Motherhood in China comes with its own set of rules, many of which are cultural or based on certain medical perceptions. Besides traditions like “postnatal confinement,” also known as zuò yuèzi or sitting the month, Chinese mothers have long relied on caesarean birth as standard due to perceived safety concerns, auspicious birth date planning, family pressure, and of course overprotective mothers-in-law.

Or it could be simpler than that. According to Pang Ruyan, vice-president of the Chinese Maternal and Child Health Association, “the only reason the rate of C-sections is so high is that people expected to only have one child. They didn’t need to think about having another, or the risk of ruptures.” However, this is changing as many experienced mothers are choosing vaginal birth for their second child after the 2013 ending of the one-child policy.

VBAC, or vaginal birth after caesarean, is an increasingly common choice for Chinese mothers having their second child. According to the US-based think tank The National Center for Biotechnology Information (NCBI), China’s cesarean delivery rates reached a peak in 2010, with some of the highest rates in the world. Most cesareans were performed without a medical need for them. According to the same study, from 2007 to 2016, cesarean delivery rates at county-level and provincial-level hospitals decreased from 46 percent to 32 percent and 68 percent to 44 percent, respectively.

National and local government propaganda efforts which have strongly promoted natural birth, as well as the abolition of the one-child policy, has led this trend to continue, making vaginal births the norm in China. Many of these mothers had cesareans the first time around, but are looking to try VBAC.

Vaginal births have several advantages over cesareans, according to syndicated news outlet LiveScience. Besides shorter recovery times and less risk of infection, for some, vaginal birth allows for a more active role in delivery, which can create lifetime moments of bonding for mothers, partners, and babies. Most glaringly, mothers have a three times greater risk of death from C-sections than vaginal birth, mostly from blood clot issues.
Dr. Sahba Farhad from the Obstetrics and Gynecology Department at Beijing United Family Hospital told us; “Most maternal morbidity related to the trial of labor after a cesarean (TOLAC) occurs when a repeat cesarean delivery becomes necessary. Thus, VBAC is associated with fewer complications than an elective repeat cesarean delivery, whereas a failed TOLAC is associated with more complications. Consequently, the risk of maternal morbidity is related to a woman’s probability of achieving a VBAC. Women may decide after careful consultation with their doctor if they are appropriate candidates for a TOLAC.”

If you or a loved one are considering VBAC, there is a wealth of information online. Note that to be able to have a VBAC in China, you’ll need a “trial of labor after cesarean,” or TOLAC. All this means is that the mother can go into labor with the goal to deliver vaginally, but a C-section will be employed if there are complications. Nearly 4 out of 10 women who have a trial of labor during VBAC need to have a second C-section.

Photo: Adobe Photo Stock
This article appeared on p18 of beijingkids May 2018 issue

Rebirth after Childbirth

Labor and delivery is an amazing natural process that can also be a testing time for mothers, especially for those who experience postpartum depression (PPD). Very few people are ready to make themselves available to help mothers during these hardships. More often than not, those who help are those who also experienced difficulty in pregnancy, birth, or depression.

Alessia Chizzoniti and her husband Luigi moved to Beijing from their home country Italy seven years ago for work.  A few years later, the couple welcomed their first son. Though she had a healthy and happy pregnancy, Chizzoniti experienced a terrible delivery that was the exact opposite of what she wanted. Chizzoniti had an emergency Caesarean section, which resulted in psychological trauma. “It felt I was treated like a piece of meat.  But even after I was driven out of the surgery room, I wanted another child,” she said.

However, that feeling changed all of a sudden as she found herself crying every day in the hospital and not successfully breastfeeding her firstborn. The new mother felt that something was wrong, and that she needed help even though her baby was healthy and completely fine. At this testing time, only her husband was taking care of her. Soon after, Luigi soon realized that his wife had been experiencing PPD.

Chizzoniti decided to get breastfeeding help and mental health support. She found an Italy-based association named Innecesareo, an Italian word that means “unnecessary.” It focuses on informing women about the unnecessary procedures in pregnancy and birth and supports women who experience PPD. Currently, she volunteers for the organization, helping others when in Italy or online by collecting complaints and information for the website.

In Beijing, Chizzoniti joined playgroups where she started to realize that she was not the only mother who experienced a traumatizing delivery. That was when she started to meet some doulas, saying that she “felt passionate about becoming a doula” herself.

Doulas are experienced women who make sure that childbirth for mothers is a pleasant experience, and that the birth plan is honored. They also give advice to mothers about positioning and natural pain management, and also making the father part of the birthing process. Doulas also take care of the hospital paperwork.

Chizzoniti said that she had taken an online course by Childbirth International Training and Certification to become a doula and also as a special therapy to deal with her first traumatized childbirth. Along the way of studying the course, she got pregnant. This time she felt not only happiness but also a sense of rebirth.

The couple had a very clear birth plan and created a safe space for Chizzonti to have a vaginal birth after caesarean. “I had the rebirth I wished for, healing from my former birth experience,” she said. Her husband acted as her doula when birthing her second child. “Everything made sense to me after having that second birth. My second postpartum period was the opposite of my first,” revealing that she felt empowered by her newfound knowledge of being a doula herself.

The family went back to Italy three weeks after Chizzoniti gave birth to their second baby. Her breastfeeding was successful and baby wearing had given her free hands to run after her firstborn. The vaginal birth after caesarean (VBAC) gave the couple the confidence to have more kids, as they always wanted a big family.

Chizzoniti was elated to tell beijingkids she had finished the doula course just after her second delivery. That allowed her to attend births in Beijing and Italy, as well as to deliver postpartum assistance wherever she can. “Being a doula,” she said, “requires me to read the birthing mother during her intense moments. I know it’s painful for many mothers, but I believe being there to help them is the most beautiful part of helping with birth.”

The passion Chizzoniti has to help pregnant and postpartum mothers just radiated while she shared her experience. “Since I was a child, I had always wanted to help the people surrounding me.  It is my nature to be very empathetic,” said Chizzoniti, explaining that it is by becoming that someone for mothers who need emotional and psychological support that she provides a sense of rebirth in their most testing times.

Photos: Courtesy of Alessia Chizzoniti

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