Antenatal Exercise (孕妇运动)

Exercise is important during pregnancy to promote physical and emotional wellbeing.
Regular exercise will improve blood circulation through the placenta and promote growth of the baby.
However, the pregnant ladies need to follow the safety guidelines to avoid unneccessary physical injury related to exercise.


Guidelines to ensure safety and well-being during pregnancy with your exercise program


Things To Do's



1) If you have been following a regular exercises program before your pregnancy, maintain that program to some degree throughout your pregnancy.

2) Exercises does not increase your risk for miscarriage

3) If you are a beginner, you should start very slowly and be careful not to over exert yourself.

4) Listen to your body signal for the level of exercises performed - the competitive element must be avoided.

5) Regular exercises sessions - at least 3 times per week - are safer than intermittent bursts of activity

6) Careful 'warm - up' should precede vigorous exercises which must be followed by -cooling-down' or gradual decline in activity.


7) Drink plenty of water and take frequent break.


8) Eat healthy diet that includes plenty of fruits, vegetables and complex carbohydrates.




Things To Avoid


1) Avoid jerky, bouncing, ballistic movement and activities.

2) Never exercises to the point of exhaustion or breathlessness. This is a sign of your body and your baby cannot get the oxygen supply needed.

3) Avoid exercise in extremely hot weather. Mother heart rate should not exceed 140 beats per minute and vigorous exercises should not be longer than 15 minutes.

4) Avoid rocky terrain or unstable ground when running or cycling.

5) Avoid contact sport (hockey, netball, volleyball).

6) Avoid lifting weights above your head and using weights that strain the lower back muscles.

7) Do not over bend any joints.

8) Stop exercises immediately if you experiences symptoms such as: chest pain, vaginal bleeding or uterine contraction, or if your membrane rupture, blurred vision, dizziness, fainting, irregular heart beats, increase swelling in your hand, feet and ankles, and Sudden change in body temperature.

9) During second and third trimesters, avoid exercises that involve lying flat on your back as this decreases blood flow to your womb.

Weight Gain (懷孕體重增加)

Overweight during pregnancy is a common problem.

Modern mothers are very critical about their body weight during the pregnancy period because they want to maintain slimmed body after delivery.

In order to avoid unneccessary overweight problem, it is important to control your body weight during the pregnancy and confinement period.

What is the normal weight gain during pregnancy?

The normal range of weight gain during pregnancy is between 10 to 15 kg.

Averagely, you should gain around 12.5 kg in weight.
It means your weight gain is about 1 kg every month.

I am already overweight before pregnancy. How much weight should I gain during pregnancy?

If your BMI (body mass index) is more than 24 before the pregnancy, your ideal weight gain during pregnancy is 10 kg.

I am underweight before pregnancy. How much weight should I gain during pregnancy?

If your BMI is less than 20 before the pregnancy, your ideal weight gain during pregnancy is 15 kg.

Why the doctor take 12.5kg as normal weight gain?

Generally, the baby birth weight is around 3kg. The total weight of the placenta(胎盤)and the water bag (羊水)is about 2.5 kg. After the delivery, 5.5kg will be immediately disappeared.
The remaining 7 kg is the weight of the fat deposited in the breast, buttock and water retention in the limbs. It takes 2 weeks for the water retention to resolve.

I am overweight during the pregnancy period, What should I do?

Of course you can’t attend a slimming programme during the pregnancy : )
You should control your weight through the food intake.
You should reduce the carbohydrate foods which supply calories to your body ( rice, white bread, noodle, sugar, meehoon).
During pregnancy period, your physical activity is limited. Therefore, you don’t need to consume too much of carbohydrate. Excess calories intake will be converted into fat in your body.
You should emphasize on high protein food, vegetables and fruits which supply vitamin and nutrition for the baby.

Reply to Claire

Claire said:

Dr. I have been breast feeding my child for one year so now planning to stop it, and what is the formula that is more recommended and better.

I listen from some body that the Soy based milk is the better choice 2nd from breast milk is it true?

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Hi! Claire,

First of all, congratulation for successfully breastfed your beloved baby for 1 year. It is not easy to breastfeed your baby for 1 year, particularly for a working mother. Your sacrifice and determination is admired by me!

Since your baby is already 1 year old, I believe his/her is already started on weaning diet. You need to provide a balanced and nutritious food in his weaning diet, eg: meat, fish, carrot, porridge, cereals and fruit juice.

Formula milk at this stage is not too important as the baby can source his vitamin from the weaning diet. Formula milk is just a supplement to his weaning diet, and not the other way round. The priority of his vitamin intake should come from the weaning food. I hope you understand my point here.

Soy based milk is not superior than the formula cow milk. In fact, the formula cow milk contains more protein ingredient than the soy milk. Protein is important at this stage to promote growth and development for your baby.

But if your baby has cow milk allergy, then soy milk is better than formula cow milk.

Cheers and Happy Motherhood.

Reply To Jess

Jess said :

dear Doctor,

I have a strong positive line of my urine test but no sac being found from the ultrasound scanning this morning.Would it be too early to detect the sac.My last menses is on 25/07/09 and provided that i have an irregular menses cycle for where it can be delayed about two weeks times. so it's hard for me to tell exactly when is my last ovulation date.

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Hi! Jess,

We are dealing with a few possibilities here:

1) Based on your Last Menses Date of 25/7/2009, currently you are pregnant at 7 weeks gestation. The pregnancy sac should be seen by ultrasound at this stage of pregnancy.However, due to your irregular menses cycle, your pregnancy may be delayed due to delay in ovulation.It means you may be pregnant at the very beginning stage. The pregnancy sac is difficult to detect by ultrasound if it is less than 6 weeks.

2) You may have a failed pregnancy where the sac fails to develop. As a result, it was not seen by the scan. Miscarriage is a common problem during early stage of pregnancy. 10% to 20% of the women actually suffer from miscarriage during early stage of pregnancy.

3) If the sac is not located inside the uterus, then it may be located at the outside the uterus. We call this condition ectopic pregnancy.

Pregnancy sac in Fallopian tube

So.. Jess, how to know you belong to which possibility ?

1) In a normal pregnancy, the symptoms of pregnancy will appear by now. Among the symptoms of pregnancy are vomiting, dizziness, breast pain and lost of appetize.If your pregnancy is a failed pregnancy, this symptoms will not appear.



2) If this pregnancy is an ectopic pregnancy, usually you will suffer from abdominal pain and bleeding from vagina.


What should you do now ?


Well, you have a few options in this situation:

1) Wait for 1 week and repeat the scan after 1 week. If your pregnancy is healthy and located inside the uterus, you should able to see it after 1 week.

2) If your are very worried and you want to know the answer now, the doctor can perform a vaginal scan which produce a clearer image. In vaginal scan, the sac can be seen as early as 5 weeks pregnancy.




3) Blood test to measure the pregnancy hormone level (beta HCG). This test is useful to early diagnose ectopic pregnancy.



Anyway, I wish you best luck in your subsequent follow up with your doctor.



Cheers!

Preparation for Breastfeeding (餵母乳計劃)

Breast milk is always better than formula milk to provide best nutrition to your baby.
Nowadays, breastfeeding is a popular option among the new mothers because they realise that breast milk is the best food for their newborn babies.
In order to succeed in breast feeding, you need to prepare yourself before the delivery.


The things you need to do before the delivery:

1) Maintain nutritious diet for yourself.

You need to take high calcium food such as milk, yogurt, cheese and meat.
During breastfeeding, your body need to supply enough calcium in the breast milk.
Protein from fish and seafood products is also very important to supply omega oil (DHA) in the breast milk.
Remember to drink plenty of water during breastfeeding.



2) Avoid taking unneccessary medicine and alcohol during breastfeeding.



3) Check your breasts before the delivery.

Some women may have an inverted nipples(乳頭凹進). They need an artificial nipples(人造乳頭) to help them in breast feeding.

The artificial nipple for breastfeeding

4) Breast Massage

Breast massage should be done 1 month before the delivery to help milk production and nipples distension.

The direction of breast massage. Do it 15 min everyday.

Things you need to buy before delivery.

1) A breast supporting bra to support the heavy and engorged breast.

Remember, always buy a bigger size bra as the breast is usually enlarged during breastfeeding.

2) Nipple pad to prevent leaking of breast milk.

Nipple pads

3) Breast pump maybe helpful to reduce breast engorgement.

Breast pump

Reply to Fion

Fion said :

Some of the peoples say you can only deliver the next baby at least after 2 or 3 years. Is it true?

Yes, it is true. The ideal birth spacing is 2 years. You need 2 years to fully recover from the lost of calcium and vitamin from your body due to pregnancy.

The rule of 2 years is not applied to caesarean delivery only. For those with normal delivery, you still need to wait for 2 years to fully recover.

A poor birth spacing is harmful to your health as the risk of osteoporosis (brittle bone) is higher in the later stage of life.

And some also say a women can only deliver 3 babies with Caesarean Delivery. Is it true?

It is partially true.

Common caesarean surgical site

The doctor usually advise you to limit to 3 caesarean deliveries because the complication for the subsequent 4th caesarean delivery is usually much higher.

For every caesarean, the doctor needs to operate on the same location.

During the wound recovery, the bladder or bowel may stuck to the wound. This will cause the subsequent surgery more risky and difficult as the chance of bladder injury or bowel injury during the subsequent caesarean is much higher.

However, if you insist to continue for the 4th caesarean delivery, most of the time the doctor will allow you to do so, but during the 4th caesarean operation, the doctor must be extra careful to avoid any complication.

If my first baby is delivered by Caesarean Delivery, can I deliver my second baby though normal delivery?

Of course you still can go for normal delivery after a caesarean delivery. However, the success rate for normal delivery after a caesarean delivery is only 60 to 70%.

It means out of 10 women who had a caesarean delivery before, only 6 to 7 of them will succeed in normal delivery.

For those who required caesarean delivery because the labour door refused to open, the chance for a successful normal delivery in the subsequent pregnancy is much lower.

Common Reasons for Caesarean Delivery (剖腹生產)

It is estimated that 20% of the pregnant women in Malaysia deliver their babies by caesarean delivery.
In the developed contries, the caesarean delivery rate is even higher. In United State, the caesarean delivery rate is estimated at 40%.

As more pregnant women require caesearean delivery, it is important to know the common reasons for caesarean delivery.


The List of common reasons for Caesarean Delivery:


1)Slow progress in labour because the labour door was not opening.

The baby maybe too big to go through the birth tunnel, or the birth tunnel is just too narrow for the baby.

The baby head diameter is bigger than pelvic bone diameter

2)The baby’s heartbeat slow down during the labour process



During the labour process, the baby's heartbeat is constantly monitored by a machine. Sometimes, the baby's heartbeat could slow down during the labour process because of cord compression.
Prolonged slowdown in heartbeat could harm the baby because of lack of oxygen supply to the baby.


3)Abnormal baby sitting position

The buttock is sitting at the bottom

The baby is in tranverse position

4) Placenta location is too near to the labour door

Diagram on the Left : Normal placental location

Diagram on the Right : The placenta covers the labour door.

5) Bleeding from the placenta

Bleeding from the placenta is an emergency and the baby must be delivered as soon as possible.


6) Multiple pregnancy

twin pregnancy