演讲MP3+双语文稿:我们如何改善产妇保健

听力课堂TED音频栏目主要包括TED演讲的音频MP3及中英双语文稿，供各位英语爱好者学习使用。本文主要内容为演讲MP3+双语文稿:我们如何改善产妇保健，希望你会喜欢！

【演讲者及介绍】Elizabeth Howell

伊丽莎白豪厄尔-产妇健康改革家伊丽莎白·豪厄尔正在致力于解决美国的孕产妇死亡率问题。

【演讲主题】我们如何改善产妇保健-怀孕前、怀孕期间和怀孕后

【中英文字幕】

翻译者 Jingdan Niu 校对者Homer Li

00:13

It was chaos as I got off the elevator. I was coming back on duty as a resident physician to cover the labor and delivery unit. And all I could see was a swarm of doctors and nurses hovering over a patient in the labor room. They were all desperately trying to save a woman's life. The patient was in shock. She had delivered a healthy baby boy a few hours before I arrived. Suddenly, she collapsed, became unresponsive, and had profuse uterine bleeding. By the time I got to the room, there were multiple doctors and nurses, and the patient was lifeless. The resuscitation team tried to bring her back to life, but despite everyone's best efforts, she died. What I remember most about that day was the father's piercing cry. It went through my heart and the heart of everyone on that floor. This was supposed to be the happiest day of his life, but instead it turned out to be the worst day.

当我从电梯里出来的时候 眼前一片混乱。作为一名住院医师，我正从值班的妇产科部门回来。我所能看见的是待产室里 一大群医生和护士 徘徊在一名病人周围。他们正绝望地尝试 挽救一名产妇的生命。病人已经休克了。她在我到达的几小时之前 生了一名健康的男宝宝。突然之间，她昏倒了，毫无反应，并且开始血崩。当我到达房间，里面有各种医生和护士，而病人生命迹象微弱。复苏组尝试使她恢复意识，但是尽管每一个人都尽力了，她还是走了。我对那一天记忆最深刻的 是那位父亲撕心裂肺的哭声。那哭声刺激了我的心，以及那层楼所有人的心。那一天本应该是他 生命中最快乐的一天，但是最后却变成了最糟糕的一天。

01:11

I wish I could say this tragedy was an isolated incident, but sadly, that's not the case. Every year in the United States, somewhere between 700 and 900 women die from a pregnancy-related cause. The shocking part of this story is that our maternal mortality rate is actually higher than all other high-income countries, and our rates are far worse for women of color. Our rate of maternal mortality actually increased over the last decade, while other countries reduced their rates. And the biggest paradox of all? We spend more on health care than any other country in the world.

我希望我可以说 这场悲剧是一个个案，但遗憾的是，并不是这样的。在美国，每一年 有700至900名妇女 死于与妊娠相关的原因。这个故事令人震惊的部分在于 我们的产妇死亡率实际上 高于其他高收入国家，并且这个概率在有色人种 的女性身上更加糟高。在过去一个世纪我们的 产妇死亡率实际上增加了，与此同时其他国家降低了。这里最大的悖论是什么？ 我们在医疗保健上有着 比其他所有国家都要高的花费。

01:51

Well, around the same time in residency that this new mother lost her life, I became a mother myself. And even with all of my background and training in the field, I was taken aback by how little attention was paid to delivering high-quality maternal health care. And I thought about what that meant, not just for myself but for so many other women. Maybe it's because my dad was a civil rights attorney and my parents were socially conscious and demanded that we stand up for what we believe in. Or the fact that my parents were born in Jamaica, came to the United States and were able to realize the American Dream. Or maybe it was my residency training, where I saw firsthand how poorly so many low-income women of color were treated by our healthcare system. For whatever the reason, I felt a responsibility to stand up, not just for myself, but for all women, and especially those marginalized by our healthcare system. And I decided to focus my career on improving maternal health care.

当然，几乎与在住院时 那位新母亲失去生命的同时，我成为了一名母亲。尽管我有着这个领域 所有的背景和培训，我仍然对无法保证一个高质量的 孕期保健而震惊。我思考着这意味着什么，不仅仅是对于我，而是对于许许多多的妇女们。也许因为我的父亲 是一名民权律师，并且我的父母非常具有社会意识，并且要求我们要坚持自己的信仰。或者是因为事实上我的 父母出生在牙买加，移民到了美国，并且能够实现他们的美国梦。又或者是我的住院医师培训，使我直接地看到了 医疗系统是多么恶劣的对待 许多有色人种的妇女的。不论是因为哪一个原因，我感觉到我有责任站出来，不仅仅为我自己，而且为了所有的女性，尤其是那些被我们 医疗系统所边缘化的。所以我决定将我职业的重点 放在改善孕产期医疗。

02:53

So what's killing mothers? Cardiovascular disease, hemorrhage, high blood pressure causing seizures and strokes, blood clots and infection are some of the major causes of maternal mortality in this country. But a maternal death is only the tip of the iceberg. For every death, over a hundred women suffer a severe complication related to pregnancy and childbirth, resulting in over 60,000 women every year having one of these events. These complications, called severe maternal morbidity, are on the rise in the United States, and they're life-altering. It's estimated that somewhere between 1.5 and two percent of the four million deliveries that occur every year in this country are associated with one of these events. That is five or six women every hour having a blood clot, a seizure, a stroke, receiving a blood transfusion, having end-organ damage such as kidney failure, or some other tragic event.

那么是什么杀害了母亲们？ 心血管疾病，大出血，高血压引发癫痫和中风，血栓和感染 则是我们国家孕产期 死亡的部分主要原因。但是孕产期死亡仅仅是冰山的一角。每一类死亡，超过 100名女性都遭受了 严重的与怀孕和分娩 相关的并发症，导致了每年有超过6万名 女性有其中的一个症状。这些并发症，被称为 严重的产妇发病率，在美国呈现上升的趋势，并且这些并发症会改变人的一生。据统计，我们国家每年 的四百万次分娩中，有1.5%到2%都与这些症状相关。也就是每小时有五到六名女性 患上了血栓，癫痫，中风，接受一次输血，患上终末器官损害比如肾衰竭，或者其它突发症状。

03:53

Now, the part of this story that's frankly unforgivable is the fact that 60 percent of these deaths and severe complications are thought to be preventable. When I say 60 percent are preventable, I mean there are concrete steps and standard procedures that we could implement that could prevent these bad outcomes from occurring and save women's lives. And it doesn't require fancy new technology. We just have to apply what we know and ensure equal standards between hospitals.

现在，这个情况明显 不能原谅的部分在于 60%的死亡和并发症 被认为是可以避免的。当我说60%是可以避免的，我的意思是有一些具体步骤 和标准程序我们可以实行，以避免这些糟糕的结果出现，并且挽救这些女性的生命。而且这并不需要高级的新技术。我们只是需要将 我们知道的付诸于行动 并且确保医院之间的同等标准。

04:24

For example, if a pregnant woman in labor has really high blood pressure and we treat her with the right antihypertensive medication in a timely fashion, we can prevent stroke. If we accurately track blood loss during delivery, we can detect a hemorrhage sooner and save a woman's life. We could actually lower the rates of these catastrophic events tomorrow, but it requires that we value the quality of care we deliver to pregnant women before, during and after pregnancy. If we raise quality of care universally to what is supposed to be the standard, we could bring the rates of these deaths and severe complications way down.

比如说，当一名正在分娩的孕妇 有着非常高的血压 如果我们及时给她正确的 抗高血压药物，我们就可以避免中风。如果我们可以准确的观测到 分娩中的血液流失，我们就会及时察觉到出血 并挽救孕妇的生命。那么明天我们就可以从根本上 降低这些灾难性事件发生的概率，但是这需要我们重视 孕妇在孕前、孕中和产后 治疗的质量。如果我们将治疗的质量普遍 提升到我们认为的“标准”，就可以将死亡率和 并发症发生率大大降低。

05:04

Well, there is some good news. There are some success stories. There are some places that have actually adopted these standards, and it's really making a difference. A few years ago, the American College of Obstetricians and Gynecologists joined forces with other healthcare organizations, researchers like myself and community organizations. They wanted to implement standard care practices in hospitals and health systems throughout the country. And the vehicle they're using is a program called the Alliance for Innovation in Maternal Health, the AIM program. Their goal is to lower maternal mortality and severe maternal morbidity rates through quality and safety initiatives across the country. The group has developed a number of safety bundles that target some of the most preventable causes of a maternal death. The AIM program currently has the potential to reach over 50 percent of US births.

当然了，也有一些好的消息。有一些成功的案例。有一些地区已经落实了这些标准，并且出现了实质性的改变。几年前，美国妇产科学院 联合了其他医疗机构，研究员们，比如我，和社区组织。他们希望在整个国家 的医院和医疗系统里 实施标准治疗工作。他们采用的方法则是一个 叫做孕妇保健的联盟创新计划，即AIM计划。他们的目标是通过 质量和安全新举措 在全国范围内降低孕妇死亡率 和严重产妇并发症发病率。这个组织已经开发了一些安全方案，针对一些最可预防的孕产妇死亡原因。AIM计划现在有覆盖 超过美国百分之五十 出生人数的可能性。

06:00

So what's in a safety bundle? Evidence-based practices, protocols, procedures, medications, equipment and other items targeting these conditions. Let's take the example of a hemorrhage bundle. For a hemorrhage, you need a cart that has everything a doctor or nurse might need in an emergency: an IV line, an oxygen mask, medications, checklists, other equipment. Then you need something to measure blood loss: sponges and pads. And instead of just eyeballing it, the doctors and nurses collect these sponges and pads and either weigh them or use newer technology to accurately assess how much blood has been lost. The hemorrhage bundle also includes crises protocols for massive transfusions and regular trainings and drills.

那么什么是安全方案？ 将这些情境作为目标所需要的 循证实践，习惯做法，步骤，用药，设备，和其他物品。以出血的安全方案为例。在病人出血时，你需要一个手推车，准备好医生或者护士 可能在急救中会用到的所有东西： 静脉注射管线，氧气罩，药物，清单，其它仪器。然后你需要测量血液流失的仪器： 海绵和衬垫。医生和护士收集 这些海绵和衬垫，称出重量，或者是 用新技术来准确的评估 到底流失了多少血，而不是一直盯着它们。出血安全方案也包括需要 大量输血时的危险期医疗方案 和常规培训和教学。

06:47

Now, California has been a leader in the use of these types of bundles, and that's why California saw a 21 percent reduction in near death from hemorrhage among hospitals that implemented this bundle in the first year. Yet the use of these bundles across the country is spotty or missing. Just like the fact that the use of evidence-based practices and the emphasis on safety differs from one hospital to the next, quality of care differs.

现在，加州已经成为应用 这种安全方案的领导者，这也是为什么加州实施 这种安全方案的第一年，医院里因出血而 濒临死亡的人数就降低了21%。但是这些方案在全国范围内的 应用是参差不齐或者不完整的。比如说，即便使用循证实践 和对安全的重视，每一个医院都是不同的，治疗的质量也不尽相同。

07:15

And quality of care differs greatly for women of color in the United States. Black women who deliver in this country are three to four times more likely to suffer a pregnancy-related death than are white women. This statistic is true for all black women who deliver in this country, whether they were born in the United States or born in another country. Many want to think that income differences drive these disparities, but it goes beyond class. A black woman with a college education is nearly twice as likely to die as compared to a white woman with less than a high school education. And she is two to three times more likely to suffer a severe pregnancy complication with her delivery.

而且对有色人种的女性，治疗的质量则区别更大。在这个国家，黑人女性分娩时 可能遭受的与妊娠有关的死亡 是白人女性的三到四倍。这个统计对于所有在这个国家 分娩的黑人女性是真实有效的，不管他们是出生在美国，或是出生在其它国家。很多人愿意相信是因为 收入差异导致了这些不同，但是这超出了阶级的范畴。一个有着大学学历的黑人女性 死亡的可能性是一个 不到高中学历的 白人女性的两倍。并且她有两到三倍的 可能在分娩的时候 经历严重的妊娠并发症。

07:59

Now, I was always taught to think that education was our salvation, but in this case, it's simply not true. This black-white disparity is the largest disparity among all population perinatal health measures, according to the CDC. And these disparities are even more pronounced in some of our cities. For example, in New York City, a black woman is eight to 12 times more likely to die from a pregnancy-related cause than is a white woman.

现在，我总是被教导着认为 教育是我们的救世主，但是在这种情况下，这根本不是真的。根据疾病控制中心所说，黑人-白人的差异 在所有人口围产期健康措施中，是最大的。而这些差异在一些城市中 则更加显著。比如，在纽约，黑人妇女因为妊娠 相关原因死亡的概率 是白人妇女的12倍。

08:29

Now, I think many of you are probably familiar with the heart-wrenching story of Dr. Shalon Irving, a CDC epidemiologist who died following childbirth. Her story was reported in ProPublica and NPR a little less than a year ago. Recently, I was at a conference and I had the privilege of hearing her mother speak. She brought the entire audience to tears. Shalon was a brilliant epidemiologist, committed to studying racial and ethnic disparities in health. She was 36 years old, this was her first baby, and she was African-American.

我想你们大部分人都可能很熟悉 谢纶·欧文博士那令人 撕心裂肺的故事，她是一名疾病防治中心 的流行病学家，死于后来的分娩。不到一年前她的故事 被ProPublica和NPR报道。最近，我在一个会议上 有幸听到了她母亲的演讲。整个观众席都被她的 演讲感动到热泪盈眶。谢纶是一名杰出的流行病学家，立志于研究种族和人种 在医疗方面的差异。她才36岁，那是她的第一个孩子，她是一名非裔美国人。

09:02

Now, Shalon did have a complicated pregnancy, but she delivered a healthy baby girl and was discharged from the hospital. Three weeks later, she died from complications of high blood pressure. Shalon was seen four or five times by healthcare professionals in those three weeks. She was not listened to, and the severity of her condition was not recognized.

Shalon得了妊娠并发症，但是她分娩了一名健康 的女孩，然后出院了。三周之后，她死于高血压并发症。谢纶在那三周里 与医疗专家见了四五次。她的话被当作了耳旁风，她情况的严重性也没有被认可。

09:27

Now, Shalon's story is just one of many stories about racial and ethnic disparities in health and health care in the United States, and there's a growing recognition that the social determinants of health, such as racism, poverty, education, segregated housing, contribute to these disparities. But Shalon's story highlights an additional underlying cause: quality of care. Lack of standards in postpartum care. Shalon was seen multiple times by clinicians in those three weeks, and she still died. Quality of care in the setting of childbirth is an underlying cause of racial and ethnic disparities in maternal mortality and severe maternal morbidity in the United States, and it's something we can address now.

谢纶的故事只是在美国的 众多关于健康和医疗的 种族和人种差异故事的其中一个，并且越来越多人认可健康的 社会决定因素，比如种族，贫穷，教育，隔离住房，都是导致这些差异的因素。但是谢纶的故事 使另外一个潜在的因素凸显出来： 治疗的质量。缺乏产后治疗的标准。谢纶在那三周里见了 好几次临床医生，但是她仍然去世了。在美国，妊娠死亡和严重并发症中，分娩环境中的治疗质量 是导致种族和人种差异的 一个潜在因素，并且这是我们现在 就可以处理的问题。

10:14

Research by our team and others has documented that, for a variety of reasons, black women tend to deliver in a specific set of hospitals, and those hospitals often have worse outcomes for both black and white women, regardless of patient risk factors. This is true overall in the United States, where about three quarters of all black women deliver in a specific set of hospitals, while less than one-fifth of white women deliver in those same hospitals. In New York City, a woman's risk of having a life-threatening complication during delivery can be six times higher in one hospital than another. Not surprisingly, black women are more likely to deliver in hospitals with worse outcomes. In fact, differences in delivery hospital explain nearly one-half of the black-white disparity.

我们团队的研究员和其他人 已经书面记录了这些状况，因为不同的原因，黑人女性倾向于在一些 特定的医院进行分娩，而不考虑病人的风险因素，这些医院的黑人和白人女性 都时常有更严重的预后不良。这样的情况在全美国比比皆是，在美国大约四分之三的黑人女性 在一些特定医院进行分娩，而同时只有不到五分之一的 白人女性在同样的医院分娩。在纽约，一名妇女在一家医院里 进行分娩时患上威胁生命 的并发症的风险 可能是另外一家医院的六倍。也难怪，黑人女性在医院 分娩时遇到不良结果 的可能性更大一些。事实上，不同分娩医院的区别 解释了接近一半 黑人-白人差异的原因。

11:02

While we must address social determinants of health if we're ever going to truly have equitable health care in this country, many of these are deep-seated and they will take some time to resolve. In the meantime, we can tackle quality of care. Providing high-quality care across the care continuum means providing access to safe and reliable contraception throughout women's reproductive lives. Before pregnancy, it means providing preconception care, so we can manage chronic illness and optimize health. During pregnancy, it includes high-quality prenatal and delivery care so we can produce healthy moms and babies. And finally, after pregnancy, it includes postpartum and inter-pregnancy care so we can set moms up to have a healthy next baby and a healthy life.

如果我们要在这个国家 真正实现公平的医疗保健，我们就必须解决健康 的社会决定因素，而这些因素大部分都是根深蒂固的，解决它们需要一些时间。同时，我们可以处理 治疗质量的问题。在整个连续的治疗中 提供高质量的治疗 意味着在妇女的整个生殖周期 提供安全而有保障的避孕。在孕前，这意味着提供孕前保健，这样我们就可以控制慢性病 并且维持最佳健康状态。在孕中，它包括了高质量的 产前和分娩治疗，让我们可以有健康的 妈妈们和宝宝。最后，在产后，它包括了 产后和怀孕间的治疗，让我们能够帮妈妈们康复，为生育下一个健康的宝宝，和拥有一个健康的生活做准备。

11:52

And it can literally spell the difference between life and death, as it did in the case of Maria, who checked into the hospital after having an elevated blood pressure during a prenatal visit. Maria was 40, and this was her second pregnancy. During Maria's first pregnancy that had happened two years earlier, she also didn't feel so well in the last few weeks of her pregnancy, and she had a few elevated blood pressures, but nobody seemed to pay attention. They just said, "Maria, don't worry, you'll be fine. This is your first pregnancy. You're a little nervous." But it did not end well for Maria last time. She seized during labor.

它可以从字面上来分辨 生命和死亡的区别，就像玛丽亚的案例中一样，玛丽亚在孕前检查时，发现有高血压之后去了医院检查。她40岁了，这是她第二次怀孕。玛丽亚在两年前第一次怀孕时，她在怀孕的最后几周 感觉并不是很好，她有一点高血压，但是并没有人注意到。大家只是说，“玛丽亚，别担心，你没事的。“这是你第一次怀孕 所以你有一点紧张。” 但是情况并没有变好。她在分娩时癫痫发作。

12:27

Well, this time her team really listened. They asked smart and probing questions. Her doctor counseled her about the signs and symptoms of preeclampsia and explained that if she was not feeling well, she needed to come in and be seen. And this time Maria came in, and her doctor immediately sent her to the hospital. At the hospital, her doctor ordered urgent lab tests. They hooked her up to multiple different monitors and paid special attention to her blood pressure, the fetal heart rate tracing and gave her IV medication to prevent a seizure. And when Maria's blood pressure got so high it put her at risk for a stroke, her doctors and nurses jumped into action. They repeated her blood pressure in 15 minutes and declared a hypertensive emergency. They gave her the right IV medication according to the latest correct protocol. They worked smoothly together as a coordinated team and successfully lowered her blood pressure.

不过这一次她的团队听进去了。他们询问了一些巧妙的探索性问题。她的医生和她讨论了 关于子痫前期的迹象和征兆，并且向她解释如果她感到不适，她需要去医院检查。然后这一次玛丽亚去了，她的医生立刻将她送去了医院。在医院，医生立刻安排了 紧急的实验测试。为她连上了不同的监控器，并且认真观察她的血压，胎儿心率，并且给她注射静脉 药物来防止痉挛。当玛丽亚的血压高到 令她有中风的风险时，她的医生和护士立刻行动。他们将她的血压重复了15分钟，然后宣布了高血压急症。他们根据最近的正确规程 给了她合适的静脉注射药物。他们作为一个合作的团队，工作进展的很顺利，并且成功降低了她的血压。

13:22

As a result, what could have been a tragedy became a success story. Maria's dangerous symptoms were controlled, and she delivered a healthy baby girl. And before Maria was discharged from the hospital, her doctor counseled her again about the signs and symptoms of preeclampsia, the importance of having her blood pressure checked, especially in this first week postpartum and gave her education about postpartum health and what to expect. And in the weeks and months that followed, naturally, Maria had follow-up visits with her pediatrician to check in on her baby's health. But just as important, she had follow-up visits with her ob-gyn to check in on her health, her blood pressure, and her cares and concerns as a new mother.

结果就是，一个潜在的悲剧 变成了一个成功的故事。玛丽亚危险的征兆被控制住了，并且生下了一个健康的女婴。然后在玛丽亚出院之前，她的医生又和她讨论了 子痫前期的迹象和征兆，特别是产后第一周 检查血压的重要性，并且给了她关于产后健康和 可能出现的情况的说明。然后在接下来的几个月里，很自然地，玛丽亚和她的儿科医生 进行了几次术后随访 来检查宝宝的健康。但是一样重要的是，她也在妇产科进行了术后随访 来检查她本人的健康和血压，以及作为一名新手妈妈的 谨慎和忧虑。

14:03

This is what high-quality care across the care continuum looks like, and this is how it can look. If every pregnant woman in every community received this kind of high-quality care and delivered at facilities that utilized standard care practices, our maternal mortality and severe maternal morbidity rates would plummet. Our international ranking would no longer be an embarrassment.

这就是贯穿整个过程的连续性 高质量治疗的样子，这就是它应有的效果。如果每一个社区里的每一名孕妇 都可以接受这种高质量的治疗，并且在使用标准治疗 实践的机构里分娩，我们的产妇死亡率和严重的产妇 发病率将会骤然下跌。我们的国际排名再也 不会让人觉得尴尬。

14:26

But the truth is, we've had decades of unacceptably high rates of maternal death and life-threatening complications during delivery and decades of devastating consequences for moms, babies and families, and we have not been moved to action.

但是事实是，我们 已经有了几十年的 高产妇死亡率和在分娩时 威胁生命的并发症高发率，以及几十年来母亲、婴儿 和家庭的毁灭性后果，我们并没有任何实质性行动。

14:44

The recent media attention on our poor performance on maternal mortality has helped the public to understand: high-quality maternal health care is within reach. The question is: Are we as a society ready to value pregnant women from every community?

最近媒体对我们在 产妇死亡率上表现不佳的关注 已经帮助公众来了解： 高质量的产妇医疗是伸手可及的。问题则是： 我们的社会是否准备好 从每一个社区开始重视孕妇？

14:59

For my part, I'm doing everything I can to ensure that when we do, we have the tools and evidence base ready to move forward.

对我来说，我做了一切来 确保当我们开始做了，我们已经准备好了 技术和证据基础 继续前进。

15:09

Thank you.

谢谢大家。

15:10

(Applause)

（鼓掌）