The system in SIN - giving birth

[2nd time around]

We're excited about moving to SIN at the end of the month – plans going smoothly and everything falling into place until I found out I will be nearly 3 months pregnant when we arrive.  Having lurked on these *** for a few months, I’ve read a lot of useful information thanks to all the posters.  

However, I assume I will need to find myself a place in the 'birth system' as soon as I arrive and I have a few questions about how that all works.  Apologies for repeating anything you may have seen many times before, but I truly have looked before I ask:

1.   Do you have to have an OB for pregnancy check-ups?  I was very comfortable (having a low risk pregnancy) going to midwives at a birth centre for my first pregnancy and would like to do that again.  It seems this option doesn’t exist in SIN, but perhaps I can go to a GP instead, leaving the OB places for women who need them?  Can you do this, and if so can anyone recommend a GP?  We’ll be looking to live in the Novena area I think.
2.   If you must go thru an OB, do you need to get a referral from a GP as you do here in Australia?  Or can you simply call up and book in to whichever one you choose?  Can anyone recommend one that advocates natural birth?
3.   Do you have to have an OB to book into a hospital?  And how do you book into a hospital – just ring them up, go for a tour and sign on the dotted line?  Does it depend on where you live as to where you can go?
4.   My first child was born in the birth centre attached to a major hospital in Sydney. No drugs, no doctor - just my husband, my mother and the midwife popping in and out and staying for the actual birth.  I was able to move around and get into the position I wanted for birth (v. important for me).  Looking at the info, the closest I am going to get to this in SIN seems to be at TMC – or are there birth centres out there, or other hospitals, that I just haven’t seen mention of?  
5.   Should I consider coming back to Australia, because it all seems very hard (and expensive) at this stage?  Has anyone done this and would you recommend it? (esp. since husband might well be in Australia for work when it happens this time anyway….)  Does it create a nightmare of paperwork in terms of dependents visa’s etc? (Reiterate here I am not considering this because of the standards in SIN, which I know are fantastic; it’s the ‘overwhelmingness’ of a new system and finding my way around it and a new country with a toddler in tow)
6.   I will need to have the nuchal translucency scan the week or so I arrive – do I need a referral from a GP to have this (as I do in Australia) or can I simply call up an ultrasound centre and book in?  Or do I need to have this done by via an OB?

A lot of specific questions I know, but I can’t seem to find the answers anywhere and so would really appreciate any advise.  

Many thanks in advance.

[awan]

congratulations and good luck with your move.
the system is easy here. you pick your own OB directly. many do the NTs in their offices, others will refer you to an u/sound facility. you book in to the hospital to deliver based on where your OB has privileges - some travel, some don't. your OB's office will advise on how to make the arrangements. there are no birthcentres. while you could probably do your check ups with a GP, most go to an OB and there is nothing to be saved by going to a GP, so not sure why anyone would do that.

[This message has been edited by BoardManager (edited 07-10-2005).]

[Friend]

I was 4 months preg when I arrived here so can understand your concerns.  Don't worry. Quick answers below.

1.  Yes you can go to a GP for prenatal check ups etc, but by about 30 weeks they would want you seeing an OB.

2. No referral needed for OB.  Ring up whoever you want and make an appointment.  You might want to have an initial visit, tell them you are seeing a GP till however many weeks etc just so you have a connection with an OB in case anything goes wrong.

3.  Here the OB usually books you into the hospital - you can't go to a hospital and have a baby by yourself.  However, unlike Australia you can pretty well book in the week you have the baby.  It's not like Aus where you book in the second you see the blue line.  No overcrowing issues here.

4.  No Birthing centre option, and midwives are NOT ALLOWED to deliver babies.  Midwives here are very much under the thumb of the medical system and are not as experienced in delivery as they are at home.

5.  Go to Australia?  Not necessary.  Paper work here to get dependents passes and passports is very easy and quick.  I've done it twice no hassel.

6.  YOu don't need a referral for an NT scan, however there is no point booking into a sonographer by yourself because you really need a skilled person to interpret it.  Also it makes more sense when viewed in conjunction with your blood work.  The top OBs have the equipment for the NT scan in their consulting rooms - so they do it on the spot - you don't have to go elsewhere.

My advice.  Wait till you get here.  Ring an OB and book in for an initial consult and NT scan.  Tell them you want low intevention etc and just a few visits.  They'll probably just want you for NT/triple test, 20 week FA scan and then at about 32/34 weeks onwards.

If you don't like the Dr you can change at any stage.  It's much easier than at home.

Singapore is a great place to have kids.  You'll be pleasantly surprised.  All the best

[This message has been edited by BoardManager (edited 07-10-2005).]

[ymk]

Best advice is not to rush choosing OB and hospital...do it once you arrive here (not before), take your time, take the hospital tours, THEN decide. Good idea is to have an OB as soon as you arrive, but you don't have to commit to that OB for the birth. As someone suggested, that OB can be as a back up in case you need help.

Be warned -- all OB's here want you sign up and commit to them (pay deposits up front) soon after you start seeing them - they are all in private practice, none are public. Hospitals are the same. I got sucked into doing this and now regret it - once I paid the deposits the service dropped of dramatically --- lengthy waits each month for an appt, rushed 2-minute OB check-ups where they forgot to do things like take my blood pressure etc. So...don't get pushed into signing up until you've seen all the OB's you want, taken all the hospital tours and are completely satisfied with your choice. Once you start making friends here with other expat mums you will begin hearing stories and getting some great advice....it's worth it to wait until you're settled before you make a final choice.

As for your questions:

1. GPs and OBs cost the same - better off with an OB. You don't want a local GP for OB  stuff, and western GPs are good, but very very busy.  It's not mandatory to have an OB but makes better sense here.  There are no birthing centres that I know of. The hospital and OB you choose will be an important factor in getting the birth you want - hospital more than OB I feel, as nurses do the majority of the birth experience anyway. There is one OB here -- Dr Ann Hagarty -- at Mt Elizabeth who I am told is excellent with vaginal deliveries with little intervention.

2. No referral needed to see an OB. Just call and turn up. Bring your Australian medical file if you like from your Australian GP/OB - they do like that. I brought mine from the US and they were very grateful. Solves alot of unknowns.  A copy of your medical file is a right, so just ask your Australian doctor.

3.  An OB is not a requirement to book a hospital, but you do have to have an OB who is registered with the hospital to do the delivery so you will be repeatedly asked this question by the hospital. My advice is not to book the hospital until you have the OB - most doctors will only deliver in one hospital, so you don't want to lock into a hospital if you then find the OB of your dreams only delivers in another hospital. For hospitals, you call, ask when they do maternity tours, turn up and that's it. Some will do the hard sell -- don't fall for it. Take your time. Tours cost nothing. Where you live has no bearing on which hospital you can choose - Singapore is a small place, so any hospital will be within easy distance anyway. You can choose any hospital you like.

4. From own research (am having second in January 06 and also arrived here at 11 weeks pregnant) TMC is a good hospital for an uncomplicated vaginal delivery. Mine is an elective c-section, therefore, I'm looking elsewhere. I think, from what other mums say here, a birthing centre experience in Singapore is dependent upon the OB you choose.

5.  The only reason I would go back to Australia to do the birth is if you are dead set on having the birthing centre experience again and you can't find it here. It's an expensive, time consuming option for you, but I can totally understand that if you put a lot of effort and research into your first birth and you just want the same thing again that you mind find it easier to just go back to Australian and do it there. God knows in the past week I have longed myself to just go back to America and do my second birth there. At least in America I know what to expect, what I want, where to do etc, and I can guaranteed the same experience. It's a personal choice -- so that's why I say TAKE YOUR TIME HERE to find the right OB and hospital.

6. You cannot do a scan here without being under the care of an OB or GP. A GP will probably refer you to an OB who will then schedule the scan. So much easier to get an OB when you arrive and get the scan done. You settle the account when you leave, without having to commit to the hospital or the OB. Ultrasound centres are in all the hospitals -- don't know of any that are separate from a hospital.

Good luck!

[ymk]

One more thing - doulas and birthing plans are very common here, but a hospital will only allow a doula if they are registered with the hospital. We had a doula for our first (in the US) and she was brilliant at navigating the US medical system for us (which is complicated at best). Most of the hospitals and OBs here that I've seen will suggest you do a birthing plan, which is a change from some countries where a birthing plan is almost unheard of and rarely adhered to.

[tmc]

Pick an OB for the NT and then shop around - there are a couple who have much better reputations for non-intervention than is the norm here.

I had my baby at TMC and the staff were very flexible, nurses were great and I more or less had the birth I wanted. I do not think this would have happened at another hospital (there were a couple of complicating factors so they had to step outside the box a bit).

At Mt E I have heard they make you deliver on a bed with stirrups (pls correct if wrong), not conducive to easy birthing! I mention this because of the other reccommendation.

[2nd time around]

Thank you so much to everyone for your detailed replies - really appreciate your comments and advice.  Am feeling a lot more confident and relaxed about it all now; just had a bit of a panic last week and needed some concrete information to help me get my head around it...

[eldery pregnancy]

Hi there,

just a little note for ya, the NT scan only can be done at maximum of 13 weeks + 6 days of pregnancy, so maybe you would need to find an OB asap once you have moved here. Good luck for ya.