One-to-one midwifery care in Singapore – the first 100 births

Abstract

The Enhanced Midwifery Maternity Care (EMMa Care) programme at the National University Hospital in Singapore was implemented in 2011 to provide women with primary obstetric care in collaboration with one-to-one midwifery support. The continuity of care women are able to access from both an obstetrician and a midwife provides a unique opportunity for women and babies to benefit from both obstetric expertise and holistic midwifery care. This article describes the development of the programme, and the outcomes of the births of the first 100 women who booked. Sixty women were primiparous and 40 were multiparous. Birth outcome data demonstrated a caesarean rate of 20% and seven out of nine vaginal birth after caesarean (VBAC) attempts were successful (77.77% success rate). Of the women birthing vaginally, 81.33% did so without any pharmacological pain management; 58 women used water immersion in labour and 36 birthed their babies in water. There were no third or fourth degree perineal tears, no postpartum haemorrhages and the episiotomy rate was 4%. Apgar scores were above 7 at 5 minutes in all but one baby; five babies required phototherapy for hyperbilirubinemia and eight babies (including one set of twins) were admitted to the neonatal intensive care unit (NICU) for hypoglycaemia and/or prematurity. EMMa Care is associated with good maternal and neonatal outcomes. Caesarean section rates were lower than overall rates in the same hospital setting and use of pharmacological pain management was minimal.