Archive | December, 2016

Lactation consultants

Lactation consultants

Posted on 16 December 2016 by Kristrun

sue1One of the biggest learning curves for me to be in Hong Kong is the knowledge and understanding I have gained through the years about other peoples traditions, systems, languages, homes etc. I had never heard of swaddling, sleep training, breastfeeding by the clock or lactation consultants – and I could not imagine could it would be offered by anyone else but midwives. Because where I come from all the postnatal care is taken care of by midwives where they have years and years of helping women to breastfeed – and they have done a magnificent job as in Iceland everybody will breastfeed. They will breastfeed on the go, in public, at a friends house and anywhere a baby gets hungry.

Now I know that in some countries there are no midwives, and in some countries the midwives are only working in hospitals and not in the communities. So lactation consultants are available for breastfeeding help and for advocating for breastfeeding and offering help on-site.

Today is a big day at Annerley, we have three midwives – all of them have spent countless hours on supporting and hands on helping with breastfeeding out in the community – but today midwife number two became registered as a lactation consultant. Well done Sue Pollard! May we keep helping women of Hong Kong to breastfeed their babies as long as they like.

Keep breastfeeding!

Kristrun Xx

More information about our breastfeeding support at home  and in our clinic.

 

Comments Off

Can I give birth in a public hospital in Hong Kong if I don’t have an HKID card?

Can I give birth in a public hospital in Hong Kong if I don’t have an HKID card?

Posted on 16 December 2016 by Kristrun

We are often asked if you can give birth in a public hospital without an Hong Kong ID card that comes with being a resident in Hong Kong. The answer is both yes and no. You cannot register with a public hospital without a HKID card, that is a NO. They will not accept you as a maternity patient and you will be sent home. So in short for anyone who is not a HKID card holder you will need to go to a private doctor and sign up with a private hospital to give birth there.

What happens in the case of complications?

For severe complications, a private doctor or hospital may refer your case to the public hospital – so you do need to prepare for this scenario also. Again, even with a referral letter you will not be accepted as a registered maternity patient. If you go into early labour you will need to go to a public hospital via the Accident & Emergency department (A&E) – and you will have to pay a full price.

How much will I need to pay?

According to hospital authorities you will be charged a minimum payment of 90,000 HKD for a non-invasive birth and then 4,650 HKD per day for the hospital stay (given there are no complications with the baby). For any additional interventions such as emergency C-section, or any emergency care for you or your baby, you will be charged further on top of this (based on a phone call to HA on 7th of December 2016). There is no ceiling on these charges so you may need to calculate the worse case scenario.

So, if you are planning to give birth in Hong Kong without an HKID card, you will need to find a private doctor and a private hospital who is willing to take care of your case. Find your obstetrician, sign up with him or her and then choose a hospital.

To keep in mind when going private.  

  • The private system works best if birth is quick, routine and scheduled which is usually in no way what birth is like, unless a scheduled C-section is chosen.

  • There is a financial gain for both the doctors and the hospitals to use epidurals, inductions, vacuum, forceps and C-sections.

  • The private doctors normally work alone.

  • Transparency is limited in terms of outcomes and statistics – not available from many doctors.

  • While private health insurance is usually the way people pay for their maternity cost, doctors may not be as conservative as they otherwise may be in using medical interventions (here is how the EHIC cover explained for European applicants).

  • Some private hospitals will not allow much movement during labour and even though in theory they support active participation of the mum, using different positions etc, in practice they may not allow it.

  • Epidural rates in some private hospitals are up to 90% for first time mothers. C-section rates of up to 90% for some private doctors. Make sure to create a birth plan and attend independent birth preparation classes!

  • C-section rates of some private hospitals are up to 80% (WHO guidelines suggest that they should be under 15%).

  • Midwives are obligated to work according to the doctor’s instructions, therefore are not always free to allow the women to be independent.

  • Breastfeeding is very hard in some private hospitals, unless you book a private room during your postnatal stay.

Conclusion?

When going private, birth planning and antenatal education is essential – make sure to book your classes in time.

It can be very expensive to give birth in Hong Kong without a HKID card and you would need to invest in the time to have someone reflect on your case before you make the final decision.

Are you still confused? Just let us know, we can arrange meetings here in our clinic, by Facetime, Skype or over the phone.

Keep the babies coming

Kristrun Xx

Comments Off

How big is my baby?  Size measurements during pregnancy

How big is my baby? Size measurements during pregnancy

Posted on 05 December 2016 by hulda

It is common for people nowadays to have ultrasound.  I am as guilty as any private practitioner in Hong Kong, of doing too many ultrasounds for pregnant women.  They are simply not needed, often give us more doubts and questions than they are solving problems and reassuring.

The pregnant mum does not know this.  Nor the dad.  They usually either ask, or are happy to see the baby moving there on the screen and everyone gets mildly addicted to seeing the little individual that now seems to look like the family, wink and kick back during the ultrasound.

Not everyone feels this way, some parents ask for less ultrasound.  They are, like myself, slightly worried that one day, even if modern research does not seem to support it, that one day ultrasound will be deemed less than good for unborn babies.

Still, we do so many ultrasounds.

I did an ultrasound course in the Chinese University of Hong Kong, as a postgraduate training.  I learned a lot.  Amongst other things I did learn that:

Size of baby during pregnancy

Size of baby during pregnancy

  1. Routine ultrasound for healthy women in low risk singleton pregnancy is not recommended except for around 12 and 20 weeks.
  2. Other times, if there are twins, low placenta, unusual growth pattern, diabetes etc, there is a reason to add more ultrasounds into the checkups, usually with at least 2 weeks in between, otherwise it is not considered accurate information.
  3. It is considered safe to do the ultrasound with a regulated machine by a person who knows how to use it, but it should be as short as is needed for each checkup.
  4. Routine palpation and fundal height measurements for baby’s growth pattern and size has very similar accuracy as doing an ultrasound as a routine to get this same information, both with around 500 gram give or take accuracy around third trimester.
  5. Head size measurements for low risk pregnancies, and how engaged the head is, is not recommended practice as it is both very inaccurate and carries little value in evaluating if the birth will be normal, easy, long or short.
  6. Measuring the baby’s abdominal circumference in the 3rd trimester  with two weeks between, is most likely to give accuracy on the growth of the baby.
  7. Telling women that they have a big baby will increase their fears a lot for the birth and the term “big baby” is widely used in a non-professional way.
  8. A normal healthy baby is somewhere between 2.9 to 4.0 kg. Around  3.4 kg is average for Caucasian babies and 3-3.2 kg for local Hong Kong babies.
  9. There can also be good reasons for babies to be 4 – 4.5 kg,  and some women have no problems giving birth to them.  It is important to exclude diabetes, but otherwise in some families this is normal size.
  10. Size measurements and ultrasounds can very important and needed for some pregnancies. Some pregnancies are more high risk than others and ultrasound can give more accurate and appropriate information than some other methods.  Therefore, it is important to use the ultrasound appropriately and wisely.

I learned a lot more.  This is just from the top of my head now, as I have been asked several times if I can measure size of babies.

Well let me share that in our practice, generally, we use the NICE guidelines and do 12 and 20 week ultrasound by a recognized radiographer, midwife or doctor that is specialized in these checkups.  If during the rest of the pregnancy, we worry about the baby’s size, I sometimes do an ultrasound myself to see if it seems to confirm it, but usually I send people off to a specialist to do further assessment.  80 percent of the time, the result is still within normal limits.

Hulda Thorey – midwife

Comments Off