SINGAPORE —  About two months into her pregnancy, healthcare worker Olivia (not her real name) was on her way to work when she vomited at a train station from a nasty bout of morning sickness.

At that point, Olivia, now 27, had only one day of medical leave left. She had used up five days of medical leave when she got Covid-19, and the rest were used for doctor's appointments after she got pregnant.

“I remember crying because I was due in November, and it was only April,” she said. 

From them on, she had to dip into her annual leave entitlement for doctor's visits and multiple trips to the emergency department because of pregnancy-related complications. 

She constantly had pains in her belly and her morning sickness was so bad that she had once vomited into her mask while she was at work.

Stories of difficult pregnancies are not uncommon, and there are women who are lucky enough to work in flexible workplaces and have understanding bosses, who can work from home or negotiate extra paid time off if they happen to suffer from complications.

But there are many others, especially those who work in sectors such as healthcare, hospitality, retail and education who have to show up at the workplace no matter what and simply suffer through their pregnancies, especially after they use the standard 14 days of medical leave offered by most companies.

On average, a pregnant woman has to have 11 doctor’s appointments throughout her term — and that excludes any extra visits she may need for illnesses, severe pains, or complications.

In Olivia's words: “With 14 days of medical leave, you can get pregnant, but you cannot get sick."

Dr Kalpana Vignehsa, a senior research fellow at the Institute of Policy Studies (IPS) at the National University of Singapore, noted: "It is pretty easy to quickly use up the 14 days of sick leave in pregnancy, especially if one has any complications that need more frequent checks."

Pregnant women undergo unique immunological changes and are more susceptible to falling ill, she added, and to qualify for paid hospitalisation leave, employees are required to have gone for a day surgery or have been warded in the hospital.

"There's definitely an unaddressed gap here, the burdens of which are borne by pregnant women," she said.

But Dr Vignehsa and other experts say the solution is not as simple as just mandating more medical leave for pregnant women. This would raise the relative cost of female labour, which could lead to more gender discrimination in the workplace. 

Still, this is an area that is worth studying, especially if Singapore is serious about encouraging parenthood and creating a family-friendly society, experts said.

OVERLOOKED AND UNDERSTUDIED 

In fact, this is an area that has not been studied much at all, noted Ms Tin Pei Ling, the Member of Parliament (MP) for MacPherson Single Member Constituency who often speaks up about family issues in Parliament.

While there is a lot of anecdotal evidence that pregnant women often have to power through work while feeling at their worst because they lack medical leave, there is little empirical data on which to base any nationwide measures, she said.

Dr Tan Poh Lin, an IPS senior research fellow, agreed, saying the matter is understudied.

“This is actually a real policy problem here that hasn't been highlighted,” she said. “Nobody knows that this is an issue... where women are unable to cope with the amount of leave they have due to pregnancy complications.”

So the first step towards any solution is to first study the magnitude of the issue, they said.

TODAY approached several gynaecologists to get a sense of how widespread the problem is.

Dr Sharon Foo, a consultant obstetrician and gynaecologist, said she sometimes encounters women with complex pregnancies due to maternal or fetal conditions.

"These conditions often require frequent follow-ups in order to monitor the health and outcomes of these patients. Additionally, they often require longer appointments and consultants with a multi-disciplinary care team," said the maternal fetal medicine specialist with Thomson Specialists.

In some cases, detailed fetal scans are needed every other day, particularly in complicated multiple pregnancies.

Patients facing antenatal complications require closer monitoring, coupled with the mental and emotional strain of a difficult pregnancy, leading to a need for extra rest and recovery and hence, possibly requiring more medical leave, she added.

Another gynaecologist, who spoke to TODAY on condition of anonymity and works in a public hospital, said this problem crops up for her “at least five times” a day.

In public hospitals, scans and consultations are often done on separate days, which might be why some pregnant women burn through their medical leave quickly, she said.

“If they have a more complicated pregnancy, then, of course, the follow-ups will be more frequent," she added.

While some pregnant women might have little to no pain at all, some women can have severe symptoms, making it difficult for them to sit, stand, walk, and move around, she said.

As women run into issues with their pregnancy and realise they are running out of medical leave, many start asking for hospitalisation leave, but she often has to turn them down. Many of these patients work in healthcare or childcare, she said.

“Based on (the hospital’s) protocol, I'm not allowed to give hospitalisation leave as much as I would like to because the patient is not hospitalised,” she said.

“It feels really bad most of the time because you feel you can't help them. It feels like you are denying them their rest. We do feel that they need rest. We just can’t do much about it.”

One mother even decided to give birth early so she could rest. Ms Ashikin, now 38, had a slipped disc during her pregnancy that sent sharp shooting pains up her back and a numbing sensation through to her right leg, making it difficult for her to walk. 

As a childcare teacher, she had to be on her feet or kneeling on the floor most of the day. Sometimes she had to carry her students too, who ranged from infants to kindergarteners.

About 37 weeks into her pregnancy, she had few days of medical leave left and was exhausted beyond measure so she asked her doctor to perform a labour induction.

“I told (the doctors), look, I don't think I can hold on anymore. I think it's time for me to bring my baby out. I just wanted to make sure that my daughter's lungs were ready."

But even though such stark stories reflect a need for change, mandating additional medical leave for pregnant women may not be the answer as it could end up disadvantaging women in the workplace, experts said.

“On one hand, we want to help working mothers or working pregnant women feel safe and also work meaningfully because women have aspirations," said Ms Tin. "But how do we do so without further deepening certain biases and making things difficult for people in an already tight workforce situation?” 

Dr Tan added that by stipulating more leave days for pregnant women, there is a risk of all women being put on the “mummy track” as employers might feel that they cannot rely as much on their female employees.

And when women are singled out in such a manner, they are less likely to be able to get on “high-flying tracks” in their careers, which would exacerbate the many negative societal perceptions of women in the workforce. 

THE DIFFERENCE A MANAGER MAKES

Without extra medical leave, pregnant women just have to rely on the understanding and support of their managers and colleagues to get through what can be the most stressful time of their lives.

Dr Vignehsa, who herself underwent a difficult pregnancy some years back while working in Australia, can attest to the importance of such a supportive workplace.

"I personally fell into the 2 to 3 per cent of women who struggle with hyperemesis gravidarum (chronic vomiting) and with my first child, this went on for the entire pregnancy," she recalled.

"I spent most of that pregnancy in a dehydrated haze, which is anxiety inducing in itself ("Will my baby be ok? Will I live through this?"), without the additional worries of whether I will keep my job. I was very lucky to have a supportive boss and team, who rallied around me and made it possible for me to feel like a contributing senior member of my team. Basically, I WFB (worked-from-bed), which was unheard of in our pre-Covid world."

Others aren't so lucky. 

33-year-old Meredith (not her real name), had exhausted her medical leave by her 30th week of pregnancy.

At the time, she was a marketing assistant at a hotel that was due to reopen after having been contracted as Covid-19 isolation centre and was opening a new outlet in Malaysia simultaneously. 

During her 33rd and 34th week of pregnancy, Meredith began experiencing pelvic pain that made it hard to walk. 

“I couldn’t sit nor stand for long periods,” she said. To make matters worse, her office was not located within the hotel itself so she often had to walk between the hotel and office multiple times a day.

Once, she felt breathless at work and requested to go home early. Her manager assented, but told her she would have to claim it as a half-day leave from her annual leave entitlement.

“I felt like (my manager) couldn’t even make an exception for me, and it was already past 3pm,” said Meredith. “I was about to give up everything. I was about to quit my job.” 

The final straw came after a particularly punishing day, at the end of which she felt like her legs had "given way".

She asked for the next day off, but her manager insisted that she show up because it was the hotel's reopening day.

As it turned out, Meredith’s water bag broke that following day and she gave birth at 36 weeks, one month early. 

“I don't know what happened. I think my body gave me the signal (that it had had enough),” she said.

IPS' Dr Tan pointed out that today, flexible work arrangements are decided between employees and employers. 

To better support workers, it might be better to have a stronger framework surrounding flexible leave policy rather than leaving it to such negotiations, she said. 

“I don't fully agree that firms should be free to decide in these negotiations because sometimes employers have much more power. We don't know to what extent these negotiations allow a voice."

Ms Tin said employers and employees have to give and take when it comes to accommodating the varied experiences of pregnant women. For example, bosses could be more flexible with a pregnant employee's doctor's appointments and give them leave when they need to rest.

Ms Tin said that the ultimate goal is for women to feel safe to seek the treatment and care they need to procreate but also continue to pursue their career aspirations and contribute meaningfully to our economy. 

MORE LEAVE FOR ALL?

Perhaps the way forward lies not in singling out pregnant women as a subgroup that needs additional help, but in rethinking how we should help anyone who might need more flexibility for a period of time for any reason, experts said.

"The question here is how our workforce should look after any employee who is facing a temporary condition that requires more leave or flexible work arrangements," said Dr Vignehsa.

"This could be a pregnancy-related condition. It could be a temporary disability owing to an accident. It could be parents who need to look after a sick child beyond the six days per parent per year. Or adults who need to look after an elderly dependent or their own mental health." 

But Dr Tan said implementing more medical leave for all might eventually backfire.

"In general, while leave policies are helpful to workers, there are also trade-offs in terms of employability and perceptions that disproportionately affect segments of the workforce, particularly women."

That said, Dr Vignehsa added that society should take into account the economic value of childbearing.

"We may then want to ask if we want a special category of leave that pregnant women can access because mothers should elicit support not just because they are valued members of society like everyone else," she said. "In bearing children, they are also engaging in valuable, generative labour that contributes to economic growth by producing citizens, workers, and consumers." 

Olivia added: "If there are more policies for pregnant women, with little things like more time allowance for doctor's appointments, for example... I think Singapore would be a much better place for pregnant women."