Giving Birth in Chengdu: Selecting a Hospital
Note: This post is the second in a multi-post series chronicling the experience of an American giving birth in Chengdu. To read the first part, click here.
A typical Chinese public hospital is run by a bureaucracy as stifling as any other public hospital around the world.
The tests and procedures are roughly the same as anywhere else, but with a one major difference: population.
In China, everything is influenced by the number 1.3 billion, nothing more so than the very personal process of giving birth to a child. On a day-to-day basis, this makes for long waits and occasional squirming matches between hefty-bellied women, as everyone tries to get to the doctor (and back out) as quickly as possible.
On a more abstract level, China’s vast population has led to a society of 三口之家 (three person families) due to a One Child Policy that is still enforced to this day. There are two particular aspects of the One Child Policy that I will discuss below, the Permission to give Birth 准生证 (zhun sheng zheng) and the 禁止透露胎儿性别的法规 (laws covering determining a baby’s gender).
The Daily Grind
The first thing you do in any hospital is get a number 挂号 (gua hao) at the 挂号处 (gua hao chu) before you can actually see the doctor. When you finally do sit down with a doctor, there are usually 5-25 people darting in and out of a crowd gathered around that doctor’s door, trying to fulfill the appointment they made hours, or perhaps even days ago. The “gua hao chu” is one of the more crowded places in the hospital and one of the things that can help you distinguish a “good” hospital from an “average” or “poor” hospital is the level of order surrounding this area. At the gua hao chu, you tell the ladies behind the window what your business is. You then pay the fee for the “hao,” which is your basic fee for seeing that particular type of doctor, and the lady will give you a slip of paper with the service you are looking for, the doctor you are to see, and the location of that doctor’s office.
For pregnant women, there is a file, called a 档案 (dang’an) with all of your previous check-ups, appointments, and doctors’ comments. After you receive your number, go to the 档案室 (dang’an shi) and pick up your dang’an and take both of these to the doctor’s office.
At the No. 9 hospital, there are usually 15-20 women waiting to see the doctor at any given time. The doctor herself will be in a small room with her assistant, slowly and methodically going through everyone she has to see in that day. The women tend to flow in and out of the office with slips of paper, random questions, and answers to questions the doctor may have posed earlier. Most women are accompanied by either their husband or their mother and the mothers tend to hover in the background worriedly asking for more information, while the husbands usually stand around and hold stuff.
An expectant mother will receive her dang’an in the third month and will make regular monthly trips to the doctor until the eighth month. A woman will receive a battery of tests and check-ups in the third month, including TORCH tests, STD tests (primarily for HIV), liver function (e.g. for hepatitis B), Type-B ultrasound and a standard gynecological test. The results will be logged in the dang’an (or 建卡 jian ka) as will all other test results from here on out. These tests are usually performed around the 12th week and are accompanied by an all-around check up to see if the mother has any vitamin or mineral deficiencies.
The test to see if your baby might have Downs Syndrome is performed four weeks later. The classic method for determining Downs Syndrome is with a blood test, but if this blood test is taken in the 16th week, the results can only come back around the 20th week (aprox. 5 months) and this is a bit late for some people. There is, however, another test that is performed here in Chengdu, but only at HuaXi Hospital, which uses an ultrasound to inspect liquid that collects in the back of a child’s neck between the 11th and 14th weeks (3-4th month). This test, called an NT test, is much more accurate than a blood test and the results can be viewed immediately. Xiao Bai was lucky to bump into a woman on Chengdu MamaNet who knew that HuaXi hospital has just began performing this test in the summer of 2009, so she went there to get this test done. Getting tests done at other hospitals can be risky in China — many larger, more sophisticated hospitals such as HuaXi might not recognize a test performed by a smaller hospital — but any result from a test done in HuaXi is considered beyond reproach by local doctors.
After these tests, there are only monthly check-ups until the 22nd-26th weeks (aprox. 6 months), when the doctor will take an ultrasound to look at the baby’s hands and feet, primary organs, brain, bone structure, and overall physical development to see if there are any problems or issues. It is also right around now (18th week on) that the mother can feel the baby moving and kicking around inside her womb. This is a good feeling for most moms-to-be, because up until now there is no real confirmation that there is a living, moving human inside. Many women will choose to take a picture of their baby at this time. There are only three hospitals in Chengdu that allow women to take pictures of the baby in the womb home with them: Angel Hospital, Municipal Maternal and Childcare Hospital (市妇幼保健院), and Jinjiang District Maternal and Child Care hospital (锦江区妇幼保健院).
Angel Hospital charges 380 yuan for the test and another 80 yuan for a CD of the baby’s pictures, but Xiao Bai was able to get the CD for free as a member of Chengdu Mamanet. Angel’s pictures are actual slides from video footage that is played on a TV screen on the wall — the whole family can come in and watch the video. The Municipal hospital charges 469 yuan for the test and an additional 30 yuan for the 2 pictures, but the pictures are paper-only. Jinjiang Maternal charges less for the test and their pictures are also paper-only.
Permission to Give Birth
The 准生证 (zhun sheng zheng) is absolutely vital for the vast majority of Chinese families. Without the Zhun Sheng Zheng (henceforth ZSZ), a child has no 户口 (hukou), without a hukou, a child is basically a non-person in China and cannot go to school, get a job or otherwise engage in the everyday social system. A hukou-less person also faces fines of up to 200,000 yuan or imprisonment, according to the law. The reasoning behind the ZSZ is to regulate and record every birth in China in order to efficiently and accurately enforce the One Child Policy.
In order to receive a ZSZ, one has to be married and otherwise childless (man and woman both). One has to provide a marriage certificate to prove the former, but the latter can be quite tricky. There are a few ways to confirm that one is “otherwise childless,”
1) a stamp from the authorities in one’s hukou (户口所在社区)
2) a stamp from your work unit (company, job, etc) danwei (单位)
3) a look at your dang’an (档案) — every person in China has a dang’an, that follows them throughout their lives, where they went to school, their grades, address, college, work unit etc. This dang’an can also be used as confirmation that one does not have any official children. Dang’an are usually kept at your danwei, or at your hukou or at the Personnel Exchange Center (人才交流中心). If you do not have a danwei, do not have it at your hukou or at your school, the dang’an is kept at the Personnel Exchange Center.
Once one has confirmed both marital status and childlessness, then these two forms are taken to one of the above three locations (danwei, your personal hukou office, Personnel Exchange Center) and then the authorities at one of these locations will tell you where to take a class on “being pregnant.” Everyone must go to this class, which lasts roughly three hours — for most of those three hours one is subjected to a barrage of advertisements selling baby clothes, milk powder, vitamins and assorted other needful things for expectant parents. After this class, one receives a small card that one then takes to one of the above three locations. In about 10 days one goes back to one of the three locations and picks up the ZSZ.
In terms of difficulty, the danwei is the easiest place to get the ZSZ, followed by the Personnel Center and one’s own hukou office (the place where one was born) is invariably the most difficult.
In a danwei, you go to the HR department and tell them you are having a baby, hand them your marriage certificate and go back to work. In about 2 weeks you’ll have your ZSZ. If you go directly to the Personnel Center and bring all of the documents you need (marriage certificate, each person’s hukou* and 4-8 pictures) in about 10 days you’ll have your ZSZ.
If you have to go to the hukou office, then you are dealing with the very bottom rung of an enormous bureaucracy and I wish you the best of luck.
To give you an idea of how serious this can get, in Guangdong there is a documented case of a woman being forced to have an abortion at 8 months because she did not have the ZSZ. This is without question an extreme case, but horror stories like this are tragically more common than we can imagine.
* as an American, I went to the Consulate and got a certificate stating that I am unmarried and childless (5 minutes) and took this to the Bureau of Civil Affairs 民政局 where I was married (15 minutes) and then we went to the Personnel Center and received our ZSZ (10 days). For children born to a foreigner, there is no need to get a ZSZ, but there are economic benefits if you do. With a ZSZ, it is quite possible that my wife’s insurance will pay for the entire birth and we might even make a little money in the process: the birth costs roughly 3-5,000 yuan and the insurance pays 6,000-7,000 yuan, depending on the type of insurance.
Is it a Boy or a Girl?
According to the laws covering determining a baby’s gender (禁止透露胎儿性别的法规), it is illegal for a doctor to tell a patient the gender of her child.
Doctors will not tell you, even if they know, but they may hint at it. When Xiao Bai asked, the doctor said, “it might be a boy.” Which could be construed as “yes, maybe, or you shouldn’t be asking.” This is far as they go, as the penalties can be anything from a suspension of license to jail time on top of substantial fines.
Nowadays, hospitals like Angel are telling their patients the gender of the baby, because they are not dealing with farmers who might abort their daughters in favor of a son who can carry on the family line and maintain ownership of the family property. That reality is virtually gone today and is being replaced with a more urbanized, more educated and wealthier populace. This “middle class” will not abort a child based on gender alone and has the money to bribe a doctor and/or pay any fines that may be levied for having more than one child or for knowing the gender before birth. The people who go to Angel expect that, due to their status, they might be treated differently and anecdotal evidence supports those expectations.
Although still rare, there are families with more than one child and the fines for this additional child differ based on circumstances. A well-connected, rich family in a large city will pay a nominal fine. A less well-connected family of modest means in a smaller town will pay a larger fine.
The One Child Policy and the many law that radiate out from this policy are still in effect, but these days it is the economy that keeps people from having more than one child: the cost of raising a child today in China (school, medicine, clothes, food, time, energy) is so much for modern parents that they often have the grandparents or a maid in the house at all times to help take care of the child.
Which brings us to the end of Part 2 and the beginnings of Part 3, which will discuss some of the unique family aspects of giving birth in Chengdu and some of the more interesting traditions and superstitions. Such as how to tell the gender of a child through the shape of a tummy!
What do you think?