Natural birth a tough sell in China's caesarean boom

by Tom Hancock

As an automatic piano chimed a wedding march, new mother Wang Dan walked down a red carpet towards a hospital room called the "White House", minutes after giving birth in a candlelit water pool.

The suite is adorned with an enormous rococo style sofa and a portrait, and 28-year-old Wang, who gave birth to a son, said: "I wanted to stay in the White House because it's large and well decorated."

But Wang's presidentially-themed chamber at Beijing's Antai hospital—an expensive private facility aimed at the capital's wealthy middle class—was not the only unusual thing about the birth of her first child.

In a country where most urban professionals choose caesarean sections, she stands out for choosing to give birth naturally.

The proportion of Chinese mothers choosing caesareans more than doubled in less than a decade, from around 20 percent in 2001 to above 46 percent in 2008—and approaching two-thirds in cities, according to the latest figures for the country.

Across Asia caesarean rates have reached "", it said in a 2010 report.

Experts say that caesareans are necessary in many cases when a mother or baby has a health condition which would make a natural birth risky, but that the risks of elective operations are often greater than the benefits.

China's caesarean rate is "definitely too high", said Shenlang Tang, a researcher into Chinese healthcare at Duke University in the US, adding that "the key factor is hospital financing".

China has made huge strides in over the past decades, slashing its rate by almost two-thirds since the mid-nineties, largely by promoting .

But Chinese hospitals receive little government funding and generate almost half their incomes from selling operations such as caesareans, with other revenues coming mainly from diagnostic tests and medicines.

"The price of based delivery can be up to three or four times that of a natural birth... which helps the hospital generate more revenue," Tang said.

China's "one child" family planning policy also plays a role, as parents with more money to invest in their only childbirth are more likely to splash out on the procedure, which they see as safer, Tang said.

"There are a lot of perceptions that if you have natural delivery it will affect your sex life," he added.

Some local governments in China have launched campaigns to promote natural birth, he said, but there is no clear central government policy on the issue.

In an attempt to encourage women to choose a natural birth, the Antai hospital offers water births and teaches expectant mothers hypnosis techniques to deal with the pain of labour.

It also charges just as much for natural childbirth as it does for a caesarean, removing incentives for doctors to promote the operation.

"Our major problem is that pregnant women in China are very scared of pain," Antai's director Chen Fenglin told AFP. "We found that even water birth couldn't reduce our patients' fear, which is why we introduced hypnosis," he said.

A red carpet runs from Antai's delivery room towards a series of recovery suites, including the western-themed White House, a room aimed at Muslims called the "Islamabad Palace," and a chamber inspired by Mongolian warlord Genghis Khan.

"Parents hope that their child can grow up to be an emperor or princess, or a president, so the rooms give the parents a beautiful dream," said Chen, who says his hospital has carried out more than 2,000 water births.

An automated piano outside the delivery room plays a wedding march when mothers walk past with their newborn baby. "We want to express that a birth is as joyful as a wedding," Chen said.

Its innovations have proved a hit with mothers such as Wang Dan, who are willing to pay its hefty fees.

"I felt really happy when the wedding music played, because some people are in a lot of pain after giving birth, but I was simply excited," she said, adding that she did not use an anaesthetic.

But downstairs from Antai's water-birth suite, the hospital's doctors are still busy performing caesareans.

Chen doubts China's caesarean rate will fall significantly, because of the financial incentives hospitals face.

"No matter how much you promote natural birth, it's ultimately a matter of economics," he said.

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