Caesarean risks disturb mothers longing for second child

Relaxation of China's one-child policy both delights and worries Wang Jingjing, who gave birth to a boy three years ago by Caesarean section and now yearns for a second child.

"I have consulted many obstetricians, but still can't make the decision on being pregnant again," said Wang, a white-collar employee in Hefei, capital city of east China's Anhui Province.

Like Wang, many Chinese mothers pleased by the loosening of the birth policy are now worried about the possibility that the Caesarean section they had might jeopardize a second child.

Last month, the government proposed allowing urban couples to have two children -- as long as either the husband or the wife is an only child. Previously, the policy required both of them to be a single child.

Before the change, the couple never considered having another baby because Wang's husband has siblings.

Desirous that her child enter school one year earlier than his peers born after Sept. 1, she chose to risk a Caesarean at the end of August. "At that time, I simply did not want him to be a late comer," Wang said, in remorse.

Her concern is confirmed by Liu Xiaojun, chief obstetrician of First Hospital affiliated to Anhui Medical University, who warned that scarring on the uterus is likely to lead to trouble for future pregnancy and delivery.

Liu said in most cases Caesareans are not the best option for either mother or child.

"For a Caesarean, a mother is subjected to anesthesia risk and faces postoperative complications, which mean more pain and a longer stay in hospital," Liu said.

Research has shown that a baby born by Caesarean is more vulnerable to asthma, allergies and lung infection as he or she is deprived of protective bacteria from the mothers' birth canal.

A 2010 survey by the World Health Organization (WHO) said that Caesarean sections in many countries had reached "epidemic proportions" and in China, a quarter of such operations were not medically necessary.

In a novel by Nobel Prize winner Mo Yan, Big Breasts and Wide Hips, a rural woman went into her room to give birth with no one around, cleaned herself up after the baby was born and went to finish her farm work.

Despite the artistic exaggeration, natural delivery at home or in hospital was the norm in China not long ago. Today, expectant mothers queue in overcrowded hospitals for Caesarean sections.

China ranks first in the world for Caesarean births at 46 percent. In some regions the proportion reaches 80 percent, far beyond the recommended level of 15 percent, according to the National Health and Family Planning Commission (NHFPC). Caesarean births have increased sharply, especially among young, educated women in urban areas, according to a WHO bulletin.

"Theoretically, a Caesarean is only performed when a woman is having complicated delivery," said Chen Ling, senior doctor of Anhui Provincial Hospital however, expectant mothers and hospitals both have reasons to welcome new lives with a risky, costly knife.

Delaying childbirth age and too much nutrition during pregnancy have contributed to the rising fetal distress that leads to surgery. However, the number of Caesareans without medical necessity is also on the rise. Some doctors in medium and small hospitals recommend the operation to expectant mothers because it is quicker than unpredictable vaginal births and more profitable.

In addition to mothers like Wang, some even have superstitious reasons for trying to designate the time and place of their baby's birth, like "auspicious" dates. For example, Year of the Dragon usually means a baby boom, while those born in the Year of the Goat are believed to have an "unfavorable fate".

Most expectant mothers today are themselves single children which partially explains the increasing fear of the pain of vaginal delivery, Chen said.

The government has taken measures recently to tackle the high Caesarean rate. The Maternal and Child Health Care of China Association ran a five-year campaign to promote natural childbirth and cool the Caesarean fervor. The program aimed to build at least 10 midwife training centers nationwide, train more than 2,000 professionals and upgrade at least 100 medical institutions to be more friendly to natural births.

Hunan provincial health department has capped proportions of C-sections at different levels of medical institutions at 25 to 35 percent to make sure the rate falls.

Tianjin city plans to alleviate pain of natural childbirth and provide expectant mothers with emotional support in all of its grassroots medical institutions.

Courses for pregnant women have expanded to popularize natural birth and breed confidence in spontaneous delivery.

Wang Siyu, a new mother in Beijing, insisted on natural delivery although her friends and doctors suggested surgery.

"When the nurse showed me my crying baby, I was overwhelmed by the happiness and instantly forgot all the pain," Wang said.