Going into Labour

Prepare for your birth journey at SGH with guidance on admission, labour, delivery and beyond. Learn what to expect and how to get ready for each stage with confidence.

Preparing for Admission

The Labour Ward (Ward 52A) is located at Block 5 Level 2 and is open 24 hours. You can contact the midwife at 6321 4520 if you have any concerns.

Please proceed to Labour Ward 52A if you are 20 weeks pregnant or more and experience any of the following:

Abdominal pain or regular contractions
- Contractions come in waves and are commonly described as period-like cramps or a strong urge to open your bowels. The duration of labour varies from woman to woman and is generally longer for first-time mothers. If the pain is persistent and becomes progressively more intense (for example, contractions every 10-15 minutes lasting more than 2 hours), you should go to the hospital to be checked.

“Show”
- The blood-stained mucus or “show” is a mucus plug that protects the cervix. When you go into labour, the cervix softens and dilates, leading to the dislodgment of this mucus plug. If the bleeding is minimal or just staining, you can continue to observe at home. If the bleeding is as heavy as your period, is it important to go straight to the hospital as it may be a sign of complication.

Vaginal bleeding
Leaking of fluid (water bag)
- The water bag (amniotic sac) can rupture before contractions start. This may present as a sudden gush of fluid, or a continuous trickle. It can be mistaken for vaginal discharge or urine leakage. If you suspect your water bag has burst, go straight to the hospital because there is a risk of infection for you and your baby.

Reduced or no fetal movements
High blood pressure accompanied by headache or blurred vision

If you are less than 20 weeks pregnant, please go to the Emergency Department for assessment.

You will be assessed by the midwives and doctors on duty in our Early Labour Suite (ELS), located within the Labour Ward.
Your assessment may include a vaginal examination, an ultrasound scan, and cardiotocography (CTG) to monitor your baby’s heartbeat and your contractions. After the evaluation, the team will advise you on the next steps for your care.

Highlights of our Labour Ward includes:

Cosy and recently refurnished delivery suites
Upgraded electronic monitoring systems for fetal and maternal surveillance during labour
24-hour medical, neonatology, anaesthetic and operating theatre support

Your spouse is encouraged to be with you to provide support during labour and delivery. For the safety of all infants and the privacy of other mothers, other visitors are not allowed in the Delivery Suite.
In special circumstances, you may nominate a female companion to accompany you.

Pink card (antenatal history card)
NRIC (for Singaporeans and PRs) or passport (for foreigners) for both you and spouse
Hospital Bag

SGH will provide the following-**

Baby	Mother
Swaddles, baby hat and vest	Disposable panties
Disposable diapers	Sanitary pads
Wet wipes	Perineal cool packs
Tissue paper	Nipple cream
Syringes or cups for infant feeding	Disposable breast pump flanges and bottle
*Hospital grade breast pump and steriliser are available for inpatient use.* *Breastfeeding friendly maternity gown is provided for inpatient use.*

** These items are part of standard ward provisions; however, charges may apply.

Additional consumables or specialised items utilised during the hospital stay may be billed separately.

Other useful items to pack in your Hospital Bag include:

Loose clothes
Sweater
Undergarments
Maternity bras without underwire
Comfortable footwear
Personal toiletries
Personal breast pump & nursing pillow (Sterilisers and hospital grade breast pumps available in the wards)
Baby car-seat

Cord Blood Banking

Labour

First stage

The first stage of labour is divided into two phases – the latent phase and the active phase. In the latent phase, contractions are usually milder and irregular, and this phase can last many hours. As contractions become stronger and more regular, you enter the active phase of labour. During the active phase, you will be in the labour ward so that you and your baby can be monitored closely. The labour ward team will perform regular vaginal examinations to assess your cervical dilatation and may intervene if progress is slow.

Second stage

The second stage starts when your cervix is fully dilated to 10cm and ends with the birth of your baby. Like the first stage, it has two phases – the passive phase and the active phase.

The passive phase usually last one to two hours and allows the baby to move down the birth canal through involuntary contractions, which helps reduce maternal fatigue and may lower the rate of instrumental deliveries.

The active phase begins when the team asks you to start pushing, using your diaphragm (holding your breath and counting to ten) and the abdominal muscles to help push the baby out. When the baby’s head reaches and stretches the skin of the perineum (the area between your vagina and anus) known as “crowning”, an episiotomy (a small cut in the perineum) may be performed to reduce the risk of uncontrolled tearing. Once the baby’s head is delivered, the shoulders will adjust accordingly, and the rest of the body is usually delivered smoothly.

Delayed cord clamping for about one minute is routinely performed unless your baby needs immediate attention from the neonatologist. This practice increases haemoglobin levels at birth and improves iron stores in the first few months of life, which may have a positive impact on developmental outcomes. There is a slightly increased risk of jaundice requiring phototherapy, but delayed cord clamping is not associated with a higher risk of postpartum bleeding.

Third stage

The third stage of labour is the period after your baby is born until the placenta is delivered, usually lasting five to thirty minutes. During this stage, your womb contracts to separate and expel the placenta. Active management is usually used to reduce postpartum bleeding – which includes an oxytocin injection to contract the womb, uterine massage and gentle pulling of the umbilical cord while supporting the womb (controlled cord traction).

Most women go into labour naturally. Induction of labour is a way of starting labour before it begins on its own, with the aim of achieving vaginal birth. Induction results in vaginal birth (normal or assisted) in about 6 to 7 out of 10 pregnancies.

Induction of labour may be recommended in the following situations:

To avoid a prolonged pregnancy
If you are more than 34 weeks pregnant and your waters breaks before labour onset
If you have certain medical conditions such as chronic hypertension, diabetes, autoimmune disease et cetera
In other situations where continuing pregnancy will affect your and/or your baby’s well-being

Induction of labour may involve one or a combination of the following methods, after a vaginal examination to assess your cervix. Induced labour can be longer and more painful than labour that starts on its own.

Membrane sweep
Prostaglandins
Cervical ripening balloon
Surgical induction (SI) or artificial rupture of membrane (ARM)
Oxytocin infusion

When you arrive at the Labour Ward, the team of doctors on duty will assess you to determine whether you need to be admitted to the Delivery Suite. Your obstetrician will be informed after you are admitted.

If your labour has not yet started, you may be offered the option to return home or be admitted to the Antenatal Ward for monitoring.

If you are admitted to the Delivery Suite for established labour, here’s what to expect:

You will change into a delivery gown
A midwife will be assigned to support and care for you throughout labour.
CTG (cardiotocography) will be attached to monitor your baby’s heartbeat and your contractions, ensuring both your and your baby’s well-being.
Routine procedures, such as IV cannulation and blood tests, may be carried out.
The team and/or your obstetrician will review you approximately every 4 hours, including performing vaginal examinations to assess the progress of your labour.

It’s important to learn about the different pain relief options before your labour. This helps you and your spouse feel prepared and make informed choices when labour begins. You can also ask your midwife for advice and more information during your admission.

The pain relief methods available in our hospital include:

Entonox (laughing gas)
Parenteral opioids such as Remifentanil patient-controlled analgesia and Intramuscular pethidine
Epidural anaesthesia

If you have concerns about pain relief options or have had previous ineffective pain relief, a consultation with an obstetric anaesthetist can be arranged.

Our Labour Ward is staffed 24/7 by a dedicated team of midwives, nurses, doctors, and obstetric specialists. You will receive the same attention and standard of care regardless of your admitting class.

Subsidized Class (B2 or C)

Your delivery will be team managed. Midwives will conduct the delivery with support from the medical team as needed.

Private Class (B1 or A1)

Your labour will be managed by the doctors and nurses on duty in concert with your chosen obstetrician.
While your doctor will make every effort to be present at delivery, there may be times when this is not possible (e.g., very rapid labour or fetal distress).
In such cases, the midwife and on-duty doctor will be available to ensure a safe and smooth delivery.

Vaginal delivery is encouraged whenever it is safe for both mother and baby.

Assisted vaginal birth

You may need an assisted vaginal birth if:

The second stage of labour is prolonged, and you have been pushing for more than an hour
You are unable to push, or have been advised not to push, during labour
There are concerns about your baby’s well-being during labour

The methods used will depend on the circumstances and your doctor’s assessment. You may need:

Forceps which are like large tongs that are gently placed around the baby’s head to help guide it out. Forceps may leave temporary marks on the baby’s face, which usually fade gradually.
Ventouse (vacuum extraction), which uses a suction cup placed on the baby’s head to help the baby rotate and move down the birth canal while you push. The suction cup may cause a swelling on the baby’s head (chignon), which also fades gradually.

Risks associated with assisted vaginal birth include:

Postpartum bleeding
Third- or fourth-degree perineal tear (a tear which involves the muscle and/or the wall of the anus or rectum)
Difficulty passing urine (urinary retention)
Rare but serious injuries to baby such as bleeding in the brain, fractures or damage to the facial nerves

Caesarean section

A caesarean section (C-section) is a surgical procedure where an opening is made in the mother’s abdomen and womb to deliver the baby. Most of the time, a horizontal cut is made just below your bikini line and on the womb, but in some situations, a vertical (midline) cut may be required.

A C-section may be planned (elective) if a vaginal birth is unsafe for you or your baby, for example because of a serious maternal medical condition or if the baby is in an abnormal position (non-cephalic). It can also be performed as an emergency procedure if problems arise during pregnancy or labour.

A C-section is usually done under a spinal or epidural anaesthesia, so you will be awake. You may feel the pressure or pulling, but no pain. General anaesthesia, where you are asleep, may sometimes be needed, especially if the C-section has to be done very urgently or if the epidural does not work well.