In her 31 years as a midwife at the Red Cross Central Hospital of Harbin, Heilongjiang province, Xiao Yan has witnessed several changes in the way women choose to give birth.

She remembers in the late 1980s when almost all expectant mothers would opt for a natural birth.

"It seemed much easier for women to deliver naturally then," she said.

"Most of them were thin and under 30. Furthermore, daily manual labor made them physically fit."

However, as the country embraced reform and opening-up, and living standards began to improve, Xiao noticed that the average woman's body also underwent change.

"As time went by, we saw more overweight women whose babies were also much bigger," she said.

"Because of this, it became popular for women to give birth by Caesarean section around 2000.

"As they were limited to one child, women would opt for C-sections because they are more convenient and carry a reduced risk for the newborns."

This changed again with the advent of the second-child policy, which was fully implemented at the beginning of last year. Since then, Xiao has observed a noticeable increase in the number of women opting for natural births.

"Now, due to the second-child policy, women have been considering the risks associated with C-sections more carefully," she said.

It is the job of midwives like Xiao to care for patients throughout a pregnancy. They are trained to help deliver babies and to intervene in high-risk situations.

"If a woman is cared for by a professional midwife and receives proper treatment, the chances of any complications are much reduced in the event of an emergency," Xiao said. "It's especially important for mothers who are having their second child to have a midwife on hand."

Conventional wisdom among many Chinese holds that if a woman gave birth by C-section the first time, then she must do so again the second time round. But this is not always the case, according to Xiao.

"In fact, there is a very high success rate for natural births among mothers who are having their second child," she said, adding that the most important factors are maintaining a balanced diet, getting sufficient exercise and avoiding overeating.

"A natural birth is good for both mother and baby, and can also reduce the risk of life-threatening complications."

As an advocate of vaginal birth, Xiao has also influenced some of her former patients to promote natural delivery among their relatives.

"I can't remember how many babies I have delivered over the decades, but I know it can't be fewer than 10,000," she said.

"Some of the mothers have since told me that their daughters or daughters-in-law also chose to have a natural delivery because of their experience."

The hospital in which Xiao works has 26 midwives on staff, yet still finds itself shorthanded sometimes, especially since the second-child policy came into force.

"Last year, more than 10,000 babies were born in our hospital," she said. "There were sometimes a dozen women waiting in the delivery room all at the same time."

The majority of China's existing midwives graduated from technical schools, but Xiao expects there to be more with university or college degrees in future.

"Midwives are commonly regarded as nurses rather than as an independent profession in China, and we lack enough opportunities for career advancement," she said.

"I hope this can be resolved so that more obstetrics graduates choose midwifery and help end the midwife shortage."

In the shorter term, Xiao said her hospital is looking to establish an outpatient service for expectant mothers.

"As far as I'm aware, it will be the first one in the city and that's quite significant," she said. "It will provide more opportunities for pregnant women to communicate with experienced midwives and receive proper guidance about natural birth."