Congratulations, you’re pregnant! But now what? Knowing where to start when it comes to selecting maternity care in Hong Kong can be overwhelming to say the least. To help you make an informed decision, we talk with Hulda Thorey Gardarsdottir, an Icelandic and HK registered midwife and director of Annerley, The Midwives Clinic.
There are several key things to consider when making the decision on where to give birth in Hong Kong; factors which may come into play might be your medical history, previous experience, cost and insurance, where you live, and how you would prefer your birth to be. However, before you can reach that decision, it’s helpful to understand that there are two systems available in Hong Kong – public and private – and there are significant differences between the two.
In short, the Government system offers comprehensive maternity care for high and low-risk mothers for a minimal cost, usually less than $500. This care includes antenatal checkups, the necessary tests and ultrasounds (as determined by the Health Authority), care during labour and delivery, and postnatal care for your and your baby. This system also provides access to district maternal health clinics, where you can have your antenatal and baby checkups, as well as the hospitals themselves. You will usually be assigned a hospital depending on where you live. The private system, on the other hand, offers the same care for any low and medium risk cases, but with a greater scope on how you deliver your baby and who will be present at the birth.
Here are some important things to consider:
1. Pregnancy care and birth in a private hospital can cost a lot!
When choosing what suits you best, it makes sense to first ask yourself: do you even have a choice? The reason for that is that antenatal care and giving birth can cost anything between $70k to $300k or more in a private hospital. Good maternity insurance cover should include all routine checkups, a routine birth, and the 3 to 5 day stay needed if going private. The trouble comes when there are complications as the hospital bill can then mount up very fast and it may not be covered by insurance.
If considering going private, and finance is a consideration, you should certainly talk to your doctor about the worst-case scenario. For expectant mothers who don’t have insurance, and choose not to pay the price of private care, the Government system offers more-or-less free maternity care for around $300 to $1,500 (that’s Hong Kong dollars) all in all, regardless of whether you need emergency care and the baby requires time in the ICU.
2. Your partner’s presence may be restricted during labour at public hospitals
Unless there is an emergency during delivery, the father is allowed to be present during the birth in public hospitals. However, his presence may be restricted during labour as the labour ward is a shared room. Visiting hours are also restricted in public hospitals. In most private hospitals, the father is allowed to join the mother throughout the process and if a private room is booked, he can also sleep there. He will also have more visiting hours and greater access to the baby, which can sway the decision for many parents to be.
3. In private hospitals it’s easier to get to know the caregivers in advance
Aside from cost, one of the main differences between the private system and the Government one is the access to the same doctor throughout your checkups. If you go down the private healthcare route, all being well, your doctor will also be the one who delivers the baby, in a hospital chosen by you. However, labour care is usually provided by a midwife who may be a stranger to you.
In government hospitals it’s unlikely that you will have met either the midwives, who usually deliver babies, or the doctors who will do the job if the pregnancy is high risk, or if there is an emergency. This is not necessarily a negative thing, but it is most definitely something that some expectant parents may care about. An additional option is to appoint a private midwife service to provide antenatal care and support during labour, advising you on the best time to go to the hospital, as well as postnatal care, whether in a public or private hospital. Insurance will often pay for such services, which usually cover antenatal classes, birth plans, and both labour and postnatal/breastfeeding care.
4. Private hospitals may allow the parents more choice
In private hospitals, expectant mothers can choose to have a C-section without providing a medical reason, whereas public hospitals follow clinical guidelines, suggesting a C-section only if it makes medical sense. Epidurals are also more readily available in private hospitals and are almost always recommended, whereas in public hospitals, they are usually only recommended after 3cm of dilation, and only if the patient requests one. The ability to choose may be more a reflection of who is paying for the provision of these services rather than one system being more accommodating than the other. If you are paying, you get more say! However, not all private hospitals are the same and some will have restrictions, for example, you may only be allowed to have one birth partner, or only be able to choose from a set number of positions during labour and birth. Make sure you ask.
A point to note is that because there is less intervention and ‘choice’, the C-section rate is much lower in public hospitals, and usually on a par with public hospital systems in other developed countries. This is generally considered a good thing with a better expected outcome for both the mother and child.
5. Despite the benefits of private care, public hospitals usually offer excellent medical care
Government hospitals have good facilities and well-trained staff, English is spoken, and in recent years they have made good progress in offering more women-centred care. This includes allowing mothers to move around during labour and birth, and in most public hospitals, making the father more welcome during the birth. Some hospitals are more forward-thinking than others, with the Queen Mary (one of the largest acute regional hospitals in Hong Kong, and the teaching hospital of the medical school of the University of Hong Kong), being a favourite. So, if you can cope without the frills, can handle eating plenty of green veggies at dinnertime, would rather spend your cash on something else, and you look neat in a set of Barbie pink pajamas, the public healthcare system offers a pretty sweet deal when it comes to giving birth in Hong Kong.
About Annerley – Annerley is a small, privately run clinic that has been operating since 1995. The team of nine midwives and nurses offer unique and invaluable support throughout your pregnancy, birth, and beyond, weather you are going through the public or the private system in Hong Kong. The aim of the support is to offer non-biased information relevant to your pregnancy to help you to know what type of experience you are hoping for, and how to utilise and navigate the systems with professional support of midwives. You can contact the team for more information.