The obstetrics community may be quite familiar with the term "local anaesthesia cesarean section" and it continues to be implemented in many hospitals, which has long become a "standard". Before the emergence of obstetric anesthesia and modern delivery rooms, "local anaesthesia c

Source: Painless childbirth China

Obstetrics community may be quite familiar with the term "local anaesthesia cesarean section". It is still implemented in many hospitals, and has long become a "standard" of inertia. Before the emergence of obstetric anesthesia and modern delivery rooms, "local anaesthesia cesarean section" was understandable. Why are there still people asking:

• "Do we have any other solutions?"
• "We don't have anesthesiologists in the delivery room, so we can only do this?"
• "We don't have an operating room in the delivery room, what should we do?"
• ...

Our delivery room needs to have the ability to remove the child within 5 minutes after the fetus suddenly interrupts blood supply [1]! This is not shifted by our will, nor is there any room for doubt. As long as we use the "delivery room" logo, this ability is a must.

We all know that in the moment of cardiac arrest in adults, external cardiopulmonary resuscitation should be performed immediately, and this is true for newborns. Why is the current textbook given a 30-minute time limit? Moreover, evidence shows that after a pregnant woman’s cardiac arrest, the perimortem cesarean delivery, which allows the fetus to be born as soon as possible, plays a decisive role in improving the mother’s resuscitation rate [2, 3]. Everyone should not have forgotten the Yulin mother and baby death incident that shocked the world on July 31, 2017? Has anyone ever asked: "Is this mother and baby aided at that time?"

1

This reminded me of a decade ago when I discussed this issue with a professor who had just returned from the United States and who focused on the field of high-risk obstetrics. The answer I got was: "We are different!" The implication is that we need to find another way.

In the next few years, I heard more and more "quasi-section" in the local anaesthesia. Is this the way that suits the national conditions? There is no anesthesiologist in the delivery room, so I took the shortcut to go back to the era when there is no anesthesia and opening the abdomen? This is no longer the 2nd century when Hua Tuo used Ma Fei to spread his belly (more than 2,000 years ago), nor the 1842 when Dr. Crawford W. Long used anesthesia gas to create a new era of modern medicine [5], or 1847 when Dr. Parker first introduced this technology to China in 1847 (more than 150 years ago), but in the 21st century when both anesthetic drugs and technologies are very popular, with anesthesia doctors, anesthesia devices, and drug consumables in the same hospital, or even the same building and the same floor.

"We are different". I often hear this when discussing clinical topics of Chinese and foreign medicine. All of them convey this message: We don't do this! Different races, different cultures, different medical education systems, different hospital management, and different instruments and equipment.

is indeed a very important topic, perhaps this reflects the different thinking of Chinese and foreign medicine. We need to learn from foreign literature and examine the medical system. When foreign professional organizations publish clinical guidelines, they often have a clear statement. For example, the American College of Obstetricians and Gynecologists (ACOG) guide published in November 2013 read [7]: "This article reflects the latest clinical and scientific progress as of the release date and may change. The guide should not be used as the only treatment plan or measure that must be followed." There are actually three meanings here: 1) Respect the specific situation of each medical system and each hospital; 2) Various clinical measures are not yet perfect, and there is still a lot of room for development; 3) Do not let medical staff fall into unnecessary legal lawsuits.

as an example. Dr. Yu Guoxian, an obstetrician at the painless delivery , contacted ACOG, hoping to obtain the copyright of its guide in Chinese to help introduce their guide to China. Dr. Yu received the answer: I don’t want other language versions to avoid misunderstanding that ACOG “sells” American medical care. ACOG understands that medical initiatives will have different outcomes in different medical settings, and inappropriate interpretation of guidelines can cause harm.

All clinical guidelines are composed of two parts: medical science and clinical practice [8]. The American Society of Anesthesiologists' clinical guidelines are often divided into three parts, including medical literature review, member survey consensus, and relevant expert survey consensus.The medical literature reflects the level of evidence in today's clinical research, the member consensus reflects various clinical practices and their environment, and the expert consensus is a supplement to many parts of the research evidence that do not have enough or good enough in the content. The three are combined to give the highest evidence, the most appropriate and feasible clinical medical norms [9].

2

The time limit for immediate cesarean section is a medical scientific issue, and how to perform anesthesia and cesarean section within this time limit is a medical management issue. For medical science issues, we cannot use "different" as an excuse to take it lightly or take a detour. The "local anesthesia cesarean section" is not groundless. History has only given it the only indication: it missed the planned epidural delivery analgesia, and cannot ventilate after general anesthesia [10]. It can only be marked as "backward" when used in other situations in modern medicine.

The directors and deans at the medical management level may feel a bit incredible when they hear this "immediate cesarean section", but they do need to be clearly aware of this backward situation. The childbirth experience of Dr. Chen Weijian, former director of the Jiujiang Maternal and Child Health Hospital in Jiangxi Province, was enough to make the dean, who was born in Iowa, USA, think deeply about the current situation of his hepatobiliary surgery. Lin Moju, former director of the Liuzhou Maternal and Child Health Hospital in Guangxi, has been thinking about how to solve the safety of delivery rooms. The concept and practice of "immediate cesarean section" teamwork has been successfully solved. There is a hospital in Shanghai. Although they don’t know how the West solves these immediate conditions, they asked medical staff to bring mobile surgical equipment to the mother based on their delivery room status, creating the unique "immediate cesarean section" model that has been produced in China so far. What did our medical staff who went abroad to observe see abroad? Have you also felt the urgency to improve?

Does it mean that "immediate cesarean section"? The book clearly states "emergent cesarean delivery"! Yes, in the official English document, in addition to the word "emergency cesarean delivery", there is also "perimortem cesarean delivery" for mortality cesarean delivery. Although there is no "stat cesarean delivery" or "crash cesarean delivery" in the ACOG guide, these American medical staff (up to more than 800 people) who have not received the "painless delivery China Tour" special training camp, when they hear "stat" or "crash", they will do their best to interpret the connotation of instant cesarean delivery, reflecting the well-trained skills and the deep-rootedness of this clinical measure in the thinking of American medical staff. Why not write "instant cesarean section" into the guide? Because every medical institution has its own specific situation, the Western professional association fully realizes that the best and most ideal things are not necessarily something that can be done. A non-one-size-fits-all approach is to protect professionals from being held accountable for unnecessary legal disputes. We went to observe and obtain the scriptures, but we observed but did not see them, and did not understand the deep marrow. No wonder I can't get into the game, but instead I preconceived ideas and use the old book knowledge of "emergency cesarean section" to view problems [11].

Little do you know that many American hospitals have adopted a fourth-level cesarean section system written or unwritten:

1. Stat/Crash/Perimortem (immediate): a cesarean section needs to be delivered immediately, and it is almost necessary to give birth to a child within 5 minutes, such as cardiac arrest of the mother, umbilical cord prolapse, and some type III fetal heart;
2. Emergent (emergency): a cesarean section needs to be delivered within 30 minutes, such as severe blood pressure in preeclampsia cannot be well controlled and cannot be delivered in a short period of vaginal delivery;
3. Urgent (sub-emergency): a cesarean section within a few hours, if the original cesarean section is naturally in labor, and if there is time to fast and drink, then cesarean section is given;
4. Elective (elective).

In the past, only the two types of elective and acute have been upgraded. In 2018, this kind of quaternary cesarean section system has been adopted in the delivery room of Shanghai Jiahui International Hospital. In other words, this is no longer a new thing in the country.

"Stones from other mountains can be used to polish jade", and predecessors left a lot of wisdom and experience. How to introduce Western clinical medicine into Chinese delivery rooms has become a very important topic in the "painless childbirth in China".Later, a series of big data clinical natural trials from specialized obstetrics and gynecology hospitals, teaching hospitals where high-risk maternal and maternal maternal gatherings to grassroots county hospitals with rural population were designed for the above considerations. This was used to test and certification series of clinical measures tailor-made for specific situations in China and aimed at improving the clinical outcomes of perinatal maternal and infants during the perinatal period [12, 13, 14, 15]. In the verification, many expected results were obtained: while promoting intra-spinal delivery analgesia, a decrease in the rate of cesarean section was seen; after changing the definition of labor, a decrease in the rate of forceps and transit cesarean section was seen. The decrease in lateral tangent rate, the decrease in blood transfusion rate, and the decrease in the high-risk rate of neonates are all unexpected. These unexpected surprises are something that cannot be seen in Western research, but have always wanted to know. Innovation sometimes doesn't need to be so deliberate.

Our Chinese colleagues are also working tirelessly. Three studies from Nanjing Maternal and Child Health Hospital have given us a good idea:

1. Early delivery and epidural analgesia does not increase the cesarean section rate and forceps rate in Chinese women [16];
2. second delivery and epidural analgesia does not prolong the labour rate and forceps rate and cesarean section rate [17];
3. Grobman scar uterine vaginal trial delivery prediction model is suitable for Chinese women [18].

originated from local clinical trials suitable for national conditions, and similar studies in the West have reached the same conclusions. The scientific nature of medicine lies in its repeatability!

Another "different" phenomenon is that in our traditional delivery room, the labor process is actually divided into four parts, allowing the mother to be transported at least 3 times: the ward's labor (early stage of the first delivery period), the delivery room's labor (after 3 cm from the uterus to the uterus opening), the fetal delivery in the delivery room (second delivery period) and placental delivery (third delivery period). Regarding the timing of analgesia, the world has concluded in 2006: Intra-spinal delivery and analgesia do not require the size of the cervix) [19]. But at an academic conference in Xi'an in 2015, this was still discussed as a key topic. Not to mention that some retrospective studies as evidence are confusing [20], the focus of the discussion is not whether analgesia with intra-spinal delivery during early delivery will lead to an increase in the rate of cesarean section, but because of the limitations of the structure of the traditional delivery room, it is necessary to "analgesia after opening 3 cm of the cervix." The actual problem of spending the first labour period of 8 hours in the ward is indeed a "different" problem from the United States today, but it was also something the United States experienced before the 1980s.

When building new delivery rooms in many hospitals, I always emphasize the above situation. After three years of hard work, a public hospital, Shenzhen Bao'an District Maternal and Child Health Hospital, was finally convinced to take action. By 2020, this may be the only public hospital in China where all delivery rooms are single rooms, the first and second delivery courses are in the same room, and no longer troubles the mother. The above three-centimeter problem of "we are different" can be solved easily.

Of course, this is just a district-level hospital, which makes me feel the insignificance of a person's power and also feels that modern delivery house construction still has a long way to go. This is also a medical management issue. Modern delivery rooms are not just about delivery rooms hardware, but not just about software that can be formed naturally. Many Chinese hospital colleagues are conducting team drills for immediate cesarean section to improve their practical capabilities [21].

Whether to advocate and implement medical science issues based on research and argumentation, and how or whether medical management can be implemented, are different and are often confused. The painless childbirth advocates painlessness throughout the whole process. This is also a problem. This kind of problem occurs every moment and can also happen in every corner of the world. During this COVID-19 epidemic, the dispute over whether to wear masks and the entanglement of whether to wear masks due to the shortage of masks is also the same. We have used the price of our lives to exchange for changes in our medical policies. Unfortunately, confused people are everywhere.

3

The normalization of the introduction of Western medicine is self-evident. It is self-evident that the introduction of "different" new concepts and new technologies requires wisdom and a global perspective. What you learn is the situation rather than the matter. The United States does not take off shoes, but the Chinese delivery room changes slippers, but India has to change shoes twice.Where should we lean? Why depend on it? What we need is to routinely normalize the verification research of the introduced technologies or concepts, create a system, and comprehensively introduce the argumentation methods of Western evidence-based medicine, avoid using the "we are different" thinking, and no longer take it for granted to make choices and medical decisions, because they will determine the mortality rate and complication rate, rather than the difference between Eastern medicine and Western medicine.

It is also important that you do not put yourself in the position of arrogance or frog in the well, you should accept new thinking and solutions with an open mind, and dare to face "different" "unknowns", because medicine itself is not simple, and medical care is even more simple. None of us can become an expert who "everything works". Our world's second economy is still frequent under such a developed anesthesia situation, which is worthy of our reflection. This team medical clinical initiative that we have overlooked, which is tangible to mother and infant lives, is a major event with great development space and milestone nature.

In the summer of 2015, at the informal meeting of the leaders of the Chinese anesthesia and obstetrics industry and painless childbirth in Wuhan, Professor Duan Tao, who was the director of the Shanghai First Maternal and Infant Health Hospital, said: "Western medicine comes from the West. Who do we learn from the West? We should first learn in full, rather than picky, because we don't understand the role and significance of various parts in it. After a comprehensive grasp, then 'localized' is how fast, good and safe it is." Professor Duan's words reminded me of the start and development of Chinese color TVs and other home appliances and current home cars. Wasn't this the path taken at that time? This also reminds me of what we often say "standing on the shoulders of giants."

"different" things, is there any necessity for medical science to explore initiatives? Is there any possibility of medical management? We need to use the wisdom and courage to embrace all rivers, make arguments and decisions after careful thinking, dare to face and follow the trend of modern medical development, perform the duties of medical staff, and ultimately reduce the mortality and complication rate of patients. Refusing to change due to the "we are different" way of thinking has led to embarrassment or faults such as "local anaesthesia cesarean section under the current situation of modern anesthesiology". It is not only the dereliction of duty of anesthesiologists and obstetricians, but also shamed our entire medical community.

Source: Painless childbirth China

Obstetrics community may be quite familiar with the term "local anaesthesia cesarean section". It is still implemented in many hospitals, and has long become a "standard" of inertia. Before the emergence of obstetric anesthesia and modern delivery rooms, "local anaesthesia cesarean section" was understandable. Why are there still people asking:

• "Do we have any other solutions?"
• "We don't have anesthesiologists in the delivery room, so we can only do this?"
• "We don't have an operating room in the delivery room, what should we do?"
• ...

Our delivery room needs to have the ability to remove the child within 5 minutes after the fetus suddenly interrupts blood supply [1]! This is not shifted by our will, nor is there any room for doubt. As long as we use the "delivery room" logo, this ability is a must.

We all know that in the moment of cardiac arrest in adults, external cardiopulmonary resuscitation should be performed immediately, and this is true for newborns. Why is the current textbook given a 30-minute time limit? Moreover, evidence shows that after a pregnant woman’s cardiac arrest, the perimortem cesarean delivery, which allows the fetus to be born as soon as possible, plays a decisive role in improving the mother’s resuscitation rate [2, 3]. Everyone should not have forgotten the Yulin mother and baby death incident that shocked the world on July 31, 2017? Has anyone ever asked: "Is this mother and baby aided at that time?"

1

This reminded me of a decade ago when I discussed this issue with a professor who had just returned from the United States and who focused on the field of high-risk obstetrics. The answer I got was: "We are different!" The implication is that we need to find another way.

In the next few years, I heard more and more "quasi-section" in the local anaesthesia. Is this the way that suits the national conditions? There is no anesthesiologist in the delivery room, so I took the shortcut to go back to the era when there is no anesthesia and opening the abdomen? This is no longer the 2nd century when Hua Tuo used Ma Fei to spread his belly (more than 2,000 years ago), nor the 1842 when Dr. Crawford W. Long used anesthesia gas to create a new era of modern medicine [5], or 1847 when Dr. Parker first introduced this technology to China in 1847 (more than 150 years ago), but in the 21st century when both anesthetic drugs and technologies are very popular, with anesthesia doctors, anesthesia devices, and drug consumables in the same hospital, or even the same building and the same floor.

"We are different". I often hear this when discussing clinical topics of Chinese and foreign medicine. All of them convey this message: We don't do this! Different races, different cultures, different medical education systems, different hospital management, and different instruments and equipment.

is indeed a very important topic, perhaps this reflects the different thinking of Chinese and foreign medicine. We need to learn from foreign literature and examine the medical system. When foreign professional organizations publish clinical guidelines, they often have a clear statement. For example, the American College of Obstetricians and Gynecologists (ACOG) guide published in November 2013 read [7]: "This article reflects the latest clinical and scientific progress as of the release date and may change. The guide should not be used as the only treatment plan or measure that must be followed." There are actually three meanings here: 1) Respect the specific situation of each medical system and each hospital; 2) Various clinical measures are not yet perfect, and there is still a lot of room for development; 3) Do not let medical staff fall into unnecessary legal lawsuits.

as an example. Dr. Yu Guoxian, an obstetrician at the painless delivery , contacted ACOG, hoping to obtain the copyright of its guide in Chinese to help introduce their guide to China. Dr. Yu received the answer: I don’t want other language versions to avoid misunderstanding that ACOG “sells” American medical care. ACOG understands that medical initiatives will have different outcomes in different medical settings, and inappropriate interpretation of guidelines can cause harm.

All clinical guidelines are composed of two parts: medical science and clinical practice [8]. The American Society of Anesthesiologists' clinical guidelines are often divided into three parts, including medical literature review, member survey consensus, and relevant expert survey consensus.The medical literature reflects the level of evidence in today's clinical research, the member consensus reflects various clinical practices and their environment, and the expert consensus is a supplement to many parts of the research evidence that do not have enough or good enough in the content. The three are combined to give the highest evidence, the most appropriate and feasible clinical medical norms [9].

2

The time limit for immediate cesarean section is a medical scientific issue, and how to perform anesthesia and cesarean section within this time limit is a medical management issue. For medical science issues, we cannot use "different" as an excuse to take it lightly or take a detour. The "local anesthesia cesarean section" is not groundless. History has only given it the only indication: it missed the planned epidural delivery analgesia, and cannot ventilate after general anesthesia [10]. It can only be marked as "backward" when used in other situations in modern medicine.

The directors and deans at the medical management level may feel a bit incredible when they hear this "immediate cesarean section", but they do need to be clearly aware of this backward situation. The childbirth experience of Dr. Chen Weijian, former director of the Jiujiang Maternal and Child Health Hospital in Jiangxi Province, was enough to make the dean, who was born in Iowa, USA, think deeply about the current situation of his hepatobiliary surgery. Lin Moju, former director of the Liuzhou Maternal and Child Health Hospital in Guangxi, has been thinking about how to solve the safety of delivery rooms. The concept and practice of "immediate cesarean section" teamwork has been successfully solved. There is a hospital in Shanghai. Although they don’t know how the West solves these immediate conditions, they asked medical staff to bring mobile surgical equipment to the mother based on their delivery room status, creating the unique "immediate cesarean section" model that has been produced in China so far. What did our medical staff who went abroad to observe see abroad? Have you also felt the urgency to improve?

Does it mean that "immediate cesarean section"? The book clearly states "emergent cesarean delivery"! Yes, in the official English document, in addition to the word "emergency cesarean delivery", there is also "perimortem cesarean delivery" for mortality cesarean delivery. Although there is no "stat cesarean delivery" or "crash cesarean delivery" in the ACOG guide, these American medical staff (up to more than 800 people) who have not received the "painless delivery China Tour" special training camp, when they hear "stat" or "crash", they will do their best to interpret the connotation of instant cesarean delivery, reflecting the well-trained skills and the deep-rootedness of this clinical measure in the thinking of American medical staff. Why not write "instant cesarean section" into the guide? Because every medical institution has its own specific situation, the Western professional association fully realizes that the best and most ideal things are not necessarily something that can be done. A non-one-size-fits-all approach is to protect professionals from being held accountable for unnecessary legal disputes. We went to observe and obtain the scriptures, but we observed but did not see them, and did not understand the deep marrow. No wonder I can't get into the game, but instead I preconceived ideas and use the old book knowledge of "emergency cesarean section" to view problems [11].

Little do you know that many American hospitals have adopted a fourth-level cesarean section system written or unwritten:

1. Stat/Crash/Perimortem (immediate): a cesarean section needs to be delivered immediately, and it is almost necessary to give birth to a child within 5 minutes, such as cardiac arrest of the mother, umbilical cord prolapse, and some type III fetal heart;
2. Emergent (emergency): a cesarean section needs to be delivered within 30 minutes, such as severe blood pressure in preeclampsia cannot be well controlled and cannot be delivered in a short period of vaginal delivery;
3. Urgent (sub-emergency): a cesarean section within a few hours, if the original cesarean section is naturally in labor, and if there is time to fast and drink, then cesarean section is given;
4. Elective (elective).

In the past, only the two types of elective and acute have been upgraded. In 2018, this kind of quaternary cesarean section system has been adopted in the delivery room of Shanghai Jiahui International Hospital. In other words, this is no longer a new thing in the country.

"Stones from other mountains can be used to polish jade", and predecessors left a lot of wisdom and experience. How to introduce Western clinical medicine into Chinese delivery rooms has become a very important topic in the "painless childbirth in China".Later, a series of big data clinical natural trials from specialized obstetrics and gynecology hospitals, teaching hospitals where high-risk maternal and maternal maternal gatherings to grassroots county hospitals with rural population were designed for the above considerations. This was used to test and certification series of clinical measures tailor-made for specific situations in China and aimed at improving the clinical outcomes of perinatal maternal and infants during the perinatal period [12, 13, 14, 15]. In the verification, many expected results were obtained: while promoting intra-spinal delivery analgesia, a decrease in the rate of cesarean section was seen; after changing the definition of labor, a decrease in the rate of forceps and transit cesarean section was seen. The decrease in lateral tangent rate, the decrease in blood transfusion rate, and the decrease in the high-risk rate of neonates are all unexpected. These unexpected surprises are something that cannot be seen in Western research, but have always wanted to know. Innovation sometimes doesn't need to be so deliberate.

Our Chinese colleagues are also working tirelessly. Three studies from Nanjing Maternal and Child Health Hospital have given us a good idea:

1. Early delivery and epidural analgesia does not increase the cesarean section rate and forceps rate in Chinese women [16];
2. second delivery and epidural analgesia does not prolong the labour rate and forceps rate and cesarean section rate [17];
3. Grobman scar uterine vaginal trial delivery prediction model is suitable for Chinese women [18].

originated from local clinical trials suitable for national conditions, and similar studies in the West have reached the same conclusions. The scientific nature of medicine lies in its repeatability!

Another "different" phenomenon is that in our traditional delivery room, the labor process is actually divided into four parts, allowing the mother to be transported at least 3 times: the ward's labor (early stage of the first delivery period), the delivery room's labor (after 3 cm from the uterus to the uterus opening), the fetal delivery in the delivery room (second delivery period) and placental delivery (third delivery period). Regarding the timing of analgesia, the world has concluded in 2006: Intra-spinal delivery and analgesia do not require the size of the cervix) [19]. But at an academic conference in Xi'an in 2015, this was still discussed as a key topic. Not to mention that some retrospective studies as evidence are confusing [20], the focus of the discussion is not whether analgesia with intra-spinal delivery during early delivery will lead to an increase in the rate of cesarean section, but because of the limitations of the structure of the traditional delivery room, it is necessary to "analgesia after opening 3 cm of the cervix." The actual problem of spending the first labour period of 8 hours in the ward is indeed a "different" problem from the United States today, but it was also something the United States experienced before the 1980s.

When building new delivery rooms in many hospitals, I always emphasize the above situation. After three years of hard work, a public hospital, Shenzhen Bao'an District Maternal and Child Health Hospital, was finally convinced to take action. By 2020, this may be the only public hospital in China where all delivery rooms are single rooms, the first and second delivery courses are in the same room, and no longer troubles the mother. The above three-centimeter problem of "we are different" can be solved easily.

Of course, this is just a district-level hospital, which makes me feel the insignificance of a person's power and also feels that modern delivery house construction still has a long way to go. This is also a medical management issue. Modern delivery rooms are not just about delivery rooms hardware, but not just about software that can be formed naturally. Many Chinese hospital colleagues are conducting team drills for immediate cesarean section to improve their practical capabilities [21].

Whether to advocate and implement medical science issues based on research and argumentation, and how or whether medical management can be implemented, are different and are often confused. The painless childbirth advocates painlessness throughout the whole process. This is also a problem. This kind of problem occurs every moment and can also happen in every corner of the world. During this COVID-19 epidemic, the dispute over whether to wear masks and the entanglement of whether to wear masks due to the shortage of masks is also the same. We have used the price of our lives to exchange for changes in our medical policies. Unfortunately, confused people are everywhere.

3

The normalization of the introduction of Western medicine is self-evident. It is self-evident that the introduction of "different" new concepts and new technologies requires wisdom and a global perspective. What you learn is the situation rather than the matter. The United States does not take off shoes, but the Chinese delivery room changes slippers, but India has to change shoes twice.Where should we lean? Why depend on it? What we need is to routinely normalize the verification research of the introduced technologies or concepts, create a system, and comprehensively introduce the argumentation methods of Western evidence-based medicine, avoid using the "we are different" thinking, and no longer take it for granted to make choices and medical decisions, because they will determine the mortality rate and complication rate, rather than the difference between Eastern medicine and Western medicine.

It is also important that you do not put yourself in the position of arrogance or frog in the well, you should accept new thinking and solutions with an open mind, and dare to face "different" "unknowns", because medicine itself is not simple, and medical care is even more simple. None of us can become an expert who "everything works". Our world's second economy is still frequent under such a developed anesthesia situation, which is worthy of our reflection. This team medical clinical initiative that we have overlooked, which is tangible to mother and infant lives, is a major event with great development space and milestone nature.

In the summer of 2015, at the informal meeting of the leaders of the Chinese anesthesia and obstetrics industry and painless childbirth in Wuhan, Professor Duan Tao, who was the director of the Shanghai First Maternal and Infant Health Hospital, said: "Western medicine comes from the West. Who do we learn from the West? We should first learn in full, rather than picky, because we don't understand the role and significance of various parts in it. After a comprehensive grasp, then 'localized' is how fast, good and safe it is." Professor Duan's words reminded me of the start and development of Chinese color TVs and other home appliances and current home cars. Wasn't this the path taken at that time? This also reminds me of what we often say "standing on the shoulders of giants."

"different" things, is there any necessity for medical science to explore initiatives? Is there any possibility of medical management? We need to use the wisdom and courage to embrace all rivers, make arguments and decisions after careful thinking, dare to face and follow the trend of modern medical development, perform the duties of medical staff, and ultimately reduce the mortality and complication rate of patients. Refusing to change due to the "we are different" way of thinking has led to embarrassment or faults such as "local anaesthesia cesarean section under the current situation of modern anesthesiology". It is not only the dereliction of duty of anesthesiologists and obstetricians, but also shamed our entire medical community.Is it time for us to face it?

References

1.Briller J. Cardiopulmonary Resuscitation of Pregnant Women. Cardiac Problems in Pregnancy. 2019 Aug 26:397-418.

2.Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O'Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011;118(suppl 1):1-203.

3.McClure JH, Cooper GM, Clutton-Brock TH. Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006-8: a review. Br J Anaestth. 2011;107:127-132.

4.Zhang L, Tang L, Hu LQ. Now, she no longer has pain… J NPLD-GHI. 2017 Sep 7; 4(9):7.

5.https://en.wikipedia.org/wiki/History_of_general_anesthesia, visited on April 16, 2020.

6.https://www.anesth.org.tw/about/history/history.asp, visited on April 16, 2020.

7.American College of Obstetricians and Gynecologists. ACOG Committee Opinion No 579: definition of term pregnancy. Obstet Gynecol. 2013 Nov;122(5):1139-40.

8. Hu Lingqun Liu Renyu Hang Yannan Zhou Dachun. Evidence-based clinical anesthesiology (second edition). People's Health Press; 2010 Feb.

9. Hu Lingqun Cai Zhenyu Yang Shuwei Rongqi. Modern Labor & Delivery Suite Book Series - Dialogues of Multidisciplinary Practice Parameters Interpretation of multidisciplinary clinical norms. World Book Publishing Company; 2018 Oct 01.

10. Hu Lingqun. Anesthesia: The wolf is finally here, "Cannot intubation - The moment when the oxygen is not available https://mp.weixin.qq.com/s?__biz=MjM5NjczOTk4Ng==&mid=204461640&idx=1&sn=80c299caceead0d1ff8c66d17a4df0b3&scene=21, visited on April 16, 2020.

11. Li Hang, Ma Runmei, Hu Lingqun. Time limit of acute cesarean section and pregnancy outcome. Chinese Journal of Perinatal Medicine. 2015(005):391-4.

12.Hu LQ, Zhang J, Wong CA, Cao Q, Zhang G, Rong H, Li X, McCarthy RJ. Impact of the introduction of neuraxial labor analgesia on mode of delivery at an urban maternity hospital in China. International Journal of Gynecology & Obstetrics. 2015 Apr;129(1):17-21.

13.Hu LQ, Flood P, Li Y, Tao W, Zhao P, Xia Y, Pian-Smith MC, Stellaccio FS, Ouanes JP, Hu F, Wong CA. No pain labor & delivery: a global health initiative’s impact on clinical outcomes in China. Anesthesia & Analgesia. 2016 Jun 1;122(6):1931-8.

14.Wang Q, Zheng SX, Ni YF, Lu YY, Zhang B, Lian QQ, Hu MP. The effect of labor epidural analgesia on maternal–fetal outcomes: a retrospective cohort study. Archives of gynecology and obstetrics. 2018 Jul 1;298(1):89-96.

15.Drzymalski D, Guo JC, Hu LQ.1 The effect of the No Pain Labor & Delivery - Global Health Initiative on cesarean delivery and neonatal outcomes in China: An interrupted time-series analysis. Anesthesia & Analgesia 2020 (in press)

16.Wang F, Shen X, Guo X, Peng Y, Gu X. Epidural Analgesia in the Latent Phase of Labor and the Risk of Cesarean Delivery A Five-year Randomized Controlled Trial. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2009 Oct 1;111(4):871-80.

17.Shen X, Li Y, Xu S, Wang N, Fan S, Qin X, Zhou C, Hess PE. Epidural analgesia during the second stage of labor: a randomized controlled trial. Obstetrics & gynecology. 2017 Nov 1;130(5):1097-103.

18.Wen J, Song X, Ding H, Shen X, Shen R, Hu LQ, Long W. Prediction of vaginal birth after cesarean delivery in Chinese parties. Scientific Reports. 2018 Feb 15;8(1):1-7.

19.Hu LQ. History review: Why waiting for the 3 cm of cervical dilation to initiate labor neuraxial analgesia is no longer a matter. J NPLD-GHI. 2019 Oct 14; 6(10):14.

20.Hu LQ. History review: What is a relationship statistically? J NPLD-GHI. 2019 Nov 15; 6(11):15.

21.Zhao XY. Summary of NPLD-GHI 2019. J NPLD-GHI. 2019 June 24; 6(6):24.

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