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Antenatal Care In Hong Kong

Written by Ólafia Aradottir on Thursday, 25 July 2013. Posted in The Next 9 Months

Antenatal care saves lives. Olafia Aradottir, a nurse and midwife from Iceland and the latest expert to join the Annerley team explains why.

Antenatal Care In Hong Kong

In Hong Kong, as in much of the rest of the westernised world, when you learn you are pregnant, you take it for granted that you will follow a programme of antenatal visits. After the initial excitement it can feel that the checkups are a bit tedious and over-fussy, especially when all that the healthcare practitioner seems to do is check your weight, urine and blood pressure, but it is exactly these checks that provide the first indicators of a problem.
 

Why is antenatal care so important?

Much research has shown how important antenatal care is for improving mother and baby survival rates, and a World Health Organization study published this year shows that even skimping on visits can have scary results, even for low-risk mothers.

Antenatal visits are important because in most cases, the indicators for some of the rare but serious conditions that cause death for mother and/or baby can easily be detected in the early stages, and this means that the condition can be treated or managed safely to reduce risk and prevent the condition escalating and causing further complications.

Who provides your antenatal care depends on where you live. In Europe midwives are generally the prime carer for low-risk pregnancies, even doing most deliveries, whereas in the US, care is more obstetric-led.

In Hong Kong’s private hospitals care is obstetrician led, but midwives take care of the women throughout labour with the obstetricians making all major decisions and then delivering the baby. However, in government hospitals, midwives usually deliver the babies having taken care of the mother throughout labour.

This involvement of midwives is important because for a vast majority of women, pregnancy is not a medical condition, but is an important life transition. A famous piece of research (Cochrane) has shown that, compared with women who were cared for under other models of care, women who received midwife-led models of care were less likely to be admitted to hospital during pregnancy, less likely to receive regional analgesics during labour and childbirth, and to have an episiotomy. In addition, women who received midwife-led models of care were also more likely to have spontaneous vaginal birth, to feel in control during labour and childbirth, and to initiate breastfeeding. And if that wasn’t enough: babies born to women who received midwife-led care were less likely to die before 24 weeks of pregnancy and were more likely to have a shorter length of hospital stay.

It makes us midwives look like angels; the truth is that most pregnancies are low-risk and midwives are more than capable of providing the necessary support, referring on only high-risk cases to doctors for some of the critical checkups. For low-risk mothers we can continue to monitor the mother’s health, but can also focus on providing the education and emotional support that helps mothers make the most of their pregnancy and early babycare – and hence the glowing figures.
 

What checkups do you need?

Your first checkup
Your first checkup will probably be to confirm your suspected pregnancy, and in most cases women visit a doctor to do this. If you are planning to use the public hospital system, you will need to get a doctor’s note to say that indeed you are pregnant before joining their system.

If you are unsure of the options, and pros and cons, you can make your first checkup with a private midwife as we have experience working with, and supporting the care provided by both private and government systems.

At this first meeting we are able to assess – from basic tests such as blood pressure, urine and weight as well as consideration of your age, ethnicity, medical and family history and personal preferences – whether you are a “low” or “high-risk pregnancy” and suggest an antenatal care plan to best meet your needs. That antenatal plan might be through the private or government system, or follow a third way with combined midwife checkups plus government/private checkups where required. If you continue care with a midwife, the plan is reevaluated each time you come, based on your and your baby´s health.


Checkups thereafter
The Hong Kong government programme comprises 7 to 12 checkups depending on how early your register as well as your general health/medical history and test outcomes. Private practitioners vary in how often they prefer to see you, and some can recommend a lot of checkups.

Whether you are a first or second-time mother will also impact the schedule. We recommend 10 visits, excluding ultrasounds, for a first-time mother, and a reduced schedule of seven visits for a healthy second-time mother. Women with certain health conditions such as diabetes or high blood pressure can expect to go for more checkups and tests.

The table below outlines the antenatal care schedule that we use at Annerley, and is based on women-centred pregnancy care. It also reflects the recommendations of most hospitals and clinics. 
 

ROUTINE CHECKUPS
Performed by Private doctor, private midwife, government hospital or clinic
 
 
Main purpose Test blood pressure, weight, urine test, foetal heartbeat to confirm normal development and check for indicators of serious conditions.
 
 
Schedule 6 - 32 weeks Monthly
 
  32 - 36 weeks Every 2 weeks
 
  36 - 42 weeks Weekly
 
SPECIALIST CHECKUPS
Medical Ultrasound / Scan
Performed by Private doctor or government hospital
 
 
Schedule / Purpose 1st ultrasound
6 - 10 weeks
To confirm pregnancy and give estimate of due date
 
  2nd scan
11 - 14 weeks
Anomaly testing / Nuchal fold test; an indicator of genetic abnormality. Further tests (amniocentesis) may be suggested if indicated. This test is optional.
 
  3rd scan
20 weeks
Full structural ultrasound to confirm baby's age and see where the placenta is implanted.
 
Glucose Screening / Glucose Challenge Test (for those at risk)
Performed by Private doctor or government hospital
 
 
Schedule / Purpose 24 - 28 weeks
 
Positive result an indicator of gestational diabetes.
 

 

Why? Why? Why?

Mothers are usually very interested in their own pregnancies and we often get asked a series of questions about the meaning and purpose of the checkups. Here is a summary of some of the most common questions with answers, of course.

Q: Why do you need to check my weight/blood pressure/urine?
A: Although pre-eclampsia only affects about 5% of pregnant women it is a serious condition and can lead rarely but tragically to eclampsia where a mother can go into convulsions, coma and even die. Pre-eclampsia can also have long-term consequences for the developing baby.

The symptoms can include sudden weight gain through oedema, protein in the urine and raised blood pressure. The simple tests performed in each antenatal visit allow us to create a baseline so that we can easily spot changes. As pre-eclampsia usually occurs in the third trimester, the recommended frequency of antenatal visits also increases at that time.

Note that a number of women suffer a higher blood pressure and/or oedema in pregnancy without suffering pre-eclampsia; it is a combination of factors that will alert your healthcare professional to take action.

If you are overweight at the beginning of your pregnancy you are also at a higher risk of complications and we will recommend a plan to best care for you.


Q: How important is my age, ethnicity, family and medical history?
A: Some conditions, such as pre-eclampsia, are more common in a first pregnancy; most women are aware that as we age there is an increased risk of the baby having genetic abnormalities and our ethnicity affects the likelihood of developing some conditions such as gestational diabetes. In Iceland, where I practised before coming to Hong Kong, we do not offer the glucose screening as standard as Icelandics are low risk, however in Hong Kong the government tends to screen more women because the incidence of gestational diabetes is higher in Asian women. Depending on your lifestyle we may also recommend further tests, or recommend a more specialised antenatal programme.


Q: How many ultrasounds do I need to take?
A: There are three points during your pregnancy when having an ultrasound is useful and is generally recommended, if feasible. However, a mother doesn’t need to take an ultrasound and you can decline.

The first ultrasound or dating scan may be performed between 6-10 weeks and is used to confirm a pregnancy as other tests can give false positives, check for multiples and to more accurately give an expected due date. This also provides an accurate date for the anomaly scan. Traditional methods such as working back from your last period have sufficed for years so this ultrasound is only generally offered in private practice, and not through the government system.

The second ultrasound at 11-14 weeks is also known as the anomaly scan or nuchal fold test. This is a thorough anatomical scan and checks for a wide range of abnormalities. Indicators, such as the nuchal fold measurements, may mean further tests such as an amniocentesis are recommended. Note that many women who are younger than 35 and are low-risk prefer not to have the nuchal fold test as there are false positives which cause unnecessary stress. Discuss this choice with your healthcare practitioner.

The third ultrasound at 20 weeks, also known as the structural ultrasound, is to make sure all organs and body parts have developed normally and evaluate the risks of any abnormalities, check the placenta and the size of the baby.


Q: Will I get stretch marks / do I have to have an episiotomy / is it normal to go off sex / I feel so tired? And numerous other questions…
A: A typical antenatal checkup with a midwife will last half an hour and this allows plenty of time for the “life in transition” kind of care that gives midwife care such a good reputation. Additionally, because midwife care tends to continue after delivery, we are able to support the mother with breastfeeding, monitor for postnatal depression, monitor the health of the baby and provide practical advice as well as answer all those small – yet important – questions. The answers to which make all the difference to a mother’s experience of motherhood.

 

Hong Kong’s success story

That Hong Kong boasts one of the world’s lowest infant mortality rates (along with Iceland) is a reflection of the quality of the antenatal care that is on offer here. The government system is thorough (if not always convenient), and the private medical care is quite efficient and professional. The emergence of midwife care means that mothers have more quality choice than ever.

In finishing I want to emphasise that whichever route you choose, do not underestimate the importance of antenatal care. Numerous studies have shown the direct relationship between the quality of antenatal care and infant and mother mortality rates. All those visits may be a bit of a nuisance, but they really are worth it for both you, and your baby.


Useful Contacts

Annerley the Midwives’ Clinic - call 2983 1558 for an initial discussion. Our free Friday group consultation is a useful introduction to being pregnant in Hong Kong

Health Authority - If you have a confirmed pregnancy, visit the closest Maternity & Child Health Centre. GeoBaby.com's directory is a good start as it has a thorough list of government resources.

Private Obstetric Care - Please check GeoBaby.com's directory listings under hospitals or doctor here.

GeoBaby's Due Date Clubs - Compare pregnancy notes, share a few laughs and make some new friends with other expecting mums.

About the Author

Ólafia Aradottir

Ólafia Aradottir

Ólafía is a registered nurse and midwife with Annerley in Hong Kong. Hailing from Iceland, she graduated with a BSc in nursing 2003 and attained a C and Ob. in midwifery 2010. She worked at the national hospital in Iceland, Landspitali, in the pre- and postnatal ward where women and their children are admitted due to complications during their pregnancy, birth or postpartum. She also worked with a team of midwives in the labor ward, where she assisted women and their partners in having the birth they envisioned. Additionally she was responsible for the establishing and implementing of hospital guidelines. 

Ólafia is passionate about understanding the needs and wishes of pregnant women here and wishes to educate and support new and expanding families as she truly believes that "professional support and informed choices can make a huge difference in this life-changing event".  

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