Childbirth in a time of Covid-19: Online doulas and virtual lactation consultations

Ms Vanessa Bay and her husband Roderic Tay welcomed their son, Matthias, on April 7, the day the circuit breaker took effect. PHOTO: COURTESY OF VANESSA BAY

SINGAPORE - While preparing for the birth of her first child, Ms Vanessa Bay found and lost not one confinement nanny, but two.

Ms Bay, 32, had hired a confinement nanny with 25 years' experience, who had returned to her home in Malaysia in between assignments. Confinement nannies, who help parents care for newborns, typically come from Malaysia.

But from March 18, to curb the spread of Covid-19, the Malaysian government barred all travel abroad.

On March 25, Singapore's Ministry of Manpower announced similar restrictions on confinement nannies. There is only a "very slim" chance of entry approval for those applying to bring in confinement nannies from overseas, according to the MOM website.

Ms Bay scrambled to find a replacement. But when she arrived home from hospital, with her two-day-old son in her arms, she was informed that the confinement agency she had engaged, which had lined up a replacement among the nannies already working in Singapore, had suspended operations.

"It was a double whammy but there was no choice; we'd been dealt this hand of cards. I'd wanted a confinement nanny so that my mum, who lives with us, does not have to work so hard," she says.

Ms Bay is married to Mr Roderic Tay, 36. The couple, who both work in human resources, welcomed their son, Matthias, on April 7, the day Singapore's circuit breaker took effect.

Early in the morning, her 66-year-old mother boils herbs used for confinement tonics, cooks meals and helps with diapering.

These and other unexpected challenges in pregnancy and childbirth during Covid-19 have thrown a spotlight on increased anxiety among women at this vulnerable juncture in their lives.

There is currently a long wait list of mothers-to-be desperate to secure a confinement nanny, says Mr Liew Fong Chee, director of Confinement Angels.

"Our pool of trained and certified confinement nannies from Malaysia are getting very tired working for one family after another here. They work around the clock as newborns need to feed every two or three hours," he says.

Confinement nannies are usually hired for a month, and they often go back to Malaysia for rest and downtime between jobs.

"We are doing what we can to ensure they have enough rest yet minimise disruption to our clients," he says.

Mr Jason Phua, HR director of PEM Confinement Nanny Agency, says that extended circuit breaker measures could worsen the shortage as exhausted confinement nannies might choose to return to Malaysia.

His agency, which has around 280 confinement nannies currently working in Singapore, has seen its supply of nannies slashed by about 40 per cent.


Besides difficulties in engaging confinement nannies in a lockdown environment, other traditional forms of post-partum support are also no longer available.

Ms Sharon Chan, who is 39 weeks pregnant and about to give birth, says: "People usually have a combination of help, such as a confinement nanny, family or a domestic helper. I was expecting to have one of the three; now I have zero."

The 37-year-old Australian expatriate, who works in a technology firm, is a single mother who lives alone. Her plan was for her mother, who lives in Sydney, to travel here for the birth. But it was not to be.

The supply of new domestic helpers has also withered amid pandemic travel restrictions.

"There's a lot of uncertainty and it's been tough. The regulations change quickly so you don't know what to expect," she says.

Many other rites of passage to prepare first-time parents have been derailed by Covid-19.

For example, group antenatal classes, which teach breastfeeding, breathing exercises and infant care, have been disallowed under social distancing rules.

This poses problems on many levels, says Ms Wendy Tay, director of ParentLink, which provides pregnancy, childbirth and post-partum services.

"The birth of a child is such a transforming part of their life that it is critical that they be supported. If you want to be a confident parent, you have to start off on the right foot," she says.

Ms Uma Thambidurai, director of Mother and Child, which offers pre- and postnatal services, says that the early days after childbirth are already an isolating time because the mother has to feed her infant so frequently, sometimes every hour or so. This sense of isolation can be exacerbated under strict stay-home conditions.

As such, Mother and Child is offering a virtual meet-up, which starts on Monday (April 27), for mothers of infants, with a midwife on hand to answer any questions they may have. The organisation also offers help with lactation via video consultations, where the consultant can observe the baby's jaw movements and swallowing rhythms to ensure the newborn is suckling well.

Hospitals like KK Women's and Children's Hospital (KKH), National University Hospital (NUH) and Thomson Medical Centre (TMC) are also offering virtual consultations and services for parents of newborns, as it is now challenging to have face-to-face consultations.

KKH, for example, has arrangements in place to provide pasteurised donor human milk from the KK Human Milk Bank to mothers with suspected or confirmed Covid-19 infection, who are physically separated from their babies.

Thomson Medical has seen demand for its confinement food home-delivery service increase by 20 per cent during the coronavirus.


For Ms Bay, whose plans to hire two confinement nannies fell through, other careful preparations for her baby's arrival also went awry.

She hired a doula when she was six weeks pregnant. But no one, except her husband, was allowed by her side when she gave birth, in line with Covid-19 regulations at her hospital.

A doula is a trained professional who provides support to a mother before, during and shortly after childbirth.

Her doula, Ms Leila Ng Caceres, 32, who is part of the executive committee of Doulas of Singapore, ended up supporting her on a WhatsApp group chat with her husband after her contractions started.

Ms Ng Caceres even advised Ms Bay's husband on how to help her manage the pain of labour, by using a water bath -- all done virtually.

It was not part of Ms Bay's plan, but virtual doulas and online lactation consultations are now part of the new normal wrought by the coronavirus.

And some new mothers see a silver lining, namely more involvement from their husbands, because of mandatory work-from-home arrangements.

Legal counsel Noor Syuhada Mohamad Rafeek, 29, gave birth to her first child, Mohammed Yasser Shukri, on March 10. Her husband, mechanical engineer Shukri Abdul Jalil, 31, now does the groceries for their household of four, which includes a domestic helper.

Legal counsel Noor Syuhada Mohamad Rafeek with her husband Shukri Abdul Jalil and their son Mohammed Yasser Shukri. PHOTO: COURTESY OF NOOR SYUHADA MOHAMAD RAFEEK

"There are three people taking care of my son, so it's less taxing on me. Both my husband and I are at home so we both have quality time with our baby," she says.

"Sometimes, my husband puts the baby in the baby carrier when he's sleeping and goes on his Zoom meetings."

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