A PUBLICATION BY REGISTRATION No. 198901967K MICA (P) 047/11/2009 COMPLIMENTARY COPY ISSUE 01 / 2010 Route to Parenthood: Boosting Your Chances of Pregnancy Health Screening for My Babe Excuse Me, I am Pregnant Your pregnancy is your best excuse Happy Labour Day All you need to know about delivery without labour Premium Delivery Packages For Mums-to-be Raffles Hospital offers a comprehensive range of maternity packages and services. Enjoy your pregnancy as you prepare for the arrival of your bundle of joy. Room Types Normal Delivery Caesarean Delivery S$2,876 (Valued at S$3,317) S$3,946 (Valued at S$5,136) 2-Bedded Room S$2,662 (Valued at S$3,103) S$3,411 (Valued at S$4,494) 4-Bedded Room S$2,555 (Valued at S$2,996) S$2,983 (Valued at S$4,066) Single Room (Upgrade to Deluxe Room, subject to room availability) Packages include: • • • • • • • • 2-day stay with nursing care in our inpatient room for the new mummy 2-day stay with nursing care in our nursery for your newborn baby Daily breakfast, lunch, afternoon tea and dinner with choices from Western, Asian, Japanese and traditional confinement menus Complimentary internet and wireless broadband access at the wards area and Raffles International Patients Lounge Complimentary 3-course romantic Celebratory Dinner for you and your loved one worth S$95 Complimentary postnatal massage (single session, subject to specialist’s certification of fitness) worth S$139 Complimentary gift hamper Complimentary breastfeeding & infant care guide (Breastfeeding to be supervised by lactation consultant) * Special rates extended for confinement stay. * Package prices exclude doctor's fees and non-standard medical supplies or tests, lodger and miscellaneous charges. * Terms and conditions apply. * Prices inclusive of GST. To sign up, or for more information, please call 6311 1111/ 6311 1507. Operating hours: Monday - Friday (8.00am - 6.00pm), Saturday (8.00am - 1.00pm) NewsRoom Contents 4 Supplements FoodNotes Ask a Raffles Doc Promotions 27 28 29 30 New Doc on the Block | New Centre: Raffles Dialysis Centre | New Clinic | Hospital Treats Rare Tumour | Superbrands Features Route to Parenthood: Boosting Your Chances of Pregnancy 6 Health Screening for My Babe 8 Having problems conceiving? Find out how you can increase your chances of getting pregnant with some help from your doctor. Assessing your unborn child’s health is no longer an impossible dream. Learn about the various types of screening available and their use. Eat Away Your Pregnancy Symptoms 16 Learn to combat common pregnancy symptoms with the right diet. Happy Labour Day 17 Pregnancy: An Emotional Roller Coaster 21 Find out about the different labour stages and what you need to do to ensure a smooth and an unforgettable delivery experience. Update on Old Wives’ Tales 10 UpClose Guidelines for Sanity: Surviving the 12 first 3 months of parenthood 23 Do you often dismiss pregnancy beliefs from your elders as old wives’ tales? Let our experts tell you the common myths that you can dispel for good. Phan Nhung enjoys putting a smile on her patients’ faces. She shares about her work and the joy of helping patients cope in a foreign land. Excuse Me, I am Pregnant Understanding your emotions can lead to a happier, healthier pregnancy for you and your family. Our experts share tips on how you can sail through this tumultuous time. Feeling overwhelmed? Not sure what to do? Learn to calm those nerves as you take on new challenges brought on by parenthood. 14 Pregnancy offers you the perfect excuse to enjoy nine months of bliss. Read on and learn to make the most of it. DIRECTORY www.rafflesmedicalgroup.com Corporate Accounts Enquiries Fax No. 6311 1333 6311 2383 www.rafflesmedical.com General Enquiries Fax No. • Anchorpoint • Ang Mo Kio • Anson Centre • Bedok North • Bishan • Capital Tower • Causeway Point • Centrepoint • Changi Business Park • Clementi • Compass Point • Fusionopolis • Harbour Front • Hougang Central • Jurong East • Lot 1 • Loyang Point • Marina Square • Millenia Walk 6311 6311 6479 6453 6225 6441 6456 6323 6894 6733 6781 6872 6881 6466 6273 6386 6899 6765 6585 6339 6337 2222 2392 3818 2288 2188 1736 7122 5212 0777 8775 7337 9043 7337 7366 3078 7896 6688 3363 3333 6644 6000 • Ngee Ann City • Northpoint • Ogilvy Centre • OUB Centre* • Raffles Airport Medical Centre Passsenger Terminal Two* Passsenger Terminal Three* Airport Transit One Airport Transit Two Changi Cargo Complex • Raffles City • Raffles Hospital • Science Park I • Sembawang • Siglap Road • Sixth Avenue • Tampines Junction • Tampines 1* • TechPlace II • Toa Payoh Central * Clinics with X-ray Facilities Hong Kong Clinics 6734 6755 6223 6535 6543 6241 6543 6543 6543 6339 6311 6776 6853 6442 6462 6788 6260 6556 6254 7355 0049 1188 2222 1118 8818 1113 1118 1038 6911 2233 7155 7703 0488 3426 2222 5116 2318 7667 (852) 2525 1730 www.raffleshospital.com General Enquiries 6311 1111 Call Centre Fax No. 6311 2136 24 Hour Emergency 6311 1555 Admissions / Business Office 6311 1888 Raffles International Patients Centre 6311 1666 International Patients Centre Fax No. 6311 2333 24 Hour Appointments Hotline 6311 1222 Fax No. 6311 2136 Email [email protected] Raffles Aesthetics Raffles Cancer Centre Raffles Children’s Centre Raffles Chinese Medicine Raffles Counselling Centre Raffles Dental Raffles Dialysis Centre Raffles ENT Centre Raffles Executive Medical Centre Raffles Eye Centre Raffles Fertility Centre Raffles HealthScreeners Raffles Heart Centre Raffles Internal Medicine Centre Raffles Japanese Clinic Raffles Orthopaedic Centre Raffles Skin Centre Raffles Surgery Centre Raffles Women’s Centre Physiotherapy Centre Radiology Regional Representative Offices / Liaison Centres Indonesia Jakarta Representative Office Semarang Representative Office Jogiakarta Representative Office 62 21 5785 3979 62 24 841 9600 62 274 623288 Vietnam Hanoi Representative Office 84 4 39367999 Bangladesh Dhaka Representative Office 88 02 8835984 Editorial: Dr Prem Kumar Nair, Magdalene Lee, Clara Cai, Fann Khoo & Manjit Kaur Creative: Edd Chua & Jenny Cheok The information contained in this publication should not be regarded as a substitute for detailed medical advice in individual cases. All rights reserved. No part of this publication may be reproduced in any form or by any means without the written permission of the publisher. Please address all correspondence to The Editor, Raffles HealthNews, Fax no. 6311 2378 Email: [email protected] Raffles HealthNews is published by Raffles Medical Group Ltd 585 North Bridge Road, Raffles Hospital #11-00, Singapore 188770 www.rafflesmedicalgroup.com Printed by Olympia Printing Pte Ltd Feb 10 Newsroom Raffles HealthNews 1New Doc on the Block Dr Wendy Sinnathamby, Specialist in Paediatric Medicine at Raffles Children’s Centre, graduated with MBBS from Guy's and St Thomas' Hospitals in UK in 1997 and obtained her MRCP (UK) in 1998. She completed her paediatric training in the UK and worked as a Consultant in Paediatric Medicine at Medway Maritime Hospital in Kent for two years prior to moving to Singapore. Dr Wendy became a Fellow of the Royal College of Paediatrics and Child Health (FRCPCH) in 2007. Her main area of interest is in general paediatrics managing a wide variety of paediatric conditions including chronic cough, asthma and allergy. She is also experienced in follow up of newborns, developmental screening and adolescent medicine. Dr Christine Hyun Jin Lee, Specialist in Dental Surgery at Raffles Dental, graduated with Bachelor of Dental Surgery from the University of Otago School of Dentistry New Zealand in 2007. She worked for the New Zealand Defense Force in year 2008. Thereafter, she worked at a private dental clinic in Hamilton City in 2009. She enjoys being a general dentist as she has the opportunity to explore a wide range of dental conditions. Treating a variety of patient groups is also a valuable part of fulfilling her role as a dentist. Her main areas of interest are paediatric dentistry, oral diagnostics and oral surgery. Dr Scott Chao, Specialist in Dental Surgery at Raffles Dental, obtained his Bachelor of Dental Surgery degree from the University of the Pacific, School of Dentistry in 2001. In 2001, he received his Doctor of Dental Surgery degree from the University of the Pacific School of Dentistry in San Francisco USA. Coming to Singapore in 2009, Dr Chao focuses on general dentistry with a special emphasis on solid periodontal foundation. Dr Chao provide a wide range of general dental services, including aesthetic crowns and bridges, dentures, extractions and minor oral surgery. 2Superbrands Raffles Medical and Raffles Hospital were awarded the Superbrands status in 2009. Superbrands is an independent arbstractor on branding which pays tribute to brands that it considers exceptional through its programs such as the Superbrand reference book, events and PR activity. The independent Superbrands survey (a brand recollection survey) was conducted by the Nielsen Company in March 2009. Raffles Medical and Raffles Hospital came up first when interviewees were asked about brands under the private healthcare institutions/hospital category. Said Dr Loo Choon Yong, Executive Chairman, of Raffles Medical Group, “We are proud to have two of our strongest brands included in Superbrands Singapore 2009. The consumers voted for us because of the quality, reliability and distinction of our brand. Raffles will continue to strive towards providing high quality and excellent healthcare services.” 3 The new clinic at Changi Business Park (CBP) is open Operating Hours Monday - Friday : 8.30am to 1.00pm, 2.00pm to 5.30pm Saturday : 8.30am to 1.00pm Address 1 Changi Business Park Crescent, Plaza 8 #01-11 Singapore 486025 Tel: 6781 9033 Email: [email protected] Raffles HealthNews Newsroom 4 Raffles Hospital Treats Rare Tumour ellor, nsen, Couns r Gong Chu ore visited Xiaokang, M ap ng ng ha Si .Z in .E y ss bassador H China Emba e, from left to Chinese Am es. In pictur ary, from the On behalf of Third Secret eir good wish eneral Manager, o, th ta ai em H th ng nd se and Mr Cha rence Lim (G r mother to Fen and he acar, Mr Law and Ms Wu Xiao Fen. Ms Wu Xiao r Diarra Boub en D ns o, hu ta C ai g H on ng Mr G right: Mr Cha u ’s mother, pital), Ms W os H s fle af R For 25-year-old Ms Wu Xiao Fen, from the Yi minority from China, the pain on her head is not just a figure of speech. Eight years ago, a tumour started growing on her head. Today, it covers 30% of her scalp. In October last year, Medical Directors of Raffles Hospital, Prof Walter Tan and Dr Yang Ching Yu, together with a team of plastic surgeons, went on a medical mission to Kunming. While they were there, they attended to Ms Wu and found her suitable for surgery. However, due to the complexity of the surgery, the team felt it would be best to do it with a multi-disciplinary medical team. Ms Wu was suffering from a malignant tumour, arising from the scalp and skin. It had eroded through her skull bone. Prior to her operation, Ms Wu was in pain and her tumour bled constantly. On 10 January, a team of three plastic surgeons led by Prof Walter Tan, Specialist in Plastic Surgery and Reconstructive Surgery, operated on Ms Wu to excise the tumour. The operation was then taken over by a team of 5 Raffles Dialysis Centre is now open. As a hospital-based dialysis centre, it offers safe, accessible and affordable haemodialysis for outpatients and inpatients. In additional, professional services and facilities are in place to support high dependency and complicated cases. The centre is supported by a dialysis team of nephrologists, dialysis nurses and a dietitian. At Raffles Dialysis Centre, you will receive your dialysis in a private area equipped with a flat screen LCD television with cable channels. Private rooms are available upon request. Meal services customised to personal preferences are also available to you during your dialysis treatments. For more information, please call 6311 1222 or email [email protected] Ms Wu’s scans show that the tumour has grown to 14.0cm by 11.0cm in size. The tumour has also made two indentations on to the skull. neurosurgeons, led by Dr Ng Puay Yong, a sessional Neurosurgeon at Raffles Hospital, who worked to remove the affected cranial bone. During the third stage, the plastic surgeons reconstructed the huge defect with a full scalp rotation flap and skin graft. “We had anticipated that the surgery could take up to eight hours to complete,” said Prof Walter Tan, “However, the multi-disciplinary team took less than four hours to complete the entire surgery. We are delighted that Ms Wu recovered so quickly.” The surgery and hospital stay of approximately $56,000 is co-funded jointly by Raffles Hospital and the Asian Medical Foundation - the charitable arm of Raffles Medical Group. Said Mr Lawrence Lim, General Manager of Raffles Hospital, “Ms Wu’s treatment represents a humanitarian effort of Asian Medical Foundation and Raffles Hospital, and a contribution to the close people-to-people relationship between Singapore and China.” Feature Raffles HealthNews Route to Parenthood: Boosting your chances of pregnancy D id you know that humans are among the least fertile species on earth? For some couples, conceiving a child is relatively simple. However, that does not apply to everyone. Conception difficulties are more common than you would imagine. Raffles HealthNews Feature Age does play a role in the reproductive game. The ideal age for conception for women is between 22 and 26 years of age. For every year after 30 years old, the chances of conception decline by 2.5% and this drastically declines after 40 years of age. Statisticians have estimated that the chances of conceiving are about 10% per month for a couple in their forties even if tests do not detect any abnormalities. The American Society of Reproductive Medicine guidelines have shown that the chances of conception at age 46 are less than 1% even with In Vitro Fertilisation (IVF). If you haven’t conceived after 12 months of trying, (or six months if you’re 35 years or more), it may be time to consider seeking medical advice. You should seek advice earlier if you are on long term medication for a medical condition such as thyroid disorder, diabetes, depression or autoimmune disorders. About one in ten couples experience difficulties conceiving. Fertility treatment can bring you a step closer to your dreams of having a child. There are many different treatment options available. They include: 1.Lifestyle modification “The most important correctable factors for fertility are weight control, abstinence from smoking and alcohol for both husband and wife, and optimisation of the female pelvic organs through the removal of cysts, fibroids, scars (adhesions) and damaged fallopian tubes,” said Dr Sheila Loh, Specialist in Obstetrics & Gynaecology at Raffles Women Centre. Body mass index below 18 and above 25 may be associated with ovulatory disorders in women. Obese men may also have poorer sperm mobility. If you’re a smoker, it’s time to stop. Smoking causes accelerated ageing of a woman’s eggs and if the husband also smokes, chances of conception in an IVF cycle would be significantly lower as compared to non-smokers. 2.Reproductive surgery There are a variety of structural causes of female factor infertility that have surgical solutions. For example, reproductive surgery and diagnostic procedures can correct tubal obstruction, endometriosis, uterine fibroids, and scarring from pelvic inflammatory disease. 3.Medications to induce ovulation Examples include Clomiphene, Metformin and Gonadotrophins. According to Dr Koh Gim Hwee, Specialist in Obstetrics & Gynaecology at Raffles Women Centre, Clomid (Clomiphene Citrate) is the most common and most useful drug for treatment of ovulation problems in women. However, it is not useful for women who are already ovulating and when the infertility is related to other problems. Clomid is safe provided its use is monitored because some women do develop cysts after taking Clomid. “The cysts are usually benign and the result of an underlying problem of the ovary. It is not directly due to the medication itself,” Dr Koh added. 4.Artificial insemination or IUI The purpose of the Intra Uterine Insemination (IUI) programme is to place some of the good quality sperms into the uterus at the time the wife releases her eggs. Hence, to ensure optimum chances at IUI, the woman must have a normal uterus and patent fallopian tubes. Her husband’s sperms must also be of sufficient quality and quantity. “Chances are also higher if she is below 37 years of age and the treatment is performed together with super-ovulation, i.e. medications to induce more than one egg,” said Dr Loh. Average success rate is about 12-15% per attempt. 5.IVF IVF is the general term covering all the various programmes that involve the help of a scientist to fertilise the eggs in the laboratory. A couple needs this treatment if they have blocked or damaged fallopian tubes, severe endometriosis or if the doctor suspects a fertilisation problem e.g. older women, women with fewer eggs or failed IUI treatment. This treatment is also suitable if the husband has poor sperm quality. IVF outcome is most dependant on the egg quality. Dr Loh stressed that although IVF has a much higher success rate, at an average of 30-40% per attempt, this must be weighed against its risks - more injections, more stress, higher complication rate of multiple pregnancy and ovarian hyperstimulation syndrome (where the woman gets very bloated with water retention and in rare situations, breathlessness). IVF is also a more lengthy and expensive treatment when compared to IUI. IVF is used for severe infertility factors or as a last resort if simpler treatments HN fail. Male Infertility Studies have shown that male infertility is on the increase because of declining sperm quality and counts. According to Dr Fong Yan Kit, Specialist in Urology at Raffles Surgery Centre, factors that can affect sperm health include: a. Varicocele (an abnormal enlargement of the veins in the scrotum draining the testicles) as it elevates the intrascrotal temperature b. Drugs, smoking and alcohol c. Previous infection of the testis and prostate d. Exposure to strong radiation e. Stress Even if you are facing male fertility issues, all hope is not lost. Dr Thong Pao Wen, Specialist in Obstetrics & Gynaecology at Raffles Women Centre, shares with us the following ways to improve their sperm quality: a. Stop smoking b. Take a regular supplement containing essential vitamins, minerals and anti-oxidants c. Prevent overheating of the scrotum by avoiding tight underwear or long stays in the sauna d. Avoid excessive pressure on the scrotum (e.g. long distance cycling). e. Learn to relax and prevent excessive stress. Eat well and sleep well f. Maintain a healthy weight as being over or under-weight can influence estrogen and testosterone levels g. Stop using recreational drugs and alcohol h. Stop using body building anabolic steroids as it can cause testicular shrinkage i. Avoid over intensive exercise which can cause a testosterone deficiency j. Avoid environmental hazards like radiation, pesticides, heavy metals, lead or paint Feature Raffles HealthNews Health Screening for My Babe Pregnancy is an amazing thing. Inside your body is a growing foetus that will, in months, come into this world. This process is incredible and usually straight forward. However, there are times when things may go wrong and your baby may not develop the way he/she should. Raffles HealthNews Feature necessary to ensure that the unborn child is of good health and not affected. When would the second trimester screening need to take place and what is it for? Foetal screening is important as doctors can detect abnormalities in the unborn child early. If there is a defect that is incompatible with life, the parents can be counselled. Early detection also allows for safe termination of the pregnancy. In the second trimester, the foetus is screened around 20 weeks for common structural abnormalities that can be detected by ultrasound, placental localisation and cervical length. This is an important scan as it allows parents to be reassured that there are no structural abnormalities in the majority of cases. It also allows the identification of structural abnormalities that may need to be treated during pregnancy or soon after delivery. Certain abnormalities necessitate the baby to be borne by a certain method (like induction for early labour or Caesarean section). Sometimes, babies with certain abnormalities require immediate specialised medical attention at birth and this could be arranged in anticipation if the abnormalities are detected during foetal screening. Foetal screening can be conducted during the first, second and third trimester. We speak to Dr Tony Tan who has special clinical interests in foetal medicine and therapy on the various types of screening and their purpose. If the placenta was low-lying, the obstetrician would have to take note of symptoms like vaginal bleeding and check the location of the placenta later in the third trimester to determine whether a Caesarean section is required for delivery. A short cervix at 20 weeks increases the risk of premature delivery before 33 weeks. For those with a short cervix, your doctor may treat you with progesterone to reduce the risk of premature delivery. What is the first trimester screening about and who needs it? What is the third trimester screening about? Is it necessary? 2 Tests to set your mind at ease Understanding Screening 1 Babies can be abnormally formed or be affected by poor development while in the womb of the mother. With modern science, assessing your unborn child’s health is no longer a dream. Foetal diagnostics allow doctors to screen your unborn child for potential health problems and physical defects. Parents are thus better able to cope with the potential stress involved. Your doctor can also better manage your pregnancy to ensure that you can have a smooth delivery. According to Dr Tony Tan, Specialist in Obstetrics and Gynaecology, Raffles Women’s Centre, about two to five per cent of babies are born with some type of birth defect. “This may be due to chromosomal abnormality, genetic disease or structural abnormality in the baby.” Women of all ages, and not just those aged 35 and above, should consider screening for ease of mind as many abnormalities in the babies are random events and may not be easily identified by factors such as age or family history. “All pregnant mothers, to a certain extent, must receive some basic form of foetal screening,” advised Dr Chow Kah Kiong, Specialist in Obstetrics and Gynaecology, Raffles Women’s Centre. “The most usual one is a routine blood test. The next almost universal test is an early ultrasonogaphy on the foetus.” However, depending on the risk factors in the pregnancy, more tests may be The First Trimester Screening combines historical data, high resolution ultrasound scans with the mother’s blood. It is conducted earlier than most other prenatal screening tests, between the 11 to 13 weeks of your pregnancy. As a routine prenatal screening test, it is safe and poses no risk of miscarriage or other pregnancy complications. It has, over the years, developed into an improved version as it screens for common chromosomal abnormalities such as Down syndrome, early structural abnormalities, and the risk of early preeclampsia (a condition which manifests as high blood pressure with proteins in the urine during pregnancy that requires delivery before 34 weeks). I recommend this test to all pregnant women regardless of age, as it is now recognised as the best screening test for Down syndrome. It is better than screening for Down syndrome just by maternal age alone. Knowing the risk of severe pre-eclampsia early in pregnancy also allows the identification of those at high risk to benefit from the use of medications such as calcium supplementation and low dose aspirin early in pregnancy. This may reduce the risk of pre-eclampsia. Our clinic has a very good performance record in the First Trimester Screen, with a very high detection rate of Down syndrome. In the third trimester, the foetus may be screened for growth disorders. In five per cent of cases, the foetus is growing below the normal range. Such foetuses should be monitored closely so as to determine the best time for delivering the foetus. A 3D or 4D scan, purely for bonding between parents and the foetus, may also be performed at this time if you wish. HN 3D/4D scan Unlike traditional 2D ultrasound scans, 3D scans send sound waves at different angles. The returning echoes are processed, resulting in a reconstructed three dimensional volume image of the foetus's surface or internal organs. 4D ultrasounds string together frames of 3D ultrasounds to see movement. 10 Feature Raffles HealthNews Updates on Old Wives Tales There is a whole range of stories surrounding the topic of pregnancy. These myths or old wives tales as some would call them, ensure that you are kept on your toes throughout the entire pregnancy period. Hear from our experts to ascertain those that you can simply dismiss. You can’t take medication during pregnancy. NOT TRUE: Many women refuse to take medication during pregnancy for fear of possible adverse effects. Often, they would rather “endure” the symptoms. Common examples include “flu” and “vomiting”. While it is generally agreed that vomiting is a common symptom of early pregnancy, severe vomiting may lead to dehydration, which can be harmful to the general health of the woman. In certain cases of upper respiratory infection, a course of antibiotics may be necessary. If left untreated, it may occasionally lead on to chest infection (pneumonia). Similarly, bladder infection should be treated. Untreated bladder infection may result in infection to the kidneys, and may increase the risk of premature labour. Women may also stop medication on their own for an underlying condition once they are pregnant, without the doctor’s advice. Examples include asthma, thyroid and high blood pressure medication. If the underlying condition is not controlled, it may have a negative impact on the pregnancy such as increased risk of miscarriages and poor growth. Therefore, don’t play doctor and consult your healthcare provider to find out what’s safe to take. — Dr Watt Wing Fong, Specialist in Obstetrics & Gynaecology, Raffles Women Centre Raffles HealthNews Feature 11 It is unsafe to undergo hair colouring during pregnancy. NOT TRUE: Hair colouring is generally safe for pregnant women. There have been no known harmful effects of dye or chemicals entering the pregnant mother's body through the skin or hair due to hair dyeing. However, do take note of the following: • Wear gloves when handling the hair dye • Clean off any dye that gets onto the skin immediately • Do not leave the hair dye on longer than the recommended duration • Wash off the hair dye thoroughly with water & shampoo • Opt for natural hair dyes if possible In addition, stick to the brand of dye that you have used before. This is to minimise the possibility of developing an allergic reaction, which would require treatment with drugs such as steroids. You should also read the instructions that come with the dye and ensure that there is no warning against its' use during pregnancy. the pelvis, throughout the flight. • A void gas producing food and airline food. Try to bring your own food if your airline allows. Epidurals are dangerous as the mother may suffer long-term damage like paralysis, rheumatism and backache. — Dr Mohamed Faizal, Family Physician at Raffles Medical’s Terminal 3 Medical Centre NOT TRUE: The use of epidural analgesia for pain relief in labour is very safe, and the risk of any complications from it is very low. Your gums bleed easily during pregnancy. Bumps or swellings on the gums are mainly due to hormonal changes and not something you should worry over excessively. If a woman in labour is unable to cope with the labour pains using other methods of pain management, then having an epidural is an effective method to relieve her pain. The pain relief it provides can last throughout labour, however long the duration of labour is. NOT TRUE: The change that affects women the most is pregnancy gingivitis. This is a condition whereby the hormones in the bloodstream cause the gums to become more sensitive to food and bacteria that naturally live in the mouth. This makes the gums more inflamed and bleed easily upon brushing. In some women this is quite mild and they may not notice it. However, in others, the inflammation can be quite marked and become painful if left unchecked. This can lead on to benign growths known as pregnancy tumours. — Dr Chow Kah Kiong, Specialist in Obstetrics & Gynaecology, Raffles Women Centre Overwhelming clinical evidence has also shown that gum disease during pregnancy can lead to premature, low birth weight babies. You shouldn’t fly. During pregnancy, it is ideal to visit your dentist, especially in the second trimester to ensure that your routine has been adequate. A cleaning and gum treatment at this time is ideal to prevent pregnancy gingivitis. NOT TRUE: Generally, commercial air travel poses no special risks to a healthy pregnant woman or her baby. The main concern for the airline is the likelihood of the pregnant woman going into labour whilst flying as this would potentially require a costly diversion and inconvenience to other passengers. Most airlines are willing to accept pregnant passengers up to 35-36 weeks. Most also require a doctor’s letter from 28 weeks onwards. These two criteria vary amongst the different airlines. Further evaluation is required if there have been complications during the pregnancy, before the journey. It is also prudent to find out what health care facilities are available at the destination and whether your travel insurance would cover for the cost of any complications of the pregnancy requiring medical input or evacuation. Some tips on the aircraft: • Take short walks along the aisles every 30mins if it is safe to do so. • Do stretches and isometric leg exercises. • Drink plenty of fluids. • Sit closer to the lavatory. • Seatbelts should be worn low around. — Dr Rachel Chan, Specialist in Dental Surgery, Raffles Dental The leakage of water is a signal that you would go into labour soon. However, the labour process could be very long and you should only go to the hospital if you experience contractions. NOT TRUE: Some women think that they should only go to the hospital if they experience contractions. They fail to realise that it is possible for the water bag to be leaking without going into labour. The danger of that is that there is an increased risk of infection once the water bag leaks. Once infection sets in, the baby may be affected. Sometimes women may not know if it is urinary leakage or amniotic fluid leakage. When in doubt, one should always confirm with their doctor. — Dr Karolyn Goh, Specialist in Obstetrics & Gynaecology, Raffles Women Centre — Dr Lee I Wuen, Specialist in Obstetrics & Gynaecology, Raffles Women Centre Post delivery, you are not to take a bath for one month (i.e. during your confinement period). NOT TRUE: In my opinion, you can take a bath as long as there is no open wound. Since hygiene is the reason for bathing, do take note of the following: • Bathe when necessary i.e. not too frequently • Bathe with warm water at 37 degrees Celsius i.e. similar to our body temperature • Use some herbal water to bath to avoid catching the cold and damp. It could also help with blood circulation • Keep the bathing process short, within five to ten minutes • Dry and dress up immediately to avoid catching a cold If the wound is still healing, it is recommended to use a warm damp towel to freshen up instead of bathing, to prevent infection. — Ms Jin Jinhua, Consultant Acupuncturist, Raffles Chinese Medicine You should not breastfeed a toddler during pregnancy, as that would affect the new baby who needs all the nourishment it can get. NOT TRUE: As long as a woman is healthy, breastfeeding during pregnancy won't harm her, the foetus, or her toddler. However, a doctor may recommend that a pregnant woman not breastfeed, if she has a nutritional deficiency, is underweight, or is at risk for pre-term labour. HN — Dr Jazlan Joosoph, Specialist in Obstetrics & Gynaecology, Raffles Women Centre 12 UpClose Raffles HealthNews UpClose Ms Phan Nhung with Manager, Hospital Marketing, Raffles Hospital 3 7-year-old Vietnamese, Ms Phan Nhung, is a blessed woman. Besides having two adorable girls (six and two years old) and a supportive husband, she is in her dream job - one that allows her to combine her interest in marketing and her desire to help others cope with health problems. She speaks about how her role as manager for hospital marketing in Raffles Hospital, helps the unwell find hope in a foreign land. Raffles HealthNews UpClose 13 How long have you been with Raffles? What is it about healthcare that attracted you? I joined Raffles Hospital four years ago. Before that, I was a Senior Marketing Executive in charge of marketing in a training and consultancy business. I always thought it would be meaningful to contribute to the health of others. With my interest in marketing, I realised I could help market the hospital. Hence I wrote in to the Human Resource department for a job opportunity. With that, I now directly market the services of Raffles Hospital to foreign patients who are seeking medical help for their ailments. So, what does the hospital marketing department do that makes it different from other marketing departments? Raffles Hospital’s hospital marketing department has several units focusing on the international markets and local markets. I belong to the International team where we bring in foreign patients. In addition, we service foreign patients who require assistance in languages. Being native speakers, we are able to provide personalised service to our patients, especially in bridging the language gap, which is one of the most challenging factors that foreign patients face. What’s a typical day for you like? A typical day for me starts with visiting the Vietnamese inpatients in the Hospital. I believe providing personalised service is the most important aspect of a healthcare business that outweighs all other marketing efforts. If we are unable to deliver our promise to our patients while they are here, no amount of marketing events or advertising campaigns will help. What skills do you need to have to be in hospital marketing? Are there any specific character traits that you need to have? As a woman working in healthcare (and having two kids), what would be your best tip for fellow women, especially those who are planning to have kids? To be effective in hospital marketing, you would require marketing sense; that includes a sense of urgency when you receive patients’ enquiries. If you have not made plans for kids, start planning today! Kids are an incredible source of joy. While it’s easier said than done, working mothers must find ways to strike a balance between their family and career. Sacrificing one for another may not bring you fulfilment in the long run though it may give you temporary relief. Since healthcare is a service industry, you must genuinely care for patients. Serving foreign patients can be burdensome if you are unable to relate to patients’ circumstances, since many come with complex medical conditions. Compassion is also important as patients depend on you for information and support. What do you enjoy most about your work? Working with a team that relentlessly cares for the patients as well as growing the market energises me. I also find it personally fulfilling to be able to make our foreign patients’ experience at Raffles Hospital complete through our assurance that we are here for them 24 hours every day. In a way, we are like their family away from home. I remember a patient from central Vietnam who came to Raffles for the treatment of tongue cancer. As it was his first time to Singapore, he had made several appointments with other hospitals in Singapore prior to the visit. After I received him from the lobby and accompanied him through his visit at Raffles, he asked if I could help him cancel his appointments with the other hospitals as he found our care comforting. A sense of peace could be seen on his face after a long search for medical treatment overseas. At times when I have to work beyond office hours or when I have to travel for work overseas, my husband and my helper would support me. That’s no easy task - balancing between family and work commitments. So what drives you on to do what you do everyday? Since I joined Raffles, I am happy that more Vietnamese patients are choosing to come to Raffles Hospital. In fact, the Vietnamese have moved up to be one of the top groups among the foreign patients in Raffles Hospital. Seeing how our foreign patients recover in the hands of our medical team and getting their positive feedback motivates me in my work. I look forward to each day as a chance to contribute to the growth of the hospital and to support the medical team to nurse patients back to health. HN The main part of my day job is to work closely with our Patient Liaison Offices, and Associates from regional countries. I also coordinate with clinics and doctors to answer patient enquiries and provide support to foreign patients who need language translation services while they are at Raffles. ir nd the ang) a ). (Jeff T Annie Tang d n a b er hus a Tang and h h it (Ann ung w an Nh princesses Ms Ph two m a I , e m a I m , e m e su use ant c n t n a g n x EE xc 14 Feature Raffles HealthNews g e e r r PP The joy in pregnancy lies in the fact that you are now in the best position to make excuses, and the people around you would not dare to call your bluff. Raffles HealthNews Feature 15 Every possible situation can be blamed on pregnancy. Forgot somebody’s birthday? – I’m pregnant! Slept the afternoon away and had no time for chores? – Pregnant! Craving for that sinful dessert? – Pregnant! Good mood? Bad mood? In the mood? No mood? – Excuse me, I’m pregnant! Much has been said about the trials and tribulations of pregnancy. While it is undeniably a trying and difficult time for women who have to put up with certain unpleasant symptoms, there’s no reason why you should not have fun during this period now that you have the perfect excuse for everything you do (and don’t do). Pregnancy is the time for self-indulgence. Enjoy it while it lasts. All Hail the Queen The changes in the hormonal levels in pregnant women are truly profound. Most men find it difficult to fully comprehend what is causing all these changes from mood swings to the need for extra sleep to food cravings. If he really wishes to understand, get your doctor to explain the details. All he really need to know is that as this is a demanding time for you, the least he could do is to give in to your requests. In addition, it’s important that you do not tire yourself too much when you are pregnant. Make full use of this fact to your best advantage. If anything, now is the time your partner should relieve you of certain household chores. He should have been doing his share of the work prior to this. However, if he had not been helping out previously, now is the best time to start. With nine months of training, your husband would no longer be able to cite ignorance as the reason for not helping out. The Dream Diet Most women, at some point of their life, would go on a diet. At least many would claim to be. Whether they keep strictly to their diet plan is another issue altogether. The point is, many women have to forgo some of their cravings due to weight or health issues. Diets are not for pregnant ladies. The baby needs all the nutrients it can get. At the same time, a bit of junk food won’t hurt either. After all, you are now entitled to have ‘cravings’ and indulge in them fully. In addition, women should not forgo this opportunity to consume the famous Chinese delicacy - bird’s nest. Said to give one good skin and health, now is the time for you to fully pamper yourself with such expensive treats. Remember, what’s good for you is good for your baby (and vice versa of course). Big And Beautiful Some of us suffer from negative selfimage from time to time. The plethora of airbrushed images in the media can be depressing even for people in the healthy weight range. As mentioned, every woman, when she becomes a mother, gets some time off from the dieting cycle. This is a great relief for many. When you are pregnant or holding a baby in your arms, people seem to forgive you more readily for carrying the extra weight. After all, babies are much more important than looking like a supermodel. You are big and beautiful. Pregnancy is the best excuse for carrying extra weight. However, if your reason to be overweight is pregnancy, make sure you use this excuse only for up to a year after your child’s birth. HN 16 Feature Raffles HealthNews Morning sickness, heartburn and constipation are common symptoms you may encounter during your pregnancy. Ms Nehal Kamdar, Senior Dietitian at Raffles Internal Medicine Centre, shares some tips on how to handle them with the right diet. Eat Away Your Pregnancy Symptoms Morning Sickness Constipation Heartburn While this is usually experienced in the morning, the feeling of nausea or vomiting can also be experienced in the afternoon or evening. Morning sickness occurs in 50 to 90% of pregnancies. It sometimes continues beyond the 1st trimester. However, it usually ends by the 14th week of pregnancy. You may also experience constipation as the muscles of the gastrointestinal tract are relaxed during pregnancy. As a result, food stays in your intestines for a longer period of time. Heartburn is usually experienced during the last stage of pregnancy. As your baby grows larger, it can push up against the stomach. As such, the acid content in the stomach is forced up into the oesophagus. Relieve the symptoms by: Control of the symptoms by: You can relieve the symptoms by: aking something light, such as • T crackers or dry toast 10 to 15mins before you get out of bed, followed by a light breakfast soon after rising. • Having smaller and more frequent meals/snacks. • Avoiding foods which you find nauseating, such as oily and spicy foods. • Wearing loose and comfortable clothing. • Drinking lots of fluid to avoid dehydration. • Increasing fibre intake. Eat more wholegrain cereals, fruits and vegetables. • Increasing fluid intake by taking a minimum of 10 glasses of fluids a day. • Increasing physical activity (in accordance to your doctor’s advice). • Taking prune/apple juice or dried prunes. These can act as natural laxatives. voiding spicy, fried food and coffee. • A • Having smaller and more frequent meals or snacks. • Drinking fluids between meals rather than together with the meals. • Sitting upright for one to two hours after meals. Raffles HealthNews Feature 17 S Happy Labour Day o it’s D-Day. You are going into labour. Understand the labour stages and what you need to look out to have an unforgettable delivery experience. 18 Feature Raffles HealthNews You should contact immediately if: your doctor • your water bag breaks, or if you suspect you’re leaking amniotic fluid • your baby is moving less than usual • you have vaginal bleeding (unless it’s just a small amount of bloodtinged mucous) • you have fever, severe headaches, changes in your vision, or abdominal pain These may signal an emergency and would require immediate medical attention. Labour Is Painful We have all heard stories of how painful the labour process is. Thankfully, with the help of modern medicine, mothers can get pain relief. “In my practice”, shared Dr Tan Yew Ghee, Specialist in Obstetrics and Gynaecology, Raffles Women’s Centre, “epidural analgesia is the most common method, accounting for 70 to 80% of all deliveries and showing an upward trend over the years. This trend is largely due to the safety record and by word of mouth recommendations”. Every labour experience is unique - an unforgettable experience that you can proudly recount to your child when he/ she grows up. According to Dr Koh Gim Hwee, a Specialist in Obstetrics and Gynaecology, Raffles Women’s Centre, childbirth can take just a few minutes or many hours. “The signs of labour can be unique to different individuals,” said Dr Koh. According to him, the simple pre-labour signs you should learn to recognise before rushing down to the hospital are: 1.Persistent lower back or abdominal pain, often accompanied by a crampy premenstrual feeling 2.A vaginal bleeding called “show” (a brownish or blood-tinged mucus discharge). If you pass out the mucus plug that blocks the cervix, labour could be imminent or days away 3.Painful contractions that occur at regular intervals, each lasting only 30 seconds 4.Clear water flowing from the vagina (broken water bag), but you’re in labour only if it is accompanied by painful contractions As with every procedure, including epidural analgesia, there is a one to two per cent risk. Serious risks from the use of epidural include possible infection, severe headache and drop in blood pressure. The medical team will adjust the dosage such that there is no complete numbness and you can push naturally under close supervision for a natural vaginal birth. TENS Transcutaneous Electronic Nerve Stimulation uses electrical current to numb areas of the body, blocking pain signals to the brain and stimulating endorphin production. Acupuncture You will require several treatments in the last few months of pregnancy, and this may result in a smoother, less painful birth. Acupressure, Massage and Counterpressure These specific touch techniques help relieve pressure or pain and enhance relaxation and release endorphins. Hot and/or Cold Compresses Applied to the lower back, these help relieve back pain. Aromatherapy The use of aromatic substances can trigger other chemical responses in the body to help relax. Music Sound can help reduce our perception of pain and enhance relaxation. Different types of music are useful at different stages of labour. Music masks the distracting sounds in the hospital environment to create a more personal atmosphere to labour in. Movement, Positioning, and Position Changes There are many alternative pain relief methods. Here are some of them: Your baby’s position contributes directly to the pain and length of labour. You should follow your body’s cues to move and change positions frequently. Some helpful movement and position changes for labour include walking, swaying, slow dancing, squatting, lunging, and hand-knee positioned pelvic rocking. Breathing and Relaxation Companionship and Support Use learnt breathing patterns to aid your relaxation. You would consciously release tension in your body, allowing your uterus to do its work without additional effort or energy wastage. To be able to relax during labour would require some practice though. Hydrotherapy Some studies have shown that hydrotherapy, when used correctly during labour, can be safe, reduce pain, enhance progress, and reduce the likelihood of tearing in your perineum (the area between your vagina and anus). A shower is beneficial almost anytime during labour. Labour support provided by a professional Doula, or birth companion, may improve birth outcomes, reduce the numbers of Caesarean sections, epidurals and other medical interventions, while promoting bonding and successful breastfeeding. Delivery Stages Childbirth can be divided broadly into three main stages. Dr Cordelia Han, Specialist in Obstetrics and Gynaecology, Raffles Women’s Centre, explains what happens during the three stages and what you need to do during each stage. Raffles HealthNews Feature 19 The first stage begins with contractions. Contractions are regular painful uterine tightening that causes progressive changes in your cervix and ends when your cervix is fully dilated. This stage is divided into two phases: latent and active phase of labour. During the early latent stage of labour, your cervix gradually effaces (thins out) and dilates (opens). During active labour, your cervix begins to dilate more rapidly. During the active phase of labour, contractions are stronger, closer and more intense. This last part of active labour is also referred to as the “transition stage”. The second stage of labour begins once you’re fully dilated and ends with the birth of your baby. It is sometimes referred to as the “pushing” stage. This is where mothers are encouraged to push when contractions are present. An episiotomy may be required for the majority of first-time mothers. This is where your doctor makes a small cut to widen the outlet for an easier delivery. This will subsequently be repaired. The third and final stage begins right after the birth of your baby and ends with the separation and subsequent delivery of the placenta. The length of labour can vary from individual to individual. “First-time mothers may experience longer labour; sometimes as short as six hours and others as long as 20 hours,” said Dr Han. Usually, the duration of labour gets shorter with each subsequent birth,” she added. Post-delivery After birth, your doctor will check your pulse, blood pressure, and uterus contraction to ensure everything is fine. Your baby may be given a dose of Vitamin K and will have an APGAR test (covering your baby’s appearance, pulse, grimace, activity and respiration). You should check with your doctor on a regular basis to understand what you can or cannot do. “Breastfeeding mothers will notice that abdominal cramps similar to those experienced during menstruation occurs after breastfeeding,” said Dr Han. “This is due to the oxytocin released during breastfeeding in the first few days.” A final word of advice from Dr Han: “every mother has an inborn strength to deliver and nurture a child. Use it and enjoy this beautiful experience.” Surviving Your Wife’s Delivery Nowadays, wives expect their husbands to be in the delivery room, and for good reasons. Dr Jazlan Joosoph, Specialist in Obstetrics and Gynaecology, Raffles Women’s Centre, shares tongue-in-cheek advice on how you can stand by your wife, and not faint, as you welcome your little one to this world. • Be prepared. When your wife announces that she’s pregnant, it also means that you are going to be a dad. Denial will not help. • If it’s going to be a caesarean birth, do not peak over the green flap unless you are sure you can handle it. • Even if you see little value in your presence, it can greatly boost your wife’s morale. Just cheer her on and be around to support her. And don’t faint. The medical team already has their hands full. • Birthing is not usually a medical emergency, so do stay calm and don’t get all hysterical at the sight. • When your wife screams at you “this is all your fault…” recognise that it is a routine result of a hormonal change during the • • • • • final stage of the birth process. And if you think about it, she’s probably right. Avoid screaming back. It’s not the right time. Should you see a pair of scissors emerge or hear the word “episiotomy”, be very engrossed by anything else you can find in the room. Turn away. This is important to your future well being. Seeing your little one come out from the love of your life is one of life’s beautiful miracles. Show extreme pride and admiration for your wife’s pain threshold and be secretly grateful that you will never ever have to go through her suffering. The cord cutting ‘ceremony’ is an unforgettable moment for many fathers. When cutting the cord, be extremely gentle and careful. It is much tougher and more sausagelike than you will expect. If you have not taken biology classes in school, you may be surprised by the birth of a second, less attractive baby. It looks like a plastic bag of frozen meat and is large. This is the placenta that played a big role in protecting and nurturing your child. After the hospital stay where you have nurses fussing over you and your wife, be prepared for the many adventures when you are home. Getting experienced hands to help is advisable but learn fast from them. HN 20 Feature Raffles HealthNews Bagging the Delivery Pack your hospital bag ahead of time to reduce unnecessary stress. Ensure the bag is roomy enough to contain all the items that you, your husband and your baby will require during the hospital stay. Below are some suggestions on what you ought to pack. Mother Extras ____ Comfortable robe ____ Electric heated massager ____ Nightgown ____ Massage oil ____ Nursing bra and nursing pads ____ Personal stereo and headphones ____ Warm socks ____ Favourite tapes or compact discs ____ Slippers ____ Books and magazines ____ Comfortable outfit to wear home ____ Camera or video camera ____ Sanitary pads (with fresh batteries) ____ Toiletries ____ Extra pillow ____ Hair clips, scrunchies, barrettes ____ Gift for sibling ____ Brush or comb ____ Hard candy to suck on during Father ____ Change of clothes labour ____ Lanolin, if nursing ____ Cell phone ____ Book or magazine ____ Toothbrush, toothpaste and other basic toiletries ____ At least $20 in cash and loose change for snacks, phone calls, etc ____ Watch with a second hand for timing contractions Notes __________________________________ __________________________________ __________________________________ __________________________________ Baby ____ Car seat __________________________________ ____ Newborn hat __________________________________ ____ 2 receiving blankets ____ 2 “onesies” __________________________________ ____ 2 pairs of socks __________________________________ ____ “Going home” outfit -- including __________________________________ sweater or bunting ____ Diapers and diaper bag Documents ____ Birth plan ____ Insurance cards ____ Address book with phone numbers __________________________________ : y c n a l l o e r R n C l a o n a o ster i t o g n Em Pre Raffles HealthNews Feature 21 A P regnancy is an exciting time when a new member is added to the household. However, it is also a stressful and worrying period coupled with many emotional and physical changes. Not surprisingly, many pregnant women develop depression. “Depression is more than just feeling blue,” explains Dr Clarice Hong, Specialist in Psychiatry, Raffles Counselling Centre. “Depression is a mood disorder that causes an extreme dip in your mood so much so that it interferes with your daily activities. While depression is not uncommon, it is a source of concern during and immediately after pregnancy as it can affect the health of both the mother and the baby.” According to studies, one in five women would experience some depression symptoms during their pregnancy, while as many as one in ten would develop full-blown clinical depression. Depression usually results from a combination of factors. These range from family history of depression, hormonal and physical changes during pregnancy to stressful life events. Pregnant women with untreated depression are more likely to experience pre-term birth, spontaneous abortion and gestational hypertension or pre-eclampsia. Baby Blues Feeling down after childbirth is common. Hormonal changes post-delivery coupled with the stress and fatigue from baby care are all triggers for one to feel blue. There are three levels of depression that’s associated with post-delivery. The most common but the least severe of them is baby blues. Symptoms include moods swings, feeling sad, anxious or overwhelmed, loss of appetite and trouble sleeping. Such feelings usually go away naturally within a few days to a week. Postpartum depression is a more severe level of depression. It can hit anytime within the first one year after childbirth. Sufferers will have thoughts of hurting the baby, themselves and lose interest in the baby. Postpartum depression usually lasts longer and will require treatment by a doctor. Early intervention can speed your recovery. A severe but rare condition affecting only four in 1000 births, postpartum psychosis occurs in the first two weeks after childbirth. Sufferers see things that aren’t there, feel confused, have rapid mood swings and will actually attempt to hurt themselves or their baby. Sufferers of postpartum psychosis should get immediate medical help. Don’t wait and hope for improvement as it may lead to lifethreatening thoughts or behaviours. HN 22 Feature Raffles HealthNews Depression Che cklist Are you: • Feeling res tless or moody • Feeling sad _______ , hopeless, and overwhelm • Crying a lo ted _______ • Having no e _______ nergy or motiva tion • Eating too _______ little or too mu c h • Sleeping to _______ o little or too m uch • Having trou _______ ble focusing or m a king decis • Having mem ory problemsions _______ • Feeling wor _______ thless and guilt y • Losing intere _______ st in activities yo u used to enjoy • Withdrawin _______ g from friends a n d family • Having ache _______ s and pains that don’t go away ______ _ Enjoying the Roller Coaster Ride Dr Hong shares eight tips to help you enjoy your pregnancy and post-delivery. 1. Get as much rest as you can. Sleep when the baby is sleeping. 2. Do what you can. There’s no need to be perfect. 3. Seek help from your husband, family, and friends. 4. Make time for yourself, to go out, meet friends or just spend time with your husband. 5. Talk about your feelings with your husband, family, and friends. 6. Talk to fellow mothers and learn from their experience. 7. Avoid making major life changes during pregnancy or right after giving birth to reduce unnecessary stress. 8. When big changes can’t be avoided, arrange for support and help in your new situation ahead of time. Raffles HealthNews Feature 23 Guidelines for Sanity Surviving the first 3 months of parenthood T he journey of parenthood is often emotionally charged. On one hand, you will be rejoicing the addition of the newest (and cutest) member to the family. On the other, the new challenges may leave you tired, frustrated, and often a little frightened. Here is your guide to surviving the first three months of parenthood. 24 Feature Raffles HealthNews Self-Care after Childbirth During the first two weeks at home, you should focus only on caring for yourself and the baby. Let your friends and relatives who are willing to help do the cooking, cleaning, shopping and laundry. Adequate help and rest can make a great difference in how quickly you feel strong and well. Therefore, all new parents can benefit from assistance at home after childbirth. For a woman who has had a caesarean birth, such help is essential at least for the first week. In addition, during the first few days, mothers should: • Do some leg exercises to reduce the chance of deep vein thrombosis. • Ensure adequate water intake and eat well. • Avoid carrying heavy objects (i.e. anything heavier than their babies), and strenuous activities. • Get help with household chores. Having a confinement lady may help. • Look after the wound by ensuring personal hygiene i.e. take a shower, but keep the wound dry and clean. Eating right Nutritional foods and beverages are just as important after birth as during pregnancy. A woman’s body has just completed one of the most physically draining tasks it ever has to do, and needs time and help to return to its normal state. Eating right after delivery isn’t that complex. Just continue eating a goodquality diet as you did during pregnancy. If you are not breast-feeding, your nutrient and calorie needs are the same as they were before you became pregnant. If you are breast-feeding or recovering from a caesarean delivery, you will have special nutritional needs. According to Ms Nehal Kamdar, Senior Dietitian at Raffles Internal Medicine Centre, it is easier for breastfeeding mothers to lose weight as breastfeeding use up to 500 calories per day. If you are breastfeeding, avoid cutting down on portion size as it will reduce the amount of breast milk you produce. However, you can reduce your intake of oily food and sugars like cakes, pies, pastries, fried chicken, roti prata etc. Raffles HealthNews Feature 25 If you are not breastfeeding your baby or have stopped, the following tips from Ms Kamdar may be of help: • Focus on Do’s rather than Don’ts For example, rather than thinking of all the yummy foods that you may need to cut down or avoid, think of the sexy dress that you can buy once you have lost weight or the pre-pregnancy clothes that you could fit into. • Establish FAST goals Keep your goals flexible, attainable and short-term (FAST) and work towards them. • Eat regular meals Do not skip meals in your attempt to lose weight. Breakfast is a very important meal of the day as it jump starts your metabolism. • Include foods that are high in fibre Fibre adds bulk to food and helps you feel fuller for a longer time. If you are breastfeeding your baby, going on a restrictive diet will reduce the amount of breast milk you produce. “Environmental contaminants are stored in body fat and losing weight rapidly can cause these contaminants to be released in the blood stream and passed to the baby via breast milk. Trying to lose weight drastically by following severely restricted diet will leave the mother nutritionally at risk, with low energy levels and low level of immunity,” added Ms Kamdar. Most doctors will advise new mums to continue with their pre-natal vitamins in addition to extra calcium. So talk to your doctor about your eating habits and what kind of vitamins he or she recommends. Nursing mums can also be anaemic, so your doctor may also recommend that you take an iron supplement. Putting an exercise plan in place Too many of us are familiar with the negative body-image issues that come along after childbirth. Although the baby is out, you may still look pregnant. Wearing maternity clothes when pregnancy is over just isn’t fun, and being offered a seat in MRT in such circumstances is no longer a relief. “You must be realistic with your weight loss goals after pregnancy. It took you nine months to gain all that weight, therefore, give yourself at least a year to get back to your pre-pregnancy weight,” said Ms Kamdar. So, when should you start exercising again? “Generally, it is recommended that women wait about six weeks after they have given birth to start exercising, eight weeks if they have had a caesarean. However, some women can start exercising before this,” said Dr Watt Wing Fong, Specialist in Obsterics and Gynaecology at Raffles Women Centre. Therefore, do discuss with your doctor if you are planning to start an exercise regime. If you are breastfeeding, there are a few things you should keep in mind when you’re exercising. “First, make sure your breasts are well supported when you exercise. Also, try to breastfeed your baby before you exercise. It will be more comfortable as your breasts won’t feel so full,” said Dr Watt. Post delivery, do you often feel overwhelmed and drained? You are not alone. Here are some tips from Dr Lim Yun Chin, Specialist in Psychiatry at Raffles Counselling Centre, to keep you on top of the situation. Take care of your own needs Rather than count on someone else to take care of you, it’s actually your job to take good care of yourself. This is one thing you simply cannot and should not delegate. Learn to cut corners on things that don’t matter Alternatively, learn to delegate them to someone else. Instead of trying to do all the household chores, leave more time for the things that really matter to you, such as spending time with your loved ones. Have a support team in place Your family members, friends, or co-workers could all be members of your support team. There should be someone waiting to cheer you on after a tiring day. Don’t lose your sense of humour It’s the ultimate weapon against the madness around you. Hanging on to it will keep you sane. 26 Feature Raffles HealthNews Operation Breastfeeding Contrary to what many believe, a mum’s role in breastfeeding is really to hold the baby close and wait for the baby to do his job. While you may wish to talk, pat or stroke him and encourage him to feed, ultimately, all you really have to do is to be patient. Never insist that a baby “has to be hungry” just because it’s been a while since he had been fed. Likewise, you can’t assume that he can’t be hungry because he just ate, for example, one hour ago. “Babies are unpredictable and no two babies follow the same feeding schedule. Some babies will finish feeding in 15 minutes; some may need an hour,” said Dr Watt. Fathers are powerful partners who can contribute to the success and failure of breastfeeding by actively supporting and helping their wives. A dad’s assistance is key in this project. Here are some pointers for our super-dads in the making: Learn to read signs Babies won’t hesitate to show you their true feelings. However, their actions can be so subtle that many of us will not be able to second-guess what they are trying to convey. Remember, when a baby is under stress (i.e. hungry, cold, wet or dirty diapers, pain and loneliness) he will show you some very predictable signs. He’ll curl up his hands and feet and bring them to the center. He’ll bend his knees and cross his feet or put his heels together. He’ll start to turn his head and may suck on his hands or fingers. Eventually he’ll start to fuss and finally cry. Tips for New Dads Basically, your baby is asking you to pick him up and tend to his needs through the above actions. Learning to read his body language will save you and your wife lots of heartache and tears. The first time alone with your burden of joy need not be a nightmare. By taking some simple steps, your first time alone with the baby will be a pleasant and enjoyable one. Remember, practice makes perfect. Be helpful The joy of diaper changing If your wife is breast-feeding, she will probably feel sleepy just after nursing. Encourage her to take a nap while the baby is sleeping. Make sure you are familiar with the steps in diaper changing. It is recommended to have practical experience beforehand. Having to change a loaded diaper without some experience could get you and your baby in a very messy situation. In addition, relieve your wife from as many of her usual roles and responsibilities as possible. Unless she genuinely wants to, she shouldn’t have to do any chores, deal with her inlaws or anything else except caring for herself and the baby. A well-rested mum is less likely to feel cranky and the whole family benefits from this. Ensure that your wife feels appreciated Surprise your wife with your thoughtfulness and get her out of the house once in a while. Even brief breaks can be relaxing. Help her realise that she is an incredibly important person in the household through your words and actions. HN Assembling milk bottles Make sure you know where all bottles are kept and learn how to assemble and disassemble one. Do some test runs under the guidance of an expert. Never feed a newborn without first testing how hot the formula is. Distraction tools Ensure you have age appropriate toys, DVDs and other such stimuli on hand. Babies are easily distracted and these tools might help ease their anxiety when Mummy is not around. Raffles HealthNews Supplements 27 PREGNANCY and the use of Nutritional Supplements During pregnancy, hormone secretion changes radically, causing the physical and emotional changes experienced by most women fairly early in the first trimester. These hormonal changes can lead to "morning sickness" or nausea in the first trimester, especially when there are nutritional deficiencies. Nearly all pregnant women can benefit from nutritional and multivitamin supplementation one year before and throughout pregnancy, labour, delivery and breast-feeding. Promotions Now buy 1 at S$16.90* Buy 2 at S$29.90* .......... S tudies have shown that deficiencies of folic acid have been linked to low birth weight and neural tube defects (in infants). It is thus recommended that all women of childbearing age take daily folic acid supplements to reduce their risk of congenital birth defects. Raffles Pregnancy Support 60’s (U.P. S$18.90) Vitamin B6 .......... Supplementation of Vitamin B6 has been linked to relieve nausea and morning sickness. Raffles DHA (U.P. S$20.30) Vitamin B12 .......... R equired for proper homocysteine metabolism and may also help in the prevention of anaemia. Folic Acid Calcium Omega 3 .......... C alcium supplements may reduce the risk of pre-term delivery, often associated with preeclampsia. They can also help to ease leg cramps during pregnancy. .......... Maternal levels of omega-3 fatty acids, especially DHA, decrease during pregnancy. In nursing women, the material levels and essential fatty acids (EFAs) in breast milk may be reduced further. For the foetus, a deficiency of EFAs, particularly Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA), may lead to a poorly developed central nervous system. * Prices are not valid in conjunction with other discounts and promotions. * Only valid at Raffles Health Retail Pharmacy at Raffles Hospital. 585 North Bridge Road | Level 1 | Raffles Hospital | Singapore 188770 Now buy 1 at S$17.90* Buy 2 at S$31.90* 28 FoodNotes Raffles HealthNews Chicken Herbal Soup 1 serving per recipe Ingredients • • • • 50g chicken leg, boneless 5 red dates 15g dang sen (codonopsis) 8g kei chee (wolfberries) • 5g dang gui (Angelica) • 500ml chicken stock • Salt and pepper to taste Preparation 1. Cut the chicken to cubes and blanch in hot water. 2. Add in red dates, dang sen, kei chee, dang gui and chicken stock. 3. Bring to boil with slow fire. After that, to simmer for 3 hours. 4. Add salt and pepper to taste. Nutrition Information per Serving Calories Fat Carbohydrate Protein Fibre 50g 2g 10g 4.3g 0.5g “A simple, easy to prepare, nutritious soup for the new mum!” Ms Nehal Kamdar, Senior Dietitian, Raffles Internal Medicine Centre Ease of preparation: Nutritional level: Raffles HealthNews Q&A 29 What are the effects of 'cooling' food on females? Is it true that eating 'cooling' foods, such as pineapple and cucumber will induce more discharge in females? Can the consumption of 'cooling' food cause miscarriages? Vaginal discharge is sometimes due to hormone changes or mild infections that can be the result of pH (acidity) changes in the vagina. It is quite possible that certain foods alter the pH and thus induce more vaginal discharge. Such mild discharge is harmless. There is no scientific proof that miscarriages are caused by 'cooling' foods. Dr Tan Yew Ghee, Specialist in Obstetrics & Gynaecology, Raffles Women Centre Cold foods in Traditional Chinese Medicine (TCM) are a type of food which may stimulate the cooling effects in your body and reduce the “yang” energy, as our body needs to counter the cooling effect with yang energy in the body. Prolonged period of taking these kinds of food without balancing them with other warm or hot food may cause yang energy and kidney yang deficiency. This interferes with the normal function of the reproductive organs and leads to irregular periods and abnormal discharge. If the woman’s constitutional type is cold and damp, then she has a deficiency of spleen and kidney in TCM terms. Taking too much cooling food will induce more discharge. For pregnant woman with a history of miscarriage, and weak kidney yang, the consumption of cooling food may cause miscarriages. Ms Jin Jinhua, Senior Acupuncturist, Raffles Chinese Medicine Why do some women put on so much weight after giving birth while others less? There are several factors that contribute to some women retaining pregnancy weight or gaining additional weight during confinement. In the Asian culture, women are supposed to observe a one-month confinement period to nurture the women’s health back to prenatal state. During this month women are to eat fatty and oily food like internal organs, fried chicken, fish and food cooked with a lot of ginger and sesame oil. Some Asian cultures encourage eating 30 chickens, 12 bottles of rice wine and 15 kilos of old ginger root. ‘Cooling’ vegetables are not given; physical activities like walking around the house or going out for walks are restricted. This high-calorie diet coupled with lack of exercise contributes to weight gain, more so if the woman is not totally breastfeeding her baby. Ms Nehal Kamdar, Senior Dietitian, Raffles Internal Medicine Centre PROMOTIONS 30 MarketPlace Raffles HealthNews Your TCM Specialist Centre Traditional Chinese Medicine (TCM) has been used for centuries to relieve many symptoms and complications of pregnancy. Acupuncture and certain Chinese herbal treatments are safe and natural alternatives for mums and babies to stay healthy, and for mums to restore their bodies after birth. Sign up for a TCM package that meets your needs. Antenatal TCM Care Packages February - March 2010 Promotion 1. Raffles Lifestyle Package at S$244.80 2. Enjoy Wellness vaccination(s) at the following prices for every Lifestyle Package sign up: • • • • • Hepatitis A vaccination S$72.20 Hepatitis B vaccination S$28.85 Hepatitis A & B vaccination S$90.50 Influenza vaccination S$23.40 Gardasil (cervical cancer) vaccination S$144.45 3. Get the following health supplements at: • Raffles Glucosamine (1500 mg) (40's) S$34.10 • Raffles Adult Multi (60's) S$25.60 • Raffles Women's Multi (60's) S$31.40 April 2010 Promotion 1. Lipid screen, glucose check and doctor's review at S$32.10 2. Travel kit at S$26.95 For more information, please call 6311 1111. Terms and conditions: * All credit card promotions are not valid with the above packages. * Packages are only valid for the promotion period. * Packages are only valid at RafflesMedical panel of clinics in Singapore. Packages are not available at Raffles Health Screeners, Raffles Executive Medical Centre and Changi Airport Medical clinics. * Prices inclusive of GST. • • • • eneral Well Being (4 sessions of acupuncture) G General Pain Management (6 sessions of acupuncture) Headaches and Migraines (6 sessions of acupuncture) Skin Care (6 sessions of acupuncture) S$190 S$287 S$287 S$377 Postnatal TCM Care Packages • • • • Post Delivery Care (5 sessions of acupuncture) Weight Management (10 sessions of acupuncture) Full Body Slimming TuiNa (6 sessions of acupuncture) Local Area Toning TuiNa (6 sessions of acupuncture) For more information or to book an appointment, call us at 6311 2388 / 2322. Email [email protected] or visit us at www.raffleschinesemedicine.com * Terms and conditions apply * Valid till 31 March 2010 * Prices inclusive of GST S$375 S$642 S$492 S$321 PROMOTIONS Raffles HealthNews MarketPlace 31 New Mum Rejuvenation Programme Restore your glow and regain your figure with a whole range of services specially designed to meet your unique needs. Maternity Wellness Package S$963 Hormonal changes in pregnancy causes three in five women to suffer from pregnancy gingivitis (inflammation of the gums). If left unchecked, this can progress to periodontal (gum) disease which has been linked to pre-mature, low birth weight babies. Pregnant women with chronic gum disease are four to seven times more likely to deliver prematurely than mothers with healthy gums. The good news is that clinical trials have shown that gum treatment and therapy can significantly reduce this risk. It is therefore recommended that you include a dental check-up as part of your pre-natal routine. This package comprises 10 Pre or Post Natal massages which may be utilised during or after pregnancy. Glowing Complexion Package S$637 This package is excellent for the treatment of fine lines, wrinkles, mild acne scarring, keratosis, orange peel skin and uneven pigmentation. Skin Renewal Package S$1,563 This helps get rid of unsightly freckles and skin pigmentation, while stimulating collagen to produce a firmer skin tone that looks revitalised and rejuvenated. Cosmetic Surgeries and Treatments Raffles Dental Maternal Health Package at S$107* • First dental GP consultation • Scaling and polishing Sign up now and receive a complimentary pre/post natal massage worth $130 at Raffles Aesthetics in Raffles Hospital. Complimentary massage to be redeemed within 3 months of purchase of the Dental Maternal Health Package. Choose something for yourself from our range of cosmetic surgeries and treatments to bring out your confidence and radiance after childbirth. Weight detox programme Hair loss treatment Hair transplantation services Breast augmentation (breast implants or breast reduction) Liposuction (for arms, thighs and tummy for a slimmer silhouette) • Abdominoplasty (tummy tuck to reduce excess skin) • Fat transfer (for facial and buttocks enhancement) • • • • • For appointment, please call 6311 2360 /2365 or email us at [email protected]. For more information or to make an appointment, call 6311 2340 or email [email protected] * Terms and conditions apply * Prices inclusive of GST * Terms and conditions apply * Prices inclusive of GST 1 tertiary hospital 72 multi-disciplinary clinics 35 medical specialties 34 years of quality health care 1 Trusted Medical and Wellness Provider Raffles Medical Group offers a complete continuum of care through its network of clinics and hospital. At Raffles Hospital, we go the extra mile to provide the highest quality medical care and services through personalised team-based care and patient centric services that are tailored to your needs. Raffles Medical provides a comprehensive range of family medicine and corporate wellness services, including vaccinations, health screening, travel health, emergency and housecall services through our islandwide panel of clinics. Our medical facilities at the Singapore Changi Airport also provide family medicine, health screening, emergency and dental services. Our medical centre at Terminal 3 is available 24 hours for your healthcare needs. With us, your health is in good hands. This is our promise. 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