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不疼不配生孩子?

不疼不配生孩子?

我们翻译这篇文章的理由

怀孕的妇女们经常忧心忡忡。她们担心自己的孩子是否健康,担心孩子们的饮食是否得当,担心自己是否为成长中的新生命规避了一切能对他们造成伤害的东西。她们也在对分娩的方式心怀忧虑。推测“自然”分娩更优越的假设,仍然建立在一些强有力的迷思之上。但她们不必如此,因为根本就不存在所谓的正确方式。作者在回顾“自然分娩”起源及发展之后,建议用一种全新框架去衡量什么才是好的生产方式,以此来消除自然与非自然分娩的错误的二分法。

——王雅婧

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为什么不说“自然分娩”

作者:JESSICA GROSE

译者:罗玉池

校对:王雅婧

策划:泮海伦 & 王瑞

It’s imprecise and can make families whose births are deemed not “natural” feel shame.

“自然分娩”的说法并不精确,甚至会让那些分娩被认为是“非自然”的家庭感到羞愧。

This week, we’re focusing on becoming a parent. We have articles on home births, C-sections, epidurals, adoption, inductions, unmedicated births, VBACs, legal basics for L.G.B.T.Q. families — the list goes on.

这周,我们将目光聚焦在“如何成为一个家长”,文章的主题囊括了家庭分娩,剖腹产、硬膜外麻醉、领养、催产、非药物分娩、VBACs,以及针对家庭成员中有性少数群体的基础法律知识等等。

注:VBAVCs 是指剖腹产后的阴道分娩

注:本文意在宣传纽约时报的“生育问题”(Parenting)专栏。这一专栏旨在为家长和有打算养育小孩的人群提供一系列相关的建议和指引。文章涵盖了从生育怀孕到基本的婴儿护理以及儿童成长关键期等话题。

One thing we noticed while editing and researching these pieces was that writers used the term “natural birth” to mean a variety of different things. Some used it synonymously with unmedicated birth — no Pitocin to induce labor, no epidural to provide pain relief. Others used it to mean vaginal birth. Still others used “natural birth” to mean midwife-assisted birth with as few interventions as possible.

在编辑、调研这些文章的时候,我们注意到作者们常常使用的术语“自然分娩”有着极为丰富的内涵。有些人将它与“非药物分娩”等同起来,即不使用药物催产或不使用麻醉减轻疼痛感的生产。还有些人则用其指代阴道分娩(顺产)。不过,也有人认为由助产士辅助、人工介入较少的生产也属于“自然分娩”。

In fact, there is no universally accepted medical definition of the term “natural birth,” according to Dr. Julie Chor, an assistant professor of obstetrics and gynecology at the University of Chicago. We strive for clarity when giving guidance, and so have decided to avoid the term in favor of more specific, less confusing phrasing.

事实上,据芝加哥大学妇产科助理教授朱莉·楚医生所言,所谓的“自然分娩”目前并没有一个被普遍接受的医学定义。鉴于我们在提供相关建议时力求准确,所以决定回避这一概念,而选择使用更具体、更不宜引起混淆的表达。

Additionally, we realized that the term “natural birth” could shame women whose deliveries were deemed not “natural” — whether they had C-sections, needed to be induced or simply desired pain relief.

除此之外,我们还意识到,对于被认为采取“非自然”分娩方式的女性而言,“自然分娩”这个词甚至会让她们产生一种羞愧感——不管她们是选择了剖腹产、催产还是无痛分娩。

Even parents who are doctors are vulnerable to this kind of shame. Dr. Anne Drapkin Lyerly, an obstetrician and professor at the University of North Carolina School of Medicine and author of “A Good Birth: Finding the Positive and the Profound in Your Childbirth Experience,” has had five C-sections. Though she understood why these operations were medically necessary (she’s a slight 5-foot-2, and her first four babies weighed around 10 pounds each at birth), when she was going through it, “I felt sad and ashamed even though I had all the rationality,” Dr. Lyerly said.

即使是医生出身的父母,在这种羞愧感面前也不堪一击。安妮·德拉普金·莉莉博士是北卡罗来纳州大学医学院教授兼产科医生,曾著有《良好分娩:在分娩过程中寻找积极与深刻的东西》一书。莉莉博士有过五次剖腹产经历,她身材娇小,只有5.2英尺(约为1.58米),而她前四个孩子在出生时都差不多有10磅(约为9斤),所以她非常理解这些人为措施在医学上的必要性。但当她选择剖腹产时,依旧 “感到很难过和羞愧,虽然自己已具备足够的理性”。

不疼不配生孩子?

The origins of ‘natural birth’

“自然分娩”的起源

The term “natural childbirth” was first coined in 1933 by Grantly Dick-Read, a British doctor, with the publication of his book, “Natural Childbirth.” In it, he argued that the “civilized” British women of the day were avoiding pregnancy — and driving down the birthrate for the middle-and-upper classes — because of their unreasonable fears of pain during labor. He believed that their fears caused tension, and that tension caused pain, so if women could become less fearful of childbirth (and hence experience less pain), they might help to reverse “the decline in middle class fertility,” wrote Dr. Ornella Moscucci in the B.M.J. Postgraduate Medical Journal.

1933年,英国医生格伦雷·迪克·里德在其所著的《自然分娩》(Natural Childbirth)一书中,首次创造了“自然分娩”一词。他在书中谈道,彼时“开化”的英国女性出于对分娩疼痛的过度恐惧而逃避怀孕,这导致了英国中产和上流阶级生育率的下降。正如欧尼拉·莫斯库奇博士在《医学继续教育杂志》(Postgraduate Medical Journal)所刊文章所写,迪克·里德医生坚信是女性的恐惧导致了紧张,而紧张又造成了疼痛,所以如果女性能减少对分娩的恐惧(并且因此减少疼痛),就能够扭转中产阶级生育率下降的困境。

Paradoxically, Dick-Read didn’t believe in drugs. He defined “natural childbirth” as when “no physical, chemical or psychological condition” disturbs the “normal” sequence of labor. With deep breathing, faith and a little preparation, Dick-Read believed that most women shouldn’t need anesthetics during birth because they’d be so ready for it that they wouldn’t feel pain. He even claimed to have had a patient who said, upon feeling contractions for the first time, “Isn’t it heavenly?”

自相矛盾的是,迪克·里德并不相信药物。他将“自然分娩”定义为“没有物理、化学和心理干扰的常规生产程序”。他相信只要深呼吸、满怀信心以及准备一二,大多数女性在生产过程中连麻醉药都不需要,因为她们已经全身心准备好,所以不会感到丝毫痛苦。他甚至声称,曾有病人在第一次感觉到宫缩的时候说,“这不就是天堂吗?”

Dick-Read brought his ideas to the United States in the late ’40s, but similar philosophies had already gained traction there. Though the terms were slightly different — “pain-free birth,” “prepared childbirth” — their beliefs were essentially the same: that a more relaxed, unmedicated birth meant a happier, healthier mother and baby.

上世纪四十年代晚期,迪克·里德把他的理念带到了美国,不过类似的理念在这里其实早已有了根基。尽管术语略有分别——“无痛分娩”、“有备分娩”——但他们的理念并无二致:愈加放松、无药物介入的分娩会带来更快乐、更健康的母亲和宝宝。

注:prepared birth:an educational approach to labor and delivery in which the parents are specially prepared for the event. The aim is for the mother to be awake and cooperative and for the father to assume an active and supportive role during the birth of their child. 在分娩前对父母双方进行知识教育,旨在让母亲保持清醒和合作,父亲也能在此过程中给予支持。

The “natural childbirth” movement gained more followers in the ’50s and ’60s, but didn’t really take off in the United States until the ’70s, according to Dr. Randi Hutter Epstein, a writer-in-residence at Yale School of Medicine and the author of “Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank.” That’s when works like Ina May Gaskin’s 1976 book “Spiritual Midwifery,” which described the euphoria of unmedicated home birth, became best sellers.

兰迪·赫特·爱泼斯坦博士是耶鲁大学医学院常驻作家,同是也是《带我出去:从伊甸园到精子库的分娩史》(Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank)一书的作者,据他所述,“自然分娩”运动(Natural Childbirth Movement)在五十和六十年代赢得了大批追随者,但直到七十年代才真正地在美国甚嚣尘上。彼时正是类似艾娜·梅·加斯金的《精神助产术》(Spiritual Midwifery)成为畅销书的年代,该书描绘了在家“非药物”分娩的喜悦。

注:在这期间,女性一直在拥抱更自然的生育方式。她们同时受到了第二波女权运动(敦促女性控制自己的身体)及《精神助产术》(mental Midwifery)等书的影响。《精神助产术》是一本广为流传的著作,它解释了没有医生或硬膜外分娩镇痛的分娩会更好;通过自然分娩,女性只是在做她们身体本来应该做的事情。

The “natural childbirth” movement was an effort to give women control in the birth process, and to push back against the paternalistic medical establishment, which at times had embraced dangerous treatments.

“自然分娩”运动旨在分娩过程中赋予女性更多的控制权,抵制家长式的医疗机构,因为后者有时会对孕妇使用危险的治疗手段。

“Doctors gave commands and handed out drugs,” Dr. Hutter Epstein wrote of midcentury obstetricians in “Get Me Out.” Because doctors believed that “bloating” triggered pre-eclampsia, for instance, some prescribed diet pills laced with amphetamines to prevent women from gaining more than 15 pounds during their pregnancies.

“医生们发号施令,接着就是分发药物,”爱泼斯坦博士在《带我出去》一书中如是描述上世纪中叶的产科医生。例如,医生认为“腹胀”会诱发先兆子痫,于是就会开一些含有安非他命的减肥药来防止女性在妊娠期间增重超过15磅。

注:先兆子痫:指妊娠24周左右,在高血压、蛋白尿基础上,出现头痛、眼花、恶心、呕吐、上腹不适等症状者称为先兆子痫。

注:安非他命:精神类药物,兴奋中枢神经,虽具有欣快、警觉及抑制食欲之作用,重复使用会成瘾,大剂量使用引起精神错乱,思想障碍,类似妄想性精神分裂症,多疑、幻听、被害妄想等,长期使用导致器官性脑症候群。

But the “natural birth” movement that once empowered women during delivery has now created a culture in which some women feel shame at not having a “natural birth” — as if their bodies are somehow defective. Furthermore, focusing on the method of birth can exclude and diminish the experiences of adoptive parents and parents who use surrogates or other kinds of assisted reproductive technologies.

但是这一曾经在生产过程中为女性赋权的“自然分娩”运动,如今却创造了一种新的文化:女性会因为没有进行“自然分娩”而感到羞愧,就像是她们的身体有某种缺陷一样。不仅如此,由于父母们对于生育方式的执着,他们可能会排斥或降低采取其他解决办法的意愿,如领养、代孕或利用辅助生育技术等。

不疼不配生孩子?

A ‘good birth’

良好分娩

While Dr. Lyerly was a professor at Duke and performing research for “A Good Birth,” she and her team of researchers interviewed 101 women from racially and economically diverse backgrounds who gave birth in all types of situations — from scheduled C-sections to unassisted home births — and included women who had different birth experiences for each of their children.

杜克大学教授莉莉博士主持了一项关于“良好分娩”的研究项目,她和她的研究团队采访了101位女性,她们种族、经济背景、分娩经历各异——从有计划的剖腹产到无辅助的家庭分娩——在这当中也有生过多个孩子的女性,她们的几次分娩经历也不尽相同。

“good births,” regardless of how their babies came into the world: agency (capacity to make their own choices, even if things didn’t go according to plan), personal security (a sense of safety during birth), connectedness (with medical providers, family members and with their babies), respect (an acknowledgment that birth is a transformative life event) and knowledge (understanding their bodies, and also understanding that birth was a process they couldn’t fully control).

研究者认为,不管宝宝是如何来到这个世界,“良好分娩”都应具备如下几个要素:个人能动性(女性有能力做出自己的选择,即使最后事情并没有按照原计划进行),个人安全(女性能在分娩过程中具有安全感),联通性(女性能与医疗提供者、家人和宝宝实现有效连结),尊重(女性认同分娩是一件会给生活带来翻天覆地变化的重大事件),以及知识(女性能够理解她们的身体,并且理解分娩是一个她们并不能完全操控的过程)。

I love the framing of a “good birth,” because it removes the false dichotomy of “natural” versus “unnatural.” The outcome everyone wants for their delivery is a healthy baby and a healthy mother. Health includes emotional health, too.

我喜欢“良好分娩”这一表达,因为这破除了“自然”和“非自然”分娩的错误二元对立。每一个人无一例外是想要健康的宝宝和健康的母亲,这里的健康当然也包括情感上的健康。

We want to help you have a good birth — whether it’s by reading Angela Garbes, author of the excellent “Like a Mother,” on how to advocate for yourself in the delivery room; or by reading Dr. Alexandra Sacks, a reproductive psychiatrist, on how to recover if your birth does not go the way you had hoped.

我们所期待的,是帮助你拥有这样一个“良好分娩”:不管是通过安吉拉·加贝斯(名作《像母亲一样》的作者)的文章,告诉你如何在产房为自己争取权益,还是通过生殖精神病学家亚历山大·萨克斯博士的文章,帮助你了解如果分娩没有如未按预期进行应当如何康复等等。

注:文末作者还邀请读者分享自身的分娩故事,希望大家以更为具体的经历打破“自然”与“非自然”分娩这种简单的二分法。

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不疼不配生孩子?

  • 本文原载于 The New York Times

  • 原文链接:https://www.nytimes.com/2019/05/07/parenting/natural-birth.html

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