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2011年12月4日星期日

时代周刊:话说自然分娩

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时代周刊:话说自然分娩

ideas.time.com : Dr. Amy Tuteur on the Myths of "Natural" Childbirth | TIME Ideas | TIME.com

译者: 小无辜 2011年10月14日 17:28 原作者: Amy Tuteur, M.D.
怀孕的妇女们经常担心自己是否选择了合适的生产方式。自然分娩是否更加安全?产痛是怎么来的?无痛分娩有必要吗?剖腹产带来了什么?种种迷思,本 文为你一一解惑。

怀孕的妇女们经常忧心忡忡。她们担心自己的孩子是否健康,担心孩子们的饮食是否得当,担心自己是否为成长中的新生命规避了一切能对他们造成伤害的 东西。她们也在对分娩的方式心怀忧虑。

她们不必如此。因为根本就不存在所谓的正确方式。出人意料的是,尽管几乎被所有文化认可,那种号称不存在任何医疗介入的"自然"生产才才最优越的 说法根本站不住脚。自然分娩运动的发起人是英国医生格兰特里·迪克-里德。他在19世纪30至50年代推广了该项运动,并写了一本书,叫做《自然 分娩,没有恐惧》。迪克-里德是一位优生学家,他认为白人妇女限制家庭人口数量的行为是在进行"种族自杀"。他认为,对生育带来的对疼痛的恐惧是 其中的罪魁祸首。他坚称,是对疼痛的恐惧,而不是疼痛本身,引起了那种剧痛。话句话说,疼痛全是妇女在脑子里自编自演的。

谢天谢地,我们已推翻了迪克-里德的妖言惑众。但推测"自然"生产更优越的假设,仍然建立在一些强有力的迷思上,比如:

迷思一号:自然分娩天生更加安全
生产自古以来——无论在什么时代,什么地点,哪种文化中,都是导致年轻妇女死亡的重要原因。对孩子来说,降生的那天也是他们在整个18年的童年中 最危险的一天。

(图片:在阿富汗生产的危险)

迷思二号:分娩其实并不痛
自然生产的拥护者坚称,产痛(即"好的痛")与其他形式的疼痛不同。此言差矣。产痛与其他任何形式的疼痛一般无二,都是被相同的神经接收,通过脊 髓向上传输,被大脑感知到。

迷思三号:无痛分娩既危险又没有必要
自然生产的拥护者坚称,分娩带来的痛苦天生可以承受,如果不能,那就应该挨过去。这是一种自然主义谬论——宣称因为某事天生有种自然而然的方式, 就该永远用那种方式施行。但在自然界,人们也要忍受一系列我们现在毫不犹豫就会施加治疗的疼痛;产痛可以说要严重得多的,更没有理由例外处理。自 然生产的拥护者还宣称,硬膜外麻醉无痛分娩对小孩和大人都很"危险"。这也是谬论。无痛分娩的死亡风险比被雷劈中的几率还低。

迷思四号:干预措施是"不好的"
既然生产本来就很危险(请见迷思一号),干预措施只是采取相应的预防医疗手段。并发症很常见,通常也可以预防,所以对怀孕妇女进行监测,预防并发 症,或宁早不晚地对其加以治疗,是唯一合乎逻辑的办法。

迷思五号:剖腹产几乎总是没有必要的
恰恰相反,剖腹产是预防事故的一种必要选择。在剖腹产比例不到百分之十的国家,死亡率却格外地高。举例来说,2007年发表在《儿科与围产期流行 病学期刊》上的一篇关于国际剖腹产比例的文章指出,埃及的剖腹产率是11.4%,而新生儿早期死亡率是万分之十六,产妇死亡率是万分之八十四。与 之相反,美国的剖腹产率相对较高,当时达到了百分之二十四,但新生儿早期死亡率只有万分之四,产妇死亡率只有万分之十七。2009年,世界卫生组 织收回了理想剖腹产率应控制在百分之十到十五的建议,并承认从未有过科学依据,支持剖腹产率应控制在百分之十五以下的要求。

"自然"生产运动让我们相信,阴道产才是天生最优越的生产办法。但它并不是。能生育出健康存活的孩子,并且母亲也存活、健康,才是天生最好的生产 办法。对于不少妇女来说,应该选择的,是剖腹生产术。
小无辜 翻译了本文,授权本站发表并对本译文保留权利。如有问题请 联系本站 。


Pregnant women worry. They worry whether the baby is healthy; they worry if they're eating right and avoiding everything that could possibly be harmful to the new life growing within. They also worry about the right way to give birth.

They shouldn't, because there is no right way. Surprisingly, despite its nearly total cultural embrace, the claim that "natural" childbirth, meaning without any medical intervention, is best is ill-founded. The movement started with Grantly Dick-Read, a British doctor who practiced from the 1930s to the 1950s and wrote the books Natural Childbirth and Childbirth Without Fear. Dick-Read was a eugenicist concerned that white women were committing "race suicide" by limiting the size of families. He thought fear of childbirth pain was the problem and insisted that it was fear of the pain that was causing the pain. In other words, it was all in women's heads.

Thankfully, we've moved beyond the fabrications of Dick-Read, but the assumed superiority of "natural" childbirth is still based on some powerful myths, such as:

Myth #1: Childbirth is inherently safe.

Childbirth is and has always been—in every time, place and culture—a leading cause of death of young women. For babies, the day of birth is the single most dangerous day of their entire 18 years of childhood.

Myth #2: Labor is not inherently painful.

Natural childbirth advocates insist that labor pain ("good pain") is different than other forms of pain. Not true. It is received by the same neurons, passed up the spinal cord, and perceived by the brain in exactly the same way as any other form of pain.

Myth #3: Epidurals are unnecessary and dangerous.

Advocates of "natural" childbirth insist the pain of labor can be managed naturally, or if not, should just be endured. That's the naturalistic fallacy—the claim that because something is a certain way in nature, it ought to be that way all the time. But in nature, people endure all sorts of pain that we wouldn't hesitate to treat; there's no reason to make an exception for labor pain, which is arguably worse. Advocates also insist that epidurals are "dangerous" to both baby and mother. Not true. The risk of death from a labor epidural is less than the risk of death from a lightning strike.

Myth #4: Interventions are "bad."

Since childbirth is inherently dangerous (see Myth #1,) interventions are simply preventive medicine. Complications are common and often preventable, so it is only logical to monitor pregnant women to prevent those complications, or treat them early rather than late.

Myth #5: Cesareans are almost always unnecessary.

On the contrary, C-sections are usually a necessary choice that prevents fatalities. In countries where the C-section rate is less than 10%, mortality rates are extraordinarily high. For example, according to a 2007 paper on international C-section rates published the journal Paediatric and Perinatal Epidemiology, Egypt with a C-section rate of 11.4% had an early neonatal mortality rate of 16/10,000 and the maternal mortality rate was 84/10,000. Conversely, the United States had a relatively high C-Section rate at 24 percent at the time, but an early neonatal mortality rate of 4/10,000, and a maternal mortality rate of 17/10,000. In 2009, the World Health Organization withdrew its recommendation of an ideal C-section rate of 10-15%, acknowledging that there was never any scientific evidence to support the claim that a rate under 15% is optimal.

The "natural" childbirth movement would have us believe that vaginal birth is inherently superior. It's not. A birth that results in a live, healthy baby and live, healthy mother is inherently superior, and for a significant proportion of women, that birth is a cesarean section.




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