Perhaps, childbirth does not mean that there will be a "nightmare" severe pain.
In 2022, the nationwide pilot work on childbirth analgesia has been carried out until the fourth year. According to the National Health Commission (hereinafter referred to as the "Health Commission"), in four years, 913 hospitals across the country have set up pilot bases for childbirth analgesia, and the rate of painless childbirth has reached 53%. Many places have also included childbirth analgesia in the basic medical insurance payment scope.
The concept of childbirth analgesia has also gradually been accepted by the public. The latest media survey data shows that 82% of researchers are willing to use childbirth analgesia during delivery. However, this research data also pointed out that at present, the overall penetration rate of childbirth analgesia nationwide is only 30%. This means that nearly 70% of women are still suffering from childbirth pain.
In an interview with a reporter from " China Report ", Xu Mingjun, director of the Department of Anesthesiology at Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University, said that domestic childbirth analgesia is already a mature and safe technology. Due to the constraints of concepts, manpower and economic benefits, the rate of childbirth analgesia in my country is still a big gap compared with developed countries in Europe and the United States.
"Promoting the national popularization of childbirth analgesia requires joint efforts from multiple parties." In Xu Mingjun's view, the increase in painless childbirth rate in my country is a slow climbing process, but with the increasing popularity and promotion, the painless childbirth rate will increase by 10% in 3-5 years.
misunderstood "painless childbirth"
"heart-wrenching" "like a huge rock hitting violently from the chest to the abdomen"... Most women compare it to a "nightmare" when talking about the pain of childbirth. In the medical pain index, labor pain is close to the pain caused by burns .
From the perspective of professional medicine, the pain during childbirth comes from paroxysmal contraction of the uterine muscles. The pain is transmitted from the lower abdomen of the mother along the lumbar and sacral plexus nerves to the spinal cord, and then uploaded to the brain pain center.
"This pain will not only bring a strong sense of pain to the mother, but will also increase the health risks of the mother and even the fetus during the childbirth." Xu Mingjun told the reporter of "China Report" that at present, experts and scholars around the world recognize that childbirth analgesia is safe and effective, which can not only relieve the harm caused by childbirth, but also alleviate women's fear of childbirth to a certain extent.
childbirth analgesia, also known as painless childbirth. As early as 1847, the British Simpson used the anesthetics diethyl ether and Gorofang to start the world's first attempt to give birth without pain. In 1853, Queen Victoria of England also used painless childbirth during the delivery process. By the late 1980s, painless childbirth had gradually become a widely promoted obstetrics work in the United States, Europe and other countries.
data shows that in the late 1990s, the painless delivery rate of British mothers had reached more than 90%, the United States had exceeded 80%, and the painless delivery rate in France, Canada and other countries had also reached or exceeded 50%.
In contrast, painless childbirth in China started late. Although China's first painless delivery surgery was completed in 1963, it was not until around 2000 that the technology was slowly launched in China. Xu Mingjun remembered that at that time, most mothers and their families questioned painless childbirth, and by 2004, the analgesia rate in my country was less than 1%.
To this day, whether mothers and babies have sequelae remains is still a concern for painless childbirth. The survey results mentioned above show that 21% of respondents believe that painless will affect fetal health and growth, and 21% of respondents believe that painless html will leave sequelae for pregnant women. Among these respondents, 36% of these respondents do not understand or have only heard of painless childbirth, and there is a cognitive gap.
Xu Mingjun has long been "not surprised" about the doubts. In 2008, he and his team launched a national promotion plan for Kangle childbirth and analgesia, going to different hospitals in 3-4 cities every year to popularize and promote painless childbirth to medical staff. In his impression, in the early stages of popularization activities, there were many medical staff who had misunderstandings about painless childbirth. These prejudices under the traditional concept of production are the most difficult hurdle in the promotion of childbirth analgesia.
Xu Mingjun told reporters that as long as it is standardized analgesia, it will not bring special sequelae to the waist.Some mothers will suffer from back pain after giving birth. Generally, the hormone secretion changes after the mother becomes pregnant, which will cause ligament relaxation. The needle for delivery analgesia is usually performed on the back of the waist, so it is easily mistaken for causing low back pain.
"Implementing childbirth analgesia can reduce the proportion of cesarean section without indications." He added that scholars around the world unanimously recognized that standardized analgesia has no adverse effects on mothers and babies, and is even beneficial to newborns. Newborns survive in the uterus mainly rely on the placenta blood oxygen supply. Analgesia will cause mild expansion of placenta blood vessels, which will help placenta blood supply and provide the fetus with sufficient blood oxygen .
The real dilemma of scarcity of manpower
In the process of promoting painless childbirth in China, it was generally considered by the industry to be a key node in 2018. In November of that year, the National Health Commission issued the "Notice on Carrying out Pilot Analgesia for Childhood", deciding to select a certain number of hospitals nationwide to carry out pilot work on childbirth analgesia diagnosis and treatment from 2018 to 2020. The notice of
also stated that hospitals should provide necessary support for childbirth analgesia, including personnel, equipment and necessary policy support, and mobilize medical staff to carry out childbirth analgesia.
Xu Mingjun is a member of the pilot work expert team. He told the reporter of China Report that for a long time, childbirth analgesia was not only a pain point for mothers, but also highlighted the pain points of medical services. Before the release of this document encouraging pilot painless childbirth, the national painless childbirth rate was less than 10%.
However, four years after the pilot work of painless childbirth in 913 hospitals nationwide has been carried out, the overall analgesia rate of pilot hospitals has reached 53%. The proportion of labor analgesia at the pilot base of comprehensive hospitals has reached more than 40%. In maternal and child hospitals, the proportion of labor analgesia has reached more than 85%.
△ An anesthesiologist at Beijing Hospital is giving pregnant women a "painless" treatment.
Xu Mingjun observed that with the development of the pilot work, my country's painless childbirth technology has become more mature, and the obstacles from traditional concepts have gradually weakened. More and more people have accepted that "giving children does not necessarily mean experiencing severe pain."
But what makes Xu Mingjun and the expert team worry is that the development of painless childbirth has a considerable demand for the anesthesia industry. For this industry that was originally short of manpower, "the burden will be heavier." He bluntly stated that judging from the situation of painless childbirth in China in recent years, the gap between domestic specialized hospitals and general hospitals is relatively obvious. The proportion of labor analgesia in obstetrics and gynecology hospitals and maternal and child health hospitals implementing labor analgesia is much higher than that in general hospitals. One of the important reasons is the shortage of anesthesiologists.
Wen Tingru, who has 10 years of experience in obstetrics and gynecology, also agrees with this. In the private maternal and child hospital where she is currently working, the painless delivery rate reaches 90%. In most cases, the mother will make a request for painless delivery by herself. She introduced that it takes more than 20 hours from childbirth to the end of the childbirth, which is a long time. Anesthesiologists need to continue to do observation after giving her analgesia. Judging from the current size of anesthesiologists in public hospitals, it is difficult to carry out the demand for entering the delivery room "at any time" or "24 hours".
For scarce anesthesiologists, the data provided in the "2017 China Health and Family Planning Statistical Yearbook" shows that in 2016, there were about 76,600 anesthesia practitioners (assistant) physicians in China, and the number of anesthesiologists per 10,000 people has only 0.5. The United States and the United Kingdom have 2.5 and 2.8 respectively. Many industry experts have made calculations about this, and there is currently a gap of about 300,000 domestic anesthesiologists.
Wen Tingru told the reporter of "China Report" that the scarcity of manpower can easily cause irregularities in the entire process of painless childbirth, increasing the risk of mothers during childbirth.
In addition, costs and benefits have also become objective reasons why some general hospitals are slowly promoting painless childbirth. Xu Mingjun said that although the charging prices have increased now, for the hospital, judging from the invested anesthesiologists, nurses and other personnel and the long-term monitoring they provide, painless delivery is still a "lose business."
Xu Mingjun admitted that the best management model for painless childbirth is to anesthesia doctors enter the delivery room 24 hours a day.The more women who perform childbirth analgesia, the higher the effectiveness of anesthesiologists entering the delivery room 24 hours a day, but such a virtuous cycle is often stuck in insufficient manpower.
"The era of painless childbirth in China has arrived"
Although the obstacles in the implementation process are still clearly visible, most experts, including Xu Mingjun and Wen Tingru, believe that: Now, "The era of painless childbirth in China" has arrived.
In August this year, the National Health Commission and 17 other departments issued the "Guiding Opinions on Further Improving and Implementing Active Reproductive Support Measures ", which specifically proposed to expand the pilot program of childbirth analgesia and improve the level of childbirth analgesia. In the industry's view, this is a positive signal in the promotion process of painless childbirth.
Xu Mingjun said: "Painless childbirth cannot be just discussed in the medical community, but there should also be policies and social media calls, so that it can be better popularized among the public."
More directly reflects that in recent years, health departments in many places have successively introduced supporting measures to promote the promotion of painless childbirth. This includes inclusion of the cost of painless childbirth in medical insurance - this is considered an important measure to promote the construction of a fertility-friendly society.
In the aforementioned media survey data, the economic burden has also affected the popularity of painless childbirth to a certain extent. 15% of respondents believe that the economy can afford to popularize painless childbirth, and called for various measures including medical insurance and popularization of science.
△ In Haikou, Hainan, a man experiences the pain during childbirth through professional instruments. How much can the cost of painless delivery be reduced after
is included in medical insurance? Taking Shanghai as an example, starting from January 17 this year, 48 medical service projects including childbirth analgesia have been officially included in the payment scope of basic medical insurance in Shanghai. Previous media reports showed that before included in medical payment, the original price of analgesia for childbirth was 2,000 yuan, all at their own expense. After being included in medical insurance, the mother will actually pay only a few hundred yuan.
From a national perspective, Shanghai, Guangzhou, Guizhou and other places have included special fees for childbirth analgesia in medical insurance payment, while Zhejiang Province has included childbirth analgesia in DRGs separately.
Xu Mingjun told reporters that at present, more than 20 cities in China have successively issued special charging standards for childbirth analgesia, and some regions have included it in medical insurance. These are all useful explorations.
"An important prerequisite for inclusion in medical insurance projects is to increase the total amount of maternity insurance or increase the special charges for childbirth analgesic medical insurance." If the total amount of maternity insurance is not increased, it is empty talk to include painless childbirth projects in medical insurance.
As a call for painless childbirth for many years, Xu Mingjun clearly realized that the development of childbirth analgesia in China has a long way to go. The current primary task is to widely promote advanced concepts and technologies to hospitals at all levels across the country, so that more mothers in our country can enjoy childbirth analgesia. But at the same time, he also reminded that promoting painless childbirth should not only focus on the analgesia rate of childbirth, but also on the improvement of the quality of childbirth analgesia, and comprehensively improve the service capabilities of my country's childbirth analgesia.
Written by: Reporter of "China Report" Qiu Hui
Picture source: Xinhuanet, China News Service
Editor: Xu Hao
