我国剖宫产率居高不下一直是社会广泛关注的话题。昨日，政协委员蔡金凤、柳文美将近年来昆明市的住院分娩情况和剖腹产情况做了现状分析，并提出降低昆明市剖宫产率的建议。

China has always been a high rate of cesarean section a widespread social concern topic.yesterday,CaiJinFeng political consultative conference (CPPCC)/LiuWen beauty nearly years of kunming hospital delivery conditions and cesarean section was present condition analysis,And puts forward some Suggestions to reduce the rate of cesarean section in kunming.

　

　现状 status

　　去年昆明剖宫产率 Kunming cesarean section rate last year

　　高于世卫警戒标准2.6倍 Higher than the world health alert standard 2.6 times

　　目前，世界卫生组织对剖腹产的警戒线是15%。而蔡金凤和柳文美援引的国内数据早已超过这一标准：2007—2008年对9个亚洲国家的超过10万名产妇的分娩方式调查报告反映，平均剖宫产率为27.3%，中国的剖宫产率(46.2%)和无指征剖宫产率(11.7%)均位居9国之首。国内的一些文献显示，国内某些大城市医院剖腹产率甚至高达70%以上。

At present,The world health organization for cesarean section line is 15%.And CaiJinFeng and LiuWen beauty quoted domestic data already more than the standard:2007-2008 to nine Asian countries more than 100000 puerpera childbirth way of survey report,Average cesarean section rate was 27.3%,China's rate of cesarean section(46.2%)And no indications cesarean section rate(11.7%)At first all nine countries.Some of the literature shows that domestic,Domestic some big cities hospital cesarean section rate is as high as 70% above.

　　昆明的情况也不容乐观。2012年，昆明市的剖宫产率为42.77%，全市剖宫产率高于全国(31.7%)和全省(20.45%)的平均水平。2012年，个别医院剖宫产率高达82.14%。在2012年开展助产的187家医疗机构中，剖宫产率≥60%以上的有18家，其中11家为民营医院。

Kunming's situation is not optimistic.In 2012,,Kunming, the capital of cesarean section rate was 42.77%,The cesarean section rate is higher than the national(31.7%)And the(20.45%)average.In 2012,,Individual hospital cesarean section rate reaches as high as 82.14%.Started in 2012 obstetrical 187 medical institutions,More than 60% of the rate of cesarean section was eighteen home,The 11 for civilian battalion hospital.

　　而2012年昆明市孕产妇死亡统计数据表明，疤宫原因导致的凶险型前置胎盘、子宫破裂、产后缩宫死亡占产后出血死亡的50%。

And in 2012 kunming maternal death statistics show,Scar palace cause dangerous type of placenta previa/Uterine rupture/Postpartum shrinkage palace death accounted for 50% of all deaths in postpartum hemorrhage.

　

　调查 survey

　　怕疼是产妇不敢顺产的主要原因 Afraid of pain is not the main cause of maternal eutocia

　　在造成市区剖宫率上升的因素中，社会因素是剖宫产手术的首位指征。有的产妇因为恐惧分娩和缺乏对剖宫产的正确认识，在入院后坚决要求剖宫产。同时，由于择期剖宫产无需医院守产程、手术费用为自然产的几倍、产科人员紧缺、追求经济效益等等原因，也使得剖宫产成为部分医院推荐产妇的首选。

In the house by cutting rate rising factors,Social factors is the first indication of cesarean section operation.Some mothers because of fear of cesarean section delivery and lack of correct understanding,After admission in insist on cesarean section.At the same time,Elective cesarean section due to no hospital keep labor/The operation cost for natural produce several times/Maternity personnel shortage/The pursuit of economic benefits and so on reasons,Has become part of the hospital cesarean section recommend maternity preferred.

　　昨天下午，在昆明医学院第一附属医院的门诊楼外，抱着两个月大的女儿来看病的李女士说：“我就是剖腹产的，特别顺利，感觉眼睛一闭一睁，孩子就出来了。”作出剖腹产决定是因为有一次在产检时，听一位要生二胎的高龄产妇讲述生第一胎时的经历。“听她说完在分娩室里生了10个小时的痛苦经历，我当时吓出了一身汗，所以下决心一定要剖腹产。”

Yesterday afternoon,In the first affiliated hospital of kunming medical college of outpatient service outside the building,Hold two months old daughter came to ms. Li said:"I am a cesarean section,Special smooth,Feel a closed eyes with a,The child came out."Make cesarean decision because once in production when inspection,Listen to a to have two fetal maternal age about the birth of their first child experience."To hear her say that finish in the delivery room gave birth to ten hours of pain experience,I was scared out of a sweat,So determined to cesarean section."

　　在妇产科门诊外的走廊上，聚集了几十位等候妻子产检的丈夫。王先生陪妻子做第二次产检，目前母婴都很健康。而在分娩方式上，王先生希望妻子能剖腹产，“听说顺产危险系数大，又疼，还是希望老婆少受点苦。”

In gynecology and obstetrics outpatient corridor,Brought together dozens of waiting for the latter's wife inspection husband.Mr. Wang with his wife with the second production inspection,Maternal and infant at present were all in good health.And in the delivery way,Mr. Wang hope wife can caesarean section,"Heard that eutocia risk factor big,And pain,I hope the wife less influenced by some hardships."

　　在昆明妇幼保健院的产科，几位产后妈妈分享了自己的生产经验。

Maternity and child care centers in kunming the maternity,Several postpartum mother share their production experience.

　　43岁的詹女士在4天前刚剖腹产下一子，这是她第二次剖宫产子，大儿子已经5岁。尽管如此，她个人还是支持自然生产。

43, ms chan in four days after caesarean birth a child,This is her second son cesarean section,The first son has 5 years old.Even so,Her personal or support natural production.

　　詹女士说：“我知道第一次剖宫产的孕妇第二次产子时会有很多危险，我认识一个朋友在剖宫产一年后怀孕，结果胎儿在4月大的时候子宫破裂，所以，我主张有条件的产妇都选择顺产。”

Ms chan said:"I know the first cesarean section of the pregnant women for the second time when delivered there are a lot of risk,I know a friend in cesarean section a year later pregnancy,Results the fetus in 4 months uterine rupture,so,I stand for conditional maternity choose eutocia."

　　前天刚顺产生完孩子的车女士，恢复得很好。昨天她就能在病房里灵活走动。她说，“虽然生产的过程中免不了疼痛，但觉得也可以忍受。”

The day before yesterday just the produce to the child car lady,Recovered well.Yesterday she can walk in the ward agile.She said,"Although the production process avoid pain,But think also can endure."

　　

医院 hospital

　　主张有条件的产妇自然生产 Advocate conditional maternity natural production

　　昆明市妇幼保健院产科杨主任说，现在医院剖宫率逐年都在下降，“其实剖宫产收费更高、更省时间，我们为什么要苦口婆心地劝有条件的产妇自然生产，作为产科医生，要在职业范围内为母婴健康负责。”

Kunming maternal and child care service centre maternity Yang director said,Now the hospital cutting palace rate year after year are in decline,"Actually charge higher cesarean section/More save time,Why do we want to persuade an conditional maternity natural production,As an obstetrician,The professional range for maternal and child health is responsible for."

　　杨主任认为倡导自然生产的宣传很重要，很多孕妇对生产的知识还不够了解，其实缺的就是勇气。在劝说有条件的产妇顺产的同时，医院还在不断改进生产技术。杨主任说，现在在医院产科的自然生产中，无痛分娩率已经达到40%。下一步，医院会引进设备，实施不用药物的“导乐”分娩，有人陪伴，还有专门的“导乐”师，这么做的目的就是要促进自然分娩。此外，最重要的一步是从门诊开始为孕妇的营养做指导，“这是一个综合性工程，在门诊引导孕妇控制饮食，更有条件自然生产，对胎儿的健康也是有利的。”

Yang director think advocate natural production propaganda is very important,Many pregnant women to the production of knowledge is not enough to understand,In fact need is courage.In persuading the conditional maternity eutocia at the same time,The hospital is constantly improving production technology.Yang, director of the,Now in the hospital maternity natural production,Painless childbirth has reached 40%.The next step,The hospital will introduce equipment,Implement don't drug"Guide music"delivery,Someone with,There are special"Guide music"teacher,The purpose of doing so is to promote natural childbirth.In addition,The most important step to start from the clinic for pregnant women do nutrition guidance,"This is a comprehensive project,In the outpatient service guide pregnant women control diet,More natural production conditions,On the health of the fetus is favorable."

　

　建议 Suggestions

　　严格掌控剖宫产手术指征 Strict control of the indications for cesarean section

　　蔡金凤和柳文美提出了几项降低剖宫率的措施。首先是希望政府决策机构制定促进自然分娩的政策措施。通过对顺产和社会因素的剖宫产手术实行限价，压缩剖宫产的利润空间，缩小顺产与剖宫产的政策支付差距。

CaiJinFeng and LiuWen beauty puts forward several measures to reduce the rate of profile palace.The first is hope the government decision mechanism for promoting natural childbirth policy measures.Through the natural labor and social factors to limit operation cesarean section,Compression of cesarean section profit space,Narrow eutocia and cesarean section policy pay gap.

　　其次是加强产科质量管理、产科人员的业务技能培训和提高孕产期保健服务质量。卫生行政部门对开展剖宫产助产机构的设备、人员、技术水平等严格管理，定期检查，不合格的坚决取消助产技术资格。同时加强对产科医护人员的“三基”培训，严格掌控剖宫产手术指征，转变对待剖宫产不正确的观念和态度。各个医院应提高产前检查、孕期保健服务的质量，及时发现并治疗孕期合并症及并发症，减少产时高危的发生。

The second is to strengthen the obstetric quality management/Maternity personnel business skills training and improve the quality of health care services there.The administrative departments for public health institutions in midwifery cesarean section of the equipment/personnel/The technical level and strict management,Regular inspection,Not qualified to cancel the skills of midwifery qualification.At the same time, strengthen the obstetric medical staff"basic"training,Strict control of the indications for cesarean section,Change to cesarean section incorrect perception and attitudes.Hospitals should improve prenatal care/Prenatal care is the quality of the service,Timely discover and treatment of pregnancy complications and complications,To reduce the occurrence of producing high risk.

　　为了改善产妇因为恐惧分娩和误解剖宫产的情况，蔡金凤和柳文美提出医院或相关机构应利用多种形式开展健康教育，帮助孕产妇及其家属正确认识不同分娩方式的利与弊，作出正确的选择。

In order to improve maternal because of fear of cesarean section delivery and misunderstandings,CaiJinFeng and LiuWen beauty put hospitals or related institutions should use various forms to carry out health education,Help the maternal and their families a correct understanding of different delivery way merits and demerits,Make the right choice.

　

　昆明妇幼保健中心副主任秦茂华： Kunming maternity and child care center, deputy director of the QinMaoHua:

　　剖宫产妇女再怀孕或人流的风险增大 Cesarean section again women pregnant or increased risk of people

　　“一剖就来钱”驱动着很多医院、医生以安全为由劝说产妇进行剖腹产。为扭转这一局面，国家已经开始调控生育方式，设定剖腹产率的数字指标便是最为常见的一种手段。

"A cutting to money"Drive on a lot of the hospital/The doctor to safety by persuading maternity for caesarean section.To reverse this situation,Countries have begun to control birth way,Set the number of cesarean section rate index is the most common kind of means.

　　昆明妇幼保健中心副主任秦茂华介绍，2010年国家实施农村孕产妇住院分娩补助项目，项目提出要求，县级剖宫率控制在20%，乡级控制在5%。3年来，昆明剖宫率呈下降趋势。

Kunming maternity and child care center, deputy director of the QinMaoHua is introduced,The 2010 national implementation of rural maternal hospital childbirth subsidy project,Project request,Profile palace at or above the county level rate control in 20%,The control at 5%.Three years,Kunming cutting palace rate declined.

　　“全市剖宫率在减少，但经产妇疤痕子宫再妊娠危险率在增加，危急抢救的发生率也在增加，我们是在承担前几年高剖率带来的后果。我有印象的是去年导致血库用血紧张的至少有3次是因为抢救产妇生命，一次抢救需要1万多毫升血量。”秦茂华说，疤痕子宫是凶险型前置胎盘和子宫破裂的元凶，已成为产妇出血的主要原因。她解释：“经历过一次剖宫产的妇女再怀孕时会增加自身危险因素，即便不生孩子只做人流手术，承担的风险也会大大增加。”

"The cutting palace in reducing rate,But the puerpera scar uterus to pregnancy risk on the increase,The incidence of emergency rescue are also on the increase,We are in for a few years ago, the consequences of the high cutting rate.I have the impression that last year in blood bank use nervous at least 3 times because of rescue maternity life,A rescue need more than 10000 ml of blood volume."QinMaoHua said,Uterine scar is dangerous type of placenta previa and uterine rupture of the culprit,Has become the main cause of maternal bleeding.She explain:"Experienced a cesarean section of women to pregnancy increases their risk factors,Even if don't give birth to a kid only do the stream of people surgery,Take a risk will increase greatly."

　　秦茂华分析，城市大部分选择剖宫产的产妇是受疤宫影响，经济欠发达地区主要是健康意识薄弱，而部分民营医疗机构趋利性质也增加了剖宫率。

QinMaoHua analysis,Most cities choose cesarean section scar the puerpera is affected by the palace influence,Undeveloped areas mainly health consciousness weak,And some private medical institutions QuLiXing mass also increased cutting palace rate.

　　她认为，降低剖宫产率需要从几方面入手，一方面是加大宣传力度，第二点是提高产科医务人员处理顺产的能力，推广分娩镇痛技术。第三是卫生行政部门严格产科质量管理。秦副主任介绍，2012年至2013年，卫生行政部门开展了全市助产机构产科质量检查，不合格的医院将通过媒体进行公示。最重要的一点还是政府政策的支持。

She thinks,Reduce the rate of cesarean section needs from several aspects,On the one hand is to increase the propaganda dynamics,The second point is to improve the obstetric medical personnel processing natural labor ability,Promote labor analgesia technology.The third is the public health administrative departments to strictly obstetrics quality management.Deputy director of the qin dynasty is introduced,From 2012 to 2013,The public health administrative department has carried out the obstetric institutions obstetric quality inspection,Don't qualified hospital through public media.The most important thing is the government's policy support.

　　

新闻链接 News link

　　山西 shanxi

　　3成以上孕妇选择剖宫产 More than 3 to pregnant women choose cesarean section

　　助产师技术日渐生疏 Midwife technology increasingly unfamiliar

　　在山西，三甲医院顺产大概2600元到4000元，而剖宫产的费用是6000元到7500元不等。尤其是一些民营医院，收费更是高达上万元。

In shanxi,3 armour hospital eutocia about 2600 yuan to 4000 yuan,And the cost of cesarean section is 6000 yuan to 7500 yuan RMB.Especially some private hospital,Charge is as high as tens of thousands of yuan.

　　“不排除剖宫产率高的一个原因是医院受利益的驱使。”一位在山西某民营医院上班的妇产科医生说，在他们医院，大家的收入是和他们的业绩及医院利润挂钩的，为了获取更多利益，有时会鼓励产妇剖宫产。

"Don't eliminate cesarean section rate high one reason is that the hospital be driven."A in shanxi a civilian battalion hospital to work in the department of obstetrics and gynecology doctors say,In their hospital,Everyone's income is and their performance and the hospital profits of the hook,In order to obtain more benefits,Sometimes will encourage maternity cesarean section.

　　山西省妇幼保健院产科主任杜秀萍说，2012年，在他们医院有4300多名新生儿降生，其中，选择剖宫产的产妇占到37%左右。

Maternal and children health care centers of Shanxi Province, director of the maternity DuXiuPing said,In 2012,,In their hospital has more than 4300 neonatal birth,the,Choose cesarean section of the parturient women account for about 37%.

　　由于剖宫产率过高，使得产科医生对助产技术越来越生疏。

Due to the high rate of cesarean section,To make an obstetrician midwifery technology is more and more unfamiliar.

　

　成都 chengdu

　　产妇择吉日生产 Maternal pick an auspicious day day production

　　推高剖宫产率 Push the high rate of cesarean section

　　成都2012年剖宫产率为55%，远高于世界卫生组织推荐的15%。社会因素以及对剖宫产的认识误区，是很多孕妇主动要求剖宫产的主因，而剖宫产背后的风险，却往往被忽视。少数医院受利益驱动，也是剖宫产率居高的另一个诱因。

Chengdu 2012 cesarean section rate was 55%,The world health organization recommends is much higher than 15%.Social factors and the misunderstanding of cesarean section,Is many pregnant women ask for the major cause of cesarean section,The risk of cesarean section and behind,But it is often neglected.A few hospital driven by,Cesarean section rate is also high in another incentive.

　　“现在产妇中80后是主力军，她们过惯了舒适的生活，怕痛，因此多数人选择剖宫产，而回避自然分娩。” 成都新生堂妇产医院院长杨钢说，成都新生堂妇产医院产科剖宫产在30%左右，但现在，在“龙宝宝”、“新年宝宝”、早入学读书等“黄道吉日”以及保持身材等社会因素的影响下，剖宫产率也上升了不少。(王琳 向星权 张萌)

"Now pregnant after 80 is the main force,They used the comfortable life,Afraid of pain,So most people choose cesarean section,And avoid natural childbirth." Chengdu new hall of maternity hospital YangGang said,Chengdu new hall maternity hospital maternity cesarean section at around 30%,But now,in"Dragon baby"/"The New Year baby"/Early admission reading, etc"Auspicious day"And keep in shape and under the influence of social factors,Cesarean section rate also increased a lot.(Wang Lin ZhangMeng to star power)