Essential birth planning tips

Written By: Dr. Edwin Thia

Senior Consultant

The Prenatal Consultants

Mount Elizabeth Novena Specialist Centre

You are now in the third trimester. This is the best time to talk about birth plans with your doctor. Birth planning includes discussing about your preferred mode of delivery, what forms of pain relief available during delivery, how you want to approach your delivery, the immediate after care for you and your newborn baby, whether you would like to store your baby’s cord blood etc.

Mode of delivery 

We start by discussing the two modes of delivery – vaginal delivery and caesarean section.

All women are encouraged to have a vaginal delivery if there are no medical or obstetrical reasons to exclude this. Most women will go into labour on their own around week 39, and they will have a normal vaginal delivery that goes well.

Labour

Labour is traditionally divided into three stages:

Stage 1

The cervix begins to dilate and is made up of two phases—a latent phase and an active phase. The latent phase is when the cervix dilates and thins out to about 3 cm. This stage is often very variable in duration and can last from a few hours to a few days. The symptoms are usually not specific and can range from mild abdominal cramps, backaches, or the passing of some bloody mucus discharge (show). Some women may not have any symptoms at all.

The active phase is when the cervix continues to dilate and thin out to be fully dilated (about 10 cm). The typical rate of dilation in the active phase is about 1 cm per hour, and hence the average duration is about 8 to 10 hours. This phase is when you have painful, regular contractions. The contractions are much more painful and more frequent, and each contraction usually lasts for up to 30 to 45 seconds. Your uterus is actively working to dilate and thin out the cervix.

Stage 2

This stage involves the delivery of your baby. This is when you have to work the hardest to push your baby out. This stage may last from 30 minutes to up to 2 hours. You will usually have a sensation and an urge to bear down due to the pressure of the baby’s head on your perineum. Your legs may be raised to allow more room for the baby. An episiotomy may sometimes be needed to increase the space.

Stage 3

The placenta is expelled at this stage. This usually lasts between 5 and 30 minutes. Your uterus continues to contract and will squeeze out the placenta after it detaches from your uterus.

Pain relief during labour 

Pain is expected during labour, and there are various methods of pain relief available to you. The three most common pain relief methods are Entonox gas, opioid injections, and epidurals.

Entonox is an inhalational form of analgesia. The mother breathes in a gas mixture of 50% nitrous oxide in oxygen. Entonox doesn't get rid of pain; it just changes the way you think about it so that it hurts less. The effectiveness is about 50%.

An opioid injection is a type of drug that is injected into the muscle of the thigh and provides pain relief for about 3 to 4 hours. It cannot be given too close to the delivery of the baby because it can make the baby drowsy at birth and cause temporary breathing problems. It can reduce pain by up to 70%, but only for a short duration of about 3 to 4 hours.

Epidural is the most effective and reliable pain relief method. This is done injecting an anaesthetic medicine into a space within the spinal canal. This is done by a trained anaesthetist. The epidural can last throughout the entire duration of the labour. If an emergency caesarean section is required, it can also be used for the operation.

Instrumental delivery 

Instrumental delivery is sometimes needed to help a vaginal delivery go smoothly. This can be done either using a vacuum suction device or forceps. There can be many reasons for needing help with the birth of your baby. Some common reasons are if you are not able to push well during the second stage of labour or if there are concerns with the well-being of your baby.

Caesarean section 

If you can't give birth through the birth canal, you will need a caesarean section. Depending on your situation, you can choose to have a planned caesarean section or you may need an emergency caesarean section.

A planned elective caesarean delivery is often done because the baby is in the wrong position or the placenta is low. Reasons for an emergency caesarean delivery include fetal distress during labour or slow progress of labour.

Caesarean delivery is considered a major operation. Although generally a safe operation, there are some risks involved, like any other major surgical operation. Most women who have a caesarean section will recover well. However, there are risks for both you and your baby, and it may take longer for you to get back to normal after your baby is born. Having a caesarean section also makes future births more complicated. The main risks associated with having a caesarean section include wound infection, more bleeding than expected, and blood clots in the legs (deep vein thrombosis) that can travel to the lungs (pulmonary embolism). Future pregnancies will be seen as higher risk, which may change how your next pregnancy is cared for.

Deferred cord clamping 

After your baby is born, the umbilical cord is clamped and cut before the placenta is expelled. Deferred or delayed cord clamping provides the newborn baby with an additional 80-100 mL of blood. The cord is not clamped in the first 60 seconds, except where there are concerns about the cord integrity or if the baby’s heart rate is abnormal. This additional blood improves the iron stores in the baby’s infancy.

Cord blood banking 

If you choose cord blood storage, it will be collected after your baby is born but before the placenta separates from your womb. Cord blood collection does not interfere with delayed cord clamping.

Some of your baby’s cord blood will also be collected for specific laboratory testing like blood grouping, thyroid function tests, and glucose-6-phosphate dehydrogenase (G6PD) deficiency testing. After that, cord blood can then be collected for cryogenic storage.

Cord blood banking is the process of storing your baby’s umbilical cord blood in the umbilical vein. Your baby’s umbilical cord blood stem cells are a rich source of haematopoietic stem cells (HSCs), which are responsible for replenishing the blood and regenerating the immune system.

In addition, HSCs are also known as naive precursor cells as they have a unique ability to differentiate into the different types of cells found in the body, namely: red blood cells, white blood cells, and platelets.

When parents decide to store their baby’s cord blood stem cells, they will be availing their baby (and family) of the following possible benefits:

1. Mainstream treatment of over 80 diseases ranging from leukaemia, lymphoma, thalassaemia as well as metabolic and immune disorders.¹ There are currently clinical trials underway for the possible treatment of Cerebral Palsy, Autism, Type 1 Diabetes, Alzheimer’s disease and spinal cord injury and many more.²

2.A sure match for autologous (donor and recipient are the same person) transplants. Since cord blood stem cells are "naive," they can change into different types of cells and do not need to be a perfect match like bone marrow transplants do. There is also a 40–60% chance of a match between siblings.³ So, parents are strongly encouraged to save for each child because it makes it more likely that they can cover each other if they need to.

3. Lower risk of Graft-versus-Host Diseases (GvHD) for autologous transplants, which makes it less likely that a stem cell transplant will be rejected.

4. A ready supply of life-saving stem cells that can be used quickly in a transplant situation where time is of the essence. Unlike bone marrow, which requires a perfect match between donor and patient, the probability of finding a match among family members using cord blood stem cells is higher.

When it comes to collecting your baby’s cord blood, it will be done by your OBGYN doctor. This process usually takes less than 5 minutes and is a safe and risk-free procedure for both mother and child.

Skin to skin contact 

After your baby has been cleaned up, he/she can be laid directly on your bare chest, and both of you are then covered with a warm blanket. This helps to calm and relax both you and your baby. It also helps to regulate the baby’s heartbeat and breathing, helping them better adapt to life outside the womb.

Conclusion

You should be all ready for the birth of your baby. Your doctor will now continue to monitor your pregnancy's well-being. Your doctor will also be doing a vaginal swab soon to check for the presence of Group B Streptococcus and will continue to monitor the growth and well-being of your baby.

Keep going to your regular appointments, and here's hoping that your birth plans go as planned.

References:

¹ For the full list of treatable diseases and references, please refer to  https://www.cordlife.com/sg/treatable-diseases.

² Diseases and Disorders that have been in Clinical Trials with Cord Blood or Cord Tissue Cells page. Parent’s Guide to Cord Blood Foundation website.  https://parentsguidecordblood.org/en/diseases#trial.  Accessed March 8, 2021.

³ Beatty PG, Boucher KM, Mori M, et al. Probability of Finding HLA-mismatched Related or Unrelated Marrow or Cord Blood Donors. Human Immunology. 2000; 61:834-840.