Doula course in Shanghai
I’ve spent over ten hours in my reasonably comfortable seat on board this brand new British Airways Dreamliner. I’ve watched three films that have made me laugh and have also had me in tears. I’ve tried to get some sleep at various points, although I was unable to get comfortable enough to do so, and now, finally, we are approaching Shanghai. It almost feels unreal and I think back to all the stories I was told as a little girl by my Dad, who at the age of only sixteen, sailed around the world for two years on a cargo ship. He told me about the amazing Shanghai Club, a British Gentleman’s club which reportedly had the longest bar in the world. He shared his excitement upon arriving in Shanghai, with his unspent wages burning a hole in his pockets after weeks at sea. Most sailors were keen to stay longer than the leave they were given and taste the life of a king in this commercial centre. Because of this, many sailors would wake up after a heavy night on the town, out at sea, hours away from Shanghai as ship captains had to resort to this unconventional recruitment technique to staff their ships, hence the name ‘Shanghaied’. I had seen old black and white photos of Shanghai from the late 1960s and I felt as if I were following in my Dad’s footsteps, returning to this oriental and mystical place. I was expecting road sweepers with conical hats, traditional Chinese architecture with multi-inclined roofs and hand-pulled rickshaws as the main mode of transport.
As the plane started descending, the view from my window was breath-taking. In the early morning mist over Shanghai, the tallest building in China, the Shanghai Tower, was stretching its steel structure above the clouds, and together with the other skyscrapers around it, formed a structure which can only be described as a giant futuristic Stonehenge. The lower to the ground we were getting, I started feeling like I was in an episode of the Hunger Games, as the rows of blocks of flat appeared, plotted out like domino bricks with only the same width between them as each building was wide. I know that Shanghai has a population of 24 million but I had not given any real thought on where all these people lived.
China is quite an intimidating country to arrive at and definitely not helped by having watched ‘Mr Robot’ and the antics of the fictional Black Army. The queue for immigration was long and slow moving but after half an hour, I was facing a female immigration officer who looked at me for what seemed ages, took my photo and stamped my passport. I had been allowed entry for seven days.
I was met at the airport by a young taxi-driver, holding a sign with my name on it. At this point, I had no idea how far the airport was from the flat I was staying in and as we exited the terminal building, the heat hit me. It was 8am in the morning and already 30 degrees Celsius which took me slightly by surprise. But I had arrived! I was in China! I was in Shanghai!
My journey here started when Francoise Freedman from the organisation Birthlight, contacted me earlier in 2016 asking if I would consider facilitating a doula course in China on their behalf. Birthlight, as their website says is “an educational charity promoting an integrated, holistic approach to pregnancy, birth and babyhood, using yoga techniques.” Since their popularity had grown at such an amazing speed in China, one of the instructors had requested countless times for a doula course to be organised. I felt extremely honoured to be asked by Francoise and after a meeting with her team, I agreed to run a trial course in September 2016. The course was to be held in Shanghai at Graceyoga hall and Grace herself was to be my interpreter.
I had communicated with Grace only via email and now I was in the back of a taxi, on my way to meet her in person. After about 15 minutes in the taxi, the driver’s phone rang and he passed it over to me. It was Grace who cheerfully welcomed me to Shanghai and told me that it would take around 45 minutes to get to her flat where she would meet me. I handed the phone back to the driver and spent the travelling time watching the passing scenery through the window. We were travelling over viaducts with some very complex interchanges and at times, I was holding my breath as we seemed so close to the cars around us. Row after row of blocks of flats, so close together with no open areas for children to play. This was, indeed, a far cry from my vision of Shanghai and I was acutely aware of how naive I had been. I guess it’s a bit like the romanticised vision of motherhood; the reality is not quite as rosy and wholesome as we think.
Finally, we come off the viaduct and we drive into the Xuhui District of Shanghai. The driver pulls into a small alley, gets out of the car and indicates that we have arrived at our destination. I get out of the back seat and my suitcase is plonked inside a gate by the driver, just at the entrance of an alley. I point towards the alley and ask: “Is this it?” and I get a nod and arm gesture to suggest I’m at the right place and then the taxi is gone.
I find it a big strange that Grace is not there to greet me, especially as I have no idea where I am or where she might be. I cross over the gate’s threshold to walk down the courtyard and can’t see any sign of anyone so I get the piece of paper out that I have with me with Grace’s address on. I can see 1412 on the building in front of me and I know that I need to get to 1414. An old man with a walking stick appears from the street and, on approaching me, he asks, in Chinese of course, what I can only assume means something along the lines of “are you lost?” So I explain and point to my piece of paper and he very kindly answers me extremely slowly, still in Chinese, where I need to go to get to this address. There’s a lot of pointing and instruction given with both walking stick and hands, so I thank him and have understood that I need to get out of this courtyard and take a left to find my destination.
Once out in the alley again, I turn to walk left, and I become aware that I am starting to feel the first impact of jet lag, when I hear someone calling my name. At the end of the alley is Grace on her electric scooter and her warm, sunny face is a welcoming sight. Together, we continue our walk down the alley and arrive at what is to be my home for the next six days. Grace has her ‘ayi’ (pronounced I-E) cleaning and preparing her small terraced house for my arrival, which consists of a small lounge, small sitting room and a bathroom downstairs. There is also a sleeping loft, reachable via a ladder and I’m grateful to see an air conditioning unit on the wall. An ‘ayi’, which means ‘ant’ in Chinese, is a maid or cleaning lady. Everyone has an ‘ayi’ in Shanghai, Grace explains, and sends her ayi on to clean the yoga studio and Grace’s own apartment above it.
I’m staying in a part of Shanghai called the French Concession which was a foreign concession in Shanghai for nearly 100 years. It is full of ‘foreigners’ as Grace explains to me and a very safe place. I settle in and we go out for lunch as we start planning for the course, which will start the day after tomorrow.
Monday morning, 9am and we are ready to start. It’s already over 30 degrees Celsius and the air conditioning units are throwing out a welcoming cool breeze. The group of five women that have turned up for the first ever BirthBliss Doula course as commissioned by Birthlight begins. Over the next four days, we share, listen, exchange, empathise, cry, laugh and celebrate together. My highlight of the week was our Chinese ‘hotpot’ we had for lunch on our last day together. Sitting in a circle, taking our time, talking about and sharing the same stuff women do all over the world every day. I could be in any country, amongst women, among sisters!
There was so much to explain and tell over the four days, about birth physiology, about pain management, about choices and basic human rights. Grace would often smile at me and say “in China, no human rights” and it hit home how incredibly lucky we are to be living in a part of the world where we can take these rights for granted.
On the other hand, these women were surprised that a woman in the UK would give birth and be out shopping the next day. “Why would anyone want to do that?” they’d ask me and I would explain the pressures of getting back to normal and getting on with life. In China, as in most Asian countries, there is a tradition of a lying-in period after childbirth, either dictated by tradition or by religion. I was told about expensive postnatal care centres as the modern answer to this Chinese tradition of zuoyuezi, costing between £8,000 and £68,000 for a month's stay. There is definitely a rising middle class in China that can afford these kind of prices as a number of these postnatal ‘hotels’ are popping up all over the place.
Antenatal preparation classes are not available to all pregnant women and if you are lucky enough to attend them, they are formal and practical but no questions are answered and no tea, cake and chatting takes place. Women often have no idea what happens during birth and there is no such thing as an ‘informed choice;’ realistically, there is mostly no choice at all. It is illegal for midwives and doctors to support women at home for births so homebirths are effectively banned. Women turn up at hospitals and simply do what the doctor says. I could argue that it’s not much different in the UK, but at least women have the right to decline procedures and medical staff need to have consent, which rarely happens in China.
I was quite shocked to learn that not only do women have vaginal examinations, but rectal examinations as well to measure their progress of labour. Yes, I know! I had to ask for clarification on this and I was told that this happens during labour as the doctor believe that they can better assess the position of the baby this way.
When we started talking about managing labour and the different options available to women, there was much confusion as to what medication was available and what impact, if any, the medication would have on the birth. They told me that women are told that if they want an epidural for pain management, it would need to be administered when they are around 2-3 centimetres dilated, as it would be too dangerous to try and administer an epidural once they were in established labour. The actual pain medication is injected when they are moved from the ‘waiting room’ to the ‘birthing room’. Women were also offered opiates, similar to pethidine and routine episiotomies are common practice.
I heard stories of how hospitals give away free formula samples and promote artificial feeding over breastfeeding. With no, or extremely little lactation support in the hospitals, and the message that ‘most women cannot make enough milk for their baby’, breastfeeding rates in China are some of the worst in the world. I found it unbelievable to hear that formula companies were allowed to run antenatal classes and also provide training to the hospital staff. The main message being that breastfeeding is for the lower classes and not as good as formula. As far as I understand, China has partially signed up to the WHO code but as long as formula companies are allowed to have the big influence they possess within the maternity system, little will change.
So, having spent four days with five amazing women, and six days with the amazing Grace, I board my early flight back to London. I’m full of gratitude and humbleness for being given this opportunity to share my experiences and knowledge whilst at the same time, learning so much myself. I’m proud to be leaving behind five newly established doulas, inspired and impatient to pass what they have learnt on to the women they come into contact with. A small beginning, from the grassroots, to help women in China, eventually bring about change themselves. I look forward to placing my feet on Chinese soil again in the future, to continue building a village of women who can support each other and help make the experience of birth and the postnatal period better for themselves, their babies and their families.
Birth Bliss Doula Services
Grace Zhou is hosting several courses in China in the coming months...