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Pregnancy: High tech or home comfort?

May 13th, 2009

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Whether you’re planning on having your baby in hospital with all the high-tech back-up it offers, or prefer the comforting familiarity of home, the following are important considerations.

One of the most important factors when considering your hospital is its location.If you will be working throughout your pregnancy and your office is not near your home, do you choose a hospital near the office so it’s convenient for check-ups plus ante-classes if you’re taking them at the same place or do you choose one near to home in case you have to make a sudden dash to delivery room?

TAKE A TOUR

If you plan to attend classes regularly, arrive early for one of them and find out if you can go on a tour of the hospital. These are usually made by appoinment, so arrange an appropriate day and time to look round; don’t forget to bring a list of the queries that you and your husband have drawn up between you. Find out about hospital policies on rooming in with baby, the presence of your birth partner or your husband and the hospital’s willingness to conform to your birth plan.

CHARGES

Delivery and hospital charges can add up quite significantly. If, like most people, you have to keep an eye on finances, you may want to consider the choice between a government and private hospital.

HELP AT HAND

Needles to say, a hospital has all the equipment and expertise to deal with pain relief (if this is what you want), and with any complications should they arise. After the birth, you will stay in the hospital for about 48 hours. This should give you some time to rest and recover before coping with the demands of motherhood full-time. This is an unlikely luxury for those who choose home births, and for first-time mothers this extra assistance can mean a lot.

MISSING THE PERSONAL TOUCH

Because you have a team attending to you, there’s no guarantee that you’ll see the same nurse or doctor throughout the course of your labor. The experience can therefore be a little impersonal, and some women find that as just one of many women having a baby in the same premises at the same time, some of the significance of the experience is lost. The hospital staff will, of course give you the best medical assistance they can, but there will undoubtedly be other mothers requiring attention,too.

YOUR GYNAECOLOGIST

Find out at which hospitals your gynaecologist usually does his/her deliveries and be sure to consider this when narrowing down in your list of preferred hospitals.

HOME DELIVERY

Women who choose this option often cite the fact that it is the most relaxing and familiar setting and that nothing beats the intimacy og giving birth alone with a midwife and loved ones in your own home. Although many ob/gyns may be opposed to home deliveries owing to the risks to both mums and babies, others are more open to home births when a pregnancy is a relatively low-risk.

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Some pre-requisite conditions for a home-delivery:

  • You are in a good medical health and are not experiencing gestational diabetes, pre-eclampsia or any other complications.
  • You do not have a history of a difficult deliveries.
  • Your caregiver/midwife is someone reliable and has all the necessary emergency medical supplies.
  • You have a back-up plan for emergencies and are prepared to stop the home birth immediately.
  • You live relatively close to a hospital.
  • Other than your midwife, other support is available, either from your partner or other family members. These people will be available before, during and after the birth.


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Pregnancy: Leaving it late

May 11th, 2009

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Becoming pregnant after the age of 35 is not unusual anymore in the fast paced modern world. But later-age pregnancies can put you at higher riskof a number of health complications and managing risk is easier if you are aware of them. The following are some of the issues your gynaecologist will discuss with you.

CAESAREAN DELIVERY

Natural birth becomes more difficult, the older you get. The risk of a first-time mother over the age of 40 needing a Caesarean is nearly 50% compared to 14% for a first time mum in her 20s.

CHROMOSOMAL ABNORMALITIES

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The most common problem is Down Syndrome, a condition caused by the presence of an additional chromosome that is associated with mental retardation and other physical abnormalities. The risk of a baby being born with Down’s increases with the age of the mother. It has been estimated that some 66% of Down Syndrome cases occured in babies of women who were 35 years and older, and more than 40% of the cases happened to babies of mothers aged 38 and above.

DIABETES AND HIGH BLOOD PRESSURE

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Both these conditions are more common in women in their 40s than in younger women. They can complicate a pregnancy and increase the risk of pre-eclampsia (higgh blood pressure), pre-term delivery, placenta problems, stillbirth, or birth defects in the child.

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DIFFICULT LABOR

First-time mothers over 35 years old are more likely than women in their 20s to have difficulties in labor, including a prolonged second stage of labor and more foetal distress.

LOW BIRTH WEIGHT

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Some studies suggest that women who delay childbearing until 35 years or older are at an increased risk of delivering a baby with low birth weight (less than 2.5kg) or premature (born at less  37 full weeks of pregnancy). These risk rise modestly but proressively with a woman’s age.

MISCARRIAGES

The rate of miscarrying during pregnancy is significantly greater for older women than younger ones. Studies show an estimated risk of miscarriage of 12 to 15 percents for women in their 20s and this increases to about 25 per cent by the time the woman is 40.

MULTIPLE BIRTHS

The possibility of having twins or triplets increases with age.

PLACENTA PROBLEMS

Placenta praevia is a condition whereby the placenta is incorrectly placed inside the uterus, covering either a part or all of the opening of the cervix. It can cause severe bleeding during delivery and can endanger mother and baby during birth. A Caesarean is usually needed. Compared to a woman in her 20s, a first-time mother in her 40s is eight times more likely to suffer from placenta praevia.

MINIMIZING THE RISKS

If you do get pregnant in your late 30s or 40s:

  • Control existing health problems such as high blood pressure or diabetes.
  • If you are overweight, lose the excess weight. Overweight pregnant women are more likely to develop health problems.
  • Take vitamins containing folic acid before getting pregnant. This can help prevent neural tube defects such as spina bifida, a condition in which the tissue over the baby’s spinal cord doesn’t close.
  • Read up about your health risks and the diagnostic tests you want to have to detect chromosome abnormalities.

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Pregnancy: Your other best friend

May 9th, 2009

There will be no shortage of people ready to give you advice once they know you’re pregnant. But the one you really need to listen to is the expert – your doctor!

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A good gynaecologist will be able to help you through all the usual anxieties and provide not just good, sound advice but psychological reassurance during your pregnancy and right through labor and delivery. You are likely to spend many an afternoon in your gynaecologist’s clinic, so look beyond the credentials and recommendations and ask yourself how comfortable you are with this person and if you trust them with your health and that of your baby.

CHOOSING A DOCTOR

Some women have no preference regarding the gender of their attending obstetrician and gynaecologist (obgyn). Others, owing to personal, religious and maybe social preferences, prefer a woman obgyn. Thre should not be a significant difference in the level of expertise between healthcare providers, but the doctor-patient relationship is an intimate one, so your choice will probably come down to personal preference. Do you feel that you can talk to this doctor about problems you may face during pregnancy and about the worries you have for both the baby and yourself?

It’s easier to rely on word-of-mouth recommendations from people whose opinion you trust rather than to go with a complete stranger whom you may only have read about. Friends, relatives and colleagues are usually happy to make recommendations. However, if you’re not ready to spread the news of your pregnancy, you should try asking the hospital at which you’ve chosen to deliver your baby for a list of specialists they work with. Narrow this down by considering only gynaecologists who have a clinic near you. If you already have a gynaecologist in mind, it may be best to ask them which hospitals they’re attached to. As there’s little difference between maternity wards, simply choose the most conveniently located.

FITTING IN WITH YOUR NEEDS

It is important to choose a doctor who will meet all your requirements. He or she should, for example, have an appointment schedule that fits yours, have the necessary expertise to deal with any of existing medical conditions that may cause complications and perhaps even share your views on pain control and the extent of your husband’s role in the delivery room. In a low-risk pregnancy, doctor’s visits are typically once a month for the first and most of the second trimester. The frequency increases to once a fortnight when you reach week 28 and once a week in the last month.

QUESTIONS TO ASK YOUR GYNAECOLOGIST

Before you go and see the first gynaecologist on your list, consider calling the doctor’s office and ask the receptionist if you may ask a few questions. Start with the following:

  1. Which health-care program does the doctor participate in? Be sure that this matches the medical program you will be using.
  2. What are the doctor’s office hours? This is especially useful if you can take time off only during evenings and at weekends.
  3. Is this a solo or group practice? In a group practice, there will usually be more than one doctor who can attend to you in emergencies. However, you may prefer the attention of one doctor who will get to know you and your baby as your pregnancy progresses.
  4. Which hospitals does the doctor work with? Do these hospitals have a neonatal intensive care unit (NICU)? This is a special nursery for babies who are born with medical complications; it may be essential if you have a high-risk pregnancy.
  5. What are the hospitals’ policies about rooming-in? Some mothers prefer to have their babies with them, others like having the time to recover without thinking of how the baby is doing.
  6. Can my partner be present during each visit? If his presence is important to you, find out what your gynaecologist prefers. Most encourage the father’s presence.
  7. Do the hospitals you work with encourage fathers during labor and delivery? If your gynaecologist is also going to deliver your baby, you will want to know:
  • During delivery, will you give me pain relief when I ask for it or when you deem it necessary?
  • Do you encourage elective Caesareans and when would you consider an emergency C-section for me?
  • Do you encourage a vaginal birth if I’ve had a previous Caesarean?
  • Would you consider alternative birthing methods, for example a water birth, if I so choose?

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