| 7.5°C Dublin

Pregnancy and childbirth questions: The obstetrician answers

Whether you're thinking of having a baby or are already pregnant, there are probably a million questions swirling around in your head, often about fertility, labour and pain relief.

Consultant obstetrician and gynaecologist Dr Andrea Nugent of Mount Carmel Hospital offers some answers.

During my pregnancy, what role does the obstetrician perform? Does he/ she need to be there for the birth?

An obstetrician is a medical doctor who specialises in the care of a woman during her pregnancy, for the delivery and in the post-natal period.

Depending on where you seek care, he/she will see you at your first visit and assess for any potential problems during the pregnancy.

If you are ' low risk', you may opt for midwifery-led antenatal care or care that is shared between the hospital and your GP.

If you are choosing private care or are classified as a ' high risk pregnancy', the obstetrician may see you for each subsequent visit.

Most pregnancies progress without problems; however, it has long been shown that by observing you within the setting of antenatal care, we can prevent or diagnose problems that cause bad outcomes such as preeclampsia or gestational diabetes.

The presence of an obstetrician at your delivery is also dependant on the type of care you choose and how the delivery is progressing.

If there are signs of distress an obstetrician will be informed and may need to perform an instrumental vaginal delivery or Caesarean section.

In private care, the obstetrician will make every endeavour to be present at normal deliveries as well for your reassurance.

I am 32 and don't want to have children for three to four years. My husband is worried I'm leaving it too long. Is he right and is there a way to check my fertility to make sure I'm not leaving it too late?

Women are the most fertile in the 20–30 year age bracket. As we age, our eggs (our half of the baby) age with us, this presents a problem for fertility after age 35.

A large, well-designed study reported the probability of women conceiving for one cycle one time to be 50pc between ages 19–26 years, 40pc at ages 27–34 years, and only 30pc if the male was the same age over age 35 (Dunson & Baird, Human Reproduction 2002).

After age 40 years, the rate of spontaneous pregnancy drops more dramatically from 30pc to 10pc by age 42 years.

It is difficult as we advance in careers to time pregnancy right. Although maternity leave time has improved from even 10 years ago, the effect of taking it in some careers can be detrimental.

Deciding on timing is important as fertility does not last our lifetime. This is protective in a way as women over 35 also have increased rates of abnormalities and complications.

My advice would be not to leave it too long as we have no perfect test to predict fertility at present.

I've just found out I'm pregnant but I have a deep fear – some might say phobia – about the thoughts of going into labour. Is it possible to have an elective Caesarean?

This is something you must discuss with your obstetrician/gynaecologist and/or midwife.

Caesarean sections are not without their own very serious risks as well.

As with most things we fear, it is good to get an understanding of why we fear them to gain a more realistic viewpoint.

Spending time in antenatal classes or discussing your concerns with your midwife or obstetrician can help alleviate fears.

There are times when a Caesarean section is completely appropriate, even electively, as described, but the risks and benefits must be discussed and clearly understood.

I really enjoy exercising, especially step aerobics, jogging and spinning. Can I continue these activities while I'm pregnant or could it damage the baby?

Exercise is encouraged in pregnancy within reason. Some research states that you should not let your heart rate go over 100–120 beats/minute as pregnancy itself requires big adjustments in our cardiovascular system.

It is vital to stay well-hydrated as dehydration is detrimental in pregnancy for many reasons including preterm labour and recurrent urinary tract infections.

Be particularly careful to refrain from engaging in activities in which you may injure yourself or the pregnant bump such as horse riding, contact sports, bicycling etc.

It is best to get involved in activities like swimming, pregnancy yoga, walking etc (a good place to meet other mums as well).

Slightly embarrassing, but should I wax my pubic area before labour for hygiene reasons?

There is no need to wax or shave before delivery unless you desire. But, do keep in mind, it may be a while before you can wax after baby is born, so do what makes you feel comfortable.

I'm worried that if I go into labour too quickly I won't be able to get an epidural. What is the procedure around this form of pain relief? And if I can't get an epidural what other options are open to me?

Most first time mothers do not labour so quickly that they miss the window of opportunity to obtain the pain relief they desire.

However, if you are lucky and labour quickly, other options do exist. 'Gas and air' (like what you might receive at the dentist) is frequently used to help take the edge off the pain as well as the utilisation of local anaesthesia injected into the perineum.

Some people also like hypno-birthing techniques and the use of a TENS machine.

I've been told that a badly- done episiotomy can leave a women with problems such as incontinence and pain during sex. Under what circumstances would I need one, and how can I make sure it is my gynaecologist who does it as opposed to someone I don't know?

The episiotomy is one of the most controversial topics in obstetrics. It is often used to prevent vaginal tears from extending into the very important muscles that render us continent. This is especially true during a ventouse or forceps delivery.

It is the repair of the episiotomy (and for that matter any laceration) that is the most important. Poorly repaired episiotomies and lacerations can cause major problems.

Rest assured, the majority of obstetrician / gynaecologists working in maternity hospitals are trained to perform this repair.

In order to have your own consultant obstetrician/gynaecologist perform the repair, it might be wise to look into private care.

Otherwise, it will often be a specialised midwife or a trainee obstetrician/gynaecologist.

How soon can I have sex after giving birth?

It takes six weeks for your womb to return to normal size and shape. Until then sexual intercourse should be delayed as you may be at risk of infection.

However, it may take a bit longer for any episiotomy or vaginal laceration to heal. If you have any concerns about your specific circumstances, ask your general practitioner, midwife or obstetrician/gynaecologist.

I've heard scary things about forceps and vacuum suction during labour. Under what circumstances would I need either of these? ( They sound painful and traumatic, are they?)

In Ireland and the UK, first-time mothers can expect a 25–30pc chance of an instrumental delivery either for foetal distress (abnormalities of baby's heartbeat) or failure to progress once the cervix is fully dilated and the head is well down into the pelvis.

These deliveries do tend to be more painful and you should be offered some sort of pain relief.

Sometimes, there is also a loss of the sense of control for the mother when undergoing an instrumental vaginal delivery, which can be compounded when there are urgent issues like foetal distress.

It helps greatly to have an obstetrician present that you have met before and trust. Unfortunately, this is not always possible, and can make the delivery seem traumatic.

The obstetrician performing the delivery should always provide a 'debriefing' session afterwards to explain what happened and answer any questions you might have.

You may also like to attend a physiotherapist afterwards to rebuild strength in the pelvic floor. It is helpful to discuss these deliveries at antenatal classes so that the fear surrounding them is addressed.

Mother & Babies