I’ve been there. Twice. I’ve heard little heartbeats that turned into none. I’ve ridden the emotional rollercoaster with its sudden drop, that even though I knew existed, hollow-hits you none the less. And whilst you’re trying to neatly collect your scattered thoughts and hopes, you realise the exact limbo you currently find yourself in: There will be no baby, but you’re not Not Pregnant. There will be no baby, but your womb is not empty… now what?
A silent miscarriage, or missed miscarriage, is when foetal development has stopped, the pregnancy is no longer viable but your body seems to have missed the memo and has not gone through the usual miscarriage procedure of expelling the foetal tissue. Your doctor may give you the choice to wait and see if it happens naturally, or they may advise assisted options – medication to bring on mild contractions or a surgical procedure called a Dilation and Curettage (D&C). Just to be clear, I have no medical background so I am not here to give you professional advise. But I can let you know what it’s like to have a D&C in both the public and private systems here in Hong Kong and I hope provide you with some clarity in what can feel like a blurry, ungrounded time.
Hong Kong offers private and public maternity healthcare, both very good medically but differing enormously in price and time. One can choose to go full private, full public or a mix of both – I have been the latter. However for all my first trimesters of pregnancy, I have only seen my private OBGYN and had both miscarriages discovered at the big 12 week scan.
The first time round I had the D&C at a private hospital with said OBGYN. We chose Canossa Hospital in Midlevels as it was slightly cheaper than the other options and I was paying without any insurance. The details were arranged via email. I arrived early morning for the procedure accompanied by a good friend, who sat by my side the entire time pre-op and waited for me while I was in theatre. My husband arrived just after I had returned to the ward and I was back home that afternoon. The hospital wasn’t busy and the nurses had time to fuss over me. It was a fairly seamless experience and cost between HKD20k-HKD30k.
Four months later I found myself at another disappointing 12 week scan. Two consecutive miscarriages is still normal, my doctor reassures me. We can run some tests on the foetal tissue as well as ourselves but it really could just be an unfortunate coincidence. Testing the foetal DNA privately will be around HKD10k so we decide to see what options are available through the public system. After chatting to a doctor friend working at Queen Mary Hospital she informs me that if I have the D&C there, they can send the foetal tissue for testing at HKU. So public it is.
And this is where the time-consuming element of public really kicks in.
- First stop: Queen Mary Hospital A&E. I hand in my HKID to the front desk and let them know I’m having a miscarriage. We go sit in the waiting area amongst the general coughing and anxious eyes. My wait isn’t too bad before my name is called and we go through. Vitals are taken and an ultrasound that shows no heartbeat. But it’s not the best machine for that sort of scan and I’m told I’ll need another scan to confirm.
- I’m sent to the Obstetrics Specialist Clinic. It’s a teaching hospital so there are medical students that sit in, but with your permission. I don’t mind but they do ask so.many.questions.
- We’re sent to another building for the second scan, this really took awhile. For some reason there was a picture of a dog on the waiting room wall that looked just like mine and I found it rather comforting. I have to go in alone. “There’s no heartbeat” they announce. Yes, I’m well aware thank you. But they do make sure that I understand all that I can see on the scan. They’ll send the results over to the Obstetrics Clinic and we’re given a timeframe for when we’ll need to be back. We go get some lunch at a coffee shop in the hospital.
- Back at the clinic they call my name and we go in to discuss the scan results and my options. It’s taken an entire day to get to where I’ve already been in one appointment with my private OBGYN. Everyone is very kind though, it’s just tedious. I’m upfront that the D&C is the route I want to go and that we hope we can test the foetus for abnormalities, but I will first need to see the specialist.
- I then get admitted to hospital and into the gynaecology ward. It’s a wait until late afternoon/early evening when I am able to see the specialist on her rounds. They run through all my options again, and I have to be very insistent about electing a D&C. There’s a lot of signing forms and understanding risks. I’m told I’ll have to spend the night in case the anaesthetist can see me late. I didn’t start my day mentally prepared for that and I’m feeling a bit fragile about it all. I’m lucky that my doctor friend has come to check up on me and we convince the specialist to let me go home with the promise that I’ll be back first thing in the morning.
- I was really thankful for this, as the next morning I’m able to go in armed with a bag of comforts (bringing my own pillow was the best thing I could have done). The anaesthetist was lovely and compassionate and I’m in theatre around midday. As a non-emergency surgery the wait just depends on what else is happening that day. They’re able to send the foetal tissue off to HKU for testing.
- They want to keep me overnight for observation. I have a great sleep. The next day it’s a bit of a wait before I can get discharged as I have to wait for a RHOGAM shot as my blood is Rhesus-negative. This is something that wasn’t discussed in private and it takes awhile as A- blood is fairly rare in Hong Kong.
- The two days of hospital cost me HKD240.
Whilst it was a much more tedious and time-consuming experience, I came out from the public experience extremely happy with the quality of medical care – I found them to be very thorough. The doctors were all great and I didn’t have any communication problems. I was also happy to get to know Queen Mary and the public system better. I had a follow-up 8 weeks later, where they were able to share my test results from the karyotyping. I was also offered a follow-up appointment with their miscarriage clinic – though the appointment was almost a year away. I did get rescheduled for an earlier date, but by the time that rolled around I was already 5 months pregnant with the nugget who would finally make me a mom. We had been prepared to pay for the HKU karyotyping but it turned out to be free of charge – how incredible.
This is never an easy road to find yourself on, and I hope this can shed some light on what to expect. Know that if a first miscarriage and going public, it will be hard to elect for a D&C – it is more costly and time-consuming for a publicly-funded system after all. But I hope whatever medical care you are receiving, that you feel supported through it and know that I am always here for encouragement.
