China has the highest rate of caesarean births in the world: time to act

by Michael Woodhead
Almost half of Chinese women give birth by caesarean section, a rate that is three times higher than the 15% recommended by WHO, according to two Chinese clinicians writing in The Lancet this week.
Dr Mi Jie and Dr Liu Fangchao of the Capital Institute for Paediatrics in Beijing say China has an urgent need to reduce the number of caesarean births because they have a high risk of related complications or death, and because babies delivered by caesarean section are more likely to have respiratory problems, obesity, and other metabolic diseases.
The doctors list five non-medical reasons why China has a 42% rate of caesareans:

1. Women fear pain and loss of vaginal tone after natural birth. They see caesareans as safer faster and less painful.
2. Women wrongly believe that they will regain their pre-pregnany figure better after caesarean birth.
3. Chinese women like to choose a 'lucky' date to have their baby by caesarean.
4. Doctors prefer to schedule the caesarean for convenience and to avoid medicolegal disputes with vaginal birth
5. Caesareans are more profitable for hospitals (12000 yuan vs 6000 yuan for natural birth).
The authors of the letter to the lancet call on the government to take control the rate of caesarean section in China,
"The Chinese government should develop specific policies and measures, such as use of rate of caesarean section without medical necessities as one of the hospital’s overall rating components, and popularising of natural childbirth," they write.
Hospitals and communities should promote health education in women of reproductive age to provide a more accurate idea of delivery," they conclude.

Pregnancy screening program set up in western and inland provinces

A program to help pregnant women get better healthcare and prevent birth defects has been launched.
The program plans to establish 22 training centers in 11 central and western provinces to improve ultrasound diagnosis, especially by doctors in far-flung areas.
Initiated by the China Medical Foundation and Samsung Electronics, the program was launched in Guiyang, capital of Guizhou province, in early November.
Pregnant women in these areas will have better facilities and diagnosis, said He Pijie, director general of the China Medical Foundation.
Statistics from China's Birth Defects Prevention Report in 2012 shows that nearly 150 out of every 10,000 infants had congenital defects in China. The report also indicates that birth defects not only cause disability but also become a leading cause of death among Chinese infants.
"Especially in China's central and west regions, the lack of fundamental equipment and doctors with proper experience are causing even higher death rates for infants," He explained.
Source: Peoples Daily

Canadian doctor promotes pain-free childbirth program in China

A 10-year initiative called the “No Pain Labor N’ Delivery China Mission.” has been founded by Ling Qun Hu, M.D., a Chinese-Canadian anesthesiologist from Northwestern University Feinberg School of Medicine, Chicago. Dr. Hu’s goal is to establish more than 10 training centers in China to teach safe and effective labor analgesia practices, particularly epidural analgesia, over a 10-year period.
The vast majority of women in China do not have the option of pain relief during labor. The country also has the highest overall Cesarean delivery rate in the world and the highest rate by maternal request (no medical indication). Although Chinese women express concern about the safety of vaginal delivery and the pain associated with it, Cesarean delivery (in both first and third-world countries) is associated with higher rates of maternal death and severe complications.
“It has been a dream for Chinese women to give birth without pain and without compromising safety,” said Dr. Hu. “Common questions on Chinese childbirth websites include Where can I get labor pain relief? Which pain relief method is the best? and Is pain relief medication safe for my baby?”
Using the No Pain Labor system, the Shijiazhuan Gynecology and Obstetrics Hospital near Beijing initiated a labor epidural service and experienced dramatic results in the first six months. Before the study, none of the women took pain relief medication, and around 50 percent had Cesarean delivery. After six months, epidural analgesia was chosen by more than half of the women, even though 100 percent of the cost was assumed by the patient. Also, the monthly birth rate in the hospital went from 747 to 1,046, despite the fact that women in the community have a choice of several hospitals and two-thirds of area births take place in other facilities.

Read more: American Society of Anesthesiologists