Tag Archive | "birth planning"

Medical Induction of labour

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Medical Induction of labour

Posted on 08 August 2014 by Kristrun

How is induction done?

Labour induction can be performed medically (artificially and drug induced) and non-medically. We will discuss how it can be performed medically first and try to set out some of the disadvantages and advantages of each method.

Prostaglandin gels or tablets

These are used more frequently when the cervix is not favorable, meaning that it is dilated less than 3 cm, hard, posterior, not effaced, or barely effaced, or any combination of the above. By using the Bishop’s score your midwife or obstetrician will decide if this is the best place to start. This can be used alone, or more frequently will be done 12 or more hours prior to the use of oxytocin. Frequently it will be given more than once over the course of an evening/night. A pessary or tampon like substance will be placed in or near your cervix during a vaginal examination.

Benefits: The more favorable your cervix, the less likely the induction is to “fail”. Sometimes this is all that is needed, other times oxytocin is also used. Can be done as an outpatient procedure.

Disadvantages: Takes longer to get into active labour, can be frustrating if your hospital policy is that you have to stay at the hospital during the waiting period. Sometimes the mother becomes nauseated or has headaches. This cannot be quite as controlled as oxytocin.

Breaking the bag of water (amniotic sac)

Using an instrument which looks rather like a crochet hook, your doctor or midwife will make a tiny tear in the bag of water. This will cause the water to begin leaking out. Since the bag does not have nerves, this should be no more painful than your average vaginal examination. The thought is that once the bag is ruptured, contractions will usually begin. In addition, the downward pressure of the presenting part e.g. the baby’s head, encourages the contractions to start.

Benefits: No drugs may be needed, you maintain more mobility than if you were required to have an intravenous drip or infusion.

Disadvantages: Contractions may not start, which means you may need other interventions such as the use of the hormone oxytocin (Syntocinon®). It may create an infection of the sac. The cushion for the baby is now removed. Rarely, but possibly, the prolapse of the cord (when the umbilical cord falls below the baby and is delivered before the baby, affecting blood supply to the baby), which means an immediate caesarean section is necessary.

Syntocinon®

This is an artificial version of the body’s hormone oxytocin. It is given by way of an IV infusion (via a drip or a pump) and is used to cause contractions. The amount of oxytocin used will depend on how your body accepts it. Generally, the amount is increased every 15-30 minutes until a good contraction pattern is achieved. Sometimes this is done in combination with breaking the water bag.

Benefits: A bit easier to control than say breaking the water, because the drug can be stopped by closing off the IV line. It can be turned off or stopped to allow you to rest or even go home.

Disadvantages: Can cause distress to the baby such as an increase or decrease in its heart rate. May not cause contractions. May cause too many contractions or contractions that last too long.

Where will I be induced?

It is usual for most medically assisted inductions to be performed in hospital. This allows both you and your baby to be easily monitored. Your midwife will need to monitor your baby’s heart constantly if you have an oxytocin (Syntocinon®) drip or infusion, or any prostaglandin drugs are given, but intermittent monitoring should be fine if your waters have broken.

Remember you don’t always have to be lying down to be monitored. Ask to be monitored while you are sitting in a chair, or even kneeling on the floor.

Will an induction be more painful than natural labour?

Not necessarily. It really depends more on your reasons for induction, the type of induction and whether or not your mobility is limited. Many women are able to be induced and still follow through with their plans for an unmedicated birth, though they can expect certain changes in their birth plans. If induction is suggested, gather facts and information, and ask questions. Why is it being suggested? How would it be attempted? What happens if it doesn’t work? What happens if you do nothing?

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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The importance of birth planning

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The importance of birth planning

Posted on 26 June 2014 by Kristrun

babyleaningonarmsAfter years of working with families to prepare for birth, we have long ago learned that the term ‘birth plan’ is probably not a good description, and by that I mean to hand out a piece of paper that states BIRTH PLAN at the top.  This indicates that there is “a” plan, and that the parents expect things to go a certain way.  This can sometimes be hard, because if there is a change in the beginning, for example if you need to be induced, sometimes the whole “plan” is then changed or not valid anymore.  Similarly, sometimes these plans are quite unrealistic and come from someone else that perhaps had different reasons for choosing what they did.

Without ditching the term “birth plan”  we go around this in a slightly different way when we assist parents in their preparation. We suggest that you view the birth similar to an adventure trip that has certain planned checkpoints beforehand, but the whole journey is unknown.  It is much better to be well prepared for it, with the right people/hospital to support you, and some parts of it need to be planned.

In the period leading up to the birth, the term ‘birth planning’ will be used many times and you will likely be asked at the hospital if you have a birth plan.  Your birth plan will always be restricted to certain hospital guidelines, but there is usually some flexibility in both public and private settings.  To ensure a realistic and tailor-made birth plan that suits your needs, we therefore suggest two types of planning/preparation: short and long term.  The long term planning involves choosing the right hospital and doctor, with direct answers about what practices and rules there may be for women who are in labour.  Statistics and details are needed when this is done.  The short term planning involves more detailed information about your own choices during the labour and birth and may include information about your care and preferences regardless what type of labour / journey you embark on.

Attending antenatal courses and/or private consultation about typical scenarios during childbirth, and what interventions are available, is normally the first step in your birth planning. This is the part where you figure out what will be important to you on the day when you go into labour. It´s also about working out if you as a couple are hoping for the same type of experience, as labour is not the right time to figure these things out.

Birth planning becomes even more important when you are seeking care in a private doctor and hospital environment. Educate yourself so you know what you prefer, rather than have the “system” make these decisions on your behalf. Are there any financial gains underlying your care? Be in charge.

In the public system in Hong Kong, you will not have many choices. The long term birth planning will be you educating yourself on what types of choices you think will be important for you and your partner and how to make the most of it. First step will be your antenatal education. From there you make your choices within a reasonable birth plan which you present and make clear to your caregivers at the hospital.

The short term birth planning is when you create the final document and submit to your caregiver. It is very important to create a birth plan that is in line with what is available in each hospital, and a plan that meets your needs even in the event of different birth circumstances than were originally planned.  This is important both to make sure you get the best birth possible, but also to ensure your emotional health and to avoid any feelings of failure after the birth. We advise against ‘copy-paste birth plans’ from the internet where individual needs are not taken into account.  Creating a birth plan is a very personal and important part of your birth preparation.

Birth planning is a big part of the support we offer. Through our classes, consultation and routine checkups we have created a detailed educational program that goes perfectly well with the public and private systems in Hong Kong. For the best results, join our ‘Best of Both’ for public hospital births and ‘Private package’ for giving birth in a private hospital in Hong Kong. Equip yourself with the tools you need to navigate the system in which you are giving birth.

The Annerley midwives

Book a private birth planning session with a midwife > let us know how we can help

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Preparing for birth in a public hospital in Hong Kong

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Preparing for birth in a public hospital in Hong Kong

Posted on 21 August 2013 by hulda

PREPARING FOR BIRTH IN A PUBLIC HOSPITAL IN HONG KONGBy Hulda Thorey –  Published in SassyMama – 20 September 2013

In Hong Kong, every person with a Hong Kong ID card has the right to use the government hospital maternity services at a minimal cost. The maternal health clinics generally provide adequate services, staff, equipment, and resources to ensure your safety. The facilities are up to standard and the delivery rooms are big and very well equipped. It can be a great experience to give birth in a public hospital but we highly recommend parents educate themselves so they know the politics, preferences and the procedures within each hospital.

Before using the services at a public hospital you will need a referral letter to confirm your pregnancy, so the first step is to visit a doctor or obstetrician to get that letter. The antenatal checkups at the public hospitals are free of charge and they will let you know how often you need checkups, roughly every month initially, then every two weeks. The checkups can take a bit of time, so allow at least 3 hours, but if you are lucky it will take less time. Many of our clients supplement the public system with a private midwife or doctor, which saves time and gives them a chance to get answers to their questions.

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Natural birthing in Hong Kong

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Natural birthing in Hong Kong

Posted on 21 August 2013 by hulda

By Hulda Thorey –  Published in Geobaby – 30 May 2013

What’s to stop you from getting a natural birth in Hong Kong? According to Hulda Thorey, founder and head midwife at Annerley, it can be many things but not a lot if you know how to ask for it.

Natural birthing in Hong Kong

The first thing a mother-to-be should know is that having a natural birth experience in Hong Kong is not necessarily a matter of finance and being able to pay for what you want. Whether you go public or private, it’s more about having the knowledge and the confidence to work with the doctors or the system, and being able to ask for the right things at the right time.

A simple way to put it is that doctors and hospitals are programmed to use their medical skills and technology to get patients through procedures following the route of minimal risk, least pain and in the quickest timeframe.

On first investigation, natural birth doesn’t appear to match these criteria. With the best intentions and without your consent, doctors usually follow the path they feel most comfortable with.

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