China: The Importing of C-Sections
China has been getting steadily more urban and Western, and along with capitalism, America has exported its medical approach to childbirth here. Hospital birth has almost completely replaced home birth, except for the poorest and most rural of women. (Families are responsible for their own birth costs).
The wealthiest of urban Chinese women give birth in luxurious private hospitals, which have a c-section rate as high as 90%; these are seen as “status births”—the most western, modern and desirable way to give birth. Members of the emerging middle class tend to give birth at state-run hospitals, where they have no choice of doctor and are placed in a room with other birthing mothers during active labor. In large towns, woman-baby hospitals, the equivalent of freestanding birth centers here, are attended by zhuchanshi, midwives who do everything from perform abortions to c-section surgery. C-section rates are around 40% at these facilities—high, but nothing compared to the private hospitals.
Yet the postpartum tradition of zuoyuezi—“to sit the month”—persists. After birth, most Chinese women spend a month “lying in,” where they do little more than breastfeed their babies while female relatives attend to their needs. Women often travel back to their mother’s home for this tradition, no matter how far away they’ve moved.
While this sounds like the world’s greatest maternity leave, lying in has its downsides, too. Some women are forbidden to get wet (even brushing their teeth or washing hair), go outside, eat raw veggies or cold drinks. But they’re also forbidden to do household chores, which probably sounds just fine to most American women.
Sweden: A Model For The Rest Of The World?
Sweden has some of the highest breastfeeding rates and lowest infant mortality rates in the world, so they must be doing something right. It’s ranked as the third best place to be a mom by Save the Children, following Iceland and Norway, due to its access to skilled maternity care and low c-section rates. Midwives generally manage births, and doctors are reserved for times when medical intervention is necessary; they usually give the baby a check-up after birth, but do little before. Prenatal care is free.
Birth is considered by Swedes to be an intensely fulfilling personal experience, and even though almost all Swedish births occur in hospitals, those institutions tend to be homey and comfortable. There are labor lounges where women can snack, chat, read or watch TV as labor progresses. A mom’s birth team consists of the midwife, the midwife’s assistant and a non-specialist attendant of her choosing—a relative, husband or friend—and she can labor alone with her attendant for long periods if she wishes.
What Swedish birth offers is choice. Unlike in some Scandinavian countries, where medication is discouraged, Swedish women are educated about medications—the possibilities, the side effects or possible complications—and can decide for themselves, without pressure either way, if they want them.