GBS & QMH delivery
- Thread starter LdeJ
- Start date
The chances of a GBS positive mother passing the infection to her baby during birth are:
- 0.5% without IV antibiotics in labour
- 0.025% with IV antibiotics in labour
It's not just about the chances of something happening that is important, you also need to couple it with the OUTCOME (catastrophic or mild), if the outcome occurs. That is called a risk rating and the hospitals have made their risk rating, and deem that for GBS positive mothers they will admit the newborn for observation for 24 hours. If the outcome is of no consequence then health economists tend not to put too many resources into it no matter how commonly it occurs i.e. mild gastroenteritis.
End of the day, if you prefer to take the risks upon your own shoulders there is a form you can fill in to free the hospital of its responsibility and you can direct your own care (but I'm not sure if you can direct the care of your newborn but having seen the form I think there is a bit for parents to fill out if I remember right). Most people don't go down this route because ultimately, it is one thing to think you are right (and possibly vent on an open forum) and another to really take responsibility for it.
Nicolejoy, I totally sympathise with your situation and the problem with the long wait to have your LO's cleft repaired, but wish to point out that waiting lists are FERAL in HK. Looking at the waiting list for cardiac investigations here vs in Australia, there is a difference of some 12-18 months (which is quite frankly ridiculous - you probably don't need the test any more if you had to wait that long and are alive after doing so) but I think this is the fault of the low taxes here and the fact that bugger all is spent on healthcare.
As I say, I think the QMH does well with the resources it is allocated, and I agree with Carang when she says the fact is that the children are born healthy in the public hospital, but not to expect the bells and whistles/hand holding (unless you are willing to pay for it - my opinion). It makes me really annoyed on the staff's behalf when we bash the system that provides a good basic no frills service for 90% of the HK population (and I am told by my husband that its not only the expats that do this - the locals are really into it).
All of us would agree that if you made a decision to pay less for a phone you might get a phone without a camera/music/video recorder other bells and whistles. And no one would go bananas at the phone companies. Same goes for when you go for spa/ to a restaurant/use a plane, yet when it comes to healthcare, it upsets me that service users feel that is it right to demand service over and above what the hospital resourced is provide. There is an alternative with loads more bells and whistles in healthcare - if you don't like what the government hospital is providing than go the alternative route or sign that DAMA (discharge/disagree with medical advice form).
- 0.5% without IV antibiotics in labour
- 0.025% with IV antibiotics in labour
It's not just about the chances of something happening that is important, you also need to couple it with the OUTCOME (catastrophic or mild), if the outcome occurs. That is called a risk rating and the hospitals have made their risk rating, and deem that for GBS positive mothers they will admit the newborn for observation for 24 hours. If the outcome is of no consequence then health economists tend not to put too many resources into it no matter how commonly it occurs i.e. mild gastroenteritis.
End of the day, if you prefer to take the risks upon your own shoulders there is a form you can fill in to free the hospital of its responsibility and you can direct your own care (but I'm not sure if you can direct the care of your newborn but having seen the form I think there is a bit for parents to fill out if I remember right). Most people don't go down this route because ultimately, it is one thing to think you are right (and possibly vent on an open forum) and another to really take responsibility for it.
Nicolejoy, I totally sympathise with your situation and the problem with the long wait to have your LO's cleft repaired, but wish to point out that waiting lists are FERAL in HK. Looking at the waiting list for cardiac investigations here vs in Australia, there is a difference of some 12-18 months (which is quite frankly ridiculous - you probably don't need the test any more if you had to wait that long and are alive after doing so) but I think this is the fault of the low taxes here and the fact that bugger all is spent on healthcare.
As I say, I think the QMH does well with the resources it is allocated, and I agree with Carang when she says the fact is that the children are born healthy in the public hospital, but not to expect the bells and whistles/hand holding (unless you are willing to pay for it - my opinion). It makes me really annoyed on the staff's behalf when we bash the system that provides a good basic no frills service for 90% of the HK population (and I am told by my husband that its not only the expats that do this - the locals are really into it).
All of us would agree that if you made a decision to pay less for a phone you might get a phone without a camera/music/video recorder other bells and whistles. And no one would go bananas at the phone companies. Same goes for when you go for spa/ to a restaurant/use a plane, yet when it comes to healthcare, it upsets me that service users feel that is it right to demand service over and above what the hospital resourced is provide. There is an alternative with loads more bells and whistles in healthcare - if you don't like what the government hospital is providing than go the alternative route or sign that DAMA (discharge/disagree with medical advice form).
nicolejoy
Registered User
I understand some of the reasons why the situations are the way that they are here, but I still firmly believe that it has detrimental effects that can outweigh the benefits.
When my daughter was in NICU I felt so strongly that my daughter shouldn't be there that I considered taking her home against medical advice. I even discussed that with the doctors. You're right though, ultimately how can anyone make that decision and then they have to take full responsibility if something adverse happens. (I probably would have done it but there's no way my risk-averse husband would have agreed to it!!)
I'm not attempting to "bash the system" - even if you search this forum, you will read many posts written by me that are positive about QMH and other public hospitals (my best experiences have been at Duchess of Kent) - however I do feel strongly about this one issue. I have discussed it with doctors and nurses there too. It's not a matter of service (I'm not commenting on the rooms, the manners, the closing of Starbucks
), it's a matter of the way that medical decisions are made here compared to elsewhere.
When my daughter was in NICU I felt so strongly that my daughter shouldn't be there that I considered taking her home against medical advice. I even discussed that with the doctors. You're right though, ultimately how can anyone make that decision and then they have to take full responsibility if something adverse happens. (I probably would have done it but there's no way my risk-averse husband would have agreed to it!!)
I'm not attempting to "bash the system" - even if you search this forum, you will read many posts written by me that are positive about QMH and other public hospitals (my best experiences have been at Duchess of Kent) - however I do feel strongly about this one issue. I have discussed it with doctors and nurses there too. It's not a matter of service (I'm not commenting on the rooms, the manners, the closing of Starbucks
), it's a matter of the way that medical decisions are made here compared to elsewhere.Mummymoo, from reading this thread I don't think anyone is venting nor bashing the system. I think most of us would agree that given their resources and workload, the QMH staff do a fair job indeed. However, a group of educated mothers having a discussion and weighing up pros and cons is entirely reasonable.
Considering most if not all GBS positive mothers at QMH are given IV antibiotics in labour, this reduces the risk of passing GBS to the baby from 0.5% to 0.025%. Of those babies, up to 15% of cases are fatal. So it can be seen that the risk is almost immeasurably low of a baby dying after being born to a GBS positive mother (0.00075% no antibiotics in labour vs. 0.0000375% with).
I don't take risks with my babies, so I certainly would not support having them taken to the NICU for "observation" in the absence of conceivable risk. Taking a baby away from his mother and depriving him of skin to skin contact and vital colostrum for a minuscule risk, and thus exposing him to a more likely risk, seems counterintuitive.
Of course a mother would be devastated if her baby contracted GBS (extremely unlikely), but likewise I'm sure she'd be just as devastated if her healthy baby went to the NICU and contracted potentially fatal (and far more likely) gastro, MRSA, etc.
Considering most if not all GBS positive mothers at QMH are given IV antibiotics in labour, this reduces the risk of passing GBS to the baby from 0.5% to 0.025%. Of those babies, up to 15% of cases are fatal. So it can be seen that the risk is almost immeasurably low of a baby dying after being born to a GBS positive mother (0.00075% no antibiotics in labour vs. 0.0000375% with).
I don't take risks with my babies, so I certainly would not support having them taken to the NICU for "observation" in the absence of conceivable risk. Taking a baby away from his mother and depriving him of skin to skin contact and vital colostrum for a minuscule risk, and thus exposing him to a more likely risk, seems counterintuitive.
Of course a mother would be devastated if her baby contracted GBS (extremely unlikely), but likewise I'm sure she'd be just as devastated if her healthy baby went to the NICU and contracted potentially fatal (and far more likely) gastro, MRSA, etc.
I really don't agree that wanting to care for your own baby after birth is excessively demanding on the staff or should require a 'bells and whistles' hospital. If anything, a mother taking over the monitoring, feeding, washing, changing and soothing of her baby decreases, not increases, the nurses workload - leaving them free to focus on the serious cases. And the opportunity to bond with your baby in those first few hours and days, let alone the health benefits of frequent feedings of colostrum, certainly should not be a privilege reserved for the wealthy.
Nicolejoy, I definitely have never thought you were bashing the system (and I know from your threads you've been through a great deal with your daughter) and know the system well, but I do think some of the tone of the other posters are negative, to keep it friendly I won't single out which ones specifically.
In terms of the GBS risk, I think the chances of contracting GBS are 0.075% (no antibiotics) vs 0.0375% unless I have done my calculations wrong. I'm not privy to whether GBS is more of a risk than MRSA/gastroenteritis for the average newborn born in a hospital but if you could show me some links/evidence that fatal MRSA/gastroenteritis contracted from being taken away from one's mother to be sent to the NICU to prevent GBS septicaemia then I'm happy to reappraise. Also if there is no evidence in existence but you still have your gut feeling/mother's intuition then you are still free if you feel you know best to sign your DAMA form, not admit your newborn to the NICU and shoulder the responsibility yourself. Staff at the hospital will not insist upon any course of action if you are happy to free them of any problems that may arise once you take a course of action they don't advise. Simple really.
Finally,
I really don't agree that wanting to care for your own baby after birth is excessively demanding on the staff or should require a 'bells and whistles' hospital. If anything, a mother taking over the monitoring, feeding, washing, changing and soothing of her baby decreases, not increases, the nurses workload - leaving them free to focus on the serious cases.
True, a mother caring for her own infant frees up the nurses to do other things and if you have read the posts on geobaby, most public hospitals do better in terms of encouraging mums to look after their own children/breastfeed than some of the private hospitals do when things go according to plan. What we are talking about here is when newborns need to be admitted to NICU. So for a routine birth, no bells and whistles seems to be the way to go if you wish to monitor, feed, wash, change and sooth your own baby.
And the opportunity to bond with your baby in those first few hours and days, let alone the health benefits of frequent feedings of colostrum, certainly should not be a privilege reserved for the wealthy.
I'm not sure where you're trying to go with this comment. I have not for one moment implied that only the wealthy should be able to breastfeed their children right after birth. In fact all babies should be given colostrum but what I am trying to say is that in cases where an infant is flagged as being of high risk or higher risk then in resources strapped system, the hospital has to make hard decisions. It has to pool it's resources for the good of MOST, as opposed to allocating all resources to one woman and her baby. When there aren't enough NICU nurses or equipment, they can't have these staff scattered over the maternity floors i.e. do observations on one ward for like 2 babies, then take the lift/stairs to another floor/ward to do observations for another 2-3 babies, then rushing back to NICU to do observations on the babies actually in NICU. Also special equipment would need to be kept nearby on each and every ward if not every floor as well as the NICU to cater for these mums and babies? Can you see how that would get really inefficient for the nurses? Doctors? Other healthcare staff? Could you see how expensive it would get in terms of equipment/labour costs? Yes, it's convenient and lovely for the mother's to bond with their babies 100% of the time but the QMH isn't resourced to do this for ALL babies. For routine cases yes, but not high risk ones. Also frequent feeding for babies, where will they get the staff to wheel the mum to her baby every 2-3 hours for the breast feed?
Unfortunately, if you are wealthy, and indeed have access to unlimited funds, the truth of the matter is you could room with your baby no matter how high risk they were as you could pay to have the nurses, doctors, equipment to be available to you and your newborn. Go take a look at the private wards of the MAYO of you don't believe this. This does not apply at a place like the public hospitals where they aren't resourced to do this, that's all I'm trying to say. Health economics, hell any economics is difficult because as they say there are UNLIMITED DEMANDS and only limited resources.
In terms of the GBS risk, I think the chances of contracting GBS are 0.075% (no antibiotics) vs 0.0375% unless I have done my calculations wrong. I'm not privy to whether GBS is more of a risk than MRSA/gastroenteritis for the average newborn born in a hospital but if you could show me some links/evidence that fatal MRSA/gastroenteritis contracted from being taken away from one's mother to be sent to the NICU to prevent GBS septicaemia then I'm happy to reappraise. Also if there is no evidence in existence but you still have your gut feeling/mother's intuition then you are still free if you feel you know best to sign your DAMA form, not admit your newborn to the NICU and shoulder the responsibility yourself. Staff at the hospital will not insist upon any course of action if you are happy to free them of any problems that may arise once you take a course of action they don't advise. Simple really.
Finally,
I really don't agree that wanting to care for your own baby after birth is excessively demanding on the staff or should require a 'bells and whistles' hospital. If anything, a mother taking over the monitoring, feeding, washing, changing and soothing of her baby decreases, not increases, the nurses workload - leaving them free to focus on the serious cases.
True, a mother caring for her own infant frees up the nurses to do other things and if you have read the posts on geobaby, most public hospitals do better in terms of encouraging mums to look after their own children/breastfeed than some of the private hospitals do when things go according to plan. What we are talking about here is when newborns need to be admitted to NICU. So for a routine birth, no bells and whistles seems to be the way to go if you wish to monitor, feed, wash, change and sooth your own baby.
And the opportunity to bond with your baby in those first few hours and days, let alone the health benefits of frequent feedings of colostrum, certainly should not be a privilege reserved for the wealthy.
I'm not sure where you're trying to go with this comment. I have not for one moment implied that only the wealthy should be able to breastfeed their children right after birth. In fact all babies should be given colostrum but what I am trying to say is that in cases where an infant is flagged as being of high risk or higher risk then in resources strapped system, the hospital has to make hard decisions. It has to pool it's resources for the good of MOST, as opposed to allocating all resources to one woman and her baby. When there aren't enough NICU nurses or equipment, they can't have these staff scattered over the maternity floors i.e. do observations on one ward for like 2 babies, then take the lift/stairs to another floor/ward to do observations for another 2-3 babies, then rushing back to NICU to do observations on the babies actually in NICU. Also special equipment would need to be kept nearby on each and every ward if not every floor as well as the NICU to cater for these mums and babies? Can you see how that would get really inefficient for the nurses? Doctors? Other healthcare staff? Could you see how expensive it would get in terms of equipment/labour costs? Yes, it's convenient and lovely for the mother's to bond with their babies 100% of the time but the QMH isn't resourced to do this for ALL babies. For routine cases yes, but not high risk ones. Also frequent feeding for babies, where will they get the staff to wheel the mum to her baby every 2-3 hours for the breast feed?
Unfortunately, if you are wealthy, and indeed have access to unlimited funds, the truth of the matter is you could room with your baby no matter how high risk they were as you could pay to have the nurses, doctors, equipment to be available to you and your newborn. Go take a look at the private wards of the MAYO of you don't believe this. This does not apply at a place like the public hospitals where they aren't resourced to do this, that's all I'm trying to say. Health economics, hell any economics is difficult because as they say there are UNLIMITED DEMANDS and only limited resources.
Sorry - i thought your reference to 'bells and whistles hospitals' and alternative options was a reference to private hospitals.
However i do think we are talking at cross purposes. I absolutely agree that a child that "needs" to be admitted to nicu should be admitted.
What I'm talking about is the 'just in case monitoring' - monitoring of an apparently healthy baby, who doesn't require special equipment or specialist nursing staff. In these cases, the question becomes which is more of a risk to the baby: reducing colostrum or a potential delay in diagnosis of a serious condition. I think the mothers should be given adequate information and allowed to decide what happens in these kind of situations. It seems to me that hospitals here over prioritise the benefits of monitoring - the belief that mothers should give birth on their back so that they can remain strapped to a fetal heart rate monitor is another example. I would like my baby's hr to be checked during labour, but I think it's better for me, the labour and therefore the baby if I can move around. Even if that means not constantly monitoring the baby's hr. I understand that this is possible, but I also understand that it can require a bit of a battle.
I'm from the UK, and the hong kong system is MILES better than what we have there. However, I want a say in what happens to my baby and I don't think that's being unreasonable.
However i do think we are talking at cross purposes. I absolutely agree that a child that "needs" to be admitted to nicu should be admitted.
What I'm talking about is the 'just in case monitoring' - monitoring of an apparently healthy baby, who doesn't require special equipment or specialist nursing staff. In these cases, the question becomes which is more of a risk to the baby: reducing colostrum or a potential delay in diagnosis of a serious condition. I think the mothers should be given adequate information and allowed to decide what happens in these kind of situations. It seems to me that hospitals here over prioritise the benefits of monitoring - the belief that mothers should give birth on their back so that they can remain strapped to a fetal heart rate monitor is another example. I would like my baby's hr to be checked during labour, but I think it's better for me, the labour and therefore the baby if I can move around. Even if that means not constantly monitoring the baby's hr. I understand that this is possible, but I also understand that it can require a bit of a battle.
I'm from the UK, and the hong kong system is MILES better than what we have there. However, I want a say in what happens to my baby and I don't think that's being unreasonable.
However i do think we are talking at cross purposes. I absolutely agree that a child that "needs" to be admitted to nicu should be admitted.
What I'm talking about is the 'just in case monitoring' - monitoring of an apparently healthy baby, who doesn't require special equipment or specialist nursing staff.
I think this is where it gets tricky. The public hospitals do not as a routine monitor babies with no risk features, however they have a set of guidelines that flags higher risk babies (who are apparently healthy) which some may disagree with. I agree that mothers should be given the information and in fact they are allowed to make their own decision (but you still have to sign the DAMA form) if what you choose to do is not within the policy guidelines. I don't think it is unreasonable for a mum to have a say in what happens to their baby but by the same token, hospitals need to protect themselves too.
In terms of being strapped to a bed during labour, I agree it's not ideal but it probably saves the staff manpower (and hence is cheaper) and as you've pointed out you can forgo this but it's a bit of a battle.
What I'm talking about is the 'just in case monitoring' - monitoring of an apparently healthy baby, who doesn't require special equipment or specialist nursing staff.
I think this is where it gets tricky. The public hospitals do not as a routine monitor babies with no risk features, however they have a set of guidelines that flags higher risk babies (who are apparently healthy) which some may disagree with. I agree that mothers should be given the information and in fact they are allowed to make their own decision (but you still have to sign the DAMA form) if what you choose to do is not within the policy guidelines. I don't think it is unreasonable for a mum to have a say in what happens to their baby but by the same token, hospitals need to protect themselves too.
In terms of being strapped to a bed during labour, I agree it's not ideal but it probably saves the staff manpower (and hence is cheaper) and as you've pointed out you can forgo this but it's a bit of a battle.
A couple of questions about the dama form:
Can I sign that on behalf of my baby or does it just apply to me?
I know it's a discharge form, but can it apply in cases where you're not asking to be discharged, you're just insisting on different treatment (eg no formula to be given to the baby, just breast milk)
Finally, are you aware of it causing any subsequent problems with health insurance?
Can I sign that on behalf of my baby or does it just apply to me?
I know it's a discharge form, but can it apply in cases where you're not asking to be discharged, you're just insisting on different treatment (eg no formula to be given to the baby, just breast milk)
Finally, are you aware of it causing any subsequent problems with health insurance?
DAMA form, this is the thing, I've never used the form myself but have seen it before and I can't 100% remember if a parent can sign for their child but I think there is a place where they can.
Not sure if the form is specifically for discharge or for disagreements but where I saw it used was where there was a disagreement in treatment (family was recommended intravenous drugs for several weeks and they preferred to change over to oral drugs instead).
In terms of insurance I have no idea at all about this. Hope this helps you.
Not sure if the form is specifically for discharge or for disagreements but where I saw it used was where there was a disagreement in treatment (family was recommended intravenous drugs for several weeks and they preferred to change over to oral drugs instead).
In terms of insurance I have no idea at all about this. Hope this helps you.
Just to add to this discussion about GBS... I was GBS positive for my second baby, she was delivered by c-sec since she was breech (which lowers the risk) but since my water broke, I was given antibiotics for the GBS. I was in the hospital at the time and they took 1 hours after my water broke to administer the antibiotic and then my baby was delivered 3 hours later. I was a little stressed out about whether the antibiotic would work but it turned out fine. My baby was taken to the special care unit for a night but this could also be because she was pre-diagnosed with a dilated kidney. I know that they did a bedside ultrasound for her kidney and also did some test for the GBS thing.
She was up with me in a day and I had no problems with breastfeeding. I did not feel the need argue with them over taking her to special care. I guess I'd rather err on the side of caution and I know enough people who breastfed successfully after being separated for a night from their baby. The public hospitals do cupfeed... I have seen them do it...and yeah they can't wheel you down because they don't have the manpower but they will help you get started pumping.
She was up with me in a day and I had no problems with breastfeeding. I did not feel the need argue with them over taking her to special care. I guess I'd rather err on the side of caution and I know enough people who breastfed successfully after being separated for a night from their baby. The public hospitals do cupfeed... I have seen them do it...and yeah they can't wheel you down because they don't have the manpower but they will help you get started pumping.