Are you ready to be a mother? Pregnancy is a very exciting time in a woman’s life. Feeling your baby growing inside you is a miraculous experience. But it can also be a time filled with questions and concerns. Knowing more about pre-pregnancy preparation, delivery options and the medical truths on myths of pregnancy can help to dispel worry and uncertainty.

Experts from the Department of Obstetrics and Gynaecology at KK Women's and Children's Hospital, as well as the Department of Obstetrics and Gynaecology at Singapore General Hospital, give detailed answers to your questions.​

Question by healthblur

I am just past 40 years old and have one child aged 6 years. Is it too late for me to have a second child? We have been trying for the past 1 1/2 years- probably two years, but without success.

I have read many stories about movies stars in their early 40s having their first baby, but am not sure if that's because they have such 'comfortable' lives.

What are the risks involved and what should I do to improve my chances, as well as reduce any potential risks? Or should I not try? thanks

Answered by Singapore General Hospital

Biologically, a woman can potentially get pregnant as long as she has not undergone the menopause. It is recognized though, that the chances of getting pregnant are reduced the older a woman gets, typically after the age of 35.

In addition, pregnancies that are conceived in older women are at higher risks of miscarriages. These pregnancies are also at higher risk of Down Syndrome – 1 in 100 pregnancies in women at the age of 40 can be affected.

Older women are more likely to have existing chronic medical problems (such as diabetes or high blood pressure) all of which can become harder to control during pregnancy. They are also more likely to experience gestational diabetes or pregnancy-induced hypertension.

Other factors that you have to take into consideration may include your ability to cope with raising a second child at an older age, as well as the financial capability of your household. Ultimately, the decision on whether to have a second child depends on you and your partner.

I would suggest seeing your doctor early for a check-up and discussion before making your decision. In the event that you get pregnant, do see an obstetrician early so that the necessary tests and follow-ups can be scheduled for you.

Question by farhanaisa

Hi, I'm 27yrs old and I've been married for about 5mths now. My husband is 35yrs old and we are trying to have a baby. The problem is, I've very irregular period. My last menses was 2 years ago, and prior to that, it was another 2years before. So in total, i've only come menses twice in 4 years. A GP once told me, it was just my hormones but now that i'm married, this matter is becoming a problem for me. Recently i went to a doctor and he gave me NORETHISTERONE TAB 5mg - he said its meant to induce my menses but so far, nothing. Please help as I'm afraid that I'm unable to conceive =(

*farhana*

Answered by Singapore General Hospital

You may be suffering from a condition known as polycystic ovarian syndrome (PCOS) in which the frequency of egg release can be decreased, leading to irregular periods.

Apart from irregular periods, patients with PCOS tend to be overweight, or they may have problems with oily skin, excessive body and facial hair.

Patients with PCOS may find an improvement in the regularity of their periods (and hence their potential to conceive) with simple measures such as dieting, exercise and weight loss.

In severe cases, tablets can be given to assist ovulation. Other factors that can affect fertility, such as your partner’s semen quality may have to be assessed if you are still unable to conceive despite ovulating. Based on the limited information you have provided, I am unable to comment on the cause of your irregular periods without a physical assessment.

I would advise you to visit a gynecologist for an evaluation. The evaluation may include getting a detailed history from you, as well as arranging for blood tests and a pelvic ultrasound. This evaluation is still important even if you decide not to conceive, as irregular and infrequent periods can potentially lead to longer term health issues.

Question by rtan

Hi Doc,

I have been married for a year now and would like to try for a baby soon. However, I have noticed recently that I have been having some abnormal discharge. It wasn't yeast infection and based on the symptoms, I can probably say it's a form of bacteria infection. I have seen doc and described the symptoms to them and was prescribed antibiotic. However the greenish or yellowish discharge still continues although the amount seems to be lessen. I will be going for my pap smear soon to determine the real causes of it. In the mean time, can I still try for baby now? or should I make sure the vaginal infection be cured before I resume the sexual activities with my partner?

Answered by Singapore General Hospital

A gynecological assessment will have to be carried to ascertain the cause of your discharge. Symptoms such as itch, irritation or fishy odour may point to the cause of the discharge.

A PAP smear is primarily a screen for cancer of the cervix although it may occasionally identify the organism responsible for the discharge (particularly for yeast infections, or infections from the organism Trichomonas).

The majority of organisms that cause vaginal discharge in women should not directly affect pregnancy. Some women may have a persistent vaginal bacteria infection (Group B Streptococcus) that may require treatment with antibiotics to prevent transmission to the baby during childbirth.

In rarer cases, persistent vaginal discharge may be a sign of a sexually transmitted infection which may have serious consequences on the developing baby. Depending on the cause of the discharge, your partner may have to be screened and treated if appropriate.

Question by jbhatia

I am 37.5 years old and have one child aged 6 years. I have low blood pressure and am prone to allergies (cold, asthma, skin rash). I really want to have a second child. What are the risks involved and what should I do to improve my chances, as well as reduce any potential risks? Any pre tests to be done?

Answered by Singapore General Hospital

There are actually several issues to be addressed here.

It is generally harder for women to conceive once they are above 35 years old. If they do conceive, they are higher risks of developing complications such as diabetes or high blood pressure during the pregnancy. There is also a higher chance of miscarriage as well as conceiving an abnormal baby, in particular babies with Down Syndrome.

From the symptoms you describe, you are likely to have eczema, which is commonly associated with asthma. Common treatments for eczema such as antihistamines or topical steroids should not have a major impact on pregnancy.

The severity of your asthma needs to be assessed prior to conceiving, as well as on a regular basis throughout your pregnancy. One third of asthmatics may improve their control while pregnant, with another third experiencing no changes and the remaining third experiencing more severe symptoms.

It is preferable that you seek an obstetrician’s assessment and advice early. A referral to a respiratory physician to assess the control your asthma may have to be arranged. The majority of the inhalers used by asthmatics are safe in pregnancy.

Question by rawatamita2000

Hi, myself amy, 29years old and husband 32 years old. my problem is i am trying to concive from last 8 months and i am keeping a check on my ovulation time also but still not able to concive. my cycle is of 36 days. pls. help

Answered by Singapore General Hospital

There are various factors that affect the ability to conceive.

The woman’s ability to release eggs (ovulate) regularly is the first pre-requisite. The egg that is released must then be able to travel down to the womb through healthy Fallopian tubes to be fertilized by healthy spermatozoa produced by the male partner. The fertilized embryo will then have to implant itself into the lining of the womb before a pregnancy ensues.

It is generally advised that in the absence of any problems affecting the above processes, 84% of couples will conceive within one year of unprotected, regular intercourse (2-3x a week). This figure rises to 92% by the end of two years of trying.

Couples who fail to conceive after two years will need further evaluation. The urgency for evaluation would obviously depend also on the woman’s age, as fertility can decline more rapidly after the age of 35.

At your current age of 29, it may be advisable to continue with regular, unprotected intercourse for now and seek medical advice only if you still fail to conceive. Timing intercourse with ovulation can be a stressful experience for couples hoping to conceive and is generally not advised.

Folic acid supplementation (0.4mg per day) is generally advised for women trying to conceive and should be continued for at least 3 months after successfully conceiving.

Question by angneo

Hi, i'm currently 4 months pregnant. And i would like to ask the following questions:

1. Can a Hep B carrier mummy safely breastfeed the baby? Will it affect the baby in any way(s)?
2. Is there anything special to take note for Hep B carrier mummy and baby during pregnancy and delivery?
3. Can the baby's blood be still stored in cord bank if the parents want? Thanks alot.

Answered by Singapore General Hospital

1. Yes. Hepatitis B (Hep B) transmission through breastfeeding was not reported even before the availability of Hep B vaccination.

All babies delivered by Hep B carriers should receive Hep B immunoglobulin at birth and vaccinated within the first 12 hours of birth.

The second dose of vaccine should be given at 1 month of age, with the remaining third dose given at 6 months of age. There is no need to delay breastfeeding until the infant is fully immunized. All mothers who breastfeed should take good care of their nipples to avoid cracking and bleeding.

2. An assessment by a hepatologist (liver specialist) should be arranged. Blood tests should be done to assess the severity of the Hep B infection as well as the likelihood of transmission.

Screening of the immediate members of the family may be arranged due to the infective nature of the disease. During labour, invasive procedures such as fetal blood sampling, should be avoided. At delivery, the baby is given Hep B immunoglobulin and vaccinated to lower the risk of mother-to-child transmission of the disease. Assessment by a paediatrican thereafter may be useful.

3. Donation of cord blood to the public Singapore Cord Blood Bank (SCCB) requires that the donor be free of any infectious diseases. As such, Hep B carriers are generally excluded. Storage of cord blood in private cord blood banks will have to depend on the presence of Hep B antibodies and antigens in the mother’s blood on testing.

In highly contagious cases, the eligibility for storage will have to be determined on a case-by-case basis. It would be helpful for you to consult your doctor and your chosen cord blood bank prior to delivering your baby.

Question by mrssng

My first child was delivered virginally. My second child was delivered by C-Section. I am expecting my third child. I learnt that there is a 0.5% risk of rupture of the wound. In addition I have quite severe stress incontinence. Are those good medical reasons to opt for C-Section? Does repeated vaginal delivery affects the elasticity of this muscle?

Answered by KK Women’s and Children’s Hospital

1. What is the chance of a successful Vaginal Birth After Cesarean (VBAC)?​​

The chance of a successful VBAC resulting in a natural delivery is between 60-70%. This is generally higher for women who have had previous successful vaginal deliveries.

2. ​ What are the advantages of a Vaginal Birth After Cesarean (VBAC) ?

As the chance of a successful vaginal delivery is high in properly selected cases, you are able to avoid a repeat Caesarean section – thus avoiding the associated surgical and anesthetic risks. In addition, it gives you an option to undergo another VBAC in the subsequent pregnancy. However, another vaginal delivery may worsen your vaginal wall elasticity and the stress incontinence.

3. What are the complications associated with VBAC?

The main concern is the risk of uterine rupture or tear.

The incidence of uterine rupture is quoted as 0.5% after 1 previous lower segment Caesarean section, and 4-9% after a previous classical Caesarean section. Even if you have had a successful VBAC in the previous pregnancy, it does not negate the existing risks of uterine rupture in your current pregnancy.

Uterine rupture can be life-threatening for both mother and child. It may need surgical removal of the uterus (hysterectomy). If there is uterine rupture, up to 30% of babies die or suffer permanent brain damage.

If you desire VBAC and your doctor deems you suitable for this, you will be allowed a short trial of labour. If the labour is not progressing as well as expected, or if the baby’s heart beat is worrying, then an emergency Caesarean section will be carried out. In most instances, spontaneous labour is awaited as there are risks associated with an induction of labour

Question by mrssng

I am very sure I do not want to have another child. What are the risks and side effects of ligation?

Answered by KK Women’s and Children’s Hospital

Ligation of the fallopian tubes is a permanent method of contraception and is irreversible. Thus, the decision must be made with great caution and it would be prudent that your husband agrees. The failure rate is 1 in 200 cases and it may lead to ectopic pregnancy (outside the womb) if the method fails. No other health risks with ligation.

Question by wlhor

Hi Doc,

My wife now are 44 and last few days just undergone the misscarriage operation. these were our 3 times.

My wife had loss confident on herself and saying that her body are to weak for pregnant. She did said to me the her menses/period are getting less over the time. Does this sign show that the changes for us to get baby are over and what can we do in order to get baby again.

Could you please advice, what can my wife eat during this few week(After her misscariage operation) to bring back the health?

Answered by KK Women’s and Children’s Hospital

I am sorry that repeated miscarriages had unfortunately occurred. While miscarriages do occur in 25% of all pregnancies, recurrent miscarriages (3 consecutive miscarriages) happen only in 1% of women.

There could be factors predisposing to recurrent miscarriages. These include womb abnormalities (such as fibroids), weak cervix (neck of womb), genetic abnormalities of parents or abnormal antibodies in the blood of the women. It is worthwhile investigating the probable causes as treatment may increases the rate of a successful pregnancy.

No special diet is needed after a miscarriage. Do start folic acid for at least 3 months before trying for next pregnancy.

Question by snz1118

Hi to all,

I am 24 year old and married. I was recently diagnosed to have Polycystic Ovarian Cyst Syndrome. i have not been able to conceive for the past 8 months. I previously have two miscarriage and no kids yet. I would really like to have kids. What should I do now?

Answered by KK Women’s and Children’s Hospital

Polycystic ovarian syndrome (PCOS) is common in 10% of women. Subfertility is a concern for these women as women with PCOS may not ovulate regularly and thus, their pregnancy chances are diminished.

However, there are effective treatment to induce ovulation, such as clomiphene, metformin and even surgery (ovarian drilling procedure).

Thus, do seek a gynaecologist's advice.

Question by kitz

I have just undergone operation due to my miscarriage on 7th May. I was 2mths pregnant then. May I know when is the recommended time for me to try to conceive again? Should there be a time frame to recuperate? I am 34yrs old.Is is possible the body is too "weak" as this has been my 2nd miscarriage? Both miscarriages occurred with spotting and bleeding just after 6 weeks of pregnancy, is this an indication of some illness that compromise my pregnancy?

Answered by KK Women’s and Children’s Hospital

I would advise you to rest for three months before you try for another pregnancy. It is important that you recuperate well physically as well as emotionally from the experience of miscarriage.

Do start folic acid for at least 3 months before trying for next pregnancy.

See a gynaecologist early next time you conceive. The chance of miscarriage increases after the age of 35.

Hormonal treatment does prevent miscarriage in some women.

Question by joyce27

Hi, myself being just over 30, and my husband (33yo) are trying to conceive, but we failed terribly. Sex frequencies are low honestly, but i think we tried hard on the right days. Are fertility assessments the priority, or any ideas how to start troubleshooting? do i go to a usual GP first or head straight to specialised clinics? pls advise. Totally clueless!

Answered by KK Women’s and Children’s Hospital

The majority of couples (90%) conceive after one year of unprotected sex. Most would copulate 2-3 times a week, especially during the fertile week when ovulation occurs.

Do see a gynaecologist if you have been trying for more than a year without any success.

Question by feria83

I have my 1st baby last year June. I tried to conceive after that till now I am still not pregnant. Is not a problem when I conceive my 1st child. My menses have resume 2 months after delivery. Occassionally, I have spotting in between my period. I ever check with Gynae before I conceived my 1st child, they say everything is fine and that may due to ovulation bleeding. I am not sure why I can't conceive after trying for 10 mths. My friend did suggest that taking ovulation pill will help, is that true?

Answered by KK Women’s and Children’s Hospital

If you fail to conceive after one year, you may be suffering from subfertility. This could be due to poor sperm quality or quantity of your husband. It can also be due to womb abnormalities (such as fibroids), fallopian tube blockage or ovulation problem. Do see a gynae to investigate. Ovulation pill is only effective for women who do not ovulate regularly.

​Ref: V10