水中分娩对母婴是否真的有益

　　导语：科学文献显示，坐在水中生产(有时被称为水疗分娩)能够帮助产妇放松，促进血液循环并减轻肿胀。

　　The Claim: Laboring in a tub of water helps relax expectant mothers, significantly relieving the pain of childbirth.

　　主张：水中分娩能帮助产妇放松，显著减轻生产时的疼痛。

　　The Verdict: A review of 11 trials, encompassing 3,146 women, published by the Cochrane Collaboration, a global network of scientists and clinicians, concludes that laboring in a tub during the first stage of labor reduces the need for epidural anesthesia. But the safety of staying in a tub during the birthing stage hasn't been established -- prompting some doctors to urge caution.

　　定论：面向科学家和临床医师的全球性网络Cochrane协作网(Cochrane Collaboration)发表的一项文献回顾,对覆盖3,146名女性的 11项试验进行了考察，得出的结论是，第一产程在水中生产可减少使用硬膜外麻醉的必要性。不过，在胎儿娩出阶段待在水中的安全性尚未得到确证——因此一些医生告诫人们要保持谨慎。

　　Sitting in water during labor, sometimes called hydrotherapy, can promote relaxation, improve blood flow and reduce swelling, according to scientific literature. Tubs -- with or without massaging jets -- are available at many birthing centers and some hospitals. For home births, women can use a bathtub or rent a birthing tub for about 0 to 0.

　　科学文献显示，坐在水中生产(有时被称为水疗分娩)能够帮助产妇放松，促进血液循环并减轻肿胀。水缸(有些带按摩喷嘴，有些没有)许多分娩中心都有提供，一些医院也会提供。如果在家中生产，产妇可以使用浴缸，或者租用分娩缸，费用在200到300美元左右。

　　Typically the water is heated to body temperature, says Jenna Shaw-Battista, director of the Nurse-Midwifery Education Program at the University of California, San Francisco. The tub is filled to cover the belly and sometimes as high as the chest, Dr. Shaw-Battista says. Clothing is optional, she adds, and many women wear a sports bra or a hospital gown.

　　加州大学旧金山分校(University of California, San Francisco)的护理和助产教育项目(Nurse-Midwifery Education Program)主管詹娜·肖-巴蒂斯塔(Jenna Shaw-Battista)表示，水一般会加热至体温。肖-巴蒂斯塔博士说，缸内的水会没过腹部，有时甚至会齐胸。她补充称，穿不穿衣服可以自己选择，许多女性会穿运动文胸或者医院的病号服。

　　The scientific literature supports claims that hydrotherapy offers pain relief and relaxation -- and may even shorten labor. But some clinicians draw the line at giving birth underwater.

　　水疗分娩能减轻疼痛并帮助产妇放松——甚至有可能缩短产程，这些说法都得到科学文献的支持。但一些临床医师在实践中却与水中分娩保持着距离。

　　In a joint opinion published this month, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, said that due to reports of newborn drownings, near drownings, and infection described in medical literature, the procedure should remain 'experimental' and be performed only in the context of clinical trials.

　　美国妇产科医师协会(American College of Obstetricians and Gynecologists)和美国儿科学会(American Academy of Pediatrics)本月发布联合意见称，鉴于医学文献中有新生儿溺亡、溺水和感染相关报告，水中分娩仍然应该是“实验性的”，只能在临床试验背景下施行。

　　In theory, in a water birth the baby is brought to the surface safely before it takes its first gasp. But if a baby is experiencing distress -- for example if the umbilical cord is crimped -- it may gasp earlier and 'that's all you need to get water in the lungs or to swallow that water into the stomach,' says Tonse N.K. Raju, chief of the pregnancy and perinatology branch at the National Institute of Child Health and Human Development in Bethesda, Md., and a liaison to the committee that issued the opinion. Another concern, he says, is that tub water can easily get contaminated with bacteria.

　　从理论上说，水下分娩的婴儿在开始呼吸之前就已经被安全地带到水面上了。但马里兰州贝塞斯达(Bethesda)的美国国家儿童健康与人类发育研究所(National Institute of Child Health and Human Development)妊娠和围产期学分部主管、负责与发布上述意见的委员会进行联络的通斯·拉朱(N·K· Tonse N.K. Raju)表示，如果婴儿出现窘迫(比如说脐带缠绕过紧)，则有可能会提前呼吸，“这就很容易导致肺部呛水，或者把水咽进胃里”。他说，另一担忧是，缸内的水很容易被细菌污染。

　　Problems are rare, Dr. Raju says. And the doctors' concerns are based not on large randomized trials but on individual case reports, which some midwives say is a flawed approach as births on land can also have complications. So far, a number of observational studies of water births in low-risk women -- including a 1999 British report of 4,032 water deliveries -- have found no higher newborn mortality than a birth out of water. In data released last week by the American Association of Birth Centers, a trade group for free-standing birth centers, there were no infant deaths in 3,998 water births conducted at 79 centers over four years. And 1.5% of babies delivered underwater needed to be transferred to a hospital for observation or treatment, compared with 2.8% delivered on land.

　　拉朱博士说，这些问题很罕见。另外，医生的担忧也并非基于大规模随机试验，而是基于个案报告，一些助产士认为，这种研究方法是存在缺陷的，因为普通分娩一样会有并发症。 到目前为止，许多针对低危产妇水中分娩的观察性研究(包括1999年英国一项覆盖4,032例水中分娩的报告)发现，水中分娩的新生儿死亡率并不比非水中分娩的死亡率高。代表独立分娩中心的行业组织美国分娩中心联合会(American Association of Birth Centers)近期发布的数据显示，79家分娩中心在四年中施行的3,998 例水中分娩未出现一例新生儿死亡事件。另外，有1.5%的水中分娩婴儿需要被转至医院接受观察或治疗，而非水中分娩的婴儿比例为2.8%。

　　The data, which the association hopes to publish, reflects that centers steer women likely to have complicated deliveries away from water birth, says the association's director, Lesley Rathbun. Even if a water birth is planned, during labor the baby's heartbeat is carefully monitored and if there's any suggestion of distress, 'we're going to get the woman out of the tub' before delivery, she says.

　　美国分娩中心联合会主管莱斯莉·拉思本(Lesley Rathbun)表示，这些数据(该联合会希望发表相关数据)反映出，分娩中心会建议高危产妇不要在水中分娩。她说，即使水中分娩是按计划进行的，分娩过程中也会进行细致的胎心监护，如果有任何窘迫征兆，“我们会在胎儿娩出之前让产妇离开水缸”。