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In this episode, we’re going to talk with Ruth Greene, birth doula, Evidence Based Birth Pro Member, and Co-owner of Having a Baby in China Consulting Services, about the challenges of giving birth in a foreign country and how pregnancy and childbirth can unite us despite our unique cultural & lived experiences.

After the birth of her second baby in a local hospital in China, Ruth began volunteering to support other foreigners as they struggled to navigate an unfamiliar healthcare system. Ruth’s passion drove her to seek formal training as a doula and childbirth educator. In May 2022, Ruth partnered with the creators of havingababyinchina.com to open an official Chinese company that offers breastfeeding, doula, and consulting services. Ruth’s clients hail from every corner of the earth, from South Africa to Brazil, to England, to Iran, and, of course, China. No matter the cultural or personal background, Ruth considers it an absolute privilege to be invited into the sacred space of pregnancy and birth.

Ruth shares her own experiences giving birth in China and how she came to find herself immersed in birth work and making a career of helping similar families navigate the process themselves. Ruth highlights the many differences and unique cultural traditions around having a baby in China, like the Zuo Yue Zi, or the “sitting month.” Despite the differences, Ruth has found that experiences of pregnancy and birth unite us all. 

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Transcript

Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk with Ruth Greene, birth doula, Evidence Based Birth® pro member, and co-owner of Having a Baby in China Consulting Services, about the challenges of giving birth in a foreign country and how childbirth can unite us despite our different cultural and religious backgrounds.

Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. My name is Rebecca Dekker, pronouns she/her, and I will be your host for today’s episode. If there are any detailed content or trigger warnings that go along with this episode, we’ll post them in the description or show notes that go along with this episode. And now I’d like to introduce our honored guest. Today, I am so excited to welcome Ruth Greene, pronouns she/her, a birth doula, and the co-owner of Having a Baby in China Consulting Services.

After the birth of her second baby in 2012 in a local hospital in China, she began volunteering to support other foreigners around her as they struggled to navigate an unfamiliar system. Ruth’s passion drove her to seek formal training, and in 2017, she was certified by DONA International as a birth doula. She is currently dual-certifying as a doula and childbirth educator through Childbirth International. In May 2022, Ruth partnered with the creators of havingababyinchina.com to open an official Chinese company that offers breastfeeding, doula, and consulting services.

As someone from the US living in China, her clients hail from every corner of the earth, from South Africa to Brazil, to England, to Iran, and, of course, China. No matter the cultural or personal background, Ruth considers it an absolute privilege to be invited into the sacred space of pregnancy and birth. We are so thrilled that Ruth is joining us here today. Welcome to the Evidence Based Birth® Podcast.

Ruth Greene:

Thank you. I’m very happy to be here.

Rebecca Dekker:

Ruth, we have just been so excited to talk with you, and I was wondering if you could start by telling our listeners a little bit about your personal story and what it was like experiencing pregnancy in a foreign country.

Ruth Greene:

Yeah. Well, my husband and I moved to China in 2008, and in 2009, we became pregnant with our first child. And at that time, a lot of foreigners in our city went to a larger city, like Beijing or Shanghai, to give birth in a Tier 1 international hospital. And so, we just kind of took it as that was what we were going to do. That’s what people did. We had health insurance to cover the hospital costs of that, but someone that I worked with really encouraged me to look into the options locally. And there’s a lot of benefits of that, not having to travel in your third trimester and not having to live away from your partner while you wait for the birth and all those things.

So my daughter ended up being the first fully foreign baby born in this hospital. It was just this magical moment where there was a brand-new hospital, a private hospital that was really looking to use evidence-based techniques alongside a… I don’t even know how to explain it exactly. I call it a liaison service. It’s like a small clinic that they provide a nurse that provides translation and then they’ll even come pick you up and take you to the hospital, and they arrange all of the payments and everything.

And so, that put us at ease enough that we decided to take the risk of staying in our city. Yeah. So it was a local private hospital, so not a public hospital. And like I said, it was brand new. And up to, I’m trying to remember, I think around 24, 25 weeks, all of my prenatals would be done in the clinic. I should back up and say that hospital birth is the only option for a childbirth in China. So there are no birth centers. Home births are not supported by the system at all. And so, your three options are public, private local, or an international hospital, and most cities will only have either a public or a private hospital.

So, anyways, for the first few months, you go to a clinic or you can go directly to the hospital. And so, this little liaison service, they would bring the doctor to me, and I didn’t realize how privileged I was at the time. I had this really sweet doctor who had delivered babies, I think around the world. She talked about being in Africa and stuff, I don’t know, because there was a huge language barrier at the time, and then they would provide a nurse who would translate for us. And then starting around 24, 28 weeks, every single appointment, we would go all the way to the hospital and do the appointments there.

Rebecca Dekker:

Mm-hmm. Yeah. So what was the language barrier at that time? Did you speak Chinese Mandarin yet or not?

Ruth Greene:

So we had been here… I mean, by the time we came pregnant, we’d only been in country for 14 months. And I do remember, when I arrived, thinking… I’ve studied Spanish, right? I know people say… When you’re immersed in the country, you learn it so fast, and then go into a restaurant a couple days after we arrived, and this other American couple was hosting us, and the waitress came over and she said something, something, right? And I turned to the friend and I said, “What’d she say?” She’s like, “Oh, I don’t know. I’ve only been here a year.”

And it is really interesting. Chinese is an incredibly difficult language to learn. The reading is not phonetic. Well, it’s like 90% not phonetic, and so that if you’re used to being able to see signs and read them and sound them out in order to learn the language, that’s not an option. And so, I studied really, really hard my first year, I think even my second year. And so, I could understand maybe 30 or 40% of what was being said, but when you got into technical language of childbirth and such, it was way above my head.

But then the issue was then that the translator, her English was probably maybe only slightly better than my Chinese. And so, that goes into a little bit of the story of my second baby, is that I just became really frustrated with having to wait for the translator to translate things, and they would only… The doctors, everybody would pay attention to the translator and not to me. And I would sometimes just speak Chinese, with the little Chinese that I had, just so that they would pay attention to me, but then they would go off in Chinese, and that was way above my head.

So it was a bit difficult. And as far as if you go in, okay, blood pressure’s good, urine’s good, those things, as long as everything is fine, then it’s really not a problem, but if you have any extra questions, it’s really hard to get clear answers.

Rebecca Dekker:

Mm-hmm. So what happened? With that birth, did you feel like you had an… Was it a normal, healthy birth experience, or did you have any complications the first time?

Ruth Greene:

Yeah. I didn’t have any true complications. I think it was a pretty stereotypical, just kind of long-ish, and people talk about 36 and 48 hours. Not like that. So in China, they often really strongly encourage you to induce between 40 and 41 weeks. And so, I remember going to my 40-week appointment and them saying, “If you’re still pregnant in a week, then we’re going to do the induction,” and just kind of feeling crushed by that.

I really knew that I did not want an induction at that time. Online classes weren’t a big thing. And so, I had one book in English that somebody had sent me, and it was Bradley’s Husband-Coached Childbirth, and I read that thing and I was convinced, 100% convinced, of natural childbirth, and as long as I just relaxed enough, then everything would be fine, and I knew I didn’t want to have an induction. And so, I felt like, “Ugh, what am I going to do?”

We were also running into struggles with paperwork. So when we were pregnant, we had kind of tried to forecast out, when’s this baby going to be born? We were coming up on the end of our two-year contract and we wanted to go to the States to see our families. And so, when’s this baby going to be born? How long is it going to take to get a passport? How long is it going to take to get a visa and then jump on a plane to get to America? And so, there was also that conflict within me of, should I induce just so I make sure that I have this baby in time to get a passport?

And so, my husband and I went… I was 40 plus three, and we went for this long walk and I was just crying and telling him about all of this, and I finally came to the conclusion of if I hadn’t had the pressure of the paperwork looming over my head and everything was normal, like I had no problems that I knew about, then I would never choose to have an induction at this point. Okay. I’m just not going to have the induction.

And he was also really stressed with preparing his lesson plans. We were both teachers at the time. So preparing lesson plans and getting ready for paternity leave. And so, he had kind of been like, “Don’t have the baby. Don’t have the baby.” And I’m like, “I just want to have this baby.” And we walked home and then I just remember he bent over and he kissed my belly and he said, “Okay, baby. I’m ready for you to come out.” And I was determined to get this baby out.

So we lived on the seventh floor with an elevator, but I did the stairs up and down a couple of times, and I went upstairs and I laid down to go to sleep and contractions started. And it was almost like stereotypically good in that the contractions were every four to five minutes, 45 seconds long, and I was like, “All right. I’m just going to try and get some rest,” but I’m so excited. I’m jazzed up, so I’m not able to sleep. And I think fatigue really kind of fed into why it was a longer-ish labor, because then I was up all night long.

And so, I let him sleep for a couple hours. I don’t even think I told him I was having contractions yet. And then after two or three hours, I was like, “Okay. These contractions are getting a little bit longer, a little closer together.” I’d had a friend in America that was like, “Oh yeah, I went to the hospital and I was four centimeters dilated in, and I didn’t even know it.” So I was convinced. I was like, “Just going to have this baby in a couple hours.”

And so, I woke him up and we called this liaison service. It’s 3:00 or 4:00 in the morning, and they come and pick us up and we drive the half an hour to the hospital. Okay. So I told you that I was the first foreigner, like fully foreign couple, to give birth in this hospital. And so, it was like, I had the top doctor at this hospital. They were convinced I had to have this great experience. And so, she comes in, and she’s like this really put-together, lovely lady, a little bit stern, and her hair is mussed on the top of her head, and I think she had no makeup on, and she does a cervical exam and she goes, “You’re one centimeter. I’ll come back in a few hours.”

And I was just devastated because, at this point, it’s been five or six hours, and I’m convinced. I’m ready to have this baby. I’ve had contractions four minutes apart and one minute long for four or five hours at this point. Yeah. She was right. Baby wasn’t born until 7:50 PM. I was really, really tired, and it was long, but no real complications. Just had to persevere through. I do remember telling my husband that he would never have any more natural-born children. This was it. He better really appreciate this because this was the only birth child that he was going to get, but I was pretty angry at Dr. Bradley at the time, like, “What was he talking about just have to relax?”

Yeah. But she was born, again, because a couple different reasons. The hospital was brand new. And so, my mom had been told she couldn’t come into the delivery room. So I just remember that there was this really sweet older doctor who was only in the room because she wanted to be there, and she would link arms with my mom, and I just remember as you’re in the haze of you’re pushing the baby out, seeing them in different parts of the room, and even at the point… I’ve tried to think back to what the setup in the room must have been, because I remember, every time that I would curl up… So most births in China are done in the reclined position.

And so, every time I would curl up to push, I would see my mom and this doctor between my feet and thinking they just needed a bag of popcorn because they were just so excited and sitting there watching me push this baby out, but it was also encouraging and fun. So I had my husband there, I had my mom there, I had a midwife there, the head doctor of the hospital, and then this elderly doctor too. So it was quite the party in the room.

Rebecca Dekker:

Yeah. That’s awesome.

Ruth Greene:

Yeah. So I want to back up just a moment and tell you what traditional birth is in China, and that is that when you go to the hospital… So like I said earlier, all births, when physically possible, as long as it’s not a precipitous birth, are in the hospital. And so, when you go to the hospital, they check you into a room and you labor in private with whoever is with you and then, after a certain point, then you move to a labor room, usually around four centimeters or six centimeters. If you’re having an induction, then you would go there directly because they’re going to hook up the IV.

It’s actually very uncommon. It’s starting to change, but it’s very uncommon for the husband to be with the birthing person or the partner to be with the birthing person. And so, after that point, oftentimes the birthing person is completely alone with just nurses and doctors, whoever’s on call at that time. And then once you get to the pushing stage, then you move to the delivery room, and then once you have the baby, the baby is whisked away and weighed and measured and bundled up in about five layers of blankets and then brought over next to you.

If it is a more progressive hospital, I think all of them are doing it now, then they’ll usually let you breastfeed at that point with all of the bundles of blankets. And then if the husband or partner is not with you, then they’ll take the baby out to meet the partner. Depending on the situation, baby might stay there or baby might come in. So you’re there for two hours and then they’ll move you back up to your private or shared room. So I push her out and she’s over… Can I tell you one more funny story?

Rebecca Dekker:

Sure.

Ruth Greene:

This is one of my favorite stories. So she’s whisked away, and everybody talks about… Nobody talks about the third stage. Everybody talks about how nobody talks about the third stage and how difficult it is, right? So she comes out. Everybody is excited. She’s whisked over to the side of the room. My husband and my mom go running over there, and I am just lying on this bed and they still do the fundal massage to try and… It’s a very managed third stage, so a shot of Pitocin and then a fundal massage. And I mean, it was really quite painful, and I hear, I’m ready for contractions to be over, the baby’s out.

And so, this 76-year-old doctor, who’s so sweet, she’s like having your grandma, comes and sits next to me and she’s just stroking my hand and she goes, “You just need beer.” And I’m like, “I need beer?” And I’ve been reading Dr. Bradley and how he talks about how a glass of orange juice can help bring electrolytes and sugar back into the system, so I’m like, “Is this some sort of Chinese culture that I’m not aware of?” And I’m like, “I need beer?” She’s like, “No, no, no. You just need beer.” And I’m like, “I need beer?” “No, no, no, no. You just need beer the pain.” So I needed to bear the pain. Oh, I always think about that now, like I need to beer the pain.

Yeah. And so, she stayed with me, which was really sweet, and then, eventually, they brought the baby over to me. And my husband and mom were there with me the whole time too, so I was really privileged to have such support.

Rebecca Dekker:

Mm-hmm. And it’s amazing that your mom was able to be there with you too.

Ruth Greene:

Yes.

Rebecca Dekker:

Is that traditional to have the grandparents involved in the birth or not?

Ruth Greene:

I think that it really just depends. I mean, just like the United States is a really big country, China is a really huge country too. And so, I actually really am very careful about saying, “Well, this is how it is in China,” because it can be completely different. As soon as I say that, somebody will say, “Well, no, that’s not how it is in my city.” But it seems to me that actually, a lot of times, the mother or the mother-in-law has… because there’s still often shared labor rooms or shared delivery rooms. They often keep it kind of a female-only space. So it might actually be more likely for a mom or a mother-in-law to be there than for the partner.

Rebecca Dekker:

Okay. That makes sense. Yeah.

Ruth Greene:

But it is usually just that it’s only one. Yeah.

Rebecca Dekker:

Mm-hmm. What about your postpartum experience with that baby?

Ruth Greene:

Yeah. So in China, there is what’s called the zuo yue zi or the sit month. And again, China is a really big country, and there are some really beautiful things about the sit month, and there’s just some things that are really foreign to people that live in other countries, or I should say that live in the West, because you’ll run across this in many Asian countries, right? But the idea is that you don’t want cold to enter your body, so you can’t have a fan on or air conditioning unit. You can’t drink anything cold. You can’t take a shower. If in the most extreme forms, you’re not supposed to brush your teeth or get up and move around, and the idea is that you really want to create this cocoon around the mom after she’s given birth.

She’s lost so much blood. She’s gone through so much work. And so, you want to create this really warm, safe cocoon for her, and that’s really, really lovely. And when it’s done in a very supportive way, it can be a really beautiful thing. But at that time, I had only heard the crazy side of it. To me, it just seemed such a foreign thing. My mom’s like, “Well, I went camping four days after I gave birth to you.” And so, I’m like, “This is nuts.” And so, I jump in the shower. I had milkshakes a couple hours after birth and we posted pictures somewhere online, and my students were like, “Mrs. Greene, you’re drinking something cold.” I threw all of that out the window.

And then the other side of it is the paperwork that I was talking about earlier. As soon as you have the baby, if you’re a foreigner, you’ve got to start working on the paperwork. And so, I think around a week old. We were traveling… I think it’s around… I don’t know how long. It’s pretty far, seven-hour train ride to Beijing at the time. Now it’s three hours, but they have much faster trains now, but it was a seven-hour train ride at the time up to Beijing, and we had to meet with the embassy and get the passport and all that.

And so, this idea of being able to just lay around and have people bring food and drink lots of soup and all that was just so foreign to me, and I was much more of the mindset of an American of like, “Well, I can still cook dinner and I can do this and I can do that.” And each baby that I have, I believe in the sit month more and more, because there’s got to be something somewhere in the middle. I pushed myself so hard and then I wasn’t breastfeeding on schedule or… Not even on schedule. I just wasn’t breastfeeding as much because we were traveling up to Beijing and everything.

And so, I ended up with a pretty raging case of mastitis, and that was pretty difficult, and I just felt really weary. And then when she was just three weeks old, we jumped on a plane to America so we could introduce her to all of the grandparents. And so, it was still just like, “Go, go, go.” And in hindsight, looking back, I wish that I had taken more time to rest.

Rebecca Dekker:

Yeah. There is something too, many cultures that have that attitude of rest towards the postpartum period, which makes sense when you think about it, to slow down after doing something so difficult.

Ruth Greene:

Yes.

Rebecca Dekker:

Yeah. And what about your other, your birth experiences? So how many children have you had there?

Ruth Greene:

So I have four children, and three of them were born in China and one of them in the United States due to just visa things. At the time, we were applying for new visas, so we happened to be in the States, but my second one was born at the same hospital, and it was really interesting in that it followed the same pattern but on hyper speed. So, again, I did the stairs up and down, up and down. I went and laid down. I was exactly 40 weeks plus four days, went and laid down, contractions started. They were one minute apart. I’m sorry, they were four minutes apart and one minute long, and I was like, “I am not staying up all night again.” And so, I was like, “I’m going to go to sleep.”

So I went to sleep and I woke up in full labor. I was like, “I’m going to take a shower.” And I was like, “I can’t lift my leg to get out of the tub.” This was the dumbest thing I’ve ever done, and I’m hollering for my husband, and we call our friend who was driving us to the hospital. Oh, I should back up a little bit. And I talked about how I didn’t like having the translator with the first birth. So when I was pregnant with my second, I studied like crazy all day, every day. And so, I was my own translator in that birth.

And so, that was a different element, and then we had a friend. We didn’t use that liaison service at all. We had a friend that drove us down to the hospital. And so, got to the hospital. The funny story about that birth is that I arrive, I’m already four and a half centimeters dilated, and it’s full labor, and they’re like, “And what medications are you allergic to?” And again, I’m my own translator, and I have not thought to study the names of medications. And at this point, we didn’t have Google Translate, or at least not very well accessible. We didn’t have smartphones and stuff.

And so, I’m trying to explain, “Well, I might be allergic to Vicodin, but it doesn’t apply to labor.” And they’re like, “But what does it do?” And I’m like, “Well, it’s like a pain medicine. If you had a really big pain, like you broke your arm, then you would want to use this medicine.” And so, they’re like, “We don’t know what you’re talking about.” I’m like, “It’s okay. It really doesn’t matter.” But then he was born really fast, I think an hour and a half after I arrived at the hospital, and I did have some tearing and they’re like, “So we don’t know what pain medicine that you’re allergic to, so we can’t give you anything to stitch you up.”

And I was just like, “Uh-huh. Okay.” I don’t know why I didn’t think like, “I was here two years ago and you gave me something then, so could we please have the same thing?” But the other huge difference on that one is, I had become a lot more educated in between the two births. So with the first one, I just kind of went along with the system. Like I said, baby comes out, they whisk it over to the side of the room and bundle it and everything. And in between the two births, I’d had a friend who’d asked about my birth experience, and she’s like, “Do you think they would allow skin to skin?” And I was like, “Well, I don’t know. I mean, you can ask.” And, “Do you think they’d allow delayed cord clamping?” And I was like, “Maybe.”

And so, she had gotten those things. And so, then when I went back and asked that head doctor, “Could I do these things?” she’s like, “Yeah. Sure.” And so, yeah, I had him immediately to my stomach, and it was a really interesting experience because it’s 100% not in their system. It’s not how they do things. They do the same thing every day exactly the same way. And so, I’m getting ready. I know he’s about to come out and I say to the doctor, “Remember, I can have him on my stomach.” And she’s like, “Yeah, yeah, yeah.”

And so, when he comes out and the nurses start putting blankets on me or something, I’m like, “No, no, no. He’s supposed to go on my stomach.” And so, they turn to the doctor and they’re like, “What? But he’ll be too cold.” And the doctor is like, “No, no.” I can hear her in Chinese saying like, “The mom’s body will warm the baby. Just put the baby right on the skin and put a blanket over,” and everything. And so, it was interesting that the knowledge is there, but it hasn’t quite made it over into daily practice.

And so, while they’re stitching me up with no pain medicine, I’m able to have that immediate first bonding with the baby and concentrate on him and start breastfeeding right away. And so, it was just all over a really smooth, easy birth. I was walking around just a couple hours later. He was born at 4:00 in the morning and I was just on a high, and a friend came down and took newborn pictures and everything.

And then my third was actually born at an international hospital, because an international hospital had opened. It had just opened in our city. And it’s a chain across China, but this was the first time they had one here. And I still wasn’t even convinced about going with them because the other one was familiar, but I had this really sweet Korean doctor, who I just adored, and she spoke English perfectly and the nurses all speak English perfectly, and it was much closer to our home too. It was only about a 10-minute drive.

And so, that she had delivered babies around the world and I believe studied in France under the Leboyer. I think it’s called the Leboyer system. And so, my funny story about that one is that as I’m laboring, I had the lights turned off. And again, I’m much more… At each birth that you have, you learn more. And so, I’m like, “Okay. I want the dark room and all that.” And the baby gets close to coming out and she calls the nurses to prepare and they come and they flip all the lights on in the room, and it’s suddenly this bright studio, and she’s like, “Are you okay with this?” I’m like, “Well, could we turn a couple off?” And she’s like, “Sure, of course.”

And so, she tells the nurses, “Can you turn off a couple lights?” So they turn off a couple lights. She’s like, “A couple more. A couple more,” and soon all the lights are off again, and they’re like, “But how will you see?” And she’s like, “I don’t need to see.” She was just so great about it. “I don’t need to see.” And so, yeah, again, just immediately straight to my stomach. That hospital, because the international hospital has the labor and delivery room, so you’re in the same room the entire time. Yeah.

Okay. And then my fourth, we were changing jobs, or I should say my husband was changing a job. And so, we had to go back to the States for the visa process, and we just didn’t know how long it would take, and his boss was kind of like, “Well, you could just stay here with the kids.” I had had a miscarriage in between the two, which was also handled at the international hospital and was handled really quite well.

There were a few things that were a little bit not as sensitive as one might hope, but overall was handled quite well, but I had kind of borderline hemorrhaged with that and ended up with an emergency D&C, and then we fell pregnant a little bit sooner than we had planned. I think it was just two or three months after, and then I had high blood pressure through that pregnancy or starting at around 21 weeks.

And so, I was immediately labeled as high risk, and I’m also just physically worn out. I have three children already and a miscarriage and the hemorrhage and now high blood pressure and all of that. And so, I was just like, “You cannot leave me in this country and go to America and get a visa. What if you don’t get back? What if I have the baby early? What if it goes into preeclampsia and I’m in a public hospital by myself? Who’s going to take care of the kids?”

And so, we made a really last-minute… Well, it was last minute that we found out he had to go to America. And so, we made a really, really last-minute decision to go back to the States. Yeah. That was a whole experience in its own, traveling internationally at about 33 weeks pregnant, and then I didn’t have-

Rebecca Dekker:

With your three kids too?

Ruth Greene:

With my three kids. Yeah. The three kids came too.

Rebecca Dekker:

Okay.

Ruth Greene:

Our parents live five minutes apart. And so, we had a lovely family support system there and moved in with my in-laws and they were a huge support, but we didn’t have doctors set up or anything. And so, that kind of go to the midwife that I’d seen, I don’t know how many years before, for just a Pap smear, and she’s like, “No, no. You need to go to a maternal…” What is it called? Fetal-maternal medicine doctor.

Rebecca Dekker:

Mm-hmm.

Ruth Greene:

So immediately bumped up to high risk again in America, and I’ll talk about this a little bit in a minute, but that was really shocking to me because I think, among foreigners in China, there’s a real distrust of the system here sometimes. And so, we can just kind of be like, “Oh, this wouldn’t be anything in my own country.” So for them to be treating the high blood pressure quite seriously in China and then go back to America and just be immediately bumped up to high risk, and yes, we need to do an induction at 37 weeks, and all of this was quite shocking like, “Oh, this is actually a serious thing that we need to be taking care of and stuff.”

So it was hard because, like I said, I didn’t have a set-up system. So I think I saw a series of doctors because I kept getting referred off to somebody a little bit more specialized or something, and then we weren’t mentally prepared to do an induction just a few weeks after we arrived, and doing hours and hours and hours of research trying to figure out what were my true risks and all of that. And so, they said that I could go… They recommended in the 37th week, so up to 37 plus six, and then we asked to delay one week. So we went in for the induction at 38 plus six, which was actually 39 weeks in China. I thought that was kind of funny, so I’m like, “Well, I made it to the 39th week. They just don’t think so.”

Yeah. I went in for… They did the Foley bulb, and then that popped out real fast, I think, because it was our fourth baby. I don’t think it really did anything. And then I was on Pitocin, but my body metabolizes the Pitocin really fast. And so, it was like, they would up the Pitocin. I’d get two or three good contractions and then they’d kind of peter off, and then a half an hour, hour later, they’d up it again, and eventually then… So they started at 9:00 PM with the Foley bulb and Pitocin. And then by 5:00 PM, I hadn’t progressed from the point that the Foley bulb fell out. And so, I was like, “I really think we’re going to have to break my water.” And the doctor was like, “I really think we need to break your water if we want to get this baby out. Otherwise, it would be, turn off the Pitocin and try again the next day.”

And we felt pretty comfortable with each of my labors. Things hadn’t really progressed until my water broke. And so, I did know that likely was going to need to happen or, I mean, you could go either direction. You could turn it off and rest again and stuff, but we decided to break the water and then it just went from zero to 100 in about an hour and it was really, really hard, a very, very difficult labor. I found out after my third that I have a fused tailbone, and the chiropractor was like, “Do you have really hard labors?” And I was like, “Well, I mean, they hurt really bad, but who’s to say mine compared to somebody else?” But that made sense to me because it’s excruciating pain.

People talk about back labor with a malaligned baby, and mine were never malaligned, but it hurt. It was always all in the back. And so, it was just incredibly excruciating, but one thing that comes into play when you are a professional and you see a lot of other births is that I had seen some pretty rough epidurals, and so I was more afraid of the epidurals, and I have also seen some really lovely epidurals, and so I know that there’s a place and a time for them, but I had seen enough really difficult epidurals. I knew I didn’t want that. I was more afraid of that than of the pain.

So I think around 1:00 in the morning, they checked me, and I was like seven centimeters and I just started bawling, and then my husband’s like, “It’s okay. That means only one more hour.” And I was like, “I cannot do this for one hour.” And then there’s always this point when I think the baby’s head pops past the tailbone for me, and then it’s like that baby… I mean, I have the strongest fetal ejection reflex you’ve ever seen. And so, here I am, seven centimeters. I cry. I have one contraction and I’m like, “This baby’s coming out now.”

My husband’s just messaged. I didn’t want my mom and my mother-in-law in the room the entire time, but I said they could come in for the delivery of the baby. So he’s just told them, “It’s going to be a little while,” and everything. And suddenly, he’s texting, “The baby’s coming now,” and the nurse is calling for the midwife and the midwife’s running through the room and the baby’s already born. So it was like, from seven centimeters to deliver it in two contractions.

Rebecca Dekker:

That’s amazing. That’s a great story for people who have that feeling and then the baby’s out in two contractions. That’s incredible, and also makes sense. You’re talking about the fused tailbone and the excruciating pain you felt in your first birth and how you said you were never doing that again. It would make sense that pain felt so unbearable that it was something that was going on in your body that you didn’t know about.

Ruth Greene:

The only thing I’ve always wondered about is why I didn’t… I mean, it definitely got to a point where it was very painful with my second, but yeah, I don’t know. It was so fast and so smooth, whereas the first and the third and the fourth were all relatively long labors. Yeah. I’ve always kind of wondered why. What was magical about that second birth that the baby was born, just everything was smooth, and we literally, after the second was born… He’s why we have more children, because we turned to each other within five minutes of giving birth and said, “I could do that again,” whereas the first one, I’m like, “Never again. Why would anybody ever get pregnant again? Who does this twice?”

And the second one, I’m just like, “Hmm, that wasn’t so bad.” Yeah. I don’t know what was magical about that one, but I was hoping for third and fourth, it would be magical, but they were not. I mean, they were magical in their own way.

Rebecca Dekker:

So tell us about becoming a doula. At what point did you decide to start attending births in China as a doula?

Ruth Greene:

Yeah. So after I had my second and I had such an amazing experience and I felt quite confident in the hospital that I gave birth in, I had a friend… I mentioned with the first one that… So for people that don’t speak the language, then there’s two options. One is you find a liaison service and one is that you travel to a bigger city, or you just do it not understanding anything that’s going on around you.

And so, we had some close friends of ours who didn’t have health insurance. They were paying out of pocket. They didn’t have the money for the expensive… I mean, I think it was around $8,000 or so for the… I mean, it’s hard because they bill it all as a package, but it was not cheap to do. I think to do the liaison service and the birth was around $10,000, or the expense of traveling to another city and then it being $15,000 plus all of the expenses of travel and living and all of that.

So, anyways, I suggested my hospital and they were going with their 10 words of Chinese, and she comes to me crying one time and she says, “I went, and my local friend went with me to the appointment, but then when I had to go in for the NST, they said, ‘Oh, you can just wait out here.'” And so, she was in the NST by herself with this technician who didn’t speak a word of English, and the technician’s strapping around the belts and everything, and she just keeps saying, “Bu hao, bu hao,” which means not good. And my poor friend just starts crying because she’s convinced something’s happened to her baby because they can’t find the heartbeat, and all the technician was saying was, “Oh no, the machine’s not working correctly. The machine is bu hao.”

And so, that was just a really terrifying experience, and I said, “Would you be interested? We can ask the hospital,” because I now know the head doctor, having given birth there twice, “if they would allow me to come in and translate,” and being more familiar with the birth experience than I knew never to leave the birthing mom by herself. Right? It’s interesting. In China, birth is a really separated experience. And so, somebody who hasn’t had their own children doesn’t have any familiarity with the system or maybe even not know a lot of the vocabulary around birth and stuff. So you might have a really sweet friend who wants to help and speaks English quite well, but then doesn’t know the system or how to advocate for people or to stand up for them.

And so, I went in just as a translator for the birth and found that my experience, my knowledge of the birth world and the policies and procedures and all of that were so valuable in the birth experience that I was like, “I need to do this.” And so, it’s funny because they ended up with a cesarean and they’ll still tell you that it was the funnest birth ever. We had such a good time and laughing over funny little things and making decisions together and all of that, but I didn’t feel equipped to really know. I mean, I could tell them what was going on in the room, but I couldn’t tell them what it meant.

And in fact, looking back, I think that my knowledge was almost more harmful because I didn’t know enough. So when the doctor is like, “Well, we think you should need to do this,” and I just do a Google search, I’m like, “Well, this is all the reasons why you shouldn’t do that,” and not understanding why the doctor was suggesting they do certain things. And so, I wanted to pursue more education. And so, we actually took a year for our family to go back to the States and reconnect with family and our community there, and I started studying to be a doula through DONA at that time.

Rebecca Dekker:

Mm-hmm. And probably, at that time, there weren’t as many online training options for birth workers yet.

Ruth Greene:

Yeah.

Rebecca Dekker:

Yeah.

Ruth Greene:

Yeah. I think that CBI was around at the time. I’m a really hands-on learner. And so, it was really important to me to be able to study in person, and I kind of asked around about what was the most… I also went with DONA because it was internationally recognized. And so, whether I talked to somebody here or talked to somebody there, that was a name that everybody knew, so that’s how I chose that.

Rebecca Dekker:

Yeah. Mm-hmm. What happened next in your journey in birth work?

Ruth Greene:

So we came back in 2015 after a year there, and I had done all of the classes and reading and all of that, but I had to do births. Right? You have to attend a certain number of births. And so, I just kind of started asking friends and everything if I could attend their births, and that went really well, and then it was a slow process for me because I was continuing to have my own children at the time too. I remember going to at least one birth six months pregnant and the doctors and nurses being like, “What are you doing here? You can’t be up for 16 hours when you’re pregnant,” or whatever.

And so, really, I felt that it was something that I needed to be available for those who needed me, but it wasn’t something I was going to go out and advertise, if that makes sense. I’m here in the community and it’s word of mouth. If somebody approaches me, I’m happy to be there and do everything I can. I can’t have a work visa at this point, and up to this point, I still don’t have a work visa. And so, I can’t accept pay for my services. We’ll talk about my company in a couple minutes.

Now, the people can pay my company for the services, but I can’t take a salary or anything like that. But at that point, I didn’t have the company, and so I couldn’t accept pay, and it was hard because it was like, I had my own family and I’m trying to do this new thing, but it was also kind of like, I’m here for those who need me and I’m happy to help people within the capacity I have, but I can’t accept pay, and so then they also didn’t feel like I owed them anything, if that makes sense. So I wasn’t being hired by people. It was more just helping those around me who needed it.

Yeah. So that was up until… Well, and then we had our fourth and we were stuck in America for five months. Oh, talking about not leaving me in China with three children and a high-risk pregnancy, I ended up taking five months to get all of our visa stuff squared away. And so, we came back in 2019, in December, and I think everybody in the world knows what happens in January 2020, and the world screeched to a halt. So that was quite a shock. So we came back ready to start my husband’s new job and we started homeschooling and all of that, and I wanted to do more birth work, and then suddenly everything’s shut down around the world.

And so, that, in its own sense though, kind of shifted us to more online. So I don’t remember what year it was that I started working with my good friends who started havingababyinchina.com, but a few years ago, we put together a course, an online course, for Having a Baby in China. So it’s kind of intended to go alongside a full prenatal course, but to talk specifically about maybe the challenges that someone would have giving birth in China. And so, it’s a six-video course taught by three different people, and I started with that and then started working more and more with them.

And so, we have various WeChat groups. WeChat is a social media that we use here since we can’t really use Facebook and other things, but there’s a max of 500 in a WeChat group. You can only have 500 people in a WeChat group. And I think, about every six months, we hit that limit and have to go through and ask people to leave if they’re no longer having a baby. And so, we’ve started a second group for people that have already had their babies but still want to stay connected. Yeah. Leading up to that, we were already doing some online stuff, but then moving into 2020 where everything was online, then that really amped up. Yeah.

Rebecca Dekker:

Yeah. That’s amazing. So people can check out the course at… It’s at havingababyinchina.com? Yeah.

Ruth Greene:

Yeah. So if you go to havingababyinchina.com and then slash the course, I think that is what… But a pop-up window will also come, I think, when you go to the website. Yeah.

Rebecca Dekker:

Mm-hmm. I was also browsing your website with you and your business partners, and it was fascinating because you have a whole vocabulary page. Can you talk a little bit about that?

Ruth Greene:

Yes. Yeah. So it’s definitely been a community-built thing, so my partners who… So I also just want to say, we literally just launched our own podcast. It’s something that we’ve been wanting to do for a very long time, and we finally started recording a couple months ago, and we have the first… Well, at the time of this recording, we have the first episode up, but we have more on the way of course, but in it, she tells the whole story. We kind of tell the origin story of Having a Baby in China.

So this is all really fresh in my mind, but they had their baby, their first baby in 2005 and, again, didn’t have health insurance and just going to a public hospital. And so, they just started studying like crazy. Every time you get stuck, you write it down and then you ask a friend, “How do I say this?” And so, they kind of created the first list. And then when I was having my second and I didn’t want to have a translator, I took that list and I went to my tutor and I would just build on it like, “Okay. Cord means this, but how do you say the cord is wrapped around the neck?” or whatever it might be, or “I want a delayed cord clamping.”

And so, again, just hours and hours and recording it and then gave that to Jeremy and he added it to the list, and then I think maybe they posted it on Facebook or something and different people have submitted it over time. And so, it’s funny because, again, China is a very big country and there’s a lot of dialects. And so, somebody might be like, “Well, that’s not how you say it in my area.” And somebody might say, “Well, we would actually have a little bit of a different tone,” but at least it’s a starting point for people to build off of.

Rebecca Dekker:

Yeah. And if you go to the vocabulary page, it has the translation to English into Chinese Mandarin along with the audio. You just click the play button, and you can hear the word. Yeah.

Ruth Greene:

Yes. Yeah. So we hired-

Rebecca Dekker:

That’s not only helpful for people living in China who speak English, but people living in an English-speaking country.

Ruth Greene:

Yeah. That’s a good point.

Rebecca Dekker:

Yeah. Mm-hmm.

Ruth Greene:

That’s a really good point. Yeah. Yeah. So we hired somebody as a native Chinese speaker to do all of those so that hopefully they’re as accurate as can be.

Rebecca Dekker:

So, Ruth, thank you so much for sharing all this information. It’s been so fascinating. Are there any other projects or resources you want to talk about?

Ruth Greene:

Yeah. So one of my passions is in connecting people. So we talked about the WeChat groups that we have for pregnant families across China or people that have just given birth, but I also have a passion for connecting birth workers across China because we’re extremely rare. There’s about 20 of us in all of China that I’ve been able to track down. I’m sure there’s other people that we haven’t found, but we’ve created an association or a group called the International Birth Workers of China Group, and that is a space for us to discuss just challenges that are unique to us, whether it be language or culture or supporting someone from another culture that’s struggling with the system here, whatever it might be.

And then we actually, last year in November, had the first annual, hopefully annual, Birth Workers of China Conference, and that was a really incredible experience where, I think, nine people came from across China, which, again, there’s not very many of us to begin with, and I hosted that in my city and we had a full two days of seminars. And one of the things that was really fun about that is, I’m thinking just schedule-wise, if we do this many, and I had an hour and 15 minutes, I think, per seminar planned, and we were just so into the material, whoever was speaking, that we would go on three hours.

And so, we had to keep rearranging the schedule because we just loved learning from each other’s experiences and expertises, and then also really just wanted to go deep into the material. So we had our second annual a couple of weeks ago. Less of us were able to join this year. We’re still struggling with COVID restrictions, and so it’s quite difficult to travel in our country, but I wanted to go ahead and continue that just so that we have kind of a rhythm, but that has been one of the most encouraging but also professionally developing supports in my life, is to have other people in a very similar situation as me to come alongside and, even if it’s just online, to work together.

Rebecca Dekker:

Mm-hmm. Yeah. So, Ruth, if anybody wants to follow you, what’s the best way to find you online?

Ruth Greene:

Yeah. So it is a little bit difficult. Probably through the website, havingababyinchina.com, or you can email me at ruth@havingababyinchina.com. Facebook and Instagram don’t really work very well here. We do have an Instagram called Having a Baby in China, but again, connection issues make it a bit difficult to connect there. If you happen to have WeChat, you can find me through Girl Travelor, so that’s G-I-R-L travel O-R. O-R as in Oregon, so not E-R, the O-R. We just launched our podcast, so you can find that at Having a Baby in China. So it’s pretty easy to remember. If you just ever put into the Google, or whatever you use, Having a Baby in China, you’ll find us.

Rebecca Dekker:

Yeah. Awesome. Thank you, Ruth, so much for joining us from the other side of the world from where I’m recording, completely different time zone, and we appreciate you joining to share about the joys and challenges of your work there. Thank you.

Ruth Greene:

Well, thank you so much for having me. It’s a real honor.

Rebecca Dekker:

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