Prenatal Care in the US vs Singapore

I know this may be boring for some readers, but it has been a while since I talked my experiences with prenatal care here in Singapore.

It is indescribably hard for me to say this, but….(looks furtively around, then whispers) I might like it better than my US options.

Don’t get me wrong…I LOVE my US obstetrician.  She is amazing, and I don’t know that I’d have hit the level of comfort with Singapore’s prenatal care that I have without her support and guidance throughout the process (making sure I knew what tests she thought were important, walking me through what my previous pregnancy’s course of action would mean for this pregnancy, etc).  In a perfect world, I wish she could deliver #2 because she’s the one who safely got Elanor out into the world.  But in that perfect world, we’d be operating under Singaporean rules, not US rules.

What’s so great about prenatal care in Singapore?

An important word before I begin–this is true only if you find the right provider for YOU.  I went through 5 OB’s before I found a good match for my approach to pregnancy/childbirth.  A general rule of thumb is that older (and especially older male, but also older women in my experience) OB’s tend to be patrician-esque and pat you on the head or get pissed at you for questioning their epic superior knowledge of all things childbirth.  Younger docs (and perhaps especially younger female docs) are the ones who are more likely to be open to giving you more say, and keeping you in the loop better.  Some of this is cultural–the most common thing I’ve read on local pregnancy boards about what constitutes a good doctor is “he doesn’t tell me things I don’t need to know/ he doesn’t worry me about things.”  This is very much not the American (and certainly not MY) approach to pregnancy, where knowledge is power, and if you tell me that there’s a “risk” of something, that’s just not good enough–what studies are you reading and is it a statistically valid “increased risk” and have those studies been repeated and peer reviewed and and and.

Keep in mind I can only speak to my own experiences at private hospitals with doctors in private practice.  BUT…if that is the route you’re interested in going, read on…

  • You can customize your care

Most people in Singapore have either no insurance, or insurance like ours, where we pay up front and then claim back the costs from the company directly.  I’ve only run into one doctor in Singapore that offers direct billing to insurance companies, and they’re not an OB/GYN (they are however, our PCP/pediatrician’s office…comment if you want their name/info).  What this means is that you are talking costs with your provider directly.

The general attitude of most doctors here is that if you want to pay extra for “additional” testing or want to opt out of a test that you don’t feel is necessary, there’s very little pressure to do otherwise.

There are doctors here (and friends have used them) who are much more hands off than doctors in the US (fewer tests/ultrasounds/visits/etc), and one doctor who will assist during home births (although home birth was never something I considered for myself, even before I had the high risk label).

In my case, which is a “high risk pregnancy” because I’m diabetic with pregnancy, and due to complications at the end of Elanor’s pregnancy, I’m also at a fairly high risk of developing a condition called pre-eclampsia at some point in October…my pregnancy was always going to be a more “medical” pregnancy. In the US, my insurance would dictate the regularity with which I would see my OB unless I developed a complication.  But here, I have the freedom to see my OB as frequently as we agree is best for my and the baby’s care.

  •  The care you receive is personalized

With this pregnancy, I’ve needed to be rehydrated via IV on several occasions (at this point I’ve lost count) during office hours and I had one little accident that required some after hours care.

In the US, regardless of office hours or not, at least at my hospital in Boston…I would not have gone to my OB’s office, but rather the hospital’s “Labor and delivery triage” center.  An attending physician or an intern would have placed the IV and done the monitoring.  The only way I would see my OB is if she were “on call” that night and in the hospital.

In Singapore, my OB has always placed the IV herself, and the night I had the accident, she came in from home to check me out herself.

In the US, there was always a chance that my OB wouldn’t be the one to deliver my baby…if it was a colleague who was on call, they’d be the one to deliver the baby.  In fact, I remember being relieved that my labor lasted past 6pm on Sunday Nov 2, 2008 because that was when my OB came “on duty” and I knew I’d be having the baby before she was off duty.  Part of me had spent most of the day wanting Ellie to take her time coming out so that Dr T would be there (of course once Dr T was on duty, I was more than ready to get on with the show…but it was almost 12 hours later before Ellie decided she was ready to come out).

In Singapore, barring vacation, I have no fear that my OB won’t be available for my delivery.

  • Doctors, not hospitals set policy regarding births

It is hard to put into words how much I want to make out with this fact of birth in Singapore.

In the US, there are rules about how long a pregnancy (particularly a high risk pregnancy) can last.  There are rules about how long a labor can last before interventions are taken.  There are rules about just about everything under the sun.  Regardless of what your doctor personally may think of them, they are required to abide by those hospital policies.

In Singapore, I have been allowed to have a say about how long I want to push the pregnancy (some hospitals in the US and doctors in both the US and Singapore require diabetics to deliver at 37 weeks, the absolute start of “full term” but my OB has consented to 39 weeks assuming everything else is ok).  I have a say in things that are routine here but not in my home country (shaving the pelvis, enemas, episiotomies).  I’ve been able to customize things like how fancy a room I want (there’s everything from a 4 bed ward to a 2 room suite that could rival any high-end hotel for luxury–and price) and that I want a mini-fridge in my room (which makes me freakish because new moms aren’t supposed to drink cold beverages in many local Asian cultures).

In the US, there are a limited number of pain relief options.  I have significantly more options here in Singapore, and I plan to avail myself of several of them, including tens therapy (if you’ve ever got physical therapy you’ll know what I’m talking about) and nitrous oxide as well as epidurals (which, yes, I also plan to get–I’m not into “natural” childbirth, but its cool if you are–just please don’t give me a lecture about *my* body and *my* choices).

  • There is plenty of support but far less pressure to breastfeed

I realize I’m about to step onto some very controversial ground here, but…

While I am very pro-breastfeeding and think that there should be all the supports necessary to help any mom who WANTS to breastfeed or who CAN breastfeed, the level of pressure and drama surrounding breastfeeding, particularly for middle class and upper class women has gone much too far in the US.

I have reason to be very sensitive about this topic.  As a diabetic, it was always a possibility that I might have lower than fabulous supply.  Having a child who went through the kind of medical hell that Elanor did and the amount of stress it placed on our family certainly didn’t help in that regard.  I have a mild form of bi-polar disorder and there are NO mood stabilizers that are compatible with breastfeeding.  With Elanor, I made the mistake of pushing on far past when it was emotionally healthy for me to do so, in large part because I felt like truly “good” moms breastfed.  There have been the numerous moms who told me that my doctors were trying to sabotage my breastfeeding relationship with Ellie when they asked that I keep pumping for her and add fats to my milk to give her extra calories because my daughter couldn’t gain weight on her own…none of these mom were doctors, or had read my child’s file, for the record.  The coup de grace was when I found out that my daughter was allergic to my breastmilk.  Even though it made me a wreck, I tried the elimination diet for a few weeks…and it still didn’t do any good (oh, and bonus! my supply tanked further).  Which was when I quit at close to six months….and much, much later than I should have.

I was lucky–even with all of those voices (and all the dirty looks I got when I gave Ellie bottles of breastmilk, thanks sanctimommies of the Greater Boston Area)–I had a fantastic support system.  My dear friend Aimee even generously donated a bottle of expressed milk a day, allowing me to keep Ellie formula free for as long as I could.  Many friends let me pump in their homes, and would even keep me company (even if I still endure jokes about my resemblance to a cow connected to a milking machine to this day).  I was championed by Ravi.  I was able to financially afford multiple pumps and pump parts to minimize the number of times I had to wash parts.  My aunt came and helped out so that I could pump and watch Ellie (and even eat or occasionally shower).

And I was especially lucky that my friends also all supported my decision to stop.  I’ll confess that there were a few superficial friendships that ended when I was told that I hadn’t done enough (mostly online friendships that had previously developed in my “birth community”), but my friends all supported me.

On our recent trip home, though, I made a point of paying attention to the attitudes about breastfeeding.  They’re even more rigidly in the breastfeeding–good mom, formula–bad/lazy mom camp.

In Singapore, there is a pragmatism that just doesn’t exist in the US.  In part this is because the majority of local moms HAVE to go back to work, and there is no cultural or legal support for them to pump (which isn’t to say that some don’t manage, but it’s much much harder).  There are support networks for moms who want to breastfeed.  Articles in parenting magazines support it.  But few, even for a second, will question your quality as a mom if they see you give a bottle to your kid or buy a container of formula.

As someone who wants to breastfeed and will do so as long as it is the right choice for me and my family, I’m relieved to know that if there comes a day when it isn’t…I won’t have to answer to a chorus of strangers judging me.

The freedom to make the choice that’s right for my family without judgement actually makes me feel more brave and ready to try breastfeeding.

I have to say that I feel very confident about having my baby here…and that the confidence I have is hard earned.  I wanted to think Singapore couldn’t possibly top my care in Boston–one of the medical centers of the world.  But I have to concede…there are ways in which I’m happier here.

For those interested in my personal countdown…

I am 37 weeks (full term) on October 25

I am 38 weeks on November 1

I am 39 weeks, and the latest we’ll let the pregnancy progress, on November 8

If a miss a day of posting between now and then, don’t assume I had the baby.  Trust me…I’m not going to hide that fact, and the blog will be one of the first places I announce it.

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15 Responses to Prenatal Care in the US vs Singapore

  1. Laura says:

    Good luck for the rest of your pregnancy and I look forward to reading your hapy news in due course.

  2. Dawn says:

    I have to say I’m very happy with the Mount Auburn midwives here in MA. They are just cautious enough when there is a concern (e.g. recommending an ultrasound when they weren’t sure if the baby’s head was down just from feel), but not overly so (e.g. not recommending any more ultrasounds after it was clear my cyst had shrunk and the placenta had moved out of the way). They also don’t hesitate to recommend treatment when advisable or necessary (e.g. the epidural I swore I wasn’t going to get before actually being in labor with #1).

    It’s the helper nurses…ohh, the nurses…they like to give you a scare by telling you about all the horrible things that can go wrong. One of them ended up freaking me out in the exit interview after #1’s birth that I apparently looked like I was about to faint, and then she yelled at my husband and said I needed therapy (!!!) I’m trusting my hubby to not leave me alone in the room with one of those for #2.

    As for breast-feeding, unfortunately I do think that while there is some cultural pressure in some circles to breast feed, the formula industry also has a LOT of power in terms of advertising and free samples and uses it to give women the impression that formula is just as good as breast feeding, and entices them to supplement and eventually wean unnecessarily when they are at the end of their ropes with bf, which is NOT easy for most moms/babies.And your case is actually a really good example of why it’s not just a choice. If I were your doctor, I would think you were crazy for wanting to breast feed; given the medications you’re better off being on, the ONLY reason why breast feeding would be a good option for you is if the hormones produced during breast feeding were a good substitute for those meds. (In my case, this was true; I have some serious issues but while breast feeding, they went away entirely.) In your case, the advice should have been, you’re welcome to try to breast feed, but if in *give time frame, probably weeks* you’re not feeling great, then go ahead and wean. And note that, at least IME, pumping did NOT bring the same euphoria that direct bf’ing did, so since E’s allergies prevented her from nursing happily, you’ve never had the opportunity to really experience that prolactin rush, so it’s reasonable for you to try again with #2 if it’s something you want to do – but don’t hesitate to go straight to formula if you’re not doing well.

    However – and this is where I think most moms who wean too soon go wrong, especially when it’s under a doctor’s advisement – don’t just start supplementing with formula because there’s a concern with the baby’s growth or some medical condition like jaundice; there are very few babies that will *actually* fail to thrive if the mother keeps at bf’ing without supplementation. Sure, they might lose some weight while mom’s supply is stabilizing (my #1 lost nearly a pound in the two days after she was born), but pediatricians these days (especially older ones that still have a stigma against bf’ing left over from the last generation when it was considered undesirable) seem to jump at the first opportunity to tell moms to supplement or switch to formula, and once they start supplementing, it’s pretty much all over, because even if you’d naturally have adequate supply, pumping doesn’t simulate demand nearly as well as a baby at the breast, and with the baby getting what he or she needs from formula, she’s not creating demand herself, so supply wanes, and then it’s all over. Worse than that, women are left with a very negative impression of bf’ing because, while nursing is AWESOME when it works, pumping universally sucks. It hurts, it doesn’t feel good, and you have to clean everything afterwards. And I’m guessing if they studied moms who only breast-fed, moms who pumped & bottle-fed breast milk, and moms who only formula-fed, you would find almost no difference in the health of the mother or baby between the latter two – that in essence, the benefit of breast feeding is largely due to the nursing process (composition changing as the feeding progresses and for different times of day, bond between mom & baby, etc.) and that if you’re just going to do stored breast milk in a bottle, it’s not much different from formula.

    • Dawn says:

      Oh, I will add that while my pediatrician did not tell me to supplement or switch to formula, I WAS told to supplement with vitamin drops – something they ONLY ask breast-feeding moms to do, because the formulas already have the vitamins added. In essence, I was told that since I’d chosen to exclusively bf, my baby wasn’t getting adequate nutrition. If that’s not pro-formula pressure, I don’t know what is.

      I’m now thinking those vitamin drops are about as important as the prenatal vitamins I never took. We were pretty bad about giving them to F; we couldn’t get her to take anything directly – she’d just spit it out – so it had to be mixed in a bottle, and she only got bottles if I wasn’t with her, which was only for a few hours, a few days a week – and even then, since she didn’t always take the bottle or the whole bottle – I think she could actually discern the difference in taste with the drops – she wouldn’t necessarily get the vitamins into her even if the person taking care of her remembered to put them in. Since she’s healthy now, and since babies have survived for millenia without any supplement to breast milk, I conclude that this is just another ploy by the formula industry to scare mothers into formula-feeding so they can make money.

    • Dawn says:

      Oh, and one more thing – one of the things they say about breast milk is that it carries antibodies to your baby. Well, your baby apparently gets most of the antibodies from you *before birth*, not during breast-feeding. A friend of F’s at school got the chicken pox (even though she was vaccinated), when her little brother was just a couple of months old, and had already been weaned to formula (due to supply issues, though the mom started supplementing immediately after birth, so who knows if she could have kept up if she had forced him to exclusively nurse). The pediatrician’s advice was to expose the little boy to the pox and hope he gets it, since he was too young to be vaccinated, and having the pox would actually provide better immunity than the vaccine. However, although he was not getting ANY breast milk, he never got the pox, so clearly he still had immunity left over from before birth.

      • Crystal says:

        You and I have probably debated this thing to death in person, and I think everyone who knows us knows how unlikely it is to get us to fully agree. But I respect you taking the time to present alternative views, and also appreciate that your presentation of those views is far more tempered and balanced than many many many women I’ve met in the last almost 3 years (such as your acknowledgement that given certain health conditions, there should be someone trying to be the voice of reason that maybe, in my case, breastfeeding might not be the best idea ever).

        At the end of the day, I think the thing that I wish I could communicate to new moms above all else….as a 6th grade teacher, I could easily point out who had involved parents and whose parents weren’t as involved. I couldn’t tell you who’d been breast vs bottle fed. Be a loving and involved parent. Be your child’s advocate. But beware of overly subscribing to any parenting theory or agenda…remain flexible in order to do what’s right for you or your babe. I think my best choices as a parent have often been when I stopped paying attention to what I thought I *should* do, and looked at what my daughter needed and what worked best for our family. And…this too shall pass is a mantra every parent needs.

      • Dawn says:

        Well said, Crystal. Every mom should feel free to do what’s best for her and her family, and other moms should never bother her about it. However – all moms should be ready & willing to offer HELP to other moms, whether it be breast-feeding advice (along the lines of how-to tricks, not should-be-doing criticism), hand-me-down clothes, or simply a sympathetic ear. Hopefully you’ll have all the support you need over there. 🙂

      • Crystal says:

        I have some good friends and some professional resources I plan on availing myself of. And one can’t underestimate the awesomeness of a helper 🙂

  3. bookjunkie says:

    Feel so fortunate to be able to share in your journey. Thanks for blogging all the way.

    I too have had much better experiences with younger female OBGYNs for the reasons you’ve stated. They are more open and less likely to talk down to you.

    Never thought about it much, but there is much less pressure to breast feed in Singapore.

    • Crystal says:

      I think pressure to do anything as a parent can turn good intentions toxic, and the pro-breastfeeding community has done a lot of harm in their efforts to help new moms and educate them.

      The thing I love best about the option to bf in singapore are the malls with the gorgeous baby rooms. They don’t ask me to nurse in a toilet, but instead give me a tasteful air conditioned private place to go. Which is also nice if I want to share a moment while bottle feeding.

  4. Stacey says:

    Nice to hear about your experiences. I’ve had such a range of stories from people here it’s hard to know what to think. This comparison is by far the most helpful thing I’ve read. My husband will be glad to hear that we shouldn’t flee from here before we have kids. 😉

    • Crystal says:

      I really did want to find a reason to complain or to flee, but Singapore really surprised me. With the right doctor, I think it’s a great place to have kids. Happy to privately pass along my ob/gyn’s contact info if/when you want it. I love her.

  5. Dawn says:

    Oh, by the way, I just thought of a reason you can feel GOOD about formula-feeding, whether or not it is necessary.

    For some moms/babies, formula is necessary. You found this out with E. BF’ing was not a viable option for either you or her, due to her allergies and your medical issues. However, even formula was an issue for her; generic wasn’t going to cut it; you needed a special formula that would agree with her. The formula industry needs revenue to develop better/specialized formulas, and they can only get revenue if enough people buy their product. So – if you choose or are forced to formula feed – you are indirectly helping future moms who cannot breast feed.

    That is, of course, assuming that the formula companies use their revenues to continue to improve their formulas, rather than to aggressively advertise their product to moms who would be better off without it. (Note my anger is towards the industry, not the moms; for generations the formula industry has been deliberately undermining breast feeding, and for good reason: to them, every breast feeding mom is a lost customer.)

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