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  • [narrator] This is a stretch test, which engineers use

    這是拉力測試

  • to measure the strength and stretchiness of materials, like rubber.

    工程師以此方法測量

  • But here, it's testing something different:

    材料的強度和延展性

  • tissue from a human cervix.

    例如橡膠

  • The cervix is the gate between a woman's uterus and her vagina.

    不過現在要測試不一樣的物品

  • It blocks anything,

    人類子宮頸的組織

  • -like a penis, from going any further up. -[whistle blows]

    子宮頸位於

  • [narrator] And it stops important things in the uterus,

    女人子宮和陰道中間

  • like a growing fetus, from coming down too early.

    它能擋住任何東西

  • Think of the uterus like a balloon.

    像是防止陰莖進入

  • You blow up the balloon with air.

    還能守住子宮內重要的東西

  • You have to keep the air in the uterus or the baby inside the uterus,

    例如防止發育中的胎兒太早出生

  • and that cervix is the knot that keeps the uterus closed.

    想像子宮是一顆氣球

  • As an engineer, what's really struck me about the cervix

    朝氣球內充氣

  • is that a pregnant specimen in the lab...

    要把空氣留在子宮裡

  • It just keeps stretching and stretching. It never breaks.

    也就是把胎兒留在子宮裡

  • [narrator] Over nine months of pregnancy, the cervix gets five times stretchier.

    子宮頸就是把子宮關起來的關鍵

  • When it's soft like the skin on your lips, it opens up.

    身為工程師

  • And as you may know from experience

    子宮頸讓我訝異的是

  • or from a common TV trope,

    實驗室裡的懷孕樣本

  • that's usually when...

    它能不停延展開來,不會斷裂

  • Mindy, your water just broke.

    超過九個月的懷孕期間

  • Ah! My water just broke.

    子宮頸的延展性會增成五倍

  • Oh! I'm sitting here in a puddle of water.

    觸感和嘴唇一樣柔軟

  • Uh... my water broke.

    它會打開

  • Oh, that's cool. We got another one here in the fridge.

    或許你有經驗

  • After the baby comes out,

    或者在電視上看過

  • this very compliant material has to remodel and repair itself.

    通常發生在

  • I don't know of any other engineering material

    明蒂,妳的羊水破了

  • that can soften or remodel itself that quickly.

    我的羊水破了

  • [narrator] Put simply,

    我坐在一灘水上

  • the cervix is an anatomical and engineering miracle.

    我的羊水破了

  • But that doesn't make childbirth itself any less daunting.

    沒關係,冰箱裡還有一罐

  • I'm not really scared. I'm, like... Yeah, I am nervous.

    嬰兒出生後

  • [laughs] I'm completely nervous, like, but it's only

    這種富有彈性的材料

  • because this is my first kid, so I don't really know what to expect.

    必須自行改造和修復

  • [narrator] Around the world, 250 babies are born every minute.

    我不知道有哪一種工程材料

  • In hospitals or at home

    能夠如此迅速的自行軟化和改造

  • with midwivesdoulas, and doctors.

    簡單來說 子宮頸是解剖學和工程奇蹟

  • Some women use drugs for the pain,

    不過生產過程並不會因此而輕鬆

  • some have C-sections

    我並不害怕

  • or use other medical technology.

    沒錯,我很緊張

  • And others don't.

    我非常緊張

  • [doctor] Sweetheart, show me what you got. Ready? Nice deep breath in.

    但只是因為這是我的第一胎

  • Breath. And push from your bottom. You got this.

    所以我不知道會發生什麼事

  • Two, three, four...

    世界上每分鐘有250個嬰兒出生

  • [narrator] But childbirth still kills more than 800 women every day

    無論是在醫院或家中生產

  • around the world.

    有助產士、接生員、醫生陪伴

  • And one global survey found that up

    有些婦女會用藥物止痛

  • to 30% of women rate childbirth as traumatic.

    有些會選擇剖腹產

  • I just remember, like, closing my eyes and going inside

    或者採用其他的醫學技術

  • into, like, the deepest part of myself

    有些什麼都沒有

  • to just be like, "I have to get through this."

    讓我看一下,準備好了嗎?深呼吸

  • I was, like, really traumatized for a really long time.

    從底部推,妳做得到

  • [narrator] So, what makes childbirth so hard?

    二、三、四

  • And what can women do to have the easiest and safest experience?

    世界上每天有八百名婦女因生產而死

  • -[woman] You got this. -[inhales]

    一項全球調查發現

  • -[theme music playing] -[moaning]

    30%婦女認為生產很痛苦

  • [gasps, exhales]

    我記得閉上眼睛

  • [narrator 2] The contractions in true labor

    進入自己最深層的一部分

  • always have a definite rhythm.

    才能告訴自己:“我要把孩子生下來”

  • [narrator 3] You may suddenly wonder

    我嚇壞了,久久不能回復

  • how the baby can possibly get through that small opening.

    是什麼原因讓生產這麼困難?

  • Don't worry, you'll stretch enough.

    女人該怎麼做 才能有最簡單及安全的體驗?

  • [man] It is not only pathological knowledge

    分娩過程中的收縮

  • which makes the great obstetrician.

    總是有一定的規律

  • It is vigilance.

    各位可能會猜想

  • One that does not let you forget you have in your hands the lives of two people.

    嬰兒怎麼可能經過這麼小的開口

  • [narrator] Most large primates give birth in relatively similar fashion.

    別擔心,有足夠的延展性

  • The female carries the fetus in her womb for 30 to 40 weeks,

    成為優秀的產科醫生

  • and then the baby emerges from the birth canal,

    不只要有病理學知識

  • usually headfirst, within hours.

    還要心存警惕

  • But there's one key difference:

    不能忘記手中握有

  • humans suffer a lot more.

    兩個人的生命

  • It's not like a baby just falls out,

    多數大型靈長類的生產方式極為相似

  • like some Monty Python sketch, for non-human primates.

    女性的胎兒會在子宮裡待上30至40週

  • They do struggle, and still,

    然後嬰兒會從產道出來

  • they have a seemingly much more easy childbirth

    通常頭先出來,要花上幾個小時

  • than we have.

    但有一點不同

  • [narrator] Humans labor around nine hours the first time they give birth

    人類要承受更多痛苦

  • and often go much longer,

    嬰兒不會像蒙提派森的喜劇那樣

  • while most chimps labor for just two hours.

    輕鬆地掉下來

  • And there's one part of the struggle of childbirth

    非人類靈長類動物要用力生產

  • that's harder to quantify-- the pain.

    但牠們的生產過程

  • [woman 1] It felt like the bottom half of my body was gonna explode

    比起我們看似簡單許多

  • and erupt goo all over the four walls of the room.

    人類第一次分娩要花上大約九個小時

  • [woman 2] Like you're in some kind of pain blender,

    甚至會更久

  • where you're just being spun around,

    大部分黑猩猩分娩只要兩個小時

  • and you don't know what's going on. It feels like you're being ripped in two.

    生產的艱辛有一部分

  • [woman 3] Everything painted red,

    難以量化

  • and there's, like, this alarm that's like... [imitates siren]

    痛苦

  • [woman 4] It looked like I was experiencing an exorcism.

    我感到下半身

  • [narrator] The question of why humans have painful births comes down

    快要炸開來了

  • to anatomy and evolution.

    噴出黏液沾滿房間牆上

  • The theory goes like this:

    像是在痛苦攪拌機裡似的

  • Humans, unlike other primates, evolved to walk on two legs,

    一直不停的轉圈圈

  • which meant pelvises became more complicated and narrow.

    不知道發生了什麼事

  • Our brains also evolved to be bigger than other primates',

    身體像是被撕成兩半

  • which means bigger newborn heads.

    一切都塗成紅色

  • {\an8}So chimps get to push out a small head from wide hips,

    警報聲開始響起

  • {\an8}while we're stuck squeezing out a big baby through a narrow space.

    我看起來像在做驅魔儀式

  • But why did it stop there?

    人類生產過程如此痛苦的問題

  • Why didn't we keep evolving our anatomy to make childbirth less painful?

    能從身體構造和演化中找答案

  • Well, why didn't we evolve

    理論是這樣的

  • away from painful bowel movements?

    人類和其他靈長類不同

  • And why didn't we evolve out of painful breakups?

    已演化成用兩隻腳走路

  • [narrator] Natural selection doesn't care about pain,

    這意味著骨盆構造更加複雜和狹窄

  • just survival. And even though it hurts...

    我們的大腦也演化到比其他靈長類大

  • [screams]

    這表示新生兒的頭也比較大

  • ...we keep making babies anyway.

    {\an8}黑猩猩要將小頭從寬臀部推出來

  • What works, works. And what's good enough is good enough.

    {\an8}我們要將大嬰兒從狹窄的空間擠出來

  • It's a terribly tight fit.

    為什麼到此為止?

  • It's a painful labor. It's a long, protracted labor,

    為什麼身體構造沒有持續演化

  • but it works. It's good enough.

    減低生產的痛苦?

  • [narrator] So, to continue the survival  of our species,

    為什麼沒有演化到

  • women have always been stuck  with difficult childbirths.

    排便時不感到痛苦?

  • -[doctor] Almost there. -[Daysha Anthony] How much more?

    為什麼沒有演化到分手後不會難過?

  • [doctor] Not much more. One push at a time.

    物競天擇和痛苦無關

  • [narrator] The Old Testament says,

    只有生存

  • "With painful labor, you will give birth to children,"

    即使很痛

  • after Eve ate from the Tree of Knowledge.

    我們還是會生小孩

  • And this scroll from 12th-century Japan shows childbirth as so deadly

    行得通就行

  • that it attracted evil spirits who were drawn to near-fatal events.

    夠用就好

  • That's why so many cultures throughout history found ways

    產道很窄

  • to protect and comfort women during childbirth...

    分娩很痛苦

  • with rituals and the support of friends and family.

    分娩很漫長

  • Women also tried to numb their pain

    但行得通

  • with opium and hashish in the Mediterranean,

    就已經足夠

  • or in ancient Greece, willow bark, which is chemically similar to aspirin.

    為了讓物種存活下去

  • And scientists invented new tools and technologies

    女人的生產過程中經常遇到困難

  • to help if the baby got stuck.

    -快好了? -還有多久?

  • Thanks to medical progress, childbirth got less deadly over time.

    再用力

  • And one of the biggest areas of progress

    《舊約》記載

  • was the Caesarean section.

    “你生產兒女必多受苦楚”

  • C-sections actually originated thousands of years ago.

    因為夏娃吃了知識樹的果實

  • They're referenced in almost every ancient culture,

    這是來自日本12世紀的畫

  • and were performed to save the baby

    上頭畫了致命的生產過程

  • when the mother had little or no hope of surviving labor.

    招來被瀕臨死亡吸引的邪靈

  • One of the first known C-sections where the woman actually survived

    所以許多文化歷史上

  • happened in South Africa in 1826,

    有生產過程中保護和安慰女人的方法

  • performed by the British surgeon James Barry,

    像是儀式和親朋好友的陪伴

  • who was actually born a female, Margaret Bulkley.

    女人也曾試過麻痺痛苦

  • But that wasn't discovered till after his death.

    地中海地區有人使用鴉片和大麻膏

  • And around the same time, a medical missionary

    古希臘人會用柳樹皮

  • observed Ugandan doctors performing C-sections.

    作用類似阿斯匹靈

  • He wrote about one operation where the mother and baby both survived.

    科學家發明了新工具和技術

  • There was no anesthesia,

    幫助被困住的嬰兒

  • but the woman was liberally supplied with banana wine.

    多虧了醫學進步

  • In the 20th century,

    因生產而死的人數隨著時間下降

  • C-sections started to consistently save women's lives.

    其中進步最多的領域

  • And then, birthing technology really started to pick up.

    是剖腹產

  • Scientists started using pelvic X-rays

    剖腹產起源於數千年前

  • to chart the average length and rate of labor.

    幾乎每個古老的文化中曾記載

  • And for women who didn't progress fast enough,

    母親在分娩時看似撐不下去時

  • they developed a new drug to artificially speed it up,

    要剖腹拯救嬰兒

  • called pitocin, a synthetic form of oxytocin.

    首樁產婦接受剖腹產存活下來的案例

  • It's a naturally occurring hormone,

    發生在1826年南非

  • but it floods a woman's body at three events in her life:

    由英國外科醫生詹姆士貝利執行

  • orgasm, breastfeeding, and labor.

    他其實是女人,叫瑪格麗特巴克利

  • Pitocin worked so well that doctors and women

    不過這件事到他過世後才被人發現

  • started scheduling inductions if a woman went a week over her due date,

    同一時期

  • bringing some certainty to an otherwise unpredictable event.

    一位醫學傳教士觀察烏干達醫生

  • The history of medical intervention, when it comes to childbirth,

    進行剖腹產

  • has a lot to do with the emergence of obstetrics as a medical profession.

    他記錄了一場手術

  • [narrator] For most of history, doctors didn't deliver babies,

    母親和孩子都活了下來

  • midwives did.

    當時沒有麻醉

  • Women trained in the real world, through experience and observation.

    但此名婦女能盡情喝香蕉酒

  • {\an8}Then in the 1700s in Europe, midwives opened up schools

    20世紀

  • {\an8}with more official training programs.

    剖腹產拯救了婦女的生命

  • {\an8}And as waves of European immigrants

    此後的生產技術日益更新

  • came over to America in the following century,

    科學家開始用骨盆X光

  • they brought these skills with them as they settled in the northern states.

    預測分娩時的長度和比例

  • While in the American South, enslaved black women were forced

    對於過了預產期的產婦

  • to attend to the deliveries and care of white children

    發明了一種能加速生產的藥物

  • and were torn from their own families.

    稱為合成催產素

  • And they continued working as skilled midwives

    是人工合成的催產素

  • long after slavery ended.

    這是體內會自然分泌的荷爾蒙

  • They were often referred to as "granny midwives."

    但只有在三種情況下才會大量分泌

  • They tended to be senior, older members of their community

    性高潮、哺乳和分娩

  • who had themselves already given birth

    合成催產素的絕佳效果讓醫生和產婦

  • and were viewed with respect among their community.

    在超過預產期一週後會開始施打

  • [narrator] But in the 1900s,

    替無法預測的生產日定下明確的範圍

  • doctors started to edge midwives out of the delivery room,

    歷史上在生產時讓醫療介入

  • and they made a convincing argument.

    主要和產科成為一門醫療專業有關係

  • Birth might look simple. It may have been going on for centuries.

    歷史上大多不是由醫生接生

  • But in fact, it was a pathological event that requires medical intervention.

    而是由助產士接生

  • [narrator] Like a procedure called the episiotomy.

    她們透過經驗和觀察

  • {\an8}During birth, it's common for a woman to tear her vaginal opening.

    累積了實務經驗

  • {\an8}Then in the 1920s,

    {\an8}歐洲的助產士在18世紀創立學校

  • {\an8}doctors started proactively cutting the opening instead.

    {\an8}教導更正式的訓練課程

  • I think the idea was that that would... that would be easier to sew up.

    下一世紀的歐洲移民潮前往美國時

  • And it turned out that giving people an episiotomy

    將這些技能一起帶到北方各州定居

  • makes the tearing much worse.

    然而在美國南方

  • [narrator] And around that same time,

    女黑人奴隸被迫

  • Western doctors also started offering new pain drugs,

    替白人接生和照顧小孩

  • like one trend that emerged out of Germany called twilight sleep.

    被迫與家人分開

  • It was a mixture of a heavy narcotics:

    她們在奴隸制度瓦解後

  • {\an8}scopolamine and morphine.

    繼續擔任資深助產士

  • Extremely controversial 'cause it was really dangerous.

    人們常稱她們為“助產士奶奶”

  • Many of the women who were behind twilight sleep

    她們通常是社區裡的年長者

  • were involved in the suffrage movement.

    有生小孩的經驗

  • And their argument was

    而且受社區的人敬重

  • that women should have the right to have a painless childbirth.

    但20世紀時

  • [narrator] But the drugs didn't actually get rid of the pain,

    醫生開始將助產士請出產房

  • just the memory of the pain.

    他們的說法很有道理

  • Women in delivery rooms thrashed violently and screamed.

    生產或許看似簡單

  • They were often hooded or placed in cage-beds while they labored.

    已經存在了幾世紀

  • The birthing experience differed enormously

    但其實是醫療案例

  • based on where you lived,

    需要醫療介入

  • your class background and the color of your skin.

    例如會陰切開術

  • There is a theory that the more civilized a race or a culture is,

    {\an8}生產過程中,經常造成陰道撕裂

  • the more difficulty the women have experiencing childbirth.

    {\an8}1920年代醫生開始

  • And so, anesthesia was also required

    {\an8}主動將陰道剪開

  • to make sure they could get through the process.

    這麼做是因為

  • Working-class women, women of color,

    縫合起來比較簡單

  • immigrant women, no problem.

    事實證明會陰切開術

  • Babies could just pop out.

    會導致撕裂傷更加嚴重

  • It was the over-civilized, upper-middle-class women

    大約同一時期

  • that needed help.

    西方醫生開始研發新的止痛藥物

  • [narrator] That stereotype lives on today,

    其中一種來自德國

  • and it's one reason black women in the UK

    {\an8}叫做朦朧麻醉

  • are five times more likely to die in childbirth than white women.

    {\an8}那是一種強力麻醉劑混合物

  • And they're three times more likely in the US,

    {\an8}成分有東莨菪鹼和嗎啡

  • where disparities exist even at the same income level.

    因極為危險而備受爭議

  • Biggest issue, they're not being heard.

    許多支持朦朧麻醉的婦女

  • When women have said, "I'm in pain,"

    參與了投票表決

  • the understanding or stereotype of women of color,

    她們主張的是

  • that they're not really in pain the way they are.

    婦女有無痛生產的權利

  • [narrator] So back in the 1950s,

    但藥物沒有讓疼痛消失

  • while many black women didn't get pain medication

    只有讓疼痛的記憶消失

  • even when they needed it,

    產房中的產婦

  • white women started to speak out about being over-medicated.

    猛烈地敲打和尖叫

  • In 1958, The Ladies Home Journal published an investigation,

    分娩的時候

  • "Cruelty in Maternity Wards,"

    經常要戴頭罩或躺在有柵欄的床上

  • "They give you drugs whether you want them or not

    生產的經驗因人而異

  • One woman wrote in,

    決定因素有居住地區、階級背景

  • "They give you drugs whether you want them or not,

    還有膚色

  • and strap you down like an animal."

    有理論認為,種族或文化越文明

  • Women start reacting to what they believe to be

    婦女在生產時遇到的困難越多

  • absolutely horrific birth experiences.

    於是進行麻醉

  • They get angry and think they have missed out

    能確保她們能順利生產

  • on what should be the most incredible moment of their lives.

    對工人階級婦女、有色人種婦女

  • And that somehow that gets completely lost

    移民婦女來說沒問題

  • in the process of medicalizing birth.

    小孩能順利出生

  • [narrator] One of the most influential voices

    過度文明和中上階級婦女

  • in the grassroots movement

    需要幫助

  • was Ina May Gaskin, a midwife-turned-activist.

    這種刻板印象延續到今日

  • In her 1975 bookSpiritual Midwifery,

    導致英國的黑人婦女

  • she said that when women are

    比起白人婦女難產的死亡率高達五倍

  • "empowered to birth without drugs  or interventions,"

    美國的比例為三倍

  • "birth is a spiritual experience that each woman deserves

    就算收入水準相同也有差距

  • in a safe and comfortable setting."

    最大的問題是沒有人回應她們的感受

  • There were a lot of hippie women involved in the natural childbirth movement,

    婦女喊痛的時候

  • but there were also middle-class suburban housewives.

    對於有色人種婦女的刻板印象

  • There were people on all sides of the political spectrum

    會讓人以為並沒有那麼痛

  • that simply thought, "I don't need to be knocked unconscious

    回到1950年代

  • in order to give birth.

    許多黑人婦女即使需要

  • I am capable of doing it."

    也拿不到止痛藥

  • [narrator] And by that time, there was a hot new drug in town:

    白人婦女卻開始提出

  • epidurals.

    過度用藥的問題

  • Scientists discovered that injecting anesthesia

    《婦女家庭雜誌》 在1958年刊登一份調查

  • {\an8}into a certain spot in the spine called the "epidural space"

    “產房的殘酷現況”

  • {\an8}stopped pain signals traveling from the spine to the brain.

    記錄婦女在醫院面臨的傷害

  • {\an8}The entire lower half of a woman's body

    有位婦女寫著

  • would go numb within minutes, while she remained fully alert.

    “無論是否想施用藥物,他們都會給

  • It was great.It was very nice.

    還會把人像動物一樣綁起來”

  • No regrets on the epidural.

    女性開始對描述中

  • I couldn't feel my body from the waist down.

    可怕的生產經驗做出反應

  • And I knew at that point,

    她們很憤怒,認為錯過了

  • it was one of the best decisions I'd ever made in my life.

    人生中最美好的時刻

  • I-- I was like...

    因為有藥物輔助生產

  • [narrator] The World Health Organization says epidurals are perfectly safe

    而完全失去經驗

  • for healthy women in labor.

    這場草根運動中最有影響力的聲音

  • But of course, half your body is numb so...

    是伊娜梅加斯金

  • The pushing stage of labor tends to be a bit longer,

    她是助產士,也是社運人士

  • maybe, on average, about-- about 20 minutes.

    她在1975年出版《心靈助產學》

  • You have less control over your bladder,

    書中提到女性

  • and it may be less easy to walk around afterwards.

    “有權在生產時不以藥物干涉”

  • [narrator] Another medical intervention that's been surging in popularity:

    生產是“心靈上的體驗

  • C-sections.

    女人應在安全舒適的環境下進行”

  • That's how one-fifth of babies around the world are now delivered,

    許多嬉皮婦女

  • twice as many as in 2000.

    參與了自然生產運動

  • In some countries, they account for more than half of all births,

    還有郊區的中產階級家庭主婦

  • like Egypt, the Dominican Republic

    和各種政治立場的人士

  • and Brazil, where the overall rate is 55%.

    他們的想法是:“我不要在生產時

  • But in private hospitals, where doctors are being paid per service,

    失去意識

  • not per hours worked, it's 83%.

    我辦得到”

  • One study noted,

    當時市場上已經出現了熱門的新藥物

  • "Savings in time gained by cutting labor short

    無痛分娩

  • may motivate obstetricians to choose a cesarean delivery."

    科學家發現注射麻醉劑

  • And while the maternal mortality rate is lower

    {\an8}到脊椎中的“硬脊膜外腔”

  • in countries that perform more C-sections,

    {\an8}能阻斷脊椎到大腦的痛覺神經傳導

  • that's only true up to a C-section rate at 19%.

    {\an8}產婦的下半身

  • Above thatit doesn't make a difference,

    會在數分鐘內失去知覺

  • suggesting a lot of C-sections are medically unnecessary.

    人卻還能保持清醒

  • Women who have had a C-section on one pregnancy are

    很棒的經驗

  • at higher risk for complications in later pregnancies,

    感覺不錯

  • including higher risks of miscarriage and even stillbirth.

    一點也不後悔打無痛分娩

  • [narrator] Natural birth advocates say unnecessary C-sections

    我感覺不到下半身

  • are a result of messing with a woman's natural rhythm of labor,

    那一刻起我就知道

  • a concept now known as the "cascade of interventions."

    這是我這輩子做過最棒的選擇

  • I "consented" to this emergency C-section

    很好

  • due to, in my records, fetal distress because of the heart rate monitor.

    世界衛生組織認為無痛分娩

  • We'll see babies have fetal heart rate changes,

    對健康產婦很安全

  • particularly after getting an epidural.

    身體有一半是麻痺的

  • [narrator] And epidurals tend to follow pitocin because...

    分娩時要花更多時間將嬰兒推擠出來

  • As they started increasing my dosage,

    平均多上約20分鐘

  • I started having really, really painful contractions.

    這時很難控制膀胱

  • [narrator] Pitocin can help when a woman's cervix

    生產完很難下床走路

  • isn't opening up fast enough.

    另一種廣受歡迎的醫療介入

  • And so they upped my pitocin,

    剖腹產

  • which I needed because I hit my due date

    如今世界上五分之一的嬰兒是剖腹生

  • and I still hadn't gone into labor.

    是2000年的兩倍

  • You know, the minute I had to be induced, it was up to technology.

    在某些國家佔了超過半數

  • [narrator] But there's one problem with the cascade of interventions theory.

    像是埃及、多明尼加共和國

  • In a large, randomized trial, researchers found...

    巴西的比例是55%

  • Women who are induced

    不過在私人醫院

  • are actually not more likely to have a C-section.

    醫生的收入是來自病人

  • We probably do induce more frequently than we need to,

    而不是工作時數,佔了83%

  • but there aren't any hugely obvious downsides.

    有項研究指出

  • [narrator] But last-minute changes  at the hospital

    “分娩時間減短

  • can impact a woman's mental health.

    可能會促使產科醫生選擇剖腹產”

  • One study found that women who had unplanned C-sections

    產婦死亡率

  • were more likely to experience post-traumatic distress and depression.

    在常進行剖腹產的國家較低

  • In her 2004 bestselling book, Ina May Gaskin wrote 

    這只適用於剖腹產率19%的地方

  • that more drawn-out labors could be "because of a lack of privacy or fear."

    超過這個數據就沒有差別

  • She called it the "sphincter law,"

    這表示許多婦女不需要接受剖腹產

  • saying the cervix was like a sphincter muscle

    曾經剖腹生產過的婦女

  • and that "sphincters do not respond well to commands."

    再次懷孕時出現併發症的風險更高

  • Let's say you're in a public bathroom, and you're trying to take a crap,

    更有可能流產或死產

  • and someone opens the door...

    自然產倡導者主張不必要的剖腹產

  • or a loud noise, something happens.

    會搗亂女性自然的分娩規律

  • Your sphincter will freeze.

    這種概念為“生產干預的連鎖效應”

  • Think about trying to push a baby out of your vagina.

    我同意接受緊急剖腹產

  • You're trying to be relaxed, breathe...

    因為心率監測器顯示

  • Fear is going to have a major impact

    我有胎兒窘迫

  • on your ability to do so.

    我們會看到注射無痛分娩後

  • [narrator] The idea that fear made  childbirth harder was also preached

    嬰兒的心跳有所改變

  • by the French obstetrician Fernand Lamaze in the 1950s.

    無痛分娩經常會搭配催產素

  • He popularized the psycho-prophylactic method,

    他們增加我的劑量後

  • now just known as the Lamaze method,

    我開始感到疼痛的收縮

  • a set of techniques for a pain-free, fear-free, drug-free birth.

    催產素的使用時機

  • It involved breathing techniques, different laboring positions, and massage.

    是產婦的子宮頸張開得不夠快時

  • In his book, Lamaze wrote

    他們增加催產素的劑量

  • that we should not try to "cure the pain of childbirth

    那時預產期到了,只好這麼做

  • by the use of drugs"

    我仍然還沒開始分娩

  • and instead, just stop fearing the pain itself.

    由於科技,我得去催產

  • But women's reasons for choosing or rejecting pain relief

    生產干預的連鎖效應理論有一個問題

  • have always been complex.

    一次大型隨機試驗中,研究人員發現

  • In Japanjust 6% of women get epidurals,

    進行催產的產婦

  • because there's a cultural expectation that suffering is a part of childbirth.

    其實不太可能進行剖腹產

  • And while more than 70% of American women choose epidurals,

    或許有許多人不需要接受催產

  • that means almost 30% decide to go without.

    但這麼做並沒有明顯的缺點

  • My family, when I told them that I wanted to do a natural childbirth,

    但在醫院臨時做的決定

  • they were like, "You can't do it. You won't make it."

    會影響婦女的心理健康

  • [laughs] And I was just like, "Oh, no, now I have to do it,

    有項研究指出 婦女未經計畫接受剖腹產

  • 'cause you can't tell me that I can't do it."

    有可能會經歷

  • I just had this weird fascination with what it would feel like,

    創傷後壓力和憂鬱症

  • and I just wanted to know what it would feel like.

    伊娜梅加斯金2004年的暢銷書中寫著

  • Now that I look back, I'm like, "Why didn't I, like, want an epidural?"

    漫長的分娩可能的原因

  • I have no idea why I didn't want an epidural.

    “因為缺乏隱私或感到恐懼”

  • [narrator] Today, some scientific research suggests that being relaxed

    她稱之為“括約肌定律”

  • could have real physical impacts on labor,

    內容是子宮頸就像括約肌一樣

  • just as natural childbirth advocates have argued for decades.

    “括約肌經常不受控制”

  • The top of the cervix actually has a lot of muscle that does contract,

    假設你在公共廁所裡

  • so that's what made us start to think, "Okay, well maybe this is a sphincter."

    試著大便

  • And so, that actually completely changes the map that we're working with

    有人把門打開

  • to understand what goes on in pregnancy,

    或大聲喧嘩之類的事發生

  • because in women who deliver early,

    你的括約肌會動彈不得

  • that cervix starts to open prematurely,

    想像一下將嬰兒推擠出陰道

  • and it might actually be a sphincter that's relaxing too soon.

    要試著放輕鬆、深呼吸

  • [narrator] But why that happens in one patient over another,

    恐懼對於生產

  • we don't fully understand.

    會造成重大影響

  • Mechanics obviously play a really important role in pregnancy.

    恐懼使得生產更困難的說法

  • I do need an engineer to help me understand how strong is the tissue.

    法國的拉梅茲醫生在1950年代

  • We can run "what if" scenarios.

    也曾提出過

  • So, what if the patient has a short cervix?

    他推廣心理預防方法

  • Will her cervix open if the baby kicks or if there's a small contraction?

    也就是拉梅茲呼吸法

  • Can that cervix mechanically withstand, you know, the loads of pregnancy?

    這些技巧能帶來無痛、放鬆 無藥物的生產過程

  • We should know those answers. You know, we're curing cancer.

    包含了呼吸技巧

  • We should be able to understand pregnancy a lot better.

    不同的分娩姿勢和按摩

  • [narrator] That's why there's still so much conflicting information out there

    拉梅茲在書中寫著

  • on the best way to give birth.

    “我們不應該試著使用藥物

  • And a lot of it is very insistent.

    治療生產的痛苦”

  • These baby boards are probably where the seed was planted for me.

    應該停止害怕疼痛

  • Things like an epidural were cheating,

    不過婦女選擇注射止痛藥

  • and that the best way forward

    有諸多原因

  • would actually be give birth

    日本只有6%的婦女選擇無痛分娩

  • without any medical intervention whatsoever.

    因為當地的文化期待

  • I think sometimes the voices there in the movement

    痛苦是生產的一部分

  • can push themselves into a particular set of choices.

    美國有超過70%的婦女選擇無痛分娩

  • And rather than saying,

    這表示有將近30%決定不用

  • "Let's empower people to make whatever choices they want,"

    我和家人說我想要自然產時

  • say, "Let's empower them to make these particular set of choices."

    他們都說:“妳做不到,妳不會成功”

  • Well, when I found out that my daughter

    我心想:“不,我真的要這麼做

  • was going to need to be delivered via C-section,

    你們這麼說是激將法”

  • I felt like a failure.

    很奇怪,我很想嘗試一下這種感覺

  • [laughs] I felt like I had failed to do what I set out to do.

    我想知道那是什麼感覺

  • [narrator] Natural childbirth advocates may be criticized by some

    我現在回想起來的感覺是 當初為什麼不選無痛分娩?

  • for exaggerating the negative impact of medical interventions,

    我不知道當初為什麼沒有選無痛分娩

  • but their advocacy has also dramatically improved

    如今有科學研究指出放輕鬆

  • the way many women give birth.

    對分娩確實有生理影響

  • In the 1970s, episiotomy rates in the UK were over 50%,

    和自然產倡導者數十年來的理念相同

  • sometimes performed without the permission of the patient.

    子宮頸頂部有許多會收縮的肌肉

  • But then, there was a backlash against so-called "birth cuts."

    所以我們開始設想

  • A survey was organized by British midwife and activist Sheila Kitzinger.

    “或許真的就像括約肌”

  • And she found episiotomies caused more lasting pain

    那麼我們已知的結構圖要做變更

  • than any other procedure in childbirth

    才能理解懷孕時的生理作用

  • and that a natural tear generally caused much less pain

    對早產的婦女來說

  • than a cut.

    子宮頸還沒準備好就打開了

  • A study was launched, and three years later, it concluded

    或許是括約肌太早放鬆

  • that there was "no evidence to support the supposed benefits of episiotomy."

    不過我們無法全然了解

  • More research confirmed these findings,

    每位患者早產的原因

  • and by 2012, episiotomies in the UK were down to 15%.

    身體構造在懷孕期間扮演重要角色

  • And the natural childbirth movement

    我需要工程師幫我了解組織有多強韌

  • brought back one of the most ancient types of labor support...

    我們可以先預設場景

  • having a doula present.

    萬一患者的子宮頸較短怎麼辦?

  • Doulas aren't doctors or midwives.

    如果寶寶踢一腳,子宮頸會打開嗎?

  • They're trained birth coaches,

    萬一出現小力收縮呢?

  • there to support the laboring woman and help make sure her wishes

    子宮頸的構造能承受懷孕的負擔嗎?

  • are being respected by the medical provider.

    我們應該要知道答案

  • -[loud moaning] -You're so strong. Look at you.

    我們能治療癌症

  • [narrator] A number of studies have confirmed the presence of a doula

    我們應該要更了解懷孕過程

  • "reduces the need for interventions,"

    說到生產的最佳方式

  • finding a 51% decrease in C-sections.

    有許多備受爭議的資訊

  • I think it's partly just that it's nice to have somebody in the room

    其中許多資訊非常堅持

  • to say, "Yeah, this is-- this is normal." Like, "This is okay."

    或許是這些育兒討論版

  • Like, "Everything is going fine."

    讓我有這種想法

  • I think that that part of labor is quite-- can be quite scary.

    例如無痛分娩像作弊

  • [Anthony continues moaning]

    最好的方法

  • We almost there, sweetheart.

    就是生產時不需要醫療介入

  • [Anthony panting]

    我認為運動中有些意見

  • We are almost there.

    會促使人做出某些選擇

  • [narrator] And the natural childbirth movement's

    應該要說

  • underlying message continues to resonate around the world...

    “人們都有權利做出想做的事”

  • that women should make their own choices

    而不是“人們有權利做出這些事”

  • based on what's best for them.

    我發現我女兒

  • I decided to have a natural childbirth

    要透過剖腹產出生時

  • because you go to a hospital,

    我覺得我失敗了

  • black women are kind of disproportionately, like,

    我覺得我沒辦法做到

  • ignored, I guess, in hospitals.

    我該做的事

  • The only birth I ever had witnessed before was a friend who gave birth

    有人批評自然產倡導者

  • without any medicine or interventions, but it was in a hospital,

    誇大醫療介入帶來的負面影響

  • and I thought that was the best of both worlds.

    不過那些倡導者也大幅改善了

  • My birth plan was go to the hospital,

    許多婦女生產的方式

  • listen to everything the doctors say, and then come back with a healthy baby.

    英國在1970年代 選擇會陰切開術的比例超過50%

  • That was 100% of my plan.

    有時未經病人同意就執行

  • [narrator] There's no way yet to predict how any one birth will go

    當時出現了反彈

  • or what interventions are necessary for each person

    抨擊剪開陰道

  • because every woman is different.

    英國助產士和社運人士希拉基青格 整理了一份調查

  • And then also, like, every baby is totally different.

    她發現會陰切開術造成的疼痛

  • The baby was, um, sunny-side up,

    比生產時其他手術要更久時間復原

  • the kind of labor pain that's, like, way worse than regular labor pain.

    自然撕裂的疼痛比剪開少很多

  • I turned blue. There was blood everywhere.

    有人開始進行研究,三年後結果出爐

  • They ended up giving me pitocin without any epidural,

    “沒有證據顯示

  • and then I had an episiotomy,

    會陰切開術能帶來好處”

  • and all of it was like a total shock.

    更多研究證實了這項結果

  • I had no idea that any of this would be so hard.

    2012年,英國的會陰切開術

  • I was really nervous. I know how much the tissue stretches,

    下降到15%

  • but I trusted my physicians, and I was in good care.

    自然產運動

  • With my first kid, the experience was more overwhelming.

    帶回了最古老的分娩幫手

  • The birth experience with my second kid

    請接生員到場協助

  • was, like, sort of a very idyllic experience.

    接生員不是醫生或助產士

  • I mean, also, with a lot of blood.

    而是受過訓練的陪產人員

  • I'm not gonna lie. I am angry and resentful,

    能協助分娩中的婦女

  • and I have a lot to process, five years later.

    並確保她的意願

  • And yet, at the same time, it was amazing and wonderful.

    得到醫療人員的尊重

  • I still consider my C-section to be natural childbirth.

    妳真強壯,太好了

  • I don't consider anything humans do to be unnatural or supernatural.

    一些研究顯示有接生員在場

  • [laughs] And so natural is the only other option.

    “能減少藥物需求”

  • I was afraid of pain, and I had a full epidural.

    “剖腹產比例降低51%”

  • I thought, "This is so silly.

    我想這是因為有人陪伴

  • I'm missing out on something. I could have done this."

    有人說:“這樣是正常的

  • I was angry at myself and kind of ashamed that I just caved.

    沒有問題

  • They have nothing to be ashamed of because they're still doing a big work,

    一切都會很順利”

  • -which is bringing life into the world. -...two, three...

    我覺得分娩時挺嚇人的

  • [Nicola Pemberton] Growing a human and bringing that human into the world

    快出來了,親愛的

  • regardless of the route of delivery...

    我們快成功了

  • Nine and ten. Beautiful. Deep breath, deep breath!

    自然產運動的理念

  • ...is still a big feat.

    持續在全世界引起共鳴

  • Right back at it. Ready? And push on your bottom!

    女人應該自行做決定

  • [screaming]

    選擇最好的方法

  • [clinician] Come on, baby, you got it. That's it. You got it.

    我決定自然產

  • -[doctor] Come on, give me another one. -[clinician] Ready? This is it.

    因為去醫院

  • -[screaming] -[doctor] Here we go. That's it.

    黑人女性的比例不多

  • [chattering continuing]

    會被人忽略

  • [moaning]

    我唯一看過的生產過程

  • -[doctor] Let's go. -[clinician] Ready?

    是一位朋友生小孩

  • [doctor] Most important push of your life. Ready? One, two, three. Right back at it!

    她沒有使用藥物或手術

  • -You got it. Yes, Daysha. Hold her down. -[screaming]

    可是地點在醫院

  • [doctor] Open your eyesOpen your eyes! Open your eyes!

    我想那是兩全其美的方法

  • -[clinician] Look at your baby. -[doctor] Open your eyes.

    我的生產計畫是去醫院

  • [Anthony gasping]

    聽醫生的話,抱著健康的寶寶回家

  • -[woman] Oh, my God! -[sneezes]

    那就是我的計畫

  • -[woman] Oh, my God! -[doctor] Okay.

    沒有辦法預測生產過程如何

  • -[woman] Oh, my God! -[doctor] Congratulations, Mommy!

    或每個人需要的醫療協助

  • You never worked on anything so hard in your life.

    因為每個女人都是獨一無二的

  • -I know he's worth it, right? -[woman] My grandbaby.

    每個嬰兒也完全不同

  • -My grandson. -[doctor] Mm-hmm.

    我的寶寶臉朝上

  • [woman] Oh, look at him! He's so little!

    分娩過程的痛苦

  • -[doctor] All right. Come on, bud. -[baby crying]

    比一般分娩疼痛還要劇烈

  • There you go. There you go. There you go.

    我的臉色發青

  • -[woman] Welcome to the world, sweetie! -[baby continues crying]

    到處都是血

  • -[womanDaysha, Daysha, you did it! -[theme music playing]

    結果他們給我催產素

[narrator] This is a stretch test, which engineers use

這是拉力測試

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