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 midwives, doulas, 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.