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.


Christa said...

I've been catching up on your great blog and thought maybe you were announcing something with these thoughts on maternity wards and the health-care system here in HK... but alas, no :) I did want to point out that in the Oct. 4 HK Postmagazine there's a feature on a USA midwife which quotes a 30% (and still rising) C-section rate in the USA. One other thought... Isn't competency & positive outcomes in medical procedures (such as child-birth assistance) statistically correlated with raw number of procedures done?... wonder how the # of births per obstetrician/obstetric RNs in HK compares with # of births per obstetrician/obstetric RN's in the US?

foodsmith said...

hmm, yeah that's an interesting question about statistics. Certainly obstetric care in the US isn't where it should be ,,, in fact I think I've read that out of developed countries the US has some of the worst outcomes, both for mothers and babies. But at least we understand the system and we know what our options are there ... :)  By the way, i just posted a VERY LONG review of a movie we saw last week. You guys would find it interesting ... the movie, I mean, not my review. It's called Secret Sunshine and it's Korean.   Hope your week is off to a good start! Monte

Julia said...

hi monte!

i just finished a great book which i had bought and also just happens to fit in with one of the choices for required reading to get a doula certification-- ina may's guide to childbirth by ina may gaskin.

she is an amazing midwife who started a hippie commune in the 70's called "the farm". over time, she has become one of our country's leading midwives (along with her midwife partners at the farm). the book is half beautiful birth stories and half information, including a lot of statistics, laying out some of the cultural birthing history in the US that might blow your mind. she explains it so well. anyway, i highly recommend it for everyone!


p.s. did i miss something? are you planning to have another...? :)

foodsmith said...

Hi Julia--no immediate plans for another, but it's the aspect of the HK healthcare system I hear the most about, due to being part of an online mothering community. We read two of Ina May's books when we were pregnant and love them! Some stories were a little wacky but overall it gave us so much confidence.

Marcy said...

That sounds a lot like what Geneva was like, as far as the public vs private clinics. I heard a rumor that one of the private clinics had something like a 50% c-section rate. I was VERY glad to have found my midwife and the birthing center where D was born, otherwise I would have gone with the public hospital as the midwives who worked there seemed very nice and very supportive of natural labor and helping you through it (though that can vary depending on who you get during that particular shift).