Childbirth Education

When to go to hospital?

The first part of the course explains signs of labor, which will tell the mom when to go to the hospital and what to expect when labor starts.

What to pack?

What to take with her to the hospital, we help her fill her birth plan, teach her the breathing techniques that helps in labor pain, we demonstrate and show the couples positions that can help progress delivery, and we teach them different techniques that can secure comfort in the labor room.

Medication

We inform them about medications used in labor, and explain all about epidural, and if the woman is planning for it, we help the mom to know how to push with epidural to reduce its side effects. Indications for cesarean section delivery and recovery tips.

Breastfeeding

Positions, how to get the best latch, how to know if the baby is getting enough milk, challenges and how to overcome it, diet to increase breast milk and what to avoid from food during breastfeeding. Pumping and storing milk and going back to work while breastfeeding.

First Aid and CPR

We highly recommend and assist you to attend comprehensive basic first aid for choking baby and CPR.

What’s Cord Blood Donation?

Cord Blood Storage:
We strongly recommend stem cell banking and are now considering mother’s fat cell stem collection at C section births, the science is expanding and 30 years later our abilities in medicine will most definitely surprise us.

Our team has evaluated quality, performance, success rates, and responsibilities and liabilities and strongly recommend the use of CRYOSAVE ARABIA for storage.

  • Immediately collected after birth and stored within 48 hours for 30 years. Consider the fee a purchased insurance policy.
  • Private Bank: Cord blood banking for family use. The cord blood will be collected and stored for a fee to be reserved for a family’s exclusive use. This option is fee-based.
  • Cord blood is one of three sources of stem cells used in transplants to treat patients with blood cancers and other hematologic malignancies. The other sources are bone marrow and peripheral blood stem cells.
  • Cord blood is an especially important resource for those patients who do not have an immediate family member who is a match to donate bone marrow or stem cells for transplant.
  • Cord blood is also helpful when a patient needs a transplant quickly. Because the units are stored and readily available, they may be a better option for a patient who cannot wait weeks or months to find a suitable bone marrow donor.

​Families should also be aware that for some blood cancers and malignancies, such as Leukaemia, a patient’s own stored blood most likely could not be used for treatment as those blood stem cells would have the same mutation that caused the disease. However, there are currently clinical trials being performed to treat conditions and diseases such as diabetes, other autoimmune diseases, autism, cerebral palsy, stroke, and spinal cord injury could significantly increase the likelihood of using one’s cord blood.

Vaginal birth after cesarean section(VBAC) is a safe and reasonable alternative to repeat cesarean.

TOLAC(trial of labor after Cesarean delivery) is attempted vaginal delivery following a previous C-section and about 40% of TOLAC ends up with a repeat c- section but with normal maternal and fetal outcomes.​

Benefits of (VBAC):

  • Short recovery
  • Easier recovery
  • Reduced complication​

Risks of TOLAC:

  • Uterine rupture (rare but serious)
  • Maternal Hemorrhage
  • Fetal loss
  • Increased cesarean section rate(40%)


We agree to TOLAC when:

  • The hospital facility is prepared to handle an emergency in a short time
  • There should be no relative or absolute contraindication to TOLAC
  • Artificially inducing labor is not recommended.​

Changes to your Delivery Plan

Encountering complications during your TOLAC can make it unsafe to give birth vaginally. Be receptive to your options and choose the safest delivery route with an open mind.

Vaginal delivery is when a baby is born through the mother’s birth canal.

Labor: The duration of labor varies with Some deliveries taking only a few hours, while others may take a couple of days.

  • to allow the baby to pass through the birth canal.centimetersDilitation: the cervix gradually opens to 10
  • Braxton-Hicks Contractions: “practice” contractions.
  • Contractions: Contractions are the rhythmic tightening and relaxing of your pelvic muscles.​​​

Signs Of Labor:

Latent Phase:

  • Regular minute-long contractions, in approximately 5-minute intervals, for 60 minutes.
  • Ruptured membranes
  • Pressure
  • Diarrhea or indigestion
  • Bloody show

Active Labor:

  • Stronger, Longer duration with shorter intervals
  • Cervix at 4 centimeter
  • Descending fetal presenting part
  • Relaxation techniques for active labor:
  • Ask for medication, if this is a part of your birthing plan.
  • Practice breathing exercises.
  • Have a light snack and drink plenty of fluids.
  • Keep your blood flowing by walking around the room, or switching positions.
  • Urinate normally.

Have your birth plan discussed with your consultant in advance.

Second Stage of Labor:

  • Pushing:
  • listen to your doctor for direction when to push:
  • Take a deep breath and hold
  • PUsh down as if you are constipated
  • Push for full 10 seconds
  • Exhale
  • Repeat the cycle x 3
  • Keep breathing between pushing cycles

The third stage of Labor:

After Delivery:

  • Your doctor will examine the placenta.
  • Within about 5-30 minutes, you will need to deliver the placenta as well. This will be much easier than delivering your baby! You will likely continue to have small contractions, and your doctor may massage your belly to help it along. You may need to push again to completely expel the placenta.
  • Your doctor might massage the uterus so it clamps down
  • Receive an IM injection to prevent bleeding
  • Push for delivering the Placenta
  • Baby on your chest with skin to skin contact and breastfeeding
  • Cord stem collection is performed if indicated

Non-Invasive Prenatal Test (NIPT) is a DNA test on maternal blood to screen for the most common fetal chromosome anomalies: Trisomy 21 (Down Syndrome), Trisomy 18 (Edwards Syndrome) and Trisomy 13 (Patau Syndrome).

  • Trisomy 21 is the most common trisomy at the time of birth. Also called Down Syndrome, it is associated with moderate to severe intellectual disabilities and may also lead to digestive disease, congenital heart defects and other malformations.
  • Trisomy 18 (Edwards Syndrome) and Trisomy 13 (Patau Syndrome) are associated with a high rate of miscarriage. These babies are born with severe brain abnormalities and often have congenital heart defects as well as other birth defects.
  • This test can be requested for any singleton or twin pregnancy, including those conceived naturally or by IVF using the patient’s own egg or a donor egg. Please note, however, that sex chromosome (X and Y) analysis is not available for twin pregnancies. The test can be ordered for women with pregnancies of at least 10 weeks’ gestational age.

Although NIPT can be performed in every pregnancy, it is especially indicated:

  • If the triple test or first-trimester screening indicates an increased risk for Down Syndrome, Trisomy 18 or Trisomy 13.
  • Advanced maternal age.

The testing is non-invasive:

it involves taking a blood sample from the mother. The pregnancy is not put at risk of miscarriage, or from other adverse outcomes that are associated with invasive testing procedures such as amniocentesis. Once the mother decides to have the test performed, she will be asked to sign a consent form and her blood sample can be taken from a vein in her arm.

Clinical studies have shown NIPT has exceptional accuracy for assessing fetal trisomy risk. A high risk result is indicative of a high risk for a trisomy. The test identifies in singleton pregnancies more than 99% of fetuses with Trisomy 21, 98% of fetuses with Trisomy 18, and 80% of fetuses with Trisomy 13, and 96% of fetuses with Turner Syndrome. X and Y analysis provides >99% accuracy for fetal sex.

1 week. inThe results will be ready in approximately​

Genetic disorders:

Aneuploidy is a condition in which there are missing or extra chromosomes. In a trisomy, there is an extra chromosome. In a monosomy, a chromosome is missing. Inherited disorders are caused by changes in genes called mutations. Inherited disorders include sickle cell disease,
cystic fibrosis, Tay–Sachs disease, and many others​

Prenatal Testings:​

  • Prenatal screening tests: These tests can tell you the chances that your fetus has an aneuploidy and a few additional disorders. This FAQ focuses on these tests.
  • Prenatal diagnostic tests: These tests can tell you whether your fetus actually has certain disorders. These tests are done on cells from the fetus or placenta obtained through amniocentesis or chorionic villus sampling (CVS).

Genetic screening tests:

  • ​They include carrier screening and prenatal genetic screening tests:
  • Carrier screening is done on parents (or those just thinking about becoming parents) using a blood sample or tissue sample swabbed from inside the cheek. These tests are used to find out whether a person carries a gene for certain inherited disorders. Carrier screening can be done before or during pregnancy.
  • Prenatal genetic screening tests of the pregnant woman’s blood and findings from ultrasound exams can screen the fetus for aneuploidy; defects of the brain and spine called neural tube defects; and some defects of the abdomen, heart, and facial features. They include first-trimester screening, second-trimester screening, combined first- and second-trimester screening, and cell-free DNA testing.

First-trimester screening:

First-trimester screening includes a test of the pregnant woman’s blood and an ultrasound exam. Both tests usually are performed together and are done between 10 weeks and 13 weeks of pregnancy:

  • The blood test measures the level of two substances.
  • The ultrasound exam, called a nuchal translucency screening, measures the thickness of a space at the back of the fetus’s neck. An abnormal measurement means there is an increased risk that the fetus has Down syndrome or another type of aneuploidy. It also is linked to physical defects of the heart, abdominal wall, and skeleton.

 

Second-trimester screening:

  • The “quad” or “quadruple” blood test measures the levels of four different substances in your blood. The quad test screens for Down syndrome, trisomy 18, and neural tube defects. It is done between 15 weeks and 22 weeks of pregnancy.
  • An ultrasound exam done between 18 weeks and 20 weeks of pregnancy checks for major physical defects in the brain and spine, facial features, abdomen, heart, and limbs.

Cell-free DNA testing:

Cell-free DNA is the small amount of DNA that is released from the placenta into a pregnant woman’s bloodstream. The cell-free DNA in a sample of a woman’s blood can be screened for Down syndrome, trisomy 13, trisomy 18, and problems with the number of sex chromosomes. A positive cell-free DNA test result should be followed by a diagnostic test with amniocentesis or CVS.

This test is non invasive but due to costs and some false positive rate is not offered to all patients.Discuss with our physicians about your specific risks and available testing.

  • A positive screening test result for aneuploidy means that your fetus is at higher risk of having the disorder compared with the general population. It does not mean that your fetus definitely has the disorder.
  • A negative result means that your fetus is at lower risk of having the disorder compared with the general population. It does not rule out the possibility that your fetus has the disorder.

There is no right or wrong testing protocol but an informed process.

Nuchal Translucency (NT)

Nuchal Translucency (NT) measures the fluid under the skin at the back of baby's neck between 11-13 plus weeks with limited structural examinations to evaluate:

  • Pregnancy dating by measuring the Crown Rump Length.
  • Diagnose multiple pregnancies.
  • A number of common major structural anomalies can be seen at this stage
  • Risk assessment of your baby being affected by most common chromosomal anomalies like Down’s Syndrome.
  • Training, Experience of physician or sonographer and obviously better technological support via better imaging machines improve the accuracy of this test but NT risk assessment alone can miss 500/10,000 affected pregnancies.
  • A blood test will be taken as well which will measure levels of two pregnancy-specific hormones in your blood (beta hCG, plasma protein-A). to asses risks of (T21, T13 & T18).
  • A better, more accurate but more expensive test is developed called NIPT which insurances unfortunately only cover with many exclusions.
  • At our center, almost all patients perform NIPT testing missing 1/10,000 affected pregnancies and performed at 9 weeks & 2 days instead of 11-13 weeks.
  • With follow up structural NT scan.

Twins, Triplets or more​

Chorionicity and Amnionicity:

There are three types of twins:

  • Dichorionic–diamniotic—Twins who have their own chorions and amniotic sacs. They typically do not share a placentaand can be fraternal or identical.
  • Monochorionic–diamniotic—Twins who share a chorion but have separate amniotic sacs. They share a placenta and are identical.
  • Monochorionic–monoamniotic—Twins who share one chorion and one amniotic sac. They share a placenta and are identical.


Monochorionic babies have a higher risk of complications than those with separate placentas.

Twin–twin transfusion syndrome (TTTS): the blood flow between the twins becomes unbalanced. One twin donates blood to the other twin. The donor twin has too little blood, and the recipient twin has too much blood. The earlier TTTS occurs in the pregnancy, the more serious the outcomes for one or both babies.

Although monochorionic–monoamniotic babies are rare, this type of pregnancy is very risky. The most common problem is an umbilical cord complication.

Identical

When more than one fetus originates from the same egg, we call them identical. Identical babies will be the same sex and will have the same blood type, however, they will have their own unique fingerprints and not 100% same. Family history plays no role.

Fraternal

When two or more eggs are fertilized by more than one sperm, the resulting babies are fraternal. More common with a family history.

They are genetically different, but will likely resemble each other.

Carrying more than one baby increases the chances of:

  • Pre-eclampsia.
  • Gestational diabetes.
  • Pre-term delivery.
  • Birth defects.
  • Miscarriage
  • Cesarean delivery

​Carrying more than one fetus is harder on your body, visit your OB more frequently and increase fluid intake and reduce unnecessary activities.

Bleeding during pregnancy

It is a common problem that usually resolves however may be a warning sign for:

  • Miscarriage: 25% of all pregnancies
  • Cervical Infections & Polyps
  • Placenta Previa: Placenta tissue covering the cervical os
  • Placental abruption: Placenta tissue may separate from uterine wall and becomes a serious medical emergency.
  • Ectopic pregnancy
  • Vaginal Bleeding and Labor: May signal labor.
  • Pre-term labor

We Are here to help reduce your anxiety levels by a quick consultation.

Early miscarriage occurs in the first trimester of pregnancy. It’s a fairly common occurrence, affecting an estimated 10%-20% of pregnancies.

​Etiologies:​

  • 50%-60% due to chromosomal mutations
  • Idiopathic or Unknown
  • Progesterone deficiencies
  • Uterine cavity abnormalities
  • Thrombophilia
  • Risks increase with advanced maternal age.


The following actions do not cause an early pregnancy loss:

  • ​Having sex
  • Working and increased activity
  • Exercising or contact sports
  • Using birth control pills before pregnancy
  • Falling
  • Symptoms of Early Pregnancy Loss

​The most common symptoms of an early pregnancy loss are bleeding and cramping, but these are not sure signs. Many women experience these in their first trimester, and their pregnancies continue normally.​

​Diagnosis of Early Pregnancy Loss

​Physical examination, Ultrasound evaluation and follow up serial HCG levels can diagnose and rule out serious conditions such as ectopic gestation.​

​Post Diagnostic follow up

​You need to make sure all the pregnancy tissues are removed from your uterus. There are both surgical and non-surgical options available.​

​Non-surgical post miscarriage care options

​If there’s no risk of infection, it may be possible to allow the tissue to pass naturally, which usually takes 1-2 weeks.

You should expect bleeding that is longer and heavier than your normal period. You may also pass tissue that resembles blood clots. Symptoms can include nausea, diarrhea, and/or painful cramps, for which we can prescribe you medication. Afterward, you should have an ultrasound to make sure all of the tissue has passed.​

​Surgical post miscarriage care options

​If your bleeding is heavy, or if you show signs of an infection, we will recommend surgical removal of the tissue. There are two common procedures:​

​Suction Dilation & Curettage

​It involves inserting a thin tube into the uterus, and using gentle suction to clear out the tissue under local or general anesthesia.​

​Dilation and curettage (D&C)

​It involves dilating the cervix, and using a special instrument to remove all of the tissue. You may receive general or regional anesthesia.​

​Follow up

​To prevent infection, you should avoid vaginal intercourse for 1-2 weeks following the miscarriage. During this time, do not put any objects in your vagina, including tampons and birth control devices.

Signs of infection:

  • Severe Pain
  • Fever
  • Chills
  • Heavy bleeding (going through two or more pads per hour, for longer than two hours)
  • Your OB/GYN will guide you for your future pregnancy plans.
The loss of a pregnancy during the first 13 weeks of pregnancy (the first trimester) is called early pregnancy loss, miscarriage, or spontaneous abortion.
Early pregnancy loss is common. It happens in about 10% of known pregnancies.
About one half of cases of early pregnancy loss are caused by a random event in which the embryo receives an abnormal number of chromosomes. Chromosomes are the structures inside cells that carry genes. Most cells have 23 pairs of chromosomes for a total of 46 chromosomes. Sperm and egg cells each have 23 chromosomes. During fertilization, when the egg and sperm join, the two sets of chromosomes come together. If an egg or sperm has an abnormal number of chromosomes, the embryo also will have an abnormal number. Development will not occur normally, sometimes resulting in loss of the pregnancy.
Some women worry that they have done something to cause their pregnancy loss. Working, exercising, having sex, or having used birth control pills before getting pregnant do not cause early pregnancy loss. Morning sickness does not cause early pregnancy loss. Some women who have had an early pregnancy loss believe that it was caused by a recent fall, blow, or even a fright. In most cases, this is not true. Smoking, alcohol, and caffeine also have been studied as causes of early pregnancy loss. Some research suggests that smoking increases the risk, while other research suggests that it does not. Alcohol use in the first trimester may slightly increase the risk of early pregnancy loss, but the research is not clear. In any case, it is best to avoid smoking and drinking alcohol during pregnancy. Consuming 200 mg or less of caffeine a day (the amount in two cups of coffee) does not appear to increase the risk of early pregnancy loss.
The likelihood of early pregnancy loss occurring increases as a woman gets older. Early pregnancy loss occurs in more than one third of pregnancies in women older than 40 years.
Bleeding and cramping are the most common symptoms of early pregnancy loss. A small amount of bleeding and cramping in early pregnancy is relatively common. Bleeding often stops on its own, and the pregnancy continues normally. Bleeding and cramping also can be signs of other pregnancy problems, such as ectopic pregnancy. If you have any of these signs or symptoms, contact your obstetrician–gynecologist (ob-gyn) or other member of your health care team.
If you have signs and symptoms of early pregnancy loss, you most likely will have a physical exam. Your obstetrician will ask you questions about when the bleeding started, how much you are bleeding, and whether you have pain or cramping. An ultrasound exam may be done to check whether the embryo is still growing in the uterus or to detect the presence of a heartbeat. You may have a test to measure the level of human chorionic gonadotropin (hCG) in your blood. This substance is made by the developing placenta. A low or decreasing level of hCG can mean loss of the pregnancy. Several ultrasound exams and hCG tests may be necessary to confirm that pregnancy loss has occurred.
When a pregnancy is lost, some of the pregnancy tissue may remain in the uterus. This tissue needs to be removed. There are several ways this can be done. If the situation is not an emergency, you can help choose the type of treatment. The available options have similar risks, which include infection and heavy bleeding. The risk of serious complications, regardless of the type of treatment, is very small. If your blood type is Rh negative, you also likely will receive a shot of Rh immunoglobulin after an early pregnancy loss. Problems can arise in a future pregnancy if you are Rh negative and the fetus is Rh positive. These problems can be prevented by giving Rh immunoglobulin after a pregnancy loss.
If you do not show any signs of an infection, one option is to wait and let the tissue pass naturally. This usually takes up to 2 weeks, but it may take longer in some cases. Another option is to take medication that helps expel the tissue.
You will have bleeding. The bleeding usually is heavier than a menstrual period and lasts for a longer time. Cramping pain, diarrhea, and nausea also can occur. Your ob-gyn may prescribe pain medication. You may pass tissue in addition to bleeding. With an early pregnancy loss, the pregnancy tissue resembles a blood clot. It does not look like a baby. An ultrasound exam or blood tests for hCG usually are done afterward to confirm that all of the tissue has been expelled. If it has not, you may need to have surgical treatment.
Surgery is recommended if you have signs of an infection, heavy bleeding, or other medical conditions. One surgical option is called vacuum aspiration. In this procedure, a thin tube attached to a suction device is inserted into the uterus to remove the tissue. The procedure may be performed in your doctor’s office. Local anesthesia is used. You also may be given medication to help you relax. Another option is called dilation and curettage (D&C). In a D&C, the cervix is dilated (opened), and an instrument is used to remove the pregnancy tissue. A D&C usually is done in an operating room or surgical center. General anesthesia or regional anesthesia may be used.

You may be advised not to put anything into your vagina (such as using tampons or having sexual intercourse) for 1–2 weeks after an early pregnancy loss. This is to help prevent infection. Call your ob-gyn right away if you have any of the following symptoms:

  • Heavy bleeding (soaking more than two maxi pads per hour for more than 2 hours in a row)
  • Fever
  • Chills
  • Severe pain
If you or your partner is having trouble handling the feelings that go along with this loss, talk to your ob-gyn or other member of your health care team. You also may find it helpful to talk with a counselor. Support groups—either online or in person—can be helpful. SHARE: Pregnancy and Infant Loss Support, Inc. (www.nationalshare.org) lists local support groups and offers online resources to help with grief and healing.
Pregnancy loss in the first trimester usually is a one-time event. Most women go on to have successful pregnancies. Repeated pregnancy losses are rare. Testing and evaluation can be done to try to find a cause if you have several pregnancy losses. Even if no cause is found, most couples will go on to have successful pregnancies.

You can ovulate and become pregnant as soon as 2 weeks after an early pregnancy loss. If you do not wish to become pregnant again right away, be sure to use a birth control method. You can use any contraceptive method, including having an intrauterine device inserted, immediately after an early pregnancy loss. If you do wish to become pregnant, there is no medical reason to wait to begin trying again. You may want to wait until after you have had a menstrual period so that calculating the due date of your next pregnancy is easier.

Oligohydramnios: Too little fluid production.

​Amniotic fluid cushions the baby to move and grow inside the uterus & keeps some space between the baby, the umbilical cord, and the uterine wall so that the cord doesn’t become compressed.

​Low amount of fluid may be an indication of:

  • Intrauterine growth restriction (IUGR)
  • Fetal kidney or urinary tract problems
  • Genetic disorder
  • The placenta is not properly functioning
  • The mother has chronic high blood pressure
  • Membranes have ruptured silently
  • Amnion fusion is a valuable option for individual cases

Polyhydramnios: Too much fluid.

  • Severe polyhydramnios may cause:
  • Shortness of breath
  • Swelling in the feet, ankles, and vulva
  • Decreased urine production
  • Preterm contractions
  • Placenta abruption

Causes of Polyhydramnios:

  • Rh incompatibility
  • Fetal anemia
  • Maternal diabetes
  • Genetic conditions
  • Complications due to multiple gestation

Treatments for Polyhydramnios

  • Treat underlying disease
  • Amnioreduction to drain excess fluid

Medication: Indocin but not after 31 weeks as it affects the fetal heart as well

Contact our consultants if you are diagnosed with these conditions and seek expert help.