The idea of drug-free birth
In the older days, the low-risk pregnancy and child birth were handled by midwives to give birth naturally while the higher-risk mothers were handled by gynaecologists who were trained to perform surgical procedures like caeserian section. However, in the recent decades, the default route of a childbirth is to engage a gynae. As a result, the rate of medical induction, pain-relief and csect increased, but mostly unnecessarily.
In fact, drug-assisted birth has become such a norm now that many people see epidural as the default way to manage labour pain. Most people would advise "Do you have high pain tolerance? If not you should take the epidural early". Personally, I do not see myself as having a high pain tolerance, but I was more inclined to options that help to tap on the body's natural pain management mechanism instead of medical means.
The Birth Team
- Doula: Dewi Chen - I used to attend her yoga class 2 years ago, when she was pregnant. She has a warm personality and makes everyone feel comfortable as they are. She later opened her own Yoga studio and she also became a doula and I attended the open house. I thought we had a nice affinity so I engaged her as my doula.
- Gynae: Dr Paul Tseng - I had my first appointment with him on 32w. I chose him as he was known to be pro-natural, doula-friendly and does not perform epsiotomy. My doula also said that Dr Tseng is not just pro-natural, he is also pro-mother in that he would respect mother’s birth preferences as much as it is possible.
- Hospital: Mount Elizabeth Novena - Dr Tseng delivers at either TMC or MENH. I went for the maternity tour of both hospital and MENH was clearly better furnished and felt more like a hotel than hospital. The price was slightly higher than the equivalent room at TMC. I also later found out that MENH is a baby-friendly hospital, while TMC is not. Baby-friendly certified hospitals promotes skin-to-skin after birth, and avoids teats/pacifiers for breastfeeding babies.
*How to engage a doula?
You can choose a doula from the list of registered doulas in Singapore from this page. You can contact them directly without going through an agent. Some doulas have specialties like massage, yoga, hypnobirthing etc. You can choose one that matches your needs and preferences. There are also options of engaging a trainee doula at a lower cost.
Birth Preferences
- No epidural unless medically necessary - I'm hoping to tap into the body's natrual pain management mechanism without drugs, because I think it's possible. Unless there's a strong medical reason to perform an intervention such as the event of fetal distress and there may be a need for csec.
- No medical induction - I read that doing an induction increases the chance that you will take on the pain-relief intervention, because your body loses control of what is happening. Hence as much as possible I wish to try to get the baby into position by exercises instead of medical means. This also mean that I prefer my waters to break spontaneously instead of medically.
- Minimal invasive procedures, such as checking for dilation, catheter and enema - Anything invasive will cause stress to me, and may hinder my mind-body connect to manage the birth process naturally. Moreover, knowing the status of dilation does not help with progress anyway, it just causes more stress if things are progressing slower than you wish. Many people did not know that they could turn down such procedures!
- No epsiotomy - Some people believes that cutting the perineum would prevent severe tears and easier to stitch back up due to the straight controlled cut. That belief may not be wrong, but I choose to attempt to manage the tearing with more controlled pushing and hypnobirthing breathing techniques. One of the reasons I chose Dr Paul Tseng as my gynae is that he does not perform epsiotomy. Some gynaes does it as a routine, which I find it unnecessary.
- Intermittent fetal monitoring - I did not want to be tied up to the bed because I wanted to be able to move around and do exercises on the gym ball. There is no reason for me (or the nurses) to know the baby's heart rate or contraction level all the time.
- Immediate skin-to-skin after birth - I do believe in the golden hour of skin-to-skin with the baby for bonding. The weighing of the baby and the tests can wait.
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| My doula made this visual birth plan for communication with hospital staff |
The Birth Day
Instead, we ordered KFC breakfast delivery. The pain was more manageable when I was sitting up instead of lying down, but it was still waves of more intense pain every 10 minutes or so. I had my breakfast in between the pain waves, while my doula start to make her way to my home. I was expecting a parcel delivery on that day scheduled on 10am-6pm. I texted the driver to ask if my parcel could be delivered earlier as I may be going on labour then nobody is at home. The driver was kind enough to prioritize my parcel and delivered at 10:30am!
My doula arrived at my home at about 11:40am. She did a few exercises with me, including the Side Lying Release, Walchers, Shake the Apple Tree, hip squeeze, and a few exercises on the peanut ball. She said that my uterus was still tilted towards the back and the baby is still stuck on the pelvin brim, hence I felt back labour pain instead of front contractions. She was trying to disengage the baby and tilt the uterus forward so that labour could start.
By the time my contractions became once every ~4 min, I took a warm shower before making our way to the hospital. We reached the hospital at around 2pm. I was taken to the delivery suite directly, and met Dr Tseng along the way as he was doing another delivery next door! He came in to do a check on me - I was 3cm dilated and baby was still in -3 station (This mean that the baby had 6 stations to go, from -3 to +3, you can read about how labour progresses here). The check was so painful, so was the contraction that came right after! I had a good cry after that contraction till the next wave. My doula asked me to not cry to save energy for pushing later, but my husband explained that crying is my way of relieving major stress. True enough I felt a lot better after crying.
I was stuck on the bed for about 40 minutes for the baseline monitoring right after admission to check fetal heartbeat and contractions. Meantime my doula helped me with the contractions by pressing into my knees. My husband went to get lunch for himself and Popeyes mash potato for me. Once the baseline monitoring was done, I was free to get out of the bed. We proceeded to the birth ball (provided by the hospital!).
My doula hooked up a long scarf on the bathroom door and I was to sit on the birth ball and pull on the scarf while pushing on the door with my legs during the contraction wave. Sometimes, she would press on my back while I'm pushing backwards. This was repeated several times and was quite effective. Between the contractions, I eat the mash potato for comfort.
As I opted to go without catheter and enema, I had go to the bathroom even though I did not really have the urge. I stayed in the bathroom long enough that eventually the nurse and doula forced me to come out. Apparently my water bag has broken into the toilet unknowingly, and i had been pushing the baby down quite a bit in the toilet. The nurse later said that if I continued to push in toilet for another 15 min or so the baby’s head might have been in the toilet bowl!
I was made to lie on the bed to put on the fetal monitoring, but I could only manage lying on my side. The nurses still managed to hook up the fetal monitoring and stopped me from pushing as doctor is not here yet. Meantime they did perineal massage to help reduce tearing. The doula helped me with the breathing through the contractions.
When the doctor was finally here, the pain had taken over my brain and i started blabbering nonsensical questions. I asked the doctor what were he doing before coming to me, and he eventually told me he was next door after some persistent questioning from me (I'm usually not like that). I did a few pushes lying on my side, and then on my back, then the baby was born at 6:08pm. As I requested for immediate skin-to-skin, I was breastfeeding once the baby was born while delivering the placenta.
Finally, the doctor checked for tears and did 3 stitches for me. It was painful and I almost kicked the doctor. I had to request for someone to hold my legs in place to prevent myself from kicking the doctor while he was stitching me up. Luckily it was over quite soon.
That sums up my rather uneventful birth - the way I wished it to be. I felt very fortunate that I managed to go through the whole birth as described in my Birth Preferences. Not only did I not need the epidural, I did not take the laughing gas or intra-muscular injection as well. There were no induction, and baby went from 3cm dilation and -3 position to birth in about 4 hours. I only had the check for dilation once throughout the whole birth.
Preparatory works that helped me (on hindsight):
- Side Lying Release
- Rebozo Sifting
- Shake The Apple Tree
- Forward Leaning Inversion (Good for turning a breech baby)
- Clamshell with ball between thighs and calves - With toes pointing inwards, squeeze the ball at thighs and calves.
- Back traction against wall - partner to pull hips backwards while you lean on the wall
- Double hip squeeze - parter to press on thigh bones while you lean on the wall
When I was about 3 months pregnant, I slipped and fell on my back, and I had been suffering from back pain throughout the rest of the pregnancy, eventually getting worse in the last few weeks. I started seeing a pregnancy chiropractor in my third trimester and found that my pelvics was out of alignment which was due to poor posture and possibly worsened due to the fall. I was advised to sit on gym ball instead of normal chairs so as to achieve more active posture. Getting my alignment adjusted probably did help in getting the baby into a better position for smoother birth.
I attended prenatal yoga classes intermittently. Did not manage to attend regular classes because work was very hectic during the pregnancy. Instead, I try to squeeze in ~10 min yoga sessions just before I sleep whenever I can. This is one of the tracks I enjoyed the most: https://www.youtube.com/watch?v=4NwQKXpWN_A. My doula package also included 3 prenatal yoga sessions, but I only managed to utilize 2 sessions as I gave birth earlier than expected.
Many people recommended doing the Kegels exercise during pregnancy. I attempted during some of the trial prenatal yoga classes but I never got the hang of it and it was quite uncomfortable for me in terms of breathing. I did not continue to do it.
I also listened to hypnobirthing tracks and meditation whenever I can (link below with the Mindful Hypnobirthing book). It helped me to manage the anxiety about childbirth and remain positive despite stories of mostly difficult childbirth that we hear more often than not.
Most importantly, having a very supportive partner throughout the pregnancy helped the greatest deal. Emotional support is important, to help you be in the correct state of mind despite the challenges in pregnancy. I was going through a bit of depression in my first trimester due to the morning sickness concurrent with high work stress. I received some help from the NUH WEHS where I got to rant my frustration without judgement and interruption. I recommend pregnant women who are undergoing difficult emotional periods to seek help from WEHS.
List of books that influenced my pregnancy and birth approach:
Most of the books were borrowed from NLB ebooks for free, except for the Mindful Hypnobirthing book which I purchased from iTunes. These books were ranked roughly in order of influence to my birth approach. I did most of my readings during my hour-long commute to work and another hour back home. | Common Sense Pregnancy by Jeanne Faulkner - Navigating a Healthy Pregnancy and Birth for Mother and Baby |
 | Mindful Hypnobirthing by Sophie Fletcher - Hypnosis and Mindfulness Techniques for a Calm and Confident Birth Hypnobirthing tracks (free download): https://www.penguin.co.uk/articles/2016/mindful-hypnobirthing/ |
 | Natural Childbirth the Bradley Way by Susan McCutcheon |
 | The Doula Advantage by Rachel Gurevich - Your Complete Guide to Having an Empowered and Positive Birth with the Help of a Professional Childbirth Assistant |
 | The Doula Guide to Birth by Ananda Lowe - Secrets Every Pregnant Woman Should Know |
 | Your Best Birth by Ricki Lake - Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience |
 | Pregnancy, Childbirth, and the Newborn by Penny Simkin - The Complete Guide |
 | The Fourth Trimester by Kimberly Ann Johnson - A Postpartum Guide to Healing Your Body, Balancing Your Emotions, and Restoring Your Vitality |
I also recommend the Spinning Babies website which is filled with many informative materials on baby positions, techniques to prepare for birth and labour progress.
Finance Matters
The drawback was that I see random doctors every visit so there were not so much patient-doctor attachment, and there were only 3 scans throughout the whole pregnancy, one in each trimester - First Trimester Scan, Fetal Anomaly Scan and Growth Scan. So I don’t get to get the baby scan pictures or get updated on the baby’s weight and position as regularly as the private patients. Need to live with some uncertainty there.
From 32w onwards, I began spending a lot of money on the pregnancy, as I started to go on private gynae visits (no package), engage a doula, go for chiropractic sessions, and also doing some last minute shopping for baby and postpartum needs.
The hospital bill added up to be around $10+k including hospital fee, gynae delivery fee (inclusive of pre-payment), pediatrician fees and the newborn tests. We opted to pay fully in cash by credit card without Medisave, and we did not claim the $900 Medisave for antenatal visits too. Apparently this is not a popular choice, and we had to fill a form to acknowledge the non-usage of Medisave too.
The reason for opting not to use Medisave is so that when you max out the Medisave limit of $57.2K, any excess contribution will flow towards your Special Account and become withdrawable at 55 years old. Hence if you have enough cash, you don't need to touch Medisave to enjoy the overflow to SA at high interest and early withdrawal. CPF hack!
Concluding Words
Now that I have delivered the baby, the entire journey of pregnancy still felt like a dream and I couldn't believe it was over. My pregnancy tracking app is still counting down to my EDD. I guess you can never be fully prepared. It is now a whole new world of dealing with a newborn!
As you may see I had made some unconventional choices, there were a lot of uncertainty that I faced too throughout the pregnancy too, and I wasn't sure what would work out, hence the above recommendations could only be made on hindsight when everything works out for me.
One small tip I would give to mums-to-be who are making unconventional choices is to avoid too much discussion with your peers especially when you are still unsure of what you really want (which can be throughout the whole pregnancy!). There are many well-intention advices out there, many of which contradicts each other, and not all would align with your personal beliefs and preferences. It can be tiring to explain, and you may start to doubt yourself when everyone tells you to do something different from what you think is right. Know your options and make your choices on your own, then it is a good decision.
One small tip I would give to mums-to-be who are making unconventional choices is to avoid too much discussion with your peers especially when you are still unsure of what you really want (which can be throughout the whole pregnancy!). There are many well-intention advices out there, many of which contradicts each other, and not all would align with your personal beliefs and preferences. It can be tiring to explain, and you may start to doubt yourself when everyone tells you to do something different from what you think is right. Know your options and make your choices on your own, then it is a good decision.
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