sun, Nov 14, 2010 The Star/ANN 'I'll die of pain without an epidural' MOTHERS-to-be have heard their fair share of childbirth stories, some in excruciating detail. A popular fallacy - birth is an illness! "If you view childbirth as a natural process versus viewing it as an illness, it will shape how you make decisions and go through the childbirth," says UK-trained midwife Jennifer Hor of Kuala Lumpur. Let's debunk some of these myths: Myth# 1 Baby is too big or pelvis is too small One of the most common excuses women are wheedled into inducing their labour or to undergo a C-section is that her baby is too "big". In more than 30 years of practice, consultant obstetrician and gynaecologist Dr Choong Kuo Hsiang has delivered many large babies, averaging 3.8 to 4kg through vaginal delivery. "Ultrasound scans only provide an estimate of baby's weight and are not 100% accurate. I will consider intervention if the woman is physically small and the baby's head is not engaged in the pelvis," says Choong. "In a borderline case, many babies do still birth normally as the baby's skull bones are soft and compressible, and the joints in the mother's pelvis are able to relax, allowing for slight expansion. "Sometimes a trial of labour is necessary to determine whether a woman can birth successfully." Evidence-based UK National Institute for Clinical Excellence (NICE) guidelines recommend against a scheduled caesarean for estimated large baby and/or small pelvis (cephalopelvic disproportion), or low-risk women who are more than one week overdue. Myth# 2 Vaginal delivery equals pain and a slack vagina "Women should be reassured that if routine episiotomy is avoided, they are likely to recover speedily and experience minimal pain after a normal delivery," says consultant obstetrician and gynaecologist Dr T. Chow. "But even if episiotomy is medically indicated and it may take longer to recover, generally you can resume pain-free intercourse three months after delivery." As they say, do your Kegels! "Proper pelvic floor muscle exercises will help strengthen the pelvic floor muscles and tone up the vaginal muscles," she adds. Myth# 3 Asian women's vaginas are too small Some obstetricians lead women to believe that routine episiotomy is commonplace or necessary for Asian women. An episiotomy is a surgical cut in the area between the vagina and the anus (called perineum) made just before delivery to enlarge your vaginal opening. An episiotomy may be needed to speed up the delivery process if there's concern about baby's heart rate or if the baby's head or shoulders are too big, for example. "We don't practice routine episiotomy, at least not in government hospitals," says Dr Hj Mohamad Farouk Abdullah, president of Obstetrical and Gynaecological Society of Malaysia. "In fact, the Ministry of Health came out with a circular in 2008 to restrict routine episiotomy and direct hospitals to report their episiotomy rates. Government hospitals' episiotomy rates average less than 8%." The systematic use of episiotomy is not justified, according to World Health Organization (WHO). Myth# 4 Labour is too long If a woman's labour drags on for a period of time, caregivers may suggest an induction or C-section. The question is how long is "too long"? It's subjective and can be open to abuse. For first-time mothers, a normal childbirth can easily dawdle from 12 to 16 hours. "As long as the mother is progressing, her condition is okay and the baby's heartbeat is fine, I am willing to wait," says Dr Choong. "If the labour continues more than 24 hours, we have to stop and evaluate whether there's any danger or advantage in waiting. It's important to differentiate between early mild labour that can be prolonged and true labour that is more intense." Myth# 5 VBAC is dangerous Most doctors would tell their patients that a VBAC (vaginal birth after caesarean) is dangerous, saying the scars may burst open or it's risky to the baby. But in most studies, about three-quarters of women attempting a VBAC are successful, with excellent outcomes for mother and baby. Risk factors for unsuccessful VBACs are: induced labour, no previous vaginal birth, body mass index greater than 30 and previous caesarean section for dystocia (abnormal or complicated childbirth or labour). (UK Royal College of Obstetricians and Gynecologists. Birth after previous caesarean birth 2007. Green-top Guideline No. 45) It's best to discuss with your caregivers the benefits and risks of VBAC in order to make an informed choice. Myth# 6 I'll die of pain without an epidural In Hor's 17 years of experience running ante-natal classes, she finds that most women can't imagine going through childbirth without opiates or painkillers like epidurals. "A lot women are not mentally prepared for the challenge during labour," says Jennifer Hor of Jenlia Maternal Services. The UK-trained midwife has been running ante-natal classes and post-natal home visits for 17 years. "You need to think about other options to manage your pain and have faith in your body's hormones to cope with the challenges or pain." In government hospitals, epidurals are not usually available on demand. Due to lack of manpower, it depends on the availability of an anaesthetist to administer the painkiller on the day of labour, Farouk added. The ups and downs of pregnancy and labour are mentally and physically taxing, Hor added. "But giving birth is the easy part, looking after your child is the hard part. Like an initiation process, these challenges will prepare you mentally and emotionally for the long, hard road ahead."