My Pregnancy Journey – part 2 – Healthcare

I am no stranger to medical appointments. After all, having an eating disorder has implications for both physical and mental health that goes beyond weight-loss and anxiety. Check out our page on warning signs and implications here to read the effects of eating disorders. I have experienced most of the consequences listed on this page.

Pregnancy also affects a lot more of the body and mind than I expected. Given my medical history and my age, I am considered higher risk than the average Joan when it comes to pregnancy. Fun fact: you are considered a mother of mature age, or a geriatric mother at 35. Lovely! Thankfully, there has been no complications for me or baby; other than a brief scare at our 20-week-scan which turned out to be nothing. Regardless, it was important for me to keep on top of my physical and mental health more than ever during this period.

In this article, you will understand why I have a newfound respect for working mums-to-be who manage to attend all their healthcare appointments while holding down a regular job, and, what my experience has been of both public and private maternal and mental healthcare here in Hong Kong.

If you live in Hong Kong you may find my experience of the local healthcare system useful. And of course, if you have lived with an eating disorder and are now pregnant, you will likely identify some additional considerations you may need to make as you start your own journey of pregnancy in recovery.

Maternal healthcare in Hong Kong

Photo by Simon Zhu on Unsplash
Photo by Simon Zhu on Unsplash

Maternal care varies widely from country to country, but as this is my first pregnancy, I won’t draw comparisons. The care I have received has been great. I wouldn’t wish to be anywhere else. I feel every part of my physical and mental health has been considered. The doctors, nurses and midwives are doing a fantastic job here, and I am impressed (and grateful) for their competence, compassion and efficiency.

This said, there is much to be done in terms of the availability of mental healthcare services (both on the public and private systems) in Hong Kong and I have to admit that the language and cultural differences make the experience, for an expat-mum like me, a little overwhelming a times.

Public Healthcare vs Private Healthcare

There seems to be a view that maternal care is better if you have private healthcare. As I have chosen a mixture of both public and private healthcare I feel I should speak up and share my experience for those who may be considering their options.

With regards public and private healthcare in Hong Kong; the difference I have experienced is more of convenience, choice and comfort. It has nothing to do with the competency of the doctors and nurses. I trust the public doctors and nurses with mine and my baby’s physical wellbeing 100%. With regards mental healthcare, choice does matter. Especially when it comes to finding a therapist that you can trust and open-up to. The public system doesn’t have such choices because mental health isn’t recognized as important enough here by the government to fund it. And so, for mental health; if cost isn’t an issue, I believe the private healthcare route is a better option.

Public vs Private – My Experience

#1 Cost

Public services are 1000 times cheaper than private! Comparatively, we are talking the difference between approx. 1,000HKD to 100,000HKD for a routine pregnancy.

On the public system, the entire process is less than 1000 HKD for the obstetrics service. This includes the required anomaly scans and tests, diabetes screening, regular obstetrician check-ups, delivery in the public hospital and a few days in hospital for postnatal care. Not to mention baby check-ups at the hospital afterwards and prenatal educational classes regarding breastfeeding, physical health in pregnancy, bonding with baby and more. There is even a helpline for breastfeeding.

We chose the public system for all of the basics and have not had cause for complaint.

#2 Medical Competency

The care we received was on-par in both. I was tested for all the right things, at regular intervals. In fact, the only reasonable complaint I had was with one of my private doctors (but more on that later).

A lot of this comes down to luck of which hospital you are assigned to in Hong Kong I suspect. I have been really fortunate to be under the care of the Queen Mary Hospital. Probably the best public maternal unit in Hong Kong.

As for private, there are different levels of service I have found depending on how much you pay.

Nurses in both systems impress me every time. What is it about nurses that makes them super efficient and caring all at once?

#3 The New-Parent Experience

Supplementing my public journey with a private midwife package was a great choice. We signed up for a private package with a well-known midwife clinic here, called the Annerley. The package supplemented our public antenatal program with things that made the experience more fun and comfortable.

As new parents, it was nice to see the same midwife frequently and ask those extra questions that come up all the time. When the whole world gives you their two cents about what you should do now and when the baby comes, it is great to have a qualified midwife to run this past. It saved us money on stuff we don’t need and worry about preparation that isn’t necessary for sure. And, as an expat, the information was just easier to understand.

We got additional time with a midwife between hospital visits, baby-care and pregnancy-care classes for mum and dad, postnatal home visits and access to a mum and baby group. This enhanced our experience in many ways. We got to see our little-one more often, and even saw a 3D scan.

Finally, the community of expats who also attend the clinic become quite close after the classes and are a useful resource for each other. Being around likeminded parents has been a comfort as we share many of the same concerns.

In terms of the public system, it is important to keep in mind that Dad cannot be present at all times. There are visiting hours that restrict access to 3 hours a day in both ante-natal and post-natal maternity wards. He is allowed to be their in the delivery room for active-labor, so we considered this to be enough. After all, the aftercare will be maximum 2 days for a routine delivery.

#4 Mental Health

More choice is available on the private system but the cost is much higher. And, there is lots to consider when looking for help for an eating-disorder which is beyond the scope of this article. However, I would say that when it comes to finding a counsellor, therapist, or psychologist (aka, a professional who can provide help with talking therapies and things like cognitive behavioral therapy); it is most important to find someone you relate to and can open up with. There wont be an option to shop around on the public system, but then again, we are limited here in terms of specialists in the eating disorder space.

I saw my usual private psychologist during my pregnancy. We have an existing relationship and she has been a huge part of my recovery journey. I didn’t want to play around with something that works, despite the costs.

For the pregnancy, I had to supplement my recovery support team with a psychiatrist. A psychiatrist is a medical doctor who can subscribe new or a change in psychiatric medication. I saw many in the past but typically you don’t see these doctors too regularly if you are not changing medication dosage or type.

I didn’t know what to expect on the public system so I went private at considerable cost. The experience was pleasant and my doctor was great but these appointments are very short and more a ‘check-in’ than therapy itself.

Psychiatrists are available on the public system but I have no idea the level of experience they have in eating disorders. As my mental health is somewhat stable, I feel either option could work and I have asked for a referral to a public psychiatrist.

I will just add that the public doctors and nurses are aware of my history and have taken the time to sit with me twice to ‘check-in’ and to determine if my mood is stable. The nurses I met were kind and are willing to refer me to a psychiatrist if needed.

#5 Convenience

As you may expect, private healthcare is much more convenient. There is less waiting time, quicker results, choice of appointment times (within reason).

On the public healthcare system, you will be given very little choice regarding appointment time. In fact, all mothers are given the same slot and it is a first-come-first-serve basis. You can wait for 3 hours one day, 2 another or be in and out in 1 another (although on average I haven’t been kept late as I turned up really early so I would advise on preparing for the worst and you will be pleasantly surprised). Depends on the day.

Location wise, In private care you can simply choose the nearest to you. This was less important for me, given I can write from anywhere, but more important for my husband who has a regular 8-6 job. Choosing to have private scans and classes meant he didn’t miss out on the entire experience. More importantly, we choose the midwife package because of the home visits that you get after baby is born. Convenience will be very important with a new-born in tow.

#6 Eating disorder awareness

There is very little awareness in Hong Kong amongst the general medical industry (regardless of going public or private).

I mentioned in last week’s article that the public healthcare system has a huge focus on diabetes during pregnancy and as such there is excessive (in my opinion) monitoring of weight-gain during pregnancy. Don’t expect the doctors and nurses to be sensitive when they weigh you.

The private midwives have been sensitive and offered to blind-weigh me so I don’t see. They have reassured me that what I am doing is ok. But they too don’t have experience and are not a substitute for mental healthcare.

I would say, regardless of the route you choose, make the doctors and nurses aware of your history and current fears; but, also take control yourself. Discuss possible triggers with your therapist, plan ahead and most importantly – remember that anything doctors or nurses say in terms of diet and weight is usually driven by a fear of risk factors for the general population, and not geared to support your recovery. There are reasons (like risk of diabetes in pregnancy) that prompt insensitive comments. Remember, it isn’t a sign you are doing anything wrong. It isn’t personal.

Refining my recovery care

Photo by Simone van der Koelen on Unsplash
Photo by Simone van der Koelen on Unsplash

I have been in recovery for over 2 years and have had minimal care in terms of the physical and mental aspects of my health for quite some time. Pregnancy changed my needs. I needed to ensure I had the appropriate medication and care for me and my baby. This included:

  • Psychiatric Medication: Not all anti-depressant medications prescribed for eating disorders are considered safe for pregnancy. I changed from Fluoxetine to Sertraline. Changing medication is something that cannot (or at least should not) be done without the care and monitoring of a qualified professional. I had to see a psychiatrist for the initial change and to monitor my transition after.
  • Counselling: I have been fortunate that my mental health has remained stable throughout my pregnancy (ok, within reason!). And so, I just continued with the existing frequency of my counselling sessions throughout pregnancy. It has however, been useful to have these sessions so if you have none, I would recommend considering finding someone to talk to. There is a lot of worries, fears and concerns that come up during pregnancy.
  • Thyroid Function: An underactive thyroid (hypothyroidism) is a risk to my baby’s health and so additional monitoring of hormone levels and medication dosage is required during pregnancy.
  • Diet: It was useful for me to discuss changes to my diet with dieticians and the midwives I saw. My diet was already quite varied. It included all the macronutrient groups, and a huge variety of micronutrients. So, the changes I had to make were minimal. I tried to follow more intuitive eating to manage bloating and discomfort, as the body does unpredictable things in pregnancy. And, I simply took the supplements recommended to every pregnant lady.

Doctors are human, mistakes happen

Photo by rawpixel on Unsplash
Photo by rawpixel on Unsplash

So, I mentioned above that I did have a complaint about the competency of one of my private doctors. Let me explain. This was a one off mistake, and in the grand scheme of things, could happen to anyone. Doctors are human after all. I guess the point I am making is that people are people so private vs public care is irrelevant, mistakes happen. Added to this, I want to highlight the importance to trust your gut feeling.

Here’s what happened….I had been taking a low dose of thyroid medication to stabilize my thyroid function since diagnosed with hypothyroidism over 2 years ago. It just so happened that my repeat prescription ran out last July when we were trying for a baby and I needed to find a new specialist to prescribe more medication.

I met a new specialist and had the usual blood test and a consultation. The new specialist gave me a very short session where he told me he disagreed with the diagnoses I had been given by my previous doctor and he advised that I come off the medication to ‘see if I didn’t need it’.

I mentioned that we were trying for a baby, but he still pushed ahead with the recommendation to stop the medication to test his theory. To this day, I wish I had pushed more about whether this was a good idea given our situation. I wish I had asked if the medication was harmful and why should I play around with it at this time. I wish I had listened to that gut feeling that says – that doesn’t sound right.

Two weeks later I was back to see him on an emergency consultation. I was pregnant and angry I had taken his advice to come off my thyroid meds. The tests confirmed my fear. My T4 hormone had hit a new low.

I was so mad at the specialist for his recommendation. My first thought was ‘how dare he play around with my babies health and mine’. But I soon came to realize that doctors are human too and make mistakes. Sometimes, if you have a bad feeling about something, you just need to go with your gut and question the doctors, even the specialists.

Luckily, with an increase in the medication, my hormone levels got back in the right range quickly and my baby’s development has been normal so far, so it looks like there has been no impact. Time will tell, but there is no need to worry about what cannot be changed.

I hope you will come back to join me again next week as I continue my pregnancy journey and talk about all that head-stuff. The worries, concerns and mood swings I experienced this past 8 months and how I used my recovery tools to help me cope.

Have a lovely week. x

Lots of Love,

Aunty Pam x

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