Given the significant differences in the healthcare delivery system between China and our respective Western countries, one can easily imagine that the experience of having a baby in China is quite different than it is back home, especially outside the three major international cities of Shanghai, Beijing, and Guangzhou. Within these three aforementioned cities, the demand for more modern levels of care with Western trained doctors who can communicate freely in English has spawned an outgrowth of boutique Western maternity hospitals that are comparable in quality to—and often exceedingly costlier than—what one would expect to find and pay back home. One such example of a high-priced boutique Western maternity hospital would be Care Bay in Shanghai, which boasts a “luxurious experience” and professional services that include “maternity yoga.”
The vast majority of foreign teachers who live outside a first-tier international city will have little choice but to rely on the maternity services provided in second- and third-tier cities, so this section will primarily focus on that experience as we feel it represents what most foreign couples and foreign male teachers married to Chinese women can expect. Obviously, most of this will not pertain to Western employees of international companies who have comprehensive medical insurance that covers maternity expenses and can afford to commute to and from Shanghai or Hong Kong for prenatal care and delivery.
Routine and free prenatal care is available in second- and third-tier cities but it is limited. Typically what happens is that a pregnant woman will receive a red prenatal care book from the hospital early in her pregnancy and this book is used to track and record nominal data such as vital signs and weight, as well as the results of a cursory gynecological examination to rule out obvious signs of colpopathy (vaginal disease). The frequency of these visits is expected to increase from monthly to biweekly and finally to weekly as gestation progresses from the first six months, six to eight months, and finally from eight months to delivery, respectively. For an additional 100 yuan, the patient can request additional blood and urine lab tests but these will typically not be ordered unless the gynecological exam reveals some abnormality or the expectant mother presents with a specific complaint. Often, the gynecologist will suggest that the patient purchase “prenatal care vitamins” for an additional 100 yuan.
At 20 weeks of gestation, the mother may elect to have an ultrasound ostensibly to rule out any gross physical abnormalities but, more commonly than not, to determine gender. Technically, it is illegal for the ultrasound technician and doctor to reveal the gender of the fetus: However, anecdotal evidence suggests that the determination of a male fetus is generally confirmed via some unofficial congratulatory remark while the determination of a female fetus remains undisclosed. In addition, in the absence of clear confirmation either way, there are rumors that fetal gender can be ascertained for the right price.
Of considerable concern to international healthcare professionals is the alarming increase in the number of cesarean deliveries being performed in China: While C-sections accounted for only 5 percent of all births in the 1970s, that number jumped to 50% in 2007 and exceeds 60 percent at many urban hospitals throughout mainland China. These statistics far exceed the standard rate of 10 to 15 percent established by the WHO (China Daily, 2007). However, the popularity of C-section deliveries across mainland China appears to be part of an international trend. Recent statistics indicate that in 2006 the rate of C-section deliveries in the United States had also risen to about one-third (31.6 percent) of all births, representing a 50 percent increase over the past decade (Rubin, 2008). The reasons cited for this increase include greater convenience and higher fees for the doctor, and the avoidance of labor pain for the mother. As a cesarean section is a major surgical procedure, there is consensus among healthcare professionals that a vaginal delivery will generally be safer for mothers unless there is a complication or clear indication for the procedure, such as insufficient pelvic space. The total cost of a C-section delivery will run anywhere from approximately 5,000 to 7,000 yuan (USD $730 to $1022), depending on location and hospital, while total expenses for a vaginal delivery are typically around 2,000 to 3,000 yuan (USD $292 to $438; China Daily, 2007).
Another predominant concern among foreigners is the ability of mainland Chinese physicians to respond to neonatal complications or emergencies. This appears to be a hit or miss type of proposition and will vary considerably depending on the hospital and doctor.
The following is an excerpt from a report shared by a foreign teacher in China regarding his experiences with his Chinese wife’s delivery:
The hospital, in spite of its reputation as the best in the city, did not inspire confidence. The floors were scuffed and unclean looking, the walls were dirty, and the hospital was undergoing construction within.
Inside the glass-windowed room labeled “Clean Room,” a nurse slurping a bowl of noodles sat next to a doctor calmly smoking a cigarette.
At that time, there was also a media exposé of cases involving contaminated needles and fake plasma being sold to hospitals in our region that further failed to bolster my confidence.
The doctors determined that a cesarean delivery was called for and my wife reported to the hospital the day before the operation. In China, a natural delivery is price-capped while a surgical procedure is priced higher; some say the use of C-sections is overprescribed. A similar criticism is made of American doctors too. In our case, we believe the procedure was correctly prescribed.
We paid for a private room to ensure privacy and accommodate visiting relatives and friends. The room was absent any medical equipment similar to what you might find in western hospitals, (monitoring equipment, etc.) It was pretty much a one-star hotel room in a hospital (without a private bathroom).
The hospital had no cafeteria or meal service. Patients were expected to have meals delivered by family members. In our region, it is still possible to see elderly visitors bringing live turtles to patients during hospital visits. Fresh turtle blood is considered a tremendous tonic for the sick.
Patients are not provided hospital gowns nor are there any to provide. Patients wear street clothes or their own night clothes, even into surgery.
My wife’s surgery was scheduled for 12:30 p.m., so I arrived at the hospital at 11:00. Upon my arrival, I found out that the surgery had been suddenly and inexplicably moved up. Complete strangers were shouting at me when I arrived outside the hospital—gesturing to me to go in. Once inside, others were directing me, urgently, into the surgery ward. She was being wheeled out of the surgery room when I arrived.
The baby had already been transported (accompanied by grandma) to our room. The baby had been cleaned and then completely covered in a white powder intended to disinfect and protect the skin.
Parents have a great concern about newborn theft or swaps in hospitals and, consequently, babies are never out of the family members' sight. If a doctor or nurse asks to remove the baby for some reason, they will be refused unless accompanied by a family member.
After checking on my wife, I dashed downstairs to check on the baby. After a quick count of appendages offered initial reassurance, I asked if an APGAR (Appearance, Pulse, Grimace, Activity, Respiration) test had been done. After some initial translation, I was told that an APGAR had been performed and that the score was a perfect ten.
My wife then arrived on the scene. The baby was all of about thirty minutes old when he developed a breathing abnormality. At the end of each breath, he developed a trailing gasping sound that increased in volume and duration minute by minute.
The doctors and nurses were huddled in consultation after we pointed out this alarming development to them. Finally, they told us there was nothing they could do. We would have to transport the baby to a nearby pediatric hospital if we wanted care for the newborn.
At this point, granny—my mother-in-law and a retired Chinese doctor—stepped in and declared that nothing was wrong with the baby except that he just needed feeding. This is the same retired medical doctor who warned me to stop rubbing a cold can of cola on top of my head during the summer lest I would “freeze the blood to my brain”.
She said the baby would be endangered by being transported and that when we got to a pediatric hospital, we’d end up subjecting the baby to tests and procedures that would be of no use. So (with misgivings on my part), we went with the granny option as our first try.
After his first feeding, the baby’s breathing irregularity disappeared: never to be heard from again.
My wife stayed in the hospital for a few days. During this period we discovered one area of unadulterated excellence in the hospital: the billing system. The billing system was modern, efficient, and prompt. We were delivered a fresh, crisp, itemized bill each and every morning, requiring immediate payment.
The entire cost of the hospital stay and surgery was about $5,000 RMB.
While I cannot say I was pleased throughout the process, I can report full satisfaction with the outcome: a healthy 10lb baby boy.
When a child is born to a foreigner in China, he has the choice of filing for Chinese citizenship for his child or registering that birth with his embassy, in which case the child would receive citizenship in the same country as his father: Dual-citizenship is not allowed.
Foreigners living in the three international cities in China will have the option of sending their child to an international school, while those who do not will usually elect to home-school their children and there are numerous resources on the Internet for doing so. A good place to start your search, especially for American families, is Jon's Homeschool Resources: it contains numerous articles and materials for teaching children at home with excellent links to many other useful resources. However, in the vast majority of cases, most foreigners married to Chinese women with children seem to return to their countries of origin well before the child ever reaches school age.