【龙腾网】分娩之痛：拉丁美洲未能改善待产母亲的待遇

正文翻译

“Come on, smile! This is the most important day of your life.” The midwife was upbeat. But Agustina, a 38-year-old comedian and brand-new mother, was shaken. It was 2012; she had just undergone a Caesarean section at a hospital in Argentina. Her obstetrician, she believes, had made the surgery more likely by inserting hormones into her vagina during a check-up, without explanation.

助产士开朗地说：“来，笑一个！这是你人生中最重要的日子。”但38岁的喜剧演员兼准妈妈阿古斯蒂纳感到内心动摇。2012年，她刚刚在阿根廷的一家医院做了剖腹产。据她判断，她的产科医生在体检时为了让手术更顺利未经解释就向她的阴道注入了荷尔蒙。

Such abuse is, perversely, a consequence of progress. Better health care reduced maternal and infant mortality. Yet it also reinforced a culture that treats doctors as infallible, patients as passive and medical intervention as the first resort, even when harmful or against a woman’s wishes. Covid-19 may make the problem worse.

说来反常，正是医疗进步引发了这样的虐待。更好的医疗保健降低了母婴死亡率，然而也同时深化了这样的文化：医生是绝对可靠的，病人是全然被动的，即使医疗干预有危害或有违产妇意志，也是首要选择。新冠肺炎可能会使这一问题更加严重。

In 2007 Venezuela became the first country to define “obstetric violence” in law and make it a criminal offence. There it means the “appropriation of women’s bodies and reproductive processes by health professionals”. Similar laws followed in Argentina, Bolivia and Panama. Other measures are more practical. In 2001 Uruguay gave mothers-to-be the right to have a companion during delivery. This month Puebla, a Mexican state, classified as obstetric violence filming a birth without the mother’s consent. 

2007年，委内瑞拉成为第一个在法律中定义“产科暴行”并将其规定为犯罪行为的国家。其法律认为“产科暴行”是指“医务人员对产妇身体及生产过程做出的不当行为”。阿根廷、玻利维亚和巴拿马随后也制定了相关法律。还有另一些更加实用的举措。2001年，乌拉圭给予产妇在分娩时可有一人陪同的权利。这个月，墨西哥的普埃布拉州将未经同意拍摄分娩过程划定为产科暴行。

Venezuela’s ruined health system makes a mockery of its “humanised-birth policy”. Women often have to bring their own medical supplies, such as antiseptics, to delivery rooms. When the country’s obstetric-violence law was enacted, Rogelio Pérez-D’Gregorio, a former head of the Society of Obstetrics and Gynecology, advised obstetricians to protect themselves by making note of missing medications and other problems beyond their control.

委内瑞拉崩溃的医疗系统嘲弄了其“人性化分娩政策”。产妇时常需要自行携带抗菌剂等医疗用品到产房。委内瑞拉通过产科暴行的法律之时，妇产科协会的前负责人罗赫略·佩雷斯·格雷乔里奥建议产科医生们记录好缺失的药物和无力控制的其他问题来保护自己。

Such deficits do not explain why women like Agustina, who gave birth at a well-appointed private clinic, suffer as they do. Mr Castro blames an “authoritarian medical disposition”, instilled at medical schools in male and female doctors alike. Critics say that teachers often emphasise technical prowess rather than patients’ welfare. Complaints to prosecutors in Brazil revealed that doctors-to-be were taught to perform episiotomies, surgical cuts to the perineum, to practise their skills, whether or not patients needed them. 

上述资源不足的情况无法解释像阿古斯蒂纳这样在设施完备的私人诊所分娩的产妇为何也有同样遭遇。卡斯特罗先生认为这是由于医学院向男性和女性医生灌输了“独裁的医疗处置方式”。批评人士说，教师通常强调技术能力而非病人福祉。在巴西，检察官收到的控告揭露了教师让准医生们对产妇进行会阴切开术来练习技法，而不考虑产妇是否有此需要。

While activists focus on pressure and punishment, some governments and international agencies are trying to be less confrontational, starting with the language they use to describe the problem. Last year Rio de Janeiro’s Regional Council of Medicine, which supervises doctors, declared that the term “obstetric violence” was “invented to defame” them. The Pan American Health Organisation prefers to talk of “abuse during childbirth” because “many times just mentioning [obstetric violence] closes to us the possibility of dialogue”, says Bremen De Mucio, an adviser to the group. It plans to launch a seminar on respectful maternal care by October.

活动人士致力于对医疗人员施加压力并进行惩处，而一些政府及国际机构正试图减缓医患对抗，首先从描述问题的语言解决起。去年，里约热内卢负责监管医生的区域医学委员会称，“产科暴行”一词的发明对医生“造成了中伤”。泛美卫生组织更倾向于使用“分娩虐待”一词，因为“很多时候，光是引用‘产科暴行’的表述就关闭了双方对话的通道。”该组织的一位顾问布莱梅·德姆茨奥这样说道。泛美卫生组织计划在十月前举办一场有关孕妇保健的研讨会。

Governments are beginning to emphasise training. Brazil’s ministry of health has started a programme that stresses women’s rights in obstetrics in about 100 teaching hospitals. A similar programme in Argentina contributed to declines in infant and maternal mortality.

政府开始重视培训。巴西的卫生部门启动了一个项目，在100家教学医院的产科强调孕妇权益。阿根廷的一个类似项目帮助降低了母婴死亡率。

But progress is slow. When Agustina got pregnant again, in 2014, she changed obstetricians and hospitals and wrote a birth plan. It included a vaginal delivery and immediate skin-to-skin contact with her baby, who would drink breast milk, not formula. The hospital rejected all her requests. After a birth by c-section, a female doctor threatened to report Agustina to child-protection services. She left “screaming in my mind”, unable to work and struggling to bond with her baby. Her marriage ended. In 2016 she filed a lawsuit against her doctors, the hospital and the health insurers, the first case of its kind in Argentina. She is still awaiting a verdict.

但进步是缓慢的。2014年，当阿古斯蒂纳再一次怀孕时，她换了产科医生和医院，并写下了她的分娩计划。其中包含阴道分娩以及与婴儿的亲密接触，让孩子喝母乳而不是奶粉。医院拒绝了她的所有要求。在阿古斯蒂纳做了剖腹产手术之后，一位女性医生威胁称要向儿童保护机构投诉她。离开医院时她的内心大声呼喊着，无法工作，难以与孩子建立亲子关系，随后与丈夫离了婚。2016年，她向医生、医院及医疗保险公司提出了诉讼，这是阿根廷的第一例此类诉讼。现在，她仍在等待裁决结果。