More women in China are choosing Caesarean section over natural birth. Liu Zhihua finds out the reasons as well as the pros and cons.

Wu Liujia, a publicity staff member with Xin-qiao Hospital in Chongqing, has recently been busy rejecting pleas from friends and relatives. They requested to have Caesarean section before Sept 1, so that their children will be able to go to school one year earlier. "I tried my best to persuade them to drop the idea," Wu says. "C-section is not as good as natural birth, both for babies and mothers." Wu has personal experience. She had C-section in 2010, and regretted it. "When my baby was born, it seemed to be very immature. I also took a longer time to recover from labor (compared to those who chose natural birth)," Wu says.

But not everyone feels the same as Wu about C-sections.

About 47 percent of all births in China are through C-section, representing the highest rate for the procedure worldwide, although the recommended rate is less than 15 percent, according to a World Health Organization report in 2010.

"Chinese people's mindset of giving birth has changed profoundly," says Zhai Guirong, a senior obstetrician with Beijing Obstetrics and Gynecology Hospital.

"In the past, women and babies were expected to go through the natural course, but not now."

In the 1970s when she started working, C-section would only be adopted when necessary, and such an operation must obtain approval from the obstetrics department director, Zhai recalls.

According to Zhai, only about 10 percent of children were born through C-section at that time.

In the 1980s, the rate increased to about 15 percent, and has been increasing very quickly year on year ever since, according to Zhao Yangyu, director of the obstetrics department of Peking University Third Hospital. In some provinces, the rate has climbed as high as 70 to 80 percent, Zhao adds.

And the reasons are varied, ranging from improvement in medical technology, to the change in society's attitude toward C-section.

Wu Liujia, the Chongqing resident, chose C-section in 2010 for a number of reasons, although doctors strongly recommended natural birth.

Ultrasound examination suggested her baby was about 3.7 kg, and Wu was afraid the baby was too big to be delivered naturally. She was fearful of the pain and concerned that her vagina would be enlarged, which would affect her sex life.

Such fear and concern is common among China's new mothers.

Zhang Yiwen, 28, a Beijing resident who is in her third trimester of pregnancy, says she only wants C-section.

"My baby is big. But even if it is not big, I will not go through natural delivery," Zhang says. "I can't even stand the pain of finger pricks during blood tests, not to mention the pain of natural birth."

Zhao Yangyu, the obstetrician, observes that women born in the 1980s and 1990s led better lives compared to their parents, and they have low threshold of pain and suffering, which is the main reason they don't want natural delivery.

Besides, the family planning policy the country has adopted since the late 1970s also indirectly contributes to the increasing demand for C-section. Many women do not intend to have a second baby, thus they are less worried that their uterus would be harmed by C-section.

There are also many who decide to have C-section so they can bring their children into the world on a specific day or time considered auspicious or special.

Zheng Yaya, 28, mother to a 100-day-old boy in Baoji, Shaanxi province, says most young mothers she knows had C-section, and many chose specific dates for the operation.

One of them picked her husband's birthday to have the surgery.

Families with older people give greater importance to choosing an auspicious day or time for their babies to see the world, while young couples may want to give birth before Sept 1, so that the children can go to school a year earlier, according to Yang Ying, director of the obstetrics and gynecology department of Xinqiao Hospital in Chongqing.

"Many people may not be well informed of the risk of C-section, and irresponsible hospitals and doctors take advantage of this," Yang says. "After all, C-section is more profitable than natural birth."

Yang says 46 percent of births in his hospital are through C-section, while the proportion for the city is 50 to 60 percent.

Addressing the concerns by some mothers-to-be that natural birth may damage the vagina, Yang says: "With proper guidance from professionals, natural birth has limited effect on vagina architecture, especially for women having only one or two births."

Zhao Yangyu, the obstetrician with Peking University Third Hospital, agrees, but says there are more factors behind the dynamics for C-section.

An obstetrician may opt for C-section if the would-be mothers insist, just to avoid trouble, especially when there is a chance of risk for natural birth, Zhao explains.

Besides, many Chinese hospitals lack experienced midwives and cannot perform difficult natural delivery, since many experienced midwives have left their profession because of poor wages and high career risk, Zhao adds.

"A doctor should make decision on behalf of patients' interests, but a doctor is also a human being, and has weaknesses and fears," Zhao says. "If the would-be mothers cannot be convinced of the benefits of natural birth, we cannot force them."

Wu Liujia, the hospital staff member in Chongqing, agrees.

"Given another chance, I will definitely choose natural birth," she adds.

Contact the writer at liuzhihua@chinadaily.com.cn.

(China Daily USA 09/04/2013 page9)