Birthing In Modern China: Biographies From Parents and a Midwife

0514_Feature_cover storyYou have just found out that you are pregnant. I’m speaking to you too, men. Congratulations! But wait—you are living in China. Is it feasible, safe, scary (add personal adjective here) to have a baby in China? You start searching and scouring the Internet for all types of advice that is now mostly several years old and outdated from the rapid changes taking place in China, even in the world of maternity care.

Suzzane Ryan, MSN, CNM, CPM takes a moment to pose with a new born.

Suzzane Ryan, MSN, CNM, CPM takes a moment to pose with a new born.

Unpacking your thoughts, the first run goes through the choices. Option one? Go home to familiar surroundings where care and support is bundled in a family-sized package. It sounds good, but worry sets in when it is discovered that your closest partner can’t leave the company position in China and you either go it alone at home or decide to stay in China till the last minute. Maybe you even convince yourself it is possible to hide the pregnancy bump while boarding the plane in the last trimester if the case there is trouble getting a medical certificate.

The second choice may be to go to a neighboring country. Let’s say Hong Kong. If you live on the bordering provinces in mainland China and the traffic isn’t bad, you may make it—if this is your first birth. Second and third time moms can and will deliver within a couple of hours. You could rent an apartment in town close to the hospital, but that may become costly. If your wife is Chinese, it’s best to cross over in a van as the border guards may not allow entry once they see her bump.

Plan three is to stay in China and have this baby. Why of course! Women have been having babies for centuries and location shouldn’t matter. You start doing your research and find where China lies in the maternity/infant morbidity and mortality scores. Your country, let’s say the U.S. is number 34, and China is at 116 for the world. Three times higher and you start to get worried. The reason for this is the lack of good maternity care in the rural settings and unless you find yourself in outer regions of Xinjiang Province this shouldn’t be an issue.

The Things I’ve Seen

As a retired American midwife consulting at Maria Dongguan Hospital, I have seen a variability of hospitals in the area. Public ones can be a bit culturally shocking. Forget privacy, the niceties of soap, towels (paper or cloth) and meals would help.

I went into a delivery suite where five women were in five beds next to each other in active labor and then went next door to see two ladies confined to hard delivery tables in a row with their legs up in stirrups fully exposed in the pushing stages. No pain relief, no support, lying there being told to, “push it out,” with one nurse on top pushing down on the belly and another cutting at the perineum because, how else would the baby get out?

At the Hangzhou Aima Maternity Hospital, Ryan assists new parents after a water birth.

At the Hangzhou Aima Maternity Hospital, Ryan assists new parents after a water birth.

And remember, the baby, once connected in the most literal way to its mother, is taken away without a first embrace because you are not sterile. You are then taken to a ward of eight other women in a room to rest and recover till discharge. Hopefully you have brought a family member who can attend to you and perhaps several of the other poor ladies in the room. Cost factor is approximately RMB 600. Now, that is a bargain.

So we enter the modern age of maternity care in China. Private hospital corporations have sprung up everywhere in China. American-Sino, Parkway and United Family in Beijing, Shanghai and Hangzhou to name a few.

American-Sino in Hangzhou opened last year. I was excited to know one of my favorite Chinese midwives was working there at the time and I got the full tour of all the new equipment, bright clean shiny walls and floors and eight LDRP (labor, delivery, recovery and postpartum) rooms with American standard labor and delivery beds. It also had a small Level 2 neonatal intensive care set up (allowing for intravenous access for low glucose levels or antibiotics and bilirubin phototherapy lights for newborns with severe jaundice).

The appearance was even better than some of the maternity hospitals back at home. But as a midwife who has delivered babies in hospitals, birth centers and client homes, having the latest and greatest isn’t necessary unless you want to impress friends and empty wallets.

Posing with a newborn, one of the maternity nurses coddles a newborn at the Maria Maternity Hospital.

Posing with a newborn, one of the maternity nurses coddles a newborn at the Maria Maternity Hospital.

I personally consulted in five cities through a private Chinese hospital chain called Baijia Maternity Health Care Holdings, as a part of a program designed by vice president Steve Gergely to recruit expat medical providers and midwives to assist. Currently they have fourteen maternity hospitals of different levels of care throughout China, four of them located in Guangdong.

During the months of February and March I was at the Dongguan Maria Maternity Hospital along with three others—Guangzhou Elizabeth, Huizhou Elizabeth and Zengcheng Aima. I find the hospitals to be more affordable with delivery package prices averaging RMB 5,000 to 20,000. The hospitals may not always be shinny bright, but they offer individual rooms and impeccable attention from the staff.

The midwives are open to Lamaze, water births and having the father’s in the room. Breast feeding rates are at 85 percent and they even allow their clients to eat chocolate during labor, whereas in America we only allow ice chips. Two of the hospitals, Guangzhou and Dongguan, also have small Level 2 neonatal intensive care units thus minimal separation of baby and mom.

Variations from the Norm

Speaking of cultural norms, pregnancy and TCM-mixed Western medicine, the Chinese staff may practice a bit differently with their approach, but never in a way that would harm mom or baby. I feel at times they are over cautious. A local expat Angel was interviewed about her first birth in Shenzhen at a public clinic. It was traumatic.

“I’m guessing this is what they do to all the Chinese women, but they didn’t want to give me anesthesia and I needed stitching,” she said. “They strapped me down to the table for 14 hours.” Ironically this occurs in the USA.

The view from inside the Maria Maternity Hospital’s fifth floor VIP rooms.

The view from inside the Maria Maternity Hospital’s fifth floor VIP rooms.

Our women, once getting to the labor room, are also treated like they were in a high risk pregnancy and constant monitoring is done when in fact only 20 percent need this type of care. I have seen the practice of keeping women in bed throughout the labor in China if their water has leaked. There is a fear of cord prolapse, a complication where the umbilical cord precedes the child through the birth canal.

“They thought it was dangerous for me to walk around they didn’t want me to move because I kept getting up and walking so they strapped me down, and then when the baby started to come, they were pushing on my tummy to get the baby to come out faster,” Angel said.

In their mind, they are doing what’s best for the baby. They worry that labor should not last more than six hours in active labor with an even shorter pushing stage. Thus they have a higher cesarean rate. Pushing on the uterus by staff in the U.S. could lead to the loss of license, the practice can cause a stuck shoulder or placenta coming away from the wall, but here it is a norm and a hard habit to break. So weighing the difference of pushing on the belly rather than using forceps or a vacuum to extract the baby (done in America) may be the question of what is worse of the two.

Take the time to shop around and find one that is best for you. Bring a list of questions to ask and get the prices down firm. For many American men, the question of circumcision will be addressed. This isn’t done here, but the staff may refer you to a pediatrician in the area. Don’t take it upon yourself.

Another issue is the lack of RhoGam in China. If you are Type O Negative and your spouse is A Positive, the womb can be exposed to positive antibodies (even after a miscarriage), and with the next pregnancy, if the baby has negative antibodies, he or she could die from the positive antibodies you now have.

0514_Feature_cover story 5Getting RhoGam on ice from your country or Hong Kong will work, but will the staff allow you to receive or inject the medication for you, and do they fully understand the reason for it?

Read as much as you can. I prefer British midwifery/childbirth books. They look at pregnancy as a natural event, whereas American books written by OB’s look at each week of your pregnancy as if a disaster would occur any minute. You already have enough fear of giving birth here in China, don’t make it worse.

Typically you are screened for every lab test available in China (except antibody screens, available at the local blood bank, or GBS cultures in which case they use Iodine preps and not antibiotics), then given multiple ultrasounds—yep that baby is still in there—and routinely asked if you want a cesarean section cause, God forbid you would want to do it naturally.

Ask or go online to find the best vitamins, see if there are childbirth courses, like Lamaze, in the area, or if their midwives are trained in Lamaze, hypnobirthing, water birth. Or, start up your own mom social group, post natal and breast feeding groups. Learning from others who have survived can help with a new colicky baby. Take control of this pregnancy. Best of all, this will be your story to write, and the one to tell your child for birthdays to come. How you gave birth in a different country.

Our Stories

The following are three experiences from three families. These early-life biographies should not be considered typical operation procedure for the hospitals where they took place. Some are complicated; some are magical; all end with a new beginning, because the cliché, no person is the same, starts at birth and it ranks among a family’s most intimate junctures.

“Not pleasant, but livable”

0514_Feature_cover story 2Brett and Kerryn Walker’s experience started at Cong Hua, but they found the obstetrician too “cold and clinical.” Little Noah is their first, and though they recognized that they were not the center of the universe, they were expecting to be guided through the birth with the excitement that they felt the situation deserved. Next was a short stop at Dong Hua, where Brett was told he would not be allowed in the labor ward, so they kept on for their dream birth.

It was then that the difficulties turned from trivial to worrisome. The Walkers decided on Maria. “We were very happy with the doctor … and with the lady that was doing the translating,” said Kerryn. The happy, likable couple settled into the routine, booking a fifth floor VIP room for the birth and the regular check-ups began.

Then three months into the pregnancy their doctor found a small black dot on the latest 4D scan and turned to them, fighting with broken English, to say, “your baby … really … stupid.” The dot marked a mis-formed corpus callosum, a diagnosis which meant baby Noah would suffer serious challenges and a bedside manner that simultaneously infuriated and upset the parents. As doctor’s appointments continued recommendations were stringently repetitive, “abort.”

The Walkers, determined to have and love the child anyway, carried on—then relief. On a trip home to their native South Africa, a specialist told them, while he was impressed that they the doctors found the issue, it did not mean the child would be unhealthy. Back on track, back to the dream. But it was not to be a casual pregnancy.

With three weeks on the countdown, during a visit to Maria so routine that Kerryn decided not to bother Brett with attendance, the staff “tweaked their tune.” Suddenly the baby had supposedly developed serious heart and respiratory issues and the hospital decided that they were not prepared for such a case. They reasoned that it was vital Noah be born in a hospital “that had incubators and had respiratory machines in case he needed them. And so I was transferred that Saturday to People’s Hospital in Wanjiang,” said Kerryn. Now this new hospital found nothing, surprised that they were sent over.

So another surprise for the Walkers, and their extended Dongguan family, before the birthday, where they were slightly shocked by the over booked ward, with mothers sitting on the floor in queue. But Noah came, healthy and happy, and was treated with extreme approval, and all was right in the world of the Walkers.

“I told you so”

0514_Feature_cover story 7Keith Pocock and his wife Lin Zhou met, fell in love and made a family in Dongguan. Things lined up for them and brought about a handsome, mischievous two-year-old named Thomas. On deciding on a hospital, Keith mostly deferred to his wife on account that she would be doing most of the work and she was local with local customs. But having the child locally was not their choice. Thomas had different plans.

Leading up to the birth, Lin had done most of the prenatal discovery alone, because the nature of Keith’s business kept him often on the road. But she seemed to be pretty well taken care of at the Dong Hua Hospital during prenatal check-ups, and the reports were comprehensive enough for Keith to follow along with the process. Everything was normal—a rookie assumption.

“Our original intent actually was to go down to Hong Kong and have the child there,” said Keith. With the delivery date calculated, they would head across the border right on time. But on a different birthday, one belonging to a friend of Keith’s, the father-to-be became familiar with the unexpected. Only 30 minutes into the party at a Dongcheng teppanyaki restaurant, and luckily early in the rounds of sake, Keith received the call. “Honey, I think I’m having the baby,” said Lin. “Oh, shit!’” said Keith.

Arriving home Keith found his wife doing breathing exercises, and that she thought it was a false alarm. He didn’t agree, but he couldn’t convince Lin to let him find a taxi. As the labor contractions increased in frequency, the inevitable became obvious and down to the street they went to wait, pregnant waddle and all. At their back-up hospital they were checked into a private VIP room. Upon proper dilation, Lin was wheeled into the delivery room for a natural birth without the epidural pain control, which turned out to be a second I-told-you-so moment for Keith, but he could not relish the rare moment, stuck outside listening to the screams of his wife’s labor.

Luckily for Lin Thomas took only about 4 hours to make his way to the world. And the new family was moved up to their “hotel room” to recover.

“That’s when panic set in”

0514_Feature_cover story 8“For me, it was wherever she is most comfortable,” said a dad, who, concerned that he would have to speak harshly about a low moment, shared the story requesting anonymity. Being American, Dad had heard a lot of family and friends pushing him to take his Chinese wife to the U.S. or Hong Kong to have their children, but, not surprisingly, Mom felt more comfortable staying in Dongguan with her support network.

With their son, born seven years ago, Mom chose the Tong Hua Hospital for their first child, and though the pregnancy was pleasantly uneventful, Dad was quite nervous. It was inexperience with “Chinese hospitals and childbirth to boot.” Fortunately the worry and stress was unnecessary. The birth was a routine cesarean section, bringing the boy to the world at the lucky 8 o’clock with the assistance of a nurse, who as a friend of the family gave them the inside help needed to make it happen.

The second round started out stress free for both parents. Upon the recommendation of a local friend that had a great experience at Maria Maternity Hospital, the couple decided it was good enough for them as well, and this time the check-ups, Dad thought, were performed in a much cleaner and safer environment than before, when they had gone to a small clinic in Gaobu Town for prenatal care.

“You walked in and it had a KTV feel, there were pretty girls in dresses welcoming you at the door. The rooms are kind of cute like some kind of one night hotel vibe,” said Dad. The positive experience lasted through till the big day. Then things went wrong, very wrong. Stuck outside the delivery room with Mom’s sister, panic was sneaking in after a forty minute wait, much longer than their first experience. And when a nurse came out speaking to the sister in a panicked tone, Dad couldn’t help but follow suit.

They pulled him in where “it was like a scene out of Dexter, man.” Doctors were screaming, blood was pooling and surgical rags were running out. But these were not big problems. Rushed through the scrubbing process, pulled past the hectic, intense eyes of the surgeons, past the screen that protected Mom’s view to the epidurally induced calmness of his wife. “How is the baby?” she said. “Fine,” he answered. “Sign those papers,” she responded.

Complications during the procedure, left Mom bleeding, and the hospital had run out of her blood type. In the end Mom survived, baby sister was healthy, and Maria was able to provide a European physical therapist to assist her in recovery. “Every once in a while she has pain. She probably wouldn’t say great things, but at this point we’re just happy that everybody is healthy,” said Dad.

Superstition or Good Advice?

0514_Feature_cover story 9Local customs surrounding pregnancy have a ring that sound like “Old Wives Tales,” but as with all myths, there is likely a little truth hidden in the traditions.

Sealed lips– During the first three months, the pregnancy must be kept secret. If not, the belief says the child could have a short temper, or worse it could cause a miscarriage.

Dangerous hobby– Needlework and the use of scissors while on a bed is prohibited. This will give the child an unattractive face, or cause a cleft lip.
Walled up- Watching anyone paint or patch a wall is a no, no. It could lead to the child being born with a birthmark.

Stay square– Attending an event that marks either a sad happening, e.g. death or illness, or a happy affair could also cause a miscarriage. If it can’t be avoided, wear ginger around the neck for protection.

Gender rolls– if the family is hoping for a male heir, feed mama fish or acidic foods; for a little girl, keep it sweet.
Sturdy bed- Moving a bed at home is considered bad luck. During the couple’s wedding, a ritual is performed by finding a placement for the bed, symbolizing the settled life.

Do you dig?– Ditches and mopping floors is not an undertaking for the lady with child. The symbolism seems to depict the same action in the mother’s womb.