NUH midwife scheme helps with unassisted births: Study

Midwife Kelly Er (centre), who is with EMMa Care, helped Mr Wesley Lim and his wife Stephanie with the natural birth of their daughter Agnes.
Midwife Kelly Er (centre), who is with EMMa Care, helped Mr Wesley Lim and his wife Stephanie with the natural birth of their daughter Agnes.PHOTO: NATIONAL UNIVERSITY HOSPITAL

More mothers delivered without need for caesarean section, use of instruments

Expectant mothers who sign up for an optional midwife scheme at the National University Hospital (NUH) seem to have a better chance of giving birth unassisted. This is according to a study by NUH on its Enhanced Midwifery Maternity Care (EMMa Care), which was set up two years ago and costs $1,450 for the full package.

Those who opt for the scheme will be put in touch with a midwife earlier in their pregnancies instead of just before labour. They can talk about issues such as birth positions with the midwife, have the same midwife with them during labour and continue to be in contact with her two months after giving birth.

"It is quite common for patients to ask for extra help, like painkillers, as they enter the later stages of labour," said midwife Kelly Er, who was involved in the study published last month in the British Journal of Midwifery. "That is when we give them additional support to calm them down, (and) tell them that everything is going along normally."

The familiarity of having the same midwife through the pregnancy helps patients feel less anxious. The midwife, who will be able to better understand the mother's needs and concerns, will also be in a better position to give advice, added Ms Er.

The service can also be useful for those with a higher risk of complications - for instance, diabetic patients or women expecting twins, she explained.

The study, done on the first 100 mothers who signed up for EMMa Care up until August last year, found that 75 per cent of them managed to have an "unassisted birth". This means that they did not require a caesarean section and their babies were delivered without the use of instruments such as forceps and vacuum suction.

More than half did not use painkillers such as nitrous oxide gas and epidural injections during labour. And nearly 80 per cent who had a caesarean section before also managed to deliver normally.

These figures are better than those registered in 2011 among women not on the scheme. Out of 2,447 births then, just 63 per cent were unassisted, while 65 per cent of patients who previously had a caesarean section gave birth the normal way. Painkiller use was also more common, although exact figures are not available, said NUH, adding that further studies on EMMa Care are in the pipeline.

Meanwhile, KK Women's and Children's Hospital said it does not run a similar scheme. Instead, women with straightforward cases can choose to be cared for by a team of midwives after the first 28 weeks of their pregnancies. The midwife will continue educating mothers, for instance on breast-feeding, after the baby is born. But there is no guarantee that the same midwife will be with the mother when she goes into labour.

Sign-ups for EMMa Care have doubled from 2011 to about 100 this year. Most are interested in natural methods, such as giving birth in a water tub, said NUH.

Earlier this year, housewife Stephanie Lim, 28, opted for a "birthing stool" for her first daughter Agnes. The crescent-shaped seat helps mothers to get into a comfortable squat position during labour.

"To be honest, I had underestimated the pain," she said. But the constant assurance of her EMMa Care midwife helped her through an unassisted birth. Being able to contact the midwife any time was also a big plus. "As a first-time parent, there were many things that I did not know."

Meanwhile, Agnes' father Wesley Lim, 29, believes midwives have an important role during pregnancies. "It is not just the doctor who matters," said the civil servant. "When it comes to emotional support, midwives do it better."

chpoon@sph.com.sg