May 5 is the International Day of the Midwife. To highlight the important work that is carried out by midwives across the world as part of the project “Midwives4all”, the Embassy of Sweden in Singapore conducted an interview with Ms Susan Kok, Director of Nursing at Thomson Medical Centre, a private hospital for Women and Children and a Board Member of Singapore Nursing Board, and Ms Ow Jee Hia, Assisting Executive Secretary at Singapore Nursing Board (SNB) (the regulatory authority for nurses and midwives in Singapore) to learn more about the midwifery profession in the country.
Midwives have been around for quite some time in Singapore. In fact, midwifery was regulated as a profession already in the 50’s, even before the regulatory framework for nurses was put in place. Today, midwives are working in both public and private hospitals in Singapore, and in some public hospitals, there are also special midwife-led clinics.
All the midwives in Singapore are required to register with the Singapore Nursing Board in order to practice as one. To obtain a midwifery certificate in Singapore you have to be a registered nurse first. It used to be possible to become a so called “pure midwife” in the past, by undergoing a two year training program, but that option has since aborted. Singapore today has a little over a 100 “pure midwives” whereas the number of “registered nurses cum midwives” amount to around 8000.
In light of the fact that Singapore has one of the lowest birth rates in the world with only 1,2 children per woman, the need for midwives has been declining over recent years. As a consequence of the limited number of births nationwide it is a challenge for nurses undergoing training to get the practical experience needed in terms of participating at births. According to Ms Kok, “midwives to be” have to fight with students for delivery of babies, to be able to complete their course.
Given the low birth rate the midwife training course is offered every alternate year and the number of trained midwives in Singapore is declining. The only educational institution in Singapore that offers midwife training is the Nanyang Polytechnic. The training is an eight months course and the candidates are usually sponsored by their respective hospitals.
According to Ms Kok this is a worrying trend. “I try my best to encourage the educational institution to offer more places for the nurses to be trained to become midwives and fortunately, this is supported by my hospital as they see the value in having more trained midwives.” This is, however, not the case at every hospital. Some general hospitals may have priority needs for other disciplines in nursing other than midwifery. At the same time, the Ministry of Health of Singapore still requires all institutions with maternity services to have at least 60% of its trained nurses to be midwife certified.
According to Ms Kok cultural aspects do play a role when trying to explain the reluctance felt by some pregnant mothers towards having a midwife deliver your baby. “Asian people prefer to have a medical doctor there to help them during child birth, they feel more reassures with a doctor than with a midwife. In Europe on the other hand the midwives are more empowered and can make their own decisions on what to prescribe and which actions to take as the doctors”.
The scope of the work that a midwife can do is quite different here, says Ms Kok. In Singapore the main task is to look after the patient when she is admitted in labour and most often the doctor is not present during the latent phase. This is even more so in the private hospitals set up where patients feel that they have paid more and thus want to get more of the doctor’s attention. Still, the doctor usually only arrives just in time for the delivery and the midwife will be in charge of caring for the patient before and after delivery. Should the doctor not come in time, the midwife has to be prepared to deliver the baby and hence she must have the necessary skills and experience.
The fact that there are no male midwives in Singapore also has to do with cultural factors and mindset. Both Ms Kok and Ms Ow believe that mothers to be are likely to feel uncomfortable with having a male nurse as their midwife. The number of male nurses in Singapore is also limited, with only 10% of all nurses being men.
Embassy of Sweden in Singapore