Monday, July 06, 2015

Giving birth in China: 10 things to expect

One of my good friend's just had a baby this past weekend. Like me, she is a foreigner who gave birth in China. I'm amazed at her courage, as her husband (also foreign) has been out of the country recently so she's had to navigate the Chinese hospital system mostly on her own. She also has rather rudimentary spoken Chinese which presents other challenges. Though we live far apart, I've tried to be as helpful as possible during her pregnancy. We've talked a lot about differences between pregnancy and giving birth in China versus our home countries. Though I've talked about some of my experiences in other posts, I thought I'd put together a list of some of the issues I discussed with my friend. For those interested, here is my list of what to expect when giving birth in China:

the hospital where I gave birth

1. Your partner will not be allowed in the delivery room
Most people I've talked to who gave birth in China told me their husbands were not allowed inside the delivery room. I was told that my doctor that I would only be accompanied by nurses during labor. Chinese Potpourri gives a good account of her experience here. When I pushed my doctor to allow my husband to accompany me during labor, she eventually relented. If you give birth at a private or international hospital, I expect you'll have more options, but if going local, be prepared for the fact that you may be giving birth without your significant other.

2. You may not be offered an epidural
I didn't realize that in many countries, epidurals (spinal anesthesia) aren't standard procedure. In the US, you practically have to beg NOT to be given one. You will face eye rolls and questions, “The drugs are available, why not take them?” This was my attitude before, but after learning I'd be having a natural labor I educated myself more about going through labor and delivery without drugs. I now have a better understanding of why they aren't administered and why some women opt not to have them. But it is a harsh reality to face if you are expecting them only to find they are not given, as was my case. Be sure to talk this over with your doctor. If you will be giving birth naturally, I did find some solace in the book Mindful Birthing and Active Birth was a worthy read as well.

3. You will be allowed to move somewhat freely as well as eat and drink during (early) labor
This is a side note that I found interested. After reading about giving birth naturally, I learned that it was best to eat and drink during labor to keep up your strength. It is also good to move around and find positions most comfortable for you. In the US, since most women are administered epidurals, they aren't allowed food or drink (only ice chips, from what I've heard) and are mostly restricted to their bed. I asked my Chinese doctor about this and she said I was definitely free to eat, drink, and move about while in labor.

4. You may end up with a c-section
I spent a lot of time worrying about who would be in the delivery room with me and how I was going to get through a natural labor only to end up having an emergency c-section. My friend who just gave birth also ended up needing an emergency c-section. In China, c-sections are incredibly common and many women decide to have them electively. In the US, people tend to look down on them and even the women who have them. I didn't want one and honestly, I felt (and still feel) like a bit of a failure because I did. Which is stupid, as I should be grateful to live in a time when such technology even exists. But the moral of the story is this: You don't know how your birth will go. You may end up with a c-section. While it may be the last thing you want, try to learn some of the basics about what it entails just in case.

5. Recovery from a c-section sucks
As someone who had a c-section in China, I can tell this, it is rough. I'm sure giving birth the other way is no walk in the park either, but I can only attest to the suckiness of a c-section. The day I found out I'd be having a c-section (the day before I gave birth), I called the only person I knew back home who had had one. She was a bundle of positivity. “It's a breeze!” She assured me. “I felt fine by the second day and I was even up and walking around the first night!” That is not how it went for me. Not AT all. I was forced to lay flat on my back, without a pillow, for eight hours after surgery (which is a torture I would not wish inflicted on anyone; forget bamboo shoots up the fingernails). I was hooked up to numerous tubes and a machine to monitor my vitals. I was unable to hold my baby. They tried to set him on my chest, but it was awkward. There was no way I could try to breastfeed him. It took two days for me to get out of bed. I couldn't even make it to the bathroom. I felt weak and pathetic. Worst of all, I didn't feel like I got to properly bond with my baby.

I know it's not like this for everyone, not by a long shot. But I write this for those who prefer to prepare for the worst. I wish I had had a better idea of what recovery after a c-section would be. For me, the first two days were utter hell, the third day was awful, and after that it was much better. It took about two weeks for me to feel comfortable being myself (as I didn't want to open or infect my incision) and three months before I dared to do any real exercise.

6. You will likely be very hot
This wasn't much of a problem for me, as I have birth in April. But for those who give birth in summer, be prepared. Due to Chinese beliefs about wind and temperature and all that good stuff, don't expect an air-conditioner to be turned on. Don't even expect a window to be opened. You can try begging or just do what you want if you have your own room (you will get scolded when you are caught).

7. Dietary restrictions
Phase one: If you have a c-section, don't expect to be eating for awhile. After giving birth, I wasn't allowed to have anything until I could manage to pass gas. I think I triumphantly accomplished that on the day after surgery. I was rewarded, by my mother-in-law, with a steaming bowl of turnip soup. It may have been the best thing I've ever tasted. I wasn't allowed any protein or sugars until I had a successful Number 2. Anyone who's had surgery can probably attest to the difficulty of accomplishing that. It didn't happen for me until I was out of the hospital.

Phase two: Regardless of how you give birth, you may find that you also have to deal with some very unfamiliar dietary restrictions. This is particularly true if you or your partner is Chinese. Even if you are a foreign couple, you may get accosted by the doctors or nurses if they catch you eating or drinking anything improper. I can't provide a full list of such items, but the most basic rule of thumb is that you are expected to eat and drink everything warm. There are lots of particular foods that are “off limits” but it's nearly impossible to keep track of them all! This was perhaps one of the hardest issues for me to deal with postpartum, but I had a rather insistent husband and mother-in-law.

8. Differences in handling the baby
This is where things may start to get emotional. Most parents have a specific way they want their baby treated after birth. I, for example, didn't want my baby washed off as there is evidence that it is actually healthier for the baby not to be cleaned right way. Of course, they bathed William immediately after birth, despite my wish that they didn't. 

While I was uncomfortable with the idea, I did agree to giving the baby water as that is the practice in China. Be prepared for doctors and nurses who encourage this. Another issue, I did not want him to have formula until I had a chance to work on breastfeeding, but most Chinese people who insist on formula feeding the baby until a mother is able to properly breastfeed (if that's what she plans to do). Many western doctors advise against relying too much on formula (if at all) to mothers who want to establish proper breastfeeding.

A final issue: clothing. The baby will be overdressed. In fact, William broke out into hives due to all the clothes and blankets he was swaddled in after being born! As I wrote in his birth story, my American baby clothes were deemed completely inappropriate and my mother-in-law actually ran out to buy him other baby clothes the very day he was born.

9. You pay first
Before any of the prior stuff even can happen, you need to pay up. Do not expect care in a Chinese hospital without paying or putting down a sizable deposit first. In my case, I think we somewhat paid as we went, paying 1000 or 2000 rmb (US$150-300) when I checked-in and then adding to that after my surgery. When I checked-out we settled the bill down to the last mao (cent) and were give a print out of all the charges. My friend, on the other hand, was told to deposit 5000 rmb (over US$800) into her patient account before giving birth. The cost of birth can widely vary, even at a local hospital. At a standard hospital where I live, a vaginally delivery is about 2500 RMB and a c-section twice that. Double those figures for the “best” local hospital. In larger cities or at private hospitals, the cost will probably be more.

10. You will need someone to mind you and the baby
This is last, though it's perhaps the most important. At a local Chinese hospital, you cannot expect the nurses to take care of you or the baby. They will only attend to the most basic of tasks and often only when prompted. I don't say this as a criticism of them, this is simply how the system works.

Whenever you stay at a local hospital, you need to be damn sure you have a friend or family member around to take care of you. You need people to help you change your clothes, go to the bathroom, bring you food and water, keep an eye on your IV, etc. After giving birth, the baby will likely be in-room with you and someone must be around to help feed, change, and hold him. The nurses won't. If you have a c-section, you physically won't be able to do it. No matter how you give birth, you will be exhausted and need people around you to help. If you, for whatever reason, don't have someone, you can hire someone. In Chengde, the going rate for a 24-hour minder is less than 200 rmb/day (US$30/day). They are called hugong (护工) in Chinese and you should be able to ask the hospital staff about arranging one.

My final advice: Assume nothing. And ask lots of questions so there are fewer surprises. My hope is that I didn't scare anyone by writing this, but provided a realistic view of some of the experiences you might expect. Remember, most things are negotiable, so if you try talking to your doctor or nurses, you may be able to have some things done “your (crazy foreigner) way” but it's easier to accomplish this if you have such talks before you are actually in labor! If you have any questions or comments, please post.


Anonymous said...

Wow this blog post was super educational, and I have mucho respect for you for giving birth in China. That must have been severely difficult! When I went there for just minor health issues I was always frustrated, I can only imagine how hard it must be to put up with Chinese healthcare during pregnancy and childbirth!

That's a really big shock about giving water to the baby. I asked my bf (doctor) about that, and he was very adamant about giving the child breastmilk only. Do you know why Chinese people are so insistent on water?

And the price of childbirth is SO CHEAP! In America I think the total bill amounts to 30k+. If you're 'low-income' sometimes the government will foot the bill, but otherwise, families here have to have a good health insurance plan or cough up 5 figures.

MAJOR respect to you for having a C-section (in China!!). I'm just so full awe and respect after reading this post! Do you think you'll have another child in China?

rosieinbj said...

Hi Mary,

We aren't planning on any more kids and we'll actually be moving to the US later this year.

I talked to my husband and mother-in-law about the reasoning behind giving babies water. They believe that this helps newborns flush out their system and since the body is mostly made of water it is important for babies to drink pure water to keep a clean and balanced system. My husband also said it is one of the reasons Chinese people have such good skin. Take it for what you will!

As far as the cost, it's hard to compare. Healthcare in American is insane and it's a completely different system. Good healthcare is out of reach for many Chinese, I'm sure, especially since you have to pay upfront. The quality of care is also much, much lower in local hospitals. Like I said, you can't really depend on doctors or nurses. A patient needs someone around to help them with everything and be his or her advocate.

Autumn Ashbough said...

So it's cheaper in China, but you have to hire your own nurse!

Okay. What do the nurses DO in the maternity ward? Are they just there for emergencies?

Did your C-section go well? Any complications?

The number of C-sections in the US has also gone up dramatically. Mainly due to lawsuits. No doctor wants to risk it -- the minute the baby appears to have the slightest distress, it's off to the OR.

rosieinbj said...

The nurses are actually pretty busy, I think. They administer IVs a lot, I know that (Chinese people love IVs!) But the nurse to patient ratio is not so good. I only think one nurse was on duty at night (in the maternity ward) and maybe just a few doctors in the whole hospital!

My c-section went just fine. I would loathe to do it again though.

I know what your saying about fear of lawsuits. I actually don't know many people who have had c-sections (my mom and one friend) but almost everyone I know was induced, which I think doctors also do in fear of complications.

Anonymous said...

Uf, I have always thought that if I had a baby I would like to give birth in Spain, but you never know how thing will end up.
My experiences with Chinese hospitals have been mostly fine, except for one time a doctor said I had fluid in my pelvic cavity and I needed medicines. I went for a second opinion and turns out I didnt have anything! And the other day, the skin by the base of my toe nail was inflammated and the doctor wanted to take my nail out!! I said no way...

Taiwanxifu said...

I was amazed at how similar some of these experiences are to what happens in Taiwan, with the exception perhaps of epidurals. I had a large baby (nine pounds), and I later found out that it is usually standard for C-sections for babies of that size. I had to do a lot of doctor/hospital shopping before I could have confidence that my choices for non-invasive procedures would be respected.

rosieinbj said...

@Marta, Did you write about post about that? I think I remember that story! Hospital experiences here are always strange. I thought it would get better as my language skills improved but sometimes I miss my blissful ignorance when I didn't understand a damn thing!

@Serina, Thanks so much for your comment! I actually read most of your pregnancy and zuo yuezi posts before I gave birth. :) They were very helpful. There are lots of small differences, even regionally (in Mainland China), regarding birthing practices. As far as the epidural, that might have even just been that hospital's policy. But overall, so much was different from how things are done in my home country (the US).

Sara said...

Thank you so much for this post! I'm not 6 months pregnant and looking for hospital to give birth. For the reasons above, I don't want to give birth in the local hospital where I'm having prenatal check-ups. Instead I'm looking at a bigger public hospital that has some experience in foreigners giving birth, allows the dad to be there during the whole thing and can also have epidural. I hope that a doctor/hospital who has had foreign patients before would have more understanding for our different requests.

Anonymous said...

Very real experience, me and my wife are from Hunan province, China, live and work in Beijing now. My wife gave birth in our hometown Xiangxiang county, Hunan province, China. My wife definitely has exactly the same experience with you, at the beginning, we decide to do a nature labor, but due to position of the fetus not perfect, if we choose nature labor, it will be very dangerous for the baby,he may suffocate, so we have to end up with a c-section. I could feel she was suffering a lot pains after the c-section, cant move, eat, drink and even pee for two days, and I as her husband help to clean her body. c-section definitely is not shameful for her.

rosieinbj said...

@Sara, I think you are in a much better situation since you are in (near?) GZ. I had relatively few options and no one at the hospital was familiar with our crazy western ways! Things are slightly behind the times here since it's a pretty small city.

@Anonymous, thanks for your comment. Yes, that sounds so much like what happened to me! Hope your son and wife are doing well.

Unknown said...

Hi, and thanks for sharing your story. What about humanised birth, birth plan and doulas? And obstetric violence such as verbal abuse and unnecessary medical intervention? I might move to China in my third trimester (I'm 14 weeks atm) from Brazil (though I'm Italian) and ready to freak out to adapt to the whims and fancies of a new system!

Desde Sudan! said...

Hello, my wife gave birth in China as well but we had a different or I should say, smoother experience. I was allowed in the delivery room with her before, during and after the delivery. No water was given to our baby , and no c section was ever mentioned, Our baby wasn’t washed off until after the next day or so, we didn’t need to pay at all as insurance covered everything, she was offered and given an epidural. Although we live in a small city, It sounds like we were at a more western hospital, with English speaking nurses and doctors, but I had friends who gave birth st more local hospitals with similar experiences as Rosie. Glad to hear she’s