Each country has their own birthing rituals and practices that shape their health industry, influencing its very nature as well as bringing forth institutions hitherto unheard of in the other parts of the world. In China, one needn’t look far to chance upon a unique combination of local characteristics; high-end, c-sections and “month centres”.
As with many things in China, it has been the one child policy in combination with the rising middle class that have led to a substantial transformation of the pre and post-natal health care sector.
In terms of where and how to give birth, local standards have risen exponentially. This has led to the existence of what can only be termed luxury gynecologists. With only one shot at producing a healthy heir, families are happy to pay vastly for a high-end delivery experience in hospitals that increasingly resemble five-star hotels.
One such is the HSCYBele hospital close to Mouchou Lake. Taking inspiration from the American approach, one cannot help but feel that one has indeed stepped into the Chinese version of a US medical TV show, with the staff in their pink and purple nurse’s scrubs. The entire hospital has its own eco-system including baby spa and swimming pool, baby photography studio and rooms for pre-natal classes. The luxury chandeliers and gold-bespecked decorative items reveal quite a different approach than the sanitized, impersonal institutions with which one is familiar in Europe. In China, for a cost of between ¥10,000 and ¥35,000 the whole five-star experience is yours, including a 5-day post delivery stay and a nanny to show you the ropes depending on which set deal you order.
Back in America, the same equipment and service would probably be unaffordable, but in a society that values ancestry and familial heritage as much as China, nothing is too expensive when it comes to ensuring a smooth arrival in this world for the long awaited offspring. Gynecological hospitals, much like any other area in the Middle Kingdom, have been bling’d up in the latest fashionable equipment, be that medicinal or interior decoration-wise, for the ultimate birthing experience.
Smooth Operator;The Rise of C-Sections in China
Aside from the where, another aspect of birthing traditions that has been unhinged over the past decades is the how. The delivery process has, much like America, seen a stark tendency towards Cesareans. The trend of having one’s sterilized belly slit open rather than going the old fashioned route has spread through the country like wildfire. The WHO has calculated that China’s Cesarean rate quadrupled in just eight years from approximately 5 percent in 1993/1994 to 20 percent in 2001-2002. Five years later, the figures had shot up to almost 50 percent in 2007-2008, putting the Middle Kingdom in the global lead for the highest percentage of birth by operation, an ominous title that is viewed critically by many international health bodies, first and foremost the WHO. Their recommended threshold for C-sections lies at 15 percent, while an operation is deemed necessary in merely 10 to 15 percent of cases worldwide.
A number of factors play into the popularity of the procedure, particularly the set-up of the obstetric care system and certain cultural factors.
Once again, the impact of the one child policy on today’s birthing landscape should not be underestimated. The same logic that sees the mother checked in to incredibly expensive specialist institutions is a considerable driver behind the trend to cut. The go-to midwife for foreigners in Beijing known as MK explained to UK newspaper The Telegraph in 2013 how the fear that something could go wrong during the birth and the perception among locals that c-sections are the safer option is driving pregnant women to put themselves through the procedure. In addition, NetEase asked in 2010 “Why do so many Chinese mothers want C-sections?” suggesting that the one child generation is too afraid of the pain of vaginal birth, an argument with which some staff at HSCYBele and Beijing midwife MK agree. “Many women born in the 1980s and 90s – the ones under the one-child policy – … are protected and more spoilt, they are not at all into suffering or pain,” explains the medical professional up North.
Then there were those arguments to be found in the NetEase article that can seem a little “out there” to Western minds. For example, a common issue is that the parents-in-law decree, often with help from a professional fortune teller, an auspicious date for the baby’s birth. A c-section is the logical conclusion in order to ensure everything proceeds according to schedule. Auspiciousness of certain dates can even go as far as to cause a “c-section rush hour” as it were. According to local media reports, the number of operations scheduled before the Chinese New Year 2015, which rung in the year of the sheep, was uncharacteristically high due to beliefs associated with this Chinese zodiac. Sheep are seen as meek creatures with a docile character made for following others rather than becoming leaders, on top of which they are also said to suffer bad luck in love. Its predecessor, the year of the horse, on the other hand is considered very auspicious, resulting in parents and grand-parents rushing to hospital to make sure the next generation won’t end up a bleating disappointment.
Reason number one for mums to choose the operating table, however, is more rooted in societal structures than superstition. “Because everyone else does it” seems to be the main consideration for Chinese women according to the NetEase report; in a collectivist society where fitting in with the masses is as important as the polluted air we breathe, the latest hype takes only a few days to spread throughout the entire country, c-sections are just another, albeit rather risky, game of “Keeping up with the Wangs”.
The final reason is altogether more sinister, leading us away from cultural and on to structural issues with China’s obstetric system. The fact that many doctors and nurses alike pressure young women into ignoring nature is a concerning but sadly all too common practice. Due to the high number of overall deliveries in China and low staffing levels in non-private hospitals, c-sections are the more time efficient approach. Reports cite a level of 1.5 nurses per capita, less than a sixth that of the UK. With natural births taking many more hours on average and being unpredictable in terms of duration, doctors prefer to take the operative route. Most importantly, though, the preference for the knife is further solidified by the fact that many physician’s salaries are subject to bonuses based on patient volume as well as certain types of procedures. Not only do c-sections deliver a higher completion rate, in the Chinese medical system they also pay more. It is therefore of financial motivation when medical staff are quick to “guide” their patients down the route of an operation.
That being said, private hospital HSCYBele’s Dr. Wang insists that they favour a natural approach. “We look to steer clear from the operating table whenever possible. We even have a quota prescribed by the government we are not allowed to rise above.” While doctors might push less in non-public institutions, it remains questionable whether paying patients demanding an operation would be refused that request.
The veritable Cesarean epidemic is now at a point of becoming dangerous. With the loosening of the one-child policy, in the near future more women will be going through a second pregnancy. However, c-sections hold well-known risks for any follow-up pregnancy, considerably increasing complications such as potential hemorrhage, and therefore making a natural birth mostly impossible for child number two. After all, the fancy name does much to disguise the fact that this is a serious surgery with severe effects on one’s health. In light of this, experts the world over agree that something must be done to steer the Chinese populace in a more natural direction. How this will be achieved in the face of a system that rewards people for cutting is the real challenge the country will have to face in the near future.
Month Centres – An Innovative Health Service
The local tradition of confinement, or sitting the month, as it translates literally, has given rise to an entirely new health service sector unknown in the West; the “Month Centres”.
The custom of Yuezi has been reported on by many a Western media. The accepted practice for women who have just given birth is to return to their home for a month of rest, during which time family members (mainly the mother, mother-in-law and other female relatives) would help care for the newborn. During this time strict rules are to be followed, especially in terms of diet, but also relating to physical hygiene, where in conservative families women are not permitted to shower for the entire month or even brush their teeth, though this is fairly uncommon in today’s modern age.
Living under the same roof as one’s in-laws is not a simple task to many, even under normal circumstances. Add a newborn baby to the mix plus differing ideas of child rearing between two generations and conflict is almost inevitable, even more so since grandparents at an advanced age are likely not open to new ideas and often find they lack the patience for taking on a newborn full time.
This is without a doubt one of the motivators that led to the invention of the Yuezi Centres. Having come into existence in the mid-1990’s, the luxury confinement centres have been steadily growing in popularity as an alternative to having mum-in-law move in. These institutions, of which a few can also be found in Nanjing, are staffed with a variety of health professionals whose job it is to take care of mother and baby for this critical month after birth. Post-natal care medical staff, nurses, pediatricians, nutrition experts; a host of medical personnel is on-call for fresh mothers 24/7, while they rest-up in their luxury suites.
An argument in support of this latest health trend is over the many rules that need to be obeyed during the period after birth, be they in relation to the mother’s food intake or basic training on how to take care of the little human being one has just produced. Pre-natal classes, though on the rise, are not as integral a part of Chinese culture as they are in the West, Here, once again, the one-child policy rears its head as there are no older siblings who needed care; as a result fresh parents are unprepared for the obligations that come with a newborn.
Yet, the Yuezi centres are facing criticism for their approach of taking the child away from the mother as soon as it screams, which has adverse effects on mother-child bonding. Even at HSCYBele one cannot help but notice how it is the nanny that carries around the few days old newborn in her arms, while the mother strolls leisurely alongside them.
A possible lack of bonding though has done nothing to stymie local’s enthusiasm for the overpriced institutions that in Taiwan charge around ¥3,000 per day. The 21st century Chinese, however, seems to feel more secure with the help of an army of professionally trained people than the household remedies of an older generation.
This article was first published in The Nanjinger Magazine, September 2015 Issue. If you would like to read the whole magazine, please follow this link.
