剖腹產還是自然產？

【英文原文1】

With her due date approaching and her unborn son pointed feet first, Fiona Simmonds tried every technique she knew of -- acupuncture, raising her pelvis above her head and playing music near her belly -- to encourage the baby to flip around and allow him be delivered normally. But in the end, the baby remained breech and she needed a caesarean section.

Today, about a third of U.S. births are done by caesarean section, up from 21% in 1998, one of the highest of any developed country, the National Center for Health Statistics reported in March. Public-health officials are concerned about the rising rate because c-sections hold more health risks for the mother -- including possible infection and blood loss -- and are more expensive than a vaginal birth.

Medical experts say many c-sections -- which involve delivering a baby through a surgical incision -- are performed unnecessarily. But for a growing number of women, a c-section is the safer option for delivering a baby, and in some emergency cases, it might be the only choice. Medical experts say they're now seeing more medically-necessary c-sections as women have children later in life and obesity rates rise.

'We're seeing more obese women and that leads to more' caesareans because they are more likely to have other medical conditions that can lead to complications during childbirth, such as diabetes and high blood pressure, says Jacques Moritz, director of gynecology at St. Luke's-Roosevelt Hospital Center in New York.

Moms with diabetes tend to have larger babies that can get stuck in the birth canal and obesity can make it more difficult to monitor the baby during delivery. Older moms are more likely to experience complications during pregnancy such as gestational diabetes and preeclampsia (a condition characterized by high-blood pressure during pregnancy), which can boost the risk of a c-section. And the increased use of fertility treatments including in-vitro fertilization, which can result in multiple births, also can make a c-section necessary, Dr. Moritz says.

【英文原文2】

When a baby weighs more than 10 pounds, a c-section is often the safer option. Dr. Moritz also chooses a c-section when the mother has been in labor for a long period and not able to deliver. A long labor could signal that the baby is having trouble fitting through the mom's pelvis. A caesarean also is necessary for twins whose heads are not pointed down and anytime there are triplets, he says. And c-sections are often ordered when a baby's heart rate goes down during labor.

The number of c-sections performed in the U.S. each year for medical reasons isn't counted. But the World Health Organization has said that when c-sections rates go above 15% of total births, that usually indicates too many are being done.

The rise in caesarean sections hasn't resulted in fewer delivery complications or healthier moms and babies, says George A. Macones, chairman of obstetrics and gynecology at Washington University in St. Louis and a spokesman for the American College of Obstetricians and Gynecologists.

Women who deliver a baby by caesarean section face a number of medical risks, including the possibility of infection, blood loss, pulmonary embolism and death.

The risks are magnified after a first child is delivered by c-section: In subsequent pregnancies, there's an increased likelihood that the uterus could rupture. Second and third c-sections also have higher risks of excessive bleeding that could necessitate a hysterectomy.

Vaginal deliveries, of course, carry their own risks, the most common of which are pain and trauma to the pelvic floor, which can sometimes result in incontinence. But they are generally safer than c-sections, Dr. Meyer says. And there are also health benefits for babies: Passing through the birth canal helps prepare the lungs for breathing air.

But doctors say that a c-section is indicated if a normal delivery would be risky for baby or mom. When Mrs. Simmonds baby failed to move out of the breech position, she scheduled a caesarean.

【中文譯文1】

隨着預產期的臨近、腹中男寶寶的胎位是頭上腳下，菲奧納•西蒙斯(Fiona Simmonds)嘗試了自己知道的各種方法──鍼灸、膝胸臥式運動、在肚子旁邊播放音樂──來試圖讓胎兒翻轉過來，讓自己可以自然生產。不過最後，胎位依然是臀位，她需要進行剖腹產了。

Bryan Derballa
菲奧納•西蒙斯上個月做了剖腹產，因爲寶寶的胎位是臀位據美國國家衛生統計中心(National Center for Health Statistics)3月份公佈的數據，目前，美國的剖腹產率約爲三分之一，較1998年的21%有所上升，成爲發達國家中剖腹產率最高的國家之一。公共衛生官員對上升的剖腹產率表示擔心，因爲剖腹產會給產婦的健康帶來更多的風險──包括可能發生感染和失血，而且比自然生產的費用要高。

醫學專家說，很多剖腹產都是不必要的。不過對於越來越多的女性來說，剖腹產是一個更安全的選擇，在某些緊急境況下，還有可能是唯一的選擇。醫學專家說，隨着高齡產婦的增多和肥胖率的上升，他們認爲從醫學上講進行更多的剖腹產是必要的。

紐約聖盧克─羅斯福醫院(St. Luke's-Roosevelt Hospital Center)婦科主任莫瑞茲(Jacques Moritz)說，肥胖的女性越來越多，由於她們更有可能患上糖尿病和高血壓等其他易導致生產併發症的疾病，剖腹產也隨之增多了。

患有糖尿病的準媽媽更容易生下巨大兒，太大的寶寶有可能會卡在產道中，而肥胖則可能增大生產期間對胎兒的監護難度。高齡產婦在懷孕期間更有可能出現併發症，比如妊娠糖尿病和妊娠高血壓，進而可能會增大剖腹產的風險。莫瑞茲說，不孕症治療的增多──包括試管嬰兒──有可能會導致多胎，進而必須進行剖腹產。

【中文譯文2】

當胎兒體重超過10磅時，剖腹產往往是更安全的選擇。莫瑞茲還會在產程過長的時候使用剖腹產。產程長有可能意味着胎兒難以進入母親的骨盆。他說，胎位不正的雙胞胎也需要進行剖腹產，所有的三胞胎都要進行剖腹產。當生產過程中胎兒的心率減慢時，也常常會進行剖腹產。

美國每年因醫學原因而進行的剖腹產數量沒有進行過統計。不過，世界衛生組織(WHO)說，當剖腹產率超過了總數的15%以上時，往往意味着剖腹產做的太多了。

聖路易斯的華盛頓大學婦產科主任、美國婦產科醫生協會(American College of Obstetricians and Gynecologists)發言人馬肯斯(George A. Macones)說，剖腹產的增多並沒有使生產併發症減少或母嬰更健康。

進行剖腹產的女性面臨各種醫學風險，包括感染、失血、肺部栓塞和死亡的可能。

如果頭胎是剖腹產，之後上述風險會增大：在之後的懷孕中，子宮撕裂的風險會更大。第二次和第三次剖腹產還會有更高的大出血風險，有可能需要對產婦進行子宮切除。

當然，自然生產也有風險，最常見的是疼痛和對骨盆底的創傷，這有時候可能會導致小便失禁。不過梅耶說，通常來講，自然生產比剖腹產更安全。自然生產對寶寶也是有好處的：經過產道生產可以幫助寶寶的肺部爲呼吸做好準備。

不過，醫生說，如果自然生產對胎兒或產婦可能有風險的話，建議進行剖腹產。當西蒙斯的胎位沒有糾正過來時，她做了剖腹產。