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 Ask ObGyn Dr Seng
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   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 now 35 ½ weeks pregnant and my baby is in breech. I would really like to avoid a C-section birth if possible. What are the chances my baby would change her position for me to have a normal birth? Or is there anything I can do to encourage my baby to turn for her head to be engaged, such as exercises, sleeping posture or is there any way to “turn” her?

Thank you.
Rachelle Tan

Answer 1:
Dear Rachelle,

The best time to try to turn a breech baby is between 34-37 weeks of pregnancy There are many different types of methods to use and all have different levels of success. Talk with your doctor about which options they feel would be best for you to try.
Medical Techniques:
  • External Cephalic Version (ECV): External Cephalic version is a non-surgical method in which a doctor can help move the baby within the uterus. Before starting this procedure , it is important to ensure the baby is suitable for ECV. This is done by an ultrasound exam to check the position of the baby, the location of the placenta, and the amount of amniotic fluid in the uterus. With addition of a medication to help relax the uterus, gentle pushing on the lower abdomen can turn the baby into the head-down position.

    Throughout the external version, the baby's heartbeat will be checked closely so that if any problems should occur, the doctor will stop turning immediately. Risk of such a procedure is that of early placenta separation and cord accidents both of which can be considered an emergency and an emergency caesarean section for delivery must be performed immediately. 
Non medical methods:
  • The Breech Tilt: Raise hips 12" or 30cm off the floor using large, solid pillows three times daily for 10-15 minutes each time. This is best done on an empty stomach, and at a time when your baby is active. Concentrate on your baby and not tensing your body, especially in the abdominal area.

  • Using Music: We know that babies can hear sounds outside the womb, so many women have used music or taped recordings of their voice to try to get their baby to move towards the noise! Headphones placed on the lower part of your abdomen, playing either music or your voice, has encouraged babies to move towards the sounds and out of the breech position.
If all else fails, it is still safer for the baby to be delivered via a caesarean section. 
All the best,
Dr Seng Shay Way
    

Question 2:
Dear Dr Seng,

I am currently breastfeeding my 10-month-old child. My husband and I are contemplating on whether we should have another baby, hence we have decided against going for a ligation or vasectomy.

Our current means of contraception is the withdrawal method paired with regular checks of the level of cervical mucus. If we rule out birth control pills as an option, what other forms of contraception would you recommend?

Thank you.
Abigail Cheng


Answer 2:
Dear Abigail,

Congratulations on your baby, it is also very encouraging to hear that you are breast feeding. It is also important to think about birth control options well before the time you become fertile again. For the nursing mother who wants to space her pregnancies, there are many birth control options to choose from. Each method offers advantages and disadvantages.

As long as the nursing mother is exclusively breastfeeding, (nursing frequently day and night with no supplemental feedings), the baby is younger than 6 months of age, and the mother has not started having periods, she is more than 98% protected against pregnancy. It is important to understand that as soon as there is a decline in breastfeeding, due to the baby eating supplemental feedings or nursing less often, the contraceptive protection decreases, and other methods should be considered. Fertility is most effectively suppressed when the baby goes no longer than four hours during the day and six hours at night between feedings. The pattern of breastfeeding is a key factor, but the mother's own body chemistry also has an influence. Some mothers nurse without supplements and still start having periods within the first few months of nursing. Others whose babies sleep through the night or have supplemental feedings will not have a period for twelve months or longer. Some women go as long as two years or more without menstruating. After the initial flow of lochia (the bleeding experienced for two to four weeks after birth) has stopped, nursing mothers will usually experience no vaginal bleeding for several months. Often, the first period occurs without ovulation. Many women refer to this as a "warning" period, and take it as a sign that they are fertile from that point on. Often light bleeding or spotting is the first indication of the return of fertility. Any bleeding or spotting that lasts more than a couple of days should be considered a sign that the mother is fertile again. It is not unusual for a mother to have irregular periods during the time she is nursing.

The first choice of birth control for nursing mothers is non-hormonal methods. This includes condom use, which has the advantages of being readily available, and having no effect on breastfeeding. Condoms can be very effective if used correctly. Condoms offer some protection against STDS (sexually transmitted diseases) and have no risks to the mother or child, but can be irritating to vaginal tissue and may require additional lubrication.

IUDs (intrauterine device) have no effect on breastfeeding, and are very effective. There is a possible risk of expulsion or uterine perforation if the device is not properly placed or is inserted before 6 weeks postpartum. Mirena is another new form of IUD, this is progestin delivering IUD. Good option for women who seek mid to long term contraception 3-5yrs.

If the nursing mother chooses to use a hormonal method of birth control, the second choice is progestin only methods, such as implanon (implants), mini-pills, or injectables (Depo-Provera).

  • Implanon is a progestin releasing implant that is inserted under the skin of the upper arm. It releases progestin continuously, preventing ovulation. It is a long lasting form of contraception of 3 yrs duration; some women may experience spotting and irregular menstrual bleeding.
  • Each Depo-Provera shot provides contraception for up to 12 weeks and is highly effective in preventing pregnancy. It may cause spotting between periods or other undesired side effects in some women.
  • Progestin-only pills have a higher rate of failure than combination pills. They must be taken at the same time each day to work. Even taking the mini-pill a few hours late could result in pregnancy. Because of this, some mothers use a barrier method as extra protection while taking the mini-pill. If the mini-pill is used, the mother should contact her doctor or midwife when the baby is weaned. At that time it may be best to switch to combination birth control pills.

All of these methods can be very effective, and may even increase milk volume. Although some of the progestin hormone may enter the breast milk, there is no evidence of adverse effects from the small amount of hormone that passes into the milk.

These are some of the common contraceptive methods used for breast feeding mothers, you would have to find one that suits your lifestyle and you are comfortable with. It would also be helpful if you can discuss this with your obstetrician who can further guide you on the choice.

All the best,
Dr Seng Shay Way
    

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