Archive | Pregnancy

10 Top Tips for New Parents – Sue shares her advice in ‘Around DB’ magazine

10 Top Tips for New Parents – Sue shares her advice in ‘Around DB’ magazine

Posted on 06 November 2017 by Kristrun

Becoming a parent is a life-changing event to say the least. Add in sleep deprivation, sore breasts, cramping and a demanding newborn, and it’s no wonder new parents struggle at times. Here are 10 tips to help keep mum, dad and baby healthy through the first few weeks. If your spouse snores at night and you’re having a hard time sleeping at night get some comfortable ear plugs for sleeping to help block out the snoring.

1. Expect that you will fit around the baby’s needs, and not the other way around. Don’t put undue pressure on yourself to keep to your old routine.

2. Sleep when the baby sleeps—Facebook can wait. A proper rest will leave you feeling refreshed and better able to cope when the baby wakes.

3. Accept help when it is offered. Although many people in Hong Kong are fortunate enough to employ domestic helpers, there are still times that you need that extra pair of hands from a friend.

4. Sit in front of the TV with the family while feeding. You don’t need to live in the bedroom for months!

5. Go out for gentle walks. Getting out is good for you both physically and mentally, but halve the distance you think you can walk—your body has been through a lot!

6. Eat and drink well. Have healthy snacks and a bottle of water nearby when feeding. Give your body the nutrients that it needs to cope with the demands being placed on it.

7. Babies cry. Accept it.

8. There is no magic formula for sleeping and feeding routines. There are, however, many wealthy book authors.

9. Listen to the friendly, contradicting advice of friends and relatives, then take what you want and disregard the rest.

10. Babies are tiny for such a short time. Enjoy them. Remember everything is just a phase.


To read the full article in Around DB – click here

Sue is a registered midwife and lactation consultant and she and our other midwives are available for office consultation, home visits as well as teaching group antenatal classes at Annerley. Please call 29831558 or visit www.annerley.com.hk for more details.

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What exactly is Hypnobirthing?

What exactly is Hypnobirthing?

Posted on 08 June 2017 by Kristrun

WD-TamaraQuinn med 081The name tends to put most people off.  Like some one is going to be front of you holding a watch on a string, telling you “ you’re getting sleeeeeeepy”.  But HypnoBirthing is really about teaching yourself to breathe and relax.  Its just a deep relaxation that you will learn to do to/for yourself and your partner is there to help you stay as relaxed as you can through loving words and touch.

When working with women in labour you find that women who are able to stay more relaxed usually have shorter and less painful births than those who “fight” against their bodies.  HypnoBirthing is simply a method to help you understand what your body is doing and how to work with it and not against it.  Its about letting go of the fear. Remember that Fear is not your friend in labour!  It causes women to tense up and go against what their body is trying to do.  This is why prenatal classes are so important! Knowledge is key.

I’m not going to guarantee you a pain-free labour (although I have had moms who have done it!) but  I will give you great tools to help you cope and deal with it.  You will learn to understand what/ how/ and why your body in labour works the way it does, which helps to give women the confidence and trust to work through their labour.  Also the confidence to ask questions, be included in all decisions, understanding every decision that is made and having no regrets.

One thing I always say when I teach is that you have these moments in labour where fear may try to sneak in and you second guess yourself.  Its like having two little birds sitting on your shoulders – one telling you to “fight it”, the other saying “just breathe and relax”.  Its about listening to the right bird! Its about looking forward to your labour and embracing what it can do.  Don’t psych yourself out before you’ve even begun. Remember – you are not your friend, mother, sister or someone you read about on an online forum.  This is your own experience – you and your baby.  I want every woman to embrace it and love it because… what a gift at the end!!

Tamara Quinn, Hypnobirthing instructor

You can find more details about our Hypnobirthing course here, or give us a call for more details.

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I have a heartburn! Why?

I have a heartburn! Why?

Posted on 25 April 2017 by Kristrun

Relaxin is a hormone that does exactly what it says on the tin; it relaxes the ligaments in the pelvis and softens and widens the cervix, in preparation for childbirth.
What is relaxin?
Relaxin is a hormone that is secreted into the circulation by the ovary. the placenta, the membranes which surround the foetus, and the lining of the uterus. During pregnancy, relaxin levels are at their highest in the first trimester. At this time it is believed to promote implantation of the developing foetus into the wall of the uterus and the growth of the placenta. Early in pregnancy, relaxin also inhibits contractions in the wall of the uterus, to prevent premature childbirth. It also relaxes the intrauterine ligaments in order to provide enough flexibility for the growth of the baby’s living quarters.
Relaxin can regulate the mother’s cardiovascular and renal systems to help them adapt to the increase in demand for oxygen and nutrients for the foetus, and to process the resulting waste products. It is thought to do this by relaxing the mother’s blood vessels to increase blood flow to the placenta and kidneys. Towards the end of pregnancy relaxin promotes rupture of the membranes surrounding the baby and the growth, opening and softening of the cervix and vagina to aid the process of childbirth. There is also some evidence that relaxin can relax the ligaments at the front of the pelvis to ease delivery of the baby. There are several other factors involved in labour, but the exact trigger remains unclear.
What happens if I have too much relaxin?
Studies have suggested that high levels of circulating relaxin in the mother are associated with premature birth, presumably via its effects on the rupture of the fetal membranes and the opening of the cervix. However, further research is needed to confirm these findings. In addition sometimes it affects things you don't want relaxed. For instance, what happens when relaxin is working particularly well on your pelvic ligaments? – symphysis pubis dysfunction or the muscle that prevents stomach acid from creeping back into your esophagus becomes floppy?
You got it: heartburn.

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Hypnobirthing and normal birth in government hospitals

Hypnobirthing and normal birth in government hospitals

Posted on 31 January 2017 by hulda

As you may know, the  government hospitals are constantly trying to increase their normal birth rates.  They have in the last 15 years introduced the birth balls in all labour rooms, the dad’s massage programme and labour position choice for birth.  You also all know that this is not always obvious, not always offered to you. In fact, you may have to ask for it more than once, but usually in the end, if you know this is possible, it will make your experience and outcomes much better.
Annerley Hypnobirthing Classes

Hypnobirthing in Hong Kong

Luckily for me, when I had my last baby in the Queen Mary Hospital I knew what to do and even if I was asked to stay on my back, I smiled politely and told them that I had been trained to be mobile, even with the IV lines and monitors attached to me.  Then I moved to my knees on the bed and was able to do pick any position I liked.  I guess I would not have done that so comfortably had I not known that it was possible.
What I am trying to say is that the staff is now allowed to allow you to be more free in your movements during labour, they are able to encourage more participation of the dads in the labour room and now, have one more addition:
HYPNOBIRTHING training for the midwives in government hospitals is in the cards.  The training course for the midwives is scheduled for April, meaning that hopefully you will be able to enjoy even more support from the staff, for breathing and relaxation during childbirth.  At Annerley we can do YOUR  part of the training, i.e. the classes that prepare you with the Hypnobirthing techniques.  And then you will know that you will be greeted by staff that knows how to follow up.  Hopefully many midwives will sign up for this course, offered by the Department of Obstetrics and Gynaecology.
What is also very important to know is that none of the above will actually ever become the NORM, unless you actively ask to use it.  I.e. now that it is allowed in the hospitals does not actually have to mean that all staff wants or is used to using it.  It means  you can ask for it and actively participate in helping the staff to train their own skills too.  This is a constant co-operation that needs all of us to participate in.
So again, I encourage all of you mums- and dads-to-be to be proactive, positive, and help others to help you.  Slowly good things happen.
Happy new year to all,
Hulda Thorey, midwife

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What is Is Delayed cord clamping and is it available in Hong Kong?

What is Is Delayed cord clamping and is it available in Hong Kong?

Posted on 11 January 2017 by Kristrun

delayed cord clamping

Delayed cord clamping – DCC

Delayed cord clamping (DCC)  is the practice of leaving the umbilical cord that supplies blood and nutrients to the baby, intact for several minutes following birth. The umbilical cord pulsates for some time after the birth and continues to propel blood into the infant. DCC has several benefits, including improving neonatal blood pressure and cerebral oxygen perfusion, as well as lowering the risk of necrotising enterocolitis.

The biological importance of DCC

The blood volume of the baby, the umbilical cord and placenta combined is around 450 mls. 300 mls is in the baby and 150 mls in the cord and placenta. This 450mls of blood does a circuit around the baby and placenta delivering oxygen and nutrient-rich blood to the baby and taking carbon dioxide rich blood away from the baby and back to the placenta.

DCC increases neonatal blood volume by up to 30% for children born at term and by 50% for preterm infants (compared with immediate cord clamping). DCC is associated with a wide range of neonatal benefits, including: improved neurodevelopment,  improved blood pressure; improved cerebral oxygen perfusion, and reduced need for blood transfusions due to decreased anaemia, increased level of stem cells and improved outcomes for premature babies.  WHO recommends DCC, not earlier than 1 minute after birth, “for improved maternal and infant health and nutrition outcomes”. The Royal College of Midwives (RCM) recommends between 1 and 5 minutes.

Long-term outcomes

DCC is associated with up to a 60% increase in red blood cells, higher haemoglobin levels at 24 to 48 hours of age, and increased serum ferritin levels at 4 to 6 months. DCC helps protect very low birth weight male infants against motor disability at a corrected age of 7 months. Cord blood is a rich source of stem cells, which seem to be critical in normal development of the central nervous, respiratory, cardiovascular, haematological, immunological and endocrine systems.

Is delayed cord clamping harmful?

None of the randomised controlled trials published since 1980 support a link between DCC and symptomatic polycythaemia or hyperbilirubinemia.

Nevertheless,the proportion of infants that require phototherapy for jaundice is increased with DCC compared to immediate cord clamping. Therefore phototherapy should be available.

NICE recommendations

NICE recommends that healthcare professionals do not clamp the cord earlier than 1 minute from the birth unless there is a concern, such as about cord integrity or the baby’s heartbeat is below 60 beats per minute and is not increasing.

The cord should be clamped between 1 and 5 minutes after birth followed by controlled cord traction, which should not normally be attempted until there are signs of separation of the placenta if an oxytocic has been administered.

Umbilical cord milking

During umbilical cord milking, a healthcare professional grasps the unclamped umbilical cord and pushes the blood several times toward the infant over, for example, about 20 seconds.

Umbilical cord milking may improve blood volume more effectively than DCC in premature infants who are delivered by caesarean section. Further studies are needed to identify fully the place of umbilical cord milking in practice.

Impact on Breastfeeding

DCC seems to facilitate breastfeeding, partly by countering the cognitive and physiological consequences of hypovolaemia. Placing the baby immediately on the mother’s abdomen during the delay to cord clamping promotes skin-to-skin contact, which enhances mother-baby bonding, helps regulate neonatal temperature and heart rate, and encourages breast feeding.

Is DCC available in Hong Kong?

Yes! In the public sector DCC is becoming more widely available and in some hospitals is heading toward standard practice. In the private sector availability is dependent on your doctor’s preference. This is something that should be discussed beforehand and expressed in your birth plan.

Cord milking is a somewhat new concept to Hong Kong, but with the childbearing community increasingly demanding this practice, it is likely to gain popularity and therefore benefit future generations.

The Annerley team

Consultation with the midwives, available on Skype (face time or other platforms), over the phone or in the office. Click here to book. More information about our services on our website.

References

Hutchon DJR. Immediate or early cord clamping vs delayed clamping. Journal of Obstetrics & Gynaecology 2012;32:724-9.

World Health Organisation. Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Geneva: World

Health Organization; 2014.

Leslie MS. Perspectives on Implementing Delayed Cord Clamping. Nursing for Women’s Health 2015;19:164-76.

NICE. Intrapartum care: care of healthy women and their babies during childbirth December 2014

https://www.nice.org.uk/guidance/CG190/chapter/1-Recommendations#third-stage-of-labour Accessed July 2015.

Katheria AC, Truong G, Cousins L, et al. Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants. Pediatrics 2015;136:61-9.

Amitay EL, Keinan-Boker L. Breastfeeding and childhood leukemia incidence: A meta-analysis and systematic review. JAMA Pediatrics 2015;169:e151025.

McDonald SJ, Middleton P, Dowswell T, et al. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane

Database of Systematic Reviews 2013;7:CD004074.

Weeks AD, Watt P, Yoxall CW, et al. Innovation in immediate neonatal care: development of the Bedside Assessment, Stabilisation and Initial

Cardiorespiratory Support (BASICS) trolley. BMJ Innovations 2015;1:53-8.

Uwins C, Hutchon D. Delayed umbilical cord clamping after childbirth: potential benefi ts to baby’s health. Pediatric Health, Medicine and Therapeutics

2014;5:161-71.

Pelaez-Nogueras M, Gewirtz J, Field T, et al. Infants’ preference for touch stimulation in face-to-face interactions. Journal of Applied Developmental

Psychology 1996;17:199–213.

Lagercrantz H, Changeux J-P. The emergence of human consciousness: From fetal to neonatal life. Pediatric Research 2009;65:255–60.

Hood B. The Domesticated Brain Pelican. 2014.

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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

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5 things to know about giving birth in Hong Kong – public private health care – published in Localiiz

5 things to know about giving birth in Hong Kong – public private health care – published in Localiiz

Posted on 16 October 2016 by Kristrun

blog

“There are several key things to consider when making the decision on where to give birth in Hong Kong; factors which may come into play might be your medical history, previous experience, cost and insurance, where you live, and how you would prefer your birth to be. However, before you can reach that decision, it’s helpful to understand that there are two systems available in Hong Kong – public and private – and there are significant differences between the two.

In short, the Government system offers comprehensive maternity care for high and low-risk mothers for a minimal cost, usually less than $500. This care includes antenatal checkups, the necessary tests and ultrasounds (as determined by the Health Authority), care during labour and delivery, and postnatal care for your and your baby. This system also provides access to district maternal health clinics, where you can have your antenatal and baby checkups, as well as the hospitals themselves. You will usually be assigned a hospital depending on where you live. The private system, on the other hand, offers the same care for any low and medium risk cases, but with a greater scope on how you deliver your baby and who will be present at the birth…..”

Click here to read more -
Consultation with the midwives, available on Skype (face time or other platforms), over the phone or in the office. Click here to book. More information about our services on our website.

 

 

 

 

 

 

 

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Prepare for positions in birth

Prepare for positions in birth

Posted on 19 September 2016 by Kristrun

birthballIt may not have occurred to you to practice birthing positions in different places before the actual day of the event. And why should you? Normally we only attend hospitals when something is wrong and then we are so used to be being told what we SHOULD be doing and how and where we SHOULD be. If you are unprepared, you may end up tethered to the bed – on your back, with feet in stirrups. It can be that this is normal protocol in your hospital – the staff are just doing their job and if you don’t object or have any better ideas, this may be where you may be throughout your birth.

Take some time to understand your options and practice your positions BEFORE going into the hospital on the day of your baby’s birth. The more we learn about labour and birth, the more health professionals, as well as pregnant women, are aware of the importance of being active and upright to help the labour progress. We can describe the advantages of upright positions during labour in short as follows:

Upright positions may:

  • Increase the strength of contractions

  • Speed up the labour process

  • Open up the pelvis

  • Increase space for the baby’s head (around 2-3 cm)

  • Help you to feel in control

  • Make you relax

  • Increase the blood flow to the baby

  • Decrease risk of interventions

  • Decrease use of drugs in labour

  • Relieve back pain

  • Greatly increase your chance of a natural birth

If you have difficulties standing/sitting try to:

  • Squat for a few minutes regularly

  • Change positions frequently

  • Use a birthing ball/fit ball

  • Use pillows/bean bags to lean on

  • Lean on the bed or a chair

  • Sit on the toilet

  • Sit on a chair in the shower

You are stronger than you think:  

  • When you are upright in labour, YOU ARE GIVING BIRTH, a baby is not being delivered to you.

  • In the labour room the BED is usually the centre of attention, and you immediately assume the role of the patient – unless you act strong yourself. Create your personal headspace – and escape.

  • Women who labour alone will almost always use upright positions when they give birth, not lying down and certainly not on their back.

 

2011/updated 2016 – Annerley the midwives clinic

 

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“A Class Act” Hulda talks about antenatal classes in the Liv Magazine

“A Class Act” Hulda talks about antenatal classes in the Liv Magazine

Posted on 02 October 2015 by Kristrun

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“Looking for an antenatal class “made and led by people who know their stuff”? Your first stop after the little blue line appears should be Annerley, a Hong Kong institution that has gently steered baffled parents-to-be through the process of pregnancy and birth for well over 20 years. Founded by midwife and mum-of-four Hulda Thorey, whatever questions you have, you can be sure that the team at Annerley will have heard them before.

When asked how best expectant parents can prepare themselves for what’s to come, Hulda suggests that the one-size-fits-all approach taken by many hospitals is rarely the best option. “Have positive, professional and ethical healthcare. Mix different professionals and make informed choices. Take antenatal classes that are personalized and don’t assume everyone wants the same!”

Click here to read the full article>

All our antenatal classes are personalized with a private birth planning session after the group sessions have been conducted.

For a private consultation with the midwives – please email us to info@annerley.com.hk

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Birth – gratitude – love

Tags: ,

Birth – gratitude – love

Posted on 03 July 2015 by hulda

I will never let you go

I will never let you go

Today is the day, that 18 years ago, I gave birth to my first baby.

I remember every little detail of that day.

It was more important to me that any other day in my life, although others were to follow when my other little babies were born.

But it was such a special day -  filled with kindness, hardship, patience, pain, unpredictability, sunshine, music, pressure, excitement, anticipation, warmth, love and relief.

It was a long day that started two days earlier actually, by me being induced after being more than 2 weeks past the 40 weeks of pregnancy.  I had no real expectations and did not know that induction meant anything different than a normal start of labour.  Except for the lack of candlelight on the bathtub and an exciting 100km drive to the hospital.

But apart from that, I was not concerned – I was in a very nice hospital with very nice people around.  My family were coming and going while the induction was starting, I was walking around in the park outside the hospital, food and drinks were served and finally, waters broke and the real work started.

I never forget that feeling, the waters breaking.  A flood of warm liquid everywhere, over me, on the bed, floor, everywhere.  A slight feeling of, not shame, but some strange sensation that I was looking ridiculous to the people around me, the midwives.

But they seemed happy and things were progressing.

Stumbling to the toilet where I sat on a birth ball, vomited into the sink and someone had the shower-head with warm water on my back.

Mess, pain and desperation for an hour or so.

Does it really have to be this way?  Would a C-section not just be better?

A warm smile from the midwives.

Sun shining through the glass of the windows.  Enya singing.

Pethidine.  Calm, sleep, smiles.

Sit up on the bed, husband behind, pressure, hands on the baby’s head, enormous pressure, hair between my fingers, midwife sat on a stool on the floor as I was standing with my butt resting on the side of the bed. Finally head out – what a relief after two days of labour.

The music gently in the background, shoulders out and the most beautiful feeling in the whole world when the 4 kilo boy scrambled into my hands and onto my chest.

Smiles, kindness, relief and an enormous feeling of something I had never felt before.

Waking up the next day, remembering that something absolutely amazing, amazing, amazing had happened, but not sure what? Like the day after Christmas when you had your very favourite gift, except 100 times stronger.

Looking to the side and seeing the little bundle in the cradle next to me, remembering what it was that had happened.

Such love I never felt in my life before.

Since then, never wanting to let go of him.  Kept him in my arms, fed him, had him next to me in the bed for as long as I possibly could do.  And he was always happy.

Now, 18 years later, trying to let my baby fly on his own wings into this world, but the love is no less.

I remember every detail of that day.  The smell, the touches, the sounds, the feeling.  Still brings tears to my eyes.

Thank you everyone that made it that way.

Family, midwives, friends, and Starri, my baby, thank you all.

 

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