality,” says Dr Daly. “For women, drinking more than one or two units of alcohol twice a week, or becoming intoxicated, reduces the chances of getting pregnant and can be harmful to the unborn child.”
#5 Start taking folic acid
Women should take folic acid for at least 12 weeks before getting pregnant, as this reduces the chances of spina bifida by 50 to 70 percent, explains Dr Daly. Some women may even require a higher dose if they have certain underlying medical conditions, so it’s best to consult your doctor.
#6 Keep at it, but keep it relaxed
As soon as any form of contraception is stopped, you can get pregnant if sexually active. To improve your chances of getting pregnant, Dr Daly suggests having sexual intercourse every two to three days. Periods of abstinence, she says, can reduce the number of sperm.
However, try not to overthink everything! “All too soon, sex can become a chore. Try to keep things relaxed, and focus more on the connection and relationship with your partner rather than endless ovulation and pregnancy testing kits.”
Fertility struggles – When to seek help
According to Dr Daly, 80 percent of couples will get pregnant within one year if:
- they are having regular intercourse without contraception; and
- the woman is less than 40 years old.
Yet, while some people conceive quickly, one in seven couples face difficulties for a number of reasons, she says. The biggest determinant of fertility is the woman’s age, followed by sperm-related causes in the male.
Not getting pregnant?
“If you haven’t conceived after one year of unprotected sex, a good starting point would be a discussion with your GP for a clinical assessment and investigation, along with your partner. Your GP can start with relatively simple, noninvasive fertility tests. Semen analysis is the most important male fertility test; it measures the number of sperm and their quality. Female fertility tests include a pelvic ultrasound scan and blood tests.”
If you’re over the age of 36, or have known underlying conditions that could affect fertility – including endometriosis or polycystic ovaries – then an earlier assessment can be offered after six months of trying.
Check out Baby Steps, the brand new e-book that covers getting pregnant, baby’s first year and more. Created by IMC doctors and other specialists, the e-book is now available at imc-healthcare.com.
International Medical Clinic
IMC Camden, IMC Children’s, IMC Jelita and IMC Katong
6733 4440 | imc-healthcare.com
Need Some Support?
The fertility journey can be very stressful. Getting the support you need for your mental wellness is just as important as all that poking and prodding, wishing and waiting.
So, whether you’re trying to get pregnant naturally or via fertility treatment, and whether you’re just starting to try or have been trying for some time, know that counselling can help, says certified coach and counsellor, TANJA FAESSLER-MORO. She and the team at Counsellingconnectz provide fertility, IVF and donor counselling, as well as pregnancy, birth and postpartum counselling.
Here, Tanja explains the benefits that counselling can bring for couples at every stage of their journey on the road to parenting.
What is fertility counselling and how can it help struggling couples?
A specialty within the counselling field, fertility counselling requires counsellors to be trained in the area of female and male infertility. They have medical knowledge and familiarity with the mental and emotional struggles that couples can experience during their fertility journey.
Infertility is still very much a taboo topic, which means that, very often, a fertility counsellor is the first person a couple might talk to. With this type of support, couples can share their struggles with someone who understands them and can help normalise their feelings and support them from where they are at to where they want to get. This type of counselling has been shown to make parents-to-be feel calmer, enjoy their pregnancy more, and be better prepared for a gentle birthing experience.
When clients come to us, it’s important that we first understand their journeys and where they feel most of the struggles. This can vary from anxiety, stress and lack of confidence to depression, trauma, marital issues and much more. Depending on their primary areas of concern, we focus on the best therapy that can help them release any burden, and allow them to experience a refreshed perspective, hope, inner strength or whatever it is they need.
When should a couple consider seeking help from a fertility counsellor?
As early as possible! We know from working over 10 years in this field, just how much fertility stress factors can put pressure on a relationship. Many couples feel alone on this journey, and do not feel understood or supported by their partner. We focus a lot on strengthening couples’ relationships so that they feel empowered, and as a strong team on this journey.
How do you support couples going through IVF treatment?
Our counselling service is unique in that it includes support for all IVF clients, as well as specialist counselling for our donor programmes and genetic testing. Clients are offered specialised coaching and counselling sessions prior to starting hormone stimulation, egg retrieval and embryo transfer, and during the two weeks’ waiting time. We like to work closely with the medical specialists to know the protocols and the dates of procedures so that we can give our clients support exactly when they need it most.
It’s also important to us that we support husbands during IVF, as they are closest to their wives and very often their important role is totally disregarded by IVF doctors.
What are the advantages of seeing a counsellor during pregnancy and beyond?
Depending on the individual woman’s experiences before getting pregnant – including experiences that lead all the way back to childhood – she can become more suggestible during pregnancy, and these “old” feelings can come up. If a mum-to-be suddenly feels emotionally low or anxious, is struggling with her identity or is even having difficulty feeling happy about the baby, she should know that these feelings are coming up because she’s ready to work through them. We call this the “golden opportunity”.
The immense benefit of seeing a counsellor at that point is to successfully work on those challenges, and make space for love, creativity, abundance and being able to bond with baby. This will also help with postpartum depression, breastfeeding and finding her new identity after birth.
Keep in mind that no matter what stage you’re at in your journey, you are not alone! There is plenty of support surrounding you, and we’re all here to help you every step of the way.
#09-01 Scotts Medical Suites, 9 Scotts Road
The pregnancy journey – Prenatal visits and more
Once you get pregnant (congrats!), you can expect to be busy with prenatal visits in your first trimester, says obstetrician-gynaecologist DR DHARSHINI GOPALAKRISHNAKONE. The first antenatal tests include blood work to check your basic health and immunity, and scans to ensure that your baby is well, and without genetic or physical issues.
By the 12-week mark, visits will become monthly, and you can breathe a bit easier, says Dr Dharsh. This is when the chances of miscarriage drop from 20 percent to two percent, and it gets much lower thereafter.
“Most visits after the twelfth week are stress-free, easy-going consultations with scans and discussions about the baby’s progress, and how mama’s coping with pregnancy issues.”
These routine scans are important in making sure baby is growing properly, and to look for any potential signs of distress. But, rest assured – there is no radiation involved, and these scans are harmless to the foetus, says Dr Dharsh.
“By 36 weeks, you’ll switch to weekly visits, and start talking about birth preferences and how baby is getting ready for birth!”
Dr Dharsh’s dos and don’ts during pregnancy
Here are the OBGYN’s top tips to get you through pregnancy safely, and sanely.
DO: keep your wits about you at all times!
“Read widely, but be smart about what information you accept and what sounds off. Engage your obstetrician if any information seems questionable. It’s important that you DON’T fall for well meaning advice that can throw you off kilter and question all your life choices!”
DO focus on your physical and mental health
“Keep yourself in good physical and mental condition by eating healthily, getting plenty of safe outdoor exercise and keeping up with social activities.”
DO start creating your “village” now
“Reach out to friends who are mums of little ones already, arrange for grandparents to get ready to fly over to Singapore around the expected due date, and start interviewing nurturing helpers and confinement nannies who can help you navigate life with a newborn,” says Dr Dharsh. “It truly takes a village to raise a child, and you will be surprised at how everyone is willing to help, if only you prep them and ask.”
DON’T overplan your labour and delivery
“It’s important not to fall into the trap of overplanning for your labour and delivery with extensive birth plans you’ve found online. This only sucks you into a spiral of an incredulous amount of information and choices that you honestly may not have any control over on the big day. Instead, focus on being mindful that mum’s and baby’s health comes foremost and that, sometimes, nature takes a different path to what we were expecting or wanting – and that is perfectly fine as long as everybody is safe and healthy!”
DO plan for what to expect after the baby is here
“I’m always surprised at how couples get caught up in the whole pregnancy experience and the birthing issues surrounding labour, yet nobody tells them that the biggest fireworks happen when the baby actually arrives!” says Dr Dharsh. She suggests talking to grandparents, doulas, lactation consultants and friends who seem to have it all together. “Ask them about breastfeeding, co-sleeping, growth spurts, how to calm a crying baby (keyword: swaddle!) and everything else during the postpartum period.”
She also recommends reading up on the postpartum phase more than any other phase. “This is the time when baby needs you the most. The uterus and placenta are no longer there to provide nourishment and protection for the little one; now, it’s all on mum and dad to help her thrive in this world.”
DON’T let COVID concerns consume you
“Stay safe and advised, but do not overdo it! Never give in to fear or anxiety,” says Dr Dharsh. “Instead, continue to enjoy your pregnancy in the COVID-endemic world we are heading towards. As long as mama is vaccinated and keeping safe, there is nothing to worry about.”
If you do get COVID while pregnant, don’t panic. “Our infectious disease and respiratory doctors are absolutely amazing at handling such cases. We have excellent data so far of vaccinated mums with COVID-19 coming through this well, healthy and thriving, along with a baby who now has antibodies!”
The postpartum period: What to expect after pregnancy
“The postpartum period, also known as the ‘fourth trimester’, is the immediate period after childbirth when a woman’s body physiology returns from pregnant to non-pregnant state,” explains DR TRISHA UPADHYAYA, a British-trained GP at Osler Health International.
In Singapore, it’s typical for a six-week postnatal check to be performed by either a family doctor or obstetrician. If you’ve had a caesarean section (C-section), you will have a scheduled review of the wound within the first week as well, says Dr Upadhyaya.
Five things to know now about the postpartum period, so they don’t surprise you later
Of course, there are many reasons you may need to see your doctor sooner than the six-week mark. Here’s a look at some very common (nobody-seems-to-tell-you-beforehand) things you can expect, or at least watch out for, during the postpartum period.
#1 Breastfeeding can be tough
Despite what some women make it look like, breastfeeding can be a very challenging journey. You also may very well find yourself visiting your doctor for common postpartum concerns such as breast or nipple pain, breast engorgement, mastitis (infection of the breast) and supply worries.
“Support is essential for both mum and baby to achieve the most optimal goal for each parent and baby,” says Dr Upadhyaya.
Getting support from a lactation consultant at home or in hospital can be helpful. Talk to your doctor to get the guidance you need.
#2 You’ll bleed for about six weeks
Vaginal bleeding after birth is normal and usually stops by six weeks, says Dr Upadhyaya. However, a doctor’s evaluation is required if:
- the bleeding is sudden or very heavy;
- there has been an increase in bleeding;
- significant clots are passing; or
- there is an unpleasant smelling discharge.
#3 You can still get pregnant while breastfeeding
It’s a common misconception that breastfeeding women cannot get pregnant. While it’s true that many women who exclusively breastfeed do not get their periods back until they have stopped breastfeeding, it is very much still possible to get pregnant without the return of your period. Therefore, “the importance of contraception cannot be stressed enough to avoid unplanned pregnancies,” says Dr Upadhyaya.
“Contraception is an important aspect of women’s health and continues to remain so in the postpartum period. Talk to your doctor, as there are different types of contraception available for postpartum women.”
#4 You might leak urine
Urinary incontinence is a common pelvic floor dysfunction that affects nearly 47 percent of women in the first 12 months after childbirth. It involves loss of bladder control, usually prompted by exertion such as laughing, sneezing or coughing.
The good news is, it does improve over time, says Dr Upadhyaya. “Regular pelvic floor muscle exercises, especially if started prenatally, help with reducing postpartum urinary incontinence. Occasionally, some women may require referral to a physiotherapist, or a urogynaecologist for further evaluation.”
#5 You might get the blues – even though you’ve got a new bundle of joy
Changes in one’s mental health are very frequently seen during pregnancy and up to one year after birth, explains Dr Upadhyaya. In fact, she says up to 18 percent of women experience depressive symptoms, while perinatal anxiety affects nearly 22 percent of women. What’s more, these symptoms of perinatal depression and anxiety often overlap.
“Postnatal mental health is extremely important as it affects not only the individual experiencing these debilitating symptoms, but the entire family,” she says. Common things to watch out for, which may indicate the need for further review by your doctor, include:
- low mood most of the day;
- Feelings of uneasiness, worry or fear;
- loss of interest or pleasure;
- a change in weight or appetite;
- insomnia or sleeping more than usual;
- slowed-down movements and emotions;
- fatigue or loss of energy;
- feelings of worthlessness or feelings of guilt;
- panic attacks;
- slowed concentration or indecisiveness; and
- recurrent suicidal thoughts.
Additionally, some women with postpartum depression may have thoughts of harming their babies,” says Dr Upadhyaya. “These thoughts can be very scary, but they are not the mother’s fault and do not reflect how she feels for her baby.”
If you find that you’re experiencing any symptoms of postpartum depression, do talk to your doctor, who can help.
This article first appeared in the March 2022 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!
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