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 26, 2015
Jiading, Shanghai, China
Ethnographic research is all about going into your fieldwork expecting one thing from your background research, and then in the midst of it, encountering an entirely different set of circumstances. As I prepared for my “on the ground” research in China with the literature from previous years, I was thinking that the cesarean section rate would be sky high, that women perhaps would be requesting them left and right, and doctors would be wielding their surgical tools very liberally. Perhaps I was hoping to encounter all of this to confirm my expectations and then parse out the details from there.
Of course, the reality is quite different, and quite a bit more nuanced than the picture my imagination painted. In fact, at a secondary hospital in the outskirts of the city, I find myself surrounded by women who overwhelmingly prefer natural, vaginal delivery, and by doctors and nurses who encourage it. In fact, everywhere I look—on the walls, on brochures, even on the little pouches given to pregnant women to place their medical slips—the hospital clearly broadcasts: “Natural delivery is good.” Apparently, in the past few years, the government has been vigorously trying to lower cesarean section rates with more education, brochures, and TV ads, as well as new penalties for hospitals who have unacceptably high rates. Therefore, rather than having a cesarean section rate of 50%, as I was expecting, the hospital has since dramatically decreased it to around 30%—still high, but comparable to the US.
Nevertheless, confronting the differences between my expectations and reality allows me to keep an open mind, and to adapt and build off of this unexpectedness. It gives me the opportunity to attempt to understand how that change has occurred, how women’s experiences have evolved, and what hasn’t changed at all. Indeed, many of these women have given birth and the doctors have attended births through this change, and from their narratives, I have noted that while rates of cesarean have decreased, the general birthing culture and experience remains largely the same.
For example, one of the most peculiar things I discovered was that a number of the midwives, who work in the delivery room, had themselves requested cesarean deliveries. One of them did it 5 years ago during the era of very liberal use of cesareans, and one did it less than a year ago even after the changes were implemented. Wait a minute. Why are the midwives, who are supposed to promote vaginal delivery and who are perhaps the ones who most clearly know the health risks and benefits of each, asking for cesarean deliveries? Even more curiously, how were they getting around hospital regulations largely prohibiting women from requesting cesareans? Clearly something was contradictory here.
When I probed further, the midwives told me they felt like they themselves couldn’t go through the natural delivery experience. After all, they worked day in, day out in Labor and Delivery where women labored in an open room with other laboring women, without family, and mostly without anesthesia (there is very little use of epidurals in China, for reasons that require a whole other explanation). Although many of the women I talked to preferred vaginal delivery, citing the benefits to their baby and the harms of surgery, there seemed to be a universal fear of delivery magnified in an open, public space of shared pain. The midwives felt that they might as well undergo the cesarean without the long, painful process of labor; and then accept the post-surgery pain.
This contradiction signaled to me that while incentives for hospitals and education reforms are, on the surface-level, successful in lowering the “alarming rate” of cesarean deliveries, they simply do not change the generally negative experience of vaginal birth that may be driving the fear underlying requests for cesareans. Looking only at the numbers to determine what is wrong or what has been successful brushes over these deeper reasons for cesarean deliveries on maternal request.
Of course, I am not meaning to say that this is true of all women who want cesareans or of all midwives in China, as I am merely a participant observer at one local hospital. But I think the great thing about focused ethnographic research is that I am able to collect particular stories and pinpoint these slight contradictions in order to tease out their meaning in the larger context. In a world where numbers and rates are highly valued, ethnographic research and anthropology can play a powerful role in revealing cracks in those numbers.