低風險孕婦敦促避免住院分娩

Low-risk pregnancy cases are being urged to avoid hospital birth under new NHS guidelines Photograph: Katie Collins/PA

根據英國國家醫療服務體系指引，低風險孕婦敦促避免住院分娩

Women with low-risk pregnancies are to be encouraged to have non-hospital births under new NHS guidelines, which could see almost half of mothers-to-be planning to deliver their baby away from traditional labour wards.

根據新的NHS指引，鼓勵低風險孕婦不在醫院分娩，這就意味着半數左右的準媽媽們將不在傳統的產房分娩。

Guidance from National Institute for Health and Care Excellence (Nice) says that midwife-led care has been shown to be safer for women and recommends that all women with low-risk pregnancies – 45% of the total – should be advised that giving birth in a midwifery-led unit, whether attached to a hospital or not, is “particularly suitable”.

Nice（國家臨牀醫學研究所）指引表明由助產士護理更安全，建議那些佔總數45%的低風險孕婦在助產士機構分娩是極爲妥當的，無論這些助產士機構是否附屬於醫院。

The changes, published on Wednesday , have been made because women who give birth under midwife-led care have less chance of being asked to undergo medical interventions such as episiotomies, caesareans and use of forceps or ventouse.

星期三發佈了新的指引，由於在助產士的護理下分娩的女性，被詢問實施諸如會陰切開術，剖腹產，產鉗產以及吸引產的醫療干預的機會較少。

Susan Bewley, professor of complex obstetrics at King's College, London, and chair of the Nice advisory group, added that infections were more common on hospital wards.

倫敦國王學院綜合婦產科教授兼國家臨牀醫學研究所諮詢小組主席Susan Bewley補充道，感染在醫院病房更常見。

"We're supporting an individual calm conversation about what is right for each individual in her circumstances," Bewley said. "They may choose any birth setting and they should be supported in those choices as that's their right."

我們支持那些根據自己的情況做出適合她們的選擇。Bewley說道，應該支持她們選擇分娩環境的權力。

The NHS body also advised midwives not to clamp and cut a baby's umbilical cord until at least a minute after birth in the absence of complications, and generally within five minutes.

NHS還建議在沒有併發症的情況下，助產士應在一分鐘以上五分鐘內剪斷嬰兒的臍帶。

The announcement reverses decades of NHS policy and its own advice from 2007 recommending "early clamping and cutting of the cord".

這條指引的宣佈顛覆了數十年來的NHS制度以及2007年推崇儘早剪斷臍帶的建議。

Research suggests that early clamping and cutting may leave newborn babies deprived of vital blood from the placenta, risking anaemia.

研究表明儘早剪斷臍帶會使新生兒過早失去胎盤血，導致有貧血的風險。

In separate guidance on postnatal care, Nice said parents should also be informed about the association between falling asleep with their baby on a bed, sofa or chair and sudden infant death syndrome until the baby is 12 months old.

關於產後護理的指引，NICE指出父母應知曉在嬰兒滿12個月之前，和嬰兒同睡與嬰兒猝死綜合徵之間有關聯。

The change represents another significant change to the guidelines, issued in 2006, which only applied to babies up to the age of six to eight weeks. Parents should also be informed that the association may be greater if parents use drugs or have recently drunk alcohol, or if the baby was of low birth weight or premature.

這項新的指引對2006年公佈的適用於6-8周大的嬰兒身上的指引作出了顯著的修改。應告知父母，在孕期服藥或飲酒，還有嬰兒出生時體重過輕，早產和嬰兒猝死綜合徵的聯繫更大。

Nine out of 10 of the 700,000 babies born in England and Wales each year are currently delivered in hospital under the supervision of obstetricians. Nice added that commissioners should ensure that women have all four possible options for giving birth available to them: hospital care, midwifery units in hospitals, midwifery units based in the community and at home.

每年有700，000的嬰兒在英格蘭和威爾士出生，其中90%的嬰兒在產科醫生的監護下出生。NICE補充道 應確保女性有四種分娩環境的選擇，即選擇在醫院，醫院附屬助產士機構，社區助產士機構以及在家中分娩。

Professor Mark Baker, Nice's clinical practice director, said: "It's very difficult to explain why this is happening but the closer you are to hospital, and indeed if you are in hospital, the more likely you are to receive hospital care and surgical interventions."

Nice臨牀實踐主任Mark Baker教授說道“離醫院越近以及已入院，接受醫院護理以及外科手術的可能就更大，很難解釋爲什麼會這樣。”

"Surgical interventions can be very costly, so midwifery-led care is value for money while putting the mother in control and delivering healthy babies."

因爲外科手術費用昂貴，當產婦在可控範圍內分娩健康寶寶時，助產士護理會物超所值。

The outcome for the baby is the same in different settings except in the case of first-time mothers giving birth at home, where there is a "small increase" in risk of serious complications – nine in every 1,000 compared with five in every 1,000 in the other settings – which the guidance says mothers should be advised about. Home births are the cheapest, followed by midwife-led units and then hospitals but Bewley said costs did not come into the equation.

在不同環境分娩嬰兒結果是相同的，但不包括初產婦在家分娩，因爲會有小部分人有嚴重的併發症-千分之九的概率，而在其他環境分娩的概率爲千分之五- 在家分娩花費最少，其次是助產士機構，醫院花費最多，但是Bewley說費用不是作出選擇的關鍵。

Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said: "For low-risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions."

皇家助產士學會首席執行官Cathy Warwick說：對低風險孕婦來說，在助產士機構或在家分娩是安全的，減少醫療干預。

“We hope this will focus commissioners' and providers' of maternity services attention on ensuring that women have a real choice about where they give birth.”

我們希望這會使婦產科機構的管理層關注於確保女性能選擇適合他們分娩的環境。

The RCM has been campaigning for about 5,000 extra midwives to be recruited. Warwick said the new guidance would not stretch existing medical staff further but ensure they were better employed, as more women would have births without interventions, which require more resources.

RCM正致力於再招收5000名助產士。Warwick說：在新的指引中，現有的醫務人員不再擴增，但會被安排在更合適的崗位，因爲更多的女性將在沒有醫療干預的環境中分娩，這將需要更多的資源。

Elizabeth Duff, senior policy adviser for the NCT (National Childbirth Trust), welcomed the advice and urged the NHS to "put these guidelines into practice as soon as possible and make home and community birth, a real, not just theoretical, option".

國家剩餘信託基金會高級策略顧問Elizabeth Duff對這個指引表示歡迎並敦促NHS儘早將指引落實，在家和社區分娩將會是個真實的選擇而不光是理論的。

Community midwife units have lower medical intervention rates and rates of transfer to obstetric wards than those in hospitals but many have been closing recently. For women not giving birth for the first time they also have a lower rate of transfer to an obstetric ward than mothers who planned to give birth at home.

相對醫院來說，在社區助產士機構中醫療干預和轉到產科病房發生率較低，但是最近很多社區助產士機構已經關閉。比起那些打算在家分娩的孕婦來說，經產婦轉移到產科病房的發生率更低。