The 14Th of January 2013 I had the opportunity to visit the maternity units of the 100 years old Kwong Wah Hospital in Hongkong.
That was a very interesting visit.
I was particular interested in the integrated birth centre run by midwives. The receiving was warm, open and friendly. Mrs. Alice Sham, midwife general manager, Mrs. Pey Leng Tang the first consultant midwife in Hongkong and the midwives working at the integrated birth centre showed me with pride there centre and gave me all the information I asked for.
The specific objective of the birth centre is ‘keeping birth normal’. The environment is a University Hospital in the middle of the modern metropolis Hongkong. Mrs. Alice Sham the general manager of the maternity unit and the integrated birth centre of the Kwong Wah hospital, is as well general nursing manager at the TWGHs Wong Tai Sin Hospital and the president of the Hongkong Midwives Association. What she with her team is achieving in perspective of ‘keeping birth normal’ is a wonder (see ‘The state of the world’s midwifery’ below).
Mrs. Alice Shams’ objectives are clear and she has a sound vision. Care with total focus on needs of individual women and respect for the physiological process as is estimated and proved over and again that an undisturbed physiological birth process protects women and children. No epidurals or other pharmaceutical pain relievers are offered, without a solid indication and after using alternative methods to overcome problems during birth in this centre. The vision is ‘that birth is a physiological autonomous process’. Leave it as it is. Facilitate the process as professional the best you can, but without disturbance or fuss.
Primarily ‘one to one’ care is given from pregnancy on, so women know their midwife. Furthermore is much time spend in preparing couples. Women are given massage and are informed and use specific methods and advises during pregnancy for better neuro -physiological balance. This to enhance wellbeing, reduce stress and so avoiding problems during pregnancy and avoiding induction of labor after 41+ weeks. The same methods are used as alternative for pharmaceutical methods of pain relieve during birth and by signals of arrest of labour. Women are well and openly informed about the policies and methods of the birth centre on forehand. The specific policy and methods of this integrated birth centre are an incentive to Hongkong women to give birth there. Every year 750 women are guided in the birth centre by 15 midwives.
Thus the group midwives of this integrated birth centre are continue aware of keeping birth normal and are using as less as possible interventions. They enhance particular the physiological process by the use of new knowledge from the neuro-physiology, neuro- psychology in combination with fine tuned midwives knowledge for the guiding of a physiological birth process. They all follow regular (refresh) courses in Hongkong, Australia and the UK to enhance their skills; to be able to keep birth normal with creativity and joy.
The chosen policy generates success, more and more normal births are observed in the birth centre. There is openness in the centre and a ‘yes’ culture has developed. Happy atmosphere there, with time for women and visitors.
One of the basics principles the centre use, are the ‘Ten Top Tips’ for normal birth. The simple Tips generate new ideas and improvements in a very natural and ‘step by step’ way. Gradual change guided by the clear vision and objectives on what to avoid and what to promote seems to be most vital to achieve more spontaneous happy births and happy and healthy mothers and babies in this birth centre.
The state of the world’s midwifery
___________ 2011 _____________
Continuous midwifery care in Kwong Wah Hospital, Hong Kong
In 1999, the Continuous Midwifery Care (CMC) Team started midwife-led care service in
Kwong Wah Hospital, Hong Kong. Two teams of experienced midwives provide
comprehensive antenatal, intra-partum and postnatal care to low risk childbearing women.
These midwives also act as health educators and counsellors for the mothers-to-be and their
families. In 2007 an Integrated Birth Centre for low-risk care was built with a home-like
environment and is run by the CMC Team midwives. This care model aims to:
· promote natural birth;
· provide continuity and individualized maternity care to low-risk women throughout
pregnancy and childbirth;
· provide women with an alternative choice of maternity care;
· promote non-pharmacological pain management in pregnancy by using fit ball,
breathing exercises, music therapy and childbirth massage during labour;
· promote breastfeeding;
· promote family-centred care; and
· support professional development and enhance job satisfaction of midwives.
This service is guided by the departmental protocols agreed to by midwives and
obstetricians. Normal, low-risk women with no medical complications or unfavourable
obstetrical history are eligible to join the CMC Team care. During the first antenatal visit,
women interested in this model will be interviewed by CMC Team midwives and seen by an
obstetrician. With the consent of the woman and obstetrician, CMC Team midwives will
provide the subsequent antenatal, intra-partum and postpartum care. Birth plans will be
designed by the midwives with the women and their families. During pregnancy, labour and
after delivery, whenever an abnormality is detected, the woman will be jointly consulted by
an obstetrician and the CMC Team midwife.
In 2010, 94.4 percent of women cared for by the CMC Team midwives achieved normal
deliveries. More than 70 percent of them started breastfeeding immediate after childbirth and
more than 52.4 percent sustained breastfeeding six weeks postnatally.
Prepared by: Chu Sing, Pey Leng Tang and Alice Sham, Kwong Wah Hospital, Hong Kong
The Hongkong midwives I have met, send all reading of this blog warm greetings. They like to visit the Netherlands for the exchanging of ideas and establishing inspirational professional peer connections. Contact: email@example.com.
· IsHak, W,W., Kahloon, M., Fakhry, H. (2010). Oxytocin role in enhancing well-being: A literature review. Journal of Affective Disorders. doi:10.1016/j.jad.2010.06.001.
· Keijzer, Gré., Oudshoorn, Tine. (2009). Tien Top Tips voor normaal bevallen. Tijdschrift voor verloskundigen. Vol.34(1):142-3.
· Khazipov, R., Tyzio, R., Ben-Air, Y. (2008). Effects of oxytocin on GABA signalling in the foetal brain during delivery. In: Neumann, I.D., Landgraf, R. (Redacteur). Advances in Vasopressin and Oxytocin. Progress in Brain Research. 170:243-257.