Educated by cesarean

Throughout late August and September 1, Liu Lihua (pseudonym), a doctor with the obstetrics and gynecology department of the Beijing Jishuitan Hospital, entered the operating theater at 7:30 am and left at about 8:30 pm. Each day she spent 13 hours doing cesarean section operations required by pregnant women but most of them she thought were unnecessary.

Many of these women had requested that they have the operation between two and 21 days in advance of their due date so they could give birth before September 1, so that their children could be admitted to primary school on September 1 six years later.

According to China's Compulsory Education Law, amended in 2006, when children have reached the age of 6, their parents or other statutory guardians must send them to school. For children in areas with limited schooling options, the beginning of their formal education may be postponed to the age of 7.

The cut off date for admission is September 1, meaning that if their children are born after September 1, they will be admitted to primary school one year later and some parents believe this will be a year of wasted time, according to Li Jiafu, an obstetrics and gynecology specialist with the Zhongnan Hospital of Wuhan University in Hubei Province.

Risking health for time

Every year, during this period, Liu sees a peak in cesarean sections. This situation also happens every year at Li's hospital.

"At other times, only seven women need to receive the operation a day. But during this period, the number doubles and sometimes triples each day. And 90 percent of them have demanded the operation," Li said. "At this time, pregnant women are everywhere in our hospital, which has put extreme pressure on the hospital's capacity and the staff workload."

"It's also riskier. In all the phases of operations, including anesthesia, risks exist," Liu said.

In most cases, medical staff try to persuade pregnant women to choose standard childbirth. Compared with cesarean sections, standard childbirths make infants' brains and lungs grow stronger due to the pressure of passing through birth canals. Cesarean sections on the other hand, can leave three out of every 1,000 children at risk of breathing difficulties, according to Li.

"The risks last for a short period after the infants are born. In the long run, cesarean sections have little influence on their physical and mental health," Li said.

Mothers face even greater health risks. Cesarean section operations can create scar tissue around the pelvis causing chronic pain, and can also create scar tissue leading to obstructions in the intestines.

These problems can take a long time to recover from, during which time the mothers may have difficulty eating, Liu said.

"The operation is not good for the mother or the infants. But some parents can not understand our explanations and they insist on receiving the operation," she said. "Doctors have an obligation to inform them of the risks but should respect the patients' choices."

Generally, cesarean sections are recommended for women who are above 35 years old or women who have hypertension or heart diseases, Li said. Women who receive cesarean sections should fulfill strict conditions, including being pregnant for 39 weeks at the time of the operation. But frequently, there are cases where the women do not meet these conditions.

"Some parents are very stubborn. If doctors disagree, they will look to health authority figures to put pressure on doctors or will choose another hospital," Li said, adding that few people hesitate to consider the cost of a cesarean section, which is 8,000 ($1,307) to 10,000 yuan per person in his hospital, twice a standard birth.

A 2007 World Health Organization (WHO) bulletin on cesarean section rates in China indicated that this profit motive was another factor driving up the number of cesarean sections, indicating that doctors may be reluctant to strongly dissuade parents from choosing them.