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无痛分娩因“产妇坠楼”再受关注 国内谁在“阻碍”它?

2017-09-14 13:06:23   中国青年网

“因为怕疼而选择剖宫产的人,太多了。”杭州市妇产科医院院长张治芬感叹,“明明可以镇痛的,为什么要忍受呢?”

多年实践中,胡灵群及团队总结了无痛分娩在中国推广难的几大原因。

首先是对麻醉针的害怕和怀疑。山西晋中市民肖女士向南方周末记者回忆其生产经过,她拒绝了主治医生和助产士的无痛分娩建议。“我事先没有了解过无痛分娩,害怕对自己有不好影响。据说要在脊柱打麻醉,还有可能过敏、瘫痪什么的。”

杭州市妇产科医院医生费华丽曾对该院2015年3月-5月的100位待产妇进行分娩镇痛认知调查。其中,顾虑会对胎儿健康产生影响的有75人,无任何顾虑的仅3人。

其次是来自老一辈的传统观念。张治芬发现,很多人生孩子,婆婆或者妈妈都会传授“经验”:生孩子哪有不疼的?忍忍就过去了。“无痛分娩中国行”在北京站、温州站都遇到产妇要求无痛分娩而家属不同意的情况,又因为国内很多地方采用“双签字”的知情同意书,没有家属同意,产妇是得不到镇痛的。

再者,医务人员也有很多误区。

三年前,27岁的吴晶晶在中国中部某省会城市一家私立医院剖宫产后,疼痛难忍。医生则告诉她,疼是有益的,产妇忍受生产之痛天经地义。她丈夫是美国人,非常不能理解中国医生为何不愿给妻子止疼,因为三十年前,他母亲在美国已是无痛分娩。

对此,北京和睦家医院麻醉科副主任杨璐医生亦表达了坚决的否定态度:“产痛会使产妇血压升高、心率增快,随着不停地哈气、喘气、换气,容易出现呼吸性的碱中毒,并进而影响胎盘对胎儿的供血,出现胎儿缺氧的可能。”

另外,一些医护人员还顾虑,椎管内分娩镇痛会导致产后头痛、腰背痛、难产性剖宫产、产伤等。实际上,目前科学研究没有发现椎管内分娩镇痛会增加这些并发症。

“正确的给药方法,合适的给药剂量,对母亲和胎儿都是没什么影响的。”广州市妇女儿童医疗中心麻醉科主任宋兴荣此前接受媒体采访时说,尽管存在1%的镇痛失败率,药物确有一定副作用不能否认,但麻醉师所控制的剂量和给药途径是经过研究证实安全的,分娩镇痛药物的剂量是剖宫产手术麻药的1/20-1/10,因此进入母体、血液、通过胎盘的几率微乎其微。

最后,一些医务人员和产妇认为“镇痛会使产程延长”,理由是,镇痛后会使得宫缩感受不明显,更难生产。

“不应该以产程时间作为剖宫产的临床指征。”胡灵群说。在他看来,产程的定义是人为的,最终大家在乎的是母婴安全和产妇满意。现在的医学研究也得出结论,所有分娩镇痛的产妇,只要母婴正常,产程没有停滞。而全程镇痛的产妇,第一产程时间还会缩短。

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