FAQ

Prepregnancy
Smoking has a detrimental effect on fertility for both the man and the woman. So the “harm” that smoking has on pregnancy starts even before conception occurs. Male smokers usually have poorer quality of sperms, which may render them subfertile. Women who are exposed to smoke have a higher risk of having ectopic pregnancy. Ectopic pregnancy is one that implants outside the womb, most commonly in the fallopian tubes. In such pregnancies, the fetus can never survive and the woman herself will be at risk of severe internal haemorrhage and will most likely need an operation to remove the abnormal pregnancy.

First trimester
Women who smoke have a higher risk of miscarriage and fetal abnormalities. The organs in the fetus actually are formed in the first trimester. Exposure to smoke at that time can lead to higher risk of fetal abnormalities, examples of which include heart defects ( like hole-in-the-heart), gastrochisis ( where the intestine is protruded outside the abdominal cavity) etc

Second & third trimester
Women who smoke have a higher risk of having premature delivery, small-for-gestational age babies and intrauterine death.

Post-delivery
The ill-effects of smoking on the baby continue even after delivery. Babies who are exposed to smoke have a higher risk of sudden infant death. Children of pregnant smokers are especially likely to have learning disorders, behavioral problems, and relatively low IQs.

How commonly do you see women who have 2 babies (one after another consecutively) in a span of under two years? How about women who have 2 babies in just one year?

Based on our Singapore gynae’s own anecdotal experience, it is relatively common to see women who have two children within two years. It would be about 1 in 20 women in our practice.

Apart from twins, it is not so common to have two consecutive births within one year.

Is this trend increasing over the years?
Yes, I can see this trend amongst the patients in my practice. Not only do I have patients who have two kids within two years, I have patients who tell me that they wish to conceive again quickly just one month after their delivery!

What are these women’s reasons for spacing their babies so closely together?

More and more women are postponing their childbirth till their careers are established. When they are ready to do so, they realize they are not getting any younger. It is a well-known fact that older women have lower fertility rate and higher risk of complications during pregnancy. Hence, many women would like to complete their family soon.

The other common reason is “the economy of scale”. Some parents think that it is more cost-efficient to raise children of similar age. For example, if one needs to engage a helper at home when the children are young, the number of years one would need a helper would be less if the age gaps of the children are small. Besides, having children of similar age group enables the siblings to play and get along well with one another.

Of course, there are quite a number of patients who have the second child “by accident”. Many people believe that there is no chance of pregnancy if the woman is breastfeeding the baby exclusively. I know of doctors and nurses who were caught unaware. I always tell my patients to use contraception even if they are nursing their babies. The chance of conception exists, albeit low. Although nursing suppresses ovulation, it is not absolutely fool-proof.

How closely/ far apart would you advise your patients to space their babies? Is there such a thing as an “ideal” interval between baby number 1 and 2? Why/ why not?

There is no right or wrong answer that best fits everyone. The “ideal” interval differs for each household, depending on many factors like the dynamics, the financial status and the circumstances of each individual family.

Personally, I think the ideal interval between consecutive children is between 18 months to 3 years. With such intervals, each baby gets enough one-to-one attention during the first year of life. By the time the second child comes along, the first would be more independent.

If the pregnancies are too close to one another, the woman’s body may be depleted of essential nutrients like iron, calcium etc. This is known to lead to complications like anaemia in pregnancy, small-for-gestational age babies and premature deliveries.

If a woman waits too long before conceiving another child, she may risk lower fertility rates and higher risks of complications during pregnancy (especially if she is over 35 years old by then).

That said; What are some health and emotional issues mums face when they space their babies too closely (eg 2 babies in 1 year)?

Each pregnancy will take a physical toll on the mother. The stores of iron, calcium and other essential nutrients may be depleted with each pregnancy. If the interval between consecutive pregnancies is too close, the woman may not have enough time to replenish the essential nutrients in her body. This may be one of the many reasons that newborns who are delivered within 18 months of their older siblings have been found to have higher risk of complications like prematurity, small-for-gestational age, low birth weight etc. Short intervals between births have been shown to have a negative impact o the mother’s health as well. There is a higher risk of bleeding in pregnancy and mortality.

The task of looking after newborns is taxing, both physically and emotionally. Infants need care 24/7. Unless the mother has assistance from other family members or helpers, it can be physically draining. And when a person is physically exhausted, it is common to be emotionally labile as well. In addition, it is also not uncommon for women to experience post-natal blues. Thus, a woman who has babies within a span of one year may find it overwhelming both physically and emotionally.

What are some factors eager parents should consider to see if they are ready for another baby?

• Many factors need to be considered before a couple should embark on another pregnancy. Apart from financial and childcare considerations, the rest of factors can be grouped in the following ways:
• Review any complications that may have happened in the previous pregnancy. For example, if there was a premature delivery, it would be good to consult your obstetrician why that happened and is there any way you can reduce the chances of that repeating in future pregnancies.
• Review the current health status. Especially for women with chronic health conditions for which they need long-term medications, they should check with their obstetrician if the medications have teratogenic effects. If so, the woman should change to a safer alternative before conception.
• Update vaccinations. If a woman is not immune to diseases like chickenpox or Rubella ( German measles), it would be advisable for her to be vaccinated before trying to conceive. These infections can cause severe abnormalities in the fetus should the woman contract them during pregnancy.
• Review lifestyle. Adopt good habits like eating healthy well-balanced meals, doing moderate amount of exercise to maintain a healthy weight, staying away from cigarettes, alcohol and other hazardous materials.
• Visit the dentist. The incidence of gum and teeth infection increase during pregnancy. If the infection is severe, it may even lead to premature delivery. As such, it is always advisable for a woman planning to get pregnant to have an oral examination by the dentist.

From experience, do local pregnant women tend to put on more weight than required during pregnancy? How common is this?
Most pregnant women in Singapore put on more weight than required. Many people think that once they are pregnant, their tummy should be big and round. But they do not realize that the big and round tummies they see probably belong to women who are in their third trimester. As such many women in early pregnancy think that they are not showing as much, and hence eat more to encourage the growth of their unborn child. However, there is a fixed rate of fetal growth in early pregnancy. Regardless of how much a woman eats, the amount of food that gets transferred to the fetus remains the same. If she eats excessively, the excess would be stored as adipose tissue in her own body. In other words, the woman will grow fat while the fetus continues to grow at the same rate. What is most important is the growth of the fetus. Even if a pregnant woman’s tummy size increases due to a thicker layer of her own fat, it does not mean the fetus is growing as well.

How does the food a pregnant woman eat during pregnancy affect her unborn child?
All the nutrition the fetus gets is supplied by the mother through the placenta. So obviously, if the pregnant woman consumes stuff that is detrimental to the fetal health and development, the fetus would be negatively affected. Similarly, if the woman has a well-balanced diet, then the fetus would be supplied with adequate amount and range of nutrition.

I’ve read articles which tell pregnant women not to overeat, or “eat for two” during pregnancy, as well as others which talked about how poor diets during pregnancy can affect brain development of unborn child. So, what should a good diet be like, during pregnancy?
There’s no need to eat for two because the increase in daily caloric requirement for a pregnant woman is only 300 calories. That is equivalent to an extra bowl of rice, one roasted chicken wing or two small apples. Conversely, if a woman is severely malnourished and has poor weight gain, there is a higher risk of prematurity, low birth weight and growth restriction of the fetus.

A good diet during pregnancy is a well-balanced diet that provides comprising of carbohydrates (50%), protein (30%) and fat (20%). Women planning for pregnancy and in the first three months of pregnancy should supplement their diet with folate. Folate, a form of vitamin B, is the only supplement scientifically proven to reduce birth defects; specifically those associated with incomplete closure of the brain and spinal cord. Women should have at least 400 micrograms daily prior to conception and during early pregnancy. Although folate can be found in green leafy vegetables, legumes, oranges and food enriched with folate, it is usually not enough to acquire the recommended daily level from diet alone during the periconception period. To reach the recommended daily level, most women will need folate supplement supplement.

Whilst on the topic of vitamin supplementation, here is a note of caution. Some vitamins, like vitamin A, should not be taken in excessive quantities as it may cause problems in the growing fetus. Overdose of vitamin A has been linked to birth defects such as facial and nerve abnormalities. As a general rule, do not exceed the recommended daily allowance (RDA) for all vitamin and mineral supplementation.

Some studies have shown an association between high levels of caffeine and miscarriages. High consumption of caffeine has also been linked to low birth weight of the babies. But caffeine is not an absolute no-no in pregnancy and can be taken in moderation. One cup of coffee per day has not been proven to have much ill-effects. However, one must bear in mind that caffeine is found in many other beverages as well, like tea and cola. Hence the caffeine contents in these drinks must be taken into consideration as well.

Alcohol consumption in pregnancy has been linked to fetal alcohol syndrome- a condition characterised by low birth weight, physical defects and learning problems in affected children. It would be wise to avoid alcohol completely during pregnancy. But for those who need to drink, it is recommended the pregnant woman drink no more than one or two units of alcohol, no more than once or twice a week.

What is healthy pregnancy weight gain?
A healthy weight gain for pregnancy is usually between 12 to 15 kg. However, it also depends on the woman’s pre-pregnancy weight. A woman who starts off obese needs to gain less than 12 kg, whereas a woman who is underweight can gain more than 15. Another important point to note is that when the weight is gained. Most of the weight should be gained in the second and third trimesters.

What are some problems – both to the mum and the unborn child – that can arise from severe weight gain during pregnancy?
Severe weight gain during pregnancy may predispose the pregnant woman to develop gestational diabetes ( diabetes in pregnancy). That condition in turn leads to higher risk of the woman having pre-eclampsia ( high blood pressure in pregnancy). The latter poses serious risks to both the woman and her unborn child, including that of mortality.

The main complications of gestational diabetes affect the baby. If the gestational diabetes is not well-controlled, the baby may be excessively big. This would hinder the mummy’s decision for natural birth vs C-section as the chances of a smooth natural birth may be lowered. In such cases, there is a higher incidence of instrumental deliveries (like vacuum or forceps), operative delivery ( caesarean section) and birth injuries to the baby. In addition, babies of women with gestational diabetes may have more severe jaundice and transient excessively low blood sugar after delivery.

If you think your private area is malodorous, the first thing you ought to do is to exclude infection of the vagina. Apart from unpleasant smell, the other common symptoms of vaginal infection include abnormal discharge, itch and / or pain at the perineum. The most common vaginal infection is fungal infection, of which the classical symptom is thick curd-like discharge associated with itch. Another common vaginal infection is bacterial vaginosus where there is a fishy odour associated with grayish watery discharge. Sexually transmitted infections like gonorrhea may also cause smelly vaginal discharge. It may not be obvious if one is having vaginal infection based on smell and discharge, let alone which type of infection. So if infection is suspected, it is advisable to consult a doctor who will examine you and do the relevant tests to diagnose the specific infection. Only then, the appropriate treatment can be administered to clear the infection.

Another cause of smelly discharge from the vagina is due to retained foreign body in the vagina. Albeit not very common, but the foreign bodies can emanate a very pungent odour after a while. Examples of things that may be left inside the vagina include tampons, whole or part of condom, sex toys. It may be difficult for women to check for and remove these foreign objects by themselves; so consult a doctor who can do a speculum examination to check the vagina.

If infection and foreign bodies are definitely excluded, then the odour may be the natural odour of vaginal secretions. It is normal to have a certain amount of vaginal secretion; the amount and consistency of these natural vaginal secretions will change throughout the menstrual cycle under the influence of the female hormones.

Douching of the vagina and over-washing of the private area in an attempt to eliminate the natural occurring odour is counter-effective as such actions actually disrupt the pH and microbial balance in the vagina and more infections may result. The same with wearing of panty-liners everyday; this practice should be avoided.

It is best to wear loose cotton underwear to allow more ventilation. Wash with water if desired after visiting the toilet. Restrict washing with feminine wash or soap to twice a day. Try to use brands of feminine wash that contain strains of good bacteria like lactobacillus, as these can restore the beneficial micro-flora in the vagina and reduce incidence of infections.

‘Cystitis’ refers to inflammation of the urinary bladder. The most common cause of cystitis is bacterial infection of the urinary bladder. Women with cystitis usually complain of pain when passing urine, frequent need to pass urine and feeling of incomplete emptying each time after passing. Some may even find blood in their urine. Frequent infection is defined as three infections in a year or two infections in six months. People with frequent infections should see a doctor to ensure there are no underlying cause like kidney stones, abnormalities of the urinary tract etc. 

How common is vaginal infection?
Vaginal infection is one of the most common reason why women seek medical attention. Most women will have at least one episode of vaginal infection in their lifetime, though some may have multiple episodes.

What are the causes and the symptoms of vaginal infections?
There are many types of vaginal infections, but the three most common types are bacterial vaginosis, candidiasis and trichomoniasis. The vagina contains both ‘good’ bacteria and ‘bad bacteria. Normally, there is large numbers of ‘good’ bacteria called Lactobacillus which keep the vagina healthy. When the normal balance is changed by overgrowth of other organisms (like ‘bad’ bacteria or yeast ), vaginal infection results.

Bacterial vaginosis (BV) is probably the most common form of vaginal infection. It is usually caused by overgrowth of a bacteria called ‘Gardnerella vaginalis’, as well as many other organisms, in the vagina. BV is more likely to happen in sexually active women. Other risk factors for developing BV include multiple or new sexual partners and vaginal douching.

The most typical symptoms of BV include increased amount of watery clear, greyish or yellowish discharge which has a fishy odour. Sometimes, BV may be associated with itching or burning sensation.

Candidiasis, or yeast infection, is another very common vaginal infection. This infection results from the overgrowth of yeast in the vagina. This often occurs after a course of antibiotics taken for other reasons. Candidiasis also tends to happen more in pregnant women or women with diabetes. Women with yeast infections commonly complain about thick, curd-like white discharge. They usually have itch, irritation, swelling and pain around the vagina as well.

Trichomonas vaginitis is probably the third most frequent vaginal infection. The cause is a type of germ called Trichomonas. This is a sexually transmitted disease. Infected women may experience frothy, yellow-green vaginal discharge with a strong odor. There may be redness and irritation around the vaginal area which may cause discomfort during sex.

Apart from the above three common vaginal infections, there are other types of infections like gonorrhea, chlamydia, herpes

Is it possible to self-diagnose and treat vaginal infections? How? Under what circumstances should they see a doctor?

Most vaginal infections, regardless of the type, present with discharge associated with itch and irritation. It is hard to differentiate the various types of infection just based on symptoms alone.

Different infections will require different treatment. For example, anti-fungal treatment will not solve the problem of bacterial vaginosis.
So whenever a woman suspects that she has a vaginal infection, it would be advisable to seek the opinion of doctors to arrive at the correct diagnosis, so as to be able to institute the correct treatment.

How can women prevent vaginal infections?

As the cause and the mode of transmission for the various vaginal infections is different, the preventive methods are different too. Generally the vagina should be regarded as a self-cleansing organ which functions best when the balance of acidity and organisms is in equilibrium. Too much douching may affect the normal balance of organisms and hence result in more infections. Use of perfumed panty-liners or tissue may affect the acidity balance and lead to infections as well. Use of condoms may help to prevent sexually transmitted infections.

To prevent yeast infections, one should allow the genital area to “breathe” as much as possible. To do that,

• Wear loose cotton panties whenever possible.
• Avoid tight-fitting clothing like g-strings, tights, leotards, panty-hose.
• Avoid inner wear made from synthetic material.
• Change out of wet swimsuits or other damp clothes as soon as possible.
• Avoid daily use of panty-liner.

• Have a well-balanced diet that allows you to maintain a weight that is within the healthy range. For Asians, that would mean a body mass index (BMI) of between 18 to 23. If you plan to start a family soon after your wedding, it will be advisable to start taking folate ( also known as ‘folic acid’) supplements. Folate has been proven to reduce the brain and spinal cord abnormalities in the baby, and folate supplement ideally should start 3 months prior to conception.
• Sleep enough. Adequate rest not only ensures that you look radiant, it also allows you to have a stronger immune system and ability to work at your fullest potential.
• Moderate amount of exercises. Aim to exercise at least thrice a week to maintain a healthy weight as well as to keep your body well-toned.
• Healthy lifestyle, which means no smoking and moderate alcohol intake (if at all). Not only will this keep you healthy before the wedding, it will be advantageous should you consider conceiving soon after your wedding. Smoking and alcohol intake are discouraged in pregnant women as well as women who are trying to conceive.
• Vaccines. Consider vaccines that can protect you against certain diseases and cancer. For example, having vaccines to protect yourself against Human Papilloma Virus (HPV) can help to reduce cervical cancer. Although such vaccines are efficacious in preventing certain conditions, they are not advised for women who are planning pregnancy or are already pregnant. The course of HPV vaccines requires a period of 6 months. Hence it would be perfect timing if you should complete the course of vaccinations prior to your wedding; this will allow you to plan for pregnancy anytime thereafter.

Pre-wedding check-up includes

• A detailed history-taking regarding your general well-being, with specific emphasis on your gynaecological health (like regularity of menstruation, menstrual problems like severe pain or heavy flow etc), past medical history, family history of major illnesses.
• By doing so, the doctor can help to identify if there could be possible gynaecological conditions that can be treated before wedding; or potential problems that may result in complications to the pregnancy, and taking active steps to eliminate or reduce that risk.
• Blood tests that assess the general health condition, as well as targeted investigations that screen for conditions that may have a negative impact on pregnancy. One example of which would be sexually transmitted diseases.
• Depending on your fertility wishes, a pre-wedding check-up will also be a good time to discuss with the gynaecologist the type of contraception that would be suitable for you and your partner, or the steps that you should adopt to ensure that you can get pregnant as soon as you wish. Planning for pregnancy should entail taking periconception folate supplements, adopting a healthy lifestyle for the couple, as well as knowing when is one’s fertile period.

Bartholin’s glands are inconspicuous glands on each side of our external genitalia near the vaginal opening. They are present in every woman although most of the time we are not aware of their presence as they are tiny and do not cause symptoms. The Bartholin’s glands secrete fluid that helps to lubricate the vagina. The fluid is secreted through ducts. If these ducts get clogged, the fluid produced by the glands would then build up to form a cyst.

Infections of Bartholin’s glands can happen, just as any other glands in the body can be infected. Unless there is a predisposing factor like a Bartholin’s cyst, infections cannot really be prevented. The best treatment probably is to see a doctor early when you feel discomfort in the affected area. Adequate oral antibiotics given early enough may be sufficient to treat the infection. If the infection is left untreated or treated late, an abscess (infected cyst) may result. The only treatment for that would be surgical drainage of the accumulated pus through a procedure called “ marsupialisation”.