Archive | November, 2011

Antenatal preparation in Hong Kong

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Antenatal preparation in Hong Kong

Posted on 16 November 2011 by Annerley

“I am 7 weeks pregnant and I have just moved to Hong Kong.  How does the system work; where do I register and where is it best to give birth?“  Calls or emails of this sort are not uncommon in our practice and every time I wish there was a concrete answers for all the parents in this situation.  There is no such answer though, and each couple finds different reasons for doing different things to prepare for the arrival of their child.

Just pregnant – public and private maternity services

In Hong Kong, every person with an ID card has the right to use the government hospital maternity services and the cost will be minimal.  The maternal health clinics generally give really good service, although sometimes English is not perfect and communication aims more for being efficient and medical than “consumer friendly”. However, in terms of staff, equipment, safety and resources, clinics and hospitals are perfectly up to standards and Hong Kong is one has one of the lowest morbidity and mortality rates in the world.

When people have insurance cover or simply chose to pay for private maternity services, there is a variety of hospitals to choose from and most of them offer all basic care, emergency cover for operation theatre and paediatric backup.  Choosing this, you will often have more choices in terms of the birth itself; less policies to worry about and can decide more who is with you during the labour.  You will also both be pampered more and given more privacy than public hospitals can offer.  I found the entire procedure very simple as I had Health Insurance In Maryland. I also find that after the birth, women that have stayed in some of the private hospitals will have more success with breastfeeding, mostly because the staff seems to have more time to help with initial challenges.

Private hospitals are usually also well equipped but it is important to know that they not be able to take care of seriously ill newborn and premature babies before week 34 of pregnancy are taken to a public hospital for intensive care.

Maternity checkups

In the beginning, you are advised to see a midwife or doctor around every 4 weeks for routine checkups and screening of risks/abnormalities.  Luckily most women come away from those without complications but depending on circumstances, some women would be recommended or offered the following screening tests and scans:

  • 6 – 10 weeks:  Early ultrasound scan to confirm pregnancy and possible due date.
  • 11 – 14 weeks:  Nuchal Translucency Scan.  This is a risk assessment to screen for Downs syndrome.  The test is often combined with a blood test to give more accuracy and if the result indicates a high risk, you might be offered amniocentesis, which then would be done around week 15-18.
  • 18 – 20 weeks:  Ultrasound to confirm due date and to check with accuracy for any physical abnormalities with the baby.  Also to check the lying of the placenta and to confirm singleton/twin pregnancy.
  • 24 – 28 weeks:  Glucose tolerance test to exclude diabetes during pregnancy.  Usually good to check iron levels at the same time (Hb and/or Ferritin).
  • 34 – 36 weeks:  A scan to confirm that baby is growing and developing well.

When the pregnancy progresses, you will see the doctor/midwife more frequently, or around every 2 – 3 weeks.  The visits are routine health checkups for you and the baby, but you can try and use the time to get to know your caregiver and introduce to her/him the ideas you might have about the birth itself.  That way you will slowly find a way to try to fulfil the wishes you have and minimize fears that sometimes arise when communication is not good.

Preparing for the birth 

When it comes to preparing for the actual birth, in some ways it can be best to not have any set ideas about how you want it to be, to avoid a complete shock or disappointment if it does not turn out the way you had planned it to.  There is, however, a great difference between preparing and detailed planning.

The birth is a journey

It is in a way similar to prepare for a marathon hike that you don’t know how long is, or where it is taking place.  You gather general information, try and think about different scenarios and how you think you would respond to those.  Other than that, the preparation is mostly about staying fit, feeling psychologically well, eating a balanced diet, drinking plenty of water and making sure you get plenty of rest.  This sounds familiar, since, this is what all pregnant women are advised to do anyway.

Sometimes, when planning for the birth, people tend to think that all of a sudden some new powers start to work on the body to change the way it functions, and therefore they need to learn a totally new technique to deal with this.  In my experience as a midwife, this is not the case; there are surely physical challenges that are new, but mostly you rely on already established methods that you just don’t know that you have!

What do I need to know?

To help yourself to feel more in control when you are in labour, it is useful to gather some information about the process and what to expect from the hospital staff.  Reading, talking to friends and family and discussing with your doctor or midwife is all a part of this.  If you want to go one step further, antenatal classes might be an option.  In Hong Kong, the Queen Mary hospital offers English speaking classes for parents that plan to give birth there, as well as a tour of the labour ward.  Some private hospitals also offer this, and in most cases you will find them to be specially aimed for presenting each hospitals ideology and protocols, often involving the staff of the actual labour ward – which is useful.

When deciding on preparation classes you might want to ask yourself:

1.     What do you want from the classes?

2.     Who is teaching them and what background do they have?

3.     Do they follow any special philosophy?

4.     Are they mainly giving practical information or is there any training also involved?

5.     How many couples will there be in the classes?

6.     Is there a chance for questions and discussions?

Private midwives, such as here at Annerley offer childbirth preparation classes that usually aim for more independent view, meaning that parents are encouraged to rather follow their own intuition than the hospital protocols.  This sometimes can be a challenge for parents if the staff at the hospital does not have the same ideas about what are reasonable demands and what is too independent.  Luckily though, most of us are being realistic and we help parents to find a way that suits everyone without any dilemmas.  With parents being more demanding, there have been a lot of changes towards more modern attitude in the labour room, including the option of mothers using different positions when giving birth, use of birth ball and less routine use of episiotomy and medical pain relief.

Minimizing interventions

Most antenatal classes have one of their aims to minimize the chances of negative birth experience caused by unexpected events.  A part of this is to encourage the parents to be actively involved in the process of making decisions, and being informed.  To decrease chances of medical interventions, it is also important to find a balance between physical activity and relaxation, and be upright and mobile to speed up the process of contractions.

Sometimes, however, it is necessary to step in the process and use medical interventions, such as emergency C-section, vacuum extraction or forceps.  For parents that are well prepared, this is usually not a desired outcome but it should not have to be too shocking, given that communication channels are kept open and people feel informed at all stages in the process.  This is why it is important in the preparation of the birth to not have a rigid plan, but rather ideas that then get developed when you actually feel what it is like to be in the process.

You just have to go with the flow

When I started doing antenatal classes, I soon found that parents often walked away with too unrealistic image of what might happen during the labour, so I added a private lesson into the antenatal package.  This, I found, helped greatly to clear out misunderstandings or dilemmas that often rise in group lessons and also gave the parents a chance to write down their ideas of the birth with some private guidance.  I find that most midwives and doctors will give you the chance of something similar if you ask for it, and actually value your involvement when it not too unrealistic.  In the end of the day, you just have to go with the flow, trust your instincts and make sure you at all times make your wishes clear to the ones around that are trying to help.

Hulda Thorey 2011

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Posted on 15 November 2011 by Annerley

Stand, sit or squat: Angela Baura writes in Playtimes publication about labour positions

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Acupuncture for pregnant women and new mothers

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Acupuncture for pregnant women and new mothers

Posted on 06 November 2011 by Annerley

Dear all. I am writing these words from Iceland, where I am at the moment, studying acupuncture for pregnancy, birth and postpartum. This has been a very interesting education for me, which started earlier this year and is undoubtedly going to take some time to get advanced in.

So far I have treated quite a number of women and luckily I can say that the feedback has been fantastic – it seems like acupuncture will be a nice addition to other treatments that I have been able to provide.

It is interesting to have to travel around the world, back to the snowy Iceland to study this ancient form of therapy that we all know comes from right where we are in Hong Kong and China – but the reason is that in Iceland but rather, in Scandinavia, this is now a very well established and recognized form of treating women during the pregnancy, birth and postpartum, so much so that it is now offered in most hospitals here before offering any more intense interventions of more western medicine type.

I am lucky that my colleagues here in Iceland, including my aunt who is in charge of the biggest maternity unit in the teaching hospital here, have offered a very good insight into how the acupuncture is used and what has been particularly helpful and giving good results.

Amongst those are treatments for inducing labour, relaxing women, turning breech babies and pain relief during labour. Additionally, back, hip and joint pains, oedema and nausea have very successfully been treated with acupuncture here. Read more here to learn other ways to deal with joint pain.

One might ask why not just go to the acupuncturist for all of this and true, I would very much suggest that women do so, – but it is fantastic for me to be able to also offer this along with other things that I work on and not have to send the women off elsewhere, particularly when it is often in the middle of the night or at some weird hours where acupuncturists are not working.

More to come later, – I trust that my Annerley team members are all working hard in the clinic while I am here and that you are all having a great time in this fantastic season where crispy days with sun and less humidity give you a pleasant feel and positive spirit.

Best,
Hulda midwife-in-constant-training

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