Yang Jie, head nurse of the gynecology and obstetrics department at Beijing Friendship Hospital, has her hands full. The top-tier hospital recruits midwives who have an associate degree or higher, but Yang has found it hard to employ enough midwives with the requisite skills.
"To my knowledge, there is only one school in Beijing that offers the midwifery major. Junior high school graduates study for four years there and get an academic degree of a vocational high school education," said Yang, who is also a midwife.
To relieve the heavy workload, her department has had to train some of its nurses who didn't major in midwifery. The training lasts about three years, after which nurses can be certified to assist in deliveries, she said.
A pilot programme that the National Health and Family Planning Commission launched in April may help address Yang's concerns. The commission has asked eight universities to start recruiting midwifery majors who can get a bachelor's degree in 2015.
Eighty-five per cent of midwives in China have educational qualifications lower than a bachelor's degree. Such an academic background usually does not meet the recruitment standards of hospitals in urban areas, where the rate of caesarean sections was 41 per cent in 2012, higher than the 29 per cent in rural areas, said the commission.
"The lack of qualified midwives has become a key factor limiting efforts to reduce the C-section rate in urban areas," it said.
China reported the highest rates of caesarean sections among nine Asian countries, a World Health Organisation survey conducted in 2007 and 2008 showed.
The report, published in medical journal The Lancet in 2010, was an important catalyst for the pilot programme, said Pang Ruyan, vice-president of the China Maternal and Child Health Care Association, which is helping to carry out the programme.
Undergraduate education not only improves a midwife's ability to discover and solve problems during pregnancy and delivery, but also facilitates the development of the specialty, said Cai Wenzhi, deputy director of the school of nursing at Southern Medical University, in Guangzhou, Guangdong province.
"It helps students get a comprehensive and systematic view of the profession, and significantly improves their recognition of their future career," she said.
At her school, students take general nursing courses during their freshman year and focus on theory and practice over the next three years, including assisting in 20 deliveries under their teachers' supervision, Cai said.
"The students are very popular. Though our first class of midwifery students recruited in 2011 will not graduate until next year, about half of them already have job offers from the hospitals they are interning in," she said.