“You deserve the birth you desire.”

 

Birth Options In Singapore

No one becomes pregnant and says, “I want the most dramatic and painful birth experience”.

What do you think a pregnant woman would say if I were to tell her, ““You are going to have an easier, shorter, more relaxed and comfortable birth.” What would her immediate response be?

Everyone wants a good birth experience, however they do not believe that it is possible. The media, our friends and society tell us that childbirth is painful. When we think of the word “childbirth”, the next word we usually think of is “epidural”.

YOU DESERVE THE BIRTH YOU DESIRE, however, it is the noise that gets into the way of you having an easier, shorter, more relaxed and comfortable birth.

When you are in a country where restructured (public) hospitals have an approximate 25-30% cesarean rate and private hospitals have an approximate 40-50% cesarean rate, and an approximate 90% of the mothers who birth vaginally would have an epidural, amongst other birth interventions, it is hard to believe that having an easier, shorter, more relaxed and comfortable birth is possible.

Fortunately, we have a small and growing niche of mothers and their families who are having a better birth experience.  Giving birth is a very special and intimate event. If you prepare for it, it can be a joyous and wonderful experience. A birth of a baby also marks the birth of a mother and father, over and over again, with every birth. A good birth experience enhances bonding and sets the pace for breastfeeding and parenting.

Your roadmap to learning how you can have an easier, shorter, more relaxed and comfortable birth experience is to learn how to work with your hormones and your body to have a shorter birth. Once your birth is short, the need for medical interventions will decrease. Learn what you can do to enable your body to labor smart and not labor hard. If you don’t know your options, you cannot exercise any. Find out what you need to know about your birthing options – an Obgyn, a Paediatrician, a birth team and a place of birth that truly support your choices.


 

Hospital

Home

Philosophy of Care

Active Management

Expectant Management

Type of Pregnancy

All Types

Low Risk

Environment

Clinical

Safe

Fetal Monitoring

Yes

Yes

Labor & Birth Positions

Doctor & Hospital dependent

Yes

Comfort Measures & Pain Relief Options

Yes

Non-pharmaceutical pain relief options

Hydrotherapy and/or Water Births

Doctor & Hospital dependent

Yes

Medical Interventions

Yes

Limited

Paediatric Care

Yes

Yes

Baby Friendly

Some

Yes

Postpartum Care

Clinical

Depends

Birth Registration

Yes

ICA (www.ica.gov.sg)


Philosophy of Care

The kind of care you receive from your Obgyn, Paediatrician, and choice of place of birth would be dependent on their philosophy of care. It is first and foremost beneficial to find out what you want for your pregnancy, labor and birth, postpartum and parenting journey. An empowering antenatal class will take you on a transformational journey to birth you into a mother and a father, as well as empower and equip you with questions, applied knowledge, tools and skills to navigate your way to having your best birth possible.

Active management takes the approach of “ Let’s intervene before something happens”, whereas Expectant management follows the method“If it ain’t broken, don’t fix it.” Labor and Birth in normal, low risk pregnancies are in fact normal and not a medical condition. ACOG has given the recognition that “Less is More” in normal, low risk pregnancies and agree that mothers should be given more time to labor and birth.

It is important to differentiate between bedside manners of your care providers versus philosophy of care.

Type of Pregnancy

It is at the Obgyn’s discretion to determine if your pregnancy is considered low or high risk. Conditions of the pregnancy such as multiple gestation, gestational diabetes, preeclampsia and eclampsia, could place a pregnancy at risk. Only low risk pregnancies are allowed for homebirths, and only one Obgyn will attend homebirths in Singapore.

Environment

It is very important for a woman to feel safe during labor and birth. All of the hormones she uses for making love are the same hormones she uses for giving birth – oxytocin, your love hormone. It is very important for a woman to feel safe and to have access to simple tools that could enhance the place of birth that she chooses to be at - be it home or hospital - such as aromatherapy, dimmed lighting and music. Apart from the physical environment, it is even more important that the care she is receiving from her team of Doctors (Obstetrician & Paediatrician), the choice of place of birth, her birth partner, and her Doulas (if any) – enables her to feel safe in their presence.

Fetal Monitoring

Whether you are needing continuous or intermittent fetal monitoring during your labor and birth is dependent on your type of pregnancy, how your Obgyn practices and the hospital protocols. For low-risk pregnancies, most Obgyns and hospitals require 20-30 minutes of continuous fetal monitoring in whatever laboring positions you feel comfortable, such as sitting on a gym ball next to the CTG machine, intermittently monitoring thereafter unless there is a medical need for continuous monitoring at any point during your labor. For home births, there is a hand held Doppler for intermittent monitoring every ½-1 hour.

Labor & Birth Positions

The choice of labor and birth positions a woman chooses plays a vital role in a laboring mother’s comfort level as well as how quickly and effectively her labor does or does not progress. Your ability to labor and birth would depend on your choice of Obgyn and place of birth.

Comfort Measures & Pain Relief Options

Whether you choose to have drugs during labor or not, all mothers need to be supported through their options. During labor, there is a difference between comfort measures and varying positions and techniques that enables labor to progress.

Comfort measures may ease labor pain directly or indirectly by soothing and relaxing you, such as hot/ cold packs, massage, positive encouragement, enabling the mother to feel both safe and comfortable are essential. Learning how to work with her body through her breathing, relaxation and knowing how to use various laboring and birth positions to optimize the opening of the pelvis at various levels and situations are essential in enabling the labor to progress.

Should pain relief become necessary, women have the option of renting a TENS machine and even consider sterile water injections for back pain if their Obgyn provides these options. Otherwise, all hospitals would have the option of gas, pethadine or an epidural(walking or spinal) . It is helpful to understand how pain relief can enable or hinder labor progress; its side effects; and how it can increase the likelihood of further birth interventions, so parents can make a decision that is right for them.

Hydrotherapy and/or Water Births

Hydrotherapy, also known as water immersion means to labor in water and to come out of the tub to birth. Water birth means to labor and birth in the water. The choice to labor and/or birth in water is determined by how their Obgyn practices, and hospital protocols.

Hydrotherapy and/or water birth is a very well sought after option for mothers who plan to have a natural birth. However, due to the lack of availability in having adequate Obgyns both experienced and supportive in encouraging a mother to labor and birth in water, as well as limited options from the hospital of their choice – mothers therefore have very limited options. The choice to labor and/or birth in water is determined by how their Obgyn practices, and hospital protocols.

Research shows that laboring in water allows a mother to relax even more, and in doing so, it can speed up the labor progress. Buoyancy promotes more efficient uterine contractions and improved blood circulation resulting in better oxygenation of the uterine muscles, less pain for the mother, and even more oxygen for the baby.

Women should only use hydrotherapy when she is in active labor. It is essential for her to have a team skilled in supporting hydrotherapy and/or water births in order to ensure that the set up procedure is a safe option.

Medical Interventions

There are various medical interventions used during the different stages of labor. Medical interventions, when used appropriately, can enable a mother’s labor to progress and help her to avoid a cesarean. Despite the fact that the medical communities agree that “Less is More”, that mothers with low risk pregnancies should be given more time for labor to progress naturally – how much medical interventions are needed is dependent on your choice of Obgyn and hospital protocols.

Pediatric Care

Once your baby is born, a baby doctor also known as a paediatrician, will be assigned to care for your baby medically. If you choose to have a home birth, you will need to find a paediatrician who is willing to do a home visit within 24 hours of your baby’s birth, and it is recommended to discuss with your paediatrician the optional medical tests that you would like post birth.

Baby Friendly

As obesity becomes a rising issue, Singapore has finally jumped onto the WHO Baby Friendly Hospital Initiative (BFHI) bandwagon to promote breastfeeding where immediate skin-to-skin contact after the birth for an unlimited time, 100% breastfeeding, and rooming-in are now part of the policies.

Studies have shown that the ability to breastfeed successfully in the first few days after the birth has a direct impact on the period of time that mothers continue breastfeeding, yet many healthcare providers in Singapore are still not practicing evidence based guidelines in promoting breastfeeding. Mixed feeding is still the most common choice in Singapore, not 100% breastfeeding mostly due to lack of support and information.

As of 2017, hospitals that are currently accredited WHO BFHI friendly are National University Hospital, Singapore General Hospital and KK Women’s & Children’s hospital.

Postpartum Care

As new parents, you need as much support as you can get emotionally, physically and understanding your real options. After being in your womb for over 9 months, babies do need time to transition into this world, therefore getting practical help in breastfeeding, understanding your baby’s cues for feeding, sleeping, soothing, and learning how to wear your baby, can all be very empowering tools and skills to have to survive the first 6 weeks. Wherever you choose to give birth, and the help you choose to engage, when you bring your baby home they should empower you to know what to do to survive the first 6 weeks postpartum.

Birth Registration

If you are married and have given birth at the hospital, you can register your baby’s birth at the hospital within 2 weeks of your baby’s birth. If you are not married and/or have given birth out of the hospital, you will need to get a letter from your Doctor for ICA (link to www.ica.gov.sg), and proceed to ICA within 2 weeks of the birth to register your baby’s birth. Registration can be done by the birth partner as long as you have all the required documentation.

If your baby is going to be a foreign passport holder, please check with your embassy what the passport registration process and datelines are, as well as what is needed to apply for a dependent’s pass for your baby.

If you would like to find out more about your birthing options in Singapore, and explore alternatives to bridge the gap between the hospital and home birth experience through continuous birth and postpartum support; as well as understand the roadmap to having a good birth experience, come join us for our monthly Open House & Meet the Doulas event to have all your questions answered. We look forward to meeting you and your birth partner.