Mount Alvernia Hospital No part of this publication would like to thank all may be reproduced who are involved in the in any form or by any editorial of Mother&Child means without the written Guide, including our on- permission of the publisher. campus medical and health professionals. Please address all enquiries to The Editor Email: [email protected] Editor and Researcher Joyce See made to ensure this book Writers Joyce See medical advice at the time Melanie Liew of publication. However, information may change and Contributing Reviewers should be checked against the Judith Lee latest information from your Chris Tan family physicians or specialist doctors. Editorial Consultant Goh Hock Soon The information contained Director, Corporate in this publication should not Development be regarded as a substitute for detailed medical advice in Publisher individual cases. Mount Alvernia Hospital 820 Thomson Road All rights reserved. Singapore 574623 2017 First Edition Publication Consultant Bold Ink Magazines Pte Ltd Printed in Singapore

Printed By The book is given free to all Ho Printing Singapore Pte Ltd expectant mothers.

It is NOT for sale.

Mount Alvernia Hospital Mother & Child Guidebook | 1

Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & &Child Child Guidebook Guidebook 1| 1

This guide saves parents the trouble of searching for the right answers online yet having to question the reliability of the source. How I wish I read this during my !

Jes www.simplyjesme.blogspot.sg A mummy blogger who delivered her baby at Mount Alvernia Hospital in March 2016

This book is a valuable one-stop resource that provides parents with what they need to know before, during and after pregnancy. I’m surprised that there’s even a section on what baby may be saying to you when they cry! If only this was available during my time!

Chris Tan www.budgetpantry.com A mummy blogger who delivered her baby at Mount Alvernia Hospital in May 2016 CONTENTS MOUNT ALVERNIA HOSPITAL MOTHER&CHILD GUIDEBOOK FIRST EDITION - 2017 PLAN YOUR PREGNANCY 7 Before Pregnancy 14 Congratulations! You Are Pregnant MUMMY’S HEALTH PREGNANCY CARE & 120 Postpartum Concerns MANAGEMENT 127 Gynaecological Disorders 23 How You And 131 General Wellness Your Baby Develop 34 INVOLVING DADDY 44 Healthy Pregnancy 136 In Pregnancy, and 54 Labour and Delivery Child Development 144 Dads for Life THE BABY IS HERE !! 65 Your Newborn ADDITIONAL RESOURCES 72 Baby Goes Home 148 86 Breastfeeding – Nature’s Perfect 149 List Of Support Organisations Food For Your Baby & Their Contacts Details 98 Entering Toddlerhood 152 Glossary Of Terms

4 4| MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook INTRODUCTION

here are few moments in one’s life that will rival joy of . While it is exciting and highly Tanticipatory, you might be feeling nervous as well. And if it is your wondering where to start, what to expect and how to do it.

A healthy pregnancy is a fabulous start to your child’s life. And you will do anything to nurture, protect and giving only the best for the little one.

Mount Alvernia Hospital’s Mother&Child Guide is a reference guide developed by a team of specialist doctors and clinical experts to help you and your spouse along on this amazing transformative journey of bringing and raising a new person into this world.

We like to thank the following doctors and heads of departments who collaborated and provided medical guidance in developing the book:

Obstetrics & Gynaecology Paediatric Medicine Alvernia Parentcraft Centre Dr Chen Lin Han Dr Darryl Lim Ms Kang Phiak Gaik Dr Chua Yang Dr Ong Eng Keow Head Of Department Dr Goh Shen Li Dr Simon Ng Nutrition & Dietetics Services Dermatology Ms Sarah Sinaram Dr Mark Tang Head of Department

Mount Alvernia Hospital January 2017

Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & &Child Child Guidebook Guidebook 5| 5 With Every Step of the

Enjoy motherhood with the Alvernia Ladies Card.

Alvernia Aviva Personal Maternity Parentcraft Accident Plan Packages Centre Services Coverage

Sign up before Get Started admission in 3 Easy Collect your card Steps at the Patient Liaison Centre Enjoy your membership for the next two years!

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820 Thomson Road Tel: 6347 6688 www.mtalvernia.sg Singapore 574623 Email: [email protected] www.facebook.com/mtalverniahospital PLAN YOUR PREGNANCY

Before Pregnancy Having a child is a BIG life event. It is absolutely exciting, incredible and life changing. But parenthood is a lot of work with no end in sight. It is a decision that cannot be taken lightly. It is important therefore to prepare yourself and your partner – emotionally and physically – so that both of you can be as ready as possible to welcome this momentous event.

Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & &Child Child Guidebook Guidebook 7| 7 PLAN YOUR PREGNANCY

8 8| MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook OVULATING AND So, you are ready GETTING PREGNANT

Ovulation refers to the time of the to start a family! month when an egg matures with hormonal changes in the menstrual cycle to pop out of the ovary into the fallopian tube. It is in the tube that guide your planning and to this egg meets with the sperm and get IS THE TIME stage your way to a healthy fertilised. This cycle gives the woman RIGHT? pregnancy and enriching an opportunity to conceive. parenthood. Ovulation is typically 14 days before the next menses. It only works if your There’s never a perfect cycles are regular. A woman with a time to have a baby; some IS YOUR BODY 28-day cycle will ovulate on day 14. phases of life may be more However, if you have a 32-day cycle, conducive to pregnancy READY? ovulation happens on day 18. and new parenthood than others. One thing is for sure: If sperms are deposited into the babies don’t come with a Healthy lifestyle choices woman, they remain viable for two manual and for the most to three days. Once the egg pops part, you and your partner healthy pregnancy. from the ovary, it also survives for will have to end up making one to two days. Therefore, the fertile all sorts of adjustments to If you are a smoker, period ranges from three days before suit the little one. you may like to get ovulation till two days after. advice to quit smoking Here are some questions to ask yourself to determine if It is best to avoid the time is right: alcohol

How will having a baby Eat a balanced and at or rrnt an healthy diet future lifestyles or Maintain a healthy career? weight Are we ready and Exercise regularly willing to make those How do you know you changes? Keep stress under are ovulating? control Emotionally, are Some women do feel a slight pinch on we ready to take on the side of the lower abdomen during parenthood? If you or your partner is ovulation. Following ovulation, body taking any medication, temperature rises marginally. Also at Financially, can we consult your doctor to get ovulation, the cervical mucus becomes aor to rais a hil advice on whether it will an egg-white-like consistency, which is thin and stretchy, conducive for sperm Does my insurance likewise if you have a health penetration. Without examining the plan cover maternity mucus, the woman may feel that she is and newborn care? condition, for example: or a family history ‘wetter’. Accompanying the hormonal Do we have access to a changes, women tend to have a higher of inherited disease. By libido or sex drive at this time. good child care support consulting with your doctor system if I decide to on these health matters, you Some women may have vaginal return to work? and your partner will gain spotting following ovulation but it is knowledge and be able to important to exclude other reasons for Even if you have not increase preparedness to intermenstrual bleed if this occurs. thought about these take precautions or After ovulation, the second half of the questions before starting a necessary treatments during menstrual cycle brings on the usual family, you can use this to or post pregnancy. breast tenderness and bloating.

Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & &Child Child Guidebook Guidebook 9| 9 PLAN YOUR PREGNANCY

HOME PREGNANCY TEST

They are designed to tell if your urine or contains THE SIGNS OF a hormone called human chorionic gonadotropin PREGNANCY (hCG), associated with For women who have a regular monthly cycle, the most visible pregnancy, in your urine. sign of pregnancy is when you miss your period. In addition to the This hormone is produced onset of certain listed below, home pregnancy right after a fertilised egg tests kit are very accurate. However, you can be pregnant without attaches to the wall of a experiencing any of these symptoms: woman’s . You can purchase do-it-yourself ‘’ is a classic symptom though it can happen pregnancy testing kits from at any time of the day. It is a feeling of nausea with or without any retail pharmacies. vomit. If you are sick all the time and cannot keep anything These user-friendly testing down, contact your doctor. kits give you quick results and you can do the test in private and at your own Changes in your breasts – your breasts may become larger and feel tender, like they do before your menstruation. They may also tingle and veins may convenience. show up more, and the nipples may darken and stand out. To take the test, hold the test kit pointing downwards Headaches and dizziness due to increased blood circulation either in the urine stream caused by hormonal change. or dipping the stick into a cup of collected urine. The result windows on the Feeling tired. stick will show a control line (to show that the test is working) and the test result. Needing to pass urine more often Most test results show up as a line, plus sign or change There is an increased without any soreness or irritation. in colour, depending on the

Having a strange taste in your mouth – many women describe it as metallic. If you have a positive result on your home pregnancy test, you can contact your Develop aversion to certain foods or smell, and experience food cravings. blood test may be ordered or you may be advised by your Hormones natal appointment with an During pregnancy, your hormone levels change. obstetric and gynaecology As soon as you conceive, the amount of oestrogen (OBGYN) doctor. and progesterone in your blood increases. It causes the uterus lining to build up, the blood supply to your uterus and breasts increase and the muscles of your uterus to relax to make room for your growing baby.

1010 | Mount Alvernia Hospital Mother & Child Guidebook Boy Or Girl Every normal human cell contains 46 chromosomes which are tiny, thread-like structures. Each chromosome has about 2,000 genes. These genes determine your baby’s inherited characteristics, such as the hair colour, eye colour, blood group, height and size. A fertilised egg has one sex chromosome from the mother and one from the father. The sex chromosome from the mother’s egg is always the same and is known as X chromosome. However, the sex chromosome from the father’s sperm can be an X or a Y chromosome. If a sperm containing an X chromosome fertilises the egg, the baby will be a girl (XX). If a sperm containing a Y chromosome fertilises the egg, the baby will be a boy (XY).

Twins or More Identical twins are conceived when one fertilised egg splits into two. Each baby will have the same genes, same sex and look very alike. Non-identical twins, however, are the result of two eggs being fertilised by two sperms at the same time. The babies and most likely look no more alike than any other brothers and sisters. You may be carrying twins if:

You feel very sick in the early pregnancy stage

You are bigger than you should be for your ‘dates’

Twins run in your family

twins through ultrasound scan, which happens between eight and 14 weeks.

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DELAYED PREGNANCY AND FERTILITY

Many married couples HEALTH RISKS until they feel that Complications of an older mother. In one pregnancy stable to give their study, the duration was kids the best. Career From the previous reported to be 25% is the other commonly factors mentioned, the longer than in younger cited reason and given chance of spontaneous women due to advanced medical and (foetal loss required about two to prenatal care; most before 24 weeks of Reduced functional three times as often as in women can have a pregnancy) and activity of the uterus younger women and the healthy pregnancy and a (foetal loss after 24 rate is healthy baby even at an weeks of pregnancy) Less elasticity of the increased fourfold. advanced maternal age. are increased. The risk soft tissues of the of having an abnormal birth canal, and Complications after birth However, delaying foetus is also increased. motherhood has a Reduced muscular Postpartum haemorrhage of the increased risk and joint mobility is increased in older implications to women is due to abnormal mothers. It may be planning a pregnancy, genetic makeup in Abnormal position of the a result of greater which impacts their the foetus. Excessive foetus often necessitates instrumentation and spouses and their nausea and vomiting in the use of assisted/ operation required families. pregnancy, hyperemesis instrumental vaginal during birth. Coupled gravidarum, is also delivery and Caesarean with decreased elasticity more common in an section (also known as of the organ and the AGE AND older mother. The C-Section) delivery. blood vessels, it can CHANCES condition is often result in greater blood OF CONCEIVING attributed to the Signs of maternal distress loss. patient’s increased and foetal distress also There are approximately anxiety. tend to occur more It appears that two million cells in the often than expected ovaries at birth. Only There is also in the older woman. is slightly more common about 400,000 of the increased incidence Close monitoring of among older mothers. cells survive till puberty of pre-, the maternal and foetal However the condition and only about 400 of conditions is necessary. may be multi-factorial, those that survive until mellitus and preterm and age may play only puberty will be released labour. The risk of low As the perineum a small part in the at ovulation during a , placenta or and lower vagina do causation of depression woman’s lifetime. The previa is also increased, not stretch so well, in the puerperium. rest will degenerate. although there is no is often Another point to ready explanation performed and extensive However, as long as remember is that the for this. perineal tears are more the woman is in good quality of the cells that common. health before pregnancy, survive also deteriorates Complications she can reasonably, be with age which will of labour The net result of all expected to have a good increase the risk of The duration of labour this is that assisted/ obstetric and healthy Down’s syndrome. tends to be longer in instrumental delivery is pregnancy. M

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PLAN YOUR PREGNANCY

Congratulations! You Are Pregnant

Amidst all the excitement there are several things that you will want to do as soon as possible now, and T quick tips to get ready.

1414 | Mount Alvernia Hospital Mother & Child Guidebook tart planning for antenatal CHOOSING A care as early MATERNITY as possible. CARE Antenatal Scare is the care you PROVIDER will receive from healthcare professionals throughout your Finding a doctor by pregnancy. You will word-of-mouth is be asked to attend a common practice for series of appointments expectant mums. It allows with your obstetrician you to learn more about who will check that a friend’s or relative’s you and your baby are experience with that well, give you useful obstetrician, and they information about can also provide some being pregnant and non-medical insight such answer any questions as the doctor’s bedside birth, Caesarean, you may have. And manner. Other sources water births and if you have special of information that are home birth. Not all health needs, this is useful would be from a women are suited the time to let your clinic’s or a hospital’s for certain types of doctor know so that website. These websites delivery so there he or she can organise provide information such may be reasons for your appointments as a doctor’s credentials your doctor’s advice. and maternity care as well as previous accordingly. training and work experiences. management practices, Use this time to learn depending on their more about birthing When deciding on a work experiences and locations and to doctor who specialises professional guidelines. register for maternity in and gynaecology (OBGYN), However, if you about the various a mum-to-be (with her realise that you are services and facilities spouse) should consider not comfortable with several factors. It includes your OBGYN as your maternity hospitals. proximity to the home, pregnancy progresses, And, in your to-do list the hospital where they you can still change to include attendance to would like to deliver another doctor. Bear a childbirth education their baby, if the doctor in mind that you need programme. puts them at ease and if to have a copy of your the doctor has previous follow up records or Most importantly, experience in certain tests that had been you and your partner types of . done earlier in the should factor in These considerations pregnancy, so that considerations such as are essential especially if you can show the new personal adjustments, doctor these results. the cost of having medical problem of twin Some doctors may a baby, setting up a pregnancies. not accept patients nursery, a list of items who are late in their baby will require, Speak to your doctor pregnancies, as your early on to see if his or due date may clash and whether to bank her medical and delivery with other patients cord blood for future practice is what you are they are already health needs. seeking; such as vaginal seeing.

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birth, you will recover and a team of doctors CHOOSING in the same room before will monitor the baby’s A BIRTHING the nurse transfers you health each day. LOCATION to the general ward. Neonatal Intensive General wards Care Unit After you decide on an The neonatal intensive OBGYN, you should either single or multi- care unit attends to also think about where bedded room options. high-risk deliveries, Before you want to have your Each room is furnished resuscitation of the baby. Most women in with pleasant themes sick newborn, neonatal making a Singapore have their and cool colours to intensive care, well- decision, babies in a hospital. create an environment baby nursery care and However, there are for rest and recovery. follow-up. it is emerging trends that Single rooms have more important to some women are space and come with a Home discuss with choosing to give birth personal dressing table The trend for home at home. and a sofa armchair, your births is still relatively which can be converted new but is getting OBGYN Hospital into a bed easily if popular. The advantage and have Most hospitals today a family member or of delivering at home caregiver wants to is that you’re in a a full and private setting for lounge. The multi- comfortable and familiar understanding you to have your baby, bedded room comes environment. The with options as follows: with shared bathroom lack of proper medical of what is facilities and amenities. equipment poses a risk involved Labour wards Each bed has a privacy should complications curtain, a side table, These suites are all arise during delivery during the telephone, television single-bedded, each and potentially, a delay and a single seater sofa birthing equipped with foetal of care which could for visitors. process. monitoring and baby compromise your health resuscitation system along with that of your to closely detect foetal Nursery baby. Before making a movement and identify Your baby will be decision, it is important babies that require staying in the nursery to discuss with your immediate delivery. attached to your OBGYN and have a full Your partner can be maternity ward. The understanding of what an active part of the specially trained nurses is involved during the birthing team. After will care for the baby, birthing process.

1616 | Mount Alvernia Hospital Mother & Child Guidebook to worry about it. However, are pregnant and return to work PAY MORE putting too much or too little while they are breastfeeding. ATTENTION TO weight is unhealthy for you and YOUR DIET your baby. Be mindful of the During the early pregnancy period, desired weight gain required if your work situation allows it, for you and your baby. What you may want to adjust your job There is no magic formula you should work towards is a activities. You can pick it up again for a healthy pregnancy diet. steady weight gain, so that it is once you enter into your second Follow the basic diet principles easier to shed the kilos after your trimester when you will be less of a healthy balanced diet baby is born. Eating a healthy, nauseous and feel much better. that includes plenty of fruits, balanced diet will help your vegetables and whole grains. baby get the nutrients he or she Another point to consider is your While there are always seasonal needs and grow at a healthy rate. sitting posture at work if you have and festive foods, these should On average, a pregnant woman T be consumed in moderation. requires only about 300 healthy body will increase as the months go Although it is safe to eat most calories more a day than she did by, and you will need a seat where foods, there are certain foods to before she was pregnant. you can adjust the height with avoid. These include processed good back support and adjustable foods, raw or undercooked arm rests. A comfortable seating seafood and meat. area with a good back support is WORKING WHILE necessary as it makes long hours of PREGNANT sitting much easier and also helps when you get up from BE MINDFUL the chair. Going to work can be agony ABOUT WEIGHT especially if you have to deal Lastly, be aware of any chemical GAIN with morning sickness and you are exposed to at work and make sure that your place of However, being pregnant does work has the appropriate safety Pregnancy is the one time that not prevent you from working measures and practices to ensure you can put on as much weight and developing your career. minimal risk from falling or as you want and not having Many women work while they getting hurt.

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GET ENOUGH KEEP A REST AND HEALTHY SLEEP ORAL yourself sleeping more than usual during the There is good reason to pay attention to pregnancy. This is your dental care while because of hormonal pregnant. During changes and morning pregnancy, our teeth and sickness causing a lack of poor appetite. And your oral health can have the changes in your body to protect and nurture your developing child. the developing baby is another reason why you While you may not notice need rest. trimester, continue your and rinsing routine. If you are visiting your SETTING UP dentist, do let him know A NURSERY that you are pregnant so that no x-rays will be taken for assessment Designing and and any necessary dental furnishing a nursery procedures required for your little one can during your pregnancy be fun but daunting as will be done with caution. well, especially if you do not know where to begin. A bright nursery PLAN YOUR that is all white and full of natural light looks TRAVEL amazing. However, WISELY make sure that the brightness does not overwhelm and over Being pregnant should stimulate, otherwise not disrupt your holiday your baby will not be plans overseas. You can able to sleep. one that supports your onesies, leggings, tops, still plan for a vacation back during feeding bibs, hoodies, booties overseas as long as you Another essential and is big enough and so on. Baby are in good health and factor to consider is to provide relaxing clothes are too small to observe basic safety the nursery chair in support. put on coat hangers, precautions. Always the room. Whether you so drawers are much consult your OBGYN breastfeed, bottle feed, Storage is another easier for storing their or mix feed, you will necessity. Buy a decent- clothes, in addition to also check the airline spend a lot of time in sized chest of drawers storing diapers and policy about travel that chair, so make sure for your baby’s clothes all baby skincare during pregnancy. you get a comfortable – singlets, jumpsuits, products.

1818 | Mount Alvernia Hospital Mother & Child Guidebook comfortable with. However, otherwise discarded — and GETTING A it is equally important cryogenically stored for a CONFINEMENT to have reasonable fee at a cord blood bank. NANNY expectations of the nanny The blood, which is rich in stem cells, can make every pregnancy. It is normal type of blood cell and is The post-natal period is a to feel anxious since you retrievable if the child or special time for new mums don’t know what to expect. a family member develops to recuperate and rejuvenate T diseases such as leukaemia, from the pregnancy and you and the nanny, you lymphoma, immune delivery. However with a may like to consider a face newborn on hand, getting to face interview to assess disorders. the time and space you her personality, habits and need to recover is not easy. style. You can also use Some parents can also Having an experienced this meeting to state your consider storing the lining expectations and needs. of their baby’s umbilical helper and nanny, however, cord. This lining contains to whip up nutritious, Nannies who are not other forms of stem cells delicious meals and to look Singaporeans need to have after your baby can allow work permits, so if you have role in the ‘infrastructure’ you to get that much-needed engaged your nanny from formation in the human rest. an agency, do check that she body such as the formation of skin or muscle. While it may still be early Manpower (MOM) . It is advisable for you to consult your OBGYN or trimester, mums-to-be PRESERVING other relevant medical can start checking around CORD BLOOD professionals before among friends or pregnancy deciding on the type forums for referrals of of cord blood banking reliable nannies. The process takes blood that services and its service remains in the umbilical providers. When selecting a nanny, cord and placenta after pick someone you are childbirth — which is

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make when planning Bear in mind that from family and COST OF for a baby. You will additional out-of- friends who have had HAVING A have to factor in the pocket costs may be the experience of BABY costs of consultations incurred in the event costing for pregnancy. and prenatal should pregnancy and Experienced parents supplements. Most delivery complications arise. tips on how you can The whole new packages, usually from stretch your dollar experience of becoming the second trimester Set a while shopping for a parent is truly onwards, that cover budget for yourself and your baby. priceless and is one of routine check ups, shopping Save whenever you the many life changing 2 ultrasound scans to can. moments in your life delivery. With a wide variety that you will cherish of choices out there, Pro-family most. However, you will However, the package it is so tempting to go Initiatives also want to plan well usually does not on a shopping spree ahead to ensure that 3 include the cost for mother and baby you are covered; from of detailed scans, essentials. Set aside a There are many the price of diapers to certain screening budget for must-buy initiatives that the the medical fees for a tests or when your Singapore Government Caesarean section. doctor prescription of baby luxury items only has announced to certain medications or when your budget support your aspiration Here is a list to guide supplements. permits it. of setting up a family your planning as you and enabling a quality prepare to welcome a The next big-ticket Remember to set a life as your child new addition to your item is the hospital grows up. You can family. delivery package post-delivery expenses, get updates about the and the cost varies such as hiring a various parenthood Prepare an depending on the packages which estimate location of birth and baby’s one-month includes Enhanced 1 the birthing methods. celebration as well Child Development as baby’s medical Assistance, parental Prenatal and delivery the expenses using the checkups and costs are among funds in your Medisave vaccinations. Medisave grants for account under the newborns at Medisave Maternity http://heybaby.sg M you would have to Package. parent, get advice

2020 | Mount Alvernia Hospital Mother & Child Guidebook PREGNANCY CARE AND MANAGEMENT

How You and Your Baby Develop menstrual period of a presumed 28-day cycle, to the estimated due date. This is the common measure used by all OBGYNs to monitor baby’s growth and to make decisions about the timing of tests and intervention. So do not get confused when your obsterician says you are eight weeks pregnant and your hubby raises an eyebrow in bewilderment! It is in Week 2 that the baby was conceived and time when the body prepares for the pregnancy.

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baby, you may be overwhelmed and confused by the many changes that your body goes through. However, understanding these changes can help you face each new A day with a sense of wonder and anticipation. menstrual period, and assesses progress in terms of weeks. So let’s take you and your baby during this adventure. THE FIRST TRIMESTER WEEK 1 occurs. Baby is now a cell that is dividing in mummy’s fallopian MUMMY tube while making its way This is the start of the menstrual towards the womb. period and the womb lining renews itself by shedding. WEEK 4 WEEK 2

BABY Of the thousands of follicles that have been lying dormant in mummy’s ovary, one little follicle carrying half of baby’s genetic material now responds to the hormonal changes, rapidly growing and maturing. BABY The baby is now a clump of MUMMY cells called the blastocyst that The womb lining regenerates and gets ‘plumped up’ in in the womb and implants itself. anticipation of the arrival of The outer cells become the baby. placenta and derive blood supply from mummy’s womb lining. The WEEK 3 inner cells develop to become various parts of the baby.

BABY MUMMY The matured Following successful conception, egg extrudes a large amount of progesterone from the ovary is produced to support this in the process pregnancy. You may start to feel of ovulation. That fastest swimming sperm tenderness and engorgement. carrying the other half of You may experience very light genetic material from daddy bleeding at this time, or the

2224 | Mount Alvernia Hospital Mother & Child Guidebook implantation bleed, colour! Little buds the closed membrane which suggests menses, that will become the WEEK 8 layer that will become but the period does not arms and legs appear the eyelids. come. this week. The site BABY for the eyes and ears Fingers and toes are The baby’s head takes become evident. formed this week. WEEK 5 shape and tiny dimples

show the future location On average, the baby Baby now measures of the eyes and ears. measures about 3mm 17mm to 22mm and from the rump to the Little rays on the limbs weighs 2g. tip of the head. start to form and will MUMMY The digestive system starts to develop. If you do not believe the positive results from several home The tissue connecting pregnancy kits, a the embryo to the uterus visit to the doctor’s turns into an umbilical cord. Clusters of cells BABY The brain and the pregnancy via the that will become the backbone begin to take ultrasound scan! testes or ovaries appear. shape. The external MUMMY Many of your relatives covering also changes Hormones are rising The crown to rump now know that you and the process of rapidly, and you may length is now 9mm to are pregnant and creating the placenta start to experience 14mm. and the amniotic cavity some nausea. (which will surround MUMMY advice! There are the placenta) begins. Your appetite is varied opinions…‘no WEEK 7 behaving strangely now. pineapples or cold MUMMY You may feel hungry but drinks’, ‘no more You miss your period cannot seem to eat too BABY – it is brain food for and start to feel By the end of this much food. There may unusually tired. The be unusual cravings for the baby!’, and the list week, the basis for goes on. lower part of your your baby’s brain, food you never thought tummy feels bloated. blood and nervous you liked before. Some A home pregnancy odour (like when your What are you to do? systems are in place. You already have test will announce the Eyes, ears and mouth good news! starting to bug you! begin to form. many foods.

WEEK 6 Tissues that will form WEEK 9 It is essential that you the backbone, and the take into consideration abdominal muscles what your appetite begin to develop. BABY allows you to eat. If Your baby now has there is no nausea or The baby now vomiting, you should measures 5 to 7mm spontaneously. The start to focus on a in crown to rump thorax and abdomen good balanced diet. length. are entirely formed. But if ‘healthy food’ The lungs begin their only serves to induce MUMMY development. The heart vomiting, then it is not Your doctor tells you is now in the chest cavity the time to be fussy BABY the estimated date and beats strongly. about your nutrition. The embryo now looks of delivery (EDD) Remember that like a small ‘alien’! A and you can start The head is becoming whatever you manage primitive heart starts planning for your more prominent. The to hold down will be to pump, and there is baby’s arrival! eyes can be seen behind nutrition for

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and sex chromosome WEEK 12 aneuploidy. You will also know in 10 working days if you are going to BABY have a little boy or girl! The brain is developing fast, and your baby’s WEEK 11 head is the biggest part of the body. All the organs, limbs and BABY external genitalia Your baby will open are fully formed. Having completed time. Salivary glands organogenesis and vocal chords begin (formation of organs) to form. The eyes are also implies that baby completely formed, but is now less susceptible the membranes that will to external assaults like become the eyelids keep chemicals and drug them covered still. exposure.

Hands and feet develop Your baby is now your growing baby. genitalia begins to rapidly. The heart about 5cm from head T form. is beating strong at to rump and 7.5cm baby will not amount around 150 beats if the expanding to much when it cannot Your baby now per minute. legs are taken into be kept down! measures 3cm and consideration. weighs 3g. Your baby now weighs WEEK 10 about 10g. MUMMY MUMMY Congratulations! You Seeing your baby MUMMY have reached the end of BABY on the ultrasound The lower tummy feels Your baby, which was scan is an emotional increasingly full and an embryo up until experience! Baby is bloated. Not being able feel less discomfort. now, has become a starting to look like a to move your bowels foetus. ‘little human’, and you daily makes it worse. You are less nervous as can start to make out Your sleep is disturbed the doctor tells you that Baby’s framework is little hands and feet! by these discomforts the pregnancy is now made up of cartilage. This little one is going and frequent leg a lot more stable and T to be yours for life, and cramps. the risk of miscarriage bone cells begin to that just makes all the replace this cartilage. discomfort of early Your doctor tells you diminished. The bones for arms pregnancy worthwhile. that this is the time and legs begin to when the rapidly A risk assessment harden, and joints A possible test growing womb is now for Down syndrome begin to form. The for chromosomal called, OSCAR, is face and jaw are also abnormality, the exerting pressure on usually performed at formed. Noninvasive Prenatal the bladder and bowel. this time. Your doctor Testing (NIPT), can Lots of women at this runs some blood tests All of the vital organs be done by a simple time unwittingly drink and measures the are in place: heart, maternal blood test less water because they baby’s neck (nuchal lungs, brain, and at this week. This test keep feeling the urge translucency) to assess intestines. However, will aim to exclude to pee. Do note that this risk. If NIPT was they are all still Down syndrome, dehydration is one performed at 10 weeks, immature and will Edward’s syndrome, of the most common this is usually not develop further. The Patau syndrome reasons for leg cramps. necessary.

2426 | Mount Alvernia Hospital Mother & Child Guidebook THE SECOND TRIMESTER begins to take on WEEK 13 the role of blood circulation. BABY Your baby now Your baby is now able measures 10cm and to swallow and urinate weighs 45g.

All the vital organs MUMMY are formed and are After making do with functional. From now all the larger sized on they will grow in and loose clothes you decide it is time to go shopping for maternity MUMMY wear. This is the turning point that you have been waiting for. The WEEK 15 nausea left, and you are eating well again. You do not feel as tired and BABY light-headed and it is The neck is developed possible to resume some and the head is now exercises which also able to turn freely. help to improve energy levels. The lungs improve You notice some and there are tiny pigmentation or movements, darkening of the which are practices nipples, and there is for breathing. a dark line running down the tummy which MUMMY your doctor calls the The more experienced . Colleagues mummies can start to start to realise you are pregnant because you baby movements. cannot hide that bulge anymore! You are trying not to gain excessive weight now, as your appetite WEEK 14 is back to normal, or may be even better than normal! You BABY remind yourself to stay The placenta begins away from unhealthy proper function and high-calorie snacks like the umbilical cord cookies and chocolates.

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news is that it takes Doctor has advised knowing if it is going only three days for the you to keep your meals to be a little boy or a results to be out! light and not to sit or little girl helps so much lie down straight after in bonding with your WEEK 18 a meal. An baby, in your prayers obstetrician and good thoughts You can take a stroll throughout the day. Of after every meal – calculates BABY window shop for baby course, you can now Your baby now hears pregnancy start shopping for more sounds from the fresh air and blood external environment dates as well! Remember circulating in your legs after dinner. from the though that you may manner. first day want to recycle these If a loud noise is WEEK 20 of the last second child so don’t made near the menstrual just keep buying mummy, you may feel everything pink or the baby ‘jump’. BABY period, and blue! Neutrals are Hair begins to grow, assesses good too! Your baby now weighs and the teeth are now in about 250g. the jawbone. progress WEEK 17 in terms of MUMMY Your baby has a distinct You need larger sized and unique identity weeks. BABY bras! The breasts are Baby begins to hear! starting to enlarge are developed. The surrounding and get engorged. Colostrum may start At this time, baby is external sounds travel. to form and you notice At this time, mummy’s these slightly cloudy only about 12% of the heart, stomach and voice can be heard. your garments. This WEEK 16 However, these sounds MUMMY may not be interpreted Today is the by the immature brain T appointment for a at this time. with nutrients and detailed ultrasound BABY antibodies. scan. This scan aims Hand movements are to rule out serious MUMMY Your doctor WEEK 19 structural abnormalities is now able to clench such as heart defects, has scheduled skeletal anomalies. amniocentesis for mummies who are BABY The various organ assessed to be at high There is rapid growth The little buds that systems are shown to risk of having Down in size. Baby now will become adult you, and it is amazing measures 14cm and Syndrome babies. Your teeth start to appear to see the baby’s insides weighs 110g. partner and you should behind the structures as well! decide to go ahead that will form milk MUMMY with the test because it teeth. & DADDY WEEK 21 This is the if your baby is OK. MUMMY appointment you This procedure comes Although your have been waiting for. with a small risk of appetite is great, you BABY Your doctor will try to miscarriage and you still cannot eat as Hair appears. A downy identify the gender of may feel anxious about much as a heavy meal light hair called ‘lanugo’ your baby! the results. The good may cause heartburn. is in place to help baby

2628 | Mount Alvernia Hospital Mother & Child Guidebook maintain a constant to bleed if stools are not and exposing the baby your tummy and share body temperature. This kept soft and regular; to calming soothing the joy! hair will have mostly and congested vulva music may help those disappeared by the time giving an uncomfortable, sounds to register and WEEK 26 of birth. engorged or swollen provide a sense of feeling. security even after birth. MUMMY For those of you who Baby now measures BABY WEEK 23 During this week, have not started using 30cm and weighs 650g. your baby’s eyes will oils or creams to prevent begin to open and , you may even blink. If baby start to notice them on BABY were to be born your tummy, thighs and Your baby is producing now, there would breasts. and swallowing the be a 50% chance of around. This swallowing survival with advanced You probably heard neonatal care. from friends who went action sometimes results through pregnancy that in a cough or hiccups, which can be felt by MUMMY Baby now weighs they may fade after Your antenatal classes 850g. delivery. However, they you. They are transient, regular, almost pulsatile have started. You have usually do not disappear not attended any classes MUMMY altogether. movements, which can be mistaken for a for a while, but you are Leg cramps seem heartbeat. determined to ace this to appear more WEEK 22 class and pick up as frequently. This may many parenting skills as be due to circulation MUMMY you can! Baby is getting heavier changes and water BABY and that stretchy feeling retention. It could also The brain and all senses in the groin can be quite WEEK 25 be due to inadequate are developing very unbearable! Particularly water intake. Many pregnant women rapidly. Muscles are for mummies who have drink less water to getting stronger too, and delivered vaginally BABY avoid frequent visits Vernix is a white oily, before, the ligaments are to the bathroom, get your attention when creamy substance that now starting to loosen and this can lead to he or she want to! coats your baby’s body up, and there is a sore dehydration. wobbly feeling when and protects the skin The chest muscles are you are walking or when from being soaked in getting baby ready for you stand suddenly after T WEEK 27 breathing actions and sitting for a while. the lungs are maturing content with more urine day by day. This ligament strain input from the baby. BABY behaves like an old ankle The vernix will mostly Your baby opens eyes MUMMY sprain injury. Once it is dissolve by the time of periodically. Eyebrows You see some dilated stretched, the ligaments delivery but enough of and eyelashes are blood vessels on your are ‘weakened’ and it will help to lubricate in place! legs. These varicose prone to further injuries. as your baby negotiates veins are common the birth canal on the MUMMY during pregnancy as the way out. As you increase in pressure in the tummy WEEK 24 weight, and this hinders blood as they MUMMY & weight is mostly in the return from the legs to DADDY front of your body, the heart. BABY Both mummy and take care not to arch Your baby’s hearing daddy can now feel your back more and Dilated blood vessels is now developed and baby’s movements! more. This would also develop elsewhere, acute. External sounds Daddy can now feel result in muscle spasm such as piles, which tend can be heard really well the movements through and backaches.

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Posture is very THE THIRD important at this stage. Remember always TRIMESTER to encourage a slight forward pelvic tilt are practices by the and to pick things by WEEK 29 womb to prepare bending the legs rather for labour. They are than the back. usually irregular and BABY reasonably painless. WEEK 28 Your baby’s hearing has developed further and is approach, these now able to distinguish contractions may even softer voices. Baby’s become more frequent BABY heartbeat increases and intense. Your baby when mummy’s and now manages daddy’s voices are regular heard! WEEK 31 rhythmic breathing MUMMY movements. the third trimester and Little boys have their look forward to seeing testicles descend into your baby soon! the scrotum. As you begin to set Your baby measures up the nursery, it is 35cm and weighs important to be safe BABY about 1.2kg. when redecorating! Your baby’s movements Remember not to carry MUMMY heavy things and to space is running out. As your baby gets ensure good ventilation The legs are folded heavier, the weight in the house when at the knees, and the of the womb may exposed to fumes from arms are crossed, with compress on your new paint. the chin resting on the large blood vessels and chest. impede circulation back to the baby. As WEEK 30 If not turned around yet, baby will probably sleep sideways. The make this manoeuvre water comfortably BABY this week and get into Your baby is putting on position for the big is no worry about more fat to maintain move out through the ‘squashing’ the baby! body temperature at birth canal! birth. If prematurely born at this time, there MUMMY is already a very good As baby increases chance of survival. in size and stretch is felt all around, the Your baby now weighs diaphragm also gets 1.5kg. pushed upwards. This is felt as discomfort MUMMY just below the It is common to start ribs accompanied feeling some tightening by a sensation of in the tummy. These breathlessness. To are Braxton-Hicks relieve this feeling, contractions, which limit yourself to small

2830 | Mount Alvernia Hospital Mother & Child Guidebook meals to help minimise go before the big pop! the contribution of It is time to think about names! You plough stomach. Propping up in through all the books bed to sleep helps relieve breathlessness as this T helps the diaphragm stay your baby, a name down and keep pressure for life, a name to be away from the lungs. proud of! WEEK 32 WEEK 34

BABY BABY Your baby’s skin gets Most of baby’s organs less wrinkly, and the are mature, and the lanugo and vernix start lungs will follow soon. to disappear. Baby also Your baby tries to Your baby’s lungs are the bathroom more starts to get chubbier breathe but there is no mostly matured and baby often. This situation and approaches 2kg air, only liquid, and now weighs 2.5kg. and discomforts are in weight. baby gets bouts of similarly experienced hiccups. MUMMY MUMMY At this stage of pregnancy, trimester when You may feel more Head hair starts your tummy is probably the whole womb is tired now. Part of the to grow. most prominent. The exerting pressure on reason for this is the baby’s head will soon be your bladder. weight you have gained Your baby now engaged and you will feel since the start of your measures 43cm and ‘lightened’. Breathlessness WEEK 37 pregnancy and this is weighs 2.3kg. and heartburn will start to weighing you down a go away. little. If you continue MUMMY to exercise frequently Before baby’s head is BABY and stay active, this can engaged, the stretch WEEK 36 Baby has reached be controlled. On the and discomfort at full term! other hand, sitting down the ribs can be quite excessively will result in unbearable and sleep is BABY T early and severe water disturbed by a sensation Over the last trimester grown to the tips of retention, which worsens of breathlessness. This is of your pregnancy, your the weight gain and most severe at this time. baby has been taking in organs are mature. tiredness. your antibodies and will develop some protection Baby now weighs WEEK 35 from what you have 2.9kg. WEEK 33 passed on. MUMMY BABY The rate of growth You have made it to BABY This week, the slows down but baby full term! It starts to Although still premature baby’s weight gain is is still growing and now get really exciting as and a little weak, your considerable and will measures 46.5cm and baby is now fully formed feel snug in your womb. weighs 2.7kg. plans with your doctor. and with almost the You are careful to note same proportions as at Most of the protective the possible ways by birth. lanugo and vernix start MUMMY which labour starts to disappear leaving As baby’s head gets and take comfort in MUMMY & only a minimal coat for engaged, your bladder understanding the DADDY lubrication during the will feel the pressure and various options for Less than two months to birthing process. you will need to frequent managing labour pains.

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Understanding these changes can help you face each new day with a sense of wonder and anticipation.

WEEK 38 baby’s head to come Your baby’s wake encourages baby’s head down lower and and sleep rhythm is to descend and labour eventually through established and this to start. the birth canal. This pattern may continue BABY sensation makes you The bag is packed Your baby’s lungs slightly nervous. You of life. for hospital, and are ready to expand, feel that your baby all is ready. You are can ‘pop out’ any Your baby now now on high alert for developed, and adipose moment! measures on average contractions that are tissues are in place 51cm and weighs 3.3kg. progressively more under the skin for WEEK frequent and intense, temperature control. In MUMMY a blood stained mucus other words, your baby 39 & 40 It is a waiting game plug or show, or water now measures 50cm, from now. You may bag break. It is also weighs about 3kg and have started your important to monitor is ready for the world. BABY leave to relax at Your baby’s growth your baby is as active MUMMY continues to slow home arrangements as before! Pelvic ligaments are down as the placental to receive your baby. softening resulting in reserves start to run Do remain active and Good luck! You a stretchy feeling in out. As the baby’s ambulate frequently. It will soon begin the groin area. This metabolic rate slows, your journey into process prepares the as it avoids excessive motherhood! M pelvic bones to spread may relatively be water retention and apart allowing the diminishing. leg swelling. It also

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3234 | Mount Alvernia Hospital Mother & Child Guidebook Prenatal Care

There are a series of antenatal appointments that you have to attend. And during these visits, your doctor will check that you and your baby are well, give you useful information about nutrition and what to expect as well as answering any questions you may have.

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YOUR FIRST APPOINTMENT WITH YOUR DOCTOR

You will be given information and advice on nutrition and diet at this appointment. Your doctor will also discuss how the baby develops during pregnancy, the need for folic acid and calcium, your physical changes and a series of antenatal screening tests that are available as the SCREENINGS pregnancy progresses. AND TESTS It is also essential to let six weeks, the gestational DURING your doctor know if sac may be seen as a YOUR small white circle in the WHAT ANTENATAL There were gestation sac. The sac is IS AN complications from attached to the embryo VISITS IN previous pregnancy and it holds the nutrients ULTRASOUND or delivery to feed your baby at each SCAN? LATER development stage. The The ultrasound (also PREGNANCY You were treated for crown to rump (head to called a sonogram) high blood pressure bottom) length of embryo is a non-invasive or diabetes will be measured by your diagnostic test that In the second trimester, doctor to calculate your uses sound waves typically between 24 to There was a due date. Heartbeat is to create a visual 28 weeks, your doctor family history usually clearly detected image of your baby. may order oral glucose of any inherited by the time the embryo The scan also shows tolerance test (OGTT) disease such as reaches seven weeks. By placenta, and uterus, to check for pregnancy- Thalassemia this time, you will be as well as other induced diabetes. This able to determine if it is pelvic organs. It condition can result An ultrasound scan a singleton or multiple allows your doctor in overly large babies, is also recommended pregnancies, e.g. twins. to gather valuable information about health problems for you During one of your the progress of your and your baby. This test weeks (three weeks initial examinations, pregnancy and your measures your blood after conception), the your doctor may order baby’s health. sugar level when you scan may see a small blood tests to identify have fasted, and in two gestational (pregnancy) your blood type and Rh hours time, after you sac that looks like a (rhesus) factor, screen drink a standard dosage black space because for anaemia, check for glucose drink. immunity to rubella The scan is to identify (German measles), During the 35 to 36 whether the sac is and test for hepatitis weeks of pregnancy, properly implanted in B, syphilis, and HIV your doctor will take your uterus, to rule out and other sexually vaginal and rectal an . At transmitted diseases. swabs to detect group

3436 | Mount Alvernia Hospital Mother & Child Guidebook genetic disorders. Non- invasive prenatal testing (NiPT) can be done as early as 10 weeks, or OSCAR, a risk assessment test, can be Your appointments may become done at 12 weeks. Discuss more frequent as your pregnancy with your doctor on these progresses. Ultrasound evaluation options if you wish to do a of foetal growth is conducted during prenatal screening. every visit to check on weight and T conducted to check: REGULAR CHECKS The position of your AT EVERY baby and placenta ANTENATAL APPOINTMENT B (strep) Your baby’s growth bacteria. Although The nurse at the clinic and development group B strep can will weigh you at every be present in up to appointment to check 30% of all healthy your weight gain. Much mummies, it is the of the extra weight gain is Monitor your baby’s leading cause of life- due to your baby growing. threatening However, your body will heartbeat in newborns and can also be storing fat ready also cause mental to make breastmilk after retardation, impaired birth. Weight gain is linked vision, and hearing to quantity and also the Detect late onset loss. Mummies who type of food intake. During or presentation of test positive are pregnancy, there may be treated with certain cravings and while abnormalities during delivery to it is normal to eat more lower the risks of the than the usual, do eat baby contracting the sensibly, be attentive to at birth. Your what you should be eating OBGYN physician or and if possible, exercise. midwife may choose not to test for strep but Your urine and blood to treat you when you pressure will be checked are in labour if certain as well during each risk factors develop, appointment. The urine such as prolonged is checked for glucose . (presence is a sign of gestational diabetes) and albumin (presence of OPTIONAL protein may indicate pre- TESTS eclampsia), pregnancy- induced high blood pressure, or urine infections. There are optional See page 39 for more tests to help screen for information Down Syndrome and on Complications other chromosomal of Pregnancy.

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PREGNANCY CARE Changes during pregnancy Nutritional needs during pregnancy and after delivery REGISTER Back care and FOR exercises during CHILDBIRTH pregnancy EDUCATION LABOUR AND CLASS DELIVERY Signs of labour

Antenatal Education Pain relief in labour or Childbirth Stages of labour Education Class is conducted by a team of Breathing relaxation parentcraft specialists, techniques to cope physiotherapists and with labour dietitians to help prepare you for your Methods of delivery baby’s birth as well as for looking after and POST-NATAL CARE feeding your baby Care of mummy at home. It can help after delivery you keep yourself Bathing and care of pregnancy and give your newborn as more information about basic parenting skills.

Expectant mummies are encouraged to BREASTFEEDING th from the 20 week Infant feeding of pregnancy and daddies are strongly Importance of encouraged to attend breastfeeding & as well. The format bonding includes lectures, video shows, demonstrations o to gt o to and practical sessions. a good start in You will also learn tips breastfeeding on post-delivery care for you and baby. The Breastfeeding broad topics covered in positions and the class are usually latching on as follows: techniques How to manage minor problems in breastfeeding

3638 | Mount Alvernia Hospital Mother & Child Guidebook COMPLICATIONS OF PREGNANCY

Gestational Diabetes Gestational Diabetes (GDM) happens when glucose levels in the blood are higher than usual during pregnancy. A high blood sugar level can put the health of you and your baby at risk.

Gestational diabetes is diagnosed with a 75g OGTT during the second trimester. Risk factors for GDM include having a pre-pregnancy body mass index (BMI) of >25kg/ m2 Recommended Weight Gain During Pregnancy diabetes, a history of previous The maternal weight gain recommended during pregnancy is listed in GDM or large babies >4kg, the table below. and/or a history of poor obstetric outcomes usually Total weight *Ideal Total weight Weight gain associated with diabetes. GDM Body weight gain during Weight gain for 1st for 2nd & 3rd can also occur in women who lassiation pregnancy Gain trimester trimester gain excessive weight during the current pregnancy or have Underweight none of these risk factors. ( BMI 12.0 – 18.0kg 15.1kg 2.0kg 0.5kg / week < 18.5kg/m2) You can help control GDM by eating healthy foods, exercising Normal body weight and, if necessary, taking ( BMI 18.5 – 11.0 –16.0kg 12.7kg 1.6kg 0.4kg / week medication. Controlling blood 24.9kg/m2) birth and keep you and your Overweight baby healthy. Babies born ( BMI 25.0 – 6.0 – 11.0kg 10.2kg 1.0kg 0.3kg / week to diabetic mummies have a 29.9kg/m2) lifelong risk of diabetes and obesity. Obese ( BMI 5.0 – 9.0kg 7.6kg 0.5kg 0.2kg / week 2 Blood sugar levels usually ) return to normal soon after Table 1: Recommendations for Total and Rate of Weight Gain during Pregnancy. delivery. However, if you have Reference: Institute of Medicine (IOM) 2009 gestational diabetes, there is an increased risk of developing Excessive weight gain during pregnancy has an impact on the health of type 2 diabetes in future. Your your baby and can worsen blood glucose level throughout pregnancy. doctor will usually ask that you You may wish to discuss your expectations of weight gain with your repeat the OGTT six to 12 OBGYN. weeks after delivery to ensure that your blood sugar levels Losing weight through over-restriction of foods while pregnant can also are normal. harm the health of both mummy and baby and is strongly discouraged.

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High Blood Pressure And Pre-Eclampsia During pregnancy, your blood pressure will be checked at every antenatal appointment. A rise in blood pressure of a condition known as pre-eclampsia or pregnancy-induced hypertension (PIH). Your urine is also checked for protein at every visit, and if detected after the 20th week, this may be a sign of pre-eclampsia. Some of the symptoms of pre-eclampsia includes

Headaches some pregnancies, the placenta is located low Experiencing in the uterus and partly blurred vision or completely covers the or lights flashing opening of the cervix. before the eyes If the placenta is still Swelling of the low towards the end face, hands or feet. of the pregnancy, (condition is also known However, you can have as placenta previa), severe pre-eclampsia there is a higher chance without having any may happen earlier. It Placental that you could bleed symptoms at all. can also happen after problems during your pregnancy Although most cases childbirth. It is likely or at the time of are mild and no cause to be more severe if The placenta provides childbirth. The bleeding for concerns, it can the condition starts your baby with nutrients can be very heavy and sometimes be serious earlier in pregnancy. and oxygen. In a puts you and your baby for both mummy and normal pregnancy, it at risk immediately. You Treatment may start remains attached to may be advised to come the mummy (called with bed rest at home, the uterine wall until into the hospital at the but some women need your baby is born. end of your pregnancy the baby’s growth. admission to hospital However, problems if you do bleed so that It is life-threatening and medicines to can develop with the an emergency treatment if left untreated, lower blood pressure. placenta and complicate can be given very which is why routine Occasionally, pre- your pregnancy if not quickly. If the placenta antenatal checks are so eclampsia is one of detected earlier. is near or covering important. the reasons to deliver the cervix, the baby the baby early, either For nine out of 10 cannot get past it to Pre-eclampsia usually by induction of labour women, the placenta is be born vaginally, a happens in the third or by Caesarean implanted in the upper Caesarean section will trimester, though it section. part of the uterus. In be recommended.

3840 | Mount Alvernia Hospital Mother & Child Guidebook night. There are a where the acids from OTHER few theories why leg your stomach travel up COMMON cramps occur. It could to the oesophagus (the CONDITIONS be caused by fatigue tube through which from carrying your food travels from the AND pregnancy weight, mouth to the stomach), PROBLEMS IN compression of the which lies in the chest. blood vessels or nerves PREGNANCY in the legs, or changes A sphincter in the in blood circulation. lower oesophagus acts and can occur in any as a gate to prevent Backache cramps keep you up trimester. It is important gastric acids from at night – that’s when to exclude anaemia, escaping upwards. As your baby grows, the raised blood pressure, strain is on the joints exhaustion hits and During pregnancy, abnormal glucose hormonal changes of your lower back and levels and heart rhythm pelvis, which can cause becomes worse. make this sphincter irregularities as these backache. Avoid lifting need to be managed heavy objects and wear To prevent such attacks, try stretching your and medically treated. Heartburn is a calf muscles regularly If you do not have common occurence your weight to be evenly these, the most common distributed. At all times, and wear socks or and can happen in any supportive stockings. causes would be a low trimester. Nonetheless, try to sit with your blood pressure due back straight and well Get daddy to help to you can reduce the give you foot massages to postural changes, symptoms by watching supported and make under-hydration, a dip sure you get enough rest before bedtime and your diet, stay away prop your feet on a in your glucose level from food that is fried, – particularly in later (sometimes due pregnancy. pillow whenever you sour or spicy, as well as can. to irregular food intake) and tiredness e.g. Avoid lying down Pain in the heel Some research also inadequate or right after a meal. suggests that leg cramps poor sleep. Eat slowly. Instead of they don’t provide the are possibly related to taking three big meals, necessary arch support. calcium or magnesium If dizziness occurs, try As a result, you may develop plantar fasciitis most mummies who put your head between Prop yourself up (pain in the heel and are eating healthy your knees. Put your on two pillows, bottom of the foot). foods which contain legs on a pillow while or a higher one, these nutrients, such lying down will help to when resting. If the sandals, which have as in dairy products alleviate the feeling. If symptoms persist, straps that hold your and bananas, or you are in a crowded ask your OBGYN to feet in place and prevent supplementing, place with poor trippings. Better yet, should not be ventilation, move away medication. from the area. Taking that are round-toed More commonly, leg a warm drink will also Tiredness and low-heeled. The cramps are due to help. Having regular In the early months insoles should have a under-hydration. In meals and adequate of pregnancy, you supportive arch to help Singapore, due to hot rest is important during may feel tired or minimise discomfort and weather and dry air pregnancy and may even exhausted. absorb shock. in air-conditioned help to reduce the Towards, the end of environment, women dizzy spells. the pregnancy, the Leg Cramps need about 2 litres of degree of tiredness can You may experience water or more each day. Heartburn be more pronounced a sudden, sharp pain, This condition is because of the extra usually in your calf Feeling dizzy unrelated to any heart weight you are muscles or feet. It Dizziness is a common conditions. Rather, it carrying. Make sure is most common at symptom of pregnancy you get plenty of rest.

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IS THERE SUCH AS THING AS SAFE dermis of the skin. COSMETICS Initially reddish purple FOR in colour, these stretch MUMMIES? marks gradually fade with time, leaving T whitish or atrophic concerns about using lines. cosmetics in pregnancy or lactation as long as PHYSICAL & PHYSIOLOGICAL It is important to keep mummy is not allergic CHANGES DURING the tummy skin well to the product. So, moisturised and supple most should be safe, PREGNANCY throughout pregnancy unless they contain and not to gain an hidden toxic chemicals unusual amount of like mercury or heavy weight suddenly. This metals, which have Passing urine women show some will reduce the onset been reported in some often signs such as and severity of the unregulated products The urge to pass urine (dark splotchy spots on stretch marks. Not all from overseas. often may start in early the face) or new moles. pregnant mummies will pregnancy. Sometimes Your skin also tends get this as it depends it continues right to look redder due to on your skin genetics. through pregnancy as the dilated and more After your baby is the growing baby will engorged blood vessels. born, these marks increase pressure on should become paler your bladder. If you Other than breasts and and less noticeable. Avoid sitting or standing still for get up in the night, try retention and swelling Varicose Veins long periods of Sometimes, varicose time late evening, but make as well, which will veins or ‘spider veins’ sure you keep drinking revert to normal within as they are sometimes Prop up your feet six months of birth. It known, can appear when sitting the day. can also mean increased during pregnancy. This roundness in the cheeks. Elevate your feet is because blood vessels above the head for Facial feature are all engorged with Stretch marks at least half an changes hour each day Some pregnant These are pink or pregnancy. These mummies will notice purplish lines that bulging, bluish veins Keep weight gain facial feature changes usually occur on your are rarely a cause for under control concern, but they can – eg. the nose becomes abdomen or sometimes Try walking as be unsightly and even swollen and new moles on your upper thighs or much as possible. painful. appear. Hormonal breasts. It is related to This helps return changes in pregnancy the sudden distension blood to the heart. cause an increase in of the abdomen in Here are a few tips pigmentation. Nearly late pregnancy, which to keep these to Wear support 50% of pregnant results in disruption of a minimum: stockings

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4244 | Mount Alvernia Hospital Mother & Child Guidebook Healthy Pregnancy

Nutrition and a healthy lifestyle help to keep you well throughout your pregnancy and give your baby a good start in life. This chapter provides simple tips to

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and obese, you are pregnant. You should dairy products like NUTRITION at an increased risk also eat foods that high calcium cheeses, of several pregnancy have folic acid, like stemmy vegetables, A healthy diet is very problems, which green leafy vegetables, important if you are include gestational bread. You can also pregnant or trying to diabetes, high blood cereals and brown rice. take a supplement get pregnant. Eating pressure, preterm with 400 - 500mg of healthily during birth and Caesarean When you are calcium daily to make pregnancy will help delivery. Babies of pregnant, your your baby develop, overweight and obese developing baby needs mummies are also at calcium to build strong and energetic without greater risk of certain bones and teeth, to excessive weight gain. problems, such as grow a healthy heart, You don’t need to go congenital disabilities, nerves, and muscles. It on a special diet, but macrosomia with is needed to develop a make sure that you eat possible birth injury normal heart rhythm Always and obesity. and blood-clotting make sure types of foods every abilities. If you don’t day to get the right get enough calcium in you are balance of nutrients your diet when you are taking that you and your baby FOLIC ACID pregnant, your baby need. & CALCIUM will draw it from your hygienically bones, which may lead prepared The diet should be to bone loss. varied, healthy and Folic acid is important and well- balanced throughout for pregnancy as it A daily intake of cooked the day, coming from can reduce the risk of 1000 - 1200mg is food so that four food groups, neural tube defects recommended. A namely: rice or good glass of high you do not alternative staple If you did not take calcium drink like get food carbohydrates, fruits, folic acid before you vegetables, meat or conceived, you should milk or maternity milk poisoning. alternative proteins. start as soon as you would provide about If you are overweight 450mg. Add on other

4446 | Mount Alvernia Hospital Mother & Child Guidebook EATING FOR foods provide not only TWO? calories but also other essential nutrients. Examples of nutrient- dense foods include a Eating a healthy, hat ar th halth nts o balanced diet will chicken sandwich and eating durians during pregnancy? low-fat milk. help you provide your Is it true that they are a superfood? unborn baby with the How many ‘seeds’ of durian can a Try to minimise the nutrients to grow at a healthy expectant mum eat a day? healthy rate. Inevitably, temptation to load you will gain some Durians contain large amount of sugar and fats, up on ‘extra’ foods physiological weight so it is ok to eat them as long as that have calories but as your body ‘hoards’ you do not over indulge. Two medium sized seeds few nutrients such to nourish the baby. have about 60 calories, which makes durians as sugary beverages, sweet and high in calories. Pregnant mums with You will also need to french fries, fried gestational diabetes should limit the intake of foods and foods with eat well to support durians because of its high sugar content. This breastfeeding. extra fat and sugar. same concept applies to all other fruits with Instead, choose meals high sugar content. On average, pregnant and snacks that pack women with normal the most nutrition T studies about the per serving. Provide BMI before pregnancy are expected to gain pregnancy. There are also no studies that healthy calories to the about 12kg by the end say that it is unsafe to do so. daily intake by adding of their pregnancy. nutrition-packed While much of this snacks such as yoghurt, weight is the baby, nuts, a hard-boiled placenta, water bag egg, some fresh fruits or vegetables. enlarged breasts and calories during the uterus, some of the birth. If you eat extra Choose foods that are second and third extra weight is fat during pregnancy as close to their natural trimester to gain deposits and will stay and breastfeeding, the state as possible. For the recommended with you even after the feeding patterns and example, pick whole- habits are also hard to amount of weight grain bread or brown break so weight will throughout the rebound upwards once pregnancy. The truth bread or white rice, breastfeeding stops. is many of us already and fresh fruits or eat more than what frozen unsweetened is necessary daily, so fruit over canned fruits you may not have the additional need in sugar syrup. much appetite because is so easily met that of morning sickness. one really does not You should focus Therefore, it is not need to eat for two! on eating healthy surprising that you now more than ever may lose some weight. In addition to the because you are However, this should four food groups in providing nutrients not pose a problem the Healthy Diet for yourself and for the growing foetus Pyramid, you can your growing baby. because at this point, consider nutrient However, it is still the baby is about the dense foods in about balancing the size of a bean and between main intake and output. If requires very few meals, instead of you are at the gym calories. energy dense foods working out daily, you will be able to You will need an energy requirement. metabolise the extra additional 200 - 300 Nutrient-dense food intake.

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WEIGHT GAIN

The amount of weight gain in pregnancy varies among women and also between pregnancies in the same woman due to changing metabolic rate. If you start with a normal weight and are moderately sedentary, an appropriate weight gain is 12kg over the entire pregnancy.

If you have a low body-mass index before pregnancy, you should gain more weight how long or simple during pregnancy to KEEPING the routine is. Half an optimise nutrition and ACTIVE hour of walking each growth for the foetus. day is ideal. If you If you are already cannot manage that, overweight before It is easier to adapt to any amount is better pregnancy, exercise your changing shape than nothing. caution against and weight gain if gaining too much If you decide to go weight in pregnancy during pregnancy. It for exercise classes, as this increases will also help you cope try antenatal class risks of pregnancy with labour and get or make sure your complications such as back into shape after instructor is properly gestational diabetics the birth. Keep up your and big babies regular daily physical aware that you are activity or exercise pregnant and how far labour. (sports, dancing or your pregnancy has CAFFEINE simply taking a walk progressed. You might Weight gain should to the shops) as long as like to try swimming, AND be gradual and you feel comfortable. because the water will ALCOHOL can be achieved by support your increased maintaining a balanced Don’t exhaust yourself, weight. Some local These are to be diet with occasional, and remember that you swimming centres and not frequent, may need to slow down provide aqua-natal avoided during indulgences of sweets, as your pregnancy pregnancy. chocolates and progresses or if your instructors. And desserts. Carbohydrate doctor advises you to. remember to intake should also not Try to keep active on a drink plenty of water be excessive. daily basis, no matter to stay hydrated.

4648 | Mount Alvernia Hospital Mother & Child Guidebook MEDICINES

Some medicines, including some common painkillers, can harm your baby’s health but some are safe, for example, medication to treat long-term conditions such as asthma, thyroid disease, diabetes and AMPLE REST epilepsy. To be safe, you should:

Coping with physical Always check with changes to support your doctor or your pregnancy and pharmacist before trying to get some rest consuming any during your workday medicine can be challenging. Wherever possible, take Tell them you are short, frequent breaks. pregnant before Spending a few minutes they prescribe you anything or give closed and feet up can you treatment also help you recharge. Consider scaling back Talk to your OBGYN on activities to get more if you are already on rest when your work medication – ideally day ends. Aim for seven before you start to nine hours of sleep trying for a baby or every night as sleep as soon as o n helps boost the growth out you are pregnant, hormone much needed and; for growing the placenta and uterus. In a way, Avoid self- this growth hormone medicating and helps counteract many consume over the of the stresses of counter medicines pregnancy and ensures SMOKING as little as possible. foetal development during tough times. Medicines and Every cigarette you smoke harms your baby. It treatments that are In addition, lack of restricts oxygen supply to your baby, so the tiny usually safe include sleep and rest is perhaps heart has to beat harder every time you smoke. paracetamol, penicillin the most treatable There are approximately 4,000 chemicals present based antibiotics, dental stressor for expectant in second hand smoke, which are determined to treatments (including mums. You are stressed be related to cancer. local anaesthetics), out, so you do not sleep some immunisations well. Then you feel tired You and your baby are at risk if you are exposed and consequently worry to second hand smoke during pregnancy. injections) and nicotine about all the work that’s Some of the health conditions associated are replacement therapy. But piling up. That leads to a miscarriage, low birth weight, early birth, you should always check even more anxiety learning or behavioural disorders in your child, ON and worries. and Sudden Infant Death Syndrome (SIDS). before consuming.

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SKIN conditions will lighten and supple throughout in late trimester and after delivery, melasma pregnancy, which can can be prevented HEALTH on the face may delay the onset and by leg elevation, persist in up to 20% reduce the severity of compression stockings, It is not surprising of women. Avoid the the stretch marks. simple exercises and that pregnancy can sun and use sun block rest! that is at least SPF 30 There is also generally is the largest organ in whenever you plan thickening of the Some women develop the body! Many skin on being outdoors. hair in pregnancy, pregnancy related changes in pregnancy And lightening creams as the hair growth skin diseases, usually are ‘normal’ and may help prevent and cycle is prolonged. manifesting as itchy ‘expected’ and due to improve this condition. This results in thick red rashes, hives and pregnancy hormones. luscious hair which is eczema. A common Another very the crowning glory of condition is known One of the commonest common condition many pregnant women! as pruritic urticarial skin changes seen in is stretch marks over Unfortunately, this is papules and plaques most pregnant women the abdomen, butt followed by a brief of pregnancy (PUPPP) is hyperpigmentation and breasts. This is moment of hair loss which starts around or darkening of the related to the sudden following the delivery. the tummy and can skin. There is gradual enlarged size in It normalises four to six look like a very severe darkening of the pregnancy, which months after birth. skin allergy with nipples, genitalia, results in disruption an intense itch. An armpits and inner Other common skin important point to thighs as the pregnancy in the dermis of the changes include remember is that one progresses. On the skin. Initially reddish should seek medical face, it is very common purple in color, sweating of the skin, attention immediately these stretch marks swelling or of if there are blisters, brown pigmentation gradually fade with the legs and hands, and over the cheeks and time, leaving whitish enlarging skin tags or boils on the skin, as nose called melasma or atrophic lines. The growths over the neck, this can sometimes or the ‘mask of most important advice armpits and chest. be associated with pregnancy’. While most is to keep the tummy Varicose veins of the infections like Herpes of these skin darkening skin well moisturised legs are also common Zoster in pregnancy.

4850 | Mount Alvernia Hospital Mother & Child Guidebook Is it really safe to colour, perm or rebond your hair during pregnancy? What should you take note of when doing hair chemical treatment? If the chemicals touch the scalp, how will your unborn baby be at Current research suggest that the use of hair dyes and hair products is safe during pregnancy. The amount of exposure and internal absorption of TRAVEL By Sea the legs and can move chemicals from these WHEN If you are planning to to the lungs, which products during routine go on a cruise, go for a can be fatal. Wear personal use is very small PREGNANT large cruise liner which anti-thromboembolic and unlikely to cause any has a medical personnel stockings or stop once harm or problems for or a doctor on board in a few hours to the baby. The best time to travel stretch your legs. Also is in your second and some medical facilities. It is also keep well hydrated However if a woman is trimester. The nausea, and do leg exercises already allergic to hair giddiness and lethargy better to go for a cruise that stops periodically such as ankle rotations products, then she must to stimulate blood avoid these products will be reduced by then. at ports, rather than one that goes for days circulation in your legs’ all the time, even when Your energy levels will blood vessels. pregnant! be at its best during this without stops i.e. too far out in the ocean. This is period and the weight You must use a seat Some suggestions to in the event if you need of the baby is still not belt at all times, even consider include: too great to impose a hospital care. during pregnancy 1. Postpone any hair strain on your back and when the belt feels All cruise lines place treatments till beyond the restrictions on pregnant uncomfortable. The 2nd trimester. Limit the the safest time to travel belt does not compress as medical problems travellers depending on number of hair treatments their gestation. Some on the uterus nor your to one or two throughout associated with the third do not allow a pregnant baby and is crucial for the pregnancy. Consider trimester such as pre- woman to travel your personal safety. hair treatment or coloring eclampsia or preterm Place the lower belt to limited areas, rather labour do not occur onboard if she is more than 24 weeks, and under your baby bump; than the entire scalp. in most cases at this the pressure is harmless period. must disembark before 2. Minimise any direct she reaches 24 weeks to the baby. contact of the hair of pregnancy. Do check products with the skin. make sure you have no with the liner before By Air Wear gloves or seek medical complications booking your cruise. It is safe to fly during professional help. pregnancy, especially so far in pregnancy. 3. Use only high quality Get yourself reviewed By Land in the second trimester. products from reputable by your OBGYN Car trips are safe during Cabin pressures are not companies and use only before the trip. Bring pregnancy as long harmful to the foetus the recommended amount along some common as the roads are not and neither is natural of product. bumpy and along major atmospheric radiation meds or gastric meds, – the amounts are 4. Beware of ‘hidden’ towns, where access in case you fall ill with too little to cause chemicals even in to medical facilities is products that claim to these common ailments. readily available. Be any birth defects or be ‘natural’ You will also need a aware that prolonged abnormalities. or ‘organic’. letter from your doctor sitting can cause deep vein thrombosis, where Large planes have the trip. blood clots develop in cabins that are

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feeling very drowsy and tired, consider taking a nap and have ample rest before setting out for sightseeing. Drinking lots of water can counter the discomfort of jetlag.

Dress for comfort Those killer heels are definitely sexy but it is better reserved for showing off your post- birth figure. Sensible walking shoes that are pressurised, and this baby bump will make Plan a babymoon not too snug will be a pressure does not harm it harder to sit for long, destination with good choice. Choose the baby. In fact, you leg swelling gets worse, activities you can clothes that are light should avoid small and you will also have manage and easily layered planes (those with few an increased risk of like a cardigan or seats) that do not have deep vein thrombosis Extreme sports type of shawl. When you are pressurised cabins. (DVT). Try to keep the activities like skydiving, pregnant, you might be flight to less than four snowboarding or freezing one moment You can still travel by to six hours. Different whitewater rafting are and hot the next. Avoid air up to 34 or 35 weeks airlines have different probably best kept for restrictive clothing of pregnancy for short cut offs for flying specific post birth adventures. with buttons or zippers flights if you have no sectors; most do not This is not a great time around the waistline. medical complications. allow a pregnant mummy to plan a wine-tasting Instead, consider However, it is more to fly after 35 - 36 trip either! Shorter flights stretchable cotton uncomfortable as the weeks of pregnancy. All are safer than longer materials or those maxi airlines will require a ones due to risks of DVT, dresses that are comfy certification from your so destinations closer to and can make your doctor before they allow home are probably easier baby bump look stylish. you on board. to manage. Depending Choose your on mummy’s fitness level, trips that involve lots of Eat wisely destination While gastronomic BABYMOON walking and trekking wisely. Avoid may turn out to be experiences play a big punishing. Chilling out at part for many of us on going to a beach resort or driving vacation, your priorities Whether it is for a short around to sightsee may as a travelling pregnant countries getaway before the little be the break that you mummy would be where one arrives or visiting a need instead. finding healthy family member, travelling meals, and more medical during pregnancy can be Handling jetlag importantly, eating facilities are a little nerve-wrecking. upon reaching on a regular schedule. However, it is very Eating regularly and scarce or doable and can create destination supplementing it with are not well special memories for you Travelling across several healthy snacks that and your spouse. Here time zones and a change you bring along will equipped. are the main tips to make in your circadian keep your energy up your travel safer and rhythms can disrupt your and keep you going comfortable. sleep patterns. If you are throughout the day.

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PREGNANCY CARE AND MANAGEMENT

5254 | Mount Alvernia Hospital Mother & Child Guidebook Labour & Delivery

Knowing that you will be able to hold your baby in you arms is very exciting, though you may also feel apprehensive and anxious. Therefore, it helps to be prepared well in advance and pack what you need one month before your expected delivery.

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FOR MUM

Pyjamas or night dresses with front opening to facilitate breastfeeding Personal toiletries THE BIG DAY Non-slip bedroom slippers in the wards Nursing Bras Before your estimated date of delivery (EDD), your Socks (to be worn in the OBGYN clinic will arrange Delivery Suite) maternity admission Casual wear upon discharge booking for you. The Optional maternity unit will follow Sanitary Pads On the day of your letter on your booking and Breastfeeding (nursing) pads admission, you should admission information. have the following FOR BABY documentation with you Usually the hospital maternity packages will Two pairs of mittens NRIC Full set of clothes and a wrap Passport Hepatitis B injection for to go home your baby (during hospital (for foreign patients) stay only) if conditions Original marriage permit. However, you may rtiat or registration of your OBGYN clinic and your baby’s birth the hospital of your choice. rtiat The hospital will also Maternity provide a personal onration lttr toiletry pouch comprising Insurance card, shampoo, shower gel, doctor’s referral body lotion, toothbrush, letter, letter of toothpaste, comb, shower guarantee (if any) cap and face towel. However, you should still pack the following items:

5456 | Mount Alvernia Hospital Mother & Child Guidebook the uterus during IN THE WHEN TO pregnancy, dislodges GO TO THE and discharges from DELIVERY HOSPITAL the vagina. This small WARD amount of sticky pink mucus is called Regular the ‘show’. It usually The midwife will ask the baby’s position comes away before or contractions you about what has and record or listen to in early labour. There been happening so your baby’s heart and During contraction, should only be a little your uterus gets tight far and will examine probably do an internal blood mixed in with you. She will take your and then relaxes. the mucus. You may have had pulse, temperature how much your cervix and blood pressure has opened. These these throughout Your water bag your pregnancy – and check your urine. checks are repeated at particularly towards breaks Then she will feel your intervals throughout the end. Before The bag of water abdomen to check your labour. labour, these are surrounding your baby called Braxton Hicks may break before contractions. When labour begins. To you are having prepare for this, you regular painful should keep a sanitary contractions, labour towel ready with may have started. Your you if you are going contractions become outdoors, and put a more prolonged, plastic sheet on your stronger and more bed. If your water frequent. bag breaks before labour starts, you will feel a slow trickle The ‘show’ or a sudden gush of The mucus plug in water that you cannot the cervix, which control from your has helped to seal vagina.

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open to about 10cm baby’s head is crowned, IN LABOUR for your baby to pass most of the hard work through. Contractions is over. With one more There are three stages at the start of labour gentle push, the baby to labour. In the help to soften the cervix is born quickly and so that it gradually easily. The exception to gradually opens up opens up. Sometimes this is when the baby (dilates). In the second the process of softening is macrosomic and stage the baby is pushed can take many hours the body has grown down through the before reaching an bigger than the head so vagina and is born. ‘established labour’. the rest of the baby’s This is when your cervix body fails to deliver placenta comes away has dilated to at least easily even after the from the wall of the 4cm. head is pushed out uterus and is also – a condition called pushed out of Your baby’s heartbeat . As the vagina. will be monitored baby is detached from throughout the labour the umbilical cord The duration of process. Your midwife after a brief moment, labour varies between will watch for any you will be handed pregnancies and changes in the heartbeat your newborn to have between individuals. pattern. These changes skin to skin contact. Generally, labour can indicate that the The cord is cut by is faster with each baby is distressed and your husband or your subsequent pregnancy. the labour needs to be doctor. Your baby may The early phase of sped up or have the be born covered with labour can range from baby delivered as soon some of the white, half a day to two as possible. greasy vernix, which days, and the active acts as a lubricant phase (when there’s The second stage during the descent progressive cervical of labour – the through the birth dilation) can be as baby’s birth canal. short as one hour for When your cervix is those having their fully dilated, you will The third stage second/third child, feel the urge to and can of labour – the to an average of 10 start to push during placenta - 12 hours for those contractions. This stage After your baby is is hard work, but your born, the uterus will Normal progression doctor and midwife will contract to push out of labour in its active guide and encourage the placenta. Your phase constitutes a you all the time. The cervical dilation of other integral part of an injection, called 1cm per hour in the the cheer team is daddy! Syntocinon in your thigh just as the baby the intial 3 - 4cm. The delivery, this stage may is born. This is to help active phase of labour take an hour or more. It contract the uterus starts usually when the helps to have conserved after the delivery. cervix is 3 - 4cm dilated energy for this end stage The medication and the cervix has to takes a while to kick reach 10cm of dilation place! in so it need to be before you can start administered before pushing. As you bear down, the placenta is out the baby’s head inches to avoid unnecessary h rst stag o down until it starts bleeding, if the uterus labour – dilation to peek through from fails to contract as the The cervix needs to below! Once your placenta is expelled.

5658 | Mount Alvernia Hospital Mother & Child Guidebook APGAR stands for

APPEARANCE of labour, and but (colour/tone), contractions do not occur until a few hours later. In the PULSE active phase of labour, (heart rate), contractions are regular and increasingly GRIMACE painful. There are pain (response to relief options such stimulation), as Entonox gas, pain relief injections and epidurals. Epidurals are ACTIVITY (muscle tone/ of pain relief rfl rsons in labour and the medication does not RESPIRATION cross the placenta so there are no (respiratory ort your baby, unlike the intramuscular injection.

SPEEDING AFTER BIRTH UP THE LABOUR Immediately after birth, you baby will be weighed, Walking around wrapped in blankets to or climbing stairs, keep him warm. Apgar when the pain is still scores are taken and tolerable, is a good recorded at one- and way to expedite the process. Other options are medications that placed immediately on can increase the the ankle of your baby. frequency and strength In most cases, you will be of your contractions. able to hold and breastfeed These medications your baby immediately. are usually given via an intravenous route (through an infusion PAIN in your hand). Your doctor may order them MANAGEMENT if your labour has been abnormally slow, or there is a need to speed In the early phase of up your labour. An labour, the contractions example of this is when can be mild and your water bag has infrequent, and are usually been ruptured for too bearable. Sometimes, long, hence increasing the rupture of the water the risk of infection to bag indicates the start your unborn baby.

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CAESAREAN BIRTH (C-SECTION)

Emergency cases We hope that all our deliveries will be smooth, uncomplicated and done the natural way but unfortunately, things sometimes do not go according to plans. Certain conditions would require an elective Caesarean, such as a low lying placenta, two or more previous Caesareans, abnormal presentation of the foetus and many others. Assuming you do not have any of these, then there’s a potentially life-saving good chance that you and foetal-health will deliver vaginally. preserving procedure now would save you However, the situation a lot more than if may change during your baby encounters labour, when it may be problems during prudent to perform an delivery and needs emergency Caesarean, intensive care unit or such as when the develops problems in foetus is in distress or the future. when labour doesn’t progress, amongst Every year, 25 - 35% be awake during the may be given antibiotics others. Your good of babies in Singapore surgery and will not feel to lower the risk of doctor will have the are delivered by pain; you will not miss infection. unenviable task of Caesarean section. It making this call if the is a major operation, can probably hold your Most C-section situation arises calls for which can be baby right away, too. mummies experience it but remember, it is performed under tenderness around all done in the interests Compared to mummies the incision. If your of mummy or baby (where you are who have had vaginal OBGYN prescribes and sometimes both. completely unconscious births, your hospital stay painkillers to help, you Safety should always during the whole will usually last a day will probably be able to procedure) or regional longer. While you lie get out of bed and move anaesthesia (where in bed recovering, try around within a day or Most certainly an only the lower half of to exercise your legs to two after giving birth. operative delivery your body is numbed reduce the risk of blood Take it easy and avoid will cost more but if to pain). clots from developing strenuous activities; the you look at the bigger with prolonged pain will progressively picture, spending With regional inactivity. Depending subside over a few days a little more for a anaesthesia, you’ll on your condition, you if you do not strain.

5860 | Mount Alvernia Hospital Mother & Child Guidebook Vaginal soreness and immediate bonding Once a Planned (elective) Caesarean A Caesarean is after delivery is quite and breastfeeding after ‘elective’ if it is common and may the delivery. always a scheduled in advance linger for several weeks. Caesarean? before your EDD. In the acute phase The average length This usually happens of stay for C-section If you have days after birth, one is about three nights. because your doctor thinks that labour will may use a sitz bath The skin incision site by Caesarean be dangerous for you (warm water and sea usually takes about 10 section, it does not or your baby. salt) and ice packs to days to heal in the acute necessarily mean the perineum. That phase. Pain is usually that any subsequent said, vaginal birth has more acute over these births will have to RECOVERY a shorter recovery time be delivered this and less pain after can be managed with way. Vaginal birth DIFFERENCE the birth than those painkillers. C-section after a previous BETWEEN who have C-section has a longer recovery Caesarean can and delivery. This allows period and there is does happen. This VAGINAL for a shorter hospital also an increased will depend on stay, about 24 to 48 risk for longer lasting circumstances. AND hours. Mothers who physical pain after birth, CAESAREAN have C-section under particularly where the BIRTH regional anaesthesia incision is made and a will not compromise prolonged discomfort.

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give birth by Cesarean section.

Breech birth If your baby is breech, it means that it is positioned with its bottom downwards. This makes delivery more complicated and at risk. Your OBGYN will talk to you about the best and safest way for your breech baby to be born. Twins, Triplets Or More If you are expecting twins, labour may start early because of the expanded size of the uterus. It is uncommon for multiple pregnancies to go beyond 38 weeks. The process of labour SPECIAL care and attention at trigger natural labour. is the same but the all times. If your labour still babies will be closely CASES does not start over monitored. T the next couple of premature babies days, your doctor O Labour that will be transferred will suggest having been born, the doctor starts too early to the Neonatal your labour induced will check the position (premature labour) Intensive Care Unit of the second by feeling Infants are called (NICU) immediately most post-date babies your abdomen and after birth instead are born healthy, performing a vaginal 28 days of life and they of the usual nursery. overdue pregnancies examination. If the can be born full term Here the nurses are second baby is in a good or prematurely (before specially trained to higher risks. Some position to be born, the 37 weeks of gestation). provide care may show signs of waters surrounding the In most cases, labour for the need of the foetal stress which baby will be broken. The starts by itself, either premature neonates. mean the baby’s second baby should be with contractions heartrate does not born very soon after the or with the sudden Overdue react normally. breaking of the waters pregnancies Stressed out mature is now opened fully. If or a ‘show’. There (post-term) babies tend to poop contractions stop after are cases where the If your labour does in utero, and they contraction is induced if not start by your due may aspirate this at will be added to the drip the mummy is at risk as date, your doctor will birth or ingest the to restart them. Certain the pregnancy advances. presentation of the Very premature babies sweep’, which is a labour. Furthermore twin babies will require are safely delivered by vaginal examination, if the baby grows C-section for safer C-section. These babies to stimulate the neck too big, it is harder births. Triplets or more have very specialised of your uterus to to deliver vaginally. are always delivered by needs and require extra produce hormones to You may need to elective C-section.

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Your Newborn O T

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Activity (muscle tone) EXAMINATIONS *APGAR Limp; no movement SCORE After your baby is born, Active motion the nurse or midwife The Apgar Pulse (heart rate) will perform a physical (Appearance, Pulse, examination on your baby, Grimace, Activity, No heart rate in a crown to heel manner. and Respiration) score Fewer than 100 beats per minute All newborns look somewhat is a quick overall At least 100 beats per minute bluish grey at birth for the assessment of your to 10 minutes after birth, after birth, followed by No response to airways being suctioned their skin colour will turn Grimace during suctioning pink. Your baby is given a Grimace and pull away, cough, or sneeze health booklet where the if your baby needs during suctioning weight, length, and head immediate medical circumference at birth will attention. Your baby’s Appearance (colour) be measured and recorded. heart rate, breathing, The whole body is completely bluish-gray You should use the muscle tone, response measurements as a reference or pale for future growth. Good colour in body with bluish hands skin colour are assessed, or feet and a score of zero, Good colour all over You may be engrossed in one, or two is given to meeting your baby for the each area. The total Respiration (breathing) score is added, with 10 long hours of labour, but do being the maximum Not breathing Weak cry; may sound like whimpering, out more about newborn is often lower compared slow or irregular breathing care, the appearance of the to the second because baby and what you should the newborn’s condition of breathing be looking out once you and has improved with time your baby are back at home. or assistance. Asking questions and getting information from the nurses *The Apgar Score. Retrieved from http://www.babycenter.com/ as a new parent. 0_the-apgar-score_3074.bc

6266 | Mount Alvernia Hospital Mother & Child Guidebook What the Apgar scores mean eventually. Babies Your doctor can refer born prematurely or delivered by C-section, Apgar score to decide if for example, sometimes baby needs immediate have lower-than-normal medical help. If the scores, especially at one score comes in at minute. between seven and 10, it usually means baby is in good shape and does not need more than routine Apgar score post-delivery care. The second score helps your doctor If the Apgar score is see how your baby between four and six, is progressing and baby may need some whether he or she has help to breathe. This responded to any initial help can be suctioning medical intervention. the nostrils or massaging, A score of seven to or it could be giving your 10 is deemed normal. baby oxygen. If your If your baby scores baby scores three or less, he may need immediate minute mark, it means medical attention. Do medical help may be keep in mind that a low needed. Your doctor VACCINATIONS GIVEN AT score at one minute will determine the next does not mean that steps. BIRTH

BCG or Bacille Calmette-Guerin This vaccine protects your baby from (TB) disease. It is usually given to your baby soon after birth. A weal appears after the injection, but will disappear within half an hour.

nodule will appear and slowly increase in size within a week. From nodule stage, it develops into a small ulcer. It looks red and sore, but you need not worry about it as it will heal on its own. DO

area, apply ointment or powder. If there is a lot of discharge from the area, you can put a sterile gauze over it. Make sure the gauze is light and porous. By the 12th week, the redness and sore will heal, leaving behind a small scar.

prevention of tuberculosis, its protection is not absolute. Normal care and precaution against the disease should still be practised. Possible complications related to BCG vaccination range from an to enlarged regional lymph nodes.

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OTE NTONS

S T

T T

oination ains HEPATITIS B T S T AGE IMMUNISATION AGAINST BIRTH T 1 MONTH 3 MONTHS T T 4 MONTHS T T T 5 MONTHS T T T 5-6 MONTHS 12 MONTHS 15-18 MONTHS 18 T T MONTHS 10-11 T T YEARS O

6468 | Mount Alvernia Hospital Mother & Child Guidebook NEON T T ISSUES Jaundice T T If your child has i n T T

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NE ON SCREENING

taoli rning T S T N C M

Y CM MY CY CMY K O N SS aring sts EE S EE E

Mount Alvernia Hospital Mother & Child Guidebook

THE BABY IS HERE!

68 | Mount Alvernia Hospital Mother & Child Guidebook

T

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SN

N

S O T T S

70 | Mount Alvernia Hospital Mother & Child Guidebook TOUCH HEARING REFLEXES SIGHT Your baby is born with some reflexes. Rooting is a reflex that prompts your baby to turn in the direction of food such as the breast. If you gently FIVE stroke his cheeks, he will automatically turn in that direction and open SENSES his mouth ready to suck. Sucking is another reflex that helps your baby to eat and calm him down. You will notice this reflex when your baby is latched to your breast. When startled by noise or sudden movement, babies may throw both arms outward and cry. TASTE SMELL

SENSES During pregnancy, your Your baby also shows baby may kick or jump a strong preference in response to loud for human milk and Babies are born with noises and may quieten T Your T down with soft, soothing especially true if they are sight, hearing, T baby is smell, taste, and is fully developed in touch. However, not T or a bottle. comforted all the senses are pay quiet attention to by touch. fully developed. Your the mummy’s or daddy’s Your baby is newborn is nearsighted voice. And they will comforted by touch. Place your and can only manage Place your hand on hand on the distance between sound at a conversational your baby’s belly or your face and his face level begins. Hearing cuddling can help the your baby’s when you hold him in screening for newborns little one feel more belly or your arms. Newborns can be conducted while secure. Swaddling can identify light and you and your baby are your baby is another cuddling dark but cannot see all still in the hospital. technique used to help close can T him or her feel secure. many baby books and Studies have found S help the infant toys have distinct that newborns have a their babies comforted little one black and white patterns. strong sense of smell. when being carried Babies are able to follow Newborns prefer the in a sling or carrier. feel more or trace an object in the smell of their own Holding a baby secure. mummies, especially her for feeding is also his life. breastmilk. important.

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ON O

E CHANGING a sr o gt th si

N na orrsoning to or as ight T T S EEN N OON T E RASH T

72 | Mount Alvernia Hospital Mother & Child Guidebook BATHING O

raring or a

S T

raration or th ath E N laning as s

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S laning th ttos gnital ara olting th ath laning th face & hair laning ar o th ilial cord laning th o S S T S S

T T

74 | Mount Alvernia Hospital Mother & Child Guidebook EATING STESTON O EEN OTTES

T T METHODS YOU NEED STEPS T T tong S S T O T N S O NOT SO ET TES N TE SOTON

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IS IT TRUE THAT YOU COULD SPOIL YOUR BABY BY PICKING HIM UP SLEEPING CRIES? T CRYING

T S PLEASE HELP ME CHANGE MY DIAPER HOW LONG IS IT OK FOR A BABY TO CRY? T T COLIC T T

76 | Mount Alvernia Hospital Mother & Child Guidebook OON ss rni Causes: NEON SN SSES T N E S OTNE T T Issue 1: ral a T Causes: When to seek medical attention: How to care: T ss ils or s on a skin How to care: S Causes: T T How to care: When to seek medical attention: If there

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T N T When to seek medical attention: How to care: T When to seek medical attention: T When to seek medical If there are attention: N listrs or the rashes and you an s s collection in TNS Issue 4: Cord care th listrs TRIPLETS Condition: O OE you must ring th ss a rash a to s Causes: T medical How to care: The onsltation O E T N ET

78 | Mount Alvernia Hospital Mother & Child Guidebook OON ESTONS NE MUMMY SURVIVAL E

s it sa to t a ros of oil on your norns ars and naval? o to trat T as ril heat rash? What os na rash loo li an ho do you treat it? S N T o otn shol o h T formula does a you cut your as nails norn n T N ill inhing T or as nos a it sharr oint T s it sa or a N to sl in th S sa ith T you? T T o to ar or T as gnitals

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When should you Why is oral care Why is it let visitors hold so essential for iortant to r or a or a or a S S When can you la or a unattended? N O s it sa to gi sgar atr When can you or honey to norns gi th a N a soother or air S S Is it safe to use a tal or on or a

80 | Mount Alvernia Hospital Mother & Child Guidebook NOTES

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8286 | Mount Alvernia Hospital Mother & Child Guidebook N

T

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o BENEFITS noraging O mummies to rast ill hl to reduce health rols or th a ring th groing ars T

O

T S S

E T

8488 | Mount Alvernia Hospital Mother & Child Guidebook BENEFITS TE O O O ESTEEN MUMMY o to gt a orrt ositioning an a goo 1 2 3 S S O TO ET O TO OO STT N ESTEEN 4 S 5 T 6 T T E 7 O E O N STT TO 8 E ESTEE TE CAESAREAN BIRTH 9 E S S

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o to no i or a is lath on to th rast orrtl

T

o otn an ho long shol a nrs

E THE FIRST SLEEPY BABY E S o to no or a is gtting nogh il

86 | Mount Alvernia Hospital Mother & Child Guidebook GETTING OO S O EST

T E

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ONTS TO NOTE OT S NTTON EN O

ESTEE E

E TO STOE O EESSE BREAST T T N WARM UP T STES TO ESTEE T EN O O TO O O ON SO O ESTEE O OT OT EEOENT N ET T O O S to to ars or on

88 | Mount Alvernia Hospital Mother & Child Guidebook OEON ngorg rasts CHALLENGES Prevention or nils Prevention E E E Treatment E Treatment S

Mount Alvernia Hospital Mother & Child Guidebook | 89 THE BABY IS HERE!

THE TRUTHS EN s il is th SOE most natural milk and MYTHS th goonss is in its OT NURSING A oosition BABY

E E S Myth #3 Breastfeeding changes the shape and size of your breast. T T T Myth #4 Breastfeeding prevents you from getting pregnant. Myth #2 If babies feed frequently, that means they aren’t Myth #1 getting enough milk. Women with flat or inverted nipples cannot breastfeed. T go through growth

90 | Mount Alvernia Hospital Mother & Child Guidebook OON ESTONS

1. How does a new mummy deal with the pressure of being prepared to feed your baby on demand? I have heard that it is pretty tiring and emotionally draining. N

T 2. Will smoking artts at the quality of my breastmilk? Should I pump and dump too? EE S T O to

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T

6. Is it true that T eating spicy food a at rast taste? T S 8. How should a T new mummy avert negative remarks made by elders in the early days of breastfeeding when the milk supply is t s strss at your breastmilk supply? S T 4. Since my newborn 5. Will my baby is facing some get emotionally T issues with latching, atd y t ara it is making me or the bad mood I 7. How do you relax extremely anxious. am showing while I during breastfeeding What can I do to breastfeed her? and combat keep myself calm breastfeeding and collected so I boredom? can help my baby latch on properly? N

9296 | Mount Alvernia Hospital Mother & Child Guidebook

THE BABY IS HERE!

9498 | Mount Alvernia Hospital Mother & Child Guidebook Entering T

NO T

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Do not add an sasoning to or as oo igh salt content or stn oo an aag or as ins

T

EARLY OOS S T O N S First foods need to nl r the tongue ontaining onl on ingrint WEANING S T

96 | Mount Alvernia Hospital Mother & Child Guidebook ring r gtals and fruits are also grat rst T oos st Purees & Mashes ensure that the O or al consistency is four aning smooth and runny – easy to sallo ais ar as ais messy eaters T at r littl T cook your as oo in ig ortions an r into with sall srings n ath an T last you a T PROS CONS S O T O

N O S E T T

Mount Alvernia Hospital Mother & Child Guidebook | 97 THE BABY IS HERE!

Food safety r ar a tis checklist DiscardDiscar all Never use When Make When nnish ta atr sing a sure all ring a oo to rar iroa a oo as Bacteria 2as 3to heat 4containers 5oo on from saliva oo s oo ar ath an and the oil alas stir hthalat srroning atr th r and lead to to areas can insta to avoid hot r s contaminate sots or as oo

Foods to avoid

REASON WHEN IS IT SAFE?

S S

S N S o to thr T meals r a or inants si to ight onths o ag Three to four meals r a or infants nine oo llrg to 23 months o ag

98 | Mount Alvernia Hospital Mother & Child Guidebook ET OEOOE EES O T S

SEET OTTO EE SE OONESS S S

NEENTS NEENTS ETOS ETOS 1 1 2 S 2 3 o an tr th olloing altrnatis 4 S

o an tr th olloing altrnatis ggis Fruits: Grains:

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ES OE O ES EE OONESE S S

NEENTS NEENTS ETOS 1 2 ETOS 1 3 4 2 3 5 S 4 thr ingrints o an tr 5 6 S

100 | Mount Alvernia Hospital Mother & Child Guidebook

OE E S E EN NET S S NEENTS NEENTS ETOS ETOS 1 1 2 2 3 3 S 4 4 5 T 5 6

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ON FUSSY EATERS

O

HERE ARE FEW TIPS YOU CAN USE:

MAKE IT MIX ADOPT FUN IT UP NOT PUNISH ROUTINE

E S E

102 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook O S IMMUNE SYSTEM EOES

O T Nutrition N Immunisations S T T l S

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 103 THE BABY IS HERE!

RELIEVING BABY’S STRESS WHEN VISITING THE DOCTOR

It is perfectly reasonable for a child to be frightened or anxious during doctor visits especially when he is already feeling unwell or when there are vaccination injections involved. Very young babies don’t usually present

six to nine months of age, they start becoming aware of new surroundings and strangers so it

avoid anxiety entirely. Admittedly, some children do not take to we tell them and they new people or places feel more secure in the too well, and parents long run. just have to do the best they can. Here Avoid rushing. Arrive are some strategies to early at the clinic, so reduce the child’s (and the child has time to parents’) anxiety settle down. and fear: Distractions help Honesty is the best because they give the policy. Tell the child kids something to do beforehand what is while in the waiting going to happen. room. demeanour will bring Often, the unknown the child’s emotional is more frightening. Most importantly, state down to match Being up front with parents need to be the parent’s calmness. children who are calm and neutral toddlers and older is when the kids are When kids cry best. A nasty surprise already distressed and are frightened for an unprepared during a doctor visit, child just sets things our emotional state. remember that it’s up for future distrust Vigorous and frantic common and normal. and fear. Let them Most kids outgrow the know what is going crying child may result on. This will teach time they are two to them to trust what Instead, a steady three years old.

108104 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook Why is this not aisal

What should arnts o insta T NOT os this also al TO O to rast ais EN O S S MISTAKE 2: MISTAKE 3: BABY A COLD BATH WHEN BABY HAS MISTAKE 1: WHEN SHE HAS WHEN BABY HAS A HIGH RAGING THE COUNTER HER UP WITH A BLANKET TO Why is this not LET HER ‘SWEAT aisal hat ar th angrs o oing Why is this not hn to orr IS COMMON this? aisal an th angr signs to look out for MANY OLDER- GENERATION T Why is this not aisal hat ar a has a r th angrs o oing hat shol arnts this? do instead? When songing a hat ar so tis to songing a rish a rorl n hat instans is it oa or arnts to hn a has a has a gi r s r hat ar th r hat shol stos arnts o insta o oring hr ith a lant s it aisal to lt a ar long sls MISTAKE 4: an ants hn sh WHEN BABY HAS is feverish? SHOULD CONTINUE

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 105 THE BABY IS HERE!

OTO SS

T S HAND EYE HAND HAND COORDINATION COORDINATION T

IN HAND TACTILE POSTURAL MANIPULATION PERCEPTION CONTROL the other

106 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook T 12 months: T S S T i 3 months: S ii 4 months: iii 5 months: T irnt tros 7 months: S T 9 months: E 10 months:

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ACTIVITIES O

0 - 3 months old

4 - 6 months old 10 - 12 months old E

7 - 9 months old O

108 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook ACTIVITIES O TOES

T i ii T T iii S

S S S S

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 109 THE BABY IS HERE!

SLEEP the HELPS growth T N O with S OT beginning of Getting enough S T S

TS TO E O SEE ENSURING A SLEEP E not be getting enough

110 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook T TRAVELLING WITH NO T ling E aing is O E aing to ol oa ris country aing tos T or oa ri E T T S T T

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 111 THE BABY IS HERE!

a tr st ar them keeps them comforted and settles them down easily, particularly at bedtime in a strange place. Hydrate and if their mosturise S o st ho O T of

112 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook MUMMY’S HEALTH

Staying healthy during your pregnancy does not stop even after childbirth. Continue to stay healthy and keep well afterwards so that you can care for your little one and enjoy parenthood every step of the way.

If you already have a pre-existing medical condition, pay special attention to your personal health so that you remain well after childbirth.

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 113119 MUMMY’S HEALTH

YOU CAN STILL BREASTFEED IF YOU ARE ANAEMIC

iron stores laid down in utero and by the high lactose and vitamin C levels in breastmilk, which facilitate iron absorption.

ol it at th ntrints in rastil i th is anai No. Breastmilk is amazingly homogeneous in uses the iron that is available to make the milk. While breastmilk has less iron than formula baby is unlikely to become anaemic during the POSTPARTUM blood during childbirth, CONCERNS had twins or other ol rasting orsn th s multiple births. anai onition Lactation demands maternal nutrient stores of Anaemia With the increased energy and nutrition food intake. Breastfeeding The period after awareness around will not worsen mummy’s anaemic condition folic acid, anaemia in if she consumes high iron foods such as lean giving birth can be a meat, poultry, green leafy vegetables and takes fascinating experience pregnancy is becoming drinks high in vitamin C to help the body to for new mummies. less common, but folate absorb more iron. It helps to rebuild the iron However, they are also store to support her optimal health and sustain at risk for postpartum second most common adequate energy. Otherwise, the iron stores anaemia if they were cause of anaemia. If in her body will be depleted and worsen the anaemic during the left untreated, low blood anaemic condition, then she may need to take third trimester of count predisposes the iron supplements with a doctor’s advice. pregnancy, lost a postnatal patient to postpartum infection ol anaging s on atig especially to iron in an rasting orsn ostnatal ls infections and poor Breastfeeding mummies need support, wound healing. It may encouragement, reassurance and help from result in inadequate milk the family, community and employer. Anaemic mothers get tired easily and need help with their Fatigue and breastfeeding. daily chores, caring for the baby so that they exhaustion, have more rest and less stress. beyond the The best way to prevent anaemia is to make sure hat an is o to o ttr an usual feeling you have a balanced diet sssl in rasting of tiredness rich in foods that are high Eat a well-balanced diet with a variety of foods in iron, such as red meat, and drink enough to quench their thirst to expected of support optimal health and ensure well-being. t firstt wholemeal bread, eggs, Try to get rest in between feeding and when the green leafy vegetables, baby is asleep. y t dried fruits and oral iron a r supplements. Vitamin C, are clinical from oranges, lemons, supporter of breastfeeding, particularly when limes and raw vegetables, they have a positive mind-set relating to syts helps the body absorb breastfeeding. Getting daddies to help in infant aaa the maximum amount of care and be there always for emotional support iron from your diet. is important to the new mummy’s feelings of adequacy and mental well-being.

120114 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook rssion attacks, reduced libido, relatives and friends can happen to some Childbirth brings hopelessness and can recognise warning mummies. The suicidal thoughts. The signs and symptoms usual cause is the and physiological depressed mood leads and intervene early. drop in hormone changes in a woman’s to a lack of interest in Many hospitals today levels – Prolactin and life. These changes all activities and being also have excellent Oxytocin. Prolactin, could compound unable to cope with programmes to the hormone that anxiety, stress and daily routines. support women who stimulates milk worries during are struggling with production, helps the pregnancy that may Simple coping new motherhood. lactating mummy to increase the risk techniques for depressed There are more feel calm and relax. of depression after mummies include support groups, help T delivery. If there was a getting enough rest and hotlines and forums also from Oxytocin, family member who had sleep, having a balanced where depressed the hormone released mental illness before not diet and exercising mummies can connect while breastfeeding. limited to depression, regularly. Try to get as with other mummies The faster the rate it predisposes a new much help with the baby who can empathise of weaning, the mummy to the risk. as possible. Emotional with sleepless nights more abrupt the support and reassurance and inconsolable shift in hormone levels, the more likely The warning signs could from spouse and family crying. They also the new mummy be extreme fatigue, as well as allowing the share happy tales of will experience sleep & eating disorders, depressed mummy to agitation, irritability, express herself and talk smiles. Mummy with a depressed mood, about her feelings, is another technique. history of depression sadness, insomnia, ostnatal before is more low self esteem, guilt, rssion Fortunately, with likely to experience poor concentration, ring aning depression after heightened awareness tearfulness, increase While this condition weaning. anxiety and panic of depression today, is not common, it

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 115121 MUMMY’S HEALTH

rgnan alth onitions hat ill o a tr hilirth

stational iats If you have gestational diabetes during your pregnancy, there is a high chance the condition will go away immediately after the childbirth. This condition is only true if your diabetes was controlled with a ntion Caesaerean incisions the baby well on her strict meal plan and Postpartum infections are that usually breasts. Ensure your regular exercise during occur after delivery, heal with little or no baby latches well to pregnancy. You should whether it is through problem, but it can be prevent sore nipples. continue to check your vaginal or caesarean infected if the wound Applying many layers blood glucose levels for at birth. While it seldom does not heal properly. of breastmilk after least several days to make Infection occurs if the feeds helps to soothe sure your sugar level is happens, it may be within normal range. serious if it does. skin around the wound the pain and heal the Clinically, the most is not cleaned properly nipples. or if the skin is rlasia an dangerous infection lasia would be sensitive to the wound Mummies with covering. If infected, One of the biggest risks – infection of the may develop of gestational diabetes endometrium or inner the skin around the a , chills, cold wound will appear red, is developing pre- lining of the uterus. eclampsia, a condition Symptoms varies swollen and painful. with body aches. It is Wound infections that raises the blood depending on the advisable to consult pressure. It could develop extent of infection. can cause fever and a lactation nurse or into eclampsia which They may include fever, you should contact see your OBGYN causes seizures. It is only enlarged and tender your OBGYN if the for antibiotics that by delivering your baby uterus, anaemia due symptoms appear. are safe for lactating that you can eventually to excessive bleeding mothers. Mummies recover from pre- from the vagina, and astitis with mastitis can eclampsia. Your doctor in extreme cases, This is a condition continue to breastfeed will be able to perform severe may even when bacteria their babies. If left the necessary tests to lead to multi-organ enter the breast untreated, it will detect the presence of failure. Fortunately, these complications and while breastfeeding. develop into a breast determine the baby’s endometritis can be Nipples may become abscess, which will well-being and advise treated successfully cracked or sore from require further you on the appropriate with a simple procedure breastfeeding. Cracked intervention by a course of treatment to where the uterine cavity nipples are common breast surgeon to be undertaken before is cleaned (evacuation in the early days drain the pus. childbirth. of the uterus) and of breastfeeding if antibiotics. mummy is not latching

122116 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook A few of the common breastfeeding, most means eliminating or WEIGHT DIET TRAPS are listed new mummies will minimising distractions. MANAGEMENT below: experience some weight Tune in to your meal, loss during this period. 1 You feel you have Focus on providing temperature, texture Looking pregnant even good nutrition in the and taste. Focusing on after childbirth can be t s t atr giving birth, so you form of healthy foods your meal enables you disconcerting, but it is to your child and to listen to your body’s a dt normal. Some get back in yourself. You can start cues of hunger and shape faster while others New mummies who are to lose the postnatal feelings of fullness. In take a longer time. If you breastfeeding should weight once you have order to have such a are on a mission to get NOT go on any calorie luxury of time, as a new back in shape, it is always restriction diet because breastmilk. mummy, you can either tempting to go on a crash higher nutrients are plan your meals around diet. While a rapid weight required by lactating *Breastfeed for The Best your baby’s nap times or loss can bring noticeable mummies. According Start. Retrieved from ask someone to tend to results within a short time, to the Singapore’s http://www.hpb.gov.sg/ your baby while you are HOPPortal/health- it can impact your physical Health Promotion having your meals. health and well-being. Try Board*, energy needs article/5498 adopting a gradual weight- for lactating mummy 3 loss approach instead and could be as high as 2 While having your ad s set realistic targets for your an additional 500 a y d t foods thinking that weight loss. It requires calories. And any ay at t sa ty ar ad r y patience, but you get better nutrients a lactating t ad s d ss results in the long run. mummy consumes will You end up eating t rary be absorbed by her dssy ad trts baby too. The good ry aa atr The key to healthy news is that because of To eat mindfully is eating is to have the increased energy to eat with intention balanced meals from requirements during and attention; which the four food groups

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 117123 MUMMY’S HEALTH

EXERCISE How soon after giving birth can you start jogging and doing sit-ups and crunches?

It depends on your mode of delivery and if there were any hn an complications during childbirth t on on which include rice that require a longer recovery. als and alternatives, A general rule would be at least vegetables, hang or six weeks after giving birth. Breastfeeding fruits, meat and diet attitude After birth, you can start pelvic may help you to alternatives. Practise moderation when onntrat on incontinence whenever you feel lose weight too. aing halthir Be cautious about consuming ‘not so ready. It is helpful to strengthen hois rathr the muscles before abdominal dieting during healthy’ foods, for than oltl example, limiting exercise to reduce the likelihood breastfeeding, as aoiing or of leaks during exercise. poor nutritional deep fried foods to aorit oos intake will twice a week. If you had a Caesarean section, reduce calories ratis inl it will take longer to recover. in the breastmilk. ating hn haing Tiredness and abdominal Instead of cutting or aorit soreness will be common. After down on meals, o ast oos six to eight weeks, you can take eat a healthy shol los up exercise other than walking. balanced diet. ight os on saoring Walking is a good way to start Remember that or oo weaning your body into exercise your body needs t is st to gradually. Avoid sit-ups and time to recover los ight at a stalish flil aerobic exercise, at least until and is normal orat a shorttr it that it takes osing ight at a attainal goals have recovered. Strenuous months to return or rai rat is exercise may strain your pelvic not norag as a roo or to your pre- or aorit pregnancy weight. it a an that incontinence or prolapse if o a rgain th oos t onl started too soon. lost ight il oasionall an in as ll sall ortions

124118 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook BIRTH Family life brings psychosocial needs of challenges and T SPACING As a general compromises, but notion of having a indescribable pride brother and sister to guide, and joy! In building a share your love and The spacing of births OBGYNs family and planning for attention as well as depends on the additions, work towards space and possessions mummy’s age, the encourage achieving a balance may not appeal pregnancy, delivery, between your personal social and family t goals, having a family, especially when your support. Another being there with your toddler is already used consideration, which is t children during their to getting your full often less considered, is tr ay growing years, and most attention. your personal goals and before importantly, spending career aspirations. time with your partner. Some couples a consider a smaller hiing alan ling or gap between children At times, it is rstorn aat if they have a good For young mummies, support system and if challenging to cope; A good juggler is one time is on their side. work demands are who will be honest Hence a good gap and delivery were always in motion, and about priorities and feels maybe three years or uncomplicated. A happy with the amount so. At this age, their are endless mummy toddler would be more is little rivalry and duties. And there is that she can put into independent, have attention sought by also the desire to climb a day’s work without verbal abilities and the career ladder taking work home. As social skills developed there is a sibling on which sometimes, can she steps into her own at playgroups or with the way before the outweigh the need to sanctuary, the feeling family and friends. spend quality time is that of bliss and that There is also less of of self and needs. with the kids. Couples home is where all her a need to carry the This choice may be stop talking to each loved ones are. toddler while pregnant a necessary one for other other, apart from with the second child. older mummies as a their children’s needs And there’s the ‘me’ Straining can be higher maternity age and occasionally, it time. Couples that dangerous as there is a means a higher risk of could escalate into an support each other to risk of miscarriage. medical complications argument over minor have ‘me’ time as well during pregnancy as issues. That feeling Besides physical well as chromosomal nights will continue to considerations, there abnormalities in discourage them from be loving and close-knit is also the need to babies. having more children. as a family. be aware of the

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Start pregnancy again on a right note It is important for mummies who are planning another pregnancy to be very disciplined and motivated to recover well from a pregnancy. For mummies who are already overweight from a previous pregnancy, stricter diet and exercise regime is necessary to lose the weight gained during pregnancy. For a mummy starting pregnancy at a normal body mass index, an average of 12kg gain during a pregnancy is normal. However, if the weight gain from previous pregnancy is not lost, the next pregnancy means more weight and increasing the risk of obesity. So it is useful to bounce back to normal weight if a pregnancy or the young baby. Any vaginal birth, she may after each pregnancy delivery is complicated. pregnancy will pose be advised to deliver and start the next on This is true for both a physical stress and her next pregnancy the right note. Caesarean as well strain, and the rigours by C-section. In this as vaginal birth. A of a delivery followed case, the same timing If there are pre- traumatic vaginal by the needs of the and interval above existing medical birth with tears and newborn will render applies. conditions like heart the new mummy tired disease, thyroid disease, may require even The emphasis here diabetes or epilepsy, more time to heal than time between each really is that there is chronic medications an uncomplicated pregnancy allows no hard and fast rule. may need tweaking C-section. mummy to focus on The ideal interval and allow conditions to recuperating, resting for each couple to stabilise before it is safe Typically, another more adequately so space their pregnancy to start a pregnancy. pregnancy can be as to prime her health should be discussed attempted soon with all the factors after delivery and pregnancy. Ideally, an in mind. In general, The right breastfeeding. Even interval of two years after each pregnancy, i nterval for an uncomplicated before trying again it is good to have The decision for C-section, getting should be considered a discussion with the interval is also pregnant again six unless mummy’s age is your OBGYN about dependent on the months after delivery already advanced. when it would be type of delivery from does not increase risks appropriate to have previous pregnancy. by much. However, In many situations the next baby. A longer interval this is not ideal for may be necessary both the mummy and severe tears during a

126120 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook COMMON GYNAECOLOGICAL DISORDERS

Beyond pregnancy and childbirth, you should continue to care for your general health to reduce risks such as breast cancer, cervical abnormalities, ovarian cysts. For most, it is easily treatable, but for others the condition may have devastating consequences. The latter can impact the ability to health if you are planning to have another pregnancy. Here we list the most common in Singapore:

trin iroi Fibroids are tumours or growths that develop in the wall of the uterus (womb). These growths tissue. Fibroids are common and usually occur in women aged 30 and drinking alcohol appear considered small, 4cm to 6cm to 50 years old. to increase the risk. There are considered moderate in size is no evidence to correlate and at more than 8cm, they are No one knows what can cause considered large. although eating plenty of green predisposition, the presence vegetables has been linked to a of female hormones such as lower incidence. heavy menses leading to oestrogen and progesterone anaemia. They can also cause Fibroids may grow again after constipation or frequent surgery, and there has been tend to grow in pregnancy as pressing against the bowel or these hormones increase but will avoiding certain foods will bladder. shrink after menopause as these prevent its recurrence. After a hormone levels decrease. myomectomy, there is a 15 to Fibroids are occasionally Obesity increases the incidence may grow again in the next associated with infertility, miscarriage, and premature 10 years. However, it is not increases the level of oestrogen necessarily a recurrence of the labour. Very rarely, extremely in the body. with uterine cancer. Other factors such as early onset Women can develop several of menstruation, having a diet rinar nontinn higher in red meat and lower If you have a , in green vegetables and fruit, of less than 2cm to 3cm are it is common to experience

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urine leakage when incontinence. The caused by overactive Here are the you cough or sneeze. most prevalent type bladder muscles forcing Urinary incontinence is stress incontinence the urine through refers to the inability to where the urine leaks Urge incontinence control urine and the through weakened muscles. - it occurs due to occurrence is common damage to the lining, among women. Such leakage can Then there are rarer muscle or the nerves occur during normal to the bladder. It The key to the activities, such as incontinence due to may be caused by management of coughing, sneezing weak bladder muscles urinary infection, or urinary incontinence and exercise. Another or nerve injuries, and bladder stone. The is to recognise the common type is urge functional incontinence main treatment for incontinence which is as a result of dementia. urge incontinence is

128122 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook Stress incontinence - is usually caused by stretching and weakening of the pelvic muscles during childbirth results can only be maintained with regular exercise. In more serious cases, other treatment options include:

aginal ssar ling agnt rgr A pessary is a plastic ring intion T inserted into vagina to Collagen and carbon and correct the position of correct the position of the spheres can be injected into the urethra and bladder bladder neck, located at the the lining of the urethra neck are the mainstay junction of the bladder and to increase resistance to treatment for serious stress urethra. It is relatively side incontinence. There are result may be unpredictable many variations of the frequent visits to doctor’s and occasional serious surgery, ranging from the clinic for change of pessary. and allergy simplest (Kelly’s stitch) may occur. to complex combined abdomino vaginal slings.

bladder training and feel socially embarrassed amount, appearance and Any abrupt change medication to decrease to bring up the subject duration, it usually starts in your vaginal bladder sensitivity. with caregiver. Greater discharges may hint a Surgery is rarely used. public awareness as if you are having vaginal infection and through media and heavy menses. The the most common are: r ad education will go a long lochia will slowly taper functional way in bringing the Change of incontinence - the patient’s problem to the discharge before the colour or treatment is complex attention of the doctors, stopping in another two consistency of the and will require thereby facilitating to four weeks, and in discharge joint management the administration of some cases up to eight by a gynaecologist, necessary and correct weeks. Bad odour urologist, and doctors treatment. from the relevant Vaginal discharge is Increased amounts disciplines. aginal a normal occurrence, of discharge isharg and a normal discharge The management of Lochia is vaginal does not have a smell or Another symptom urinary incontinence discharge during the colour. Unless at the end alongside the has advanced by . It of your menstruation, discharge, such as leaps and bounds consists of blood, tissue you may have a brown vaginal itching or over the years, and shed from the lining discharge. You may pain in pelvis or there is treatment for of the uterus, and feel an uncomfortable tummy most situations. The bacteria. The discharge wetness, but you should fundamental issue is should lessen each day, not feel any itch or Unexpected underreporting, as lightening in colour. soreness around your bleeding from the often, the patient will While it varies in vagina. vagina

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 123129 MUMMY’S HEALTH

In case if you notice a an One of the unusual any change and are not ainl nss patterns is heavy menstrual sure if it is something to bleeding, which is also worry about, consult your Menstruation does not called as menorrhagia. OBGYN. continue immediately It is characterised by postpartum. Most women an excessive amount The female vagina is a self- begin menstruating between of bleeding during cleansing organ, so there is three and 10 weeks after menstruation. Menorrhagia no need to especially giving birth and the average can occur independently or it (or douching). Douching is 45 days after. However, as a symptom of another can cause an imbalance the return to normal underlying problem such as of bacteria and fungi who menstrual pain, known as are natural inhabitants woman to woman. And dysmenorrhoea. of the vagina and lead to infections. Do not use if you are breastfeeding, Most of the time, there strongly perfumed soaps and how often you nurse are no root cause of heavy and washes to clean as is another major factor periods although certain overuse of these products conditions such as uterine can result in vaginal periods return. soreness and abnormal menstrual bleeding. Your vaginal discharge. Instead, Most women also wonder OBGYN will order further you can use a mild soap whether the pattern of your investigations if required. and warm water to gently periods after pregnancy These examinations involve wash around your genitals. would be the same as it having a , was prior to pregnancy. a blood test for anaemia As your body has recently undergone so many changes ultrasound scan. and is still experiencing a few after childbirth, it may take some time to get back the rhythm.

130124 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook SPECIALISED SCREENING FOR WOMEN

A health screening safeguarding your health and more importantly, you are also doing it for your One of the family. Early detection 45% in 1978 - 82, to in the family. The most easiest and and timely intervention 82% by 2002. common mutations are pave the way for early st the BRCA1 & BRCA2 screening is to detection, treatment The risk of breast cancer genes, both of and can reduce future d a rast cancer is higher in complications and women with the increase the risks of aat treatment cost, more following traits: obesity, both ovarian and aars so if your children alcohol, family history uterine cancers. If you are still young and are yrs t of breast cancer and have a family history, t ra dependent on you. you should consider However, if you of your breast period before age 12) seeing a genetic tissue so that you already have signs or counsellor to discuss symptoms, you may child at an older age. can recognise need to undergo other limitations of genetic ay ara There is also a risk testing. as out what are causing if you have relatives involves looking them. These diagnostic with history of breast/ In addition to t rrr r ovarian/uterine ultrasound, the changes, feeling screening tests. cancers as there may mammogram remains Most hospitals be a genetic mutation the primary screening r as y d ad both general health screening t sr and specialised ilins or gynaecological on rnti ar assessments such as ovarian cancer Osteoporosis markers, mammogram Screening (Bone mineral tool for women who and pap smear. density test) display no symptoms of the disease. A anr rning Breast & Ovarian Cancer Screening regular mammogram In Singapore, breast (Mammogram/ Ultrasound of Pelvis) and ultrasound breasts cancer is the number plus monthly breast one most frequent Cervical Cancer Screening (PAP smear) self-examination are cancer in women. the usual breast cancer There were more screening methods. than 8,000 women Blood Pressure, Cholesterol (Lipid) Test, Diabetes If there is no family diagnosed with (Glucose) Screen history, you may just breast cancer from opt to do a yearly 2009 - 2013. With all Anthropometry ultrasound pelvis and the improvements in (Height, weight, fat analysis, vision assessment) ovarian cancer marker treatment, the relative CA125 which are 10-year survival rate 18-25 26-35 36-45 46-55 56-65 easy to perform and has improved from YEARS OF AGE relatively inexpensive.

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ar s at tt tt r s on health issues at tday

In addition to strengthening the cancer screening rras s as aras for breast cancer ad a sar for cervical cancer for Singaporean rrts d increased aarss bone health and td rts to help prevent dats a t a at Cervical screening on rning thus compromising especially using a pap smear Without an assessment their personal long rat helps reduce the of bone density, despite term bone health. ar r incidence of cervical being symptom-free, to gestational cancer. However, it At a glance, adults you will not realise that dats remains one of the your bone health may under 50 need about top 10 most common be in trouble. 800mg of calcium a day and those above 50 women in Singapore. Most mummies are require 1000mg a day. A regular pap smear still young and in Pregnant and lactating us understand our is advisable if you are the prime of health mummy needs about estimated daily intake. sexually active. during pregnancy. 1000-1200mg a day. If They should have there is a high calcium A bone density test You can use the naturally quite good drink, such as milk can be ordered as table in this section bone mass and it will or high calcium soy part of your regular – ‘Guidelines For not compromised drink, a big glass will health screening by Women Preventive during pregnancy, your doctor. If this Care’ – to help you if the mother is Asian diet (non-dairy density test is normal, understand which eating healthy and products) will give the next test may be appropriate preventive supplementing with us about 300mg of health screenings are calcium. For mummies calcium only. The later. If there is a sign right for you based on who are calcium other half of the daily of bone loss, the test your age. intake can come from may be conducted end up freeing calcium a modest supplement twice in a year to from their own bones of around 500mg. monitor for speed of to supply to the baby, Label-reading will help deterioration. M

Retrieved from http://www.channelnewsasia.com/news/singapore/revamped-women-s-health/2691536.html

132126 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook INVOLVING DADDY

Daddy has the least attention when comes to pregnancy. Yes, mummy’s and baby’s health and development are is daddy’s. The good news is that most 21st century dads are willing to be more involved in their spouses’ pregnancy, from going along to childbirth education class to every doctor’s visit and to being present in the delivery room. A walk down Orchard Road in busy Singapore and you will see daddies with tiny babies in carriers or strollers. However, during the nine months, it is also equally important for the soon-to-be dad to share in the entire pregnancy process.

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BE PART OF THE PREGNANCY

1 Emotional preparation It is important for dads, as it is for mums to be emotionally ready when having a baby. During the nine months, dads can read the new expectations there are also some pregnancy. If you about babies and what and responsibilities. decisions on optional smoke, don’t smoke to expect, especially In some cases, you tests to be made. More around her. Better yet, will need to adjust importantly, this visit make a commitment to and being around responsibilities quickly allows your doctor quit smoking before the young children will be to help with the mum- to understand your baby is here. Likewise a new experience. to-be needs during personal and family for alcohol, you can pregnancy. While many medical history to support your wife’s Share the journey with pregnant women feel determine the best abstinence during your pregnant wife good, some may have antenatal care for pregnancy by reducing by being engaged in challenges that could your baby. And taking your own consumption. the process such as limit what they can the class together accompanying her to physically do. Be ready can help you and 5 Support your the doctor, shopping to take on more before your pregnant wife pregnant partner for baby items, helping the baby’s birth. Early in the pregnancy to paint or decorate the what to expect during (up to 14 weeks) baby’s room, setting up One other thing, be labour and delivery, expectant women can the baby crib as well as well as taking care feel exhausted and as choosing a name help around the home of the newborn. A nauseated. Certain for the baby. Taking and help without being smells and tastes might part in the pregnancy asked. Sometimes, your of learning together make mum-to-be feel process will enable you emotional and physical during the pre- sick; and she may be to feel more a part of presence is all that is parenthood stage helps irritable about things things. needed to help share both parents ease any that are seemingly in the pregnancy. pressure associated minor. 2 Work together with bringing a new 3 Attend baby into the world After this time, many If mum usually does doctor’s visit all the housework, then it may be time and childbirth on your relationship. much of their energy to re-evaluate the education classes returns, and usually, division of labour together 4 Stay healthy she does not need in your household. Even if you cannot together much assistance. In Having a baby in the attend all the antenatal Support the health home will mean a visits to the doctor, try of the pregnant wife (27 - 40 weeks), the to attend at least the by planning, cooking mummy will feel heavy. in responsibilities. and eating healthy The tiredness and Take some time ultrasound. Other meals together irritability that mum- during pregnancy than the excitement and keeping active to-be felt in the early to discuss with your and joy of knowing together – walking, weeks can sometimes pregnant wife how that the pregnancy is yoga and swimming return. At this time, things will change positive when you see – based on doctor’s the mum-to-be may going forward and talk the baby’s heartbeat recommendations start to feel a little about how to meet around six weeks, throughout the apprehensive about

136128 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook the birth. If she is and feelings. Talk to A pregnant wife is If you have never been on maternity leave other new dads to get facing the biggest in a delivery room from work, she might tips on managing the changes, but that before, you may feel feel lonely without household with a baby. doesn’t mean you uncertain about your the company of her Reaching out to others should ignore your role with your wife colleagues. for help and support is feelings. You need in labour. Are you a sign of strength. support, too. Keep supposed to be a coach If your pregnant wife talking and listening or an observer and is anxious, encourage 8 Other practical to each other; and talk just let the nurse and her to talk about it. support to friends. Life will get doctor do their jobs? Most of all, be patient. Cooking – in the easier in time. Well, it is usually a If you can learn early stages, the little bit of everything. to give each other smell of food may Your wife will need you support throughout at every stage, from the the pregnancy, your you cook, she is useful: relationship will be more likely to eat. delivery and beyond. stronger when the baby Make sure you are You should also be arrives. Carry physically contactable at all the one to keep in heavy loads – times touch with the rest of 6 Prepare to be carrying can put the family and screen unprepared a lot of strain on Decide how you’ll get phone calls while The nine months of mummy’s back, so do to the hospital labour is in progress. the shopping yourself And having you around so quickly, so much so or as an activity If you are using your increases familiarity the experience can be together. car, do a trial run to which helps put her rather overwhelming. see how long it takes at ease. Enjoy the experience. Accompany her to to get from your Savour it. It may the doctor when she house to the hospital You can prepare for sound strange but goes for a pregnancy this experience ahead some men may start ultrasound scan. Pack a bag for of time by taking a to feel ‘pregnant’ If additional tests yourself so that you birthing class with her when their partner are needed, your can stay with your or talking to other dads is expecting and can support is especially wife throughout the in the class about the sometimes display important. birthing process. experience. Knowing similar symptoms. The Remember to include the signs and symptoms of labour and what phenomenon is known Get as much snacks, a camera, and to expect when the as Couvade Syndrome your cellphone. information as you contraction starts can or ‘sympathetic can from antenatal help you get her to the pregnancy’. You may classes for couples, or DURING hospital on time. And not go to those lengths, partners’ evenings. LABOUR AND also knowing what to but trying to empathise Becoming a parent expect in the delivery when your wife feels DELIVERY room reduces the moody, agitated or emotional experience surprises and helps you uncomfortable will help for you and your wife. settle in comfortably so you feel involved in The information in Have you ever asked that you can then focus the pregnancy. this guide will provide your dad about the day on your wife’s needs. tips and advice on you were born? He may Lastly, recognising the 7 Financial what you can do to be able to describe the need for an emergency concerns help mum-to-be be call from your mum C-section, in the event happier and healthier or relatives about your that the labour is not parenthood brings on throughout her birth or how he waited going smoothly will worries about pregnancy. outside the delivery help you prepare for especially if mummy room. Chances are he the unexpected. Stay intends to leave her job The more you know cannot talk about your level headed, as there to look after the baby. about labour, the actual birth. Back then, may be some serious Talk to her openly more you’ll be able dads were often barred decisions to be made about your doubts to help. from the delivery room. immediately.

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DADDIES CAN HELP WITH BREASTFEEDING PROCESS

Babies need lots of physical not breastfeeding, being cradled in daddy’s loving arms is a wonderful place to be.

Beyond just being passive or an observer when mummy is role in the decision to breastfeed, usually made at the early stage. Daddies’ support and assistance to new mothers with breastfeeding on the duration of breastfeeding. Daddies can encourage, avert negative comments from friends and relatives, help calm a fussy baby and bring the new mummy food and drink while she is breastfeeding.

Most importantly, daddies can also remind mummies that breastfeeding is one of the most important things to get their baby T encouragement is much needed lack of sleep and hormonal changes can sometimes make new mummies waver in their determination to breastfeed. Daddies can come in to suggest rest in between feeding techniques learnt during childbirth classes to help mummies overcome her anxiety and lactation problems. Fetching pillows to help in positioning a newborn or encouraging mummies to call the Alvernia Parentcraft Centre to help with a breastfeeding problem are small ways to help new mummies press on towards successful breastfeeding.

138130 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook yourself by discovering GET INVOLVED simple tips of burping IN THE CARE your baby, calming and OF THE BABY keeping the little one entertained, and more.

Daddy’s help in the baby care and interaction with BENEFITS and bathe your baby the baby like bathing, as well as cuddling diapering, burping, dressing, TO and playing with hugging, caring for the baby MUMMY him or her. During will give a sense of trust breastfeeding, you and security and enhance can bring mummy a bonding between daddy and Relatives and friends snack and a drink. If baby. It also enables mummy can help so that mummy she is bottle feeding, to rest between feeds. can rest in between you could help feeds. This support is sterilise, prepare the A dad can strengthen his necessary, especially feeds and take over the feeding. few weeks by doing the childbirth. However, following: your house location may As a dad, recognise be far from relatives and your limitations as Establish a routine the new mummy will well as your strengths. of care with feeding, have only you to count Realise that you are bathing, changing, getting on. It is a good idea to not always able to the baby to solve your newborn’s sleep, etc. from work if you can. problems – babies do not always want Speaking to the baby You may want to to eat, take a nap consider limiting the or have their diaper development number of visitors changed. They can at home as it can be Have physical contact like exhausting for both the to console when they cuddling, playing, burping baby and mummy. It are in distress. and infant massages also interferes with this special time when you So, for example, if Take the night shift while are learning about being your baby is unable you are on paternity parents and becoming a to sleep or eat, keep leave. When your O calm, take a break baby wakes up at wee the baby and take over and ask for help. Just hours in the morning, the basic housework so as mummies cannot you can accompany that mummy can get a mummy to breastfeed good rest each day. problem, daddies or can try bottle feed should remember pumped breastmilk Some new mummies likewise. when breastfeeding become depressed and is established so that require a lot of practical A key point for mummy can have and emotional support. new daddy is to be more rest. Make sure you know considerate about how to spot symptoms sex. It may take Burping the baby of postnatal depression weeks or months after feeding. and where to get help. before mummy stops feeling sore. Think There is no right or wrong It helps if you get to about other ways of way of bonding with your know your baby better – showing your love for baby. You may even surprise learn to change nappies each other.

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Your interaction with are associated with BENEFITS TO your baby (engaging higher educational THE CHILD in cognitively achievement. In GROWING stimulating activities, fact, daddies who emotional warmth, are involved in their UP physical care) reduce children’s schools his or her chances of and academic experiencing cognitive achievement, There are studies to delay. Studies* have regardless of their shown that babies own educational as young as three level, are increasing involved in raising his months old can tell the chances of their children. For instance, children graduating the daddy-child play is mummy and daddy. and furthering their important for children They tell by the way studies. because it is both each speaks to them, physical and highly holds them, and by stimulating. It allows the child to experience the activation and Children whose It also helps regulation of arousal. daddies are involved It also helps the child in raising them fare the child understand and test better in cognitive understand boundaries in a safe tests and in language and test environment, which ability than those will, in turn, assist with less responsive boundaries them in countless or involved daddies. in a safe These improved out the world. cognitive abilities environment.

E T Community Sciences, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida.

140132 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook PARENTING AS A TEAM

Parenthood is one of the biggest changes to take place in a person’s both you and your wife.

It does not matter if the pregnancy has been planned for months or years, or is unexpected. The transformative feelings and emotions are the same. For some new parents, along with the joy and elation of bringing home a baby, comes with a sobering each other. This break transition to parenthood realisation that the is necessary as you less painful. No new baby is solely in your will need to keep your parent is going to care. A baby brings energy up to care and get everything right Being new responsibilities feed your baby. More that both you and your importantly, maintain every day following is patient, wife may not feel ready good health physically going to be the same. being for, whatever your and mentally. Fatigue Remember your baby is age. There are mixed due to lack of sleep also growing under your realistic feelings of anxiety and and rest can trigger care. So stay receptive with worries about the new depression. to these changes and responsibilities. It is expectations normal for both of you Another important fact something new in your to feel apprehensive is that your baby may interactions with your and being about the changes that not have the same daily baby each day. more are coming your way routine every day. There and change can be are days when your baby Raising your child can tolerant disconcerting, even if it will sleep throughout be one of the largest is key to is something you have the night and be less investments you will been looking forward. colicky. However, there ever make. However, making the are days when the baby both you and your transition to One of the basic can cry incessantly, wife do not need to be survival tips is to reach and the swaddle keeps rich to raise a family. parenthood out to family and coming undone though T friends for help and you have properly step is to look at what less painful. support to care for your tucked in the folds resources are available newborn. It gives you of the blanket. Being and adjust accordingly. some personal time patient, being realistic For instance, there is and private space for with expectations and no need to move into a you and your wife to being more tolerant are bigger house with the have rest and time for the keys to making the new arrival immediately.

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purchases accordingly work to take care For all its challenges, because the baby will of the baby. raising a child brings grow and will need unimaginable joy, fun For all its larger size diapers, It is understandable and love. It is also challenges, clothes and shoes. Do that parenting can manageable; look anticipate increase appear to be daunting around – your family raising a in food costs as well to new parents. and friends – they have child brings because, beyond the During pregnancy, it raised children of their is still about you and own. There are many unimaginable baby will need more your wife spending references available joy, fun and than just breastmilk to quiet time together, online and in print to love. grow. Another source with many occasions help you learn and of high spending to sit down for a understand. There are would be the medical, peaceful dinner. The also some parenting dental and health forums for you to join insurance premiums. your baby is home to pick up tips from The expense includes can be confusing other parents to help The baby can still completing all the and exhausting. It is you cope and manage. immunisation records common to see new But most of all, listen year so that it gives required by National parents taking turns to to yourself and take you time to plan your Immunisation Registry eat and occasionally, it one step at a time housing needs. (NIR). All these both parents trying to get to know your baby. Be sure to enjoy It is always exciting be a source of stress for the baby is still crying parenthood along to shop for clothes, both parents; the strain after a feed, amidst a the way. shoes and toys for the can be compounded if clutter of diapers and new baby. Plan your one of you has to stop wipes.

142134 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook DEBUNKING THE MYTHS OF FATHERHOOD

There are many falsehoods surrounding fatherhood. These are the 1 Only the feelings of mummy are important. This is not true. While it is important to consider daddy. The more time the new mummy’s mental you spend with your and physical condition, baby, the more you it is also important to begin to understand his consider the feelings of or her needs. the daddy. By sharing and discussing your concerns 4 Daddies have and thoughts with your to focus on their wife, you will enable her career to see and understand that pregnancy is a While this may be shared event. true, more daddies are starting to realise that 2 Newborns do not being a good daddy is also an important need the presence life goal. of the daddy This is not true. The 5 You will become relationship between the your own daddy mother and her baby is a close one, especially if she Once you become a breastfeeds. Daddies play daddy, your attitude a vital role in bonding towards fatherhood with the baby by carrying, may change. It is quite rocking, and playing normal to think about with the baby as well as your childhood and you changing diapers. You may or may not decide can also help indirectly by to follow your daddy’s taking care of household footsteps. Take all the chores. advice and upbringing techniques you have 3 learnt not only from Daddies do your daddy, but also not know how to from brothers, uncles, take care of little teachers and friends. children However, it is important This is not true. Parenting to make choices and is a journey of discovery decisions that are right for both mummy and for your family.

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DADS FOR LIFE

Launched in 2009, this is Singapore’s National Fathers Movement that aims to involve daddies to help inspire and become good children’s lives for life.

Findings from several research and studies *HERE ARE THE KEY FINDINGS FROM A RESEARCH ON shown that the more CHILDREN’S TIME SPENT WITH DADDIES IN INTACT FAMILIES: involved a daddy is, the deeper the relationship, the more successful A child’s direct 93% of the children On weekends, paternal his children will be. engagement time reported some involvement in each T with biological paternal involvement category was higher. determine a child’s daddies more than on weekends. social life, grades at doubles on weekend Parental involvement school, and future days as compared On weekdays, 75% of decreases as the child’s achievements. to weekdays, with a the children received age increases. particularly notable personal care from For this reason, a increase in household their daddies, 67% Daddies are daddy’s involvement is and social activities. were involved in play or companionship engaged with infants in simple activities, 86% of the children activities and and toddlers in play such as eating dinner spent some time 33% spent time in and companionship together, watching (engaged or accessible) achievement- activities than with movies, playing on the on weekdays. related activities. older children. Occasional outings or family vacations Learn more about the movement at http://dadsforlife.sg overseas contribute to *Children’s Time Spent With Fathers In Intact Families. Retrieved from http://dadsforlife.sg/research/childrens-time- children’s development spent-with-fathers-in-intact-families/ as well.

144136 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook TON ESOES

entitled to when you are pregnant. While it is necessary to educate yourself Parenthood in Singapore, it is also critical to discuss your options with your employer early in your pregnancy.

MountMount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook | 137147 ADDITIONAL RESOURCES

TEN ONS N SEE TEN EE T TS N and Parenthood ENETS Package and includes a cash gift and/or contributions to the T both you and your partner can take to spend more apply for the Baby time with your newborn. Bonus online at www.babybonus. this is a period for you to msf.gov.sg using your SingPass rest before returning account. to work. If you are self-employed, By default, the 16 weeks information, please in a particular business, www.ifaq. be taken continuously as trade or profession for gov.sg/BBSS/apps/ a block starting from up a continuous period of fcd_faqmain.aspx to four weeks before your at least three months before the birth of your website at www. child before you can babybonus.msf. gov.sg/parent/ out an arrangement with index.html. your employer, you can it compensates the take the last eight weeks lost income during the period of 12 months from the birth of the child. T ESTEEN You are eligible for paid working daddies so T TE OE that they can be home Your child is a to support you and be Singapore Citizen; engaged from the start. returning to work after childbirth may want to You are lawfully T continue breastfeeding and will require some married to your form of lactation support at the workplace. While child’s daddy*; enhanced maternity working mothers, they may not know how to take You have served protection, you can your employer for a www.mom.gov. continuous period of sg/employment- at least three months practices/leave-and- out an arrangement at your workplace so that preceding the birth holidays/Pages/ when you return to work, you can facilitate of your child. maternity-leave.aspx breastfeeding at work. 148138 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook ST O SOT ONSTONS N TE ONTTS

24 hr Walk-In E S

AMBULANCE Emergency

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PRIVATE AMBULANCE SERVICE PROVIDERS

Mount Alvernia Hospital Useful Numbers E ETENT OENN OS TE NO E E E Green T T S Pre-registration required

PUBLIC HOSPITALS WITH ACCIDENT S & EMERGENCY SERVICES N S Retail Pharmacy S S N O T Singapore General S

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ST O SOT ONSTONS N TE ONTTS

Doctors at Mount Alvernia Hospital

E SET N NE OTO NE T NT TE O Gynaecology

O EN E N S Gynaecology

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O E Gynaecology

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Paediatric Surgery S S S

140 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook BREASTFEEDING RESOURCES HELPLINES S S [email protected] www.breastfeeding.org.sg www.imh.com.sg Joyful Parenting and Breastfeeding Samaritans of Singapore S www.samaritans.org.sg S [email protected] 6289 8811 www.abas.org.sg Research CHILD DEVELOPMENT CO-SAVINGS (BABY BONUS) www.aware.org.sg SCHEME Postpartum Support International, www.babybonus.gov.sg S http://www.postpartum.net/ CHILD CARE SERVICES get-help/locations/international/ singapore/ www.childcarelink.gov.sg T T Road, S S T www.mindfulmums.sg

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Albumin common in pregnancy which Conception causes symptoms such as T in your urine when you are pregnant. It can be a sign of an infection or pre- Apgar score anaesthetic. down the fallopian tube to eclampsia. Your midwife will the uterus, where it attaches test your urine for albumin condition of a newborn itself to the uterus lining. at your antenatal check-ups. infant. Heart rate, respiratory plastic tube that can be Contraception Alphafetoprotein to stimulation, and skin (also known as birth diagnostic and/or control) the baby which is present therapeutic procedures. reduces your chances of bloodstream of the mother. the best possible condition. getting pregnant. See page medications into an area of measured to detect certain Baby blues the body or for drainage, of contraception that congenital defects such such as from a surgical site. depressed a few days after T T used to allow physicians to Cot death (also known access the body with surgical as Sudden Infant Amniocentesis instruments. Death Syndrome) T T Cervix is inserted into the uterus caused by hormone changes, death of an apparently through the abdominal wall tiredness or discomfort and T healthy infant during sleep. normally almost closed, with T just a small opening through that lasts longer than a week which blood passes during chromosomal and genetic could be postnatal depression. Down’s syndrome is usually carried out Balanced diet by an abnormal number into your pregnancy. It may balance of nutrients. of chromosomes. People be used later in pregnancy to Chorionic villus Birth canal sampling are mature. T learning disability and passage that the baby passes an increased risk of some through labour. disorders, particularly health problems. It also chromosomal disorders such T surrounds and cushions your Birth plan baby in the uterus. Before or usually carried out at around more information about 11 weeks. during labour the sac breaks you would like to happen syndrome, see page 24. during pregnancy, labour Colostrum and childbirth. When a baby T Eclampsia Anaesthetics is born bottom rather than T few days after your baby is take away pain. causes pregnant woman, Bloody ‘Show’ and full of antibodies to Antenatal protect your baby against T rich, creamy appearance and Ectopic pregnancy whole of pregnancy, from is round the corner. is sometimes quite yellow conception to birth. in colour. occurs when a fertilised egg begins to grow in the Anaemia When a baby is born bottom Colic T number of red blood cells generally unknown in the lining of the uterus. is lower than normal or Caesarean section S T there is a low concentration gastrointestinal discomfort of haemoglobin. It can be baby by cutting through the like intestinal cramping.

142 |Mount Mount Alvernia Alvernia Hospital Hospital Mother Mother & & Child Child Guidebook Guidebook Embryo growth, heart defects and Mastitis T facial abnormalities as well to all parts of the body. Pregnant women need to caused by blocked milk early weeks up until eight disorders. It is caused if produce more haemoglobin ducts. Symptoms include weeks of pregnancy. because they produce more hot and tender breasts and Entonox (also known enough, you can become as ‘gas and air’) the uterus. anaemic, which will make Maternity team care Foetus obstetricians, anaesthetists, tested during antenatal T neonatologists and other check-ups. another gas called nitrous week eight of pregnancy in through a mask or onwards. Home birth pregnancies. mouthpiece. Folic acid Meconium T Epidural O T the lower half of the body. naturally in foods, including Induction made up of what a baby has ingested during their time in prematurely stimulating the uterus, including mucus a long or particularly and bile. It is sticky like tar painful labour, or who are is important for pregnancy induced if they are getting and has no odour. too big, if the pregnancy defects known as neural has gone past the 42-week care tube defects. If you are mark or if there are health risks to either the baby or so that medicine can be pregnant or trying to get where the midwife is the pregnant, you should take the mother if the pregnancy continues. the spinal cord. care is suitable for women Jaundice Episiotomy are 12 weeks pregnant. pregnancy. T Fontanelle Morning sickness/ T skin and a yellowness in nausea the whites of their eyes. It done during the last stages on the front and top of a more than half of all the pigment bilirubin in the pregnant women. Symptoms blood. Jaundice is common include nausea or feeling in newborn babies and during the birth of the fontanelle allows the bony sick, as well as actually being baby. three days after birth. It can occur at any time of the last for up to two weeks after Fallopian tubes can pass through the birth day, though it occurs most birth or up to three weeks Branch-like tubes that lead T often in the morning because S jaundice can be treated uterus. Eggs are released after a night without food. by phototherapy, where a T fallopian tubes each month. Formula milk bright light. Babies who are pregnancy, peaking in weeks jaundiced for longer than one of the fallopian tubes. processed and treated so two weeks should be seen by that babies can digest it. It until weeks 14 to 16. a doctor as they may need comes in powder or liquid Fertilisation urgent treatment. form. Neonatal care Lanugo T Fundus premature babies. It takes place in a neonatal unit, in the fallopian tube. T which is specially designed and equipped to care Fetal alcohol Haemoglobin (Hb) T syndrome (FAS) Haemoglobin is found in before birth. for them. red blood cells and carries

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Nuchal translucency T scan after the birth of a baby. surface of their red blood most cases are mild and cells. identify whether you are at Perinatal cause no trouble, it can be T serious for both mother Rubella T after the birth of a baby. and baby. (German measles) weeks of your pregnancy Perinatal mental health Premature birth and measures the amount T mother gets it during the of the nuchal translucency, the standard period of early weeks of pregnancy. and that can last for up to neck of the baby. Babies at one year after childbirth. completed. When labour immunised against rubella, so they are not at risk. Placenta of pregnancy. Ultrasound/scans T T the lining of the uterus, Premature labour When labour starts before uses high-frequency sound accuracy of the pregnancy circulation from your dates and whether the O of your baby in the uterus. baby has any other health food from your bloodstream Rhesus disease problems. and organs as well as the bloodstream through the Obstetric cholestasis placenta and along the carry a baby who is rhesus called sonography, this test is widely used to estimate umbilical cord. Waste is also disorder. Symptoms include T cause problems in second without a rash, particularly Postnatal care or later pregnancies. If she is healthy and growing normally. in the last four months T gets pregnant with another of pregnancy. baby, from the birth until immune response will be Umbilical cord Obstetrician quicker and much greater. T eight weeks old. It usually T the baby to the placenta, the care of women during by the mother can cross the linking the baby and pregnancy and labour and placenta and attach to the mother. Blood circulates after the birth. both mother and baby are through the cord, carrying T Oedema be harmful to the baby as baby and carrying waste it may result in a condition away again. most often of the feet and Postnatal depression called haemolytic disease hands. It is usually nothing eelings of depression and of the newborn, which Vernix to worry about, but if it gets hopelessness after the birth can lead to anaemia and jaundice. worse suddenly it can be a T sign of pre-eclampsia. in the uterus. It mostly Rhesus negative disappears before birth but Ovulation People with a certain blood there may be some left on O type are known as rhesus your baby when they be serious if left untreated. are born. See page 82 for more information. Vertebrae menstrual cycle. If the egg the surface of their red Your spine is made up of is fertilised during this time, Pre-eclampsia T problems in second or later T E the time of the month when during pregnancy. Symptoms you are most likely include high blood pressure, middle through which the protein in urine, bad Rhesus positive spinal cord runs. People with a certain blood Paediatrician and the sudden swelling of type are known as rhesus the face, hands and feet. It T care of babies and children.

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