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Dr Chang T.C.
Obstetrics Antenatal Care
Antenatal appointments will allow Dr Chang to assess your pregnancy and ascertain whether you or your baby are at high risk of complications during pregnancy and at delivery. Dr Chang has been appointed as a Consultant in Maternal Fetal Medicine for the past 24 years and has an interest in looking after patients with high-risk pregnancies:
01
Pregnancies in mothers with advanced maternal age (35 years)
02
History of recurrent miscarriages
03
Patients with history of late pregnancy losses / still-births
04

High-risk pregnancies:

  • high blood pressure / pre-eclampsia / HELLP syndrome
  • gestational diabetes mellitus
  • auto-immune disorders, anti-phospholipid syndrome
  • thyroid disorders
  • maternal infections (eg. toxoplasmosis, cytomegalovirus, rubella)
  • multiple pregnancies (twins / triplets)
  • pregnancies complicated by bleeding - placenta praevia and placental abruption
  • fetal growth restriction / small-for-gestational age fetus
  • premature labour / short cervix
05
Patients on anti-coagulation (blood thinner injections)
06
Patients with ultrasound diagnosed fetal abnormalities or high risk of fetal chromosome abnormalities / genetic syndromes
07
Abnormal or non-informative NIPT results requiring chorionic villus sampling / amniocentesis
08
History of traumatic births / complicated births
09
Patients requiring a carefully-planned birth (eg. Vaginal-birth-after Caesarean, mums with a high risk of birth-related injuries to the mother and / or new-born), Caesarean births in complicated pregnancies
Some F.A.Qs that Dr Chang is often asked about.

Which foods are not safe to eat in pregnancy?

The foods that are not safe to eat are any that come from an unreliable source! If the food is not the temperature it should be ie. hot or cold then don’t eat it. Lukewarm foods are associated with an increased risk of harmful bacteria.

Refrain from eating: - soft or unpasteurized cheeses as they may contain harmful bacteria such as Listeria; cold cut-meats such as Salami; pate as it may contain Listeria; raw meats as they may potentially give you Toxoplasmosis; raw fish such as Sushi may contain parasitic worms; raw or partially cooked eggs as these may give you Salmonella food poisoning; liver or liver products as these contain too much Vitamin A.

Different cultures have foods that they consider unsafe to eat during pregnancy. You have to decide whether that makes sense to you!

Can I fly/travel when Pregnant?

Yes, if you have no medical reason not to, and Dr Chang gives you a letter of consent, then you can fly until 32 weeks gestation. However, if you are planning to climb a mountain or go to an unsafe or unsuitable country for a holiday then I suggest waiting until you are not pregnant. By 30 weeks flying long haul will be very uncomfortable.

Can I still exercise when I am pregnant?

Yes, provided that Dr Chang has not given you a reason not to, such as spotting or cramping etc. Carry on with sports that your body is used to doing, but don’t try and learn a new sport when you are pregnant. Learn to listen to your body, if it hurts stop and rest. If taking Yoga classes for example go to a registered pregnancy instructor. She will know the best way for you to exercise safely for you and your baby.

Is it safe to have a flu injection when I am pregnant?

According to the CDC (Centre for Disease Control) seasonal flu injections are safe to give women in pregnancy. They don’t cause any pregnancy complications or adverse fetal outcomes. The pertussis (whooping cough) vaccination is recommended at 28-32 weeks of pregnancy.

Can I dye my hair while I am pregnant?

The chemical formulas for hair dyes are constantly changing and are not evaluated for effects during pregnancy. When having a one off hair dye the skin would absorb minimal amounts of the hair dye. However ammonia fumes may be unpleasant. Therefore it is thought better to wait until you are not longer pregnant to have your hair dyed.

How much weight should I gain during my pregnancy?

The average weight gain expected throughout your entire pregnancy is 10-12kg (22-27pounds). However, it will also depend on the weight you start at.

How can I cope with the symptoms of pregnancy such as nausea, vomiting, heartburn, leg cramps and haemorrhoids?

The best way to reduce nausea is to keep your stomach lined with dry crackers. Carry some in your handbag to nibble on all day long and drink plenty of water if you can. Moving slowly first thing in the morning and staying out of the heat can help as well.

If you are vomiting excessively and are unable to keep water down you may be getting dehydrated and need to see Dr Chang. There are tablets to reduce the nausea and occasionally 24 hours in hospital on an intravenous infusion will break the cycle of vomiting and make you feel better.

Both heartburn (acid reflux) and indigestion are common in pregnancy and tend to become more so as the pregnancy progresses. By the third trimester nearly three quarters of pregnant women will suffer from heartburn.  This happens because the surge in the hormone progesterone causes muscles to relax; This includes the sphincter (ring of muscle) at the entrance to the stomach. When this relaxes, stomach acids are able to travel back up into the oesophagus (food pipe) causing heartburn. During the latter stages of pregnancy the baby physically putting pressure on your digestive tract can also cause symptoms. Not eating fatty or sugary foods and sitting upright after food will help. Taking Gaviscon liquid preparation as needed may also offer relief.

Leg cramps seem worse at night and can be relieved by doing leg-stretching exercises before getting into bed and during the attack.

The most effective way to prevent haemorrhoids is to avoid constipation. Eat high fibre foods, drink plenty of water, do your Kegel’s exercises and avoid sitting for long periods during the day. However, if you have haemorrhoids then try ice packs for relief. Dr Chang can also prescribe a cream that is effective.

When should I ring the clinic for help in between my regular appointments?

If you have any symptoms that you feel are not normal for pregnancy or make you feel anxious or unwell then you should ring the clinic for advice immediately. For example:-

Abdominal pains or cramping: Reduced foetal movements after 28 weeks or a change in the baby’s regular pattern of movements: Shortness of breath or difficulty breathing: Fresh Bleeding in the 2nd and 3rd Trimesters: Signs of premature labour such as leak of liquid or regular cramping: Chest pain: Fainting or dizziness: Excessive Diarrhoea and Vomiting: Blurred vision or seeing spots before your eyes: Severe headaches: Severe swelling of hands and feet.

When can I feel my baby moving?

The first time you feel your baby moving inside you is called ‘quickening’ and is usually around 20 weeks gestation. These first movements might feel like butterflies’ or bubbles inside your uterus. With subsequent pregnancies mothers find they feel movements earlier than during their first pregnancy.

What is it like in the womb?

Thanks to ultrasound and other high-tech tools allowing a peek inside the womb, scientists have discovered a virtual sensory playground in which your baby is living. The fetus responds to your voice and other sounds in the room, reacts to light and dark shadows as you move from place to place, tumbles as you switch positions, even tastes sweet or spicy foods you've just eaten.

When should we start our Antenatal Classes?

Classes that prepare couples for labour, birth and parenthood usually start at 30 weeks and run for 5 weeks. The aim is to make sure everyone is prepared by 37 weeks when your baby is ready to come into the world, (even though your EDD is for 40 weeks) and if born at 37 weeks is not considered premature.

Mother & Child Centre in Tanglin Shopping Mall (small groups of 8 couples in each class), ‘Parentcraft’ classes at Thomson Medical Centre and Mrs Wong Boh Boi’s birth preparation classes all offer a wide range of classes but it is best to book early as they get very full. Hypnobirthing classes are also available at the Mother and Child Centre and at TMC.

Why shouldn’t I read things on the Internet?

Once you have read, seen or heard something to do with Pregnancy, Labour or Birth it is impossible to forget it. Don’t let your friends tell you their horror-labour and birth stories while you are preparing for labour yourself. If you want information go to a good Pregnancy Text Book. Surround yourself with only POSITIVE birth stories as preparation.

Who can come into the delivery room with me during labour?

Generally in Singapore only your husband/partner is allowed with you in the delivery room on the labour ward in hospitals. However, TMC also allows you to have a Doula with you if you want to have one, but they must be registered with the Nursing Officer on the Labour Ward. Dr Chang has worked with Doulas assisting in the births at Thomson Medical Centre for the past 24 years.

When should I come into hospital if I think I am in Labour?

As everyone lives about 30+ minutes away from TMC in Singapore it shouldn’t take too long to get here except for during rush hour and in the rain! When you are in labour having had regular contractions about 5 minutes apart for a while then you might come into TMC. You go straight to the Labour Ward on the 2nd floor where you will be assessed. Unlike the UK for example, here you can stay in hospital even if you are only 1cm dilated as long as you are having regular contractions.

What is Normal Labour?

Labour is the process where there are regular intense contractions with progressive thinning and dilatation of the cervix (opening of the uterus/womb). It is an attempt at delivering your baby/babies through the mother’s vagina (birth canal).

Dr Chang fully supports natural childbirth whenever possible.

What is a Caesarean Section?

A Caesarean Section is a surgical procedure to deliver your baby through a cut in your lower abdomen and the uterus (womb). It is usually done under a regional (spinal) anaesthesia where the lower part of the body is numbed and you stay awake during the operation to see the birth of your baby. The alternative is by general anaesthesia when you are put to sleep (not likely, unless your baby is unwell and needs to be delivered within minutes.)

After having a Caesarean Section, the risk of having one in the next pregnancy increases significantly.

What is VBAC?

Vaginal birth after Caesarean Section (VBAC) is a procedure whereby an attempt is made under medical supervision to achieve a vaginal delivery in a patient where there has been a history of a Caesarean Section. The other option to having a VBAC is to have an elective Caesarean Section. Individually assessed, the overall success rate of a VBAC is usually 50%-80%.

The two main risks of VBAC are the risk of uterine rupture during the VBAC and the risk of an emergency Caesarean Section.

What is Labour Epidural Analgesia?

Epidural Analgesia (EA) and combined spinal-epidural (CSE) analgesia are the most effective methods of pain relief in labour. For Epidural analgesia, an injection is performed at the lower part of your back to locate the epidural space and a very thin tube, or catheter, is inserted near the nerves of your spine. Pain medications, in the form of local anaesthetics with or without opioids, are administered through this epidural catheter via intermittent injections, or via an automated continuous pump. Combined spinal-epidural analgesia is similar, except that an initial medication of local anaesthetic and/or opioid is given for pain relief into the spinal space. CSE is usually employed for elective Caesarean section.

The onset of pain relief generally takes 20 -30 minutes after the epidural has gone in although faster with CSE.

Who cannot have an Epidural?

An Epidural may not be suitable if you have had previous back surgery, deformity and/or abnormality of the spine or problems with blood clotting.

Does the Epidural slow down labour?

Epidural analgesia gives you almost complete pain relief allowing your body to relax and get on with labour. It does not slow down the dilatation of your cervix. However, with reduced sensation in your cervix, vagina & rectum you may not be able to feel your contractions. This may in turn slow the baby’s descent down the birth path and increase pushing-timeduring the 2nd stage of labour.

Will the Epidural harm my baby?

The effects of an Epidural analgesia on the newborn baby are minimal. The effects depend largely on the dosage of an epidural, length of the labour and individual characteristics of the baby. There is some evidence to suggest that the baby may have difficulty ‘latching on’ during breastfeeding if the labour is lengthy.

Can I have a water birth?

Yes, Dr Chang you may wish to discuss your strong desire to have a water birth if there are no contra-indications to it in your pregnancy. However during the Covid-19 pandemic, Thomson Medical Centre is presently temporarily not conducting water births. Patients may still use the bath tub for water-assisted labour. Two rooms in TMC (Rooms 6 and 15) may be used for water-assisted labours.

Will Dr Chang do an Episiotomy?

An Episiotomy is a surgical cut/incision made in the opening of the vagina/perineum during childbirth, to aid a difficult delivery and prevent rupture of the tissues. Dr Chang doesn’t do routine episiotomies. Each birth is evaluated individually.

When delivering your baby, there may be commonly tears in the vagina, vulva and anus. These tears will need to be stitched and may be painful. Serious tears increase the risk of faecal or urinary incontinence. Such tears may be minimized if you perform regular perineal massage from about 36 weeks onwards.

When does Dr Chang use Forceps and Vacuum?

The need for instrumental assistance with forceps or vacuum in the second stage of labour is done if: - The foetal heart rate drops and the baby needs to make a quick exit: or if there is failure to progress after a prolonged 2nd stage and maternal exhaustion. Every vacuum / forceps attempt is a trial; occasionally (<10% of cases) the trial is unsuccessful thereby requiring a birth by emergency Caesarean delivery.

The choice of instrument is largely dependent on the characteristics of the labour so Dr Chang will make the choice.

On the hospital tour they said the babies all go into the Nursery can my baby stay with me instead?

Yes of course he/she can. It is called ‘Rooming-in’. Your baby can stay with you all the time if there are no neonatal complications. But if you need to you can also put your baby into the nursery for a short while.

Will Dr Chang be delivering my Baby?

Dr Chang makes it to >95% of births – when he misses a birth, it is usually when the mother-to-be has a strong urge and delivers within minutes of arriving at TMC. If Dr Chang is on leave, he will arrange for one of his colleagues (Dr Paul Tseng, Dr Benjamin Tham, Dr WK Tan, Dr Jasmine Mohd, Dr Ong Xiao Hui) to look after you when you are in labour. You will be given ample warning and will get an opportunity to meet the covering doctor during your antenatal checks.

Do you offer ‘Meet & Greet’ appointments?

Dr Chang doesn’t do ‘Meet and Greet’ but is happy to see you for a routine antenatal check up where you and your partner can ask questions about your pregnancy, impending labour and childbirth. You may wish to ask questions before your first antenatal appointment, can call: