More talk in `breakward' West

Shanghai Star. 2005-05-19

OVER the Chinese New Year I returned with my then three-month-old son to Shanghai where I have been living on and off for the past two years. My pregnancy - like my son's young life - was a direct experiment in globalization. The first seven months were spent in Shanghai, while the last three including, of course, the birth itself, were spent in Canada.

The discrepancies between attitudes and practices surrounding childbirth in China and Canada were not what I expected and reveal much about cross cultural variation. In particular they highlight a striking difference in the relationship to technology and modernity that exists between "developed" and "developing" world.

Pre-natal care in Shanghai, at least at the top end of the market, is remarkably high-tech. My appointments consisted almost entirely of a series of tests which generally involved being strapped to one machine after the next. By the time I left China I had had at least half a dozen ultrasounds along with a host of screenings for almost every conceivable abnormality and disease.

Once in Canada I had the option of being under the care of an OB/Gyn, or, alternatively, I could try the relatively new system of midwifery. After careful consideration I chose the latter.

Traditionally, childbirth was an entirely female affair. Occurring in the privacy of the home, it was usually overseen by a midwife - a term which literally means "with woman" - who attended the mother through labour and birth.

With the rise of modern science and technology, pregnancy and childbirth became increasingly viewed as a medical procedure, which needed to be moved into hospitals and was best managed by professional - usually male - physicians. During this period midwifery was all but abolished.

The advantages of this trend are obvious. Childbirth is often dangerous and in the "natural" process many women and babies die. There is no doubt that the modern science of obstetrics has saved many lives.

Nevertheless, in the West, the influence of feminism coupled with an intensifying interest in holistic medicine led ever more women to reject the modern, high-tech approach to birth. Pregnancy, it is increasingly felt, is not a disease and - especially when no complications arise - should be radically demedicalized. The result has been a dramatic renewal in the practice of midwifery .

At first I was quite anxious that I would be unable to make the transition from the ultra high-tech care that I was receiving in a so called "developing" world to the seemingly much more traditional approach practised in the "developed" world. Moreover, I was enjoying my cyborgian pregnancy and had come to rely on the machines for comfort. When one morning in Shanghai I panicked that I could not feel the baby move I was much relieved to be immediately strapped up to monitors.

In contrast, my first midwife appointment lasted over an hour and there was not a single test. All we did was talk. Gradually, however I grew to appreciate the stress on communication which helped give me the feeling that I was a participant in a wondrous event rather than a patient undergoing a procedure.

Modern midwifery, at least as I experienced it, does not involve a rejection of technology. Midwives are well trained in the science of childbirth and, when the system works, they function alongside and in close collaboration with hospitals and doctors. Yet, their aim is to ensure that the mothers-to-be - not the doctors or hospitals - are in control.

In China, the demedicalization of childbirth has yet to take place. Perhaps this is due to a general trust in doctor's authority or to a desire to distance oneself from the traditional practices of the poor. It may also have something to do with a general enthusiasm for technology which is helping to push the country to the frontier of the global economy. Whatever the reason, the result is that though giving birth in Shanghai is safe, many women speak negatively about their experiences. Sometimes in order to go forward you have to learn from the past.

Copyright by Shanghai Star.