Write to: Dr Seng Shay Way c/o Q&A Ask ObGyn, MotherNeeds, 141 Lentor Street, Singapore 786838, or fax us at 6456-0031, or email info@motherneeds.com with "Ask ObGyn" as your subject heading.
Please limit your queries/questions to a maximum of 150 words.

Doris will select 2 letters to be answered every month. Selected letters published here win a S$12 gift certificate for purchases at our MotherNeeds online store.

Dr Seng Shay Way is a consultant obstetrician-gynaecologist at a private practice in Gleneagles Medical Centre. Dr Seng has been practicing and teaching for over 12 years.

In his spare time, Dr Seng enjoys photography and cooking.

Learn more about Dr Seng Shay Way.

Question 1:
Dear Dr Seng,

I am currently breastfeeding my 26 month-old daughter and am planning on having our second baby. I have heard that it is possible to continue breastfeeding an older child while being pregnant.

During my first pregnancy, I had frequent brown vaginal staining/ discharge in the first trimester, and was told then that I was at risk of a miscarriage. Would it still be safe for me to continue breastfeeding anyway throughout my second pregnancy? I am really enjoying my breastfeeding relationship with my daughter, and am not ready to wean her off. Is there any other way?

Thank you.

Ng Lee-Ann

Answer 1:
Dear Lee-Ann,

If you’re breastfeeding your child and you become pregnant, there’s no reason to wean the older child immediately, unless you want to. It is still possible to continue to breastfeed while you’re pregnant. It is good and important that you have a good relationship with your daughter. While breast feeding during pregnancy you would have to watch your nutrition closely and you need to increase your hydration. In the fourth or fifth month of your pregnancy, you may experience a decrease in breast milk production. You may need to supplement at this point if your child isn't getting enough nourishment . However, if your child is old enough, you may want to consider weaning at this point, but there’s no reason you must. As your pregnancy progresses, your milk will begin to change to colostrum. Your older child may not like this change or may not notice it at all. There is, again, no reason to stop nursing. The colostrum is beneficial for your older child and your body will continue to produce it until after your new baby is born. Even if you do wean your child, they may want to breastfeed again once they see the new baby nursing.

Breast feeding may cause your menses to stop, this is due to the inhibitory effect of prolactin ( breast feeding hormone ) on ovulation. If this happens and you plan to get pregnant, you may have to stop breast feeding to allow ovulation. However if your menses comes as usual during breast feeding it shows that you are ovulating and you can get pregnant.

The only time when breastfeeding is contraindicated during pregnancy is when the mother has a history of miscarriages or has previously had a premature baby. For these women, the uterus may be especially sensitive to uterine contractions and to the hormones produced during breastfeeding. If this is the case, you may want to consider weaning your child off breast milk before trying to conceive.

Breastfeeding is a tender time for both mothers and babies. Many women find breastfeeding during pregnancy incredibly rewarding, while others prefer to wean their babies after becoming pregnant. Regardless of the decision you make, you should feel supported in your efforts. If you are looking for breastfeeding support while pregnant, check out La Leche League International, an organization that offers support for breastfeeding mothers and their babies.

All the best,

Dr Seng Shay Way

Question 2:
Dear Dr Seng,

I am currently 23 weeks into my second pregnancy. My first child was delivered via an emergency C-section under general anesthesia because I had pre-eclampsia. As I do not plan on having a third child, this pregnancy could well be my last one. I would like to experience a normal (vaginal) child birth, but I understand that for most women who have had prior C-section births, a vaginal birth is discouraged.

Is a normal birth still possible for me at all?

Thank you.

Jennifer Lee

Answer 2:
Dear Jennifer,

Congratulations on your second pregnancy. Overall, about three out of four women (75%) with a straightforward pregnancy who go into labour give birth vaginally following one caesarean delivery. These are recommendations from the College of obstetrician and gynaecologist on vaginal birth after caesarian section: The advantages of a successful VBAC include:

1) Experience of a vaginal birth (which might include an assisted birth);
2) A greater chance of an uncomplicated normal birth in future pregnancies;
3) A shorter recovery and a shorter stay in hospital;
4) Less abdominal pain after birth;
5) Not having surgery.

With regards to you wanting to experience a normal vaginal delivery , I would recommend that you should voice your concerns and desire to your obstetrician and discuss the choices available for you. Factors that will determine the decision for a vaginal birth after caesarean section (VBAC) would be as follows:

1) The reason you had the caesarean delivery and what happened – was it an emergency?;
2) The type of cut that was made in your uterus (womb);
3) How you felt about your previous birth. Do you have any concerns?;
4) Whether your current pregnancy has been straightforward or have there been any problems or complications? You had pre-eclampsia the previous pregnancy , the recurrence rate in the second pregnancy would be between 20%-40%.

There are also a number of factors (risk factors) that make the chance of a successful vaginal birth less likely. These are when you:

1) Have never had a vaginal birth;
2) Need to be induced;
3) Did not make progress in labour and needed a caesarean delivery (usually owing to the position or size of the baby);
4) Are overweight – a body mass index (BMI) over 30 at booking.

But if you do decide on a vaginal delivery after a previous caesarean section, these are possible risk involved:

1) Emergency caesarean delivery
There is a chance you will need to have an emergency caesarean delivery during your labour. This happens in 25 out of 100 women (25%). This is only slightly higher than if you were labouring for the first time, when the chance of an emergency caesarean delivery is 20 in 100 women (20%).

2) Higher chance of blood transfusion and infection in the uterus
Women choosing VBAC have a one in 100 (1%) higher chance of needing a blood transfusion or having an infection in the uterus compared with women who choose a planned caesarean delivery.

3)Scar weakening or scar rupture
There is a chance that the scar on your uterus will weaken and open. If the scar opens completely (scar rupture) this may have serious consequences for you and your baby. This occurs only in two to eight women in 1000 (about 0.5%). Being induced increases the chance of this happening. If there are signs of these complications, your baby will be delivered by emergency caesarean delivery.

You and your obstetrician will then consider your chance of a successful vaginal birth, your personal wishes, future fertility plans, risk of VBAC when making a decision about vaginal birth or caesarean delivery.

All the best,

Dr Seng Shay Way

*We regret that only 2 letters will be answered by Dr Seng every month.

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