Asian women and the C-section
CMAJ 1998;159:131
© 1998 Heather Kent
The preference of some Asian women to give birth via cesarean section has led to increasing C-section rates at British Columbia's Richmond Hospital. The hospital — in a Vancouver suburb with a large Asian population — is now "trying very hard to educate a different culture," says Caroline Porter, the program manager of obstetrics.
The different cultural expectations stem from the widespread "C-section culture" in Asian countries. Many women who had their first baby by C-section in Asia have been told that they will need to repeat the procedure for all subsequent births, explains Dr. Susan Kuo, a Richmond family physician who delivers babies at the hospital. About 70% of her patients are Chinese women and she has been working hard to dispel their perception that C-section is "easier" by explaining the higher risks associated with surgery. The problem is compounded by the estimated 30% of women giving birth at the hospital who were pregnant when they arrived in Canada, with some close to their delivery date.
Porter says that pain is "one of the biggest issues" confronting her nursing staff, 45% of whom are Asian-Canadian. In response, staff are trying, to "use anything at all" to help these women cope with natural births. Physicians are also very open to alternative methods such as aromatherapy that may be helpful during birth, she adds.
Porter says demands on hospital resources are significantly higher with the C-sections, which require a hospital stay of 4 to 5 days and care from at least 3 nurses, 2 physicians and a pediatrician. Kuo calls the impact on the hospital "really unfortunate," but says that while she tries to encourage women to attempt a vaginal delivery, many are "really anxious," and "when it comes down to it, as a doctor, you can only do so much if they refuse."
In an effort to change these cultural attitudes, the hospital runs prenatal classes using Mandarin- and Cantonese-speaking nurses, who reinforce the positive aspects of vaginal delivery. Kuo says that about 95% of her patients attend. "I insist on it," she says.
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