Public or private?

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Planning for the arrival of a new baby is an exciting and wonderful time. From preparing the nursery to choosing an obstetrician, there are many decisions to be made. Perhaps one of the biggest and most important decisions is where to give birth. In countries like Australia and the UK there are many options available for expectant mothers. Home births, birthing centres, water births, public or private hospitals, access to a whole range of services – women have freedom to choose and tailor their birthing experience. In Hong Kong however, you can only give birth in a hospital. There are 56 hospitals in Hong Kong, 12 of which are considered private, and the remaining 44 public, or government-run. While the standard of medical care is world-class in both the public and private hospitals, the level of personal care and comfort varies greatly.

Take a look at any online pregnancy forum or listen to a conversation between pregnant friends and you’ll hear the conversation inevitably turn to the “public or private debate”, and most parents feel quite strongly about their preference. When I was expecting my son last year, I was both warned against the public system and criticised for considering “wasting money” at a private hospital. I was struck by how divisive this important and personal decision could be, so I decided to do a little research and determine what each of the two options offers.

Private hospitals 

If you plan to give birth in a private hospital, then you have the option of choosing your own obstetrician. For many – me included – this is, by far, the biggest advantage to the private system. Knowing who will be at the other end of the bed on the big day is very reassuring. Antenatal visits with private obstetricians are regular and consistent. Depending on who you choose to see, waiting times at appointments are generally very short, and monthly ultrasound scans and visits with both a midwife and your obstetrician provide reassurance and security that all is well with your pregnancy. The doctor’s office will handle your hospital booking and ensure that you have all the information you need.

You’ll be advised in creating a birth plan and the hospital makes every effort to ensure that this is followed. You have the option of having your husband and a whole tribe of supporters in the room with you if you so desire: a doula, your mother, your helper, an acupuncturist; if it’s in the birth plan, the hospital will accommodate you. It’s comforting to know that your wishes will be respected.

“The atmosphere at the private hospitals is designed to feel like a hotel rather than a clinic. The delivery suites are comfortable and, while you’re in labour, a dedicated midwife is always close by.”

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Your obstetrician will appear like magic at the crucial moment, and you’ll be given time to bond with your new baby and breastfeed before being taken back to your room. Mums are fed gourmet food from an extensive menu and every need is met, with regular checks from midwives, paediatricians and nurses, who are extremely knowledgeable and generally very attentive. If you’re in a “first class” room your husband can stay with you the whole time, and the three of you can hide away from the world getting to know each other, or your visitors can come and go anytime of the day. You also have round-the-clock access to advice, the nursery and medication.

While this all sounds quite idyllic, the reality can be a bit different. First, the private hospitals here are in high demand, and you need to book a bed almost as soon as you confirm your pregnancy. Even after paying a hefty deposit and making a booking, if the maternity ward is full on the day you go into labour there is no guarantee you will have your baby at your chosen hospital. Another downside to the private system is that none of the hospitals has a neonatal intensive care unit (NICU). After a difficult delivery, if there are unforeseen complications with the newborn, the baby may be taken to the NICU at Queen Mary hospital, while Mum remains at the private hospital to recover. This separation can be a traumatic and stressful experience at such an important time. If you have a complicated pregnancy, then the private system may not even be an option for you.

The cost of this deluxe birth experience is the biggest obstacle for many families. Unless you have private health insurance, a pregnancy and delivery under private care will set you back at least HK$100,000.

Public hospitals 

There are a number of public hospitals across Hong Kong, and if you choose this option, you’ll be designated a hospital based on the catchment area you live in. All antenatal appointments are conducted at a separate clinic, unless there are complications, in which case you will see a dedicated consultant. Many women complain of long waiting times at appointments and a lack of personalised care. At each appointment you’ll meet with the doctor or midwife who is available, which could mean seeing someone different every time. There is no way of choosing who will deliver your baby. In some cases, your baby will be delivered by a midwife or a doctor-in-training.

A friend once described the difference between public and private hospitals here as the difference between a five-star hotel and a backpackers’ hostel. Having a baby in a public hospital in Hong Kong is definitely a no-frills option, and the most commonly used adjective to describe the experience is “fine”. For most expectant parents the most appealing feature of the public system is the high level of care and access to specialists if there are complications after delivery – the staff are known to be very thorough and cautious – closely followed by the low cost. When staying in the public hospital, despite being on a ward with several others, mothers are encouraged to keep their babies with them at all times, while in many of the private hospitals babies are kept in the nursery. It may feel as if you’re being thrown into the deep end, suddenly having to care for a newborn baby on your own, but it is very good practice for what awaits you at home!

Some of the downsides of a public delivery include the limited visiting hours, crowded wards, limited food options, and care that is best described as impersonal. While the private hospitals seem to be very patient-oriented and focused on the fact that you’re bringing a new life into the world, in the public hospitals labour and delivery are treated as any other medical procedure, and the focus is on the task at hand. Most women I spoke with who had given birth in public hospitals suggested that it is possible to have the birth experience you want in a public hospital, but you have to be clear about what you want and be willing to speak up. You will need to inform the hospital well in advance if you have a birth plan, and they will do their best to follow it.

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On arrival at a public hospital you will be assessed and sent to a labour ward or straight to the delivery suite, depending on how progressed your labour is. Husbands are not allowed into the labour ward, and although mums-to-be can leave, there’s really nowhere comfortable to go. First-time mum Suzanne recalled being stuck in the labour ward, vomiting and in agony, for nine hours without her husband or her handbag. Fathers are allowed in for the delivery itself but, once the baby is born, they are only allowed to visit for two hours at a time, twice a day. Older siblings are not allowed to visit either, and newborns are tagged with an electronic bracelet that emits an alarm if the baby is taken off the ward. Mum-of-two Alex described her heartbreak at holding her newborn on one side of the room while her older son wailed for his mummy on the other side, her two children only getting to meet each other on the drive home.

While your baby will be delivered by an obstetrician assisted by a midwife in a private hospital, in a public hospital midwives do most of the work with doctors standing by if problems arise. Despite the fact that you can’t choose to have a caesarean if you’re giving birth in a public hospital, medical intervention rates in Hong Kong are extremely high. Hong Kong has one of the highest rates of caesarean delivery in the developed world, and episiotomies are standard for first-time births. However, epidurals are not encouraged and many women complain that they had to ask repeatedly for pain relief during and after labour.

According to World Health Organization statistics Hong Kong has a fairly low nurse-patient ratio compared with other developed countries, and many people come here from the mainland seeking medical treatment, which places strain on an already overburdened system. This places great demands on the staff and at times it can feel as if you’ve been forgotten about. New mum Natalie says the best way to get around this is to be prepared, have everything you need with you already and be proactive: ask for help rather than waiting for it to be offered. Paula, a mother of two girls, remembers being unimpressed by the food on offer in the public hospital where she delivered both of her babies. She suggests having your husband or friends bring in meals and snacks. However, a number of mothers credit the restricted diet of water and congee for their rapid recoveries after caesareans!

In an effort to save some money but still have a little comfort, some parents opt for a public delivery but choose to stay in a private or semi-private room. You can choose your obstetrician this way, and you will have a better night’s sleep than if you were on the public ward with 20 other mothers and their newborns, but the cost is on par with the private hospitals.

A matter of choice

Not all women have a choice about where to give birth. If they are likely to experience complications, or they simply can’t afford a private birth, the public system is the only option. For those of us who have the luxury to choose, it’s a personal decision. If you have insurance or can afford it, a private hospital is a good experience, provided you have a normal delivery with no or minor complications. If things do get complicated, a public hospital with a NICU is the best place to be, regardless of how much money you’re prepared to spend. Some of us may crave a bit more TLC and luxury when we welcome our new little ones into the world, while others prefer to get on with it and get home as soon as possible. We’re lucky here in Hong Kong that we have access to world-class medical care, in both public and private systems, and that the overall standard of care is very high.

After speaking to so many women, with such varying experiences, it’s clear that what it comes down to is the birth itself. If your delivery is complicated, the baby is ill, the labour is long and painful, then it’s going to be a negative experience, no matter where you are. But if you have the dream-run, textbook labour, you could probably give birth in a taxi and it would still be the most amazing experience of your life (although not a birthplace that’s commonly recommended).

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Brooke Chenoweth
Brooke grew up in rural Australia and spent most of her early days running around barefoot, playing dress-up and perfecting her mud pie recipe. After high school, Brooke hightailed it out of town and went off to university in the “city,” where she discovered the world, literally and figuratively. Some quirks of fortune, a few hurdles and several years later, Brooke found herself married and moving to Hong Kong in 2007. After a brief stint as an English teacher, she discovered that blogging and freelance writing fulfilled all of her potential career wishes while allowing her to stay at home in her pyjamas with her gorgeous little boys. While dressing up is a rare treat these days, she still enjoys going barefoot, and now makes mud pies with her sons.

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