Having a Baby: Pregnancy and Birth in Singapore

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Having a Baby: Pregnancy and Birth in Singapore

Singapore is regarded as a significant medical hub in the region. Pregnancy care and birth facilities are constantly being upgraded to world class standards in order to meet with the demands of an increasingly educated, well-travelled and affluent population. It is therefore a safe place to be pregnant and to give birth. Though most protocols adhere closely to accepted protocols in the UK, USA and other western countries, it's worth noting that there are social and cultural norms which may deviate slightly from the practices there.

Pregnancy Confirmation

It is customary to visit a gynaecologist as soon as a pregnancy is suspected or confirmed through a home test. One of the most important assessments in pregnancy is the dating ultrasound scan. This serves to exclude an ectopic pregnancy, but more importantly, to confirm the gestational age of a normal one. This is ideally done between seven and eight weeks, when the accuracy of ultrasound assessment has the lowest margin of error.

Where to go

Routine pregnancy follow-up in Singapore may be conducted in the public or private sector.

Advantages in the public sector include the ready availability of a large number of personnel, facilities and services, and a slightly lower price. However, waiting times are longer and there are queues for medication at the pharmacy. Public hospitals are regarded as teaching institutions so patients may be attended to by trainees. Foreigners usually have to pay a surcharge for treatment and/or hospitalisation (unlike Singapore citizens who get large savings).

Public hospitals offering pregnancy care and delivery include:

• Kandang Kerbau Women and Children's Hospital
• National University Hospital
• Singapore General Hospital

Private obstetric care, although more expensive has minimal waiting times, medication dispensed directly and more personalised and accessible care by the chosen gynaecologist. Private gynaecologists usually run clinics which may be located in a private medical centre or in peripheral suburban clinics.

Delivery is usually conducted in one of the six private hospitals in Singapore with maternity and neonatal facilities. Some of these hospitals have facilities for water-birthing and postnatal massage:

• Gleneagles Hospital
• Mount Elizabeth Hospital
• East Shore Hospital
• Thomson Medical Centre
• Raffles Hospital
• Mount Alvernia Hospital

Selecting an Obstetrician or Gynaecologist

All obstetricians and gynaecologists in Singapore are certified and accredited by the Specialist Accreditation Board (SAB) of the Ministry of Health. Unlike the situation in some developing (and even some developed) countries, the chance of encountering someone faking their credentials is extremely remote, as the community is small and the penalties severe.

A pregnant woman and her partner may make appointments to meet with and interview prospective doctors or rely on recommendations from friends and family. The choice should be based on the comfort and rapport with a doctor. When first meeting a doctor, take a list of recent medications including supplements and creams, and a checklist of expectations and queries. 

Most specialists allow for birth plans but few would do so at the expense of the safety of the mother and/or child. Doulas or birthing companions are also seeing an increasing growth in demand for their services and many of them deliver these services in collaboration with a certified obstetrician.

Pregnancy Investigations

Blood tests

Pregnant women are routinely screened for blood count, infectious diseases and AIDS. Most foreign patients will undergo rubella testing and Rhesus status assessment as well. Other high risk patients may also have to undergo additional testing for other conditions, such as diabetes, depending on their underlying risk factors

Genetic tests

Facilities for screening for Down Syndrome and other chromosomal abnormalities are widely available in Singapore. The usual tests offered to pregnant women include either the First Trimester Screening Panel, which consists mainly of blood tests and a scan of the foetus' nuchal fold at around 10 to 14 weeks; or the Triple Serum Test which is a blood test done at 18 weeks. Women who screen positively for either test are considered to be in the high risk group, at which point a definitive test, usually via amniocentesis is offered.

Ultrasound

Routine ultrasound scanning is widely practiced in Singapore as it is a perfectly safe and useful method of checking the baby's growth and well-being, and is also a good conduit for parent-child bonding during pregnancy. Routine detailed screening for developmental and structural abnormalities is usually carried out at around 20 weeks.

Some clinics also offer 3D scan which renders a 3-dimensional image of the baby's face; and even live 3D (or "4D") which displays a 3D video of baby moving. This is to be distinguished from older methods of software rendering, which is a delayed rendering process using 2D machines and which frequently produces a less satisfying image.

Prenatal and Delivery Packages

A one-off fee is paid for obstetric packages in order to simplify the payment process and also to increase the value of the services. Obstetric packages usually consist of a prenatal package which covers the visits to the gynaecologist and the routine ultrasounds; and a delivery package which covers the birthing. Package inclusions and their prices naturally vary from practice to practice.

The cost of the use of the delivery suite, hospitalisation and equipment used in the hospital will not be included in this one-off package but will be charged separately by the hospital. There is also an additional charge for assisted (instrumental deliveries) and caesarean sections.

Permanent Residents and citizens of Singapore have a portion of the costs reimbursed through the Central Provident Fund (CPF), a compulsory fund to which both groups contribute monthly.

Many insurance companies will cover pregnancy and delivery costs as long as pregnancy occurred after signing up for insurance. Some insurance policies offer additional insurance for medical cover in the event of pregnancy.

Enjoying Pregnancy in Singapore

For uncomplicated pregnancies, most doctors would not discourage an active lifestyle. There are many antenatal and lamaze classes available, as well as yoga centres and swimming pools. Many fitness centres and gyms will also have a program tailored for pregnancy.

The Singaporean diet is now so varied and cosmopolitan that it is difficult to isolate any one portion of the cuisine that may be harmful. Most Singaporean-styled hawker food, other than being a little high on the caloric meter, is safe for pregnancy. Nonetheless pregnant women should probably be wary of anything that is raw, that contains soft cheese, or that may have been cooked in unsanitary conditions.

The weather in Singapore, though unbearably hot and humid on occasion, has no significant impact on pregnancy. Most sunblocks and sunscreens are also not toxic to pregnancy, and very important for skin protection, especially Caucasian skin.

Recently published books on pregnancy are available in one of the bookstores in downtown Singapore or online from suppliers such as amazon.com and barnesandnobles.com.

• For a comprehensive set of links relevant to pregnancy in Singapore: Click here 

The Birth

Birth nearly always takes place in a hospital maternity ward. The choice of hospital depends on the type of practice consulted.

• Patients followed up by a gynaecologist practicing in a public hospital will almost certainly have the birth at that hospital
• Patients followed up in the private sector would probably be encouraged to visit and tour any of the recommended private hospitals to find the one that they feel most comfortable with (some private specialists may make their individual preferences known)

Note: Specialists working in a public hospitals are usually not accredited to conduct deliveries, surgeries or admissions in private hospitals. Conversely, private practitioners conduct their deliveries in a private hospital and not in public hospitals.

Pain relief and epidurals should be discussed with the gynaecologist before birth to ensure instructions are followed. This will speed up administration of the drugs because there will be no need to double check with the doctor if they are not in the hospital at the point at which the pain relief is requested.

Home births are not encouraged in Singapore in view of the potential risks and complications, most of which are easily averted in a hospital setting. Advocates of this practice would be hard pressed to find a doctor who is willing to bear the medico-legal risks involved in presiding over such a process.

After birth a health booklet is issued to the parents by the hospital. Vaccination and other information relating to the baby's health and development will be recorded in this booklet, so it is important to keep it safe.

A paediatrician will examine the baby and start the vaccinations.

Registering the Birth

The hospital will issue the new parents with a Notification of Live Birth form to take to the Registry of Births and Deaths (RBD) to register the newborn and collect a birth certificate.

Some hospitals have counters within their premises where births can be registered and birth certificates can be issued.

• The Immigration & Checkpoints Authority has information on birth registration: Click here

Births should be registered within 14 days from the date of birth (including Sundays and public holidays). Births registered after 14 days and within 42 days, are considered delayed registration. If parents fail to register the birth of their child within 42 days they are liable to a fine.

• Registry of Births and Deaths (RBD)
  At: Citizen Services Centre, 3rd Storey ICA Building, 10 Kallang Road (Next to Lavender MRT station), Singapore 208718

Documents required for registration and birth certificate are:

• Notification of Live Birth issued by the hospital
• Both parents' identity cards/passports, entry permits and Disembarkation/Embarkation card issued by ICA (for foreigners)
• Original marriage certificate/booklet (for married parents)
• A letter of authorisation from the parents of the child, if someone else registers the birth on their behalf

A small fee is levied at the time of registration, and some hospitals may make an additional charge for this service.

Citizenship

Being born in Singapore does not automatically ensure citizenship. For citizenship parents should refer to the country of origin's Embassy or High Commission and register the child for a passport or inclusion in the parents' passports.

Post Natal Care

The gynaecologist will be in charge of the post natal care of the mother. Babies are generally looked after by a paediatrician. Usually one is recommended by the gynaecologist, as they work closely together and ideally will practise at the same hospitals. This is especially practical at the time of birth, should the baby need immediate paediatric attention other than the routine check.

However, it is totally acceptable to choose the paediatrician independently.

Vaccinations

Singapore's infectious disease act provides for the quarantine and prevention of infectious diseases. This act and its regulations require compulsory immunisation of children against diphtheria and measles only.

Generally immunisation is provided against tuberculosis, poliomyelitis, measles, mumps, rubella, tetanus, diphtheria, pertussis (whooping cough) and hepatitis B. The chicken pox vaccine is available and will be dispensed on request. All vaccinations are recorded in the health booklet issued at the child's birth.

Immunisation programmes are available to all children in Singapore through government polyclinics, school health services, private and public hospitals and private practitioners/GPs.

Maternity Leave

The law allows eight to twelve weeks of maternity leave to new mothers who are Permanent Residents or citizens. At least four weeks of this must be taken after the birth. It is funded by the employer and government and the mother must meet a number of criteria to qualify:

• Her child must be a Singapore citizen
• She must have fewer than four other living children (excludes adopted and step children) at the time of confinement
• She must be lawfully married to the child's father
• She must have served her employer for at least 180 days before the birth of the child
• For more information from the Singapore Government: Click here

The mother-to-be should inform her employer as soon as possible and at least one week before she intends to start her maternity leave. She should also come to an agreement beforehand with her employer on how and when the leave will be taken.

The employer should, as far as possible, allow the mother to return to the same (or similar) job on return from maternity leave.

Further Information

• Registry of Births & Deaths
  At: Citizen Services Centre
  3rd Storey, ICA Building, 10 Kallang Road, Singapore 208718
  (Next to Lavender MRT station)

Information confirmed and contributed to by Doctor Kenneth Wong
The OBGYN centre, 290 Orchard Road, The Paragon, #09-07/08, Singapore 238859
Tel: +65 6738 5500, Fax: +65 6738 6889, After hours: +65 6535 8833
e-mail, www.obgyncentre.com
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