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Recommended Immunisations in Hong Kong

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Recommended Immunisations in Hong Kong

Posted on 03 November 2014 by Kristrun

blockforVaccinationsARrticleThere is not much difference between vaccinations in the public health system and the private health system in Hong Kong. A few things to consider are:

The Hong Kong government schedule recommends to give Hep B and BCG at birth. Some parents have a preference to delay those vaccines and then usually the Hep B is given at 1, 2, and 6 months as a part of a combined vaccine with DaPT and HIB (Haemophilus Influenza B).

The BCG (only one dose is needed), is then usually given in the buttock instead of the other option of the upper arm if given by the Government hospital staff.  There is not any obvious reason for this except that many parents feel that the scar will not be visible there as in the arm (the BCG is the only vaccine that always produces a scar, which is usually circular and can be 1 to 2 cms in diameter).  Some doctors claim that there is more risk of an infection by the BCG vaccine, or in the pimple that it gives before the scar is formed (the first three months or so there is a pimple that may burst, with some pus, but then eventually heals) – the infection being caused by rubbing of the diaper on the area, urine, stools etc.  

The HIB part of the 2, 4, and 6 months vaccine is not available in the public health system and therefore if you wish to give this to your child, you must see a private doctor.   For this you will pay a consultation fee and the fee for the vaccine.  Because the HiB can be given as a part of the 5 in 1 mentioned above, many parents then choose to give all of these together, instead of having the DTaP and Polio in the Government clinic, and then HiB in the private clinic, at the same time (2, 4 and 6 months).  It is more expensive to get the full 5 in 1 than it is to just get the HiB but it saves a trip and one injection (the actual needle).  In terms of giving many vaccines at the same time, this is a discussion of a different story, – in developed countries it is considered the safest to give these vaccines and they have been on the market for a long time, so they are not considered unsafe because of heavy metals, interactions, etc.

  • In the past, the Hepatitis B vaccine contained Mercury as a preservative, but nowadays, in Hong Kong, the vaccine used is a Mercury free Hepatitis B (ENGERIX).
  • Both private and government doctors recommend to give the MMR vaccine around 12 to 15 months.    This is the only vaccination given that contains live vaccines, and usually has side effects (the actual symptoms of all three diseases, or at least some fever and usually rashes, around 10 to 14 days after injecting it).
  • It is very important that the child is free of any diseases, colds etc. when being vaccinated, and as some get a little sick and feverish, and it may be a good idea to have some paracetamol on hand, doses depending on age and weight of baby.
  • All vaccines, can cause side effects, but they’re generally mild and short-lived and the benefits outway the risks of severe illness or fatality due to disease.

Below is information about the most common vaccinations in Hong Kong:
The 5-in-1 vaccine, the DTaP/IPV/Hib vaccine, is a single injection which protects against five serious childhood diseases. These five illnesses are diphtheria, tetanus, whooping cough, (pertussis) Polio and Haemophilus influenza type b.  In the government system, this vaccine is a 4 in 1 (without the HIB), as there are not many outbreaks of HIB in Hong Kong, although other countries see a reason to vaccinate against this.  Private clinics in Hong Kong offer this as a 5 in 1, vaccinating against the following diseases:

Diphtheria is a highly contagious bacterial infection that mainly affects the nose and throat. Less commonly, it can also affect the skin. The bacteria spread when an infected person coughs or sneezes and droplets of their saliva enter another person’s mouth or nose.  Diphtheria can lead to potentially life-threatening complications, such as breathing difficulties and problems with the heart and nervous system.

Tetanus is a serious but rare infection caused by bacteria. It usually occurs when a flesh wound becomes contaminated. The symptoms include: Stiffness in jaw muscles usually the first symptom, also known as lockjaw. Muscle spasms and stiffness then spread from jaw into neck and limbs. Other symptoms include high temperature (fever), sweating, rapid heartbeat (tachycardia), and high blood pressure (hypertension).  Muscle spasms in neck can make swallowing difficult (dysphagia). In the most serious cases, severe breathing difficulties could develop. This may lead to suffocation and death.

Whooping cough (pertussis), Whooping cough is a highly contagious bacterial infection of the lungs and airways. The condition usually begins with a persistent dry and irritating cough that progresses to intense bouts of coughing. These are followed by a distinctive ‘whooping’ noise, which is how the condition gets its name.  Other symptoms include a runny nose, raised temperature and vomiting after coughing. The coughing can last for around three months. Whooping cough is caused by a bacterium called Bordetella pertussis, which can be passed from person to person through droplets in the air from coughing and sneezing.

Polio, in the past was very common it caused paralysis and death. Since a polio vaccine was introduced in 1955, the number of polio cases has dramatically reduced. There are now only a few countries in which the condition remains a serious problem.

Haemophilus influenza type B. HiB is a bacterial infection that can cause a number of serious illnesses especially in young children. Many of children who get HiB infections become very ill and need hospital care.  HiB can cause any of the following infections: meningitis (lining of the brain and spinal cord), pneumonia (lungs), pericarditis (lining surrounding the heart), epiglottitis (epiglottis – flap that covers the entrance to your windpipe), septic arthritis (joints) and cellulitis (skin and underlying tissues). Some of these infections can lead to septicaemia (blood poisoning), which can be fatal.

Side-effects of the 5 in 1 vaccine:   
The 5-in-1 vaccine is very safe but some babies do have side effects. Your baby may have any of the following side effects after receiving the 5-in-1 DTaP/Td/IPV infant vaccine.

Very common reactions include:  pain, redness and swelling at the injection site, irritability and increased crying, being off-colour or having a fever.

Common reactions include: loss of appetite, diarrhoea, vomiting,

Rare reactions include:  febrile convulsions (fits) and floppiness.

Pneumococcal infections are caused by the bacterium Streptococcus pneumonia which can lead to pneumonia, septicaemia (blood poisoning) and meningitis.

Side effects of pneumococcal vaccine

Although the pneumococcal vaccination is safe, both the childhood and adult versions of the vaccines can cause mild side effects, including:

a mild fever, redness at the site of the injection, hardness or swelling at the site of the injection

Occasionally, the childhood version of the vaccine may lead to more serious side effects including:

high temperatures sometimes leading to convulsions (febrile seizures)
mild allergic reactions in the form of itching skin rashes
In very rare cases, children and adults can have a serious allergic, anaphylactic reaction and it can cause life-threatening breathing difficulties and collapse. It’s a serious side effect and is very alarming at the time, but it can be completely treated with adrenaline. The doctor or nurse giving the vaccine will have been trained to know how to treat anaphylactic reactions and, provided they receive treatment promptly, children and adults make a complete recovery.

Rotavirusis a highly infectious stomach bug that typically strikes babies and young children, causing an unpleasant bout of diarrhoea, sometimes with vomiting, tummy ache and fever. Most children recover at home within a few days, but nearly one in five will need to see their doctor, and one in 10 of these end up in hospital as a result of complications such as extreme dehydration. A very small number of children die from rotavirus infection each year. The rotavirus vaccine is expected to prevent four out of five cases of vomiting and diarrhoea caused by rotavirus and there could be 70% fewer hospital stays as a result.

Side effects of rotavirus vaccine

Common side effects: restless and irritability, mild diarrhoea
Rare side effects: As with all vaccines, there is a very rare (approximately one in a million) possibility of the rotavirus vaccine causing a severe allergic reaction called anaphylaxis. Anaphylaxis is very serious and a medical emergency, but with prompt treatment most people make a full recovery. All health professionals responsible for giving vaccines should be trained to recognize and treat anaphylaxis. In very rare cases (about two in every hundred thousand babies vaccinated), the rotavirus vaccine can affect the baby’s lower gut and they may develop a rare gut disorder called intussusception. The symptoms of intussusception are tummy ache, vomiting and sometimes passing what looks like redcurrant jelly in their nappy. If this happens, contact your doctor immediately.

The Meningitis group C bacteria, can cause two very serious illnesses: meningitis and septicaemia.  The Men C vaccine does not protect against meningitis caused by other bacteria or by viruses such as meningococcal group B, so it’s important for parents to be aware of the symptoms of meningitis.

Side effects of Meningitis C vaccine

The Men C vaccine has an excellent safety record. The most common reactions tend to be minor and very temporary.   Many children and adults have no side effects at all after having the meningitis C vaccine, and in those that do, any side effects tend to be mild and short-lived.

Common reactions are: swelling, redness and pain around the injection site, mild fever, vomiting and diarrhoea (more common in babies and toddlers), crying, irritability, drowsiness, disrupted sleep and going off food (more common in babies and toddlers), headaches and muscle aches (teenagers and adults).
Rare side effects:  A baby can have an allergic reaction soon after the injection. This may take the form of a rash or itching that affects part or all of their body.
In very rare cases, an anaphylactic reaction – a severe allergic reaction – within a few minutes of the vaccination. This can cause breathing difficulties and collapse. It’s very alarming at the time, but the doctor or nurse giving the vaccine will have been trained to know how to treat these reactions and, provided they receive treatment promptly, children and adults make a complete recovery.  Very rarely, vaccine may trigger dizziness, fever-related seizures, fainting, numbness and a type of muscle weakness called hypotonia.

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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Routine checks and tests for babies – the first six months

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Routine checks and tests for babies – the first six months

Posted on 08 August 2014 by Kristrun

IMG_0676At birth, your baby will be assessed by the midwife caring for you and will be given an Apgar score at 1 and 5 minutes following birth. This involves assessment of your baby’s behavior, heart rate and breathing, the score is out of 10 and most babies will be given a score of 8 or 9 by 5 minutes following birth. Your baby will also be weighed, and have head circumference and body length measured. She may also be bathed. A Vitamin K injection will be recommended.

In hospital you will have a paediatrician assigned to you/chosen by you. He/she will check the baby & discharge you from the hospital usually between days 3 to 5 after birth. Vaccinations will be commenced including Hepatitis B & BCG(TB). You do have a say in whether your baby receives these vaccinations, however if you are choosing to decline the advice, make sure this is based on independent research and be informed about what it is that you declining. You will also need to discuss this with the paediatrician prior to discharge.

Your baby needs a checkup around day 7-10. Your midwife/health visitor can perform this check up during a home visit, unless the baby has jaundice or other problems when they left the hospital. Baby will need a weekly check (roughly) for around one month, then every two weeks, and then monthly from 2-6 months. If you have a private midwife to help you at home after the birth, she will weigh the baby, check reflexes, and do a PKU test. Her visits usually finish around week 3-4 and then you can see a doctor for vaccinations and Well Baby Clinics for weight checks between vaccination appointments. Baby needs a hearing test before one month old (usually done in hospitals at birth) and a thorough developmental check around 6 to 8 weeks. Tinnitus & Hearing Center is the trusted one.

In private clinics, it is usually doctors who do the vaccinations – can be a paediatrician or a family doctor (GP). Your doctor will start the 6-in-1 vaccination at 2 months, with two more injections at 4 and 6 months. The 6-in-1 (DPT-polio-Hib-Hep) protects babies against 6 diseases: diptheria, pertussis (whooping cough), tetanus, polio, HiB (haemophilus influenzae type b), and hepatitis B.

If you are using government services, all check-ups and vaccinations are available there for free (4-in-1: DPT, polio) but will not include the HiB vaccination – this you will need to get at a private clinic. So if you want to have the HiB vaccination, it may be worth considering going privately for the whole 6-in-1 series as although you can have most for free, you will still need to pay for the HiB privately, plus the consultation fee, which will work out only slightly less expensive than having the whole series privately, and will result in more trips out, plus an extra injection for baby.

The government clinic will give the Hepatitis B vaccination at 4 weeks; private doctors give it at 6 months (included in the 6-in-1 vaccination).

Well Baby Clinics are available every week at Annerley for weight checks, consultation and development assessment and you can choose this option for regular weight checks in between your vaccination appointments. This is a lot less expensive than a trip to a private doctor and you will have access to our Health Visitor and midwives who can help and advise you on any of your baby related concerns or questions.

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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My two Birth Stories – Kristrun Lind

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My two Birth Stories – Kristrun Lind

Posted on 21 December 2013 by Kristrun

I gave birth to two children in a public hospital in Hong Kong. I had great support from the midwives at Annerley who educated me along the way. My vision was not that clear, I hoped for normal births with as little interventions as possible.
My first birth was at the QMH hospital. I had learned a few tips regarding what to expect in the hospital and all worked out for us. My first birth was very long, started very early on Friday morning and my daughter Johanna was born around 2pm on a Sunday. I happy familystayed at home until Saturday morning with my midwife and in active labour I went into QMH and straight into the delivery room. Something happened and the contractions dropped and I was transferred into the common ward. Equipped with instructions from my midwife – I was ordered to rest and sleep and the plan was to induced me in the morning. Hubby went home and rested as well. The next morning as planned I was induced, hubby was there and things moved as planned, induced with a walking epidural. When baby was about to pop out the staff panicked probably because I was on my knees and they started trying to pull her out – my husband firmly but politely requested that nature would have her way and they allowed it. 4 hours after being induced she was born. After quick examination where (high score healthy baby) they gave me my daughter and I managed to get her on the breast – the happiest moment in my life. The most wonderful sound in the world was to hear her breath.

The moment was interrupted when the pediatrician walked in and wanted to have Johanna transferred into the special unit because of “a risk of infection” (due to prolonged labour) – I could not believe my ears. My husband called our midwife and she explained how the hospital guidelines in HK differ from other countries – where this would never be suggested. And that the baby would be perfectly safe with us. So we said NO to having her separated from us and from there we requested to leave the hospital. It took them a while to sort out the papers but a few hours later we were home – continuing enjoying the moment. Our midwife came to see us the next day, followed by more home visits where she made sure everything was going well. We never went back to the hospital for follow up, the midwife took care of all off that. We enjoyed staying at home getting into the routine and getting used to being a new family.

My second birth was at the United Christian hospital. I negotiated beforehand that the baby would not be separated from us unless there was a matter of life or death. They agreed. It meant that I would need to take care of the vaccinations myself privately – as they would normally take the baby out of the room for washing and vaccinations.

Contractions started at 1am on a Tuesday morning, my midwife came around 9am, she sent us to the hospital 30 minutes later. Baby Tomas was born 10.30 am and we were out of the hospital before 12pm. They examined him on the table in the room, gave him to me – we had some time to put him on the breast and sort us out – then straight home.

It´s from my personal experience that I can highly recommend our best of both package with midwife care during labour, it´s the perfect setup for giving birth in Hong Kong. You have the public system there – the safest place to give birth in in HK. You have a fixed package and you know exactly how much you will need to pay – no matter how things go. You have private personal care combined with general public hospital care.

Happy holidays



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Breastfeeding in government hospitals in Hong Kong

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Breastfeeding in government hospitals in Hong Kong

Posted on 21 August 2013 by hulda

BREASTFEEDING IN GOVERNMENT HOSPITALS IN HONG KONGBy Hulda Thorey –  Published in SassyMama – 10 April 2013

Breastfeeding is promoted, encouraged and supported in Hong Kong government hospitals in principal. However, in practice, the level of support offered can vary. Although well meaning, some staff may want to follow routines that are not necessarily in the best interests of the breastfeeding mother, but an informed and prepared mother can confidently stand her ground to get what’s best for her and her baby. Here, Hulda Thorey, midwife and founder of Annerley, provides advice on how to prepare for breastfeeding in the government system. 

Breastfeeding immediately after birth

Nowadays, if everything around your baby’s birth is normal, most hospitals will not take them away for the traditional initial check; and a request to have the baby given straight to you means that you can usually initiate immediate breastfeeding. Of course, on the rare occasion a baby is not doing so well straight after birth and the hospital wants to transfer the baby to the special care unit for neonatal help, most parents are more than happy for the quick response.

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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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Antenatal care in Hong Kong

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Antenatal care in Hong Kong

Posted on 14 August 2013 by hulda

By Oláfia Aradottir – Published on Geobaby.com – 25 July, 2013

In Hong Kong, as in much of the rest of the westernised world, when you learn you are pregnant, you take it for granted that you will follow a programme of antenatal visits. After the initial excitement it can feel that the checkups are a bit tedious and over-fussy, especially when all that the healthcare practitioner seems to do is check your weight, urine and blood pressure, but it is exactly these checks that provide the first indicators of a problem.

Why antenatal care is so important?

Much research has shown how important antenatal care is for improving mother and baby survival rates, and a World Health Organization study published this year shows that even skimping on visits can have scary results, even for low-risk mothers.

Antenatal visits are as important as the consumption of d-mannose, as one helps in preventing urinary problems the other keeps an eye out looking for indicators for some of the rare but serious conditions that cause death for mother and/or baby can easily be detected in the early stages, and this means that the condition can be treated or managed safely to reduce risk and prevent the condition escalating and causing further complications.

Who provides your antenatal care depends on where you live. In Europe midwives are generally the prime carer for low-risk pregnancies, even doing most deliveries, whereas in the US, care is more obstetric-led.

Antenatal care in Hong Kong

In Hong Kong’s private hospitals care is obstetrician led, but midwives take care of the women throughout labour with the obstetricians making all major decisions and then delivering the baby. However, in government hospitals, midwives usually deliver the babies having taken care of the mother throughout labour.

This involvement of midwives is important because for a vast majority of women, pregnancy is not a medical condition, but is an important life transition. A famous piece of research (Cochrane) has shown that, compared with women who were cared for under other models of care, women who received midwife-led models of care were less likely to be admitted to hospital during pregnancy, less likely to receive regional analgesics during labour and childbirth, and to have an episiotomy. In addition, women who received midwife-led models of care were also more likely to have spontaneous vaginal birth, to feel in control during labour and childbirth, and to initiate breastfeeding. And if that wasn’t enough: babies born to women who received midwife-led care were less likely to die before 24 weeks of pregnancy and were more likely to have a shorter length of hospital stay.

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A Natural Birth Story

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A Natural Birth Story

Posted on 20 March 2012 by hulda

Do you have any natural birth stories to share? We’d love to hear your stories. Email your story to us at hulda@annerley.com.hk.

Heather from Pangea shares her story:

My name is Heather Cogan and three months ago I gave birth to my first son, Noah. I choose to deliver naturally (so no drugs) and after 14 hours of labour gave birth to our baby … all 4.5 kg of him and left the hospital the same day. On the way to the hospital my husband John and I felt calm, excited and prepared for what was to come and I put it all down to the help we received from the Annerley team and the daily Pilates routine I followed at Pangea.

I have been teaching Pilates for 8 years and started my own training 12 years ago. So Pilates and I go way back. Having taught over 62 pregnant women in the past, I knew a lot about what to expect and how to prevent many of those nasty pains related to changes the body goes through whilst being pregnant. To name a few, sciatica, lower back pain, upper back pain, shoulder and neck tension, hip displacements and so on. So I was looking forward to practicing what I preached.

I practiced pilates anywhere between 15-60 minutes daily. The aim was to keep my spine as mobile as possible and strengthen certain areas in my body to cope with all those changes. I also regularly practiced a few of my chosen birth positions recommended to me at the natural birthing course at the Annerley.

One of the most effective methods to reducing aches in my body was correct standing, something so simple yet so many pregnant women fall into terrible posture which leads to real discomfort and pain. However, its easier than I had imagined to let gravity have its way and draw you into bad posture whilst pregnant so brining your awareness to standing correctly is essential. I thought about it as much as I could, in the shower, standing in line and at the beginning and end my exercise and it made such an amazing difference. It kept my awareness deep inside my body so that I could cope with the huge weight spread round my center, rather than giving into gravity waddling like a duck.

No one can really describe to you what your pregnancy, and birth experience will be like, because like our children, they are all so different but once you meet the baby that has been kicking your ribs, keeping you up at night, pushing down on your bladder and caused you embarrassing episodes of flatulence, it all seems worth it.

Three months down the track Noah is already wearing 6-9month old baby clothes. I have enrolled him in a baby massage course with the Annerly team which I know he is looking forward to. I have upped the intensity of my own pilates training and I am feeling fit and mobile once again, and can fit back into my skinny jeans. Hurrah!

Heather Cogan
Head Pilates Teacher
Pangea – Align Fitness

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Natural births in Hong Kong

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Natural births in Hong Kong

Posted on 20 March 2012 by hulda

Every pregnant woman wants a healthy baby and a good birth experience and many women also say they want a ‘natural’ birth.  The term ‘natural’ can mean anything from a vaginal birth to an undisturbed home birth and for women in Hong Kong – depending on various factors such as budget and where you live – there are several different options available:

Natural birth

If we are to assume a natural birth means a birth where there is no intervention, most midwives will agree that preparing well for the birth is important. Also, the location and those selected to be present will strongly influence the outcome. Choosing a doctor and midwives that have good statistics for normal birth (for example, a C-section rate below 25 percent), and also a hospital that not only has staff but also facilities to support a natural birth is obviously important too.

Other factors that will contribute to a the likelihood of a natural birth are, for example, whether you can stay at home during the early stages of labour, being mobile and active at this time, eating and drinking regularly and choosing a position that feels good when you are actually giving birth.

Many women are quite vulnerable when they are in labour and as a result they fall into a role of a patient rather than following their own instincts – which in returns makes all of the above hard for them.  Furthermore, even though it has been long proven by research, some hospitals and doctors have a policy that all women must be in hospital right from the earliest signs of labour, lie in bed during the whole labour and birth, have continuous monitoring of the baby’s heartbeat, give birth in a hospital bed (and sometimes in stirrups) and have a routine episiotomy.

Many women don’t even dare to question this as they may have been told that this is the safest way to give birth. One only needs to look for evidence-based guidelines about maternity care, such as the NICE guidelines that are used in the NHS in the UK, to see that this practice is no longer recommended for women who are not classified as high-risk patients.  So if you are truly seeking a natural birth, it is useful to look at the birth places available in Hong Kong and what they have to offer.

Where to give birth in Hong Kong

In Hong Kong, people have the option of private or public health care.  The public hospitals here offer excellent maternity care and are both professional and have good statistics when it comes to natural birth and interventions.

Their main disadvantage is probably the fact that they are busy and the staff cannot provide continuous care which means that it is not as personal as some would like. Also, there are quite a few “rules” and protocols that are followed more strictly than in private hospitals.

One of the main advantages of public hospitals is that they are very well equipped with staff and tools for serious conditions, and for babies that are premature or ill — although luckily most babies are born healthy and well.

Also, in the recent years the public hospitals have started to offer more support for natural birth, providing birth balls, yoga mats, and the option for hypnobirthing methods and being mobile. The routine use of episiotomy has now finally been discontinued, which is great news to all childbearing women.

Private hospitals tend to be good here too. Care is usually given by a doctor you have chosen yourself and consulted with throughout pregnancy.  This means that you know who will deliver the baby, although the doctor is only there at the final part. Those who are considering private care will need to look at the budget, since private health care here is expensive and insurance does not always cover the cost.

In addition, although often very good, being at a private hospital does not necessarily mean you have more chance of a natural. In fact, the statistics for most private hospitals show us that C-section rates, epidural use, induction, and forceps and vacuum deliveries are much more common there, with C-section between 50 to 85 percent.

Either way, in my experience, both models are good for different reasons; in a private hospital the most important part is to choose a doctor who will truly support you, and regardless of where you give birth, you should prepare yourself since no one else will do the actual work for you AND – not less important, that you prepare yourself really well.

Home births

In some countries, home births are becoming increasingly popular and have been proven to be a safe option for healthy mothers in low-risk pregnancies. Those that fall into this category can expect to have an undisturbed birth in a private and quiet environment; and they should not expect to be induced, use medication or have any other intervention, since should these be needed, they would be transferred to hospitals.

Women who want a truly natural birth often opt for this and prepare accordingly. Outcomes are generally good, with only 5 – 10 percent of cases requiring a hospital transfer because of medical complications.

Many believe that home births are illegal in Hong Kong. This is not the case, although they are not supported here, nor is it easy to find staff that is willing or trained to assist.  As a result, home births are probably not as safe an option in Hong Kong as they would be in many other countries. This does not mean that it is impossible and with the help of skilled midwives and the correct preparation, a homebirth can be an option for those women who are low risk.

Doula care

To have appropriate support while in labour is so important and that person can be a husband, family member, friend, midwife, or doctor – but whoever it is, good support is invaluable.  And by good support I mean support that is on your terms. This is why it is important for those that are with you during labour and birth know you and understand what you want.

Doulas have existed for centuries and their role is to be exactly this; to provide support on your terms. They provide everything from psychological support, to physically massaging and coaching you through the birthing journey. Doulas help women to stay at home as long as they feel comfortable and then continue to help them while in hospital.

I have been a registered midwife here in Hong Kong for many years now but since midwives do not have admission rights in private hospitals and have to speak Cantonese to work in the public wards, I have not been able to provide a one-stop pregnancy and birth care service.  I have however, found myself in the role of a Doula, or birth support many times. The experience of doing this has been invaluable and given me insight into all the different birthing options that Hong Kong has – including all those that I have explained above.  It has also frequently reminded me of the fact that we professionals so often forget; that each family is unique and each birth is too. It is not just an event that results in a safe birth, but a family event that has an everlasting imprint on everyone involved and it should be treated with such respect.

More doulas are now available in Hong Kong which is a fantastic thing.  Donna Watts, our excellent early childhood nurse has just done her doula training and within Annerley. Donna, Eugenie, Rovena (and Tamara on South Lantau) and myself can offer women continuous support through labour at home, and sometimes even in the hospital. We also work with other very good doulas to provide excellent care.

Prepare well

To all pregnant women I would suggest:

  • Before the birth, ask the doctor/midwives about their statistics and how they routinely work.
  • Ask how much they will be there during the labour.
  • Tell them in advance what your thoughts are.
  • If you do a birth plan, make sure that it is short and only contains the things that are very important to you, but not the details of medical care.
  • Be firm, but polite.

If medical intervention is offered ask:  Why?  Can we wait?  Is the baby in danger?  Are there any other options? Remember that the staff takes usually extremely good care of safety but they pay less attention to comfort – this is something you must do.

Hulda Thorey, 2012


Points to remember regarding hospitals:

Public hospitals: 

Possible challenges:

  • You can only have your husband / one support person with you when you are in established labour, i.e. after around 3 cm of dilation.
  • Sometimes mobility is a bit restricted.
  • Drinking and eating is no encouraged, but you can do it anyway.
  • You cannot take showers or baths during the labour, there is no access to toilet or bath.
  • Episiotomy is very common in some hospitals, but you can usually say no to this.
  • There is less privacy and sometimes staff will come and go.
  • When your baby arrives, it is usually taken away for a check-up. Again, you can suggest otherwise.
  • Breastfeeding is supported but sometimes the staff do not have much time to assist.

On the positive side:

  • The staff are very professional and practical, and being teaching hospitals, the staff follow protocols; things are not done for personal convenience or financial gain.
  • Most public hospitals do have private rooms and allow “props” to be taken in, once you are in established labour.
  • Most wards have TENS machines and the midwives are trained to give massages and support natural births.
  • You can usually get your way if you are polite and resourceful.
  • Major medical interventions are much lower than in private hospitals.
  • Epidural rates are much lower than in private hospitals, but they are available.

C-section rates much lower than in private hospitals.

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Government maternity wards and positions during labour

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Government maternity wards and positions during labour

Posted on 19 February 2012 by hulda

Hello all, thanks again for reading.  Exciting things happening and I wanted to share them.  Some of you may be aware of the fact that Franklen and Miranda shared their homebirth story in the Ming Pao newspaper earlier this week and it has raised endless response.  Poor Franklen has had little time to anything else but to keep the home running and take phone calls/emails, and the response is not all good!   Of course, such a controversial topic as a homebirth will always raise more questions and people have strong feelings about this.  To me, this is simply an option in addition to many other good options that Hong Kong has to offer, – it is not a statement to say that other services are not good.

Franklen´s blog: http://continuum-fathering.blogspot.com/

In any case, as a result of demand for more birthing options,  our Annerley Birth Centre will hopefully open not too long from now. Preparations are in full swing and we have felt so much support, thank you all very much.  Any comments, suggestions and birth stories are very helpful to us as we use these to help us make sure the birthing options in the centre will include pretty much EVERYTHING that a woman and family can ask for.  So keep your comments coming, we are listening.

birth options in Hong KongAnother really great thing that I wanted to share with you is that this week I am conducting a midwive’s workshop at the Queen Elisabeth Hospital, where around 30 midwives from the government hospital wards will come and learn how to assist women in giving birth in various different positions, other than semi-upright.  We will cover the squatting position, standing, kneeling, lying on your side, and on all fours.

They are all very excited and I am too. I truly hope that this will help the midwives to continue the great work that they have already started, i.e. to offer more options within the maternity wards.  For women to be able to give birth in a position that they choose is an absolute right in my mind, so if we can equip the midwives to feel comfortable in assisting, then there is nothing holding us back any more!

So this Thursday, the workshop will be on and hopefully all of you going to QMH, POW, QEH, PMH, PYH, KWH, TMH will have access to midwives in the future who will happily assist you in whatever position you would like.

Additionally, together with Katrin — the Icelandic doctor who has been with me for the last 3 weeks in her internship here in Hong Kong — we did a workshop at the Prince of Wales last week for all the midwifery students that are graduating this spring, covering the same topic – positions during labour.  They were very inspired and the class this year was big, 43 students, so this means that the wards will now be filled with students and new midwives that are eager to promote these new positions.

So that this development will continue, it is however, of uttermost importance that all of you, dear pregnant mums, further express your needs during labour, rather than relying on the options that are offered to you.  You must initiate what you are after, and be confident in trying various things.  Then this will inspire the midwives, who will work with you at an advanced level.

So to conclude, more and more birthing options in Hong Kong, positive developments and many great things happening in hospitals and in the community.

I welcome any discussion, please join in!

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