Pain-free natural childbirth promoted in China

Pain-free natural childbirth promoted in China [Photo: VCG]

What does giving birth feel like in China? Chinese people usually compare the experience of labor to fighting their way through the doors of hell. Just to give you some food for thought.

Women in China usually suffered for hours, even for a couple of days, in labor, with little pain relief being offered, although pain-free labor has long been widely used in other countries. Why is that?

A pilot programme to make epidurals - a localized anesthetic more widely available across China has been launched by the health authorities at the end of 2018. How much applause for the idea has been won? How is it going? What challenges it still faces before being widely implemented? Is it going to save the lying-in women back from the door of the hell？

Just how painful is it to give birth naturally, without any pain relief? We all have different pain tolerances, but most mums agree it’s pretty bad.

“It feels like all the words and sounds are up in the air, you wanna yell, shout, scream and cry, but the only thing you can do is to grab the bedrail so hard and your fingers crack.”

“It hurts so badly, and there’s no way to ease the pain. Even grabbing a hold of someone, or biting down on something is useless.

“At the time I didn’t think it would hurt more if someone chopped me or stabbed me with a knife.”

“Once you’ve experienced the pain of natural birth, you won’t fear any other kind of pain for the rest of your life.”

And if pain were measured from one to ten, with ten being the most acute, some estimate childbirth would be at least eight or nine, on a par with breaking your ribs. And it’s not just a one-off pain - the whole process can last for hours, even days.

More than 94% of Chinese women describe the pain with the word “severe” when they gave birth for the first time, that’s according to some research done by the Chinese Medical Association. Some of them even claimed the pain was “absolutely up to 10”, so bad they almost gave up the will to live.

29-year-old Guo Jiayi gave birth for the first time three months ago. She says the experience was totally different from what the elders, especially her mom, had described.

“My mother told me it only hurts during the contractions, and it comes regularly, more and more frequent, and the baby comes out naturally when the cervix fully opens. The pain was like period pains - just stronger, and it lasted longer. My mother-in-law said when she gave birth to my husband, her back ached, but she even managed to walk around the hospital to help the baby come out faster. But if you ask me, it feels like period pains at the very beginning, then later it’s 10 thousand times worse than that.”

Her 55-year-old mom Mrs Song argues that young women nowadays have a much lower pain threshold than the previous generation.

“It’s just a natural thing, no matter what kind of hardship you have to endure - natural birth, incision or surgery, just let it be. You know why people nowadays find it unbearable? I think it’s related to both their physical condition and psychological status. And young people are quite lazy nowadays, they’d rather lie down than sit, some of them rarely exercise during their pregnancy, which means their muscles are weaker. Women my age believe that giving birth is no big deal, certainly we had less choice then - but when you believe it’s just a natural thing, you can bear anything.”

“You see, my mother believes it’s something everyone needs to go through, let alone there are people more miserable than me, so I should feel better.”

It seems her mother’s logic is not that persuasive - Guo says she believes she is one of the most “unlucky” ones. After going through more than 12 hours’ of labour, she was physically no longer capable of natural birth, and had to turn to a cesarean section to get the baby safely delivered. But C-sections have their own problems with the post-operative recovery.

“There’s a scar on my abdomen, and if I get pregnant again I’ll have to have another C-section. If my first baby had been born naturally, I would have wanted a pain-free natural labor. You don’t know how terrible it is before you give birth, and it hurts quite a lot. Trust me, nobody wants to experience that kind of pain again.”

Our reporter Lu Chang interviews professor Qu Yuan, the head of anesthesiology department with Peking University First Hospital. [Photo: China Plus]

Professor Qu Yuan is head of anesthesiology department with Peking University First Hospital, one of the country’s top public hospitals in Beijing. She says China has one of the world’s highest C-section rates, partly due to the relatively poor quality of natural delivery services.

“It’s indicated that more than fifty percent of babies are born in China through C-section, far higher than the internationally recommended standard of less than fifteen percent. And more than sixty percent of them choose to have the operation because they are scared of the pain of natural birth. So that’s to say, fear of natural birth pain is the leading cause of C-sections. Besides, doctors often agree to C-section requests because they make more money from operating, and it’s easier to arrange a time. That’s why the rate has increased over the past few decades.”

But maybe if the pain wasn’t so great in vaginal births, the rate of C-sections would go down - and that’s where epidural injections can be a great help.

Pain-free natural childbirth promoted in China [Photo: VCG]

Known as “pain-free childbirth”, it’s widely available in developed countries including the United States, where 85 percent of vaginal births are pain free, while the rate is over 90 percent in Britain. However in China, the service is only offered in a few urban hospitals. Here is Huang Yuguang, head of Peking Union Medical College Hospital's anesthesia department.

“There’s a growing demand for pain relief during childbirth with the two-child policy. However, the rate is very low in China, only around 10% currently.”

The country's lack of pain-free natural childbirth was brought under the spotlight in August 2017, when 26-year-old pregnant woman Ma Rongrong jumped from the fifth floor of an inpatient building at a hospital in Shaanxi province during her contractions, partly because she was in unbearable pain and her plea for a C-section was rejected.

In response to voices calling for painless childbirth, China’s health authorities have pledged to make epidurals more widely available across the country, and a pilot program was launched in late 2018, aiming at getting more women to give birth naturally with the help of painkillers.

A number of hospitals, including Peking University First Hospital, have been selected for the program. Qu Yuan, who is also a member of the experts committee for the pilot program, says this is the first step towards popularizing the use of epidurals during labor.

“We are trying to find a practical way of promoting natural births with anesthetic intervention, for example, get more hospitals in relatively less developed areas involved and share the knowledge nationwide, and train related medical personnel, including anesthetists, obstetricians and midwives.”

Qu adds that the program also aims to reduce the frequency of C-sections, which the World Health Organization says adds to the risk of dangerous complications and may impede future pregnancies.

“The C-section rate and painless childbirth rate can reflect a country’s social civilization status. A better civilized society means lower C-section rates and more comfortable experience of natural childbirth.”

Qu adds that the pain in a vaginal birth can be reduced from 50% to 70% by administering anesthetics or painkillers to the epidural space around the spinal cord. And the anesthetic dose is very low - only 10% of that used in a C-section surgery.

“The technology itself is very mature and has been used for more than a hundred years. 24 years ago, I gave birth to my own child with the help of an epidural injection. If we medical workers trust it, that means it’s very safe, and it has no side effects on mothers and children.”

In China’s first-tier cities like Beijing and Shanghai, more and more parents-to-be are choosing private hospitals to give birth in - In their eyes, an average cost of 10 thousand dollars is worth every penny for the promise of pain-free childbirth, and comfortable medical services during the period of pregnancy.

30-year-old Cheng Jinghan, who gave birth a year ago with an epidural at a high-end private hospital in Beijing, says she had a happy childbirth experience.

“I think painless childbirth can ease your worry and anxiety - The more pain you feel, the more worried and nervous you get. Because natural birth is teamwork between you and your baby - once your pain is eased, you have more confidence to do the job successfully. I felt comfortable, I was looking forward to welcoming my baby, being accompanied by my family, it was a happy experience for me.”

Wang Chenxu, a Post-90s father of a 2-month-old girl, says his family is happy with the pain-free techniques.

“I think it’s absolutely worth it - several minutes after the injection, my wife’s pain gradually began to ease. Ten months of pregnancy is hard enough, I think as a father and husband, I need to try my best to support my wife and treat her well. I hope all mothers can benefit from the technology.”

Amcare Women's and Children's Hospital in Beijing. [Photo: China Plus]

Flora Wang is the associate chief physician with Amcare Women's and Children's Hospital. She says pain-free childbirth gives women a sense of dignity during the process.

“Sometimes we call it ‘Laboring with dignity’, many women feel like they were saved from hell after the epidural, and felt confident to give a natural birth. They find the process less miserable and embarrassing, everything is under their control, and they don’t behave like they’re terrified or helpless.”

In addition to a heightened sense of dignity during labor, pain-free childbirth can also help new moms better prepare for the daunting task of motherhood after the delivery, to some extent. Guo Jiayi says there’s already enough pain to go through after the birth.

“Feeding a baby is very painful, even more unbearable than giving birth. Your nipples blister and bleed - I do love my baby very much and I want to feed him, but there was a time when if someone said, ‘the baby is hungry, he’s going to drink mommy’s milk again’, my heart just sank - and I couldn’t help trembling. My face would blush with sweat because of the pain. And I had to go through this every 1 or 2 hours throughout the day, because the baby need to be fed frequently. Just not being able to sleep for longer than three hours for two days, that would drive you mad. As a breast-feeding mother, you can totally lose control of your whole life.”

For many new mothers like Guo, the challenges after giving birth have only just begun. According to traditional Chinese medical beliefs, new mothers shouldn’t go outside, have showers or drink cold water for a whole month. In Chinese, this is literally called "sitting the month" or “Zuo Yue Zi" and the theory behind it is it restores balance to the new mother's body after childbirth.

“There’re many contradictions between different generations when it comes to confinement. I couldn’t bear it any more after a few days without washing, I think it’s harmful to both the mother and her child. My mother-in-law cooked special soups every day for me, which were designed to increase new mother’s milk supply - I had to drink that greasy soup even though I really didn’t want to. It was hard to refuse her, especially when she insisted this would be good for her grandson’s food supply.”

Guo says that as well as all the physical challenges, many new mothers’ emotions are all over the place after having a new baby.

“Because of the physical condition and the change in endocrines, you’re more sensitive than usual. This is common - after child birth, everyone’s focus is on your baby. Sometimes I just felt like my life was been taken away and I was alone, and my husband would never understand my feelings, because he didn’t know what I’d experienced. Impossible, never.”

Flora wang says as women’s self-awareness rises nowadays, caring and understanding are very important for new mothers during and after pregnancy.

“The family’s love and care, especially from the husband, is very important for new mothers. We now have a machine which can replicate the pain of childbirth, so men can experience it themselves - and we always encourage future fathers to try it. A lot of men understand their wives better after the experience, and are more willing to share more responsibility in the future. This is very helpful for the growth of their child, and the stability of family and society.”

According to the national plan, hospitals that take part in the program are expected to aim for at least 40% painless deliveries in all vaginal births by the end of 2020.

However, Qu Yuan says it’s not easy, since the shortage of anesthetists poses a major obstacle to promoting pain-free natural childbirth.

“In China we are short of at least 300 thousand anesthetists. But it takes almost 10 years to train an independent anesthesiologist. It’s very difficult for most public hospitals to promote pain-free natural childbirth, given the fact that understaffed anesthesia departments are kept busy with surgeries where anesthesia is required and they don't have time to do it for natural births. And it also brings challenges to the different departments and hospital administrations can work together.”

Experts including Qu agree that a lot of work needs to be done to promote natural birth using epidurals in China, including better training of anesthetists and regulation of procedures to eliminate safety risks.

At the same time, Qu Yuan adds, natural birth with anesthesia should be an option for moms-to-be, certainly, at a reasonable price.

“Natural birth with anesthesia is a kind of medical service, and the cost itself is high, so who should pay for it? As a developing country, China’s public health insurance only covers basic medical treatments. I’m looking forward to a more flexible policy, for example, set a reasonable price for pain-free childbirth techniques that are acceptable for most Chinese citizens, and also satisfy medical workers and encourage physicians to opt for the practice. It’s a win-win thing.”

There’s still a long way to go for China to promote painless childbirth, Qu yuan says she is optimistic for its future.

"Promoting pain-free natural childbirth will bring good social effects. If more women can benefit from pain-free techniques, and be more satisfied with the medical services, better doctor-patient trust will be built and all this will have a direct impact on the image and reputation of our hospitals, and the positive cycle continues.”

It’s a spring afternoon in the home of the new mom Guo Jiayi, with the baby gradually falling asleep shortly after being breast fed. The lullaby is from an ancient Chinese poem called “Dawn of Spring”, “Chun Xiao”and the lyrics go like this:

“This morn of spring in bed I’m lying,

Not wake up till I hear birds crying.

After a night of wind and showers,

How many are the fallen flowers.”

The young mother says the role of being a mother has given her lots of strength.

“Because I am the only child of my family, I was used to being surrounded by all the elder’s love and care. It’s only when I’ve had my own child that I’ve come to realize that I am a real adult - Look at my son, he is so little and so innocent, he relies on me, and I need to hold up his sky. This kind of feeling gives me lots of energy and courage, and drives me to be stronger, and I think I will be stronger, surely.”

The traditional metaphor in China says “giving birth to a child is equivalent to fighting your way through the doors of hell”, but with pain-free childbirth, women in China will find bringing a new life into the world can be full of energy, hope and happiness.

The young mother Guo Jiayi says she believes there’s a brighter future for Chinese women with this first step of pain-less deliveries.

（Written and produced by Lu Chang. Zhangwan voices the story.）