Delivery by Cesarean in China: Now the Norm? – Eileen Wang

June 11, 2015

Every year, the Penn Museum provides support to Penn undergraduates and graduate students as they deepen their understanding of the human experience outside the Museum’s walls. Follow these blog posts from our intrepid young scholars as they report on the sights and sites that they encounter throughout their travels in the field.

June 4, 2015
Richmond, Virginia

Map of China with Shanghai municipality highlighted. Source: Wikipedia Commons

Tomorrow, I leave the United States for my very first independent project abroad, in Shanghai, China. I will be doing ethnographic research there for two months as part of my senior thesis in Penn’s Health and Societies program. In particular, I am interested in understanding the high rates of cesarean sections in urban China, which are estimated to be around 50-60% (as compared to the World Health Organization’s recommended rate of 15% or the US’s rate of 30%), and, in particular, why mothers themselves are requesting cesarean sections (which are estimated to compose up to 20% of all cesareans in China).

Cesarean sections (also known as C-sections) can be lifesaving procedures for the mother or fetus when medically indicated, but that mothers ask for a C-section without any medical reason was a topic that intrigued me. This is something that does not come as common sense, at least not in the US; after all, cesarean sections are major surgeries with many potential complications, and the medical literature largely promotes the benefits of vaginal delivery over cesarean delivery in the case of low-risk mothers. So what makes China so different from the US and other countries where mothers aren’t requesting cesareans?

As part of this research, I will interview pregnant and postpartum women, their families, as well as doctors and nurses, in order to get a sense of their views on birth and modes of delivery. Furthermore, I will be doing participant-observation at Jiading Central Hospital, which is a secondary-level hospital located in the outskirts of the city, although I also hope to make excursions to tertiary-level hospitals, postpartum centers, and other spaces pregnant women and postpartum women gather.

This will give me a better understanding of how all of these actors intersect in this decision of how to deliver, as well as the larger sociocultural context. For example, is requesting a cesarean seen as an empowering choice for the mother? Or is it merely just a “choice” constrained by the larger social context, for example, one pressured by the family members for a more controlled, “perfect outcome” or by doctors who have a lot of other patients they have to see in a short amount of time? How does information and education about delivery modes get transmitted among groups of mothers or between the doctor and family? I also think this is an interesting public health question in the context of the relaxation of the One Child Policy—if requests for cesareans continue, maternal morbidity may increase as mothers have more children (since a primary cesarean increases the risk of a complication in a subsequent pregnancy).

Me and my fieldwork tool – the recorder.
Me and my fieldwork tool – the recorder.

I am very excited to be putting on my anthropological hat in China because I will be exploring it for the first time on my own terms. As a Chinese-American, I have visited China a couple of times for vacation or to see family, but never to critically understand the health context. Therefore, I will be straddling the worlds of being an “insider” and “outsider” in trying to grapple with and challenge the commonsense notions of birth in China. Not only that, I am also an aspiring physician (and perhaps OB/GYN), so it will be quite fascinating to compare how the medical profession and birthing context compare to that in the US.

We’ll see where this research takes me, whom I’ll meet, and what stories I will encounter, but I am sure it will be an exciting adventure!