China’s mothers to be offered pain-free birth option in national bid to reduce caesarean rates
- China has some of the highest caesarean rates in the world
- Many women unaware that labour pain can be optional and choose surgery instead
Painless childbirth using epidural injections will become more available to expectant mothers in China in a bid by the state health authority to reduce the country’s high rates of caesarean births.
In a circular issued on Tuesday the National Health Commission said “a certain number” of hospitals across the country would be selected to join a pilot programme over the next two years to provide epidurals to relieve pain during a vaginal birth.
“Hospitals are required to apply painless delivery in a regulated way and increase its application, lower the rates of caesareans and enhance pregnant women’s satisfaction with hospitals,” the circular said.
Second-tier hospitals equipped with both anaesthesiology and obstetrics departments taking part in the programme will be expected to meet a target of at least 40 per cent painless deliveries by the end of 2020.
China has some of the highest C-section rates in the world, booming from 3.7 per cent in 1988 to 34.9 per cent in 2014, according to a study in The Lancet medical journal.
One reason for the high rate of caesarean births is that many expectant mothers believe it is the only way to avoid or limit the pain of a vaginal delivery.
Last year, a 26-year-old pregnant woman from Yulin, in the northwest province of Shaanxi, jumped to her death from a hospital window, unable to bear the pain of her labour.
Pregnant Chinese woman ‘commits suicide’ after family refuse to allow her to have a caesarean section
Huang Shaoqiang, an anaesthesiologist from Fudan University’s Obstetrics and Gynaecology Hospital in Shanghai, said a lot of public education about painless delivery was required.
“People’s wrong ideas include that painless delivery will hurt the infant’s health, lead to future pain in the waist for the mother, and worsen both mother and baby’s intelligence,” he said.
Liu Wei, director of department of anaesthesiology at United Family Healthcare Beijing, said many people on the mainland were not even aware that painless delivery was an option.
“They take it for granted that [vaginal] delivery is painful and ask why bother to relieve the pain?” she said.
Liu is one of dozens of medical counsellors endorsed by the state authority in the first half of this year to draft the painless delivery work plan.
“The government has realised that expectant mothers have strong demands for this technology and women want to undergo a comfortable labour process,” she said.
Major health centres in big cities do offer an anaesthesiology service – at a small number of these top institutions in first-tier cities like Beijing, Shanghai and Guangzhou, more than 90 per cent of vaginal births are pain-free, but it is still not a common option for the rest of the mainland, according to Liu.
“It’s because the ordinary public and some medical staff don’t have a correct perception of painless delivery. It also couldn’t be rolled out widely due to a shortage of anaesthesiologists and midwives,” she said.
“In the past, hospitals weren’t motivated to do it as it would add to the workload of anaesthesiologists and they were not pushed by authorities to do that.”
Epidural injections involve the administration of an anaesthetic or painkiller to the epidural space around the spinal cord. They usually completely eliminate pain in childbirth, although that is not guaranteed; nevertheless, “painless delivery” is used as a synonym for the procedure.
The cost of painless delivery, which can range from hundreds of yuan to more than 2,000 yuan (US$289), is also not covered by the mainland’s public medical insurance scheme.
Rates of painless delivery vary across China, from a relatively high 38 per cent of births in the eastern region, to as low as 1 per cent in northwestern areas. The national average is 10 per cent, according to a survey by news portal People.com.cn.