Supporting normal birth in China

11th December 2012

In July, I was delighted to be selected in an RCM ballot to attend the 7th International Conference on Normal Labour and Birth in Hangzhou, China. With my study leave granted and my visa obtained, I flew to Beijing and had a few days prior to the conference to acclimatise and see some of this vibrant city’s attractions.

On arrival at the conference, Rachel (the student midwife who had also won the ballot), Mervi and I set up the RCM Campaign for Normal Birth stand next to a forceps simulation model – talk about yin and yang! By the first coffee break, all the literature had been taken by eager Chinese midwives, students and lecturers who were keen to find out as much as they could about normal birth.

The next three days were full of inspiration as delegates related their countries’ endeavours to support normal labour and birth. It was fascinating to hear how midwives were changing practice in countries where normality had been subsumed by the medical model of birth and how these midwives and the women they cared for continued to stand up for and promote normality.

Hangzhou sculpture depicting birth

Hangzhou sculpture depicting birth

On the last day of the conference the baton was handed over to the Brazilians, who will be hosting it in 2014, and the following day we went to a midwifery-led unit in a hospital in Hangzhou - what an amazing experience. The hospital was like a busy train station; people everywhere, including policemen and security guards. We went to the maternity unit and met the HoM and team of midwives, who gave us a presentation on the work they do in the unit. They are working so hard to normalise birth in China, which has one of the highest CS rates in the world. 

The team were very welcoming and asked us about how they can continue to grow and support women. They have reduced their CS rate from 78% to 5% in the midwifery-led unit and their episiotomy rates from 88% in 2002 to 34% in 2012. They reported that they were publishing individual midwives’ episiotomy rates so that they could audit practice. Their normal birth rate was 93% and they were rightly proud of their achievement.

We were given a tour of their active birth room, which is kitted out with birthing stools, posters of labour and birth positions, food and extraordinary red striped pyjamas with a large open gusset. They explained the rationale behind these was driven by their women, to allow them a degree of modesty as they explained that Chinese women were different to Western women in their attitude to clothing during labour. It was also interesting to hear about how they are encouraging the use of water in labour as Chinese traditions – based on the elements fire, wood earth, water and metal – would normally not promote the use of water in labour as their belief is that it is to be avoided.

Currently, the women labour in the active birth room and are then transferred to a delivery room for lithotomy and sterile drapes in the second stage. We encouraged them to leave women in the active birth room and let the women give birth in that room instead of transferring, as they do at present. The HoM disclosed that she'd had one delivery in the active birth room and we supported her and her team to let the women give birth without moving them, so as not to interrupt the process of birth. It was such a privilege to have the opportunity to go to a Chinese midwifery-led unit and share their experiences. 

Midwives from the hospital's midwifery-led unit

Midwives from the hospital's midwifery-led unit

I returned home energised and in awe of the motivation of these midwives to improve the birth experience for women. It was a truly unforgettable and inspirational experience.

Clinical practice