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中国剖腹产率仍偏高,且缓慢攀升

更新时间:2017-1-10 18:17:32 来源:纽约时报中文网 作者:佚名

Study Finds Lower, but Still High, Rate of C-Sections in China
中国剖腹产率仍偏高,且缓慢攀升

China, which has long been criticized for soaring C-section rates, actually has rates lower than previously reported, although they are still quite high, according to a large new study done jointly by Chinese and American scientists.

虽然中国长期因为剖腹产的比例太高而备受诟病,但中美科学家联合进行的一项新的大型研究显示,这个比例其实比以前报告中的数字低,虽然它仍然相当高。

Public health alarms were raised in 2010 when the World Health Organization reported that 46 percent of Chinese babies were delivered by cesarean rather than vaginal birth.

世界卫生组织(WHO)2010年的报告说,中国46%的婴儿是通过剖腹产而不是阴道分娩出生的,从而引发公共卫生预警。

The new study, published last week in JAMA, found the real rate to be about 35 percent. It is still climbing slowly, despite a national policy discouraging elective C-sections.

上周发表在《美国医学会杂志》(JAMA)的这项新研究发现,这个比例实际上约为35%。尽管中国的政策不鼓励选择性的剖腹产,这个数字仍然在缓慢攀升。

The C-section rate varies widely by regions. In urban, wealthy Shanghai, it was recently as high as 68 percent, while in remote Tibet it is now about 4 percent.

剖腹产的比例因地区而异。在城市,比如富裕的上海,最近这个比例高达68%,而在偏远的西藏,现在约为4%。

C-sections are medically necessary to save the life of the child or the mother in only 10 to 15 percent of all births, according to the W.H.O., and a large 2015 study found that the ideal number was about 19 percent.

根据WHO的说法,为了挽救儿童或母亲生命,医学上必需的剖腹产只占出生总量的10%至15%,而2015年的一项大型研究发现,理想数字约为19%。

China’s extraordinarily high rate is a result of its former one-child policy, changing medical care conditions and its increasingly economy.

中国剖腹产的比例之所以特别高,与此前的独生子女政策、医疗条件改善,以及该国日益增长的经济分不开。

According to the study’s authors, many parents and grandparents demand C-sections to assure that births take place on a lucky day in the astrological calendar, or because they believe that a surgically removed infant is more likely to be perfectly formed.

该研究的作者表示,许多父母和祖父母要求进行剖腹产,是希望让孩子在黄道吉日里出生,或者是因为他们认为,剖腹产的婴儿可能成型更好。

More than 99 percent of all women in China now give birth in hospitals — 30 years ago, only about half did. But they typically have gone through labor in open wards with no husband or family present, too few nurses and no pain relief. C-sections are an attractive alternative, said Dr. Susan C. Hellerstein, a Harvard Medical School obstetrician and one of the authors.

在中国,99%以上的妇女是在医院里生产的——30年前只有一半左右。但她们通常是在开放的病房里生产,没有丈夫或家人的陪伴,护士太少,疼痛无法缓解。论文作者之一、哈佛医学院产科医生苏珊·C·哈勒斯坦(Susan C. Hellerstein)说,作为替代方案,剖腹产很有吸引力。

Doctors made more money from fees and “tips” from families if they operated, the researchers found. And if they performed scheduled surgeries rather than risk vaginal births, doctors felt they were less likely to be accused of malpractice, which is a criminal offense in China, or to face angry families demanding compensation.

研究人员还发现,通过手术收费和家属的“红包”,医生可以赚更多的钱。医生也觉得,如果按预定日期进行手术,而不是冒险让产妇进行阴道分娩,他们就不太可能面临医疗事故的指控——这在中国是一种罪行,就不会有愤怒的家属要求他们赔钱。

Vaginal births can quickly go wrong if, for example, the cord wraps around the baby’s neck.

阴道分娩可能会出问题,比如遇到脐带缠绕婴儿脖子的情况。

The study was led by doctors from China’s national statistics office, Peking University, Harvard Medical School and New York University’s Wagner School of Public Service.

这项研究由中国国家统计局、北京大学、哈佛医学院和纽约大学瓦格纳公共服务学院的医生带头。

The 2010 W.H.O. survey erred by relying on figures from just 21 hospitals, mostly in cities, said Dr. Jan Blustein, a health policy specialist at N.Y.U. and co-author. The new study tallied 90 percent of the country’s births over seven years.

纽约大学卫生政策专家、论文合著者扬·布鲁斯坦(Jan Blustein)医生说,2010年WHO的调查之所以有误,是因为只采集了21家医院的数据,而且大多数都是城市医院。而新的研究统计了中国七年内90%的婴儿出生数据。

While a few cities like Shanghai had astronomical rates, half of all Chinese still live in rural areas where home births are more common and distances to hospitals are greater, so actual rates are closer to the ideal 10 to 20 percent range.

虽然在上海这样的城市,剖腹产比例非常高,但仍有一半的中国人生活在乡村地区。那些地方在家里生孩子更加普遍,家距离医院也比较远,所以实际比率接近于理想的10%到20%区间。

In Tibet, however, C-sections are so rare that mothers and children who could be saved from death are undoubtedly not getting the operations, Dr. Hellerstein said. C-sections save lives in breech or multiple births, for example, or when a mother has dangerously high blood pressure or a fetal heartbeat fails.

哈勒斯坦医生说,在西藏,剖腹产十分罕见,一些本来可以避免死亡的母亲和孩子无疑没有进行剖腹产手术。比如在臀位分娩、多胎分娩的时候;或者在母亲血压太高或者胎儿心跳暂停的时候,剖腹产本来可以挽救生命。

But babies born by C-section are more likely to hospitalized for breathing problems and more likely to suffer asthma and obesity later in life, possibly as a result of not getting microbes present in the birth canal. Mothers who have had C-sections also are more likely to hemorrhage or to have a uterine rupture in the next pregnancy.

但是剖腹产出生的婴儿更可能因为呼吸问题而住院,并且更可能在以后出现哮喘和肥胖症,这可能是由于没有接触产道中的微生物而导致。而剖腹产的母亲也更可能在下次怀孕的时候出现出血或子宫破裂的情况。

Since 2009, China has been trying to control medically unnecessary cesareans by educating patients, doctors and midwives, and by warning individual hospitals when their rates are too high, said Dr. Jianmeng Liu, director of the Office for National Maternal and Child Health Statistics of China and a study co-author.

这项研究的合著者、中国妇幼保健统计办公室主任刘建盟(音)博士说,自2009年以来,中国一直试图通过教育患者、医生和助产士的方式来控制医疗上不必要的剖宫产,并对个别剖腹产比例太高的医院予以了警告。

China’s C-section rate, the authors noted, is close to that of the United States, where it is slightly over 32 percent.

作者指出,中国的剖腹产比例接近美国,美国的比例略高于32%。

That rate is higher than it should be, and higher than in many European countries, the authors said. Some mothers choose C-sections to avoid labor pains, they said, and too many doctors suggest them for convenience and for fear of facing malpractice suits.

作者说,这一比例高于应有水平,也比很多欧洲国家高。作者表示,有些妈妈选择剖腹产是为了避免生产疼痛,而且太多的医生图方便或者为了避免医疗事故诉讼而推荐剖腹产。

In 2015, China ended its longstanding one-child policy, allowing two per couple.

2015年,中国取消了长期施行的独生子女政策,允许每对夫妇生两个孩子。

“All these older women wanting a second baby after a C-section is going to be a big challenge,” Dr. Hellerstein said.

哈勒斯坦医生说:“做过剖腹产手术的高龄妇女想生第二个宝宝,会是巨大的挑战。”

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