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Early labour and then Vaka is born in Queen Mary Hospital

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Early labour and then Vaka is born in Queen Mary Hospital

Posted on 20 August 2014 by hulda

 

 

Birthing pool

It takes around 20 minutes to get the pool ready

DSCN4361

Everyone participating in getting the pool ready
For labour

The boat looked like a war zone, – not a birthing unit

I had my last baby three years ago.  It was a challenging time in my life for various reasons and I had no time really to think about preparing for it.  Like everyone else who´s career and family are busy, I was juggling too many things at the same time and had to rely on family members and new staff members in my clinic to support me during these times. It worked out fine, but it was stressful and made me realise that all of what I keep preaching to other mums, really applies to myself as well.

 

Pre labour and preparation of the birth of Vaka

Pre labour and preparation of the birth of Vaka

I had wanted a homebirth.  The main reasons were that I wanted my family around me and I wanted no restrictions to mobility and I wanted quiet and calm surroundings.  I did not need to hear that I was a high risk case, obese with huge baby and liver problems and risks of all sorts of things, because I knew most of it (aside from the BMI) was not a problem.  Although I knew certain precautions were needed, I was hoping to get safe care but the birth environment that suited. The only midwife in Hong Kong who would support this was away for the Easter holiday but this was no problem for me, as I was not due till 10 days after Easter and with all three older kids I had been induced and very overdue.  So I told the midwife not to worry, I would wait for her.  I also had a friend of mine coming, a midwife who was doing her Phd and was going to help me and my family around the birth.

 

All three of my previous births had been annoyingly late and as much as I really tried not to be induced, it became reality in all births.  I will write about each of them later, but essentially, I got to feel supported during most of it, which was really important and made my birth experience more pleasant.

 

Vaka is born in QMH

Labour is long and boring

My office manager at work had just resigned and a new one taken over and I had so much work to finish before the Easter holiday that I was rushing that Monday morning, to go to work. It was a beautiful day and I decided to take the motorcycle in, so I was going to wear my bike boots on the way.  For the very first time in my life, I could not get my socks on.  Something kept bothering me every time I leant over and tried to squeeze my toes into the socks, so eventually I gave up.  Everyone was busy in the boat (where I live); my in-laws had just arrived the night before from Iceland, my other kids were going to school, my husband and my father were preparing to leave to China, where they were going to spend the next three days. I laid down for a few minutes, trying to comprehend what was going on.  Something totally new to me.   I was 39 weeks pregnant and it just dawned on me that likely, I was in labour.

Trying to get my motorcycle gear on was not going to work.  Trying pretend that I was not in labour was not going to work, but I did feel like I was very much in an early stage and I really did not want the whole family all over me in this early stage.  Yet, I did need to try to stop my husband from driving 300 km north of Hong Kong in the next 30 minutes.

 

Lying down can be great at times

Lying down can be great at times

I walked out of the room and announced that I needed some help with something in the bedroom, could my husband help me.  He yelled back that he was in a rush to leave, what is it? Well, the cabinet needs a bit of fixing.  Cabinet?  Ask the boatboy to help, I really must leave now.  By this stage my mother in law looked at me with suspicion.  She could obviously sense that I was in labour.  So I gave up soon and told them that I was having some mild contractions, and perhaps my husband should not go to China.  He looked at me, tired.  Really, sure? I told them I thought that I was not doing anything much, but I just could not go to work. So could everyone just continue what they were doing and let me potter around.  Fair enough, they all started to do some boat maintainance.  Basically, tearing down the ceiling covers.  And soon, the boat was without any electricity, the water heater was not working and there was no way to even manually warm up the water.

My father, together with my husband, 3 children, in laws and the three helpers, was not wanting to leave either.  This was a real family feast!

My older kids opted out of school (13 and 14 years old), and my 3 year old was happy to inflate the pool.

I tried frantically to find a midwife who could help me to stay at home during this early stage.

It was Easter time and no one picked up the phone.  Even my doctor friends were away or unable to help.

In any case, I was not in all that much pain, and the main project was to try to find water to fill up the birthing pool for my first stage of labour.
Everything was a beautiful chaos, it was a good day and I had a good feeling.

 

…to be continued…

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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

Xx

Kristrun

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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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