水中分娩對母嬰是否真的大有益處

The Claim: Laboring in a tub of water helps relax expectant mothers, significantly relieving the pain of childbirth.

主張：水中分娩能幫助產婦放鬆，顯著減輕生產時的疼痛。

The Verdict: A review of 11 trials, encompassing 3,146 women, published by the Cochrane Collaboration, a global network of scientists and clinicians, concludes that laboring in a tub during the first stage of labor reduces the need for epidural anesthesia. But the safety of staying in a tub during the birthing stage hasn't been established -- prompting some doctors to urge caution.

定論：面向科學家和臨牀醫師的全球性網絡Cochrane協作網(Cochrane Collaboration)發表的一項文獻回顧,對覆蓋3,146名女性的 11項試驗進行了考察，得出的結論是，第一產程在水中生產可減少使用硬膜外麻醉的必要性。不過，在胎兒娩出階段待在水中的安全性尚未得到確證——因此一些醫生告誡人們要保持謹慎。

Sitting in water during labor, sometimes called hydrotherapy, can promote relaxation, improve blood flow and reduce swelling, according to scientific literature. Tubs -- with or without massaging jets -- are available at many birthing centers and some hospitals. For home births, women can use a bathtub or rent a birthing tub for about $200 to $300.

科學文獻顯示，坐在水中生產（有時被稱爲水療分娩）能夠幫助產婦放鬆，促進血液循環並減輕腫脹。水缸（有些帶按摩噴嘴，有些沒有）許多分娩中心都有提供，一些醫院也會提供。如果在家中生產，產婦可以使用浴缸，或者租用分娩缸，費用在200到300美元左右。

Typically the water is heated to body temperature, says Jenna Shaw-Battista, director of the Nurse-Midwifery Education Program at the University of California, San Francisco. The tub is filled to cover the belly and sometimes as high as the chest, Dr. Shaw-Battista says. Clothing is optional, she adds, and many women wear a sports bra or a hospital gown.

加州大學舊金山分校(University of California, San Francisco)的護理和助產教育項目(Nurse-Midwifery Education Program)主管詹娜·肖-巴蒂斯塔(Jenna Shaw-Battista)表示，水一般會加熱至體溫。肖-巴蒂斯塔博士說，缸內的水會沒過腹部，有時甚至會齊胸。她補充稱，穿不穿衣服可以自己選擇，許多女性會穿運動文胸或者醫院的病號服。

The scientific literature supports claims that hydrotherapy offers pain relief and relaxation -- and may even shorten labor. But some clinicians draw the line at giving birth underwater.

水療分娩能減輕疼痛並幫助產婦放鬆——甚至有可能縮短產程，這些說法都得到科學文獻的支持。但一些臨牀醫師在實踐中卻與水中分娩保持着距離。

In a joint opinion published this month, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, said that due to reports of newborn drownings, near drownings, and infection described in medical literature, the procedure should remain 'experimental' and be performed only in the context of clinical trials.

美國婦產科醫師協會(American College of Obstetricians and Gynecologists)和美國兒科學會(American Academy of Pediatrics)本月發佈聯合意見稱，鑑於醫學文獻中有新生兒溺亡、溺水和感染相關報告，水中分娩仍然應該是“實驗性的”，只能在臨牀試驗背景下施行。

In theory, in a water birth the baby is brought to the surface safely before it takes its first gasp. But if a baby is experiencing distress -- for example if the umbilical cord is crimped -- it may gasp earlier and 'that's all you need to get water in the lungs or to swallow that water into the stomach,' says Tonse N.K. Raju, chief of the pregnancy and perinatology branch at the National Institute of Child Health and Human Development in Bethesda, Md., and a liaison to the committee that issued the opinion. Another concern, he says, is that tub water can easily get contaminated with bacteria.

從理論上說，水下分娩的嬰兒在開始呼吸之前就已經被安全地帶到水面上了。但馬里蘭州貝塞斯達(Bethesda)的美國國家兒童健康與人類發育研究所(National Institute of Child Health and Human Development)妊娠和圍產期學分部主管、負責與發佈上述意見的委員會進行聯絡的通斯·拉朱(N·K· Tonse N.K. Raju)表示，如果嬰兒出現窘迫（比如說臍帶纏繞過緊），則有可能會提前呼吸，“這就很容易導致肺部嗆水，或者把水嚥進胃裏”。他說，另一擔憂是，缸內的水很容易被細菌污染。

Problems are rare, Dr. Raju says. And the doctors' concerns are based not on large randomized trials but on individual case reports, which some midwives say is a flawed approach as births on land can also have complications. So far, a number of observational studies of water births in low-risk women -- including a 1999 British report of 4,032 water deliveries -- have found no higher newborn mortality than a birth out of water. In data released last week by the American Association of Birth Centers, a trade group for free-standing birth centers, there were no infant deaths in 3,998 water births conducted at 79 centers over four years. And 1.5% of babies delivered underwater needed to be transferred to a hospital for observation or treatment, compared with 2.8% delivered on land.

拉朱博士說，這些問題很罕見。另外，醫生的擔憂也並非基於大規模隨機試驗，而是基於個案報告，一些助產士認爲，這種研究方法是存在缺陷的，因爲普通分娩一樣會有併發症。 到目前爲止，許多針對低危產婦水中分娩的觀察性研究（包括1999年英國一項覆蓋4,032例水中分娩的報告）發現，水中分娩的新生兒死亡率並不比非水中分娩的死亡率高。代表獨立分娩中心的行業組織美國分娩中心聯合會(American Association of Birth Centers)近期發佈的數據顯示，79家分娩中心在四年中施行的3,998 例水中分娩未出現一例新生兒死亡事件。另外，有1.5%的水中分娩嬰兒需要被轉至醫院接受觀察或治療，而非水中分娩的嬰兒比例爲2.8%。

The data, which the association hopes to publish, reflects that centers steer women likely to have complicated deliveries away from water birth, says the association's director, Lesley Rathbun. Even if a water birth is planned, during labor the baby's heartbeat is carefully monitored and if there's any suggestion of distress, 'we're going to get the woman out of the tub' before delivery, she says.

美國分娩中心聯合會主管萊斯莉·拉思本(Lesley Rathbun)表示，這些數據（該聯合會希望發表相關數據）反映出，分娩中心會建議高危產婦不要在水中分娩。她說，即使水中分娩是按計劃進行的，分娩過程中也會進行細緻的胎心監護，如果有任何窘迫徵兆，“我們會在胎兒娩出之前讓產婦離開水缸”。