The term ‘midwife’ means ‘with woman’. Traditionally, mothers depended on specially-skilled wise women to care for them in pregnancy, labour, birth, and postnatally. Present-day midwifery is a reflection of how women have taken care of birthing mothers in past times. Midwives believe in the normality of pregnancy and birth, and in the workings of a mother’s body. They understand birth as an emotional and psychological journey.
In many parts of the world, midwives provide primary care for mothers who are going through a healthy pregnancy. In other places, either family doctors or obstetricians provide most of the care, or doctors and midwives share the care. Various combinations of midwife-led, medical-led and shared care are available in some countries.
In Singapore, obstetricians provide most prenatal care. In 2011, the National University Hospital (NUH) introduced Enhanced Midwifery Maternity Care (EMMa Care), giving mothers greater access to midwives, and another option for prenatal care. We find out more about this from the programme’s lead midwife, and from a mother who chose the EMMa Care route when she was pregnant.
A MIDWIFE’S PERSPECTIVE
Ms Pua Siew Keing is the Nurse Manager & Lactation Consultant at the Department of Obstetrics & Gynaecology at National University Hospital.
What does an EMMa Care midwife do?
The EMMa midwife supports, educates and advises expecting mothers and their spouses throughout pregnancy, during labour and in the postnatal period. This includes assistance in birth planning, access to a helpline, prenatal nutritional advice, and breastfeeding and early parenting support and education for two months after birth.
In this way, EMMa Care offers seamless one-to-one midwifery support as mothers transition
through pregnancy, birth and new motherhood. Mothers benefit from the support of an EMMa Care midwife, regardless of the type of birth they have.
How does EMMa Care complement the prenatal care provided by doctors?
EMMa Care offers mothers obstetric-led collaborative care. Midwives work in tandem with doctors throughout the pregnancy. The doctor ensures that the pregnancy is progressing well by performing physical checkups, ultrasound scanning and prenatal testing. The doctor also advises on the most appropriate intervention if required. The midwife attends the clinics, so mothers receive care from both.
EMMa Care combines the gentile, holistic approach of midwifery care with the safety of doctorled care so that the mother is at the centre of all our efforts and consideration.
How does having an EMMa Care midwife differ from having a doula?
Like doulas, midwives offer physical, emotional and informational support. The midwife is also able to perform some medical procedures such as physical examinations. This means that you will not be exposed to different healthcare workers if a procedure is necessary.
What are mothers’ experiences like?
For mothers, having someone to answer all their questions, and having help on hand as they prepare for labour and childbirth is important. Many labouring mothers also find having a familiar midwife with them throughout labour immensely comforting. Having the same midwife available to help with breastfeeding and newborn care after birth is a major de-stressor.
This continuity of midwifery care that EMMa Care provides results in shorter labours, less medical pain management, and fewer assisted and caesarean births. Mothers also report that they are more satisfied with their births. A growing number of referrals to EMMa Care indicates that mothers are satisfied with their experiences in the programme.
How much does it cost?
Mothers opting for EMMa Care pay between $86 and above $1,550, in addition to the usual antenatal package fees. The exact fees you pay would depend on the extent of midwifery care you choose, ranging from a one-time consultation with a midwife, to the complete package.
When do mums-to-be sign up?
Mothers are encouraged to sign up for the programme before 36 weeks of pregnancy, to allow their personal midwives to understand their needs better. However, it is possible to sign up anytime during pregnancy.
How do you see midwifery care progressing in Singapore?
In the long run, I hope to see more collaboration between midwives and doctors in supporting mothers in their pregnancy journeys. I also encourage all first-time mothers to seek out and receive continuous care and support, given that they may have many new experiences and require assurance or advice.
A MOTHER’S PERSPECTIVE
Mrs Chang, 30, is mother to a two-month-old baby boy. She shares her experience of a waterbirth with the EMMa Care programme.
“My baby’s safety was my biggest concern. I also wanted a natural birth without any pain-relieving drugs, as I did not want any side-effects for my baby or myself. I requested that no drugs be offered to me, unless I myself asked.
I planned on having a natural birth. Being a first-time mother, I also wanted to tap on the midwives’ expertise to guide me.
I found my birth experience quite positive. My baby was born within two hours of being admitted to the hospital. My midwide was with me throughout my labour and birth, constantly supporting and encouraging me. She advised me about when to start pushing, and even helped deliver my baby!
After the birth, my midwife and the EMMa Care team came to visit me and checked if I needed any help with breastfeeding. They showed me how to nurse my baby using various nursing positions. There was also a one-to-one hands-on session to guide us through bathing our baby before we left the hospital.
At my postnatal checkup two weeks later, a midwife at the clinic checked on how I was coping with motherhood. She also provided advice and answers to the problems I faced.”
Is EMMa Care for me?
Like Mrs Chang and numerous mothers who have had babies before you, you too will face choices about your birth team and your place of birth. Understanding the full range of options available helps you make thoroughly informed decisions, while taking into account your goals, as well as practical concerns like location and cost.
(See also: Hospital Maternity Packages in Singapore)