Labor of Love: Private Vs. Public Hospitals

It is a heated topic that we’ve seen debated on our own forum many times.  Do you go through childbirth — one of the most important medical moments in your life — in a government hospital?  Every HKID holder has the access to the public system at minimal cost.  Or do you experience this milestone via the private route, which can run over $300,000 HKD?  What are the pros and cons of each?  What is the maternity care like in Hong Kong like?  Hulda Thorey, a midwife and director of Annerley Midwives Clinic, offers her insight on this significant subject matter.

Queen Mary Hospital
Queen Mary Hospital

Government Hospitals

The hospital clinics generally provide fine services, staff, equipment, and resources to ensure your safety.  The facilities are up to standard, well equipped and in most ways, quite modern.  Birth in a public hospital can be a very positive experience, but we highly recommend parents educate themselves so that they know the politics, preferences and the procedures within each hospital.  Be sure to know your due date or the first day of your last period.  Based on that you will be given a date for a registration appointment and later, a clinic appointment.  Public hospitals have certain catchment areas. Find your hospital and call to register — the sooner the better.
Most of the public hospitals will have a 24-hour stay policy and depending on how your birth went, they might suggest you stay for a few more days.  However, if your birth was natural and you feel ready to go home, you may be able to check out earlier.  We always recommend that mothers have a private home visit with a midwife or nurse on the first or second day back home to check up on the health of both the mother and baby.
A typical ward in a public hospital
A typical ward in a public hospital

Pros

  • Extremely little cost (usually less than HK$500).
  • Easy to supplement with other care
  • Professional and practical.  They follow protocols, not personal convenience or financial motive to do more or less.
  • Natural birth is very much encouraged.
  • Teaching hospitals must have a reason for actions and they have an internal audit.
  • Usually you can get your way if you are polite but firm.
  • Medical interventions are much lower than in private hospitals.
  • Birth balls and TENS machines are available in most hospitals.
  • Staff and facilities for medical emergencies are better set up, both for mothers and babies.
  • You are involved in a “system” that takes care of you, more consistency and efficiency, but not necessarily very personal.

Cons

  • Want you to come to hospital as soon as any signs of labor.
  • You can only have your partner/one support person with you when you are in established labor, in some hospitals this is after 3 cm dilation, and in others, not until you are pushing.
  • Officially you cannot have anyone with you during an emergency c-section.
  • You are usually not encouraged to move around after labor is established, usually attached to a monitor.
  • You are not encouraged, and in some hospitals, not allowed to eat or drink.
  • You cannot take showers or baths during labor.
  • You may have to make an extra effort to be able to choose your positions while giving birth.
  • Episiotomy is quite common, but not a rule anymore.
  • Breastfeeding is supported in theory but not always followed up well if the baby needs to be admitted separately.
  • Food after birth is usually not good.
  • Busy staff and sometimes bedside manner and communication could be better.
  • Epidural is not easily available although it can almost always be given, but it can take around two to three hours from when you ask for it.

At Annerley, through the years, we have experienced that the government system is capable of giving excellent care for low cost and good safety.  The major complaints we get have mostly to do with inefficient use of time, lack of communication skills and flexibility.  Our opinion and experience that the not-guaranteed access for family support during labor can be a very negative experience although this is generally getting better through the years.

Matilda
Matilda Hospital

Private Hospitals

Choosing the right doctor for yourself becomes a very important factor in the private system.  If you haven’t selected a doctor yet, we suggest you get professional help to try to understand the care the different private hospitals offer and to try to work out which doctor would be most likely to understand and respect your needs.

There are many fantastic private hospitals and doctors in Hong Kong and the cost for a normal birth is generally somewhere between HK$100-300,000, and HK$150-350,000 for a C-section.  When looking at cost for the private hospitals, especially if you do not have an insurance, the fees are broken down into:
  •  The hospital fees (separate for vaginal birth and C-section) for three to five days.
  • The obstetrician’s fees for a) pregnancy and b) the birth.
  • The pediatrician’s fees.
  • Anesthetist’s fees (if you need epidural or spinal block).
  • Other fees such as induction / epidural / jaundice treatment or other interventions.

All the fees in private hospitals are based on the type of room you book, so if you book a private room, all the five fee types above will be more expensive than if you book a twin or shared room.  Also, when referring to private/shared room, this applies to the postnatal room; everyone has the same type of room during the labor and birth, as well as the same care — just the fees vary.  When booking a private hospital, you first see an obstetrician and who then will make the actual booking.

Matilda Hospital Room
Matilda Hospital Room

Pros

  • Although financial gain sometimes leads to more interventions and perhaps unnecessary procedures, the system is also designed to have happy clients, therefore offering more options and having, generally, the goal of “trying to please”.
  • Usually the rooms and facilities are nice with a warm and lovely atmosphere and food is good.
  • Likely to be allowed to stay at home as long as you feel comfortable and contractions are not more frequent than every five minutes (with no amniotic fluid leaking).
  • Bath and showers available in a few hospitals but you have to be clear that you want to use it, most doctors want you under continuous monitoring so in practice don’t really allow it.
  • Partners are allowed to stay unlimited during labor and usually allowed to accompany during C-section.
  • In some hospitals you are allowed to move around the room, as long as you can be monitored (attached, so around two meters away from the bed).
  • You are usually allowed to eat and drink during labor, depending on your doctor.
  • You are sometimes allowed to change positions during the pushing stage if you insist to do so, but this is not usually preferred by staff.
  • Episiotomy can be routine with some doctors.
  • More privacy and likely to only have two to three extra people in the room when baby is born.
  • Breastfeeding strongly encouraged in a few hospitals and more staff to help you with feeding.
  • In some hospitals the baby can stay with the mother the whole time.

Cons

  • The system works best if birth is quick, routine and scheduled  — which is usually in no way what birth is like, unless a scheduled C-section is chosen.
  • There is a financial gain for both the doctors and the hospitals to use epidurals, inductions, vacuum, forceps and C-sections.
  • The private doctors normally work alone, without a backup doctor so, they must be quick to be able to do all their duties on time (20 to 30 births per month plus a full clinic each day, usually means that it is hard to schedule).
  • Transparency is limited in terms of outcomes and statistics.
  • While private health insurances are usually the way people pay for their maternity cost, doctors may not be as conservative as they otherwise may be in using medical interventions.
  • Some private hospitals will not allow much movement during labor and even though in theory they support active participation of the mother, like using different positions, though in practice they may not allow it.
  • Epidural rates in some private hospitals are up to 90% for first time mothers.
  • C-section rates of some private hospitals are up to 80% (while the WHO guidelines suggest that they should be under 15%).
  • Midwives are obligated to work according to the doctor’s instructions, therefore not always free to allow the women to be independent.
  • Breastfeeding is very hard in some private hospitals, unless you book a private room during your postnatal stay.

Generally speaking, if you have insurance for a private hospital birth, covering fully any care, it is well worth finding a doctor and hospital that suits you, you just need to identify in advance what exactly you are looking for and what is actually available in each one of them.

About Annerley Midwives Clinic:
Operating since 1995, Annerley  is a small, privately run clinic with midwives, early childhood professionals, doulas, health visitors and more.  The midwives at Annerley offer unique and invaluable support throughout pregnancy, birth and beyond, whether going through the public or the private system in Hong Kong.  The aim of the support is to offer non-biased information relevant to pregnancy to help one know what type of experience they are hoping for and how to utilize and navigate the systems with professional support of midwives.
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