In China, where hospital delivery is virtually universal, a growing number of Tibetan mothers-to-be are turning to natural birth centers as an alternative where they can access modern medical services while preserving their cultural traditions.
Private natural birth centers that emphasize cultural practices have proven appealing to Tibetan women who reside in poor rural areas and are reluctant to let go of home birthing traditions that can be risky without proper medical help, according to Drolkar Ja, an official in charge of health and family planning in Huangnan Prefecture of Qinghai Province.
In 2014, China met the Millennium Development Goals to reduce maternal mortality by 75 percent from 1990 levels one year ahead of schedule. Now the pressure to improve delivery care and reduce maternal mortality comes from the country's ethnically diverse western interior, which faces a heavier task in poverty alleviation.
China's official statistics show that the maternal mortality rate in western China was 2.6 times more than in eastern areas in 2014. The national average maternal mortality rate was 21.7 per 100,000 last year, down 75.6 percent from that in 1990, when the rate was 88.8 per 100,000.
Lowering maternal mortality in poor, under-resourced rural regions to levels found elsewhere in China is a challenge, and medical experts are recommending incorporating cultural practices to improve maternal care in less developed regions.
Tongren Natural Birth Center, the first of its kind for Tibetans, was launched by local gynecologist Tsering Kyi and Lama Kunchok Gyaltsen in August 2009 in Qinghai Province. According to Drolkar Ja, it is a good example for what should be done in the future.
TRADITIONAL TOUCH IN CHILDBIRTH
"The biggest obstacle to promoting hospital delivery in rural and pastoral areas often comes from a family's mother-in-law, as it was normal for older generations to deliver three or four kids at home back in the 1960s and 1970s. Many mothers-in-law insist pregnant women are not medical patients and do not need to go to hospitals for delivery, especially when there could be medical expenses incurred," said Drolkar Ja.
At Tongren Natural Birth Center, however, it is not unusual to see a mother-in-law accompanying her expectant daughter-in-law during the childbirth process.
Dodan, an expectant mother from nearby Zeku County, gave birth at a local clinic in 2012. This time she traveled 80 kilometers with her mother-in-law and husband to the birth center.
"Many of my friends referred me to this place. My mother-in-law also prefers this place. It is a better choice as the doctors and nurses speak Tibetan and we can stay in home-like suites for a couple weeks. Cooking and showering are very convenient. Monks also chant scripture during the birth," she said.
Rural women have been discouraged from hospital delivery for a number of reasons, including a lack of beds due to too many patients, extra expenses for family lodging, and Tibetan cultural prohibitions against men's involvement during pregnancy and childbirth, which leads to reluctance to be treated by male doctors.
"Many Tibetan women view pregnancy and childbirth as a normal process and see hospitals as places to treat illness and emergencies. Thus, going to a hospital to deliver a baby is seen as counter-intuitive," said Kunchok Gyaltsen, the honorary president of Arura Hospital in Qinghai, who holds a doctorate in public health from the University of California at Los Angeles.
Tibetan women who have delivered at Tongren Natural Birth Center mentioned they appreciated the large rooms with heated beds, the choice of traditional delivery positions, and the presence of their families during the birthing process.
The mothers also praised the center's adherence to cultural practices such as scripture chanting by Tibetan monks, placing amulets and Tibetan thangkas on the wall, and giving newborns butter pills.
"As the birth center offers a home-like atmosphere that helps expectant mothers relax, it is much easier for them to give up home birth traditions that can be highly dangerous to both the mother and child if they fail to access proper medical help in time," said Tsering Kyi.
In addition to the rural Tibetan women who make up the majority of its patients, the center has also received a few expectant mothers of Han and Hui nationalities in ethnically diverse Qinghai. In 2010, 53 percent of the province's residents were Han, 24 percent were Tibetans, 15 percent were Hui, and 8 percent came from other groups.
