On the 35th week of pregnancy, we visited our gynae and was informed to take a Swab Test. The cost for the Swab Test is RM 85. We visited our gynae 2 weeks later meaning my wife is on 37th week, and got the report.
Our gynae informed that my wife have to start taking antibiotics for 5 days and twice daily. The antibiotic cost is RM 30.
Also, our gynae informed us that my wife will have to receive antibiotics via IV during labor.
Once reach home and upon googling the test report information, I found out that about 25% women may carry Group B Strep (GBS) at vagina and rectum area. And GBS may come and go in women's body without symptom. GBS are the leading cause for meningitis and sepsis in the newborn baby when deliver via natural birth, and it's important to take precaution during labor. The precaution action to be taken is to receive antibiotics via IV drip during labor which was what our gynae informed us. We're grateful that our gynae helps to inform us about the procedure.
Induce labor is usually initiated once the pregnancy has reached 37 weeks and onwards because the infant has fully developed, and is ready to come out at anytime.
There are 3 methods to induce labor: 1) Medication Methods
Medication
Methods
Pro
Cons
Prostaglandin
A suppositories are inserted into vagina during evening causing uterus to go into labor by morning
Allow mother to freely move around labor room
May cause uterine rupture and it's a huge risk for both mum and baby
Oxytocin
The body naturally produces oxytocin hormone to stimulate contractions. Pitocin and Syntocinon are brand name medications that forms oxytocin given through an IVR at low doses to stimulate contractions.
Can initiate labor and speed up labor pace.
Labor can progress too fast, and cause contractions to become difficult to manage without pain medication. Oxytocin IV will be stop once contractions become too strong
2) Artificial Rupture of Membranes (AROM)
This method is to rupture the amniotic sacs.
Pro
Cons
- Labor may be shortened by an hour
- The procedure allows amniotic fluid to be examined for the presence of meconium
- Heart rate can be monitored with direct access to the baby's scalp
- Baby may turn to breech position, making birth more difficult if the membranes are ruptured before the baby's head is engaged
- Possible for umbilical cord to slip out first
- Infection can occur if there are too much time between rupture and birth
Warning:
Method 1 (Medication) and Method 2 (AROM) are risky methods as it's artificially method to "force" baby to come out. If everything goes fine, then everybody is happy but bear in mind the methods are very risky. The risk are:
- Increased risk of premature baby if due date calculation are miscalculated
- Uterine rupture is rare but if occurred, then C-section is required ASAP
- Induced labor usually ends up with C-section, forceps delivery and vacuum births
- Create stress for the baby
3) Natural Methods
a) Walking to increase the chance to draw baby head to pelvis
b) Have sex as sperm contains free prostaglandins hormone, and sexual orgasm in women releases oxytocin.
c) Increase oxytocin level
- Nipple stimulation
- Massage
- Hugging with partner
- Cuddling with partner
d) Do acupressure to jump start contractions
e) Eat spicy food to irritates the intestines and subsequently cause uterus to contracts.
Example: Nasi Lemak, Tom Yam Soup, anything spicy
f) Take herbs that helps labor. Example:
- Red raspberry leaf tea
- Primrose Oil
g) Eat fruits like mango, pineapple and kiwi
h) Drink coconut drink
Best to drink fresh coconut and has not been put in the cooler
Apgar score is a test conducted at 1minutes and 5 minutes after birth to quickly access the current health of newborn baby. The Apgar score is not meant to predict the future health of the baby.
Below is the matrix for the Apgar scoring:
Example:
When baby is out, the baby cries very loudly and skin color is fully pink but the leg have some blue color with pulse above 100 beats per minute. The baby muscle is also strong however not much active motions. Therefore the APGAR score is 8 (1+2+2+1+2).
Below is the definition for the Apgar scoring:
Below is the baby with Apgar score 7 on 1st minute and 9 on 5th minutes.
The video is on baby Xavier for 1st Apgar score
There are mix opinion on when to cut the umbilical cord after baby is out. To understand better on what happen when baby is out from mother's body, below chart shows the blood transfusion after birth.
Placental transfusion takes place immediately after birth and the cord start to pulsates. Placental transfusion is the system that provides the baby with red blood cells, stem cells, immune cells and blood volume. Delayed cord clamping allows time for the placental transfusion, ensuring safe oxygen levels and blood volume in the baby.
Left: Cord containing baby’s blood Right: Cord after placental transfusion
Here is a demonstration on the reason not to cut umbilical cord immediately after birth.
The usual practise in hospital is to clamp and cut the cord in less than 30 seconds after birth. Delayed cord clamping is best to be done once the cord stop pulsating or beyond 2 minutes after birth.
Do discuss this with gynae/mid-wife before birth. Once decided, put delayed cord clamping in the birth plan so that everybody (gynae/mid-wife/nurse) helping on the delivery knows when to cut the umbilical cord.
Warning:
The 2008 Cochrane review found that infants whose cord clamping occurred later than 60 seconds after birth had a statistically higher risk of neonatal jaundice requiring phototherapy.
This is an interesting concept for mummy to kick start breast feeding, and also an eye-opening that infant can actually move towards the breast for milk once come out to the world. The process usually take between 30-60 minutes.
This is an interesting topic which drain a lot of $$$ from parent which there is no prove whether stem cells from cord blood can save the baby. It's an expensive way to buy an insurance...
Here is a video on cord blood collection
However, parent should get to hear from an expert too before making decisions
Some consideration thoughts before deciding on stem cells:
1) Cord blood have a possibility to treat leukemia or lymphoma, aplastic anemia, severe sickle cell anemia, and severe combined immunodeficiency. This is usually related to family medical history.
2) In most cases, stem cell transplants are performed only on children or young adults. The larger the size of the person, the more blood-forming stem cells are needed for a successful transplant. Umbilical cord blood stem cells aren't adequate in quantity to complete an adult's transplant.
3) Clamping the umbilical cord too soon after birth may increase the amount of collected blood, but it could cause the baby to have a lower blood volume and possible anemia soon after birth.
In Laugh & Learn lesson video (http://www.laughandlearn.com), there are 6 preliminary signs that can happen 2 weeks before labor begins:
- Braxton hicks
- Mother weight stabilization
- Burst of energy
- Baby dropping
- Increased vaginal discharge
- Diarrhea
Here are the labor process understanding
1) There are 3 signs that labor is starting meaning effacement and dilation process has started
- Water broke
- Show of blood or mucus plug
- Contractions starting or the persistent tightening of the stomach that doesn't go away and getting stronger
2) Effacement occur first which the cervix slowly become thinner and shorter
3) Dilation occur next which cervix gradually open in diameter
General Rule of Thumb:
For 1st pregnancy, the cervix is open by 1 cm every hour.
For subsequent pregnancy, the cervix usually opens by 2 cm every hour.
Here are the pro and cons of the possible delivery places:
Delivery Options
Pro
Cons
Guide
Home Birth
1) Nice to deliver in a comfortable environment
1) Not suitable if there is a complications in the delivery. e.g. Premature Labor, Overdue Delivery
2) Not suitable if there is a baby problem
3) Require a very experienced midwife to assist in the delivery
http://hypnobirthing.com.my/
Birthing Centre
1) Replicate a home environment
2) More privacy
1) Does not have a full facility like a hospital
Government Hospital
1) Cheap
1) No privacy meaning stranger can go and see the labor activity. e.g. Medical students
