VISITING Working as a nurse in 1946- 1948 in China, I had been impressed with the importance of midwifery as an essential part of nursing in that part of the world. In 1948 I returned home and shortly thereafter enrolled at

HEALTH TEAMS Maternity Center Association to fulfill my hopes to become a midwife. With- IN THE PEOPLE’S

REPUBLIC OF

CHINA, 1972

Margaret Stanley C.N.M., B.A., M.N., M.P.H.

out midwifery, I had been unprepared to provide for needs of maternity patients. Understanding some of the health problems of Chinese mothers and babies was forced upon me by experiences such as seeing mothers die in childbirth (often from osteomalacia or other forms of malnutrition), fre- quently hearing the mourning cries of bereavement at the death of mothers and babies, and being beseeched by parents to take their unwanted babies because they could neither feed nor clothe them. Disease, malnutrition, famine, war-time refugee conditions, political power struggles, natural disas- ters all took their toll of lives and health.

In 1972, twenty-four years later, I returned to China as a visitor, where health as well as other aspects of life, has undergone revolutionary changes. It may be that the present goal of hea l th care for all of China’s 800,000,000 population (one quarter of the world’s people) will have more far reaching effects than any other facet of the Chinese revolution. In the span of one generation, Chinese society has cast off traditional social norms and embraced new ones: from maximum childbearing to two- or three-child families, from early to late mamage, from concubinage and pros- titution to their eradication, from rampant disease including venereal diseases, to preventive health measures and health care delivery systems with-

Journal of Nurse-Midwifery / 14

out charge (expenses are usually cov- ered by insurance at the place of employment and amounting to less than one U.S. dollar per year) in rural as well as urban areas, from a “diet of bitterness” for the 85 percent peasant population to an all pervasive slogan “Serve the People”, from a rich-poor contrast to the world‘s most egalitar- ian living standards. Perhaps the great-

ten weeks of maternity leave from work. It is rare for a mother not to breastfeed her baby. Nursing mothers work seven hours a day in their fac- tory jobs with the same pay as if they were working eight hours. Creches and nurseries in the factory itself provide childcare for the working mothers and an opportu&y for the mothers to continue to breast feed their babies.

est results already realized have come about in the lives of women, the mothers. It is staggering to think of the possibilities of the energy released from a people no longer under the oppression of the sicknesses of the old society - and that energy now being directed to serve the needs of society.

Every school, factory, or farm commune I visited had its health teams’ At the Wuhan I talked to a gynecologist in the Clinic serving factory workers. He told me that physical examinations are given to

Birth control instructions are given postpartum to husbands as well as to wives. Methods available are: Twenty- two-day birth control pills which may be taken seven-eight years at a monthly pills which can be taken three or four years at a time with little side effects, monthly injections, and IUD’s inserted in hospitals. If an unwanted pregnancy occurs, an abortion may be requested by the pregnant woman and it will be done in the hospital. Suction method is used for abortions.

workers once a year. Married women are given routine Pap smears, and when pregnant, are seen monthly by the maternity staff until the seventh month; then twice in the eighth month; then weekly until delivery. X-rays are done if needed. Hemoglo- bin, urinalysis, and blood pressure are recorded routinely. Special foods avail- able during pregnancy include eggs, meat, fruit, vegetables, and weight gain during pregnancy is usually about twelve pounds.

If a factory worker goes into labor while at work, she is taken to the hospital by ambulance; if at home, she can go in a taxi. No anesthesia is used in normal deliveries and most deliv- eries are normal. Deliveries are done in the factory hospitals by physicians or mid wives. Post part u m hospitalization is usually four days. There are eight to

On the wall of the clinic above us hung a slogan in large Chinese charac- ters. The gynecologist drew my atten- tion to it while the interpreter translated: “Anarchism in giving birth to babies will not do. People should have planned families”.

At a farm near Shanghai where I visited a Clinic, I interviewed the mid- wife on duty. Eighty percent of the women aged twenty-five through forty years of age (considered the childbear- ing group) in her care use some form of birth control.

Abortions are done by midwives with electric vacuum aspirators. Babies are delivered by midwives, and IUD’s are inserted by them in the Maternity Department of the Commune Hos- pital. The age of women having first babies is usually twenty-five or twentysix years.

15 / Summer 1973. Vol. XVIII, No. 2

Midwives work as one member of a team of health workers including physicians with Westem-type scientific training, traditional Chinese doctors such as herbalists and acupuncturists, nurses, laboratory technicians, phar- macists, dentists, sanitarians, and “barefoot doctors.” The monthly salary of a midwife with advanced experience is usually about seventy- five yuan ($30.00). (This pay figure is misleading or meaningless unless accompanied by some indication of rent and food costs. Rent for an apart- ment for a family amounts to about four yuan a month.)

In the Clinic of a farm commune near Sian, the midwife told me that midwives usually deliver the babies. The age of mothers at birth of first babies may be twenty-four, twenty- five, or as old as thirty. After thirty, it is not usual t o have more children. “Barefoot doctors,” trained especially for the work, go to homes to teach birth control.

One of my visiting group remarked that China seems to be unique in the lack of extra marital pregancies. Our hosts answered that there are many opportunities available to women in the new society besides early marriage and child bearing. Since 1949 em- phasis has been upon semng the needs of the people. There is hard work and physical exercise. Two child families are the rule. “However, if both of the first two are daughters, then perhaps a family will wish to have a third baby - ason.”

At the Maternity Hospital of Peking the host midwife told me that this hospital of gynecology and obstet- rics was established in 1956. Five thousand births take place annually in it. There are two departments: Obstet-

rics, with 180 beds, and Gynecology with seventy beds.

Doctors, midwives, nurses, alto- gether make up the medical staff of 224, only one being a man. In addition to clinical work in the hospital, the staff sends teams to Clinics in factories and communes. I t also trains students and carries out research. Chinese and Western style medical practices are integrated. In selected surgery, acu- puncture is often used. In other cases, other types of anesthesia may be chosen. In prevention, family planning and Pap smears are emphasized.

A midwife took me to see a normal delivery of a thirty-five year old mother who had one seven-year- old daughter. The baby was born one hour after her arrival in the hospital - another girl. I sensed no tension in the room during the delivery, nor did I note any tension in other parts of the hospital. The staff seemed busy, com- petent, and efficient.

Pitocin was given the mother after delivery. The baby was shown the mother, then taken to the nursery immediately after delivery. The placenta was examined and found intact. There were no tears or bleed- ing. The midwife had provided a con- trolled delivery.

I saw a Cesarean Section done on a mother who was thirty-one years old. I t was her first baby. Surgery was deemed necessary because of cephalo- pelvic disproportions. Eight acupunc- ture needles were inserted: two in each leg and two in each side of the abdomen. Some medication was painted on the peritoneum to reduce pain not controlled by the acupunc- ture needles, after the incision was made. The mother conversed with her attendants (midwives, surgeon, and

Journal of Nurse-Midwifery 1 16

nurses) in the delivery room. The midwife tended the baby, taking it from the surgeon as soon as it was delivered. The mother waved, smiling, as she left the operating room.

Suction was used at the abortion I saw, and the procedure took about fifteen minutes from first to last. Tissue examination was done immedi- ately and a pregnancy of forty days confirmed. Then the specimen was sent t o the Pathology Laboratory. I was told that abortions are done up to three months and not after four. There was no charge to the patient. In a room adjacent to the room where the abortion was done, women were resting in beds in a large ward for one or two hours after their abortions before going home. I also saw a tuba1 ligation performed in the hospital’s surgical theatre. Acupuncture anes- thesia was used.

Women’s roles in China have undergone changes from the days of subservience before 1949. Legally, they have been provided egalitarian rights. Culturally, they have been given

many opportunities for work and pro- fessional careers. The present genera- tion of child-bearing women is the first to have reached maturity since the inception of health care on a country- wide scale. The children of the present child-bearing generation will not only have the advantages of health care for themselves, but the advantages of having had mothers and fathers who had health care. It is a far cry from the condition of Chinese women in the 1940’s. Whereas the generations of the past have passed on disease and suffer- ing generation after generation, it seems possible that the present healthy mothers and their offspring will be the bearers of a strong healthy people not only in their own time but also in future generations.

Traditionally, wishes for Health, Longevity, and Happiness have been typical Chinese greetings to loved ones. Health, longevity, and happiness are prevailing in China more than ever before, but not as the result of wish- ing - rather, as the result of hard work toward a goal of good health.

(Photo by the author)

17 1 Summer 1973, Vol. XVIII, No . 2

BIBLIOGRAPHY - READINGS ON CHINA

American Friends Service Committee. Experiment Without Precedent: Some Quaker Observations on China Today. Philadelphia, 1972.

Dimond, E. Grey. “Acupuncture Anesthesia,” Journal of the American Medical Association, Vol. 218, No. 10 (December 6,1971), 1558-1563.

“Family Planning in the People’s Re- public of China,” International Plan- ned Parenthood Federation Medical Bulletin (June 1972).

Horn, J.S. Away with All Pests: An English Surgeon in People’s China 1954-1 969. New York: Monthly Review Press, 197 1.

Quinn, J.R. (ed.). Medicine and Public Health in the People’s Republic of China. (DHEW Publication NIH 72-67; Geographic Health Studies Program) Washington, D.C.: U.S. Gov- ernment Printing Office, 1972.

“Science and Medicine in the People’s Republic of China,” Ash (New York), No. 26 (Summer 1972).

Sidel, V.W. “Barefoot Doctors of the People’s Republic of China,” New England Journal ofMedicine, Vol. 286 (June 15,1972), 1292-1300.

Stanley, Margaret. “China: Then and Now,” American Journal of Nursing, Vol. 72, No. 12 (December 1972).

. “Hospital Beds - North China Style,” American Journal of Nursing, Vol. 50, No. 2 (February 1950).

Victor Bostrum Fund Committee and Population Crisis Committee. Popuh- tion and Family Planning in the People’s Republic of China. Washing- ton, D.C.: The Committee, 1971.

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