Is being an older couple a problem?

By Dr. Ann Tan

Obstetrician and Gynaecologist

MBBS (S'pore), MRCOG (London), MMed (O&G), FAM (S'pore)

What is older? Is there a difference being older?

Being older is, by definition, a mother who is greater than 35 years of age at delivery. It does not matter that she or the couple have had other children before.

The older male partner also has a part to play, and the age and well-being of the father should never be overlooked.

What are the issues of being an older mother?

Shrinking egg bank

At 35 years old and above, a woman is more than likely to have used up a large part of her egg bank. She therefore has fewer chances of conception and of a live birth than her younger sisters. Not only is the number of available eggs smaller, the quality of the eggs is also in question as she is more likely to have abnormal eggs.

Increased miscarriage risk & increasing risk of abnormal babies

In the 20s, 10% of pregnancies miscarry, 15% between 30 and 34 years old, and that rises to 20% by 35 to 39 years of age, and 35% by 40 to 44 years of age. This is because the number of abnormal eggs increases with the age of the mother, thus leading to an increasing number of abnormal conceptuses, which account for the spontaneous miscarriages.

The risks of having a chromosomally abnormal baby, e.g., down syndrome, also increase exponentially after 35 years of age. The risks of Down syndrome rise from 1 in 800 at age 20 to 1 in 250 for mothers aged 35 years or older at delivery and increase to 1 in 100 at age 40.

The risks of autism and educational disabilities are also linked with the increasing age of the mother at conception.

Increased risk of medical and gynecological disorders

Being older also increases the risk of having developed other medical and gynecological issues. Common medical issues are thyroid disease, whether it is hyperthyroidism or hypothyroidism; hypertension, diabetes mellitus, or even renal or autoimmune disorders. Such medical conditions, like diabetes, can make pregnancy more difficult by increasing the risk of birth defects in the baby if they are not well controlled. If thyroid disease is poorly controlled, there could be potential damage to the foetuses’ IQ development as well. There is also a chance of having a hypertensive crisis if you have kidney disease or one of a few autoimmune diseases.

What tests are available to screen for the health of the foetus?

Maternal serum screening and other tests can give you an approximation of risk. For more certainty, tests such as chorionic villus sampling or amniocentesis can provide a firm diagnosis, which allows a woman either to terminate a pregnancy or help prepare her for the special needs her baby will have. No woman has to undergo any tests if she would rather not have this information.

There is another small but serious risk to the babies of more mature mothers. More babies die in the uterus right at the end of pregnancy in mothers aged over 40. Figures for 2006 showed that the rates of stillbirth were steady at around 5 to 6 babies per 1,000 births for women aged 20 to 39, but increased to just under 9 babies per 1,000 births for women aged 40 and above.

This increased risk cannot be explained by complications in pregnancy or other illnesses alone. For this reason, caregivers are often more vigilant about older mothers in their final weeks of pregnancy. Despite the increased risk with increasing age, it is important to remember that the vast majority of babies are fine. Figures show that, with the exception of chromosomal abnormalities, babies of older mothers don't have a higher risk of most birth defects than babies of younger mothers.

What are the advantages of being older?

Financially and mentally prepared

Being an older couple usually implies that you are financially in a better position and are mentally more prepared for the changes that a child would bring into their lives, as the pregnancy would usually be planned for. Resources for prenatal care and nutrition for the mother and her developing baby are usually better. This can only be beneficial to the health of the mother and help her start off on a better footing for motherhood.

What can one do to prepare for motherhood eventually?

Diet

Stay healthy, eat fresh foods, take prenatal supplements, and ensure adequate hydration at all times. Exercise and keep limber to ensure one’s circulation is good, as that would definitely enhance the quality of egg production.

What tests are there for the older mother?

Ensure that the annual health checks are taken and corrective measures are taken to improve the health of the prospective mother. For example, diabetes should be treated aggressively to reduce the risk of abnormal babies.

Ensure that all your vaccinations are up to date and you have good nutritional habits, as well as consume additional prenatal supplements to reduce the risk of congenital defects.

What effect does age have on the birth itself?

The older the mother is, the more likely it is that someone will step in to help. If you are over 35 years of age, you are more likely to have induced labour, an epidural, forceps or vacuum delivery. Virtually all studies agree that the rate of caesareans also rises with maternal age. This is not necessarily a bad thing, as there are always good reasons for interventions.

Does the older partner play a part?

A man who is older is more likely to get medical and physical problems, such as varicocele, urinary tract infections or stones, or prostatitis, which can hurt the quality and quantity of sperm.

Being an older male also means that his hormones are lower and his stressful lifestyle may hinder sperm production due to lower quality of life due to decreased male hormones and poorer nutrition. Do ask your partner to get a full medical checkup before the two of you plan to get pregnant.

In conclusion

At the end of the day, having a child to add to one‘s home is always a blessing. The journey of becoming a parent is always a joy, and one should always feel blessed to be a part of this journey with them through unchartered waters.

Social induction

By Dr. Chow Kah Kiong
MBBS (S'pore), MMed (O&G), MRCOG (UK), FAMS

What is social induction?

Social induction: an induction for the convenience of either the pregnant mother and her family or the caretaker and the medical team. It is when labour is induced "electively" and there is no clear medical reason for the induction.

The World Health Organisation (WHO) recommends that induction rates should not exceed 10% (15% at most). However, despite the possible risks of induction, many people will still desire to select the birth date of a baby.

Reasons for social induction

Individual opinions of pregnant women often vary, depending on how they perceive induction. Many welcome the intervention happily. Possible reasons are:

• Choosing a date to fit in with the woman’s work or study schedule or with the partner’s work or leave arrangements or with sibling’s childcare; also for visiting relatives.
  
• Feeling tired of being pregnant and wanting the pregnancy to end. Having pregnancy complaints, (such as heartburn or varicose veins) can cause the pregnancy to be uncomfortable.
  
• Being due around a holiday season. Some women choose to be induced before Christmas, Easter or school holidays.
  
• Living a long distance from the hospital, especially in isolated rural areas may consider induction to avoid living away from home for weeks, awaiting labour or travelling long distances to birth.
  
• Anxiety about the baby due to a previous complication e.g. previous stillborn baby.
  
• The labour needs to be under controlled conditions. For example, the caregiver may suggest that a woman, who experiences a psychiatric disorder, would be better managed if the labour was planned for, and the woman was cared for, during periods of peak staffing at the hospital.
  
• Mother and father are ready; planned & completed their work and social schedules. This is preferred in a society where most activities are planned & scheduled. How nice when an impending child birth does not come unexpectedly and interfere abruptly your work & social schedules.
  
• To ensure the child is borne at a ‘decent’ time of the day when the labour and neonatal wards are well staffed and urgent laboratory, imaging and other support services are easily available.
  
• Allow the child to be borne on an auspicious day; making the whole family happy and adding a sense of confidence to the baby the rest of his/her life.

Possible risks of social induction

However, several possible risks have been identified and documented. For these reasons, many birth centres, hospitals, teaching institutions highly discourage social induction of labor.

• Premature baby, even if you believe your baby is term
• Failed induction and resorted to C-section
• Prolonged difficult labour
• Fetal distress (e.g. cord prolapse; hyperstimulation; long labour)
• Uterine Rupture (in the presence of previous C-section)
• Placental Abruption (sudden artificial rupture of membrane)
• Amniotic fluid embolism & Post Partum Hemorrhage

How to avoid these risks

However, several possible risks have been identified and documented. For these reasons, many birth centres, hospitals, and teaching institutions highly discourage social induction of labour.

Prematurity

Ensure correct dating of the pregnancy by:

• Taking a good menstrual history.
• Early dating with an ultrasound dating scan in the first half of pregnancy, especially in the first trimester.
• Perform an ultrasound assessment of the maturity of the placenta, prior to induction. Whenever there is a doubt on the dates of a pregnancy, avoid social induction.

C-section

Ensure a favourable cervix and absence of disproportion:

• Prior to induction, assess the cervix for favourability to induced dilatation. Cervical priming by prostaglins could help in cervices that are less favourable. However, time should be allowed for safe, gradual, monitored priming and patient’s prior agreement to call off the process when necessary.
• Baby should be assessed to be not disproportion to mother’s pelvis. Avoid inducing presentations other than cephalic and the head is fully engaged.

Prolonged difficult labour

To avoid this risk, ensure the following:

• A cervix should be assessed to be favourable or easily primed.
• Use of oxytocin drip early to ensure good regular uterine contractions.
• Continuous monitoring of labour with CTG.
• Artificial rupture of membranes only when uterine contractions are established, so that labour induction could be called off.

Fetal distress

Avoid this by ensuring:

• CTG assessment of baby prior to induction, including and not limited to an admission CTG test.
• Artificial rupture of membrane only when the head is well applied to avoid cord prolapse.
• Continuous CTG monitoring of labour.
• Prior agreement to call off induction and/or accept intervention by C section.

Uterine rupture

Ensure the following:

• Avoid social induction for previous C-section and other significant uterine surgery especially myomectomy and major corrective surgery for uterine malformation.
• Continuous CTG monitoring of labour.
• Avoid hyper stimulation with oxytocics.

Placental abruption

This is a rare complication of induction. However, the presence of excessive amniotic fluid and a history of hypertension in pregnancy may increase this risk. Avoid rupturing the membranes on purpose as much as possible until very close to the second stage, especially if there is a lot of amniotic fluid and the mother has high blood pressure. Use of continuous CTG monitoring reveals the unregulated uterine contraction the moment the membrane is artificially ruptured. The patient and family are prepared for an emergency C-section.

Amniotic fluid embolisation & PPH

Many obstetricians believe that these complications are increased in induced deliveries in some ways related to the use of prostaglandins to prime the cervix, plus oxytocics to enhance the uterine contraction, plus artificial rupture of membranes, and the rapid speed of labour due to these agents. There is very little to prevent these complications, but just be prepared to treat them. We could start a syntocynon infusion immediately after the baby is delivered. Close monitoring of the patient, even up to 12 hours after delivery. Start breast feeding immediately. Keep an intravenous line for 6 hours after delivery - may need to have blood grouped and X-matched ready.

IVF journey in the East

By Dr. Roland Chieng
Obstetrician and Gynaecologist
MBBS (S'pore), MRCOG (UK), GDip (Acu)

What is an IVF treatment?

IVF treatment is the very first treatment tried when an egg donor is being used, there are severe cases of male infertility, or a woman’s fallopian tubes are blocked. Still, this comes after years of trying to get pregnant, followed by a slew of fertility tests. According to the World Health Organisation, incidence is about 10 percent worldwide. Another 10% to 12% of all other couples have only one child and would like to have more. The incidence of infertility is gradually increasing all over the world. For many people going through infertility treatment, the level of distress and tension can be very high. Mutual trust and faith in the doctor can help couples enquire about different types of treatment for both the male and female partner and make informed decisions about their reproductive status.

How is fertility assessment done?

For Female

Assessment of female fertility traditionally includes the assessment of ovulation and the physical condition of the fallopian tubes. Various methods are available for ovulation. The direct assessment using ultrasound to track how the egg develops in the ovaries is still the most reliable method.

Serial ultrasound visualization of the ovaries will be done to follow the development of eggs from about Day 10 of the cycle till the day of ovulation. Actual ovulation can be confirmed, and timed intercourse advice will then be more precise for a possible natural conception. “The gold standard for assessment of tubal conditions is still by laparoscopy or keyhole operation,” says Dr Roland Chieng. However, in the absence of other indications, x-ray or ultrasound assessment of the fallopian tubes is usually adequate. These can be done in a clinic setting.

1.       Blood test for follicle-stimulating hormones (FSH) level at the time of menses

It dictates the amount of medication required for successful stimulation of the ovaries for egg development.

2.       Antral follicular count (AFC)

This is done by a 3-D ultrasound examination of the ovaries. It has to be done on Day 2 of menstruation and measures the number of new egg follicles before stimulation is started.

3.       Trail cannulation

This is a process whereby a trial run embryo transfer is done before the actual procedure.

For male

Assessment of the male is of equal importance before IVF. Full assessment goes beyond just semen analysis or sperm quality assessment. There are numerous conditions in men that are amenable to treatment, which will increase the chances of spontaneous pregnancy.

01 Semen analysis and culture

A detailed semen analysis is necessary to determine the method of obtaining sperm at the time of IVF, whether obtaining sperm normally through masturbation or surgery.

02 Sperm function test

Sperm function tests include DNA fragmentation tests, hyaluronon binding assays (HBA), egg penetration tests, and others. Infertility can be explained by these tests, and they can also show if intracytoplasmic sperm injection (ICSI) or microinjection of the sperm into the egg for fertilization in IVF is needed.

What is involved in an IVF treatment?

There are basically four steps in the IVF treatment and embryo transfer process, which include:

Step 1: Ovarian stimulation

Injections are used during ovarian stimulation to stimulate multiple eggs to grow in the ovaries instead of having a single egg that is normally produced each month. Some eggs will not fertilise or develop normally after fertilization. With multiple eggs, the chances of successful treatment become higher. With the help of an ultrasound, the follicles can be found and evaluated one by one until the right time for egg retrieval.

Step 2: Egg retrieval

Egg retrieval is a minor surgical procedure that is performed via the vaginal route. During this time, both ovaries will be enlarged with egg follicles and they will be right next to the vaginal wall. A small injection using an aspiration needle is made through the wall under ultrasound guidance. The needle is connected to a suction device.

Eggs will then be aspirated from all the follicles. Multiple eggs can be aspirated in less than 15 minutes.

Step 3: Fertilisation

Once the retrieval of eggs is completed, they are observed in the laboratory for maturity and quality. Fertilisation is achieved either through insemination, where the motile sperm are placed together with the eggs incubated overnight, or through ICSI, where a single sperm if directly injected into each mature egg. Successful fertilisation can be assessed the following day.

Step 4: Embryo transfer

Embryos are fertilised eggs. Embryo transfer is the last step in the IVF process.

One or more embryos that are floating in culture medium are drawn into a transfer catheter with a syringe on one end. The tip of the transfer catheter is guided through the cervix and into the uterine cavity, where embryos are placed.

The most important thing that leads to multiple pregnancies is the number of embryos that are transferred. Commonly, Dr Roland Chieng advises only two embryos to be transferred at any one time.

How effective is an IVF treatment?

IVF treatment is often successful, though it may take more than one try. Studies show that the potential for success with IVF treatment is the same for up to four cycles. In general, the live birth rate for each IVF cycle is 30 to 35 percent for women under the age of 35, 25 percent for women aged 35 to 37, 15 to 20 percent for women aged 38 to 40, and 6 to 10 percent for women over the age of 40.

Pregnancy myths vs facts

From the day people come to know about your pregnancy, you will be bombarded with well-meaning but confusing and always conflicting advice from friends, family, the annoying neighbours, and that complete stranger when you are in a department store. "Hmmm, your tummy has not gotten that large, so...", "Your face is glowing, you will definitely have a..." — the list of myths is endless. We will make your life a bit easier as we go on to break down the wall of superstition and facts so that you can enjoy a safe and enjoyable pregnancy.

Myth: Keep your feet up for nine months

Fact:

While pregnancy is definitely the time to abandon risky activities, doing light, regular exercise carries more benefits than risks. Researchers have found that women who stay active tend to have short labours, regain their pre-pregnancy shape, have a lower chance of postpartum depression, and sleep better than those who don’t exercise. However, you should also know that pregnancy is a time for maintaining your fitness routine and not taking up a new sport. Specialists believe aerobic exercise (the kind that leaves you slightly out of breath) will keep your heart and lungs healthy. Brisk walking in the morning can make a huge difference too.

According to fitness experts, light swimming is a perfect antenatal exercise. The body joints that usually soften during pregnancy are supported, and the water will keep you cool.

Myth: Whatever you eat you need to eat for two

Fact:

Okay, you're eating for two, but keep in mind that the other person you're feeding is too small, so being pregnant won't give you an excuse to double your calorie intake. As a guide, you are looking at between an extra 200 and 300 calories a day. Overeating and making the wrong food choices can lead to complications such as gestational diabetes and excessive weight gain, both of which can be harmful and can make labour more difficult. Consequently, eating well – rather than calorie counting – is the key during your pregnancy and means ensuring you eat good quality protein (eggs, meat, fish and beans). You should also be eating lots of vegetables and carbohydrates (unrefined), like brown bread, rice, etc. Good snacks include fruit, nuts (avoid peanuts), seeds, oatcakes/biscuits etc.

Myth: If you are carrying high, it's a boy

Fact:

Guessing the baby's gender is the part of pregnancy that is most full of old wives' tales. The most common myth is that boys make neat little bumps while baby girls cause the weight to spread more evenly around your abdomen — something that could seem plausible. But ideas like predicting a baby's sex by dangling a wedding ring over your belly and seeing which way it swings are surely traditional folklore. While these urban legends can be a fun way for others to get involved with your pregnancy, there's a danger they can distract from medical problems. And theories like light bleeding during pregnancy, which would indicate a boy while extreme morning sickness would signify that you are carrying a girl, are nowhere proven. While bleeding during pregnancy is common, it's always safe to check with your doctor. Even though scans aren't 100% accurate, the only way to be sure about your baby's gender is when you meet your baby.

Myth: Backaches are an unavoidable part of being pregnant

Fact:

You can avoid backaches with some simple changes. First, pay attention to your posture. Don't arch your back by pulling your shoulders back but not your abdomen. Don't wear shoes with any heel height; it will force you to arch your back, which puts pressure on the lower back. Try pelvic rocking to give your back a break, and squat throughout the day to stretch the muscles in your back. 

Myth: Slow heart rate means a baby boy and a fast heart rate means a baby girl

Fact:

A normal foetal heart rate is between 110 and 160 beats per minute (bpm), although some people think if it’s faster (usually above the 140 bpm range) it’s a girl and if it’s slower it’s a boy. However, there is no evidence or statistical proof to support this theory. Your baby’s heart rate will probably differ from one prenatal visit to the next anyway, depending on the age of the fetus and activity level at the time of the visit. Also, changes in a pregnant woman's heart rate and blood pressure caused by stress, as well as long-term anxiety, can affect the heart rate of her growing baby.

Myth: You shouldn't have sex when you are pregnant

Fact:

Making love will not hurt your baby or your partner. In fact, experts encourage lovemaking during pregnancy. It will also help strengthen the bond with your partner, which you will both appreciate when the baby arrives. However, there are a few medical conditions where sex is not advised. Do consult with your doctor if you are unsure.

Myth: You can't have hot baths

Fact:

Again, a folklore that you’re not to take baths because germs could get into your vagina and be passed to the baby. This is not entirely true. When everything aches, it can be tempting to sit under a steaming hot shower or relax in a tub. Baths are a great source of relaxation and are very good for pregnant women. Avoid using too hot water or temperatures above 38 degrees Celsius. These can cause your body temperature to rise, which can cause problems for a developing baby, particularly in the first trimester. Overheating can increase the risk of neural tube defects such as spina bifida, and staying in hot water for too long can cause dehydration and dizziness in pregnant women. But your baby is definitely not in danger of getting germs from bathing as the baby remains protected by the amniotic sac and the mucous plug.

Myth: You can't get pregnant as long as you are regularly breastfeeding your baby.

Fact:

Tell this to thousands of women who are now with their second child, while the older one is hardly a year of age, or less! Hence, it is always advisable to use some form of contraception to avoid an unwanted pregnancy. Breastfeeding is reliable only up to a certain period, about one-and-a-half months after delivery. However, a woman can get pregnant even without having her first menstrual cycle post-delivery, i.e., in lactational amenorrhea. There are many simple methods available for contraception. Choose the right one for yourself.

Preparing for your pregnancy

By Dr. John Yam Pei Yuan
Obstetrician and Gynaecologist
MBBS (S'pore), MRCOG (UK), MMed (O&G), FAMS (S'pore), FICS (USA)

You and your partner need to be ready mentally and physically before you get pregnant. You must prepare for the addition of a new member to your family.

Things to do

Pregnancy can be demanding, placing a strain on your body. It is important that you prepare in advance so that you will have a satisfying experience and outcome. Ideally, preparations should begin even before you conceive.

Folic acid supplements should be taken for about a month before getting pregnant to reduce the risk of birth defects in the brain, spine, and nervous system. If you are taking any medication, always consult your doctor as some drugs can affect your baby.

Be sure to avoid radiation (in the form of X-rays) too. Bear in mind that conception occurs around two to three weeks from your last menstrual period, so that is the time that the baby starts developing.

Eat sensibly and have a well-balanced diet. Try to keep your body mass index in a healthy range by keeping your weight in a healthy range. Women who are underweight or overweight at the start of pregnancy tend to develop specific problems during pregnancy and childbirth. Exercise moderately and avoid high-impact sports.

When you are about to embark on a pregnancy, it is a good idea to see your doctor to get a medical screen. Your doctor may screen you for various medical conditions like high blood pressure and thalassemia, an inherited blood condition that can affect the fetus. Certain tests can also be done, including blood tests to check your immunity to some conditions. A syphilis test and a PAP smear are recommended.

In the event that you need a vaccination, you will probably have to wait for a period of time before conceiving. For example, if you need a rubella vaccine, doctors recommend that you don't get pregnant for about 3 months after the shot.

On occasion, women who go for pre-pregnancy checks discover that they have certain underlying medical conditions that were previously unnoticed as they did not cause any symptoms, like high blood pressure or diabetes. It is important that they get the appropriate treatment for these conditions before starting a pregnancy, as pregnancy may be affected if their conditions are not well controlled.

Things not to do

Cigarette smoking causes problems such as miscarriage, placental bleeding, premature labour & decreased foetal weight. Babies born to mothers who smoke also suffer from delayed development. If you are a smoker, it is important that you cut down on the number of cigarettes you smoke, or, better still, stop completely. Second-hand smoke is also dangerous; if your partner smokes, avoid inhaling the fumes.

Alcohol, too, causes problems in pregnancy, including foetal abnormalities. You should avoid hard liquor during pregnancy and minimise your intake of soft liquor. Of course, it is best that you avoid alcohol together.

The importance of eating right during your last trimester

By the third trimester, your impending secret cannot be hidden. You will have gained much more pregnancy weight by now, and your baby is developing at a faster rate towards your due date.

According to expert articles, there is a correlation between how much weight pregnant women gain during their pregnancy and the rate of infant mortality. As a matter of fact, women who did not gain enough weight were more prone to losing their babies within the first year of birth. Therefore, it is vital that pregnant women gain a healthy amount of weight throughout the pregnancy.

It is not too late to start eating healthy for your little one.

The variety of foods and nutrients that you eat during the last three months is crucial because it supports the continual development of your unborn baby. So, it is essential that you choose nutrient-dense foods that supply the vitamins and minerals your baby needs to grow healthy.

1. Protein

It is important to have an adequate amount of protein in your diet during your last trimester. Protein helps with the growth and development of your unborn baby's tissues and muscles. Many foods, such as almonds, chicken breast, and tofu, are rich in protein and, at the same time, supply iron and zinc. Food rich in protein will not only help in the development of your baby, it can also boost your energy level.

2.Iron

Your body needs more iron to make more haemoglobin as the amount of blood in your body increases during pregnancy with the growing baby and placenta. Iron can help prevent premature delivery and low birth weight. Red meat is one of the best sources of iron for pregnant women. Besides red meat, you can get iron from legumes and grains too. Consume a variety of iron-rich foods to make sure that you're getting enough.

3.Vitamin K

During labour, it is expected that there will be blood loss, and it is crucial to prevent excessive blood loss. Vitamin K plays an important part in helping our blood clot, which is an essential vitamin for birth and breastfeeding. Dark leafy greens such as kale or rocket and berries are rich sources of vitamin K that can be found readily. So, do remember to add some of these foods to your diet.

4.Omega-3 Fatty Acids

Your baby's brain is developing at a rapid rate now, and eating food rich in omega-3 fatty acids can help to enhance your baby's brain development. Salmon, walnuts, and cauliflower are a great source of omega-3 fatty acids that promote the development of your unborn baby's nervous system. You can broil or grill the salmon for an easy-to-prepare and nutritious meal.

Your baby can tell if mommy is eating healthy or not. So be sure to eat right and stay in the pink for your little one.

Body changes during last trimester

The third trimester of pregnancy is going to be your final "home stretch". Most likely, you will be feeling worn out and more emotional than usual. Nevertheless, take it slowly so you do not wear yourself out and remind yourself to stay positive because your little one will arrive in no time.

A word of encouragement is that many pregnant mothers out there are facing the same situation as you are. Having swollen feet, indigestion, constipation, or frequent urination are some of the many common body changes that you will be facing. This can be quite a shock to you, and it can make you uncomfortable at times.

However, it is more important to focus on how to overcome these body changes. Here are some tips to help you look after your body better and feel the best you can through this last lap of your pregnancy journey.

Drink up

There is no magic potion, but the benefits of water are many and plenty. It is important to drink at least 8 to 10 glasses of water per day. It improves digestion, reduces swelling, and also eases hemorrhoids. A tip is to get a 1.5-liter water bottle and leave it in your room so you do not have to go back and forth to get more glasses of water.

Strengthening of your muscles

Doing simple light exercises can also help ease body aches, labour pains, and leg cramps. Prenatal Yoga and the Kegel Exercise are useful for pregnant mothers because they help support specific muscles used during childbirth. However, if you do not want to commit yourself to anything yet, try the Kegel exercise because you can do it discreetly just about anytime and anywhere.

Managing a healthy diet

With the indigestion and constipation, munching on more fruits and vegetables will be the cure. Including foods that are high in fibre in your diet can help to ease the indigestion, and they also contain antioxidants that will protect the baby's brain tissues. Try snacking on dark-coloured vegetables and fruits from the berry family. This will ensure a healthier lifestyle for you and your little one.

Nonetheless, it is important to "listen" to your body so that you can cope with the changes better-and so can the daddy-to-be. These tips are some advice to help you have a more enjoyable pregnancy journey. Embrace this journey towards parenthood.

Which Singapore maternity hospital should I choose?

You will make plenty of decisions during pregnancy, and choosing where to deliver your baby is one of the most important ones to make. Most obstetricians are usually affiliated with one or more maternity hospitals, so it helps you narrow down your choices by asking your doctor which hospital they are affiliated with. 

To make the best and most informed decision on which hospital to deliver, you can sign up for hospital tours to find out more about their amenities and services. As a guide, we have provided you with a summary of the private maternity hospitals in Singapore. 

Gleneagles Hospital 

Gleneagle’s packages start from $2,714 (two nights, normal delivery, GST inclusive) for a 2-bedded room. With their single-room packages (from $3,924 including GST), you can celebrate this joyous milestone with your loved ones with a celebratory tea set for 6. Daddies are also taken care of with meals and lodging during the hospital stay. Included within this value-for-money package are comprehensive newborn screenings and a personalised lactation consultation. They offer parking or a limousine service upon discharge as well. Gleneagles hospital is certified under the baby friendly hospital initiative (BFHI) to provide support to mothers in breastfeeding

The most luxurious room is the Dempsey suite, as pictured above. You can expect butler services, a customised VIP menu and additional offerings such as a romantic dinner for 2. The package for this suite starts at $10,024 (two nights, normal delivery, GST inclusive). For ease of mind, mommies can also look forward to a personalised breastfeeding coaching session with a professional lactation consultant and customisation of their confinement menu! 

To find out more about Gleneagles’ maternity services and to take a virtual tour, visit www.gleneagles.com.sg/maternity.

Mount Elizabeth Novena Hospital (MENH)

After all the hustle and bustle, some mommies-to-be might want to welcome your little one in comfort and privacy. MENH is the only all-single-room hospital in Singapore and is also BFHI-certified. You will be welcomed with a mini bar, free wifi, and a 46-inch LED TV with an in-room entertainment system that includes a Parentcraft channel that screens breastfeeding education videos. MENH ensures that all of your needs are met, including meals and lodging for your accompanying family member. Their packages start at $4,062 (two nights, normal delivery) for single rooms, which includes a newborn hearing test and free parking for one vehicle during the package length of stay.

Mommies-to-be who are considering an upgrade to the junior suite can expect personalised breastfeeding coaching and a personalised newborn bath demonstration conducted by their experienced lactation consultant. MENH’s junior suite is priced from $9,393 for three nights for a normal delivery, which comes with an adjoining living room and an outdoor terrace and includes parking for two vehicles.

To find out more about Mount Elizabeth Novena’s maternity services and to take a virtual tour of the rooms, visit www.beststartinlife.sg.  

Mount Elizabeth Hospital (MEH)

All maternity packages at MEH include customised confinement menus, a baby care and breastfeeding class, newborn health screening, hearing test, wifi, and parking for one vehicle during the package length of stay. For a regular single room, packages start at $3,970 (two nights, normal delivery, inclusive of GST). There is also two-bedded room option starting at $2,996 (two nights, normal delivery, inclusive of GST).

For a more lavish stay, the Daffodil and Magnolia Suites are specially designed to provide a luxurious setting that includes a spacious guest lounge to enjoy the delights of birth with your family and friends. The suites come with a butler, a personalised baby care and breastfeeding lesson, a limousine service upon discharge, and a baby metabolic screen and bilirubin test. Mommies can also enjoy a head-and-shoulder massage, a pampering hair spa, a manicure or pedicure while partners enjoy lodging and meals. 

Parents can request a romantic dinner for two or mocktails for up to six guests to celebrate the birth of their child. The packages for one of these suites start at $12,741 (three nights, normal delivery, inclusive of GST).

To find out more about Mount Elizabeth’s maternity services and to take a virtual tour of the rooms, visit www.mountematernity.sg or call 6250-0000. 

Parkway East Hospital (PEH)

At PEH, they try to give nursing care in a warm, supportive environment to women who are expecting. Apart from providing newborns with a comprehensive health screening, from blood screening to their first dose of vaccination, PEH also ensures that mothers get a supportive environment by offering complimentary Parentcraft classes to help you pick up nutrition tips for breastfeeding and advice on maternity confinement. Mothers also get a diaper bag with gifts and things they and their babies will need. Being BFHI-certified, PEH has lactation consultants to visit mothers to help them with breastfeeding.  

Their packages for the single room start at $3,883 (two nights, normal delivery). Mothers will be served with a personalised postnatal confinement menu and fathers can select their meals from their wide range of choices!

To find out more about Parkway East’s maternity services, visit  www.parkwayeast.com.sg. 

Thomson Medical Centre (TMC)

If you’re looking for peace and space, the rooms at Thomson Medical Centre are designed to look like a contemporary resort setting with an understated luxury and spaciousness. The Thomson Family Suite comes with a dedicated team of staff, a separate living room area, free wifi, a mini fridge with a beverage corner, and daily newspapers. 

The packages for a single single-bedded room start at $4,039.25* (two nights, normal delivery, inclusive of GST). There are also two- and four-bedded room options starting at $2,785.21* and $2,469.56*, respectively (two nights, normal delivery, inclusive of GST). 

Find out more about the hospital tours at  www.thomsonmedical.com or call 6358-0055 or 6350-8876. TMC’s diagnostics centre (TDUC) is located at Novena Medical Centre. When maternity tours resume after the COVID-19 situation, they are held Mondays to Fridays at 1pm, 2pm and 3pm, and Saturdays at 11am and noon. 

*These rates are published from June 2020. 

The best way to clear up any doubts you may have is to find out more with the help of the person in charge of the hospital tour. Cordlife is also located at MENH, PEH, and TDUC (TMC's diagnostic centre located at Novena Medical Centre). Drop by our consultation booths to find out more about how you can protect and safeguard your family’s health for a lifetime!

Preparation for breastfeeding

Breast milk is the "best food" for your baby, and breastfeeding benefits mothers too. Breast milk has all the nutrients your baby needs to grow up healthy, like proteins, lipids, carbohydrates, vitamins, minerals, and other nutrients, in the exact amount she needs for her age. In the form of antibodies in your breast milk, you give your baby part of your immune defense when you breastfeed. This helps your baby's immune system because their natural defenses aren't quite ready yet.

Most of all, breastfeeding can heighten the bond between mother and baby.

Preparation for breastfeeding

Breastfeeding is a skill that may or may not come to you naturally in the beginning, but you will pick it up eventually once you get started. Therefore, it is important to prepare yourself mentally and physically for a good start.

Physical preparations

Having a well-balanced diet is important during pregnancy and after giving birth. Go shopping for nursing bras with good support and clothes (preferably 2-piece clothing) with roomy fitting for breastfeeding. If you have any doubts or worries about your physical condition, you can seek advice and help from a doctor by taking a breast examination.

Mental preparation

Read more about breastfeeding and the experiences that other mothers are sharing. Find out where you can look for help if needed. Most maternity hospitals have trained lactation nurses that you can call on for help regarding breastfeeding. You can also attend a breastfeeding talk with your partner to learn more.

Do think and plan how long you will breastfeed your baby so that you can make the necessary arrangements, especially if you are returning to work after your maternity leave. Check to see if your place of work has a nursing room or a private place for you to express milk, and let your boss know that you will need some time off to do this.

Most importantly, keep a positive mindset and be confident that you will succeed.

What is cord blood banking and why you should consider it?

The term “cord blood banking” has been heavily discussed among parents lately. But what is it exactly and what can it do for you and your family?

We have put together some information to help you understand exactly what it is.

Stem cells are essentially the building blocks of the human body. The umbilical cord, which serves as the lifeline between mother and baby for nine months, is an abundant source of these stem cells.

What is cord blood and cord lining banking?

Cord blood, also called “placental blood”, is blood that remains in the umbilical cord and placenta following the birth of a baby and after the umbilical cord is cut after delivery.

Cord blood banking is the process of storing your child’s umbilical cord blood, which is a rich source of stem cells should the need for a stem cell transplant ever arise.

Cord blood is particularly rich in haematopoietic stem cells (HSCs), which are responsible for replenishing the blood and regenerating the immune system. HSCs are known as "precursor cells’ as they have the unique ability to differentiate into the different types of cells found in the body, namely:

• Red blood cells – to transport oxygen throughout the body
• White blood cells – produces antibodies and fights infections
• Platelets – assists in blood clotting

Haematopoietic stem cells, or HSCs have been used to treat over 80 diseases such as leukaemia, lymphoma, and thalassaemia, as well as metabolic and immune disorders._¹ Clinical trials are also underway to use cord blood for the treatment of autism, cerebral palsy, type 1 diabetes, Alzheimer’s disease, spinal cord injury, and many more.² Clinical trials are one of the main ways that medical advances happen, and they give hope to families whose loved ones have diseases that have no known cure.

Other than cord blood, there is also a sheet-like membrane surrounding the umbilical cord, known as the cord lining. The cord lining contains an abundance of mesenchymal stem cells (MSCs) and cord lining epithelial cells (CLECs), which are the “muscle-forming” and “skin-forming” building blocks in the human body. Both MSCs and CLECs have shown potential in aiding the repair of injured tissues and organs, as well as the treatment of various diseases.

Since cord lining stem cells can change how the immune system works, it is easier to find a match between a donor and a patient. This makes them a good choice for both your baby and other members of your family. Although the medical use of cord lining stem cells is still under clinical trials, the list of potential treatments includes stroke, heart failure, Alzheimer’s disease, Parkinson’s disease, spinal cord injury, and type 1 diabetes, just to name a few.

While different types of stem cells serve varying functions, when used in tandem, they can work in synergy to help speed up the treatment process by promoting the growth of healthy cells and reducing immune system complications.

By storing a combination of HSCs, MSCs and CLECs, you are enabling your children and family to be part of a medical revolution with access to the growing applications of stem cells and the therapeutic potential they hold.

Why should I save my baby’s cord blood?

Data has shown that there is an increasing likelihood of using HSCs for medical treatments as one ages. With statistics also showing that 1 in every 217 people may require a stem cell treatment in their lifetime, storing your baby’s cord blood gives you the assurance of having a ready source of HSCs, should a time-critical situation ever arise.³ While it is possible to do a national or international search, the process can be both costly and time-consuming. Furthermore, the odds of finding a match for a transplant within the same racial group are around 1 in 20,000.⁴

There are also other sources of stem cells, such as those from a matched bone marrow donor and peripheral blood. However, the advantage of using cord blood stem cells is that they’re younger and more primitive, meaning these cells are faster in generating healthy cells and are also more tolerant to tissue mismatches, which may happen in transplants involving a donor.

Advantages of using cord blood over other sources:

Source	Bone Marrow	Peripheral Blood	Cord Blood
Collection	Multiple extractions	Needs multiple growth-hormones injections	Quick, painless & risk-free for both mother and child
Type of stem cell	Adult	Adult	Perinatal*
Availability	Donor search	Donor search	Readily available (for family bank)
Graft vs Host Disease	High Risk	Higher risk	Minimal risk
Cost of obtaining a matching unit	Can cost up to S$64,000	Can cost up to S$64,000	$0 (100% ownership for family cord blood bank

^*Definition of perinatal: pertaining to the period immediately before and after birth

By storing your baby’s precious cord blood, you are giving him/her ready access to his/her life-saving stem cells should the need for a stem cell transplant ever arise. As a baby’s cord blood is a 100% match for him/her, it is a guaranteed match for autologous transplants (where the donor and the recipient are the same individual) with no risk of post-transplant rejection.

If there is a suitable match, his/her cord blood may also be used for an allogenic transplant (in which the donor and recipient are different people) for his/her siblings or family members. Studies have shown that the overall 3-year survival rate for patients who got cord blood from a relative was 95%, while it was only 61% for patients who got cord blood from someone else.⁵

How do you choose the right family cord blood bank?

Given the current and potential value that the stem cells in your baby’s cord blood hold, it’s important to choose the right family cord blood bank that you trust and know will be with you for the long haul. Here are some key factors to consider when it comes to choosing the right family cord blood bank to store your baby’s life-saving umbilical cord stem cells

Long-standing establishment

A family cord blood bank that has been around for a long time gives parents peace of mind that their child's valuable cord blood stem cells are being kept by a trustworthy partner who will be there for the long haul. With over 21 years of experience and establishment in Singapore, Cordlife is the 1st and largest family cord blood bank in Singapore.

Accreditations

Choose a family cord blood bank that has been accredited by independent international bodies. The Parent’s Guide to Cord Blood Foundation, an educational resource for parents, recommends selecting a family cord blood bank that is accredited by international bodies such as the American Association of Blood Banks (AABB) and the Foundation for the Accreditation of Cellular Therapy (FACT).⁶

These accreditations ensure that the family cord blood bank adheres to the highest standards of quality when it comes to the handling, processing, and storing of cord blood through regular and rigorous audits. It also ensures that your child’s cord blood stem cells will still remain viable should the need for transplantation ever arise. Cordlife is AABB and FACT-accredited, and is one of only six family cord blood banks in the world to be internationally dual certified.

Transplant track record

Another important factor to consider is whether the family cord blood bank has a proven track record of releasing cord blood for transplants. A family cord blood bank with a proven track record and experience in successfully releasing cord blood for transplants is an indication that the cord blood stem cells are being stored according to the highest standards and will still be viable for transplantation.

Unique service offerings

Find out if the family cord blood bank has other services to offer, as it means that you will be able to maximise the medical options for your child and family members.

Apart from storing cord blood stem cells, Cordlife is the sole provider of umbilical cord lining storage in Singapore and is also one of four family cord blood banks worldwide licensed to store an additional two types of stem cells-mesenchymal stem cells (MSCs) and cord lining epithelial cells (CLECs).

This increases your child and family’s medical options for possible therapeutic and regenerative applications in the future, especially for conditions that currently have no known cure.

Facility

A family cord blood bank that owns its own processing and storage facility is able to maintain direct control over critical services, quality, licensing, and accreditation, thereby ensuring the well-being of the families whose cord blood units are stored under its care. It also lets the family cord blood bank use its resources right away in case of an emergency. Cordlife has over 21 years of experience and lab management expertise.

Financial stability

Deciding to store your baby’s precious cord blood is a long-term decision. Public listed companies offer financial transparency for increased assurance.

As storing your child’s cord blood stem cells is a life-saving investment, it’s important to ensure that the family cord blood bank is financially stable, has a good reputation, and has many years of operation and experience. This is to ensure that they will be with you and your family for the long haul.

Some other factors to take note of also include the family cord blood bank’s processing technology, customer service, and enrolment process, just to name a few.

Setting aside a budget to store your baby’s cord blood is a smart investment, but it will be a futile one if you pick the wrong family cord blood bank to safeguard it. So, be diligent in researching the family cord blood bank’s certifications, reputation, facilities, and technologies used to process and store your child’s cord blood unit, and you will be on your way to making a lifesaving investment for the future.

Written by Mummy Mylene

¹Diseases Treated page. Parent’s Guide to Cord Blood Foundation website. https://parentsguidecordblood.org/en/diseases. Accessed July 16, 2018.

 ²Diseases and Disorders that have been in Clinical Trials with Cord Blood or Cord Tissue Cells page. Parent’s Guide to Cord Blood website. Therapies in Clinical Trials. https://parentsguidecordblood.org/en/diseases#trial. Accessed July 16, 2018.

 ³Nietfeld JJ, Pasquini MC, Logan BR, et al. Lifetime probabilities of haematopoietic stem cell transplantation in the U.S. Biology of Blood and Marrow Transplantation. 2008; 14: 316-322.

 ⁴Chew J. Criterion for new stem-cell transplant 50% match. The Straits Times. July 18, 2013: 12-15.

 ⁵Bizzetto R, Bonfim C, Rocha V, et al. Outcomes after related and unrelated umbilical cord blood transplantation for hereditary bone marrow failure syndromes other than Fanconi anemia. Haematologica. 2010; 96(1):134-141.

 ⁶Frequently Asked Questions page. Parent’s Guide to Cord Blood website. https://parentsguidecordblood.org/en/faqs#q-18082. Accessed July 16, 2018.

This article was adapted from SuperMom, 25 August 2018.