Prenatal rigor in public system-43 & pregnant

Posted by fushingbayloo (240 days ago)

I'm 43 and newly pregnant for the 2nd time (have a 2 yo) and new in HKG and don't have insurance. Thinking about going through the public system but would like to know the rigor of prenatal care...are they offering nuchal translucency? quad screening? amnio, if needed?

Does anyone have experience being a "high risk" patient in the public system? There is no cost to what we would spend if needed, for appropriate prenatal care.

Thanks

(I am based in Hong Kong)

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Posted by RachRobin (240 days ago)

Congratulations!
I can't comment on what the public system actually offers in terms of specific tests, but I do know that you can have all of the above tests privately and still deliver through the public system. The private clinic simply sends (or gives you) all test results to add to your antenatal notes with the public clinic.
If you need to get any scans etc. done before you register with the public system, I would reccommend the HK Prenatal Diagnostic Centre (in Icehouse St, Central). Ph. 28773280. Each scan I had (i.e. OSCAR test) cost about HK$1200. I have not had any of the more invasive tests, but I know they do them and have a very good reputation.
Good luck with everything.

(I am based in Hong Kong)

Posted by cara (240 days ago)

if you are over 35 and going through the public system you'll get the nuchal test for virtually nothing.

the public system is great medically. it is just "no frills" for bedside manner/amenities.

i was a high risk case at QMH last year.

(I am based in Hong Kong)

Posted by fushingbayloo (240 days ago)

Thanks Robin and Cara. Where do I start with public system then? I live in Happy Valley. Isn't it by the location where you live that you are supposed to see a certain clinic?

(I am based in Hong Kong)

Posted by cara (240 days ago)

i think that you would be ok for QMH...
if yes, then you register at Tsan Yuk Hospital. they will assess you and possibly recommend you go to high risk.

if you are not considered high risk (maybe judging from your age, you would be bumped up automatically, i don't know) then you have your appts at Tsan Yuk or a clinic nearer to you. you deliver at QMH. if you ARE high risk, then you have all your appts at QMH. you will be always seen by the same 3 or 4 doctors. so, they get to know you.

with my last one, i was hospitalised 8 times and i delivered 1 month early. the doctors were great and the nurses were too (although really overworked). the nurses used to come by to visit me if they had a minute, just to chat. i guess being pregnant 2X in 2 years and being in hospital 13 times for a total of over 2 months, they got to know me. (my favourite nurse was a young gal named amy! there was another one who used to come by to see what i was reading. she'd then go to the library and borrow the same book!)

(I am based in Hong Kong)

Posted by cara (240 days ago)

ps> you need a letter from a private dr confirming pregnancy

(I am based in Hong Kong)

Posted by fushingbayloo (239 days ago)

Thanks Cara. I appreciate your advice. I received the "introduction letter" from the doctor at HK Santiorium yesterday confirming the pregnancy. He of course, wanted me to stay at the Sanitorium, which I may consider if we can get a handle on costs since it's just so darn close to our flat. Nevertheless, I will go to the Tsan Yuk Hospital, maybe today, to register. A girlfriend of mine also suggested I could do private care for first trimester then switch to the public system for later care and delivery if all is good with the baby. She's been here over 20 years and claims that a lot of expat women do just that.

(I am based in Hong Kong)

Posted by cara (239 days ago)

no, don't go there... just call them... they will book you a "registration" day/time.

(I am based in Hong Kong)

Posted by RachRobin (238 days ago)

That's right - you can't just show up, you need to make an appointment at Tsan Yuk for registration.
After this initial appointment, you will then have another appointment scheduled at Tsan Yuk where you actually see the doctor and they assess your health, risk etc.
If you are judged to be low risk, they will send you to an outside clinic for followup care. I will be going to a clinic on Queens Rd East (just near Happy Valley racecourse end) as I live in Wanchai. Otherwise if deemed high risk, all followup care is done as Tsan Yuk (no longer at QMH) up until delivery.

(I am based in Hong Kong)

Posted by cara (238 days ago)

really? when did they change that? i delivered 14 months ago and all my appts were at QMH...

(I am based in Hong Kong)

Posted by fushingbayloo (237 days ago)

I called on Saturday and Tsan Yuk said they would only book me an initial consult. when I was 10 weeks along. That's too late in my opinion and I told them so. I explained that I was 43 so they asked me to fax my intro. letter to them on Monday and they'd consider getting me in earlier. I will push on this as I've heard if I go public I need to push here and there to get things done.

(I am based in Hong Kong)

Posted by RachRobin (237 days ago)

Hi Cara,
I think they may have changed the policy recently. I am, however, just quoting what is in the antenatal booklet Tsan Yuk gave me (my maternal record book). Maybe they refer you on to QMH in specific cases?

(I am based in Hong Kong)

Posted by cara (237 days ago)

my last experience getting onto the HR team was thus:

i get violently ill when i'm pregnant. this in and of itself is not necessarily a concern. however, i have chronic hyper-tension. THIS IS the concern. i was vomitting my meds, so they were doing no good.

i phoned TYH to see the "dr" i told them. i explained that it was a dangerous situation and that i needed to see one as soon as possible. they moved up my appointment by about 3 weeks. when i finally got there(on wednesday), i discovered that it was only the registration appt. i was quite upset as i felt i needed to see the dr ASAP. the head nurse told me that if i was so concerned, i should go to the A & E dept. so, i did. when i got there, the sign on the wall said a 3 hour wait. after they triaged me, they told me that they would see me very soon, i asked abotu the 3 hr wait. she said,"oh, no, you are pregnant and you BP is VERY high, too dangerous. we'll see you in a few minutes!" i was in and out in about 45 minutes. they wrote a letter to refer me to the "early pregnancy assessment" unit in QMH (where i went to the A&E). that appt was for the next day (thursday). after that appt, they referred me to the HR team. i had my first appt on friday. I was then to the dr on avg every 1-2 weeks at QMH. and as i said before, i was hospitalised (for various complications) 8 times and delivered 1 month early.

interesting if they have changed the proceedure...at my last O&G appt there, they gave me a letter saying that from now on, if i get pregnant, i go straight to them... no TYH for me!

(I am based in Hong Kong)

Posted by fushingbayloo (237 days ago)

Well TSH just called and said I was "nothing special" -- not HR because of my age (43) and they would only book my initial appt for 10 weeks on. I specifically asked when a nuchal could be done and she said "if needed, by week 14". In the US, where I had my 1 child (conceived at 40) we did the nuchal at 12 weeks, the quad screen immediately after, well before week 16 so we could make an educated decision on whether or not to do an amnio. Would my past experience be more in line with what the private sector docs are offering in terms of care?

(I am based in Hong Kong)

Posted by hkexpat2007 (230 days ago)

I've been going to Queen Mary for appointments. (I think it may be because I may be considered high risk because I did IVF with Queen Mary). However, my scans are though Tsan Yuk. My first scan with Tsan Yuk was scheduled too late in the pregnancy for the nuchal test and the first trimester blood test for down's - I think they they were just too backed up (I think my blood test one done as early as week 11). I mentioned this to Queen Mary, and the resident agreed, and recommended I do the tests privately. I did those tests through a private doctor, as I didn't want to miss my "window". You may want to do the same, so you will have your results during the first trimester.

And by the way, I think the public doctors at Queen Mary are excellent I had mentioned that I was having contractions to my private doctor who said not to worry, as they were just Braxton Hicks. When I mentioned this to the public doctor, he scheduled an ultra sound to make sure I was not at risk of preterm labor (by measuring my cervical length). When I went to Queen Mary last week due to early contractions (every 5 minutes during my 24th week), they observed me for a day, and did multiple scans, uterine activity measurements, culture tests for infections, blood tests for elevated white blood counts, etc. I felt that I was in excellent hands. The nurses also were really nice. The cost for the day at the hospital was just HK$150, including all the tests.

(I am based in Hong Kong)

Posted by ltxhk (227 days ago)

I had children at both Matilda and Queen Mary .... and having been at both, the quality of medical care at QM is world-class. Matilda was also good and so was the doctor etc, but truly very, very expensive even with insurance.... especially if risks develop or complications happen during delivery.... and this was on a package. HK private medical is very good about hidden and unexpected costs.

My second child was very high risk.... and QM could not have run more tests to monitor him and me at all times. Several of the tests were actually only available in the public sector, since the equipment did not exist in the private. Even with all this care, he still arrived several months early.... and luckily he was at public where they have 24/7 care with on-site doctors and specialists... not only for the preemies but all.

Perhaps there is a bit more attention at public when you are high risk, but I actually found this to be the same in private. I have recently had several friends who just arrived in HK and were pregnant, but also without insurance. 2 were over 40, and did not turn out to be high risk. After consideration, they all went public and were very pleased with the quality of care. But one of them also consulted a private OB to ensure some early testing. If you consult an OB in the private and also go public, you may want to find a doctor who is connected well with the public.

(I am based in Hong Kong)