What to expect when you’re expecting

Here, we talk to a children’s doctor, a doula, an osteopath and physiotherapists about being pregnant and having a baby in Singapore. From choosing doctors and birthing options to key paediatric checks, breastfeeding support and postpartum recovery, here’s what you can anticipate as an expectant or new mum.

What types of aches and pains can be expected while pregnant?

When you’re expecting a baby, the body goes through complex physical and physiological changes. The effects of hormonal softening of ligaments, the position of the growing baby, postural changes and increased weight can put additional pressure on the joints and muscles throughout the body, explains osteopath ASHLEIGH MITCHELL of City Osteopathy and Physiotherapy.

Some of the most common issues expectant mums come to them with include neck, back and pelvic pain. However, while these types of pain can be very common during pregnancy, pain does not have to be normal.

“Treatment by an osteopath or physiotherapist can help to prevent or ease any pregnancy aches or pains, and help improve the function of the body to accommodate the natural changes occurring,” says Ashleigh. “By optimising a woman’s alignment and mobility during pregnancy, we can help to allow more space for the baby to get into the correct position for the birthing process and more space to pass through the birth canal.”

What are some other benefits of osteopathy and physiotherapy while pregnant?

In addition to helping patients resolve their neck, back and pelvic pain, Ashleigh regularly sees pregnant patients for a variety of other issues, including:

• sciatica, due to the softening of the ligaments in the pelvis and the increased load on this area during pregnancy;
• headaches, which may have a hormonal component, but are often exacerbated by the increased load in the joints and muscles during pregnancy;
• reflux;
• fluid retention, caused by increased circulatory demands during pregnancy; and
• numbness or tingling in hands or fingers, including carpal tunnel syndrome, which is commonly due to fluid retention in the limbs.

Additionally, osteopathy and physiotherapy can help with optimal foetal positioning. “Releasing tension in the spine, pelvis, hips and mechanical tensions on or around the uterus creates a more accommodating space for baby,” says Ashleigh. Can osteopathy and physiotherapy be beneficial for babies as well? Osteopathy and physiotherapy can both treat a variety of conditions noticed after birth. Some of the most common conditions include torticollis (tightness in the neck muscle that affects the position of the head), and changes in head shape – for instance, flat or misshapen – which, left untreated, can cause ongoing issues down the line.

“In utero, babies develop in a confined space. There can be a restriction of movement during the development process and this can result in tension or strain patterns after birth. Even during an unassisted, natural birth, a baby goes through an enormous amount of force and pressure to fit through the birth canal. Any added trauma such as a baby getting stuck or a C-section can cause strain patterns in the baby’s head or body,” says paediatric physiotherapist RACHAL QUINLAN of City Osteopathy and Physiotherapy.

Osteopathic treatment, she says, can help remove these strain patterns, and allow for optimal development and growth. It can also help with latching and feeding problems, colic and reflux, and any restrictions in movement, reflex issues and muscle tone issues that can affect a baby’s ability to meet their developmental milestones.

Ashleigh adds that if you notice any issues at birth such as facial asymmetry, neck tension or latching issues, you can have your baby treated as early as possible, even within the first few days.

“Osteopathy for babies is gentle, safe and generally enjoyable. In fact, babies can have treatment while they’re being fed, cuddled, distracted with toys or bounced on a ball!”

Paediatric physiotherapy, too, can treat any issues noticed after birth to prevent them from impacting on the growth and development of the baby. “As baby grows, many changes occur in the body,” explains Rachal. “Paediatric physiotherapists play an important part in monitoring alignment during these periods of growth and correcting conditions affecting the spine, hips, knees, ankles and feet.”

Even babies who don’t have a specific condition or diagnosis can benefit from physiotherapy. In fact, she says families often attend a physiotherapy review to check if their baby is growing and developing typically.

“One of the best parts of being a paediatric physiotherapist is empowering families to encourage their child’s gross motor development. This starts early by helping new parents and caregivers become confident and comfortable in handling their baby,” says Rachal. “Paediatric physiotherapists can share ideas for positioning and carrying babies that will promote important gross motor development, such as head control and rolling.”

City Osteopathy and Physiotherapy
• Raffles Place (80 Robinson Road) | 6222 2451
• Bukit Timah (1 Fifth Avenue) | 6314 4440
• Novena Specialist Centre | 6339 9936
cityosteophysio.com

How do I choose an obstetrician?

An obstetrician guides you through one of life’s major milestones; so, finding the right one is a big step. Expats in Singapore whose maternity costs are covered by health insurance usually give birth in private hospitals and see obstetricians for prenatal check-ups. However, public hospitals also provide quality care and can be a more affordable option. They’re also the only choice for those women who want to opt for water births; in fact, multiple public hospitals here in Singapore have birthing pools.

Obstetricians normally only work at one hospital, sometimes two, so if your insurance doesn’t cover all hospitals, then your choice of doctor will be limited to those who work with a particular hospital.

Every woman has different preferences for childbirth, so it’s a good idea to do plenty of research and meet with different obstetricians until you find one who you feel comfortable with. With this in mind, don’t be shy about asking questions. Everything from birth plans, pain management and foetal monitoring to a doctor’s rates of caesarean sections, inductions and episiotomies is fair game; you could even inquire about their personal philosophies and beliefs about birth.

What is a doula and do I need one?

A doula is an independent caregiver who helps make an expectant mum feel safe and comfortable before, during and after childbirth. The role of doulas differs from midwives in that they offer non-medical support to mothers. Doulas can help expectant mums follow a birth plan and assist with advice on pregnancy issues, particularly when it comes to pain management. There are also postnatal doulas who help with the postnatal period and support women with the transition into motherhood.

There are many qualified doulas in Singapore – including quite a few multilingual ones, which is helpful if there’s a language barrier between mother and doctor.

NATASHA CULLEN is a UK-trained midwife and a doula here in Singapore; she is also the founder of Beloved Bumps, which offers prenatal and postnatal guidance. Here in Singapore, Natasha finds that many couples are surprised by how much time they are left alone in the hospital, which is why many women can really benefit from having a doula.

“Unlike other countries that provide one-to-one midwifery care, Singapore runs on an obstetric-led model. So, one staff member may be caring for numerous women and be unable to stay with you during labour. If you have a doula, she can come to your home to support you in early labour, go to the hospital with you, and then help you with your baby after birth,” says Natasha.

“Having a doula means you have a familiar face during a time when you may be nervous, and they can help you to relax, remain calm and be your advocate for your birth preferences.” Of course, choosing whether or not to have a doula is a personal decision.

“Some women sign up as soon as they are pregnant, while others feel that it may be ‘intrusive’ on their time as a couple in labour,” says Natasha.

However, she says it’s important to know that having a doula does not mean that Dad is pushed aside and left with nothing to do.

“We work together as a team, and suggest ways Dad can help.”

Beloved Bumps
8809 8623 | belovedbumps.sg

Can I choose my own paediatrician?

At birth, a paediatrician will check your baby over from head to toe and arrange for the newborn metabolic blood tests, hearing screens and immunisations. This can be done either by the on-call paediatrician or the paediatrician of your choice, explains DR GINA DAHEL, a UK-trained paediatric doctor at International Medical Clinic (IMC) Children’s. However, if you choose your own paediatrician, you will need to have arranged for this beforehand and ensure your paediatrician is able to do a medical visit at the hospital where you give birth.

“Alternatively, the initial examination, as well as metabolic blood tests, hearing screenings and immunisations, can be arranged to be done in-clinic by a paediatrician within 24 to 72 hours after birth.” Even if you go with a suggested hospital paediatrician at birth, the paediatrician or GP you want long-term after leaving the hospital is always your choice.

How often should I expect to visit the paediatrician?

At seven to 10 days old, you can expect a visit to the paediatrician for a thorough examination to:

• check for any physical anomalies;
• check for the presence of jaundice and early common problems such as tonguetie or umbilical issues;
• assess growth by measuring height, weight and head circumference; and
• ensure that all the necessary checks at birth such as hearing and immunisations have been carried out; if not, they can be arranged at this visit.

After that, a medical and physical assessment of your child is typically carried out at four, six, nine, 12, 15, 18 and 24 months.

“Your paediatrician will assess and monitor the growth and development of your child against key milestones,” says Dr Dahel. “Most of these visits will coincide with vaccinations. Each visit is also a great opportunity to discuss parenting concerns or issues such as weaning and sleeping.”

What injections will my baby need and when?

Most infants receive vaccines at two, four and six months of age. These are followed by additional and booster vaccines at 12, 15 and 18 months of age. In addition to the diphtheria and measles vaccines that are mandatory by law, infants are also recommended to have a number of other vaccines to protect against serious bacterial and viral infections. “Most clinics will follow the Singapore childhood vaccination schedule. At IMC, we can accommodate all other countries’ vaccination schedules to ensure your child is completely protected,” says Dr Dahel. “If you’re unsure about which vaccination schedule to follow or you’re worried about immunisations, this can all be discussed with your paediatrician.”

International Medical Clinic
IMC Camden, IMC Children’s, IMC Jelita and IMC Katong
6733 4440 | imc-healthcare.com

What can I do to make postpartum recovery as easy as possible?

As a new mum, you might experience sore nipples from breastfeeding, blocked milk ducts, pelvic floor weakness, and other aches and pains, along with your lack of sleep. While that’s not exactly ideal, it’s great to know that there are experts here who can help.

Health2mama, for instance, is a specialised women’s physiotherapist service that can ease the process of postpartum recovery and help you with most of these new baby issues. It offers physiotherapy, personal training and wellness services for mums and babies, during and after pregnancy. These include:

#1 Postnatal massage

Body aches that started during pregnancy can continue after birth. Additional aches and pains in the back, chest and shoulders can also arise from breastfeeding and lifting a baby. While any massage will offer relaxation and temporary relief, a massage by a physio can include manual therapy and can help cure the cause of your pain, explains BEX ALDRIDGE, founder of Health2mama. In addition, massaging the stomach can help speed up recovery, firm up the tummy area and reduce swelling.

#2 Breastfeeding relief

Did you know that physiotherapy can help with engorged, sore breasts and lactation relief? Health2mama’s physios are experienced in lymphatic massage and ultrasound therapy that can unblock milk ducts, relieve pain, stop mastitis from developing and improve milk flow.

#3 Pelvic floor recovery

The pelvic floor is literally the “floor” of our pelvis. Its layers of muscles perform different functions, supporting the bladder, uterus (womb) and bowel. During pregnancy and birth, the pelvic floor undertakes a lot of additional strain, which can lead to pain, incontinence and prolapse. A pelvic floor physio can check for any damage to the area, and start you on a postpartum recovery programme as soon as possible. This can help strengthen your back, hip and abdominal muscles, and diaphragm at the same time.

#4 Diastasis recti (ab separation) healing

Diastasis recti (DR) is a widening of the abdominal muscles during pregnancy. After birth, this can result in a “mummy tummy” that won’t go away. Additionally, because the core area is less stable, back pain can occur as a result. A trained physiotherapist who is experienced in seeing women after birth can examine your muscles and assess the severity of the damage to your connective tissue. You can then retrain your abdominal muscles.

“Physiotherapists trained in treating DR can start you on a safe programme of specific exercises and progress you to harder exercise gradually. This will help the connective tissue to heal and regain its tension, improving stability and strength in your body, and also help close the gap,” says Bex. “Health2mama offers a unique online Diastasis Healing exercise programme for mums to follow at home, supported by physios.” Plus, working with a specially trained physio to correct DR can help you tone up and get in shape at the same time!

#5 Help with easing into exercise

Having a physio-trainer experienced with helping mums return to exercise is really beneficial, says Bex. Not only will it help ensure that the exercises you’re doing are safe, but it also means the pelvic floor can be strengthened and the DR healed, rather than made worse, at the same time.

If you want all or a combination of these services, it’s definitely worth booking Health2mama’s 90-minute Ultimate Recovery Session package, which takes care of these things and more.

All of Health2mama’s trainers are physiotherapists who specialise in seeing mums, so they’re super experienced in dealing with prenatal and postnatal bodies. And, whether you want to meet at the park or stick with the comfort of your own home, they can come to you, making your life as a busy mama just a wee bit easier.

Additionally, Health2mama now has nutritionists and makeup and hair stylists specialising in mums, to complement the other services and help make you feel fully revitalised in your own home.

Health2mama
6255 5250 | health2u.sg/health2mama

This article first appeared in the March 2021 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!

Have a look at maternity hospitals and insurance options too!