Special delivery

The decision was easy for nature enthusiasts Ma Fung-yan and Fung Kin-hang. When the time came to deliver their first child, they opted for a home birth.

Ma, a housewife, found the idea of giving birth in a clinical hospital setting more terrifying than reassuring. 'The bright lights, unfamiliar people milling around you, the array of equipment monitoring the condition of you and the baby ... all these are frightening,' she says. 'It was my first birth and I wanted the experience to be stress free.'

Talks that the couple attended on delivery in hospitals put them off the idea altogether, adds Fung, a teacher. 'Their protocol states that if the baby does not come out by a certain time, they will use vacuum extractors. But this might produce a deformed head or lead the baby to develop allergies later.'

With pregnant mainland women flooding obstetrics wards here, expectant mothers in Hong Kong who secure beds locally are often as delighted with their booking as learning about their pregnancy. Yet a small but growing number are opting to have their babies at home rather than in a hospital. Census and Statistics Department figures show that 270 children were born away from hospitals in 2010, compared to 128 people in 2002.

Hulda Thorey, director of maternity consultancy Annerley, says demand for home births has increased significantly. In Iceland, where she worked previously, Thorey was the second of two midwives attending a birth, but in Hong Kong she has served as the main carer.

'I took on the role because of a very big demand. In the past, I got one to two calls every month about this. Today, three to four women call to ask for home births,' she says.

Even so, Thorey turns down many requests. Births can be unpredictable, which is why she only takes on clients with a good obstetrics history and an uneventful first delivery.

'I will say no straight away if the woman is a first-time mum,' she says. 'The couple must also live close to a hospital. The woman must prepare very well and her husband must be very involved. If the father is scared, I can't spend my energy and attention calming him when the woman is giving birth. It's teamwork.'

Homeopath Arden Wong Wai-tak was a pillar of support when Thorey helped his wife, Michelle Huang, deliver their baby at their Pok Fu Lam home in January. While his wife squatted on their bed as contractions intensified, Wong says, 'I helped rustle up all the equipment like gauze and scissors and pressed on [Huang's] acupressure points to relieve her pain.'

It evidently worked - young Shaun-yo emerged after just three hours of labour and Huang quickly put him to her breast.

'Immediate breastfeeding aids uterus recovery and helps the baby know early that this is how it should feed. This would be impossible to do in the hospital, as babies are taken away from mothers for bathing and measurement,' she says. 'Such procedures should be delayed as the baby craves close physical contact with its mother after it first comes into the strange new world. We only bathed him the next day.'

Ma and Fung went so far as to do without the services of a midwife, and sought the help of a friend instead.

'The process was very smooth,' Ma says.

She had read a lot of books on home birthing, and when pre-labour contractions began around noon, she called in a friend who had undergone home birth herself.

'At 4pm, with contractions two to three minutes apart, the pain grew intense, which meant I was going into labour. At 8pm, I felt the urge to push. Contrary to what I expected, the pain was not that severe,' she recalls. 'The hypnobirthing techniques I learned - meditating and breathing - helped a lot. After pushing for about an hour, she came out at 9.30pm.'

But Ma was fortunate. From the moment a woman goes into labour, it can take up to 20 hours before the baby emerges.

Keeping the women relaxed helps make for a peaceful birth, 'but in hospitals, staff intervene by augmenting the labour and breaking the water', Thorey says. 'With IV lines and epidural at the back, the woman is left immobile on the bed, unable to eat, drink or have a shower. Suddenly, the peace and quietness before are gone and the spirit of birth is changed. All these interventions can be stressful.'

Such interventions aside, Thorey says the high rate of Caesarean section is another reason for the interest in home births. 'The Caesarean rate in private hospitals is 50 to 90 per cent. This is totally unacceptable. It's not that Caesarean section is horrible. But those who do not need or want it do not have control over what happens to them,' says Thorey.

Gynaecologist Peter Ngai concedes Caesarean section is an easier option for doctors. 'I know of doctors whose Caesarean section rate is 80 to 90 per cent. They play golf every day and there's no way they will tend to a woman at 2am. Caesarean takes only an hour and you can fix the time.'

But the hospitals' interventions are for safety, Ngai says.

'They would rather err on the side of caution. Theoretically, it's OK to give birth at home. But delivery can be unpredictable. The baby's head and limbs may move [and obstruct delivery]. Labour wards are prepared for such contingencies. Cases abound where a woman is about to give birth smoothly and slides into a critical condition an hour later, or a woman has difficulty giving birth and the baby comes out two minutes later.'

Dr Ronald Chiu Hong-sing, an obstetrics and gynaecology specialist at Haven of Hope Christian Service, warns that home births are risky.

'Unforeseen incidents like excessive bleeding by the mother and irregular heartbeat of the fetus can put the life of mother and child in danger. A hospital environment can provide instant assistance, like blood transfusion and emergency Caesarean section,' he says. There are also many procedures that must be done after birth, Chiu says. Fetal membranes remaining in the uterus must be removed to prevent inflammation. Mucus in the baby's nose and mouth must also be extracted to prevent a clogged windpipe and possible suffocation.

Thorey, too, doesn't promote home births in Hong Kong.

Hospitals here aren't set up to support emergencies in the case of home births, she says, unlike countries such as Britain, which has an open attitude and will assign a midwife to help with the delivery.

In Iceland, the hospital would be informed when its patient goes into labour, Thorey says. The staff know that the mother will likely give birth at home, but if something happens they will be ready for it. In Hong Kong, however, there isn't this rapport between the home birth midwife and hospital staff.

Most of Thorey's work involves easing women's labour before their trip to the hospital rather than assisting in delivery.

'But some of my clients refuse to go to hospital and I know that they will do it at home with or without me. As a health care professional, it's my duty to attend to rather than leave the family.'

Huang is a prime example. 'Hulda had a lot of reservations when we requested her help. She agreed only after observing us over 30 weeks. She knew that we were determined. If Queen Mary Hospital wasn't so close to our home, she would not have done it.'

But Huang insists that home birthing is a safe option as long as there is adequate preparation.

'I did prenatal yoga, which can lead to better pelvic alignment, and hypnobirthing for relaxation. I swam and walked for an hour every day to stay fit. I also visited the osteopath to check my bone alignment. People fail to have natural delivery because their pelvic bones are not aligned well. The osteopath did some bone realignment for me so that there was enough space inside my body for the baby to turn around.'

For all her determination, Ma, too, had a few anxious moments when her baby arrived.

'After my daughter was born, she didn't cry. My friend panicked and suggested calling an ambulance. But her skin was pink, so I patted her back a few times and she started crying. She has been bawling ever since.'