Hong Kong - Like most things from the cradle to the grave in Hong Kong, it used to be simply a question of money. If you had it, then a bed in a maternity ward at a private hospital was yours. Hong Kong's birth rate was falling, and maternity care was very much a buyer's market.

But things have changed dramatically in the past five years. Now women opting to give birth in one of Hong Kong's private hospitals have to book their beds as soon as they discover they are pregnant, with some of the hospital's maternity units already fully booked until May.

Obstetricians in private practice are delivering almost twice as many babies as they were just a couple of years ago and even turning away pregnant women because they cannot guarantee getting them hospital beds for their deliveries.

Fiona Yu was seven weeks into her pregnancy when she first visited a private obstetrician only to find there were no beds available at the two hospitals where she had hoped to give birth.

"It was a particularly bad time," she said. "I was about five months pregnant when a bed became available at one of the hospitals."

It is a problem facing private maternity units and obstetricians all over Hong Kong, said Dr Robert Law Chi-lim, spokesman for the Hong Kong College of Obstetricians and Gynaecologists.

"All the private practitioners in Hong Kong are turning away patients every other day," he said. "The private hospitals fill up quickly."

Law said the root of the problem is twofold: firstly, the spiraling birth rate in the former British colony, and secondly, the shortage of trained midwives to work on these overstretched maternity units.

In the past five years, the birth rate has increased by nearly 50 per cent, rising from 46,965 births in 2003 to 70,875 in 2007, mainly as a result of the growing number of mainland Chinese women crossing the border to give birth in Hong Kong.

In 1998, the first year after the handover from British to Chinese rule when border crossings became much easier, there were 6,109 births to mainland mothers in Hong Kong hospitals. By 2007, the number had risen to 27,574, according to the Census and Statistics Department.

The surge, driven by mainland woman seeking to qualify their children for Hong Kong residency and evade China's one-child policy, appeared to take everyone by surprise - not least of whom was the Hospital Authority, which in 1999 had looked at the falling birth rate, seen a surplus of midwives and halted training in all but one of the midwife-training schools.

As the birth rate rose, the number of midwives being trained fell. In 2001, the city of 6.9 million people had 5,231 registered midwives, according to the Midwives Council, the official body that oversees training, registration and standards in midwifery in Hong Kong.

By May this year, their number had fallen to 4,722.

The result, Law said, has been an escalating workload with fewer midwives to take it on.

"Midwives are very important," he said. "You need to have a certain ratio of midwives for the labour ward to function safely."

According to Sylvia Fung Yuk-kuen, president of the Midwives Association, the increasing workload has left many of the existing midwives overworked, stressed and feeling burned-out.

"Obstetrics is not like other departments," she said. "There is always an uncertain element to their work situations, and things can change in a few minutes. Every midwife has to stay alert."

In the public sector, the Hospital Authority reacted to the problem by attempting to stem the number of mainland women giving birth in public hospitals.

In February 2007, it introduced a system whereby mainland women wishing to give birth in Hong Kong had to book and pay an advance fee of 5,000 US dollars for a bed in a public hospital - much more that the average cost to local women of around 25 US dollars.

Women more than 28 weeks pregnant who cannot produce a booking certificate now are turned away at the border.

But with the price of giving birth in Hong Kong's public hospitals now so high, Law said, many mainland women have been turning to the private sector, where the cost of giving birth is only 20 to 30 per cent higher.

Fung agreed, saying many mainland mothers prefer the flexibility of going private in Hong Kong. At some hospitals, 70 to 75 per cent of births are now to mainland Chinese women.

The private hospitals have responded by imposing quotas on the number of deliveries they can safely handle each month.

Dr Eric Chan Lu-shek, the Hospital Authority's principal nursing officer, said the authority was doing its best to tackle the shortage of midwives by doubling the number of trainees from 35 in 2007 to 80 a year for the next three years and introducing career incentives to encourage nurses to take up midwifery.

Fung said that although the move would ease immediate pressure, it did not go far enough.

"To cater to the needs of Hong Kong, we need 100 to 150 new midwives a year," she said. "Training is only the way out, and we have to make this profession attractive to the younger generation. We need new blood." (dpa)