Charging policy link to death of babies

PUBLISHED : Thursday, 07 June, 2007, 12:00am
UPDATED : Thursday, 07 June, 2007, 12:00am

Hospital warns of 'social obstetrics'

One stillbirth by a mainlander and another baby's tragic death have been linked to the new charging policy in public hospitals.

Doctors at Kwong Wah Hospital said the women's financial constraints led them to wait beyond 41 weeks, the full term of pregnancy, before seeking hospital treatment.

The tragedies could have been prevented if the women had had prenatal checks or been monitored when overdue, the doctors wrote in the latest issue of the Hong Kong Medical Journal released yesterday.

The two cases illustrated 'a new challenge' faced by obstetricians and midwives, the doctors said.

'This phenomenon is known as 'social obstetrics': when a standard obstetrics practice is affected by a socio-economic situation,' said the doctors, led by Cherrie Yeung of the department of obstetrics and gynaecology.

They said the phenomenon began when public hospitals started charging mainlanders HK$20,000 for an obstetrics package in an effort to deter abusers of the system.

Mainlanders came to Hong Kong for delivery for 'a specific social reason - children born in Hong Kong to mainland Chinese women have the right to stay in Hong Kong', the doctors said.

Since February 1, mainland women who are 28 weeks pregnant or more have been barred from entering Hong Kong if they do not have a hospital booking. They pay HK$39,000 for an obstetrics package while those who do not have bookings are charged HK$48,000.

The first case involved a 27-year-old woman who was 41 weeks pregnant when she sought accident and emergency consultation for abdominal pains. She refused to be admitted and returned nine days later at 42 weeks and six days.

It was already too late and an ultrasound examination showed that the baby girl had died.

The second case involved a 37-year-old mainlander who attended Kwong Wah's accident and emergency department at 44 weeks. An emergency caesarian operation was performed as the baby was distressed. The baby girl died 18 days after birth.

'No cause beyond postmaturity was found [in both cases],' the doctors said.

They noted that the incidence of post-term deliveries in non-local pregnant women was 3.2 per cent, compared to 0.9 per cent in locals.

'Our two reported cases might well have been prevented if the standard obstetrics protocols for post-maturity had not been hindered by this special 'social obstetric' phenomenon,' they said.

They warned that stillbirths due to overdue pregnancies were only one example of the new 'social obstetrics' phenomenon.

The obstetrics department also saw babies' deaths due to mother's untreated diabetes, breeched twins, placenta problems and eclampsia, or convulsions.