What is Contraception? Contraception is a device or medication that is used to prevent unplanned pregnancies. Unprotected sexual intercourse can result in unwanted pregnancy and may lead to abortion. Thus, contraception or birth control methods are used to avoid pregnancy which may end up in abortion. There are many different methods of birth control and each one is different in its mode of action and efficacy. Each one has its advantages and disadvantages, hence women can choose the best method based on their unique needs and requirements.   Birth Control in Singapore One of the most common birth control methods used in Singapore is condoms. While the contraceptive failure rate is highest with condoms among all other methods (because when and how the condom is put on will significantly impact the protective function of it. There is also a chance of the condom tearing during intercourse), they are the only method that gives protection against sexually transmitted infections (STIs). Condoms are conveniently available at any convenience store or supermarket; whilst the other methods. require a prescription from a gynaecologist in Singapore after a proper consultation is made. The prices might vary depending on where you see your gynae (public vs private hospitals).   Types of Birth Control Methods There is a wide array of contraceptive options available in Singapore, divided into 2 major categories: 1a. Temporary (Reversible) Contraception - Short-acting i. Oral Contraceptive Pills (aka Birth Control Pills) How do Birth Control Pills (BCPs) work?In a natural menstrual cycle, the levels of female hormones i.e. estrogen and progesterone will rise and fall accordingly to result in ovulation. The progesterone will also help support implantation of the egg if it is fertilized by the sperm. BCPs are oral tablets that contain synthetic versions of these female reproductive hormones either singly or as a combination. They are taken daily for 3 weeks of the menstrual cycle starting from Day 1 or Day 5 of menstruation, as advised by your doctor, and stopped for 1 week to allow menstruation to occur.As a result, a steady hormonal level is maintained, which in turn prevents ovulation from taking place. In addition, it causes thickening of the cervical mucus to prevent the sperm from reaching the egg and also changes the uterine lining to prevent implantation should fertilization of the egg still take place. How effective are BCPs?It is generally about 98-99% effective (NHS UK), provided it is taken strictly as instructed. Advantages of BCPsBCPs are suitable for most women, provided they are committed to taking the pills regularly. They also help women who have irregular menstrual cycles regulate their menstruation (menstruation happens during the 1-week gap of no pills in a 28-day course). Disadvantages of BCPsThey cannot be taken by breastfeeding mothers and those with medical problems such as liver disorders, high blood pressure and women older than 40 years. They must be taken strictly as instructed to ensure contraceptive efficacy. Missing a pill for a day would require you to check with you gynae on the next steps.   ii. Birth Control Patch How does the Birth Control Patch work?The birth control patch is an adhesive that is stuck on the skin, where it releases hormones gradually over time to prevent ovulation, thicken cervical mucus and change the uterine lining. The hormones progestin and estrogen would be absorbed through the skin.Each patch lasts for exactly a week; therefore, it should be changed every week on the same day for the first 3 weeks. This is then followed by a rest period of one week, to allow menstruation to take place. The patch is put on Day 1 of your menstrual cycle. How effective is the birth control patch?It is 91-99% effective (NHS UK). Advantages of the patchWomen may experience less acne, a lighter menstrual flow and less menstrual cramps. It is also a very convenient option for women. Disadvantages of the patchIt can get uncomfortable to wear and some women may even experience skin irritation. Some negative side effects include nausea, tender breasts and in some instances, bleeding between periods. Some of the side effects do go away once your body gets used to the patch after about 2-3 months.    iii. Contraceptive Injection How does the contraceptive injection work?It is an injection of long-acting progesterone (called Depo Provera) that prevents ovulation from taking place and thickens the cervical mucus which prevents sperm from meeting the egg. How effective is the contraceptive injection?It is about 98% effective (NHS UK) provided you go for your injection regularly. Advantages of the contraceptive injectionYou will only need to go for your injection 4 times a year i.e. every 12 weeks. The injection also reduces the risk of developing endometrial cancer. Disadvantages of the contraceptive injectionSome women may not get menstruation at all, while 1/3 get irregular staining on and off and 1/3 get regular menstruation. Some women experience weight gain as their bodies adjust to the injection for the first few months.   1b. Temporary (Reversible) Contraception - Long-acting i. Implanon: Contraceptive Implant How does the contraceptive implant work?Contraceptive implants are devices that can be injected under the skin. They contain hormones such as progesterone, which is released from the implant slowly over time, to exert the contraceptive effect by preventing ovulation from taking place. How effective is the contraceptive implant?It is 99% effective (NHS UK). Advantages of contraceptive implantsIt can last for as long as 3 years and is convenient with no need for annual checkups. Some women may also find that they get lighter periods or do not get their period at all with these implants. Disadvantages of contraceptive implantsInsertion of the implant involves a small 1 cm cut on the skin of the arm, to insert the implant, which can cause mild scarring. Other side effects include weight gain, headaches, tender breasts and nausea. Another more common side effect is irregular bleeding. Also, if the woman gains too much weight after 3 years from the point of insertion, removal of the implant may be more difficult.   ii. Intra-Uterine Contraceptive Devices (IUCDs) IUCDs are tiny contraceptive devices, measuring approximately 2cm, that are inserted within the uterus to prevent pregnancy from taking place. These devices can be easily inserted in the gynecologist’s clinic in a short 15-30min procedure. It is needs to be inserted on Day 5 of menstruation. The slight discomfort associated with the insertion procedure can be reduced by having the procedure done during your menstruation, as that is when your cervix is dilated. Oral painkillers can also be given to help with pain relief. A. Hormonal IUCD How does it work? Release progesterone, which thickens the cervical mucus and prevents the sperm from entering the uterus. Prevents implantation of the fertilized egg by altering the uterine lining and also acting as a physical barrier in the uterus. How effective is it? 99% effective (NHS UK) – more effective than sterilization Advantages Helps women with heavy menstrual flow to lighten their bleeding, very long-lasting (up to 5 years) Disadvantages An annual gynae check-up is needed to ensure that the device is located in the correct position inside the womb. Other side effects include mood changes, breast tenderness, irregular bleeding or spotting and even more acne in some cases. The side effects might go away once your body gets used to the IUD. B. Non-hormonal (Copper) IUCD How does it work? Copper is toxic to the sperm, acting as a physical barrier to prevent the implantation of the fertilized egg How effective is it? 99% effective (NHS UK) Advantages Hormone-free means there will be no side-effects related to hormonal changes Disadvantages An annual gynae check-up is needed to ensure that the device is located in the correct position inside the womb, side effects include irregular periods, heavier periods and more cramps   2. Permanent Contraception i. Tubal Ligation How does ligation work?Ligation involves a minor surgery which can be done as a day surgery procedure. The fallopian tubes in a woman can be cut and ligated or clips can be applied. Both are equally effective. This ensures the eggs cannot travel to the uterus anymore. Men can have sterilization in a similar fashion. It is also a day surgery and the procedure is comparatively less risky than the fallopian tube ligation for women. How effective is ligation?It is considered to be 99.5% (NHS UK). Advantages of ligationIt is a permanent method thus when it is done, you do not need to worry about having unprotected sexual intercourse. Disadvantages of ligationAs it is an irreversible method, it will not be possible to have another baby in future. Also, it is a surgical procedure and is associated with surgical risks. There is still a small risk of contraceptive failure, 0.5%, meaning 1 in 200 may end up with pregnancy. This pregnancy may be outside the womb (ectopic pregnancy), which can be life-threatening. If you are considering this option, have a detailed discussion with your gynaecologist.   What about the morning-after Pill? This is a birth control measure used after unprotected sexual intercourse to prevent pregnancy. It works by preventing implantation and is given in a single dose. How effective is the morning-after pill?It is generally about 98% effective, but it can only be taken up to 72 hours after sexual intercourse. Do I need a doctor’s prescription for the morning-after pill?Yes. The morning-after pill needs to be prescribed by your gynae. You would need to see the gynae and not send your partner to pick it up on your behalf. The reason is that gynaecologists need to check you before you can take the medication. Can it be taken frequently?This is only for emergency purposes; if taken frequently, it can cause menstrual irregularities. Thus, it is advisable to use other contraceptive measures.   Contraception is important if you are not ready to have children yet. Consult your gynaecologist about the options available as he/she will take into consideration factors like your medical history, family planning, pre-existing gynaecological issues and your lifestyle to help you choose the most appropriate method of birth control. * Content is republished with permission from SMG Women's Health, in collaboration with Dr Kanika.

Pregnancy and delivery changes a woman forever – beyond physical changes, it also changes one mentally and emotionally. At a time when the new arrival takes priority over everything else, many women find themselves sacrificing their own practical and self-care needs in favour of the baby’s nutrition and safety. It is important to remember that postpartum care for yourself is critical so that you can be your best self as you bond with and care for your infant. Understanding the postpartum periodThe postpartum period encompasses the first 6 weeks after giving birth. This period, often dubbed as the fourth trimester, is a time when your body begins to heal and adjust to not being pregnant. It is described as a period of significant transition characterised by changes in self-identity, the redefinition of relationships, opportunities for personal growth and alterations to sexual behaviour as women adjust to the ‘new normal’. In short, there is definitely a lot going on!  There are many factors that come into play in your postpartum recovery journey. These include whether you’ve just had your first child or your third, vaginal or C-section delivery, if you had gestational diabetes or if your baby was born preterm. Nevertheless, there are some general changes in your body and mind that you can expect.  Changes to your bodyExpect some soreness in your vagina if you had a vaginal delivery. This would be accompanied by some bleeding over the first week. Bleeding is likely to gradually change to light-coloured discharge that may continue for about 6 weeks. You would also feel contraction-like sensations as your uterus is contracting back to its pre-pregnancy size.If you had delivered via C-section, you will experience pain at the site of incision. Movement is likely to be difficult. For example, you may have trouble getting in and out of bed. However, you are advised to move around to avoid blood clots from developing. Mood changesIt is common to feel sad during the first few days after delivery. You may also feel irritable, moody, anxious, may have difficulty concentrating or even experience sleep problems. As your hormone levels are changing during this period, with oestrogen and progesterone levels dropping off and prolactin and oxytocin levels rising and falling as your baby nurses, it is normal to experience a case of baby blues. These feelings typically peak on the third or fourth day and subside within 2 weeks. Do seek help if you find yourself experiencing severe mood swings, loss of appetite and overwhelming fatigue as these may be symptoms of postpartum depression. How can you care for yourself?Your body has done a lot of work throughout your pregnancy and continues to as you care for your newborn. It’s important that you also care for yourself and get the support that you need to cope during the intense postpartum period. Ask for and accept help from your partner, family and friends. There are many remedies you can try to ease discomfort and pain, including pain medications. Talk to your doctor to know what is safe to take, especially if you are breastfeeding. It’s okay to feel uncomfortable about your postpartum body but remember to be gentle on yourself and set realistic weight loss expectations. Plan small trips to get out of the house from time to time for a change in environment It’s normal to feel like you have no idea what you are doing in the early days. As you spend more time with your baby, you’ll be able to figure out what your baby needs and wants. The postpartum period is overwhelming. You may experience a range of conflicting and contrasting emotions, including intense feelings of joy and love as well as guilt and lack of control. Be gentle on yourself. Accept that your life has changed and while the transitioning phase may be hard, it will get better.   References Healthline. Your Guide to Postpartum Recovery. Available at: https://www.healthline.com/health/postpartum-recovery-timeline Accessed 10 November 2021. Finlayson K, et al. PLoSOne 2020;15(4):e0231415. MSD Manual Consumer Version. Overview of the Postdelivery (Postpartum) Period. Available at: https://www.msdmanuals.com/home/women-s-health-issues/postdelivery-period/overview-of-the-postdelivery-postpartum-period Accessed 10 November 2021. 

There is a misconception that a snoring baby is one who is in deep, restful slumber. While often times snoring is due to mucus in the nostrils, in rare cases, it can be a sign of a more serious problem such as sleep apnoea. What does normal sleep look like?Sleep patterns of infants vary with age. In their first month of life, a newborn sleeps up to 20 hours a day. This gradually reduces to about 11 hours by the time they are 2 years old. It is normal for an infant to have short pauses in breathing followed by rapid breathing during sleep, however, this should not be seen with colour changes or loud, noisy breathing. When snoring is harmlessIn most cases, babies who snore simply have blocked noses. This is because the nasal passages of infants are very small, so even a tiny bit of dryness or extra mucus in their noses can make them snore or have noisy breathing. A stuffy nose can usually be cleared up using a simple home remedy of saline drops or may not need any treatment at all. If the loud breathing or snoring does not resolve over a short period of time, it may be an indication of other underlying issues, requiring the attention of a paediatrician. Infant sleep apnoeaPersistent snoring in babies may indicate the presence of a sleep-related breathing disorder called infant sleep apnoea. This is a condition where there is a pause or reduction in breathing when an infant sleeps. Infant sleep apnoea may be central, obstructive or mixed. Snoring is more commonly associated with obstructive sleep apnoea. SymptomsThe following are some signs of the presence of infant sleep apnoea: Prolonged pauses in breathing lasting 20 seconds or longer A breathing pattern of repeated pauses, gasping for breath or choking Persistent snoring Difficulty breathing while taking naps during the day Risk factorsPremature babies are more likely to have infant sleep apnoea than those born full-term. The risk is more pronounced during the first months after birth in infants with lower birth weight. Apart from that, a variety of medical conditions can cause infant sleep apnoea or make it worse, including acid reflux, anaemia, infection and lung disease. Infants with underdeveloped facial features, such as a small chin or jaw, having a large tongue, tonsils or adenoids or those with a floppy airway due to a softening of the voice box (larynx) are also at risk. Seeking interventionUnresolved sleep apnoea is of concern as it may affect growth and development and lead to long term physical and behavioural issues. So, if you are concerned about your baby’s consistent snoring, it’s best consult a paediatrician to get it checked. Taking a quick recording of the snoring and playing it for the paediatrician would be helpful to determine if there’s anything of concern going on. A sleep study may be recommended to monitor breathing during sleep, which can detect and identify any problems. In most cases, infant sleep apnoea resolves as the child grows and matures. Studies have also found breastfeeding to be protective against snoring. In other cases where there are other underlying medical conditions, treatment with medications or surgery may be necessary depending on the nature of the problem.   References Hong H, et al. Am J Respir Crit Care Med 2018;198:15-16. American Academy of Sleep Medicine. Sleep Education. Infant Sleep Apnea. Available at: https://sleepeducation.org/sleep-disorders/infant-sleep-apnea. Accessed 13 August 2021. Healthline. Why Is My Newborn Snoring? Available at: https://www.healthline.com/health/parenting/newborn-snoring. Accessed 13 August 2021. Bonuck K, et al. Pediatrics 2012;129(4):e857-e865. Katila M, et al. Acta Paediatr 2019;108(9):1686-1694.