C-Section Rates Too High in China

By Dr. Lori Gore-Green / Obstetrics and Gynecology Physician

According to a commentary recently published in BJOG: An International Journal of Obstetrics and

Gynecology and summarized in an article completed for Science Daily, the rate of cesarean sections in

China is far too high and efforts need to be made to reduce the reliance on the procedure.

The research completed for the commentary indicates that, of the sixteen million babies born in 2010, approximately half of them were delivered

through cesarean section.

However, the article did acknowledge that the exact rate of births by cesarean section, but the literature

available on the topic in China indicates that the rate of C-sections could range anywhere between thirty

six percent and fifty eight percent.

Several reasons for the priority placed on cesarean sections are discussed. With the existing high

number of deliveries occurring in the nation, cesarean sections may simply be the preferred method, due to the advantages of managing an enormous volume of

births with limited resources.

There are also a series of financial incentives for hospitals and physicians who engage in cesarean

sections as opposed to traditional vaginal deliveries. Insurance is more willing to cover the costs of childbirth, if the baby is delivered by cesarean

section.

Physician and hospital revenues are also increased with the procedure as well; in addition, physician salaries are

often supplemented, based in patient volume and collections. In this sense, cesarean sections allow for a higher salary for physicians, as they collect more than

traditional vaginal deliveries.

Money also plays a role in the staffing influences over choosing cesarean sections as the preferred method of delivery. Staffing levels in China public hospitals are low and limited, due to government

regulation. Per one thousand people in the population, there is only one and a half nurses or

midwives.

As cesarean sections require less nursing hours when compared to vaginal deliveries, it makes sense

to pursue this avenue in the interest of staffing. Finally, training is varied and inconsistent in

obstetrics and gynecology in China; less than two percent of physicians complete a masters or PhD

level in their training.

There is also a factor of patient preference. Since the One Child Policy has been passed, mothers demand

perfect outcome on the one and only attempt, particularly in wards that don’t offer pain control,

epidurals or much nursing support.

Fundamentally, there is a fear of labor that inclines mothers towards cesarean sections. However, in

November, a less strict version of the One Child Policy is expected to go into action, which would allow for

the birth of a second child.

With the increased number of births would come an increased reliance on cesarean sections; therefore,

the commentary postulates that this will force medical professionals to return once more to

traditional vaginal deliveries, as to cut back on the risks in childbirth.