PhD student Jin Meng writes about her experience of developing pre-eclampsia during first child-birth, and reflects on how cultural differences affect her pregnancy experience as a Chinese expat living in the UK.
A Different Childbirth Culture in China
My name is Jin Meng, a Chinese expat living in the UK. In my country, the culture of giving birth and post-natal care is very different. Chinese women tend to accommodate their lifestyles to pregnancy and so are more careful in many ways. Our journey of becoming a mum starts several months before getting pregnant.
Anyone who is financially capable and reasonably aware of the potential risks of childbirth has pre-pregnancy health check-ups first. Most couples adjust their diets, adopt a healthy lifestyle, and start taking supplement tablets as soon as they decide to expand their family. I was shocked when my midwife told me that some of her ladies were still smoking while pregnant because “they just can’t stop!” This would be unimaginable in the culture I grew up with. Even men stay away from alcohol and cigarettes during the period of preparation for conception (bei-yun qi) in China.
As for post-natal care, we believe that the 42 days after childbirth are vital for recovery and re-establishing overall well-being. That is why we must have a postpartum confinement (yue-zi), during which women usually rest in bed, have special meals which are supposed to help recovery and breastfeeding, avoid social activities and exposure to cold drafts.
When my friend made me some post-natal nourishment soup, his mum gave him a list of ingredients that he can use and asked him to stick to her instructions strictly. According to the philosophy of traditional Chinese medicine, every ingredient is either of a yin or yang nature and hence bears a “cold” or “warm” character (not in the sense of temperature). What post-natal women need is mild, nourishing and warm ingredients. For example, choy sum was the only green vegetable my friend put in the dish because most green vegetables are considered “cold”. He accepted no other substitutes even though he had to spend quite a while searching in Chinese shops. Chinese people take it seriously and care about every detail when it comes to post-natal care. In what seems like a sharp contrast British people are more likely to take it easy and carry on their life as usual, “You are only pregnant!” or “you’ve only had a baby!”
My roller-coaster experience in the UK
I had always been confident that I would be able to have a straightforward natural birth. I used to be a dancer for ten years and had always been good at sports, and therefore had good body strength. Also, I did not have any major health issues and no inherited diseases running in my family. The only concerns my midwife had were that my body mass index (BMI) was a bit low and my low iron level. But these easily resolve with some iron tablets and a balanced diet.
Having a few good friends in China experiencing pregnancy at the same time was a blessing. Living in different countries allowed us to share varying perspectives and experiences in pregnancy. All my friends in China had hospital appointments and scans far more often than me, which I did not mind because I was aware of the cultural difference between Chinese and British people when it comes to pregnancy and post-natal care.
The only thing that raised my eyebrows was that an oral glucose tolerance test (OGTT) is one of the basic tests for all pregnant women in China, whereas in the UK, as the NHS website says (NHS 2019), you are not offered this screening test unless any of the following factors apply to you:
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- your body mass index (BMI) is above 30
- you previously had a baby who weighed 4.5kg (10lb) or more at birth
- you had gestational diabetes in a previous pregnancy
- 1 of your parents or siblings has diabetes
- you are of south Asian, Black, African-Caribbean or Middle Eastern origin (even if you were born in the UK)
Based on my concern about the high incidence of gestational diabetes among Chinese women, I requested the test and expressed my worry to my midwife. The response was not surprising, “Your BMI is low, and you are not south Asian. It is not necessary.” “But my friends in China all had the test.” “You will be fine.” I did not insist because I was told that I am not of one of the listed ethnicity groups and I did not look like someone who would be high risk at first sight.
As my pregnancy came to the 3rd trimester, something started bothering me. I had severe pain underneath my ribcage every day and sometimes the pain even woke me up in the middle of night. I spoke with my midwife a few times about it, and our discussions always ended up with her telling me: “It is just a muscle pain because of your fast expanding uterus,” or “It is because you are quite petite and your body is carrying extra weight.” I was assured by the confidence of my midwife to an extent that I neglected a few other symptoms that should have rung the alarm. I saw a flashing light in front of my eyes once and convinced myself maybe I did not see anything, and when I did mention it to my midwife, she gave me a similar response. I felt extremely thirsty in the evening and needed to drink a whole bottle of water over night. My nose was stuffed all the time especially in the evening time, and so on.
Even though suffering from all kinds of discomfort, I remained optimistic and confident about my labour thanks to unawareness of my actual condition and the assurance that my midwife had been giving me. During my last midwife appointment, protein was found in my urine sample, which did not raise any attention either. My tummy was measuring slightly large for dates at 38+ weeks and I was referred to Day Assessment for an extra scan. Yet the doctor said the fluid volume was normal, so I was discharged.
It was a horrible shock to learn about an unexpected severe condition on my labour day. My blood pressure elevated on admission and protein was noted in my urine again. Based on this situation, I was transferred to the labour ward from the birth centre. I ended up having an emergency Caesarean section with significant complications, which was the last thing I had expected to happen in my life. I narrowly escaped completely life-altering consequences during the surgery. After staying a day in the high dependency unit for monitoring, my status stabilised. I was informed that it was very likely that I had gestational diabetes during my pregnancy and I had developed pre-eclampsia. At that moment, I just felt extremely thankful for the safe arrival of my son and did not trouble myself more with my major complications.
Worries and Hopes in My Second Pregnancy
After almost two years, the dramatic experience of my first pregnancy has finally sunk in. As a Christian, looking back over my experience of pregnancy and childbirth and seeing God’s plan unfold in my life is both comforting and strengthening. I have embraced the changes my last pregnancy has brought in my life. Being pregnant with my second baby now, I cannot say that the past did not give me any burden. As my second pregnancy progresses, though thankfully uneventful so far, I gradually realised how much my previous condition and experience of a caesarean section due to pre-eclampsia had limited my birth options, thus affecting my confidence towards a smooth delivery and impacting future growth plans for my family.
I recently had my first consulting session with a doctor regarding my current pregnancy experience and birth plan. The focal point of our discussion was my birth options after the previous caesarean section. I was informed of different advantages and risks for both vaginal birth after caesarean (VBAC) and elective repeat caesarean section (ERCS). Before the meeting, I had lost my confidence in trying to have a VBAC, even though my doctor said I still have that option. I was almost certain that I would like an ERCS this time.
However, at the meeting, I learnt that due to my previous condition, an ERCS would not be as simple as I imagined and would carry more risks than the first time. As the risks increase with each caesarean section, I was advised to avoid another one if possible if I plan to have more than two babies in the future. I felt overwhelmed by facing both potential intimidating medical risks and decisions to make regarding our family dream of having at least three children.
I am still thankful for my midwife’s encouraging words and the way the hospital staff handled my labour emergency once my situation was recognised last time, but I must admit that I felt deep regret about my undiagnosed condition, due to assumptions based on my ethnicity group and petite stature, and the long-term impact this experience has had on my physical as well as mental well-being and future life. Giving birth is beyond simply a medical experience. It has changed my life profoundly on every level.
I became a more deliberate, cautious and firm patient this time, especially as a Chinese living in the UK. I try to read every piece of information I can regarding my medical concerns and I am not satisfied until I feel fully convinced by the doctors’ explanations and suggestions in making any decisions. I even found myself more sceptical in many other arenas of life! Questioning “authoritative” voices does not seem as intimidating to me anymore if I am trying to be responsible for myself. To be realistic, even though my husband and I dreamed of having a big family, we are now mentally prepared that this could be my last pregnancy as well due to the potential risks.
Spiritually, as Christians we trust in God’s sovereignty in all circumstances. Although on the human level it is right to ask, “couldn’t things have been handled differently?”, we are genuinely thankful for what we have now. As a new family, we experienced great blessings and found joy even in the most challenging seasons of life, which made us know God and each other deeper and treasure our life and family even more.
References
NHS. 2019. “Overview: Gestational diabetes.” Last reviewed August 06, 2019. https://www.nhs.uk/conditions/gestational-diabetes/.
About the Author
Jin Meng is a PhD candidate at the centre for the study of World Christianity of the University of Edinburgh. Jin’s research interests include East Asian Christian theology, Chinese Christianity, Christian spirituality, Confucianism, inter-faith dialogue and comparative theology. Her email is s1341497@ed.ac.uk.
