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这是工程师用来测量 This is a stretch test, which engineers use
诸如橡胶等材料的强度和拉伸性的拉伸测试 to measure the strength and stretchiness of materials, like rubber.
但在这里 测试的是不同的东西： But here, it's testing something different:
人类子宫颈的组织 tissue from a human cervix.
子宫颈是女人的子宫和阴道 两者之间的大门 The cervix is the gate between a woman's uterus and her vagina.
它阻挡一切东西 It blocks anything,
比如阻挡阴茎继续往上 -like a penis, from going any further up.
它也能阻止子宫里的重要东西 And it stops important things in the uterus,
比如生长中的胎儿 防止其过早落下来 like a growing fetus, from coming down too early.
把子宫想象成气球 Think of the uterus like a balloon.
你用空气吹气球 You blow up the balloon with air.
你必须让空气留在子宫里 或者子宫里的婴儿 You have to keep the air in the uterus or the baby inside the uterus,
子宫颈是保持子宫关闭的结 and that cervix is the knot that keeps the uterus closed.
作为一名工程师 子宫颈真正让我震惊的是 As an engineer, what's really struck me about the cervix
是实验室里怀孕的样本… is that a pregnant specimen in the lab...
它一直在伸展 伸展 从不断裂 It just keeps stretching and stretching. It never breaks.
怀孕九个多月后 子宫颈的弹性增强五倍 Over nine months of pregnancy, the cervix gets five times stretchier.
当它像你嘴唇上的皮肤一样柔软时 它打开了 When it's soft like the skin on your lips, it opens up.
你可以从经验中了解到 And as you may know from experience
或者来自一个普通的电视比喻 or from a common TV trope,
那通常是… that's usually when...
明迪 你的羊水破了 Mindy, your water just broke.
我的羊水刚刚破了 Ah! My water just broke.
我坐在水坑里…水 Oh! I'm sitting here in a puddle of water.
我的羊水破了 Uh... my water broke.
太酷了 我们冰箱里还有一个 Oh, that's cool. We got another one here in the fridge.
婴儿出生后 After the baby comes out,
这种非常柔顺的材料 必须改造和修复自己 this very compliant material has to remodel and repair itself.
我不知道有什么其他的工程材料 I don't know of any other engineering material
能够那么快软化或重塑自己 that can soften or remodel itself that quickly.
简而言之 子宫颈是一个解剖学 和工程学奇迹 Put simply, the cervix is an anatomical and engineering miracle.
但这并没有让分娩本身变得 不那么令人畏惧 But that doesn't make childbirth itself any less daunting.
我不是真的害怕 我就是…是的 我很紧张 I'm not really scared. I'm, like... Yeah, I am nervous.
我非常紧张但这只是因为 这是我的第一个孩子 I'm completely nervous, like, but it's only
我不知道接下来会发生什么 because this is my first kid, so I don't really know what to expect.
在助产士、产妇陪护和医生的 帮助下 Around the world, 250 babies are born every minute.
全世界每分钟有250个婴儿 In hospitals or at home
在医院或者家里出生 with midwives, doulas, and doctors.
一些女性使用药物止痛 Some women use drugs for the pain,
有些剖腹产 some have C-sections
或者使用其他医疗技术 or use other medical technology.
其他人没有 And others don't.
给我看看你的能耐 准备好了吗 深呼吸 Sweetheart, show me what you got. Ready? Nice deep breath in.
然后…从底部推 你能行的 Breath. And push from your bottom. You got this.
二 三 四… Two, three, four...
但是在世界各地 每天分娩 But childbirth still kills more than 800 women every day
仍然导致800多名妇女死亡 around the world.
一项全球调查发现 And one global survey found that up
高达30%的女性 将分娩视为 一段创伤经历 to 30% of women rate childbirth as traumatic.
我只记得闭上眼睛 走进去 I just remember, like, closing my eyes and going inside
进入我内心最深处 into, like, the deepest part of myself
就像 “我必须挺过去” to just be like, "I have to get through this."
很长一段时间 我真的受到了精神创伤 I was, like, really traumatized for a really long time.
是什么 让分娩如此艰难？ So, what makes childbirth so hard?
女人能做些什么来获得最简单 最安全的体验呢？ And what can women do to have the easiest and safest experience?
真正分娩的收缩 The contractions in true labor
总是有明确的节奏 always have a definite rhythm.
你可能会突然想知道 You may suddenly wonder
婴儿怎么可能穿过那个小开口 how the baby can possibly get through that small opening.
别担心 你会伸得够开的 Don't worry, you'll stretch enough.
不仅仅是病理学知识造就了 It is not only pathological knowledge
一位伟大的产科医生 which makes the great obstetrician.
这是活力 It is vigilance.
一种不让你忘记你手中 有两个人的生命的东西 One that does not let you forget you have in your hands the lives of two people.
大多数大型灵长类动物以相对 相似的方式生育 Most large primates give birth in relatively similar fashion.
女性在子宫中携带胎儿30至40周 The female carries the fetus in her womb for 30 to 40 weeks,
然后婴儿从产道出来 and then the baby emerges from the birth canal,
通常会在几小时内头先出来 usually headfirst, within hours.
但是有一个关键的区别 But there's one key difference:
人类遭受更多的痛苦 humans suffer a lot more.
不是一个婴儿就这么掉了出来 这么简单 It's not like a baby just falls out,
就像一些为非人灵长类绘制的 巨蟒素描 like someMonty Python sketch, for non-human primates.
它们确实在挣扎 They do struggle, and still,
它们仍然有一个看似 they have a seemingly much more easy childbirth
比我们更容易的分娩 than we have.
人类第一次分娩时大约要 九个小时 Humans labor around nine hours the first time they give birth
并且经常持续更长时间 and often go much longer,
当大多数黑猩猩分娩时 就两个小时 while most chimps labor for just two hours.
分娩过程中有一部分 And there's one part of the struggle of childbirth
很难量化…疼痛 that's harder to quantify-- the pain.
我觉得我的下半身要爆炸了 It felt like the bottom half of my body was gonna explode
粘糊糊的东西要冒出 喷满整个房间的四壁 and erupt goo all over the four walls of the room.
就像 你在某种 “疼痛搅拌机” Like you're in some kind of pain blender,
你刚刚在那里不停地旋转 where you're just being spun around,
你不知道发生了什么 感觉你被撕成两半了 and you don't know what's going on. It feels like you're being ripped in two.
一切都被漆成红色 Everything painted red,
有一个警报就像… and there's, like, this alarm that's like...
看起来我正在经历驱魔 It looked like I was experiencing an exorcism.
人类分娩疼痛的原因 The question of why humans have painful births comes down
归结为解剖学和进化 to anatomy and evolution.
理论是这样的： The theory goes like this:
与其他灵长类动物不同的是 人类进化成两条腿走路 Humans, unlike other primates, evolved to walk on two legs,
这意味着骨盆 变得更加复杂和狭窄 which meant pelvises became more complicated and narrow.
我们的大脑也进化成比其他 灵长类动物大 Our brains also evolved to be bigger than other primates',
也就是意味着 更大的新生儿头 which means bigger newborn heads.
因此黑猩猩可以从宽阔的臀部 伸出一个小脑袋 So chimps get to push out a small head from wide hips,
不过我们却在狭窄的空间里挤出 一个大婴儿的时候 while we're stuck squeezing out a big baby through a narrow space.
但为什么它就停止进化？ But why did it stop there?
为什么我们不 不断改进我们的解剖结构 以减少分娩的痛苦？ Why didn't we keep evolving our anatomy to make childbirth less painful?
好吧 为什么我们不能从痛苦的 Well, why didn't we evolve
大便中解脱出来呢？ away from painful bowel movements?
为什么我们不能摆脱 痛苦的分手呢？ And why didn't we evolve out of painful breakups?
自然选择不在乎痛苦 Natural selection doesn't care about pain,
只关乎生存 即使很痛… just survival. And even though it hurts...
不管怎样 我们一直在生孩子 ...we keep making babies anyway.
什么有用 那就有用 什么够好 那就够好 What works, works. And what's good enough is good enough.
它非常紧 It's a terribly tight fit.
这是一次痛苦的分娩 这是一次漫长的分娩 It's a painful labor. It's a long, protracted labor,
但它还是可以用 够好了 but it works. It's good enough.
所以 为了继续我们 物种的生存 So, to continue the survival of our species,
女人总是难产 women have always been stuck with difficult childbirths.
-快出来了 -还有多少？ Almost there. How much more?
一次推一下 Not much more. One push at a time.
旧约说 The Old Testament says,
“痛苦的分娩之后才会有孩子” "With painful labor, you will give birth to children,"
夏娃吃了知识之树后 after Eve ate from the Tree of Knowledge.
这张12世纪日本的卷轴 显示分娩是如此致命 And this scroll from 12th-century Japan shows childbirth as so deadly
它吸引了恶魔 而恶魔被几乎致命的事件所吸引 that it attracted evil spirits who were drawn to near-fatal events.
这就是为什么历史上有那么多的文化 找到了保护 That's why so many cultures throughout history found ways
和安慰分娩中的妇女的方法… to protect and comfort women during childbirth...
有仪式 有朋友和家人的支持 with rituals and the support of friends and family.
在地中海 妇女们还试图用鸦片 和大麻来 Women also tried to numb their pain
麻痹她们的疼痛 with opium and hashish in the Mediterranean,
或者在古希腊 柳树皮 化学性质类似阿司匹林 or in ancient Greece, willow bark, which is chemically similar to aspirin.
科学家发明了新的工具和技术 And scientists invented new tools and technologies
来帮助如果被卡住的婴儿 to help if the baby got stuck.
多亏了医疗的进步 随着时间的推移 分娩的死亡率降低了 Thanks to medical progress, childbirth got less deadly over time.
最大的进步之一 And one of the biggest areas of progress
就是剖腹产 was the Caesarean section.
剖腹产实际上起源于 C-sections actually originated thousands of years ago.
几千年前 它们几乎在每一种古代文化中 都被提及 They're referenced in almost every ancient culture,
当母亲活下来的希望很小或者 and were performed to save the baby
没有希望的时候 他们就去救孩子 when the mother had little or no hope of surviving labor.
1826年 英国外科医生詹姆斯巴里 在南非进行了第一次 One of the first known C-sections where the woman actually survived
让母亲存活下来的剖腹产手术 happened in South Africa in 1826,
而这位医生在出生时 performed by the British surgeon James Barry,
实际上是一位女性 叫做玛格丽特布尔克利 who was actually born a female, Margaret Bulkley.
但这直到他死后才被发现 But that wasn't discovered till after his death.
大约在同一时间 And around the same time, a medical missionary
一位医学传教士观察乌干达医生 进行剖腹产 observed Ugandan doctors performing C-sections.
他记录下了这个 母亲和婴儿都活了下来的手术 He wrote about one operation where the mother and baby both survived.
没有麻醉 There was no anesthesia,
但那女人有充足的香蕉酒 but the woman was liberally supplied with banana wine.
在20世纪 In the 20th century,
剖腹产手术开始持续挽救 妇女的生命 C-sections started to consistently save women's lives.
然后 生育技术开始真正的 发展起来 And then, birthing technology really started to pick up.
科学家们开始使用骨盆X光来 Scientists started using pelvic X-rays
绘制平均产程和产率 to chart the average length and rate of labor.
对于生产过程不够快的女性 他们开发了一种 And for women who didn't progress fast enough,
新的药物 即合成的催产素 they developed a new drug to artificially speed it up,
来人为地加速生产过程 called pitocin, a synthetic form of oxytocin.
这是一种自然产生的 荷尔蒙 It's a naturally occurring hormone,
但它会在女人一生中的三个事件中 充满她的身体： but it floods a woman's body at three events in her life:
性高潮、母乳喂养和分娩 orgasm, breastfeeding, and labor.
脑垂体后叶催产素作用 如此之好 以至于如果 Pitocin worked so well that doctors and women
一个女人超过了预产期一周 医生和妇女就开始安排引产 started scheduling inductions if a woman went a week over her due date,
这给原本不可预测的事件 带来了一定的确定性 bringing some certainty to an otherwise unpredictable event.
关于分娩的医疗干预史 The history of medical intervention, when it comes to childbirth,
与产科作为一门医学专业的出现有很大关系 has a lot to do with the emergence of obstetrics as a medical profession.
在大多数的历史中 医生不会接生孩子 For most of history, doctors didn't deliver babies,
而是助产士接生 midwives did.
妇女通过经验和观察在现实世界中接受培训 Women trained in the real world, through experience and observation.
然后 在17世纪的欧洲 助产士们开设了 Then in the 1700s in Europe, midwives opened up schools
更多官方培训项目的学校 with more official training programs.
在接下来的一个世纪里 And as waves of European immigrants
随着一波又一波的欧洲 移民来到美国 came over to America in the following century,
他们带着这些技能来到北方各州定居 they brought these skills with them as they settled in the northern states.
而在美国南部被奴役的黑人妇女被迫 While in the American South, enslaved black women were forced
负责白人孩子的分娩和护理 to attend to the deliveries and care of white children
被迫与自己的家庭分离 and were torn from their own families.
奴隶制结束很久以后 And they continued working as skilled midwives
她们继续当熟练的助产士 long after slavery ended.
她们常被称为“助产士奶奶” They were often referred to as "granny midwives."
她们往往是社区中年长的成员 They tended to be senior, older members of their community
她们已经生了孩子 who had themselves already given birth
在她们的社区里受到尊重 and were viewed with respect among their community.
但是在20世纪 医生开始 But in the 1900s,
向助产士施压 让其走出产房 doctors started to edge midwives out of the delivery room,
他们提出了令人信服的论点 and they made a convincing argument.
出生看起来可能很简单 这可能已经持续了几个世纪 Birth might look simple. It may have been going on for centuries.
但是 事实上 这是一个病理事件 这需要医疗干预 But in fact, it was a pathological event that requires medical intervention.
就像会阴切开术一样 Like a procedure called the episiotomy.
在生产时 女人撕裂阴道是很常见的 During birth, it's common for a woman to tear her vaginal opening.
然后在20世纪20年代 医生开始 Then in the 1920s,
主动切开开口 doctors started proactively cutting the opening instead.
我认为想法是 那会更容易缝合 I think the idea was that that would... that would be easier to sew up.
结果是给人们做会阴切开术 And it turned out that giving people an episiotomy
让撕裂变得更严重 makes the tearing much worse.
大约在同一时间 And around that same time,
西方医生也开始提供新的止痛药 Western doctors also started offering new pain drugs,
就像德国出现的一种趋势叫做“模糊催眠”剂 like one trend that emerged out of Germany called twilight sleep.
这是一种重麻醉剂的混合物： It was a mixture of a heavy narcotics:
东莨菪碱和吗啡 scopolamine and morphine.
极具争议性 因为这真的很危险 Extremely controversial 'cause it was really dangerous.
许多支持“模糊催眠”的女性 Many of the women who were behind twilight sleep
参与了选举权运动 were involved in the suffrage movement.
她们的论点是女性 And their argument was
应该有权拥有无痛分娩 that women should have the right to have a painless childbirth.
但是药物实际上并没有 让疼痛消失 But the drugs didn't actually get rid of the pain,
只是让痛苦的感觉消失 just the memory of the pain.
产房里的女人猛烈地捶打 尖叫 Women in delivery rooms thrashed violently and screamed.
在她们分娩时她们经常戴着兜帽或者 被放在笼子里 They were often hooded or placed in cage-beds while they labored.
分娩经历基于你 The birthing experience differed enormously
所居住的地方 你的阶级背景和你 based on where you lived,
皮肤的颜色而差异很大 your class background and the color of your skin.
有一种理论认为一个种族或 一种文化越文明 There is a theory that the more civilized a race or a culture is,
妇女分娩越困难 the more difficulty the women have experiencing childbirth.
因此 麻醉也是必需的 And so, anesthesia was also required
确保她们可以完成这个过程 to make sure they could get through the process.
工人阶级女性 有色人种女性 Working-class women, women of color,
移民妇女 没问题 immigrant women, no problem.
婴儿可能会突然出来 Babies could just pop out.
是过度文明的中上阶层妇女 It was the over-civilized, upper-middle-class women
需要帮助 that needed help.
这种刻板印象一直延续到今天 That stereotype lives on today,
这也是黑人女性在英国 and it's one reason black women in the UK
死于分娩的可能性是白人女性的五倍 are five times more likely to die in childbirth than white women.
在美国 更有可能是三倍 And they're three times more likely in the US,
即使在同一收入水平上 也存在差异 where disparities exist even at the same income level.
最大的问题是 她们的心声 没有被听到 Biggest issue, they're not being heard.
当女人说 “我很痛苦” When women have said, "I'm in pain,"
对有色人种女性的理解 或刻板印象 the understanding or stereotype of women of color,
她们并不像现在这样痛苦 that they're not really in pain the way they are.
回到20世纪50年代 So back in the 1950s,
虽然很多黑人妇女在需要 止痛药的时候 while many black women didn't get pain medication
也没有服用 even when they needed it,
白人妇女开始大声疾呼 过度用药 white women started to speak out about being over-medicated.
1958年《妇女家庭杂志》 发表了一项调查 In 1958, The Ladies Home Journal published an investigation,
“产房里的残忍行为” "Cruelty in Maternity Wards,"
记录妇女在医院面临的虐待 "They give you drugs whether you want them or not
一个女人写道 One woman wrote in,
“不管你愿不愿意 他们都会给你药 "They give you drugs whether you want them or not,
像动物一样绑住你" and strap you down like an animal."
女性开始对她们认为绝对可怕的 Women start reacting to what they believe to be
生育经历做出反应 absolutely horrific birth experiences.
她们很生气认为自己 错过了人生中 They get angry and think they have missed out
最不可思议的时刻 on what should be the most incredible moment of their lives.
而这种感觉在药物治疗分娩的 And that somehow that gets completely lost
过程中完全消失了 in the process of medicalizing birth.
基层运动中最有影响力的声音之一 One of the most influential voices
是由助产士转为活动分子的伊娜梅加斯金 in the grassroots movement was Ina May Gaskin, a midwife-turned-activist.
在她1975年的书 《精神助产士》 In her 1975 book, Spiritual Midwifery,
她说当女人 she said that when women are
“无需药物或干预即可分娩” "empowered to birth without drugs or interventions,"
出生是“每个女人在安全 舒适的环境中 "birth is a spiritual experience that each woman deserves
应得的精神体验” in a safe and comfortable setting."
有很多嬉皮士女性 参与自然分娩运动 There were a lot of hippie women involved in the natural childbirth movement,
但是也有中产阶级 郊区家庭主妇 but there were also middle-class suburban housewives.
政治派别的各个方面都有人 There were people on all sides of the political spectrum
简单地认为 “我不需要为了 that simply thought, "I don't need to be knocked unconscious
生孩子而被打晕 in order to give birth.
我有能力做这件事" I am capable of doing it."
那时镇上有一种热门的新药： And by that time, there was a hot new drug in town:
硬膜外 epidurals.
科学家发现 在叫做“硬膜外腔”脊柱的 Scientists discovered that injecting anesthesia
某个部位注射麻醉剂 into a certain spot in the spine called the "epidural space"
停止疼痛信号从脊椎传到大脑 stopped pain signals traveling from the spine to the brain.
女人的下半身在几分钟内 The entire lower half of a woman's body
就会麻木 而她仍保持完全警觉 would go numb within minutes, while she remained fully alert.
太棒了 非常好 It was great. It was very nice.
硬膜外麻醉没有遗憾 No regrets on the epidural.
我从腰部以下都感觉不到自己的身体 I couldn't feel my body from the waist down.
我知道这是我一生中做出的 And I knew at that point,
最好的决定之一 it was one of the best decisions I'd ever made in my life.
我就… I-- I was like...
世界卫生组织称 对于分娩中的健康女性 The World Health Organization says epidurals are perfectly safe
硬膜外是完全安全的 for healthy women in labor.
但是当然 你一半的身体 都麻木了所以… But of course, half your body is numb so...
分娩的推进阶段往往要长一点 The pushing stage of labor tends to be a bit longer,
也许平均大约20分钟 maybe, on average, about-- about 20 minutes.
你对膀胱的控制力变弱了 You have less control over your bladder,
事后走动可能就不那么容易了 and it may be less easy to walk around afterwards.
另一项正在迅速流行的 医疗干预措施： Another medical intervention that's been surging in popularity:
剖腹产 C-sections.
全世界五分之一的婴儿 就是这样出生的 That's how one-fifth of babies around the world are now delivered,
是2000年的两倍 twice as many as in 2000.
在一些国家 一半以上的新生儿 是剖腹产出生的 In some countries, they account for more than half of all births,
像埃及 多米尼加共和国 like Egypt, the Dominican Republic
和巴西 总体剖腹产率为55% and Brazil, where the overall rate is 55%.
但是在私立医院 医生按服务收费 But in private hospitals, where doctors are being paid per service,
不是每小时工作 剖腹产率是83% not per hours worked, it's 83%.
一项研究指出 One study noted,
“通过缩短产程节省的时间 "Savings in time gained by cutting labor short
可能会促使产科医生选择剖腹产” may motivate obstetricians to choose a cesarean delivery."
虽然产妇死亡率 And while the maternal mortality rate is lower
在剖腹产手术较多的国家 这一比例较低 in countries that perform more C-sections,
只有当剖腹产率达到 19%时才是这样 that's only true up to a C-section rate at 19%.
除此之外 这没什么区别 Above that, it doesn't make a difference,
说明很多剖腹产在医学上 是不必要的 suggesting a lot of C-sections are medically unnecessary.
一次妊娠剖腹产的妇女 Women who have had a C-section on one pregnancy are
在之后的怀孕中并发症的风险更高 at higher risk for complications in later pregnancies,
包括更高流产甚至死产风险 including higher risks of miscarriage and even stillbirth.
自然分娩的拥护者说 不必要的 剖腹产是扰乱女性 Natural birth advocates say unnecessary C-sections
自然分娩节奏的结果 are a result of messing with a woman's natural rhythm of labor,
这个概念现在被称为“一连串的干预” a concept now known as the "cascade of interventions."
我“同意”了这个紧急剖腹产 I "consented" to this emergency C-section
根据我的记录 是因为胎儿宫内窒息 不过我们有心率监测器 due to, in my records, fetal distress because of the heart rate monitor.
我们会看到胎儿心率的变化 We'll see babies have fetal heart rate changes,
尤其是接受硬膜外麻醉后 particularly after getting an epidural.
硬膜外倾向于跟随催产素 因为… And epidurals tend to follow pitocin because...
当他们开始增加我的剂量时 As they started increasing my dosage,
我开始宫缩得很痛 I started having really, really painful contractions.
当妇女的子宫颈开得不够快时 Pitocin can help when a woman's cervix
催产素可以起到帮助作用 isn't opening up fast enough.
因此他们提高了我的催产素 And so they upped my pitocin,
这是我需要的 因为我到了预产期 which I needed because I hit my due date
我还没有分娩 and I still hadn't gone into labor.
我被诱导的那一刻就取决于技术 You know, the minute I had to be induced, it was up to technology.
但是有一个 关于干预级联理论的问题 But there's one problem with the cascade of interventions theory.
在一项大型随机试验中 研究人员发现… In a large, randomized trial, researchers found...
被诱导的女性 Women who are induced
实际上不太可能有剖腹产 are actually not more likely to have a C-section.
我们诱导的频率可能 比我们需要的要高 We probably do induce more frequently than we need to,
但没有明显的负面影响 but there aren't any hugely obvious downsides.
但医院最后一刻的变化会 But last-minute changes at the hospital
影响女性的心理健康 canimpact a woman's mental health.
一项研究发现进行计划外的 剖腹产女性 One study found that women who had unplanned C-sections
更有可能经历创伤后痛苦和抑郁 were more likely to experience post-traumatic distress and depression.
在她2004年的畅销书中艾娜梅加斯金写道 In her 2004 bestselling book, Ina May Gaskin wrote
更久的分娩可能是“因为缺乏隐私或恐惧” that more drawn-out labors could be "because of a lack of privacy or fear."
她称之为"括约肌法" She called it the "sphincter law,"
说子宫颈像括约肌一样 saying the cervix was like a sphincter muscle
而且“括约肌对命令 反应不是很灵” and that "sphincters do not respond well to commands."
假设你在公共浴室 你想拉屎 Let's say you're in a public bathroom, and you're trying to take a crap,
有人打开了门… and someone opens the door...
或者一声巨响 有事情发生 or a loud noise, something happens.
你的括约肌会冻结 Your sphincter will freeze.
想想把一个婴儿推出你的阴道 Think about trying to push a baby out of your vagina.
你想放松 呼吸… You're trying to be relaxed, breathe...
恐惧会对你的能力 Fear is going to have a major impact
产生重大影响 on your ability to do so.
恐惧让分娩变得更加困难 The idea that fear made childbirth harder was also preached
也在20世纪50年代 被法国产科医生费尔南拉马兹宣扬 by the French obstetrician Fernand Lamaze in the 1950s.
他推广了心理预防方法 He popularized the psycho-prophylactic method,
现在被称为拉马兹法 now just known as the Lamaze method,
一套无痛、无恐惧、无药物 分娩的技术 a set of techniques for a pain-free, fear-free, drug-free birth.
它涉及呼吸技术 不同的分娩姿势和按摩 It involved breathing techniques, different laboring positions, and massage.
拉马兹在他的书中写道 In his book, Lamaze wrote
我们不应该试图 “通过药物 that we should not try to "cure the pain of childbirth
治愈分娩的痛苦” by the use of drugs"
而是停止害怕疼痛本身 and instead, just stop fearing the pain itself.
但女性选择或拒绝止痛的 But women's reasons for choosing or rejecting pain relief
原因一直很复杂 have always been complex.
在日本 只有6%的女性采用 硬膜外麻醉 In Japan, just 6% of women get epidurals,
因为文化上期望痛苦是分娩的一部分 because there's a cultural expectation that suffering is a part of childbirth.
而超过70%美国女性选择硬膜外麻醉 And while more than 70% of American women choose epidurals,
这意味着将近30%决定不用 that means almost 30% decide to go without.
我的家人 当我告诉他们 我想自然分娩 My family, when I told them that I wanted to do a natural childbirth,
他们说 “你做不到 你不会成功的” they were like, "You can't do it. You won't make it."
我就说 “哦 不 现在我必须这么做 And I was just like, "Oh, no, now I have to do it,
因为你不能和我说我做不到" 'cause you can't tell me that I can't do it."
我只是有这种奇怪的迷恋 我想知道是什么感觉 I just had this weird fascination with what it would feel like,
我只是想知道会是什么感觉 and I just wanted to know what it would feel like.
现在我回头看 我想 “为什么我不想要硬膜外麻醉？” Now that I look back, I'm like, "Why didn't I, like, want an epidural?"
我不知道为什么没有要硬膜外麻醉 I have no idea why I didn't want an epidural.
今天 一些科学研究表明放松 Today, some scientific research suggests that being relaxed
会对分娩产生真正的身体影响 could have real physical impacts on labor,
正如自然分娩倡导者 几十年来一直争论的那样 just as natural childbirth advocates have argued for decades.
子宫颈顶部实际上有很多收缩的肌肉 The top of the cervix actually has a lot of muscle that does contract,
所以这让我们开始思考“好吧 也许这是括约肌” so that's what made us start to think, "Okay, well maybe this is a sphincter."
所以 这完全改变了我们 正在研究的 And so, that actually completely changes the map that we're working with
来了解怀孕情况的地图 to understand what goes on in pregnancy,
因为在早产的女性中 because in women who deliver early,
子宫颈开始过早打开 that cervix starts to open prematurely,
实际上可能是括约肌放松得太快了 and it might actually be a sphincter that's relaxing too soon.
但是为什么这发生在一个病人身上 而不是另一个病人身上 But why that happens in one patient over another,
我们不完全理解 we don't fully understand.
显然 力学在怀孕中起着 非常重要的作用 Mechanics obviously play a really important role in pregnancy.
我确实需要一个工程师来帮我 了解组织的强度 I do need an engineer to help me understand how strong is the tissue.
我们可以运行“如果”场景 We can run "what if" scenarios.
那么 如果病人子宫颈很短？ So, what if the patient has a short cervix?
如果婴儿踢了 或者有一个小的宫缩 她的子宫颈会打开吗？ Will her cervix open if the baby kicks or if there's a small contraction?
子宫颈能机械地承受怀孕的负荷吗？ Can that cervix mechanically withstand, you know, the loads of pregnancy?
我们应该知道这些答案 我们正在治疗癌症… We should know those answers. You know, we're curing cancer.
我们应该能够更好地理解怀孕 We should be able to understand pregnancy a lot better.
这就是为什么在分娩的最佳方式上 That's why there's still so much conflicting information out there
仍然有很多相互矛盾的信息 on the best way to give birth.
很多是显著的 And a lot of it is very insistent.
这些婴儿板可能是我种下种子的地方 These baby boards are probably where the seed was planted for me.
硬膜外麻醉之类的东西是作弊 Things like an epidural were cheating,
前进的最佳方式 and that the best way forward
实际上是在没有任何医疗 干预的情况下分娩 would actually be give birth without any medical intervention whatsoever.
我觉得有时运动中的声音会把自己 I think sometimes the voices there in the movement
推入一系列特定的选择中 can push themselves into a particular set of choices.
与其说 And rather than saying,
“让我们赋予人们权力做出他们想要的选择” "Let's empower people to make whatever choices they want,"
还不如说 “让我们赋予他们 做出这一特定选择的权利” say, "Let's empower them to make these particular set of choices."
当我发现我女儿 Well, when I found out that my daughter
需要通过剖腹产来分娩 was going to need to be delivered via C-section,
我觉得自己像个失败者 I felt like a failure.
我觉得我没有做到我打算做的事 I felt like I had failed to do what I set out to do.
自然分娩倡导者可能是 受到一些 Natural childbirth advocates may be criticized by some
夸大医疗干预负面影响的 人的批评 for exaggerating the negative impact of medical interventions,
但是他们的倡议也显著改善 but their advocacy has also dramatically improved
许多女人分娩的方式 the way many women give birth.
在20世纪70年代 在英国会阴切开率 超过50% In the 1970s, episiotomy rates in the UK were over 50%,
有时未经病人允许就进行 sometimes performed without the permission of the patient.
但后来 有人反对…反对所谓的“分娩伤口” But then, there was a backlash against so-called "birth cuts."
英国助产士和活动家希拉基辛格 组织了一项调查 A survey was organized by British midwife and activist Sheila Kitzinger.
她发现会阴切开术会 导致更持久的痛苦 And she found episiotomies caused more lasting pain
比任何其他分娩过程都要多 than any other procedure in childbirth
一般来说 自然撕裂 比伤口造成的疼痛要少得多 and that a natural tear generally caused much less pain than a cut.
一项研究开始了 三年后其总结 A study was launched, and three years later, it concluded
“没有证据支持会阴切开术的好处" that there was "no evidence to support the supposed benefits of episiotomy."
更多的研究证实了这些发现 More research confirmed these findings,
到2012年 英国的会阴切开术下降到15% and by 2012, episiotomies in the UK were down to 15%.
自然分娩运动 And the natural childbirth movement
带回了一种最古老的分娩 支持方式… brought back one of the most ancient types of labor support...
让产妇陪护在旁边帮忙 having a doula present.
产妇陪护不是医生或助产士… Doulas aren't doctors or midwives.
她们是训练有素的生育教练 They're trained birth coaches,
在那里支持分娩妇女 帮助确保她的愿望 there to support the laboring woman and help make sure her wishes
受到医疗提供者的尊重 are being respected by the medical provider.
你太强了 看看你 -You're so strong. Look at you.
许多研究证实了 产妇陪护在场 A number of studies have confirmed the presence of a doula
“减少干预需求” "reduces the need for interventions,"
发现剖腹产减少了51% finding a 51% decrease in C-sections.
我觉得有人在房间里说 “是的 I think it's partly just that it's nice to have somebody in the room
这是正常的 比如说 这没关系 to say, "Yeah, this is-- this is normal." Like, "This is okay."
一切都会好起来" Like, "Everything is going fine."
我认为分娩的部分可能相当可怕 I think that that part of labor is quite-- can be quite scary.
快出来了 亲爱的 We almost there, sweetheart.
就出来了 We are almost there.
自然分娩运动的潜在信息 And the natural childbirth movement's
继续在全世界引起共鸣… underlying message continues to resonate around the world...
女人应该做出自己的选择 that women should make their own choices
基于什么对她们最好 based on what's best for them.
我决定自然分娩 I decided to have a natural childbirth
因为 你去医院 because you go to a hospital,
黑人女性有点不成比例地 比如 black women are kind of disproportionately, like,
在医院里被忽视 ignored, I guess, in hospitals.
我以前见过的唯一一次生育 是一个朋友 The only birth I ever had witnessed before was a friend who gave birth
在没有任何药物或干预下分娩 但那是在医院里 without any medicine or interventions, but it was in a hospital,
我想那是两全其美 and I thought that was the best of both worlds.
我的出生计划是 去医院 My birth plan was go to the hospital,
听从医生说的一切 带着健康的婴儿回来 listen to everything the doctors say, and then come back with a healthy baby.
那是我100%的计划 That was 100% of my plan.
还没有办法预测 每次分娩都会怎样 There's no way yet to predict how any one birth will go
或者每个人都需要什么样的干预措施 or what interventions are necessary for each person
因为每个女人都不一样 because every woman is different.
然后 每个婴儿也都完全不同 And then also, like, every baby is totally different.
婴儿身体正面朝上 The baby was, um, sunny-side up,
那种阵痛 就像 比正常分娩疼痛更严重 the kind of labor pain that's, like, way worse than regular labor pain.
我脸色发青 到处都是血 I turned blue. There was blood everywhere.
他们最后给了我催产素 没有硬膜外麻醉 They ended up giving me pitocin without any epidural,
然后我做了会阴切开术 and then I had an episiotomy,
所有的一切都像是 彻底的震惊 and all of it was like a total shock.
我不知道这些 会这么难 I had no idea that any of this would be so hard.
我真的很紧张 我知道组织伸展了多少 I was really nervous. I know how much the tissue stretches,
但是我信任我的医生 我得到了很好的照顾 but I trusted my physicians, and I was in good care.
对我的第一个孩子来说 这种经历更令人难以承受 With my first kid, the experience was more overwhelming.
我第二个孩子的出生经历 有点像田园诗般的经历 The birth experience with my second kid was, like, sort of a very idyllic experience.
我是说 有很多血 I mean, also, with a lot of blood.
我不会说谎 我既愤怒又怨恨 I'm not gonna lie. I am angry and resentful,
五年后 我有很多事情要处理 and I have a lot to process, five years later.
然而 与此同时 这是惊人的和美妙的 And yet, at the same time, it was amazing and wonderful.
我仍然认为我的剖腹产 是自然分娩 I still consider my C-section to be natural childbirth.
我不认为人类做的任何事 是不自然的或超自然的 I don't consider anything humans do to be unnatural or supernatural.
所以 “自然”是唯一的另一个…选择 And so natural is the only other option.
我害怕疼痛我做了全硬膜外麻醉 I was afraid of pain, and I had a full epidural.
我想 “这太愚蠢了 I thought, "This is so silly.
我错过了一些东西 我本可以这么做的" I'm missing out on something. I could have done this."
我生自己的气 有点惭愧我刚刚屈服了 I was angry at myself and kind of ashamed that I just caved.
她们没有什么好羞愧的 因为她们仍在做一件大事 They have nothing to be ashamed of because they're still doing a big work,
那就是给世界带来了生命 -which is bringing life into the world. -...two, three...
培育一个人 把这个人带到这个世界上 Growing a human and bringing that human into the world
不管分娩方式如何… regardless of the route of delivery...
九 十 太美了 深呼吸 Nine and ten. Beautiful. Deep breath, deep breath!
…仍然是一大壮举 ...is still a big feat.
再来一下 准备好了吗？推你的屁股！ Right back at it. Ready? And push on your bottom!
-来吧 再来一下 -准备好了吗？就这样 Come on, give me another one. Ready? This is it.
-来吧 -准备好了吗？ Let's go. Ready?
一 二 三… Most important push of your life. Ready? One, two, three. Right back at it!
再来一下！ -You got it. Yes, Daysha. Hold her down.
睁开你的眼睛！ Open your eyes! Open your eyes! Open your eyes!
看看你的孩子 睁开你的眼睛 Look at your baby. Open your eyes.
哦 我的天啊 Oh, my God! Okay.
恭喜你 妈妈！ Oh, my God! Congratulations, Mommy!
我的宝贝！他值得你的付出 对吧？ You never worked on anything so hard in your life. -I know he's worth it, right?
看看他！ Oh, look at him! He's so little!
他好小啊！ All right. Come on, bud.
给你 There you go.
欢迎来到这个世界 亲爱的！ Welcome to the world, sweetie!
达沙 你做到了！ Daysha, Daysha, you did it!