Health Care: a quick update

A quick update regarding maternity care in public vs. private systems in Hong Kong.

Were we to have a baby here, a priority for us would be to have the best possible chance of a natural delivery, with few medical interventions. (And lest you think I'm just trying to be a super-woman, this is as much because I'm a total scaredy-cat when it comes to hospitals, needles, IVs and the like as it is anything else.) What I've heard lately, in several conversations with women who've delivered here, is that for my goal, the public hospitals are the way to go. This is entirely anecdotal, and our speculations about why this is so are just that: speculations. But for what it's worth, here they are:

1. Cost. C-sections are expensive, flat-out. So in the public system there's no incentive for doctors to push for one unless truly necessary. Of course the fear is that doctors might encourage against one even when necessary, but nothing I've heard would suggest that happens here. They also don't hold out on medication for women who want it.

2. Doctors. In public hospitals, you see a team of doctors for pre-natal care (called ante-natal care here, but that always confuses me) and whoever is on call catches the baby. In the private system, you pick a doctor for all the prenatal care and the delivery, and so they have every incentive to encourage scheduled c-sections and to speed up labor that isn't fitting well into their schedule.

3. Population. Rates of scheduled sections are very high in the private hospitals, and this likely has something to do with both the doctors who work there, and the women who use the private system. Have to be wealthy, likely to be busy, working at an executive or managerial level, have a short maternity leave, etc.

4. Trickle effect. When the majority of women get scheduled sections, nurses and doctors don't get as much practice at helping women have natural, non-medicated births. They don't know what positions to suggest, they don't have as many tricks for helping with pain relief, and they don't always see or have experience with the wide range of "normal" in labor and delivery.

Let me be clear that this isn't to suggest that birth in the public system is always rosy ... laboring in the ward sounds horrendous to me, and I've heard very mixed reports on the amount of labor support you get from the nurses and midwives. But still, I was surprised to hear that for a natural delivery, the public system can be a better option.