导读:长期以来备受推崇的顺产，受到了专家的质疑，所谓的“顺产”真的是那么顺利吗？
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.
谈及生产，顺产似乎总被认为是最佳的生产方式——毕竟，女性用这种方式生产已经延续几千年了。
But natural birth actually comes with risks, including tearing, haemorrhage and incontinence for the mother and injuries to the baby during labour.
但是顺产其实也是有风险的，对妈妈们而言可能会出现会阴撕裂、产后大出血，和大小便失禁等问题，宝宝也可能在生产过程中受到伤害。
So why is it that the vast majority of pregnant women are only being warned about the risks of Caesarean sections?
那么为什么对于大多数的怀孕女性，医生仅仅警告她们剖腹产的风险呢？
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.
这一现象现在要改变了。因为在英国，生育孩子时，默认选择顺产的方式。对此，英国皇家妇产科学院要进行研讨了。
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.
现在他们要探讨是否应该告诉产妇，顺产和剖腹产的相对风险和益处，并将此作为一种工作流程执行下去。
While both Caesarean section and vaginal birth are considered to be relatively safe in high-income countries, each features its own set of risks.
尽管在高收入国家，剖腹产和顺产都很安全，但是也依旧有各自的风险。
How such risks are perceived and valued may vary considerably between health professionals and women themselves.
对于医护专业人员和产妇自身，对于风险的感受和评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.
对于大多数产妇，英国各大医院仍将顺产作为默认的生产方式，尽管英国国家卫生与临床技术优化研究所（NICE）已经建议要为产妇提供选择空间。
Studies from other high-income countries suggest that risks due to natural birth may be poorly appreciated by women and health professionals.
高收入国家的研究表明，产妇和医护专业人员对于顺产带来的风险没有充分的认识。
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.
英国女性在生育头胎时，有95%的人表示想进行顺产，但是只有75%的人能如愿。
Some 21 per cent experience an emergency Caesarean section during labour, which is not as safe as a planned one.
在生产中，有21%的人接受了紧急剖腹产手术，远没有计划好的剖腹产手术安全。
A further substantial proportion of women experience important complications of vaginal birth.
还有很大一部分产妇在顺产时，出现了严重的并发症。
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).
这其中有8%的人出现了产后大出血，1%的人要输血，5-6%的人三级撕裂损伤（40%的人出现一定程度的会阴撕裂损伤）
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.
有六分之一的产妇在顺产时需要器械辅助，比如使用了产钳，这会导致以后的生活中出现大便失禁和盆腔器官脱垂的问题。
Also, it’s important to realise that long labours, complications and interventions are associated with maternal distress, postnatal depression and intense anxiety in future pregnancies.
同时，产妇也应意识到长时间的生产，可能的并发症和医疗干预会导致女性对孩子出现消极情绪，产后抑郁以及以后再怀孕时的异常焦虑。
This leaves little more than half of first-time mothers experiencing an uncomplicated spontaneous vaginal birth.
结果，生育头胎的产妇仅有一半的人数可以顺利进行顺产。
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.
这一百分比也正说明了为什么想要自然生产的女性需要知道过程中可能会出现的医疗干预及并发症。
In this light, the alternative of a planned Caesarean section may be tempting.
从这一角度看，替代顺产的剖腹产手术好像很诱人。
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.
但也不是一点儿风险没有的。在短期看来，剖腹产和计划好的顺产很相似——只是在手术时，呼吸系统出现问题的概率略高一点儿——但是对于孩子来说，剖腹产整体更安全。
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.
但是，剖腹产后留下的伤疤对于以后再次怀孕是有风险的，因为这会影响到胎盘的发育，也会增大产妇出现大出血和切除子宫的可能性，当然这种可能性不高。
There is also some concern that babies born by Caesarean could be at higher risk of developing asthma.
通过剖腹产出生的孩子也更容易患哮喘病，这也有些令人担忧。
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.
不同的人对风险的评估也不同，所以告知产妇这两种方式的优缺点，才能让他们根据自己的情况和需要来决定。
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.
对一些人来说，他们乐于享受生产过程，阴道生产也对他们很有利；对于另外一些人而言，他们倾向于选择剖腹产，更好控制，也更便于预测。
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，实际情况远比这复杂。如果医院常规地告知了产妇顺产的风险，英国各大医院剖腹产的比例必然会升高。
The NICE report estimates that normal births cost an average of ?1,512, planned Caesareans cost ?2,369 and emergency C-sections cost ?3,042.
英国国家卫生与临床技术优化研究所（NICE）的报告估计，正常的顺产要话费1,512英镑，而计划好的剖腹产手术需花费2,369英镑，紧急剖腹产手术需花费3,042英镑。
Others have argued that too much focus on risk will only generate unnecessary maternal anxiety.
还有人质疑说，太过关注生产风险，只会导致不必要的生育焦虑。
A simpler option may therefore be to communicate the risks of vaginal birth only to women over an accepted risk threshold for complications – such as all women aged over 35 years in their first pregnancy or those with a combination of age over 30 years and BMI over 30.
更简单点的办法是，只和那些有可能出现一定程度并发症的产妇沟通顺产的风险——比如年龄超过35岁生育头胎的产妇，或者那些30以上且体体质指数也超过30岁的产妇。
Ultimately, a woman’s birth plan should reflect her values.
归根究底，一位准妈妈的生产计划反应了她的价值观。
If this means having a planned Caesarean section, then such informed choices should be respected and health services developed to accommodate such plans.
即便这意味着接受计划好的剖腹产手术也没什么，在充分知情的去情况下做的决定是应该受到尊重，而且医疗服务应该去适应这样的计划。
