Xinhua News Agency, Hangzhou, May 9 -
Title: children so painful, why "painless childbirth" penetration rate is not high?
Xinhua News Agency "Xinhua Viewpoint" reporters Huang Xiao and Feng Xinran
He Jing, the mother of the “post-90s” in Hangzhou, recalled her birth experience in January this year and lamented that having a baby was so painful that she was "doubtful about life". After 10 hours of labor, she was exhausted and could only "turn from Shun" to the end. .
Like He Jing, the pain of childbirth for a few hours or even more than ten hours is a memory that many mothers dare not look back on.
In fact, painless childbirth has been implemented in our country for many years. Why are so many women still unable to escape the pain of childbirth?
According to a survey conducted by a reporter from "Xinhua Viewpoint", data show that the current average penetration rate of childbirth analgesia in my country is about 30%. The shortage of anesthesiologists and midwives, and the unclear charging standards have hindered the further promotion of childbirth analgesia, and many women still To face this unbearable pain.
The prevalence of childbirth analgesia has increased but is still low
He Jing told reporters that the doctor originally said that three fingers at the mouth of the palace would be "painless", but there were too many women who gave birth that night, and they had been waiting in line for the anesthesiologist to come.
"Until I entered the delivery room, I couldn't be marked as'painless.' The pain was really painful."
Choose natural delivery or cesarean section?
"Xinhua Viewpoint" reporter survey found that before this, the cesarean section rate in some areas remained high, and the cesarean section rate in some areas was even as high as 85%.
In recent years, with the popularization of childbirth knowledge, more and more people will choose natural childbirth.
However, the pain of natural birth does make many women continue to choose cesarean section.
"Now everyone consciously chooses natural childbirth, and many of my friends have done painless childbirth. From the beginning of the checkup, the doctor told me that painless childbirth could be done. Unexpectedly, in the end, the anesthesiologist was too busy to do it." He Jing Say.
Hu Qingqing, who works at a financial institution in Hangzhou, told reporters that he chose painless delivery when he gave birth 10 years ago. "At that time, I was an acquaintance at the hospital and helped to make an appointment with an anesthesiologist. Only then did I feel that I was'alive' over."
It is understood that what is often said about painless childbirth is actually childbirth analgesia, which refers to the application of appropriate analgesic techniques and analgesic drugs or psychotherapy to reduce the pain and adverse stress reactions of pregnant women during childbirth, so that the fetus can be delivered smoothly.
Qu Yuan, the chief physician of the Department of Anesthesiology at Peking University First Hospital, is also a mother. She has personally experienced the tangible benefits of childbirth analgesia, which "can make more women become mothers with more dignity and decent dignity."
In November 2018, the National Health Commission issued the "Notice on Pilot Labor Analgesia".
In March 2019, 913 hospitals became the first batch of national labor analgesia pilot hospitals.
According to Mi Weidong, the leader of the labor analgesia pilot expert working group of the National Health Commission, the penetration rate of painless childbirth in these pilot hospitals at the end of 2017 was about 27.5%. After three years of hard work, it reached 53.2% by the end of 2020.
Chen Xinzhong, deputy dean of the Obstetrics and Gynecology Hospital of Zhejiang University School of Medicine, said that in the past few years, it was necessary to vigorously promote the advantages of labor analgesia. Now more and more women are actively requesting labor analgesia.
Analgesia during childbirth allows more women to have the confidence and physical strength to give birth without blindly choosing cesarean section.
Chen Danqing, director of the obstetrics department of Zhejiang University Women's Hospital, said that the promotion of labor analgesia has reduced the hospital's caesarean section rate by about ten percent.
"In the past, people had some misconceptions that anesthetics would affect their children’s intelligence, leading to decreased maternal memory and insufficient milk, etc. Through popular science in the past few years, these statements have become'past tense', and childbirth analgesia has become a doctor. , The first choice for parturients and family members." Chen Xinzhong said that about 70% of the parturients who give birth naturally in the hospital will choose the method of labor pain relief.
During the two sessions this year, Professor Huang Yuguang of Peking Union Medical College Hospital mentioned that the current average prevalence rate of labor analgesia in my country is about 30%.
Although this data has been greatly improved compared with the national average of less than 10% in 2018, compared with the 80% to 90% of developed countries, my country’s penetration rate is still low. At the same time, there are significant differences between the east and the west. There are also obvious differences in different regions of the province.
The reporter's investigation learned that the drug delivery analgesic rate of a tertiary hospital in Hangzhou in 2020 is about 45%.
A survey conducted by the Beijing Ivy Painless Childbirth Grassroots Program in 30 hospitals in 10 league cities in the Inner Mongolia Autonomous Region shows that the average childbirth analgesia rate in 2021 has increased from 18% in 2018 to 24%, but half of them are still The hospital is less than 10%.
The shortage of relevant doctors and unclear charging standards make it difficult to promote
Several interviewed experts said that the promotion of childbirth analgesia still faces some difficulties.
The first is the shortage of anesthesiologists and midwives.
Mi Weidong believes that the first difficulty in the promotion of childbirth analgesia is the shortage of personnel, especially the shortage of anesthesiologists.
According to the statistics of the Anesthesiologists Branch of the Chinese Medical Doctor Association in June 2019, the number of anesthesiologists in my country is 92,000, with an average of 0.6 anesthesiologists per 10,000 people, while in developed countries, an average of 2.5 to 3 anesthesiologists per 10,000 people ( Or anesthesia practitioners).
In recent years, my country's medical demand for anesthesia has continued to rise, and the workload of anesthesia has increased sharply. The annual demand for painless gastrointestinal endoscopy in the country has reached hundreds of millions of people, and the number of various operations is also increasing at a rate of 10% per year. Although the number of anesthesiologists is increasing, it is still not enough to support the demand for clinical anesthesia.
In addition to drug analgesia, other non-drug analgesia such as Lamaze breathing, acupoint massage, aromatherapy, etc. are mainly implemented by midwives, and the shortage of midwives has become another constraint in the promotion of labor analgesia.
Yin Ling, chief physician of the Department of Obstetrics and Gynecology of Peking University First Hospital, visited Guangyuan, Sichuan, and found that a local hospital did not even have a midwife. Because of the blind choice of cesarean section in the past, many midwives and obstetricians had severely degraded their midwifery skills.
In addition, Qu Yuan mentioned that the current difficulty in the promotion of labor analgesia is not technical, but the way of collaboration across departments.
"This is not a matter for the first department of anesthesiology. It requires multi-disciplinary cooperation such as obstetrics and neonatology, and requires management coordination and policy support."
Before the determination to promote labor analgesia in 2020, the labor analgesia rate of the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology was only about 10%, and in 2021, this rate reached about 60%.
Dean Dang Tong introduced that a reasonable distribution of benefits is a key step.
In the past, the hospital’s bonus for delivery of labor analgesia belonged to the department of anesthesiology. Now the hospital distributes the bonus equally to the obstetrics and anesthesiology departments. At the same time, the department no longer allocates this bonus to the department of labor analgesia directly. Personal physician.
The reporter's investigation found that the imperfect charging policy also affected the promotion of labor analgesia to a certain extent.
It is understood that compared with ordinary spinal anesthesia, childbirth analgesia takes longer and more technically difficult. However, many provinces, regions and cities have not yet issued special charging standards for childbirth analgesia, and hospitals can only charge according to the standard for spinal anesthesia. , Failed to fully reflect the labor and technical dedication of medical staff, which affected the enthusiasm of medical staff.
"The situation in many provinces and cities shows that if the charging standards are well implemented, the proportion of childbirth analgesia will rise to varying degrees." Mi Weidong said.
Let childbirth analgesia be more popular to relieve the pain of female childbirth
Many experts said that the current labor analgesia technology in my country is very mature, with strong analgesia and high safety factor. The more mainstream intraspinal block labor analgesia can help most women reduce pain by 60% to 90%, and The scope of application is very wide. It can be used by most parturients who have passed the evaluation of obstetrics and anesthesiology.
"The anesthetic drugs used for labor analgesia do not pass through the blood, but take effect through nerve block, and the amount of anesthesia used for labor analgesia is only about one-tenth of that of cesarean section, which affects the fetus. It can be said to be minimal and very safe." Qu Yuan said.
Facing the "anesthesiologist shortage" in hospitals, Mi Weidong said that it is necessary to accelerate the improvement of the anesthesiologist training mechanism and attract more young talents to join the field of anesthesiology. At the same time, anesthesiologists should strengthen the learning and update of the knowledge of childbirth analgesia. Master new technologies in the field of labor analgesia, develop and expand new drugs and equipment for anesthesia, improve anesthesia management, and improve the efficiency of anesthesia medical services.
Chen Xinzhong suggested that the current staff of anesthesiologists and midwives in general hospitals should be increased, and a collaborative team composed of anesthesiologists, obstetricians, midwives, and anesthesia nurses should be established. As a service provider, the hospital should think about how to expand its service capabilities, and at the same time, the grassroots It is necessary to continue to correct the concept of cesarean section in medical institutions.
According to Li Fang, deputy director of the Talent Exchange Service Center of the National Health Commission, Tianjin, Beijing, Hunan, Chongqing, Hubei, Liaoning, Shaanxi and other places have clearly issued special fees for childbirth analgesia. Standards are successively promulgated, which will further promote the popularization of domestic labor analgesia.
The hospital should pay more attention and provide more than financial support to relevant departments for labor analgesia.
"The promotion of childbirth analgesia is a warm and dignified medical treatment, and it is a manifestation of the progress of my country's medical concept." Li Fang said.