By Bo Gu, NBC News
BEIJING – China is trying to get its sky-high rate of Caesarean sections under control.
In a country where some 47,370 babies are born every day, 46.2 percent of expectant mothers in China choose to give birth with surgical help. That’s a rate much higher than the Asian average of 27.3 percent, according to a World Health Organization global survey published in the Lancet journal in early 2010.
And the statistics are even higher in China’s capital city. In 2010, 51 percent of the babies born in Beijing were delivered through Caesarean sections, said Mao Yu, vice director of Beijing Municipal Health Bureau, in a recent interview with Beijing News, a widely distributed local newspaper.
To be sure, C-section rates are rising globally. In the U.S., when the C-section rate was first measured in 1965, it was just 4.5 percent. As of 2009, however, the U.S. rate hit an all-time national high of 34 percent, according to a study released in July by Health Grades. In Florida, 38.6 percent of babies were born by C-section, the study found.
The modern C-section was first introduced as a clinical practice designed to save the lives of both mothers and newborns in 1881, after a long history of high fatality rate of mothers. However, doctors and experts today warn that, compared to vaginal delivery, with the C-section procedure comes increased risk of maternal death, infant death, admission into an intensive care unit, blood transfusion, hysterectomy and other potential problems. The WHO recommends an optimal C-section rate of 10 percent to 15 percent.
Chinese authorities are now making efforts to lower the skyrocketing rates, but the question remains: Why are they so high?
Following doctor’s orders
He Yuanhua, an obstetric nurse from Beijing Antai Obstetrics and Gynecology Hospital, attributes the high C-section rate in China mainly to economic incentives – and lack of patience.
“China has a lot of people, so in many hospitals, especially in the small hospitals without too much regulation, doctors and nurses don’t have the patience to wait for hours or even days for the expected mothers to deliver naturally,” she told NBC News. “The cost of C-section is higher than a vaginal birth, so many hospitals encourage the surgery to make more money.”
Hospital bills vary greatly in China’s public and private hospitals, and medical expenses can be very different depending on the patient’s insurance plans. Many hospitals’ survival depends on the cash they collect from patients, so they recommend expensive services and collect as much as they can for them.
Zhuang Ying, a Beijing mother of a 5-year-old daughter, chose a C-section at the prestigious Sino-Japan Friendship Hospital when the obstetrician suggested she did not have enough water and that the baby might suffocate from natural delivery. She spent about $3,000 on her surgery, which did not include the "red envelope" of $150 she gave to her obstetrician and anesthesiologist, a common bribe offered by Chinese patients before a big surgery.
Some Chinese mothers, said He Yuanhua from Antai Hospital, are too afraid of the pain. “Their threshold of pain is greatly lowered when they see the dramatic, long and painful labor process on TV series and movies, so they choose C-section,” she said.
Others – perhaps potential “tiger moms” – choose to bring their children into the world a few days early so they are old enough for the autumn semester when they are six years old, a minimum age for elementary school entrance in China.
Zhao Tianwei, president of Beijing Mary’s Hospital for Women and Infants, when interviewed by the Beijing News last month, said more professional women are having babies at an older age so they are not physically strong enough to endure a vaginal birth. The large sizes of newborns these days, as a result of greater nutrition, is another factor that makes natural delivery difficult.
The Beijing Health Bureau has been promoting vaginal birth in order to lower the world’s No. 1 C-section rate. Stricter supervision will be exerted and hospitals will be punished if they are found to perform unnecessary C-sections, according to Mao Yu.
Li Ruobing, a 33-year-old mother who had a son last year in Beijing Union Medical College Hospital, spent $200 on her choice for a vaginal birth.
She told NBC News many expectant mothers asked for C-sections, but in her hospital the doctors told them to try it naturally unless it’s necessary because of medical complications. “But if my obstetrician suggested I choose C-section, I definitely would have listened to her,” Li added.