Giving Birth in Chengdu: The Cesarean Conspiracy

Note: This post is the third in a series chronicling the adventures of an American having a child in China. You can read the first part of the series here and the second here.

A Cesarean – or c-section – is a surgical procedure in which the obstetrician makes an incision along the abdomen and the uterus of the pregnant woman and pulls the baby out.

The c-section was traditionally used only when the life of the mother or the child (or both) was in danger during a natural birth. There are records of c-sections being performed in ancient Greece, roughly 2,500 years ago. The practice was commonly known in ancient Rome and there is evidence that c-sections were being performed all over the world by people as diverse as the ancient Persians, Ugandan shamans and Navajo midwives. The first recorded c-section in the West after which the woman survived was not until 1800.

Until modern times, a c-section cast a pall over the birthing room and sent the old women a’wailing: Death was nigh.

But now, according to the World Health Organization, c-sections are more and more common across the world. In developed nations, almost 1/3 of babies are born via c-section and the rate is as high as 80% in some parts of Italy. The WHO report specifically targets the rise in c-sections across China, where the rate has risen from less than 5% to more than 20% nationally in the last thirty years. In some parts of China, the rate is as high as 63% and rising. The WHO recommends that a nation keep its rate of c-section births below 15%, due to a variety of reasons, the major one being the health of the woman and the child. In the report, the WHO concludes that a rise in c-sections equals a corresponding rise in health care costs, which is another major reason for keeping the rate low.

Nobody really knows why more and more women across the globe are opting out of natural births, but many people have a theory. Studies have shown that there is a correlation between social status and c-section births, with more affluent women choosing to go through with the procedure than less affluent women, but there are studies that also indicate that class has nothing to do with it. Some researchers link c-sections with the daily grind, suggesting that doctors, mothers and fathers would rather get the whole thing over with quickly, so they can get back to work.

In China, women believe that doctors will suggest a c-section because it is good business for the hospitals. One doctor can handle many such procedures in one day, whereas a natural birth can take as long as 24 hours. C-sections cost more: a typical hospital will charge around 5,000 yuan for a c-section versus around 3,000 for a natural birth, so rumors abound that doctors will recommend surgery for this reason alone.

According to a survey of 46 mothers and expectant mothers on Chengdumama.cn, safety was the number one reason. Many women believe that they will run the risk of fewer complications with a standard surgical procedure than with a natural birth. However, according to the vast majority of medical opinion, a c-section is much more dangerous, with the death rate approximately 3x higher. Chinese women are aware of this, but they still believe that a c-section is safer, because a natural birth can lead to unanticipated complications that the doctor might not be able to handle. Basically, lack of faith in the hospitals and the doctors leads women in Chengdu (and perhaps other parts of China and the world) to choose the “known path” of surgery over the “unknown path” of vaginal birth.

“I paid the money for a good doctor,” said one respondent to the survey. “I believe that doctor can carry out a c-section without any problems. If I decided on a vaginal birth, I am not sure which doctor would be there and what kind of situation I would be in.”

The second reason was the “appropriate” one: the woman had physical complications that required a c-section. Reasons included a breech (when the baby is feet first), placenta previa (when the placenta is so low it covers the cervix) and other problems, such as a twisted umbilical cord.

The third most common reason had to do with the influence a natural birth has on the woman’s body itself. Woman are worried that they will have distended vaginas, sagging breasts and a life-long roll of “mama fat” — any of which might make them undesirable to their partners. In China, it is common practice during natural births to also make an incision to allow for a quicker birth. This incision often leaves an unsightly scar and is a source of fear and trepdiation for most women.

“If I am going to have a scar no matter what,” said one woman. “I would rather have it on my belly than anywhere else.”

Also, women believe that they “cannot give birth,” because Chinese women are naturally more frail and less able to cope with the trauma and pain of childbirth than Western women. Not only do the statistics reject this notion (Western women are also having more and more c-sections), but common sense tells us that Chinese women in the 1930s and 40s, could not have been much bigger than women today and in fact were probably less well-fed than your average modern Chengdunese mama.

Other reasons included choosing an auspicious day for the child’s birth, the fact that c-section mamas have their own recovery room in the hospital and work. It is not uncommon for Chinese women to visit a fortune-teller and plan their birth around their prediction of what will be best for the child. In China, August 31 and the week before a holiday are big days for c-sections. Any child born after September 1 is technically one year behind in school and women fear that doctors will be unavailable during the holidays.

Organizations like the WHO and national health departments are taking notice of the climb in c-section and are trying to figure out why this is happening and how to control it. On January 20th, the Sichuan Provincial Health Department released new laws governing c-sections, as reported in the Chengdu Economic Daily. From now on, if a woman wants to have the surgery performed, she has to receive permission from not only her doctor, but also the doctor’s immediate superior:

“60% of the births in Chengdu’s hosptials are performed via c-section,” said Liang Hong, vice-president of Chengdu Maternal and Child Hospital’s Obstetrics Division. “This is not because hospitals just want to make money and are performing surgeries no matter what the condition is. Many expectant mothers are afraid of the pain, they also fear that they are unable to give birth, that c-sections are better for the child and are more convenient. Actually, hospitals have clear conditions under which they will perform a c-section that involve, for example, the baby’s size, the baby’s position, the mother’s hip size etc. Many mothers are fully capable of giving birth naturally — and doctors will advise them to give birth naturally — but they still demand a c-section. In reality, both c-sections and vaginal births carry risks, so a doctor cannot demand a patient go through one or the other.”

In Guangdong Province, c-sections are also on the rise and the government has moved to protect itself from malpractice lawsuits and the rising costs by issuing a new law stating that insurance companies are less liable (and therefore pay out less) if a woman chooses to have a c-section, even though her doctor believes she is capable of giving birth naturally.

On Xiao Bai’s last trip to the doctor, she mentioned that she was determined to give birth naturally and that, unless there are clear complications or problems, she had no intention of giving birth through c-section. The doctor took a look at her recent test results and smiled.

“Well, you are in great shape — perfect shape for a mama,” the doctor said. “We are happy to hear that you want to give birth naturally and we will do everything here to support you in that decision.”

What do you think?

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About Sascha

Sascha Matuszak is a writer and commentator on domestic and international culture and politics. After living in Chengdu on and off for twelve years, he now lives in Minneapolis.

15 Responses to “Giving Birth in Chengdu: The Cesarean Conspiracy”

  1. old generation like our mothers got natural birth, now young mothers more and more just want to do c-section

  2. Great post Sascha. My wife and I are only a handful of months away from the birth of our first child, and the whole prevalence of c-sections has us a bit concerned as well.

    This whole series has been great. Thanks so much for sharing it.

    • I really appreciate that ryan, we’re due any day now and its a trip. you can see her belly on my blog … huge. We’ll have superstitions, birth and 坐月子 i am not sure if your wife is chinese, but if she is, then i am sure you know about the Month of Convalescence.

  3. Charlie

    Sascha is at the hospital right now with his wife, giving birth to their first child-

    Congratulations!

  4. Great post! I found you guys through ProBlogger. Amazing. Great series. My wife and I had our baby in Shanghai also with C section. It was a little disconcerting for me, but she’s a Shanghainese so it wasn’t so bad because she had nothing to compare it with.

    Perhaps C sections are big in China because of the uncertainty of VBACs… my friend who is a doctor taught me that term. Vaginal Birth after Csections. He said in the states it’s too expensive because of liability. My wife and I want a second baby but are a bit nervous about that since we’re not sure about natural or c section again. Our site has our whole experience too about our birth… plus some comics to boot!

    • Hi Magnus,

      the video of you and your son is hilarious! yeah man we are about to leave the hospital tomorrow.

      how was your wife after the birth? any issues? all good? i saw a lot of women post-cesarian and they looked like they were in a lot of pain …

      thanks for stopping by and check out the latest baby post, A New life on the front page

      — Sascha

  5. So did you get into pitocin at all. The use of Pitocin in the western world to augment natural births is by far the leading reason for rising C sections. Pitocin, commonly prescribed as a vaginal birth accelerator forces contractions to be stronger and more frequent. Reserach has shown that the oxygen level in the unborn fetuses brain drops sharply during the onset of a pitocin induced contraction. Pitocin also has the side effect of causing extreme pain, which then leads to the epidural. A spinal tap anesthesia requiring a catheder (long needle) be ‘placed’ into the woman spinal cord. The epidural slows down the heart rate and lessens the womans ability to push through the contractions. The lessened intensity of the contraction prompts the western doctor to increase the ml of the second pitocin injection, which of course begins the same process. The process has 2 cycles, after the second cycle of epidurals the majority of doctors will sechedule a c section, usually (statistically) around 4pm or around 10pm.
    So was your birth a natural birth, did you find out what drugs where given to your child? Is the for mentioned pitocin cycle as common in China as it is in the US. Where C sections have risen to just over 1 in three births.

  6. Great article. Good to know your wife was so determined to give birth “the usual way”!

    In my country (Spain) some private hospitals have a c-section rate of nearly 50%. I find these statistics scary. All of a sudden, women in the 21st century feel (or are made to feel) unable to bring babies to this world without having someone opening them up. And of course, breasts do not work any longer in the 21st century, we need someone to stuff our kids with artificial milk or else they’ll die! (I’m being ironic, of course).

    In the same way, episiotomies are widely pratised in both public and private hospitals in vaginal births in many countries (in Spain the rate is almost 90%, ouch!). Do you know the rate in China?

    I want to point out that a vaginal birth does not equal a natural birth. As Anon mentioned in the previous comment, whenever pitocin is involved, the chance of ending with an instrumentalised vaginal birth or with a c-section is much higher.

    I was lucky enough to give birth so fast that they had no chance to do anything to us (mother and baby)… If our next child is born in China I’ll have to be very carefull to choose the right place and persons. Thanks for the posts.

  7. looks like the “conspiracy” is getting headlines in the US as well …

    http://www.nytimes.com/2010/03/24/health/24birth.html?hp

  8. This is such a huge issue in America as well (33%) rate. From my experience & those of all my friends in my due date community (my son is 4 months old), the most common causes for csections here are: “Too posh to push” (it’ll hurt too much/ i’ll be too loose/i want to schedule it), doctor pressure (Almost everyone I have talked to had their doctor offer a csection after they’ve been laboring a few hours- theory is it’s for profit, ease & mostly litigation- ARGH), doctor pressure/lack of information about inductions, which raise the c-section risk significantly, Lack of ability to have a VBAC & breech babies.

    There is the International Cesarian Awareness Network (ICAN) that has formed as support for women who are pressured into /not informed about the risks & complications of csections & they are very emotionally distraught about their experiences, and they & their children had problems from them. I really hope this is a fad that dies out before the next decade. It does much more harm than good!

  9. But thte asian caesarean study showed that caesreans ARE safer for the mother and baby so women in China are right. The whole study was a fiasco. They wanted to prove that C’s was more risky but the results showed the opposite.

    They kept the conclusion the same and hoped on-one would notice! Nigel Hawkes who is one of the UK’s leading medical correpondents wrote about it on his blog. (Google Funny statistics from WHO Nigel Hawkes)

    • I read that article. There were multiple studies that found 1) deaths (both mother and child) during birth decreased and 2) cesarians are on the rise.

      had the inverse been true, people would have blamed cesarian births; but as it stands no one credited cesarian births with the decrease in mortality.

      It would be hard to make a direct correlation, as advancements in modern science, living standards, infrastructure etc all play a role in keeping a mother and child a live. A well paved road from a village to a hospital helps; proper schooling for a country doctor helps; access to clean water etc …

      I had no idea that people would actually ADVOCATE for cesarian births. As I read on, i found that the major arguments in favor of cesarian births are

      1) Convenience
      2) serious complications

      I lmao at 1) and pity the women who choose to get cut open cuz its “easier” and for 2) there is obviously no discussion: cesarian surgery was invented for that very reason.

      It seems that the articles I read in favor of c-sections were arguing that its a matter of choice, not dangerous and therefore should be encouraged.

      I don’t feel that c-sections are anymore or less dangerous than a natural birth — but “natural” is the operative word here. Cesarian is a shock to the mothers system and affects breastmilk production ( a study “correlating” c-sections with infant formula might be interesting); it is a shock to the baby’s system because

      it is unnatural to be cut out of the womb. Being cut out of the womb means that the mother and or baby are either in danger or ‘special” in some way. Womens’ bodies are built to give birth naturally, not to be sliced open and stitched up.

  10. Sascha addressed the important points here but it’s poor medicine to surgically intervene inside the body of a healthy person when giving birth or otherwise. The body has complex mechanisms to cope with the natural trauma of childbirth.

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