A Tale of Two Births

On the eve of Thanksgiving 2012, our little Xiaobao was born in Beijing’s Chaoyang District—the district that famously produces “Chaoyang Dama,” those indomitable neighborhood-watch aunties.

Four years later, on the eve of National Day in 2016, our little Xiaobei was born in Santa Clara County, in the San Francisco Bay Area of California—where nearly half the population are engineers.

Before Xiaobao was born, my wife—then just “Baoma,” Xiaobao’s mom—chose a C-section in tears after a doctor’s earnest warning. Before Xiaobei was born, my wife—having already been under the knife once and now promoted to “Beima,” Xiaobei’s mom—was encouraged so tirelessly by the doctors that she steeled herself for a natural birth and, giving it everything, pulled off a successful vaginal delivery. (By the attitude of Beijing hospitals, once you’ve had a C-section with the first child, natural birth is simply out of the question thereafter.) This essay briefly compares the similarities and differences between giving birth in Beijing and in Silicon Valley.

Hardware

The hospital where we were seen in the US was a large general hospital, Kaiser Permanente (KP for short)—similar to hospitals back home, serving the working masses. KP’s physical facilities blow away any Grade 3A hospital in Beijing: lovely surroundings, convenient parking, and a spotlessly clean, crisp interior. Both the delivery rooms and the postpartum rooms are private, with en-suite bathrooms and a full suite of vital-sign monitoring and life-support systems. The delivery room is enormous—seven or eight people inside and it doesn’t feel crowded in the least. There are hands-free hand-sanitizer dispensers at the doorway and throughout the room; doctors and nurses always sanitize their hands and pull on disposable gloves before entering. The disposable supplies are exhaustive—tissues, gloves, sanitary pads, underpads, ice packs, recyclable cotton blankets, and every manner of single-use medical tool. The IV system is electronic: the nurse types in a rate per minute and the fluid follows it exactly. A leather sofa bed is standard in both delivery and postpartum rooms; open it up at night and you have a comfortable bed. Both rooms are paperless—nurses work directly on the in-room computer and pull up every piece of the patient’s information.

There’s no queue for a delivery room (I’ve always wondered how a hospital this big manages with fewer than twenty of them). As soon as the doctor decides you meet the criteria for delivery, a room is arranged. We spent a day and a half in the delivery room. Within a few hours of the birth you’re moved to a postpartum room for another one to two days. The postpartum room is considerably smaller but equally complete; compared with the delivery room, it’s the difference between a standard room and a deluxe one.

By contrast, at Chaoyang Hospital, where Xiaobao was born—never mind anything else, in cleanliness and comfort it’s a world apart from KP. We pulled strings just to secure a guaranteed bed, so that we wouldn’t be left with no one to deliver the baby or have to live in the corridor afterward. Even so, for the entire run-up to the birth, until my wife was wheeled into the operating room, she could only lie on a gurney in the corridor. Of course, Beijing’s resources are stretched to the breaking point; it’s hardly fair to compare comfort levels without accounting for population density.

Another measure of cleanliness and comfort is whether a hospital makes you feel oppressed. Walk into a Beijing hospital and you know instantly that it’s a hospital: the air is thick with the reek of 84 disinfectant, the corridors are narrow, the benches cold—your nerves snap taut on contact. At KP, fresh air, spacious lobbies, and sofas and coffee tables everywhere put you at ease as if you were home.

I won’t belabor the rest of the hardware; everyone knows it—Chinese wards don’t stock tissues for you, let alone sofa beds.

That said, a night at KP is not cheap: $600. We stayed two nights, $1,200, though we shouldn’t be on the hook for much of it ourselves (the bill hasn’t arrived yet).

Chaoyang Hospital seems to run two or three hundred yuan a night (a shared double room).

On hardware, KP wins without contest.

Software

“Software” divides into two parts: the professional skill of the staff and their attitude toward the work.

When people complain about American healthcare, it’s most often about the skill level of the staff. Doctors are a lot like programmers: they too have to grind monsters, bank experience, and level up to improve their skills. China has a huge population base and scarce doctors—too much work, too few people. They work themselves to death every day, and even passively their experience shoots up like a runaway level bar. Here a doctor sees a few to a dozen patients a day; they’ll spend half an hour circling the same platitudes over a stye. Fewer cases pass through their hands, experience accrues slowly, and their competence with common conditions simply doesn’t grow.

Nurses are the same. Every nurse who came at us with a needle was nicknamed “Xu Sanduo” (after the doggedly persistent soldier of a hit Chinese TV drama)—one stick, two sticks, three sticks, four, and still no tears, still no blood. Sometimes it doesn’t feel like a needle prick so much as a dagger jab or a shiv. My wife suffered plenty this time: three stabs for a blood draw, and after each one went in it was poke forward, poke back, nudge left, wiggle right—just no blood. It was basically a game of chicken: whoever breaks first loses. (More than ten days on, the purple bruises on her arm are still alarming to look at.) Before the birth she needed a local anesthetic, and the clumsy anesthesiologist had to jab her back three times before it took; I was so anxious I nearly cried, and the whole ordeal had the frozen-time quality of a bad bout of constipation. A blood draw is small potatoes; anesthesia is not to be trifled with. Luckily, nothing went wrong in the end. The IV, set up right around the anesthesia, miraculously took in only two sticks—it felt like a gift from heaven.

After Xiaobei was born he had newborn jaundice, and they needed a heel-stick blood sample. Heel sticks are the easiest thing in the world: a stapler-like device, one squeeze, done. There’s no skill to it—after watching once I could have done it myself. A fresh-faced young lab tech was shaking before he’d even started, spreading his materials over half the bed with no method at all; he seemed more nervous than I was. Just as he was about to press the trigger, at the last moment he choked like the Chinese national soccer team, wiped the sweat from his forehead, and said timidly: “I’m a student—is that okay?” My wife was having none of it: no, we want a professional. Then his supervisor arrived, smiling and saying their students were excellent too, blah blah blah. My wife turned green, the bruises on her arm throbbing—this was the very nurse who’d stabbed her three times.

On professional skill, Chinese doctors and nurses win hands down. I spent over a decade being treated and examined in Beijing. Doctors there are steady, precise, and decisive; observation, listening, inquiry, and palpation settle most things, and what they can’t settle gets a lab test. Extremely efficient: a routine complaint is resolved in a single visit. Nurses always hit the vein first try; even the little intern girls don’t flinch.

Attitude is another world entirely. Beijing’s medical staff are worked so hard that they seem perpetually tight-faced and humorless. KP’s staff smile almost all the time—as if they’d been trained in that Confucian–Mencian dictum: “Treat the elders of others as your own elders; treat the young of others as your own young.” They’re attentive to how the patient feels and cheer you on. What moved me most was that during labor, an Indian intern doctor acted like a cheerleader, counting down loudly and passionately with every contraction (OK, push—ten, nine, … one, you’re doing great!) to rally my wife, more fired up than I was. That passion infected us both; if my wife pulled off the delivery, a big share of the credit belongs to her.

Another admirable thing about KP’s nurses is how hardworking they are—they do all the dirty, heavy work, and they tend to it roughly every hour, keeping the new mother clean and tidy at all times. On this point they’re vastly better than Chaoyang Hospital. As I recall, at Chaoyang Hospital (and many hospitals in Beijing) most of the dirty work has been outsourced to nursing aides, it’s often done late, and the family caregiver has to pick up the slack.

On staff skill, Chaoyang Hospital crushes KP; on attitude, KP leaves Chaoyang Hospital in the dust.

Mindset

The differences above can be closed as each side learns from the other. The difference in mindset is where Chinese hospitals have their work cut out for them.

First, the attitude toward natural birth. Chinese hospitals, the moment the mother’s condition is even slightly off, earnestly talk you into a C-section, because a C-section is simple (you won’t push for hours and get nowhere) and shifts less liability (natural birth is more uncertain, and you might end up with a difficult labor that turns into an emergency C-section anyway). It’s the classic move: if the worst is even possible, take the most cautious, middle-of-the-road path. American hospitals, so long as there’s a chance of natural birth, will push hard for it—prepare for the worst, but go for it.

Before labor, unless the father flatly refuses, doctors and nurses tirelessly encourage him to take part. During labor, once the back of the baby’s head appears, they have the mother touch it between pushes, further stoking and steeling her resolve. When the baby comes out safely, the doctor hands over the scissors and the father cuts the cord himself. Then, with almost no cleaning, the bloody, wrinkled baby is placed on the mother’s chest so the two can have skin-to-skin contact at the first possible moment. After a spell of cuddling, the nurse takes the baby away to be washed. Once cleaned and swaddled, the nurse immediately has the father hold the baby; when the mother has recovered a little, the swaddle is opened and she holds the baby for another round of skin-to-skin.

(I have no experience of natural birth in China, so I don’t know how it’s done there.)

Last, the emphasis on breastfeeding. I remember clearly that after Xiaobao was born, if the baby was hungry and the mother’s milk hadn’t come in, the nurse would proactively bring formula. KP’s doctors and nurses push breastfeeding relentlessly: milk or no milk, however the baby cries, they keep it at the breast, and no formula at all during the hospital stay. As a reward for breastfeeding, they send you home with a breast pump.