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Dr Pamela Tan is an obstetrics and gynaecology specialist practising at Thomson Medical Center in Singapore. Prior to leaving for private practice, Dr Tan was a female Consultant in the Department of Obstetrics and Gynecology, KK Women’s & Children’s Hospital.

She obtained her undergraduate medical degree at the National University of Singapore and her post-graduate MRCOG in London at the Royal College of O&G. She is a specialist accredited with the Specialist Accreditation Board (Ministry of Health) and is a Fellow of the Academy of Medicine, Singapore (FAMS). She is an accredited member of the Society for Colposcopy and Cervical Pathology of Singapore (SCCPS) with a subspecialty interest in colposcopy (for pre-cancer of the cervix and vagina) and vulval disease.

In further pursuing this interest, she was a fellow for pre-invasive disease at the colposcopy and vulval unit at the Whittington Hospital in the United Kingdom. She is a visiting consultant at KK Hospital for colposcopy and is still involved in research on computer imaging analytics for screening cervical cancer in low resource settings in a joint collaboration with the National University of Singapore.

While in the United Kingdom, she was also a fellow at the Assisted Conception Unit in Guys Hospital to learn the latest in reproductive techniques and approaches to infertility. She is accredited to perform advanced Level 3 minimally invasive keyhole surgery such as laparoscopic hysterectomy, myomectomy and cystectomy (womb, fibroids and cysts removal).

Her philosophy to doctoring is one that is focused on building relationships with her patients. She strives to deliver patient care that is warm, caring, professional and well advised. She is a believer of pro natural birthing and providing an optimal birthing experience as desired by her patients.

Dr Pamela Tan is an obstetrics and gynaecology specialist practising at Thomson Medical Center in Singapore. Prior to leaving for private practice, Dr Tan was a female Consultant in the Department of Obstetrics and Gynecology, KK Women’s & Children’s Hospital.

She obtained her undergraduate medical degree at the National University of Singapore and her post-graduate MRCOG in London at the Royal College of O&G. She is a specialist accredited with the Specialist Accreditation Board (Ministry of Health) and is a Fellow of the Academy of Medicine, Singapore (FAMS). She is an accredited member of the Society for Colposcopy and Cervical Pathology of Singapore (SCCPS) with a subspecialty interest in colposcopy (for pre-cancer of the cervix and vagina) and vulval disease.

In further pursuing this interest, she was a fellow for pre-invasive disease at the colposcopy and vulval unit at the Whittington Hospital in the United Kingdom. She is a visiting consultant at KK Hospital for colposcopy and is still involved in research on computer imaging analytics for screening cervical cancer in low resource settings in a joint collaboration with the National University of Singapore.

While in the United Kingdom, she was also a fellow at the Assisted Conception Unit in Guys Hospital to learn the latest in reproductive techniques and approaches to infertility. She is accredited to perform advanced Level 3 minimally invasive keyhole surgery such as laparoscopic hysterectomy, myomectomy and cystectomy (womb, fibroids and cysts removal).

Her philosophy to doctoring is one that is focused on building relationships with her patients. She strives to deliver patient care that is warm, caring, professional and well advised. She is a believer of pro natural birthing and providing an optimal birthing experience as desired by her patients.

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What to Expect with IUI (Intrauterine Insemination)?

IUI has been an option for couples who struggle with conceiving. But like any potential solution, it comes with factors that require consideration. So, we’re laying down the facts to give you a heads-up on what to expect from this procedure.So, if you’re interested in a consultation for IUI soon, here’s what you need to know.

What is IUI?

Intrauterine Insemination is the first line of defense for couples who face difficulty in conceiving. Also referred to as donor insemination or alternative insemination, it is done by placing the sperm in the uterus around the time you’re ovulating.

The Facts of the Matter

IUI is a relatively simple treatment. But like any other, it requires commitment and a full understanding of the procedure. This allows you to weigh its strengths and drawbacks for you to make an an informed decision. So, let’s start with the basics.


To ensure a safe process, you and your partner must first undergo a battery of tests. This will include the following:
  • Normal Pap smear in the past year
  • Hepatitis B, C, HIV, syphilis (VDRL), Rubella Ig G testing
  • Blood type and screen
  • Ultrasound scan to determine the size and number of eggs inside each ovary and to exclude abnormalities that may hinder implantation
  • Men providing a semen specimen must be tested for infectious diseases like HIV, syphilis, hepatitis B and C
  • Fallopian tube patency check eg Hysterosalpingogram
  • +/- Cervical swab cultures for chlamydia and gonorrhea


IUI starts by obtaining the sperm from the male partner or donor. The sperm is then counted, washed, and concentrated before it is placed in a small syringe. Semen analysis is important to the IUI process to accurately diagnose male infertility. This will involve sperm count and observation of sperm motility and morphology (shape). These semen parameters will assess quality, and its results will help predict IUI outcome.  The normal semen parameters according to the World Health Organisation reference ranges are as follows:
  • Volume of Semen: More than 1.5 ml
  • Sperm Concentration: More than 15 million sperms per ml
  • Sperm Motility: More than 40%, 32% forward progression
  • Sperm Morphology: More than 4% has a normal shape
  • White Blood Cells: less than 1 million per ml
Source: WHO Sperm Washing, also called sperm preparation or spinning, is the process of preparing the sperm sample before it is inseminated. It involves techniques to separate the sperm cells from other supporting fluid or cells. It also separates the motile sperm from non-motile ones. This process is done also to enhance the quality of the initial sperm sample. Centrifugation follows once the appropriate washing medium has been mixed. A centrifuge is a machine the spins at a high speed to separate materials of different densities. From this, the sperm-rich fraction is obtained and loaded into a syringe. To aid in the insemination process, a very small flexible catheter or tube is attached to the syringe. It is then inserted through the cervix and into the lower part of the uterus to deposit the sperm directly.

What it Feels Like

IUI involves the use of the speculum to properly visualize the cervix, similar to having a pap smear. It may create a slight discomfort, but it is not painful. However, IUI itself is reported to be painless because it only uses a small and flexible catheter.


  • Women with minimal or mild endometriosis
  • Mild male sperm abnormality
  • Unexplained infertility
  • Unsuccessful fertility treatments with medications alone
  • Couples with dual factor abnormalities eg ovulation and sperm abnormalities
  • Couples with abnormal mucus (IUI can bypass possible cervical factors)
  • If sperm donor is used
  • Couples who are unable to have vaginal intercourse due to reasons like physical disability or psychosexual problem


  • Severe endometriosis
  • Previous pelvic infection
  • Blocked fallopian tubes
  • Cervical atresia (a condition where the cervix is abnormally absent)

Time and commitment are needed since the process involves several trips to the clinic.

The Heart of the Matter

The process itself may be reasonably straightforward, but the entire journey can take a lot from a woman or a couple who puts their efforts, emotions, and resources into it. Time and commitment are needed since the process involves several trips to the clinic. You must follow this through very carefully as there is only a small margin of error that could put you off your schedule when timing your fertile period. It can be distressing for women when a cycle has been abandoned due to extraneous factors like work and conflicts in schedules. What may also be frustrating to some is when they don’t ovulate in time which causes them to miss certain months. These instances are unavoidable since our bodies react to treatments differently. Furthermore, women who use medicines to stimulate the ovaries might also have to contend with unpleasant side effects. The reality is that these are just some of the challenges which can test your resilience throughout the process. The preparation, the waiting, and sometimes unsuccessful results can take a toll on your resolve. However, it is important to remember that you can always find help and support.First, your doctor is there to advise you on your next course of action. Therefore, finding a clinic you trust and a practitioner who understands your goals is important. You can also find a community online where you can reach out to others who are on the same journey as you. These support groups are not only  good avenues where you can find emotional support, but also one where you can learn from the experience of others.

IUI Success Rate

Success rates vary depending on different factors, such as:A woman’s age – IUI success rate is higher in younger women, but it starts to decline after the age of 35. Timing – If the timing of ovulation is not detected properly, the time of insemination may not be synchronized with the peak period of fertility within your cycle. Fertility drugs – You are more likely to get pregnant if you take fertility drugs that can help stimulate your natural cycle. You can ask your doctor about them and how they can improve your odds of getting pregnant with IUI. The status of a woman’s fallopian tubes – A woman interested in IUI should have at least one open unblocked fallopian tube.The quality of the sperm sample – IUI is generally less successful in men with very low sperm counts or poor motility– less than 2 million total motile sperm of normal forms. Sperm motility is the ability of the sperm to move or swim efficiently. The number of IUI cycles – Most women will have several cycles of IUI before they can conceive. This is also something to consider when you’re thinking about the costs of the treatment.The couple’s general health condition – Couple must strive to improve their health as much as possible to maximize the success rate of fertility treatment with IUI. A healthy diet and lifestyle is important and chronic conditions like diabetes should be under control prior to treatment.

How Many Times Should You Do IUI?

Since IVF (In Vitro Fertilization) is an expensive option, IUI is often the first treatment suggested to those who wish to conceive. It is also less invasive and less demanding. But what should you do if you are still unable to get pregnant after several rounds of IUI? How many times should you try before moving on to the next option? Some women are lucky enough to get pregnant after their first attempt, while others succeed after a number of tries. For this, doctors advise patients who are under 35 to try 3-6 cycles of IUI before trying IVF. Women above 35 may be recommended differently since fertility decreases at this age thereby reducing the chances of conceiving through IUI.The process behind IUI may be a personal journey but it is best that you talk with your doctor and partner regarding your next step. It helps when you understand your limits and when it is still worth another try.

IUI Cost

IUI may be less costly than IVF, but couples who go through it would still have to consider the cost. IUI, for instance, may require more than one cycle. In singapore, MediSave for Assisted Conception Procedures (ACP) is a government subsidy to help defray the costs of procedures like IUI and IVF.You can learn more about it, here. The IUI journey may not be a walk in the park, but it pays to have the right knowledge, preparation and any manner of support. If you think IUI is an option you and your partner are willing to try, you can book a consultation with Dr. Pamela Tan today for a more in-depth discussion.

Tears During Delivery and How to Reduce Them

Your baby’s entrance to the world doesn’t have to leave you with a nasty tear down there. A normal birth can result in a tear to the vagina and its surrounding tissues, but it’s something that can be reduced. Brush up on some of these facts to help lessen any injury on your part and take this knowledge with you when you come in for your next consultation.

What are Perineal tears?

The perineum is the area between the vagina and the anus. It is a strip of soft skin which is prone to tears if it comes under significant pressure, especially during childbirth. This type of injury is referred to as perineal tears, perineal lacerations, or vaginal tears.

A tear occurs due to the pressure of the baby’s head as it passes through the vaginal opening. It could be that the baby’s head is too large for the vagina to stretch or the head is a normal size, but the vaginal opening doesn’t stretch enough.

How common are Perineal tears?

There is a high risk for perineal tears to occur in Asian women because the the skin and connective tissue have less laxity and does not stretch as easily as Caucasian women. The distance between the vagina and the perineum is shorter and this anatomical characteristic also increases the risk of perineal tears to reach the anus. A study showed that asian ethnicity is 2.2 times more likely than western populations to have more severe tears involving the anal sphincter injuries during childbirth and first vaginal deliveries have a 7 times relative risk compared to subsequent deliveries.

Types of vaginal tearing

1st Degree Perineal Tear – It is a shallow tear which involves the perineal skin. It causes mild discomfort and stinging upon urination. It may or may not need stitches because it typically heals within weeks.

2nd Degree Perineal Tear – This involves a tear to the skin and muscle layers of the perineal area. In some cases, it may even extend into the vagina. It will heal better if the tear is repaired with stitches. You can expect this to heal within a few weeks.

3rd Degree Perineal Tear – This tear goes through the perineal muscles and into the ring-shaped muscle that surrounds the anus (the anal sphincter). It is important to surgically repair this to reduce the incidence of flatus or bowel incontinence.

4th Degree Perineal Tear – This tear extends from the anal sphincter all the way to the anal canal or rectum. This type of tearing will require surgical repair. It may take around three months to completely heal or for the area to feel comfortable. 60 to 80% of women have no symptoms at 1 year post delivery after a tear involving the anal sphincter or canal.

What is an episiotomy?

An episiotomy is a small surgical cut made by the doctor during labour to help widen the vaginal opening and assist in the delivery of the baby. Traditionally, it was often performed as it was thought to reduce the incidence of a serious vaginal and perineal tear down to the anus. However, now the evidence that an episiotomy prevents severe 3rd or 4th degree tears is conflicting.

Studies such as those done by Hong et. al. suggest that an episiotomy doesn’t have to be a routine procedure for vaginal deliveries. Make an informed decision by discussing the matter with your doctor. You can even include this detail in your birth plan.

Reasons for an episiotomy

    • Forceps or vacuum delivery. It widens the vaginal opening when instruments are used to assist with the delivery. Having a forceps delivery without at episiotomy increases the rate of serious tears by 6.5 times where ares having an episiotomy increases the rate to only 1.3 times.
    • A complicated birth. An example is when the baby is positioned with the buttocks or feet first (breech) or when shoulders are trapped (shoulder dystocia) such that there is more space for further maneuvers to be performed.
  • To expedite delivery during fetal distress. This is a complication of labour where the baby’s heart rate significantly decreases before birth due to the lack of oxygen (hypoxia). This may be contributed by umbilical cord compression or strong uterine contractions coupled with the mother pushing. The baby must be delivered quickly to prevent the risk of birth hypoxia or stillbirth and performing an episiotomy can help shorten the crowning stage.

Types of episiotomy

    • Midline – It involves a vertical downward cut of the perineum that extends towards the anus. It may heal faster than a mediolateral incision.
  • Medio-lateral – This is a cut that goes downwards and diagonally. It is usually used for instrumental deliveries and has a lower rate of 3rd or 4th degree tears compared to the midline.

Each type of episiotomy comes with advantages and disadvantages. Only your doctor can make the judgment on which type would be appropriate at the time of delivery. However, you can always have a discussion on this during your antenatal check-ups. You can ask about repair, scarring, post-delivery pain, and healing, among many others.

Stitches for episiotomy or tears

Stitches are usually done soon after the baby is born. It is done under local anaesthesia so that you will not feel any pain. A local anaesthetic may no longer be necessary if you had an epidural because this already numbs the area.

In most cases, the stitches don’t have to be removed since these are dissolvable within 2 weeks. The tear or cut will heal within 3-4 weeks.

Recovering from an episiotomy

To help heal perineal tearing, you may do the following:

    • Rest and assume a side-lying position as much as you can.
    • Get in and out of bed on your side to reduce any strain on your perineum.
    • Keep the tear clean and dry by regularly washing and changing pads (every 4 hours) to prevent infection. You may also be prescribed an anti-septic spray or wash
    • Always wipe from front to back after going to the toilet to avoid infecting your episiotomy site.
  • Take pain medications as prescribed by your doctor.

Immediately inform your doctor if you experience any of the following:

    • Bleeding from your episiotomy
    • Foul-smelling vaginal discharge
    • Fever or chills
  • Severe perineal pain

Baby Twins - Perineal Tear - Dr Pamela Tan

How to prevent tearing during childbirth

Since an episiotomy is an option, there are ways for you to avoid tearing or prevent serious ones during childbirth. You can do the following, granted that you are also advised by your doctor:

Nutrition: stay hydrated and drink plenty of water 2.5-3 L a day to ensure the tissues are also well hydrated. Vitamin C, omega 3 fatty acids and zinc are beneficial for skin elasticity and healing so foods like citrus fruit, avocados and nuts are beneficial.

Perineal massage: From 35- 36 weeks of gestation, there is a hormone relaxin that helps to make all the connective tissue stretchy and aids in delivery. Perineal massage during late pregnancy may encourage elasticity and reduce the risk of tearing during chldbirth. The perineum is the area between the vaginal opening and anus. Some women choose to use perineal massage as a way of hopefully reducing their risk of perineal trauma during childbirth. It also helps to accustom the woman to the sensation of stretching that she will feel when the baby’s head is born. Studies have found evidence that regular perineal massage towards the end of the pregnancy can reduce the risk of tearing in first time mothers. This research also identified that the benefits of perineal massage were greatest for women aged over 30 who had not previously given birth. Regular perineal massage during later pregnancy reduced the risk of perineal trauma that required stitches by 5% for first time mothers.

In general, it is advised to perform the massage 2-4 times a week if the woman is comfortable. If she is not comfortable, discontinue the method. It should also not be done if there is a vaginal infection, herpes sore or vaginal/ vulval conditions that may worsen with the massage.

Step 1: Find a quiet, private place to lie down. Use pillows to support your back so that you are in a semi-lying birthing position with your legs open. You may like to turn off the lights, and play some calming music to help you feel relaxed.

Step 2: Apply oil or lubricant to your fingers, thumbs and perineum. The lubrication should prevent discomfort.

Step 3: Next, insert two fingers around 3-4cm deep (2nd knuckle) into your vagina or as close to that as is comfortable. Gently, but firmly, apply pressure against the back wall of the vagina towards your anus. At the same time, gently pull your two fingers apart so that your perineum is being stretched both downwards and outwards. Keep applying pressure until you feel a slight tingling sensation, this is your perineum being gently stretched. This should not hurt, and you should not notice any burning.

Step 4: Imagine that your vaginal opening is a clock face. Next, pull your two fingers down to 6, then stretch them outwards and upwards towards 3 and then 9, applying pressure. The movement is a sort of U shape. Repeat this 20 or 30 times over several minutes. This is what a woman will feel as the baby’s head presses down before it starts to emerge from the birth canal.

Step 5: rub the perineum between the thumb and forefinger, one finger inside the vagina and one finger outside. You can use 1 hand or 2. Then place two fingers just inside the vagina, only to the first knuckle and gently stretch the perineum outward. Massage more with the thumb and forefinger if the tissue feels tight. Remember to consciously relax the muscles, using slow breathing if the sensation feels too intense.


Avoid touching the anus to reduce the risk of bacteria from the anal area entering the vagina. Avoid being too vigorous as it could cause bruising or swelling in these sensitive tissues. Avoid pressure on the urethra anteriorly as it could induce irritation or infection.

Epi- no

This is a device that helps with stretching the perineum especially if the massage is too awkward or uncomfortable. It can be purchased over the internet and is usually delivered in less than a week. From 36 weeks onwards, the device which is similar to a balloon connected to a hand pump is used and some mothers report the ability to stretch up to 8-10 cm dilation with use of the device. It also simulates the pressure feeling that occurs when the head is crowning hence users are better able to control their breathing for a slow delivery (read below). A user video can be found below:

From my own anecdotal experience, an estimated 95% of Asian ethnicity first time mothers will tear midline naturally if an episiotomy was not performed. Most of these tears are minor 1st or second degree tears that will heal well. The majority of first time Asian mothers who had an average sized baby and did not tear during delivery had prepared antenatally by either perineal massage or an Epi-No so I do believe that there is some protective effect.  

a.) Warm compress: According to some studies, applying a warm washcloth or compress on your perineum continuously in the pushing stage is associated with less tearing.

b.) Perineal Protection: Slow and controlled pushing during the final stage of labour is important to reduce tears. A hands on approach to protecting the perineal appears to have a protective effect on tears in some studies. This includes having the obstetrician guard the perineum with counter pressure whilst the other hand is placed on the fetus head to slow down the descent on crowning.  When the head is crowning, it is important not to push but breathe down and have a slow delivery to enable to perineal tissues and skin to stretch. Many patients have a strong pressure feeling that makes them wish to expel the fetus quickly. The head puts pressure on the rectum so they feel like they need to evacuate a bowel movement and hence they use the same muscles to push.

However, this is associated with a poorer outcome. If you can listen to your obstetrician’s instructions to slow down at the crowning phase and try to relax the pelvic floor muscles and breathe instead of push, the chance of a severe tear is minimised. Another helpful tip is to open you mouth to breathe or pant and say ‘ HA… ha….’ during crowning.

Now that you are more aware about perineal tears associated with childbirth and some tips to reduce the incidence, we encourage you to discuss this with your doctor. It is something you must prepare for because it may make things significantly easier and may also affect postpartum recovery.

For your concerns, you may book your consultation with Dr. Pam Tan today.

You may also call us at the following numbers:

Thomson +65 6254 2878
Sengkang +65 6384 2759

Keep Calm and Labour On: Your Guide to Pain Management in Labour


Active labour, especially in first-time mothers, can stretch up to 18 hours. Pain management during labour is important because pain can contribute to maternal fatigue which is linked to emotional responses such as anxiety and tension. The physiological stress response of adrenaline production comes with harmful effects on the body and may retard the progression of labour. So, what are the ways to make labour more manageable?

If D-day is in a few months or weeks from now, it’s important that you get acquainted with the options available to you. Here’s an easy guide on pain management while in labour.


The non-pharmacologic approach to pain comes with a variety of techniques. It not only addresses the physical sensations of pain, it also enhances the psycho-emotional and spiritual components of care.

Proponents perceive pain as a side effect of a normal process, not a sign of injury, damage or any abnormality. Instead of making pain disappear, the caregiver assists the woman to cope with it, build self-confidence, and instill a sense of mastery and well-being.

Here are the non-pharmacologic techniques in pain management during labour.


1.Breathing Exercises


We generally benefit from breathing exercises, but it is particularly helpful for women who are in active labour. Also referred to as patterned or conscious breathing, this exercise is the act of breathing at any number of possible rates and depths. It is considered as one of the most common methods used for natural pain relief during labour and even in delivery.

Some women prefer light or pursed breathing exercise where one inhales through pursed lips and takes in just enough oxygen to fill the chest. Others prefer deep breathing using the diaphragm to breathe in more air. Regardless of technique, the goal is to find a breathing pattern that has a calming and relaxing effect.

Patterned breathing can help you cope with various types of pain, anxiety and fear. In the first stage of labour, these breathing techniques can promote physical relaxation by reducing muscle tension. Consequently, this also promotes emotional relaxation. One study even states that “breathing techniques in labour have a positive influence in the development of confidence and feeling of empowerment in the expectant mother.” Effective use of these techniques contributes to better outcomes and higher patient satisfaction during the birth experience.



2. Warm and Cold Therapy


Warm and cold therapies are basic measures for pain management. Both provide pain relief but in different ways. They may both be applied on the same area intermittently or be used at the same time but in different areas where the mother feels discomfort.

Warm compresses can be dry and wet. A dry warm compress can be through a hot water bag or electric heating, while wet warm compresses can be through gauze compresses, packaged heating and bathing/showers. Warm compresses are applied in the lower back, waist, groin and perineum. According to a study, warm compresses help the muscles relax thereby decreasing or eliminating the pain. It can also facilitate the supply of blood flow.

Local cold therapy also comes in dry and wet forms. Dry cold compresses can be in the form of ice or gel packs and wrap-around packs that come with a Velcro belt. Meanwhile, a cold washcloth is used for wet cold compresses. Application can decrease muscle spasms and muscle temperature. It also creates a numbing effect that decreases sensation and pain awareness.


3. Acupuncture and Acupressure


Acupuncture involves the insertion of fine needles into specific points in the body to correct the imbalance of energy, while acupressure uses pressure applied on similar points.  As part of Chinese complementary therapies, these two have been practised for thousands of years, and are now backed by scientific studies. Acupuncture and acupressure have become widely recognized as effective methods of pain relief.

A Cochrane review showed that acupuncture during labour can limit the use of pharmacological analgesia and epidural anaesthesia. It can also trigger the release of several brain chemicals, such as endorphins which block pain signals.  Furthermore, women receiving acupuncture in labour appear to experience additional benefits such as shorter labours and reduced rates for instrumental vaginal birth. However, most labour wards in singapore are not open to acupuncture conducted in labour.

Alternatively, certain pressure points are also found to significantly reduce pain intensity during labour. A study suggests that the LI4 (Large Intestine 4) pressure point can alleviate the pain without causing adverse effects on you and your baby. A randomised trial also showed that applying pressure on BL34 (Bladder 32) can alsoimprove labour pain and even delivery outcome.



4. TENS (Transcutaneous Electrical Nerve Stimulation)


It is nerve stimulation through a device that delivers safe pulses of electrical currents that can help control labour pain. The electrode pads are placed on acupuncture points on the lower back.  The currents block the pain signals at it passes through the nerves to your brain.  It can reduce the severity of labour pain and it can delay your need for pharmacological analgesia. The gate control theory of pain asserts that non-painful input closes the “gates” to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation of the nerves in another mechanism may be able to suppress pain. The TENS machine eg babycareTENS for labour may be available online or rental from some antenatal or obstetric providers. It may be particularly helpful for early labour and back pain in labour caused by the baby’s position pressing on the sacral nerves. Alternatively, strong counter pressure in the back with massage may also help.

5. Hydrotherapy


Hydrotherapy means immersion in water and come out of the tub to birth. It should not be confused with a water birth, which means to labour and birth in the water. This pain relief option provides physiological and psychological benefits which is highly sought after by mothers who plan to have a natural birth.

For some people, water can be a calming presence. It is also an evidenced-based intervention for pain and anxiety management, which explains why hydrotherapy is introduced in several healthcare institutions in Singapore as an option for pain management during labour.

One study finds that as the mother relaxes through this method it helps reduce the duration of labour and decreases the need for epidural analgesia.

6.Continuous Labour Support


A trained birth attendant (Doula)  or partner can provide non-medical labour support to assist with pain management. While you can enlist the help of a doula, your partner can also learn how to provide effective emotional and physical support through the Bradley method in pre-natal classes. Having a birth coach has been shown to reduce the use of epidural analgesia.

Your social environment plays a powerful role in influencing your thoughts and emotions. Your support system can help you look at labour pain as a productive and purposeful pain. With pain intensity increasing by the minute, dealing with it can be hard while you are in labour. But with continuous labour support you are more empowered to use your inner capacity to cope. Research shows that this can decrease your need for pain interventions. When done correctly, this can improve your experience with labour pain.



Mental imagery is also a powerful tool in managing labour pain. By applying this method, you can prepare your mind to respond the way you want in situations that you can’t control. Through this you can rehearse the stages of labour, train your mind to stay calm during contractions, and stay focused and alert for long periods of time. The Mongan method is the most commonly used hypnobirthing method for self-hypnosis and guided imagery techniques with the aim of being in a deeply relaxed state. There are several antenatal classes that teach this technique.

Mentally rehearsing an event with emotional, visual, and auditory detail rewires your brain. It cannot tell if you have physically done it or just imagined it. So, when the event comes, your brain goes on autopilot and recollects how you have mentally rehearsed things to happen and goes about getting it done.

While it is true that labour may not always go the way you have rehearsed it, this technique can better equip you to deal with any necessary intervention with strength and clarity. This can be possible after you have fostered a connection with your internal strengths and resources.


8.Music Therapy and Aromatherapy


Music therapy is found to reduce pain and anxiety during labour. It is a cost-effective intervention that doesn’t need any training to be used.

A person’s familiarity with music and preference is strongly linked to how relaxed they feel when listening to music. One study showed that people who listen to music that they enjoy experience increased levels of natural “feel good” hormones. These are also referred to as the body’s “pleasure hormones” because it can improve your mood and happiness.

Another research also claims that music can affect a woman’s perception of pain and anxiety during the active and latent phase of labour. This study revealed that the active phase and second stage of labour were significantly shorter for participants that were subjected to music.

If you consider music as part of your birth plan, now would be the time to start making that feel-good playlist to serve as a soothing soundtrack to help you manage labour pains.

Similarly, calming smells using essential oils like lavender, chamomile and bergamot can help relax the body during labour while peppermint is good for reducing nausea. Most labour wards will permit gentle calming music and aromatherapy.

Medical Pain Management Techniques


There are two type of medication that can a help ease labour pain: Analgesics and Anaesthetics. Analgesics lessen the pain, while maintaining feeling or muscle movement. Anaesthetics relieve the pain by blocking all sensation of it.

Furthermore, the pain relief provided by these medications can either be systemic, regional, or local. Systemic medications affect the entire body, while local medications affect a small area. Regional medications, on the other hand, affect a region of the body, like the waist down.

Under the two main classifications are different pain relief options which include the following:


Labour epidural has long been considered the gold standard in labour analgesia as it is the most effective and gives the mother time to rest before the pushing stage of labour. It is administered as an infusion of local anaesthetic into the epidural space in the spine. It is normally given when you enter active labour the effects are felt within 5-20 minutes. You will experience some loss of feeling in the lower areas of your body so you will no longer be mobile, but you remain awake and alert to be able to bear down or push your baby out. Often you will have a urinary catheter inserted to drain the urine passively as you will not feel when your bladder is full.

It does not increase your risk of having a caesarean section but may prolong the second stage of labour as there is decreased sensation that the cervix is fully dilated and reduces the urge to push. Occasionally, the epidural dosage is reduced during this time so that pushing is more effective and that reduces the chance of an instrumental forceps or vacuum delivery. Some patients have a drop in blood pressure or develop shivering or fever while on the epidural. Very rarely do patients get a headache or suffer nerve injury (less than 0.1%). Contrary to popular belief, epidurals do not cause back ache but backache is common after any pregnancy irregardless of epidural usage.

2. Laughing Gas

It is made up of sedating gas that is mixed with oxygen. It will not eliminate labour pains, but it can make it more bearable. Since the effects are mild and short-acting, it is considered a very safe option. You can use it through a tight-fitting mask or mouthpiece when you feel that you need it. Right at the start of the contraction, deep inhalations of this “laughing gas” are used until the contraction starts to subside. However, it can make you drowsy, light-headed or nauseous if inhaled too rapidly or too long hence you are advised to stop once you feel light headed and in between contractions.

3.Opioid Injections

Upon request, opioid injections are often administered into the thigh or buttock to block the pain receptors to your brain. It will take 10-20 minutes before you can feel any effect.

The drug can potentially cause the baby’s heart rate to drop. Rarely, it can even cause drowsiness or breathing problems in the newborn if birth occurs close to the time of administration and in some cases, an antidote is needed to reverse the side effects. Hence it is usually not given when the patient is more than 5 cm dilated.

Isn’t it fortunate that you are now giving birth at a time where you can make the labour experience less stressful than movies make it out to be? However, even with all these pain management options at your disposal, it is still important that you work closely with your doctor in finding one that suits you best.

To know more on this topic and for other related concerns, book your appointment with Dr. Pamela Tan toda

A Mommy’s Guide to All Financial Aspects of Pregnancy in Singapore

Expecting a baby can be a beautiful experience, but it is also one that is peppered with anxiety. As an expectant mother eases into nesting, she can have a mountain of concerns running through her mind. One that usually demands attention is financial preparedness. Pregnancy and delivery in Singapore don’t come cheap. However, a woman can prepare for it and save herself from added stress once she learns about the help available to her and her baby.  

The Harmful Effects of Financial Stress in Pregnancy

  Worrying about finances and how they will be able to keep up with the changes to come not only bothers the mind, but also has detrimental effects on the baby. One study shows that women who feel anxious or stressed about finances during pregnancy are more likely to have babies with low birth weight. Furthermore, babies who are underweight are more likely to need expensive intensive care during the first weeks and months of life. They also have an increased risk of developing chronic medical issues, respiratory and digestive problems, obesity and heart disease. This sheds light on the importance of financial preparedness to ensure that financial stress does not have a chance to interrupt the baby’s growth and development in the womb.  

The Cost of Antenatal Visits

  After a positive pregnancy test, you are advised to go for regular check-ups. Antenatal appointments are very important throughout your pregnancy because it helps you monitor your health and that of the baby. These check-ups usually start from the 6th-8th week of pregnancy. It is advisable that you go for check-ups at least once a month. In the last trimester, these visits would have to increase to twice or more every month. During the entire pregnancy, you can expect to have at least 10 or more prenatal visits. Each of these visits is a chance for you to discuss any concerns with your doctor. However, you might be concerned about how these appointments can get expensive. The costs of these antenatal visits vary from $500 – $800 at public hospitals for all 10 visits, to around S$140 – S$250 per visit at a private hospital, with the total cost roughly around S$1,800-S$2,500. If you include the cost of prescribed supplements or prenatal vitamins, these visits may cost you about S$500 to S$700 more. In addition to these visits, you must also factor in the different tests to your list of expenses. These include the following:

  • Scan during the initial visit to confirm the due date, whether a mother is carrying multiples (twins/triplets/quadruplets), if it is an ectopic pregnancy, and to check the baby’s heartbeat.
  • Full blood count to check for anaemia (low blood count which can leave one tired and less able to cope physically if too much blood is lost during or after delivery)
  • A urine test every visit to check for the presence of protein (an early sign of pre-eclampsia or a urinary tract infection) and urine sugar to screen for diabetes
  • Blood screening to check for thalassaemia (a common genetic blood disorder in Singapore)
  • Blood grouping in case a blood transfusion is required
  • Hepatitis B and syphilis screening
  • Rubella antibody screening (optional)
  • HIV screening (if infection is present, this can have significant implications for your baby)
  • Down syndrome screening
  • First Trimester Pre-Eclampsia Screening (includes specific blood test for PIGF, blood pressure measurement, ultrasound examination) if there are signifcant risk factors
  • Ultrasound scan (anomaly scan) at 20 weeks to check for major structural abnormalities
  • Oral glucose tolerance test at 24-28 weeks to screen for gestational diabetes
  • Lower vaginal swab around 36 weeks for Group B streptococcus screen

Doctors may suggest these screening or diagnostic exams, but some expectant mothers may not have to undergo all of them. However, a more extensive screening and monitoring is required for high risk pregnancies. After week 13 some private gynaecologists in Singapore offer prenatal packages which includes consultation, ultrasound, additional scans and tests. Sometimes, these may even include supplements. However, these packages usually do not include a screening test for Down syndrome in the baby which usually cost around S$300 – S$350 for a OSCAR first trimester screen to up to $1250 for a non invasive prenatal test (NIPT).   Each hospital offers different antenatal screening ultrasound packages grouped according to each trimester. You can check out Thomson Medical Centre’s package, here. Whether you choose to go to a private or public hospital, the expenses for some of the tests can be subsidised by the CPF (Central Provident Fund). Through the MediSave program, you get to save some of your budget for other needs. We will discuss more on these government subsidies below.  

The Cost of Labour and Delivery

  Your choice of hospital is an important decision when you are considering the cost. The total expenses will depend on whether you choose a private or a public institution. As expected, private hospitals will be costlier. In choosing one, you need to factor in the cost of the delivery room, the need for birthing assistance, or specific requests like a water birth. Furthermore, your choice of doctor will also significantly affect the total cost. It depends on whether that doctor practices in a private or public institution.  Hospitals may show you labour and delivery packages, but these usually do not include the doctor’s professional fee.  

Room Rates

  Room rates vary for each institution and the cost also varies for each accommodation. At Thomson Medical Centre they offer the following:

  • Premier Single – S$638.00 without GST (S$682.66 with GST)
  • 1 Bedded Room – S$530.00 without GST (S$567.10 with GST)
  • 2 Bedded Room – S$288.00 without GST (S$308.16 with GST)
  • 4 Bedded Room – S$209.00 without GST (S$223.63 with GST)

The choice of hospitals will ultimately depend on the patient’s preference, budget and the level of comfort and privacy a woman wishes.  


Vaginal Deliveries

The cost of a normal (vaginal) delivery ranges from S$840 to S$9,775 depending on the hospital and ward. The highest median cost is at S$9,775 at Gleneagles (Private), and the lowest is at S$840 at the National University Hospital (subsidized Ward C). If you have the extra cash to make your labour and delivery experience more special, several hospitals in Singapore offer packages to let you do so in style. This could mean suite rooms, private nurse service, celebratory dinner or cocktails, and complimentary massages.  


A caesarean delivery costs much more than a normal delivery because it is a surgical procedure, which means it will take longer to heal. Your hospital stay may be up to 3-4 days for further monitoring. The cost of a C-section in Singapore ranges from S$1,115 to $16,314 depending on the hospital and type of ward you choose. The highest median cost for a C-section is S$16,314 at Mt. Elizabeth Hospital (Private). The lowest median cost of a C-section is around $1,115 at the National University Hospital (subsidized Ward C). C-section deliveries with serious complications often range from S$1,491 to S$17,220. The Highest median cost is S$17,220 at Gleneagles Hospital (Private), while the lowest median cost is S$1,491 at the National University Hospital (Ward C). The total cost will also be affected based on your choice between an epidural or general anaesthesia. Some women may also opt to get a ligation along with a C-section.  

Baby Admission

  In some cases, the baby may require a separate admission due to medical reasons. It could be due to a preterm birth or low birth weight. This will mean additional expenses, but you can claim a certain amount from MediSave to cover the cost. If the baby needs to be admitted in the NICU (Neonatal Intensive Care Unit), the charges are linked to the category charges of the mother. For example, if you are admitted as a Class A mother for a private room, then your baby’s NICU stay will also be charged under class A. However, the quality of care for the babies in Singapore’s NICUs is the same, even if the cost varies significantly.  

Maternity Insurance

  Maternity Insurance is an add-on to your basic health insurance policy that covers expenses related to childbirth. It is common practice for insurance companies to cover pre- and post-hospitalisation expenses along with the coverage for room and nursing charges. It often costs less for a woman to carry a separate policy from her husband or partner when it comes to maternity coverage add-ons. Prenatal insurance, on the other hand, offers a different kind of security for mothers who want to be fully prepared. It provides financial assistance for those who suffer from complications during pregnancy. It also includes coverage for newborns with congenital disorders. Example of top Maternity Insurance Policies in Singapore include: OCBC MaxMaternity Care Pacific Prime Maternity Insurance AXA Mum’s Advantage Company insurance, especially comprehensive covers provided by some large multi-national companies under Bupa, CIgna or Now health etc, may provide for maternity benefits for employees or their spouses.

Government Subsidies


MediSave is Singapore’s national savings scheme which helps CPF members to put aside part of their income into their MediSave Accounts for future personal or their immediate family’s hospitalisation. Expectant mothers can also use it for pre-delivery and delivery expenses through the Maternity Package. The MediSave withdrawal limit for pre-delivery expenses have been doubled from S$450 to S$900 for mothers who have delivered on or after 24 March 2016. This can cover expenses for consultations, tests, ultrasound scans, and medications. For delivery expenses the claimable MediSave amount is between S$750 and S$2,150, depending on the type of delivery procedure. The MediSave limit for a normal vaginal delivery is $750 while a C-section is SS2,150 and a C-Section with ligation is S$2,600. For each hospital day you get to claim S$450 to cover the cost of accommodation. MediSave can be used from the birth of your first child onwards. Both parents’ MediSave can be used for the fifth and subsequent childbirth; however, it is only applicable if the combined balance is at least S$15,000 at the time of the delivery. This is to make sure that you will still have enough funds for future hospitalisation needs, especially after retirement. In exceptional cases, the grandparent’s MediSave can be used too.  

Baby Bonus

The Baby Bonus Cash Gift is cash that is given to parents of newborn babies. The amount they receive depends on the birth order of the child. The claimable amount has been enhanced. For the first and second child, it was previously S$6,000 for those born between 26 August 2012 and 31 December 2014 (for each child). It has been increased to $8,000 (inclusive of S$2,000 Baby Bonus Plus) for babies born on or after 1 January 2015 (for each child). For the third and fourth child, the claimable amount is S$10,000 under the Baby Bonus Plus Scheme. The 5th and subsequent children did not have any claimable amount in the previous arrangement, but with Baby Bonus Plus, they can now claim a total of S$10,000. Learn more about MediSave and the Baby Bonus scheme, and how you can claim it, here. There is a bevy of resources in Singapore that you can tap for financial assistance and preparedness. Dr. Pamela also offers a maternity antenatal package that is available in her Seng Kang clinic and a promotional upgrade from 4 bedded to 2 bedded room for some deliveries in Thomson Medical Center. Book a consultation today and prepare your body, your baby, and your wallet for D-Day!  

Disclaimer: While all efforts are made to ensure that the information presented here are accurate at the time of publishing, we are not liable for any updates. The prices that are specified in this page are still subject to changes. It is advised to confirm with the primary sources.

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Male Nesting: A Dad-To-Be’s Guide Through Pregnancy and Fatherhood

Expecting a baby can be two different stories for an expectant mom and a dad-to-be. A drastic change is about to come into the family as a unit especially for first-timers. But, men should understand that these changes have taken over a woman’s body so much so that some may find pregnancy not so magical after all. This is where a man should step up to meet his partner halfway and involve himself in the process.

Your Participation Is Important

Research has shown that most new moms have a better experience during pregnancy when dads are actively involved. This makes your role essential and one you should never take for granted. Today, not only does your involvement benefit the mother and the child, but it also benefits you and how you develop your identity as a parent early on.

Always remember that the health of your baby depends on the health and well-being of the mother. Your participation as a partner is important even if you are not the one going through the physical changes.

Some may come into the process all ready and excited. But, you shouldn’t be guilty if you still feel rather clueless on what to do. Having found your way here, means that you are making an effort towards the right direction.

Male Nesting

Nesting is not only for women since expectant fathers go through it too, but it may manifest in different ways. The instinct to provide and protect could be expressed by babyproofing the house, considering buying a family-friendly car, or working harder at the office.  As a matter of fact, what you are doing now is an effort in that direction.

According to family therapist Mary Dodge to ParentMap, “Nesting’s both an expression of anxiety and an attempt at mastery of a new role.”

Men and Pregnancy

Behind all the excitement over a pregnancy is the reality of physical changes, financial preparation, and emotional preparedness among many others. You become an effective support system when you know what to expect within the coming months and the role you play in it.

Here’s a simple guide on how to support your pregnant partner:

Go With Her During Antenatal Visits

The pregnancy experience can be similar in a lot of ways and unique for several reasons. Your involvement can help you understand what is going on beyond what you can see, and empathize with what your partner is going through.

The main goal of these monthly visits is to prevent health problems in both the baby and the mother. These visits are also opportunities for you to gain foresight on what you need to prepare. Furthermore, this effort will also help you to be more open-minded and understanding to your partner’s emotional state and physiological needs.


LISTEN AND TALK. If you can learn how to support each other now, your relationship will be stronger when the baby arrives.

Listen and Talk

Pregnancy and childbirth can be a lot to handle, especially for first-time moms. The least that you can do is to be a reliable confidant whenever she wants to vent. She may feel anxious or lonely, especially when she starts her maternity leave from work. Encourage her to talk to you, to family, or her friends.

It is also normal to have worries of your own. It’s also healthy that you share these concerns with your partner. After all, you are in this together. This type of exchange will help you open up more to each other. This develops a healthy discussion on matters that concern your changing family dynamic. If you can learn how to support each other now, your relationship will be stronger when the baby arrives.

It’s also important that you talk and ask other people (e.g. your parents or friends who are fathers) for advice. As an expectant father you may struggle with the need to balance your own transition to fatherhood and that of your partner. Through this process, you may feel that your status and feelings are overlooked – which may create conflict with your other roles. If you find yourself in that state, never hesitate to ask for support and advice.

Help Her out

Hormonal changes can make a pregnant woman tire easily.  So, you have to be pitch in with the household chores. The physical changes your partner is going through may make it harder for her to perform her usual tasks. For example, lower back aches are common during the third trimester, so you might have to do the heavy shopping yourself. You can also support her by eating healthy too so that it will be easier for her to follow through with the doctor’s diet restrictions.

Your positive participation can help allay your partner’s stress, and it has profound benefits to her health and that of the baby’s. All these efforts to help out are significant expressions of love and care, telling your partner that she is not alone. 

PLAN TOGETHER. Going to her pre-natal visits is like scoring VIP tickets where you get to ask the doctor straight away.

Plan Together

If your partner is keen on doing a birth plan, it is important that you also take part  in the planning. Your involvement in the planning will help  you become an effective support system and advocate during the labour and delivery process. This will also help you to be more prepared and less anxious when the big day arrives. It is also important to attend to arrangements needed for preparation when baby comes home like preparing the nursery, washing all the baby clothes and nursing equipment, installing the car seat or getting the confinement nanny in.

Read or Attend Supplementary Classes

You may feel a bit mystified by all the changes that are happening inside your partner’s belly. Fortunately, there are several resources to educate you. Going to her pre-natal visits is like scoring VIP tickets where you get to ask the doctor straight away. On your own time, you can also peruse magazines, books, or blogs. You may also attend childbirth classes along with your partner.

A well-prepared father has a positive effect on his partner’s birth experience. Knowing what to expect can reduce your fear of seeing your partner in pain during the labour process.

man-and-pregnancy-guide-dr-pamela-tanMen and Fatherhood

Experience may be the best teacher, but that will come afterwards.  For now, preparedness will help you handle your new responsibility better. You extend your circle of concern from your wife to your new bundle of joy.  Now you get to wear another hat for another role, and here are some tips you should keep in mind:

Change Your Habits

Did you know that your habits may indirectly affect your baby even in utero? Cigarette smoking, for example, can be detrimental to your baby. Your second-hand smoke can pose the following risks:

Check your lifestyle and see what you need to change to ensure that you create a safe and healthy environment for your family.

Know Child-Care Basics

Supporting your wife also means knowing the basics of child-care. Fortunately, for you today, there is a variety of sources to help you out. You can read about it or learn from classes, friends, or family. Fathers must learn how to at least prepare formula milk, change a dirty diaper, or bathe the baby. In this way, you can take over when your partner needs to rest.

Check Out Benefits Offered By The Government

The Singapore Government offers a paid paternity leave for two weeks. You can check here, to see if you are eligible and to choose among the different arrangement options.

The government also offers a Baby Bonus Scheme which will help families defray the costs of raising a child. It comprises a Child Development Account (CDA), a cash gift, and a special co-savings scheme for children. You can learn more about it, here.

Baby Proofing

While your partner may be able to cover certain aspects of this, it is up to you to do some serious handiwork. Baby proofing your house may include the following:

  • Installing smoke detectors
  • Installing a baby camera
  • Blocking all open outlets with safety plugs
  • Latching closed any drawers, doors, or cupboards that could be within baby’s reach

If you are an expectant dad, know that you don’t have to sit on the sidelines because you can be a proactive participant during the entire pregnancy process. If you have questions, feel free to send them here.

Decoding The First Signs of Pregnancy

Pregnancy is one of the interesting processes that could happen to a woman’s body. While there are expected milestones for the next nine months, the experience may vary for each expectant mom. In fact, each pregnancy may bring a different set of experiences for a woman.

If this is your first time, these changes can be uncomfortable, while some ladies might even miss the very first signs of pregnancy entirely. However, there is something to be said about knowing if you are pregnant the earliest time possible. It allows you and your baby to receive the right diet, the right care, and proper monitoring.

So, if you are trying to get pregnant or if you are reeling from certain changes happening to your body, these are the initial signs of pregnancy to watch out for even before you get to a pregnancy test.

Light Spotting

Also referred to as implantation bleeding, light spotting occurs when a 6-12 day-old fertilized egg attaches itself to the interior lining of the uterus.This may be mistaken as menstrual bleeding since some occurs a few days before the next menstruation cycle, but it is not as heavy.

Spotting can be determined as something that is present only when wiping, while bleeding refers to the kind of flow you experience during menstruation.To determine if it is indeed implantation bleeding, you should take into consideration other accompanying signs such as, light or faint cramping, headaches, breast tenderness, mood swings, nausea, or  lower backaches.

Key differences between implantation bleeding and menstrual bleeding include the following

    • Color: Women are familiar with the color of their period as it ranges from bright to dark red. Implantation bleeding, on the other hand, is typically light pink to dark brown in color.
    • Clotting: Some amount of clotting is present during with menstrual bleeding, but implantation bleeding doesn’t come with any at all.
    • Amount: It is normal for women to soak pads and tampons during their period, but it is different with implantation bleeding. The word “bleeding” is actually misleading because implantation bleeding is actually very light, almost like a stain rather than a full flow.
  • Length of Time: Typically, a woman’s period can range from 3-7 days, while those on birth control tend to bleed for a shorter time. Implantation bleeding can last for a few hours to less than three days, and it doesn’t require any treatment.

Light spotting isn’t as cumbersome as other early signs of pregnancy. It does not require any medical intervention, however, it is important that you closely observe it.

Mild Cramping

What is tricky about interpreting this symptom is that it can be confused with ovulation cramps and menstrual cramping. The mild cramping sensation you feel when ovulating occurs when the follicle – a sac in your ovary that carries the eggs – ruptures and releases an egg. This is called “mittleschmerz,” which is a German word that means “middle” and “pain.” It often occurs mid cycle, or two weeks prior to your period, although most women don’t feel it at all. Meanwhile, menstrual cramps strike 24-48 hours before your period and goes away once menstruation starts. The pain can be range from mild to severe depending on the level of prostaglandins – a hormone-like substance that causes uterine muscle contractions.

Implantation cramps, on the other hand, are more mild and intermittent, occuring on and off for one to three days. This happens as the embryo implants itself into the lining of the uterus. It takes about a week for the fertilized egg to burrow its way into the thick, rich lining which causes the mild pain. This typically occurs about a week before you would expect your period (for those with a normal 28-30 day cycle), which is why some women confuse it with ovulation or menstrual cramps.

To relieve the discomfort you can do the the following:

    • Try sitting, lying down, or changing positions.
    • Try to do relaxation exercises.
    • Soak in a warm bath.
  • Place a warm water bottle wrapped in a towel on the area.


Feeling tired or exhausted is a common early sign of pregnancy. Some women may feel fatigued for the first 12 weeks or throughout the pregnancy, while others may hardly feel tired at all. You can get 10-12 hours of sleep but still wake up feeling lethargic. This can be frustrating especially when you can’t seem to get things done.

Hormonal changes are the likely cause of fatigue. Increased progesterone levels are responsible for making you feel sleepy. In addition, your blood sugar levels and blood pressure also lowers to provide blood flow to the baby.

As the second trimester rolls around, there is a good chance that your energy level will increase making you feel like your old self. Most call this stage “the happy trimester” and would take advantage of it to finish important tasks before energy levels are likely to decrease again during the third trimester. However, don’t be alarmed if you still feel fatigued during the second trimester.

So, if you notice your afternoon energy drop to be out of the ordinary, this could be your body’s way of telling you that a baby could be on board.

To cope with the constant feeling of tiredness, you just need to make sure that you adjust your schedule to allow yourself to get ample rest. Avoid drinking fluids several hours before bedtime to minimise on the number of times you have to get up at night to use the bathroom. It also helps that you choose a healthy, balanced diet because your level of nutrition can go a long way in supporting your energy levels. Make sure that you get enough calories, protein, and iron.

Nausea (with or without vomiting)

Along with constantly feeling tired, you may also experience light-headedness or dizziness. Commonly known as “morning sickness,” this occurs during the first week after conception as blood vessels dilate and your blood pressure drops. Not every women will experience nausea the entire duration of the first trimester. However, in some cases, it can start earlier and can last longer too.

Another reason behind this is the presence of a certain pregnancy hormone which is produced soon after the fertilized eggs attach to the uterine lining. Women with this hormone in their system experience severe nausea and vomiting (hyperemesis gravidarum), which would require medical intervention.

Estrogen is also another hormone that increases during early pregnancy which could cause nausea. Stress and fatigue brought by the string of changes pregnancy does to the body can also contribute to queasiness.

To prevent or manage nausea during pregnancy you can try the following home or natural remedies:

    • Eat smaller meals more frequently throughout the day instead of three big meals.
    • Avoid foods or smells that can trigger your nausea.
    • Stash soda crackers by your bed and eat a couple before getting up. Allow some time for it to be digested before slowly getting up.
  • Suck on hard candy.

Shortness of Breath

Feeling like you are short of breath is a common symptom of pregnancy. It can begin before any upward displacement of the diaphragm due to a growing uterus. During the first trimester, increased levels of progesterone causes the lungs to increase its demand for oxygen. There is an increase in lung capacity which increases oxygen-carrying capacity to provide nourishment for the growing fetus but your respiratory rate (breathing cycles per minute) only changes slightly. This will make you feel like you are short of breath.

To relieve shortness of breath, give your lungs as much breathing room as possible. You can do this by standing up straight, sitting up tall, and sleeping propped up on pillows to expand the space in your abdominal cavity. It also helps to slow down when you feel that your heart and lungs are working harder.

Tender or Swollen Breasts

Changes to the breasts can start as early as one to two weeks after conception. In fact, this is one of the top three things women complain about in early pregnancy. The formidable duo – estrogen and progesterone – are the main culprits behind breast tenderness. In addition to that, the fat layers in your breasts thicken, you grow more milk glands, and blood flow increases. These changes may give your cup size a favorable boost, however it does not always leave you with a pleasant experience. But, more importantly, it also serves a purpose of preparing your breasts for breastfeeding in a few months.

To take care of tender or swollen breasts, it helps that you wear a supportive bra. A full-coverage bra can offer adequate support in lifting the breasts and relieving the pressure. You must also avoid underwire bras because it has the potential of digging into the skin. Furthermore, a cold compress or a warm shower can help relieve some tenderness. Warm water, in particular, can help ease the tension and relax the muscles around your chest.

Frequent Urination

A lot of women complain of having to spend a seemingly endless loop to the loo. This heightens during the first two to three weeks of your pregnancy. The reason behind this is because the blood flow to a pregnant woman’s kidneys increase by up to 30-60%. This makes the kidneys produce up to 25% more urine soon after she conceives.

Frequent urination can also be attributed to hormonal changes. Once the embryo is implanted into the uterus, your body produces the pregnancy hormone hCG. This triggers a woman to urinate frequently. Furthermore, the spike in progesterone levels can also result in this sensation.

Unfortunately, your urge to pee often will not only be an early sign of pregnancy. As the uterus expands to accommodate the growing baby, it presses down on your bladder, urethra and pelvic floor muscles. This means that your bladder can no longer expand to the same level of fullness as before, therefore it has to be emptied more often.

To reduce the hassle of having to go to the bathroom several times, especially during sleeping hours, avoid drinking too much water a few hours before bedtime.

Besides the usual missed period to signal that something is up, these signs should compel you to take that pregnancy test. Once you have confirmed it, your pregnancy calendar should now be lined with regular prenatal visits. The earlier you know, the earlier you can get professional help and regular monitoring. We hope that this knowledge will help you prepare for what is to come if you are still planning for a baby or if you are already experiencing some of these signs now.

Proper pregnancy planning and having the needed resources along with emotional support is essential during early pregnancy. For all your concerns, from pre-conception health screening to pre-natal visits, and everything in between, book a consultation with Dr. Pamela Tan today.

Dr. Pamela Tan, gynecologist and obstetrician based in Singapore, consults at Thompson Medical Center, Crawfurd Medical Centre, and Sengkang Island Family Clinic.