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.