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骨头被生生劈开一道缝?从美国剖腹产说开去

2017-09-08 07:02:06   新华网

在美国妇产科,有个术语叫CDMR,是“产妇要求的剖腹产”这一词组的单词首字母缩写(Caesarean delivery on maternal request)。注意,只限产妇,不包括她们的伴侣。

按照维基百科的介绍,这个术语出现于上个世纪,有两个背景:一是生孩子曾被视为女人的“鬼门关”,剖腹产突破医学瓶颈后,一度被认为更安全、对产妇更“温和”;二是基于以下观念,即采用哪种生育模式,产妇的优先选择是决定性因素。用大白话说,谁生孩子,就由谁决定怎么生。

登录美国疾控中心官网,统计数据表明,美国剖腹产率是一道波折线。1996年,美国剖腹产率为20.7%,此后连年趋升,至2009年达到32.9%的最高峰。而在过去4年里,又连年小幅下降。2015年美国有超过127万例剖腹产,占比32%;2016年初步汇总的数据显示占比为31.9%。

尽管总体趋降,但不乏美国医学界人士依旧批评剖腹产比例过高,甚至把剖腹产形容成一种流行病。剖腹产和自然生产各有其利弊和风险。从结果看,剖腹产并没有提升母婴的存活水平。

美国《当代妇科学》杂志载文说,民调表明,美国绝大多数女性倾向于选择顺产,选择剖腹产的原因各式各样,最常见原因包括早产、难产和胎儿心跳异常。过去20年来,胎儿个头更大和肥胖产妇增加,是导致美国剖腹产率升高的重要因素;但“产妇要求的剖腹产”增多也是原因之一。

2015年的一项研究估计,这种类型的剖腹产在美国产妇中占比约为4%;在巴西、智利和中国台湾等地也较常见。

这篇文章还提到,一些美国妇产科医生说,他们在接生时,也会担心遭到投诉或者惹来法律官司。这种情况下,他们更有可能为产妇进行剖腹产。

美国医保体制复杂。在很多州,剖腹产需要多住两天医院,费用远比顺产高昂,且没有充分理由的话,保险公司未必肯报。很多美国女性不选择剖腹产,经济考虑是个难以忽略的因素。智利的相关研究也发现,在有经济能力享受私人护理的产妇中,剖腹产率超过40%;而在公立医院生孩子的产妇,剖腹产率不到20%。

在可以安全顺产的情况下选择剖腹产,如果排除其他因素,只考虑疼痛一项,那么统计数据或者其他女性的经验就没有什么参考意义了。痛在自己身上,只有自己知道。在生孩子这方面,个体的独特感受很难类比。即便同肤色同体质,每个人的痛觉神经敏锐度不一样,对疼痛的耐受能力也不一样。

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