You’re pregnant – congratulations! Now what? You’ll probably have a lot of questions. When do I need to stop travelling? Should I have a home birth? Which doctor should I go to? Should I consider using a doula? And what else needs to be planned before giving birth in Singapore?
“Your doctor can confirm the pregnancy on a urine test or blood test in the clinic. He or she will then discuss any signs or symptoms you may start to experience in early pregnancy and what to expect with regards to changes to your body,” says DR SONALI DASSANAIKE at IMC Camden. “Your doctor will talk to you about symptoms such as pain or bleeding in early pregnancy, which should be highlighted to a doctor as soon as possible.”
The antenatal blood tests can be done with your GP or when you’re referred to an obstetrician, who will see you in the clinic between six and 10 weeks, explains Dr Dassanaike.
“The initial antenatal blood tests include checking your blood type, rhesus status, blood count and thyroid levels; checking for hepatitis B, HIV or other viruses; screening for syphilis; checking Rubella immunity status, and more,” she says.
“Your obstetrician will do an initial scan to make sure that the pregnancy is developing within the womb, to check the foetal heartbeat and also to date the pregnancy.” She adds, “Your obstetrician will also discuss with you the important routine screening tests that are required at different milestones.” Between 10 and 14 weeks, for example, you’ll be offered a combined blood test and scan to check for chromosomal abnormalities including Down syndrome.
Assuming all is well, you’ll continue to have regular visits with your obstetrician to make sure the pregnancy is developing normally and for routine screening , which usually involves blood pressure checks, urine tests, foetal measurements and scans, says Dr Dassanaike.
But, what about those burning questions and concerns in between your monthly visits to the obstetrician?
“During your pregnancy, you can also consult your general practitioner at any time in between the appointments with your obstetrician for any pregnancy related concerns, as well as the usual non-pregnancy-related medical issues; your GP can liaise with your obstetrician if it’s deemed necessary,” says Dr Dassanaike.
Travelling during pregnancy
It’s always a good idea to be up to date with your vaccinations prior to getting pregnant, as certain inoculations required to travel may not be recommended during pregnancy. Also, travelling to high-risk zones of Zika virus and malaria may also be advised against, as these infectious diseases and others can be harmful during pregnancy.
As for flying itself, Dr Dassanaike says, “There is no evidence that flying is associated with an increased risk of miscarriage or premature labour. Most airlines will let you fly until 36 weeks, but some have an earlier cut off at 32 weeks, so it’s important to check this with the airline ahead of time.” But, since pregnancy puts you at an increased risk of blood clots, Dr Dassanaike says it’s important to consider the duration of the flight. She also suggests drinking plenty of fluids to avoid dehydration, and to move around regularly throughout the flight.
For car travel, she says, “It’s important to have seat belts, with belts that go above and below bump rather than over it.”
Planning your delivery
Choosing the right obstetrician to guide you through one of life’s major milestones can be daunting. 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.
“The private hospitals are very good at providing high-quality care for expat families, and always allow you to follow your birth plan. The public hospitals are also good, and usually cheaper, though the willingness to follow your birth plan may vary,” says DR LEO HAMILTON, senior paediatrician at IMC Paediatric. “Be aware that with the private hospitals you can elect to have your paediatrician of choice be there after the delivery. The public hospitals only allow their own doctors and training doctors to attend.”
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 (yes, epidurals are very common here, if that’s what you’d like!) 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 doulas do
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 hey offer non-medial support to mothers. Most doulas will have a lot of experience and knowledge about labour and delivery. 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 many qualified doulas in Singapore – including quite a few multilingual ones, which can help if there’s a language barrier between mother and doctor.
Choosing a paediatrician
“Most obstetricians in Singapore tend to expect you will see the paediatrician they suggest, even in low-risk births,” says Dr Hamilton. “Most have relationships with local group practices and tend to always refer to them. However, it’s never required, and you can have whoever you want to be there in the hospital. You may not be asked if you have a paediatrician you want, so sometimes you’ll need to be the one to ask (or demand!). Even if you go with a suggested hospital paediatrician, the paediatrician or GP you want long-term after leaving the hospital is always your choice.”
Is it possible to have a home birth in Singapore?
“Yes, but most obstetricians do not provide them (you can ask IMC for a doctor that does). There is also an option to deliver in a more private setting with Four Trimesters, which operates a safe and very well managed ‘Birth House’,” says Dr Hamilton. “Few paediatricians will go to a home birth (I’m one of the few who does), but more are available who will see you at Four Trimesters. The availability will likely grow here as more and more doulas and midwives practice, but it’s not a strong tradition in Singapore.”
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