LUCKY BIRTHDAY: Nurses at Xiangfan No.1 People's Hospital, Hubei Province, take care of nine babies born on August 8, 2008. Eight is considered a lucky number in China, so many women choose to have a cesarean section on that day (XINHUA)

Before shutting the car door, Zhang Yu made one last check to ensure she had everything she needed. The nine-and-a-half-month pregnant woman also brought a camcorder to film the upcoming birth, one she felt would be best carried out at a private hospital through cesarean section (C-section).

Zhang, a computer engineer in Beijing, believed a C-section could not go horribly wrong and offered the added bonus of being able to choose when the baby is born. Zhang didn't want to end up like her friend, whose baby came suddenly on a public holiday. As a result, doctors and nurses were pulled away from their dinner table for the delivery. Zhang felt haste carried risks and didn't want a similar experience. She had pre-selected her doctors and nurses, who were already waiting for her at the hospital with everything set up. Two hours later, her baby girl arrived on a beautiful day in May.

C-section is a surgical delivery method in which the baby is delivered through an incision made in the mother's abdomen. It is necessary when a natural delivery might put the mother, or the baby, at risk. Some common reasons for the procedure include fetal distress, abnormal presentation, dystocia and abnormal conditions in the mother.

In China, many women prefer C-section to natural childbirth. A recent online poll done by sohu.com, a major Internet portal in China, showed 76 percent of the 3,000 female respondents preferred C-section. Some 88.1 percent of those who preferred C-section said they were afraid that something might go wrong during labor.

Only 30.2 percent thought humans should not interfere with nature, whereas the rest thought C-section is technological progress and easier for women.

Early this year, the World Health Organization (WHO) released the result of a survey on maternal and pre-natal health of nine Asian countries during the period from 2007 to 2008, which shows China had a C-section rate of 46.2 percent. Of those, 11.7 percent were performed without a medical indication. Both rates in China were greater than those of other surveyed countries.

Change of mind

The way Chinese women deliver their kids has changed tremendously in the past three decades. An article on the website of the Beijing Public Health Information Center said before the 1980s, about 95 percent of women delivered babies naturally. In the 1980s, the percentage of C-section deliveries climbed to about 30 percent. The rate continued to rise thereafter. In most urban hospitals, the rate went to more than 40 percent. Additionally, in a small number of hospitals, it could be as high as 90 percent.

Gao Ling, a doctor in the Obstetrics & Gynecology Department of Amcare Women & Children's Hospital in Beijing described the changes in China Economic Weekly.

In the 1970s, doctors believed that a woman should have a natural delivery whenever possible. Back then, women engaged in more physical activities and babies usually had a lighter birth weight. Most of them were about 2.5 kg and they rarely weighed more than 3.5 kg. Expectant mothers delivered naturally even in case of dystocia or abnormal presentation, as long as they were not at serious risk. Some labors took two to three days. At night, Gao was frequently called into women's homes to help with childbirth.

C-section technology was not advanced at that time, and the surgery was quite risky for expectant mothers. In case of dystocia, doctors usually asked the family of an expectant mother whether to save the adult or the baby. Doctors usually would not recommend the procedure. The expectant mothers and their family members would not want a C-section either, for they thought it a horrible operation.

In the 1980s, C-sections became safer. In the meantime, the family-planning policy was implemented in China. A baby was a treasure for family members who feared any complications during birth. Many people thought that C-section would keep both the mother and the baby safe and healthy.

By then, the hospital Gao worked at also had a more scientific way to manage the obstetrics department. When labor exceeded a time limit, the doctors would usually intervene with aided-childbirth, and occasionally a C-section.

With the advance of medical technology as time went on, C-sections became more accepted by doctors. Many thought that in some cases, a C-section was better than aided-childbirth. But doctors or expectant mothers seldom requested a C-section unless they saw a medical need for it.

The current high C-section rate is, however, primarily caused by social factors, Gao said. Women request the procedure when they are afraid of pain or risks, want the baby to be born on a specific date or want the services of a famous doctor. With the development of medical science, some people who could not give birth now can, and many of them choose to deliver by C-section.

In some cases, many doctors, for fear of being sued, acquiesce when a mother requests a C-section. Medical disputes related to obstetrics accounted for 8.6 percent of all the nearly 6,000 medical disputes handled by the Beijing Health Law Society Medical Interceding Center over the past five years, reported Beijing Youth Daily in February. The center found that obstetrics was the third leading cause of medical disputes in Beijing during this period.

Some of Gao's analysis was echoed by a study published in the November 2009 issue of the Journal of Chinese Clinical Medicine. The paper analyzed the cause and effect of the rising C-section rate in the No.4 Hospital in Shijiazhuang City in north China's Hebei Province. It found that, during a 10-year period beginning in the mid-1990s, the C-section rate increased from 26.2 to 47.4 percent, while the percentage of C-sections on maternal request increased from 6.7 to 56.4 percent.