Your Guide to Birth Plans in Hong Kong

Birth plans have become increasingly popular in Hong Kong for women delivering in both private and public hospitals. While it isn’t necessary to have a birth plan, it is helpful to understand what it is for and what it typically covers – the thinking process that goes into creating a birth plan can help you better prepare for childbirth and manage expectations.

Healthy Matters brings you the very first guide to birth plans in Hong Kong in collaboration with private midwife, Hulda Thorey, founder of Annerley the midwives clinic.

 

The increasing trend towards birth plans worldwide and in Hong Kong

Birth plans were initially popularized in Western countries as part of the patients’ rights movements in the 1980s in an attempt to regain some of the agency women felt they had lost in the increasingly medicalized birth process. Additionally, medical and anecdotal information is now easily accessible online and, with that knowledge, many women want to feel more empowered and involved in the birth process.

According to midwife Hulda Thorey, in Hong Kong several factors may have influenced the increasing trend towards birth plans:
  • Better patient knowledge and empowerment in recent years.
  • More variety within the patient population in public hospitals and hospital staff wishing to know more about what the patients’ needs are (and share what they can offer).
  • Reduced comfort and personalized care in public hospitals due to higher patient volume.
  • High intervention rates (C-section, induction) in private hospitals.

 

What a birth plan is for and why it is useful

A birth plan is exactly what it sounds like: a record of the preferences and wishes you have for your labor and delivery. For some people, this is a roadmap with a general idea of how they would like their labor to proceed. For others with specific preferences, a birth plan can be very detailed.

As explained by midwife Hulda: “In creating a birth plan, parents gain practical knowledge about what they can and cannot expect during labor and birth. Doctors and midwives may not share the parents’ ideas about birth, so it is helpful to read current guidelines about what choices should be available and then discuss this with the hospital staff. That way, you can work as a team on the big day and have a safe, enjoyable, supported and strengthening experience.”

 

The importance of remaining flexible and adaptable

Simply put, labor and delivery are unpredictable. Just like parenthood, childbirth rarely follows the plan you have set out.

For some women, medical intervention is necessary, and the ideology that views medical intervention as ‘wrong’ can have serious consequences. Safety of the mother and baby should always be the number one priority and sometimes that means veering off plan. With 20 years of experience in the field, Hulda has witnessed negative birth experiences impacting women for life. According to her, what helps women the most, “is being well prepared and flexible”.

A patient who was aiming for a completely natural and intervention-free birth and ended up requiring an emergency C-section should not feel like she failed or that the medical team failed her. A birth plan can help parents and the medical team better understand each other and manage expectations.

 

What birth plans typically include

A birth plan communicates your objectives and preferences to your birth team. It is up to you how you go about doing this but many women will choose to break their birth plan down by birth phase: early labor, active labor, during birth and after birth.

If one is available, use the template offered by the hospital or doctor. This will list the choices that they will have on offer and from there, additions can be made.  This is a good way to discuss your wishes in advance with the staff and it gives you a chance to prepare accordingly.

We asked Hulda to discuss some key things to include in a birth plan in Hong Kong at public and private hospital. Below are some of the aspects you may wish to consider in your birth plan:

 

Childbirth in public hospital

Early labor – admission ward (0-3 cm)

  • Labor partner – express your need to have your labor partner accompany you.
  • Mobility – do you want to stand up and move around?
  • Discuss your non-drug pain relief options (i.e. TENS machine) for early labor. Drug options are only available in the delivery ward.
  • Epidural – If you would like to have the option of an epidural, request blood testing in early labor.
  • Access to birth ball.

Early labor /active labor – delivery ward (3-10 cm)

  • Labor partner – express your need to have your partner accompany you.
  • Mobility – what are your options, including options if you’re on fetal monitoring?
  • Pain relief – what are your pain relief options in the delivery ward?
    • Drug: epidural, etc.  If epidural is used, wait for the ‘urge to push’.
    • Non-drug: TENS machine, massage
  • Comfort – some hospitals will allow you to opt for low lighting, a quiet room, few people, medical students present at the birth. Check what options are available at the hospital and what options each hospital allows in the labor room.
  • Access to WC – use of the WC before pushing.
  • Access to birth ball.

During birth (pushing stage)

  • Choice of positions.
  • Pushing – wait until the ‘urge to push’ or do you wish to be coached? This is particularly important with an epidural.
  • Episiotomy or not (depending on circumstances).
  • Delayed cord clamping.
  • Baby to mum for skin to skin.
  • Placenta delivery – use of syntocinon
  • Who will cut the cord?

After birth

  • Baby in room with mum and skin-to-skin.
  • Breastfeeding – do you want to breastfeed immediately after birth? Would you prefer exclusive breastfeeding or would you like formula?
  • Father and baby bonding time.
  • Bathing baby – when do you want the baby to be bathed after birth? Do you want to be present for the baby’s bath?
  • Vaccinations – do you want the baby to have the routine set of vaccinations?

 

Childbirth in private hospital

Labor – same room throughout usually

  • What type of birth is preferred (vaginal, C-section, induction etc.).
  • Mobility – what are your options, including options if you’re on fetal monitoring?
  • Preference for no drugs or drugs during the process.
  • Pain relief options:
    • Drug: Pethidine, epidural, Entonox
    • Non-drug: bathtub, TENS machine, massage
  • Comfort – music, lighting, use of a birth ball etc. Check what options are available at the hospital and what options each hospital allows in the labor room.
  • Labor time limitations – how long do you want to labor naturally?

During birth (pushing stage)

  • Choice of positions, – to be discussed early in pregnancy with the doctor.
  • Pushing – wait until the ‘urge to push’ or do you wish to be coached? This is particularly important with an epidural.
  • Episiotomy or not (depending on circumstances).
  • Delayed cord clamping.
  • Baby with mum for skin to skin.
  • Placenta delivery – use of syntocinon
  • Who will cut the cord?

After birth

  • Baby in room with mum and skin-to-skin
  • Breastfeeding – do you want to breastfeed immediately after birth? Would you prefer exclusive breastfeeding or would you like formula?
  • Father and baby bonding time.
  • Bathing baby – when do you want the baby to be bathed after birth? Do you want to be present for the baby’s bath?
  • Vaccinations – do you want the baby to have the routine set of vaccinations?

Note that each hospital, whether public or private, has different policies. Some of the above points also apply to elective C-sections which are only available in private hospitals (unless there is a medical reason). If a C-section is planned in advance, it is helpful to create an entirely different birth plan which should be discussed in an antenatal class, at an antenatal check-up, or with a midwife.

Note that all birth plans should be personalized and based on your own history, real preferences (not what friends have suggested only), the available options at the hospital and the circumstances at the time of the birth.

 

Who should be involved in writing a birth plan

The birth plan should be led by the woman giving birth, taking into consideration what their birthing hospital of choice can and cannot accommodate. If a partner is planning to attend the birth, it can be helpful to discuss your plan with them so that they are aware of your preferences and are able to advocate for your choices. Labor can be a stressful time. Writing a birth plan before you’re actually in labor gives you and your partner time to research, discuss and understand the choices you may need to make.
Private independent midwives and doulas in Hong Kong can also help you draft your birth plan. Some midwives and doulas packages include support in drafting a birth plan.

 

What to do with a birth plan on delivery day

Once the birth plan has been determined, it’s a good idea to review it with your doctor (private), midwife (private midwife service), or health practitioner (public) to make sure it is realistic, achievable and makes sense for your context. If you’re giving birth in the public system, keep in mind that the health practitioner you see at your antenatal appointments will be different from who you see in the public hospital during labor and delivery.

Whether public or private, bring a few printed copies of your birth plan with you to the hospital. Keep one copy for yourself and your birth partner and give another copy to the medical team.

 

Birth plan resources and templates in Hong Kong

Birth plans in Hong Kong

The Queen Mary Hospital has both English and Cantonese birth plan templates which are specific to the services and options offered there.

Birth plans from other countries

These can be used as a reference but may not be reflective of the options available in Hong Kong.
Canada – My Health Alberta
UK – NHS
USA – WebMD

 

There is a wide spectrum of options available during birth and availability of these options may vary depending on where you give birth. You may not feel strongly about all aspects of the labor and delivery process but ensuring that the objectives you do have are communicated effectively will go a long way in having a positive birth experience. Plus, having a birth plan is not necessary! Many women choose not to write down anything and are happy to simply verbalize their wishes to the medical team on the day and when needed.
Hulda Thorey is a Director and the Founder of Annerley the midwives clinic with over 15 years of experience as a midwife.  Since 2002, Hulda has been providing antenatal care, antenatal classes and postnatal care together with her team of midwives. She guides parents who are new to Hong Kong, or newly pregnant, on how best to go about their care and support while pregnant and as new parents.  Giving focused, personal and professional care is a real passion of Hulda’s; she wishes for all women and men to feel confident and supported through this part of their lives. 
This article was independently written by Healthy Matters and not sponsored. It is informative only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.