英國專家新建議 順產並不一定優於剖腹產!

When it comes to childbirth, vaginal delivery is often assumed to be the best thing – women have, after all, done it for thousands of years.

談及生產，順產似乎總被認爲是最佳的生產方式--畢竟，女性用這種方式生產已經延續幾千年了。

But natural birth actually comes with risks, including tearing, haemorrhage and incontinence for the mother and injuries to the baby during labour.

但是順產其實也是有風險的，對媽媽們而言可能會出現會陰撕裂、產後大出血、大小便失禁等問題，寶寶也可能在生產過程中受到傷害。

So why is it that the vast majority of pregnant women are only being warned about the risks of Caesarean sections?

那麼爲什麼對於大多數的懷孕女性，醫生僅僅警告她們剖腹產的風險呢？

This could now change, as the Royal College of Obstetricians and Gynaecologist is to discuss the current view of vaginal birth as the default option for childbirth in the UK.

這一現象現在要改變了。因爲英國皇家婦產科學院要對生育孩子時默認選擇順產的方式進行研討了。

Now they will consider whether there's merit in routinely discussing the relative risks and benefits of vaginal birth and Caesarean section with pregnant women.

現在他們要探討是否應該告訴產婦順產和剖腹產的相對風險和益處，並將此作爲一種工作流程執行下去。

While both Caesarean section and vaginal birth are considered to be relatively safe in high-income countries, each features its own set of risks. How such risks are perceived and valued may vary considerably between health professionals and women themselves.

儘管在高收入國家，剖腹產和順產都很安全，但是也依舊有各自的風險。對於醫護專業人員和產婦自身，對風險的感受和評估可能有很大的不同。

UK hospitals still treat vaginal birth as the default birth mode for most women, despite its risks and the fact that the National Institute of Health and Care Excellence (NICE) has recommended that there should be some room for choice.

對於大多數產婦來說，英國各大醫院仍將順產作爲默認的生產方式，儘管英國國家衛生與臨牀技術優化研究所已經建議要爲產婦提供選擇空間。

While up to 95 per cent of UK women aim for a vaginal birth in their first pregnancy, only around 75 per cent achieve this.

英國女性在生育頭胎時，有95%的人表示想進行順產，但是隻有75%的人能如願。

Some 21 per cent experience an emergency Caesarean section during labour, which is not as safe as a planned one. A further substantial proportion of women experience important complications of vaginal birth. These include an 8 per cent postpartum haemorrhage rate, 1 per cent blood transfusion rate, and a 5-6 per cent third-degree tear rate (40 per cent suffer some degree of tearing). One in six women end up having an operative vaginal birth, such as use of forceps, which is associated with faecal incontinence and pelvic organ prolapse in later life.

在生產中，有21%的人接受了緊急剖腹產手術，這遠沒有計劃好的剖腹產手術安全。還有很大一部分產婦在順產時，出現了嚴重的併發症。這其中有8%的人出現了產後大出血，1%的人要輸血，5-6%的人三級撕裂損傷（40%的人出現一定程度的會陰撕裂損傷）。有六分之一的產婦在順產時需要器械輔助，比如使用了產鉗，這會導致以後的生活中出現大便失禁和盆腔器官脫垂的問題。

This leaves little more than half of first-time mothers experiencing an uncomplicated spontaneous vaginal birth. This is a considerable number which illustrates why women aiming for a natural birth may need to know that such attempts could involve a medical intervention or complications.

結果，生育頭胎的產婦僅有一半的人數可以順利進行順產。這一百分比也正說明了爲什麼想要自然生產的女性需要知道過程中可能會出現的醫療干預及併發症。

In this light, the alternative of a planned Caesarean section may be tempting.

從這一角度看，替代順產的剖腹產手術好像很誘人。

While not risk-free, it appears to be similar to that of of a planned vaginal birth in the short term and – with a slightly higher risk of respiratory problems at birth – may be even safer for the baby.

但這也不是一點兒風險沒有的。在短期看來，剖腹產和計劃好的順產很相似——只是在手術時，呼吸系統出現問題的概率略高一點兒——但是對於孩子來說，剖腹產整體更安全。

However, the scarring from a section will make each future pregnancy more risky as it can affect the development of the placenta, resulting in increased risks for the mother of developing major bleeding and hysterectomy, although this is rare. There is also some concern that babies born by Caesarean could be at higher risk of developing asthma.

但是，剖腹產後留下的傷疤對於以後再次懷孕是有風險的，因爲這會影響到胎盤的發育，也會增大產婦出現大出血和切除子宮的可能性，當然這種可能性不高。通過剖腹產出生的孩子也更容易患哮喘病，這也有些令人擔憂。

Since women will value these risks differently, informing them of the merits of both options would empower them to decide what matters most to them.

由於不同的人對風險的評估也不同，所以告知產婦這兩種方式的優缺點，才能讓他們根據自己的情況和需要來決定。

For some that will be the opportunity to experience labour and the benefits of vaginal birth, for others it will be the option of a more controlled and predictable Caesarean birth.

對一些人來說，他們樂於享受生產過程，陰道生產也對他們很有利；對於另外一些人而言，他們傾向於選擇剖腹產，更好控制，也更易於預測。

But in reality things are more complicated. If potential risks of vaginal birth are routinely discussed with all women, Caesarean section rates in UK hospitals are likely to rise further.

但是，實際情況遠比這複雜。如果醫院常規地告知了產婦順產的風險，英國各大醫院剖腹產的比例必然會升高。