演講MP3+雙語(yǔ)文稿:我們?nèi)绾胃纳飘a(chǎn)婦保健

聽(tīng)力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語(yǔ)文稿，供各位英語(yǔ)愛(ài)好者學(xué)習(xí)使用。本文主要內(nèi)容為演講MP3+雙語(yǔ)文稿:我們?nèi)绾胃纳飘a(chǎn)婦保健，希望你會(huì)喜歡！

【演講者及介紹】Elizabeth Howell

伊麗莎白豪厄爾-產(chǎn)婦健康改革家伊麗莎白·豪厄爾正在致力于解決美國(guó)的孕產(chǎn)婦死亡率問(wèn)題。

【演講主題】我們?nèi)绾胃纳飘a(chǎn)婦保健-懷孕前、懷孕期間和懷孕后

【中英文字幕】

翻譯者 Jingdan Niu 校對(duì)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.

當(dāng)我從電梯里出來(lái)的時(shí)候 眼前一片混亂。作為一名住院醫(yī)師，我正從值班的婦產(chǎn)科部門(mén)回來(lái)。我所能看見(jiàn)的是待產(chǎn)室里 一大群醫(yī)生和護(hù)士 徘徊在一名病人周圍。他們正絕望地嘗試 挽救一名產(chǎn)婦的生命。病人已經(jīng)休克了。她在我到達(dá)的幾小時(shí)之前 生了一名健康的男寶寶。突然之間，她昏倒了，毫無(wú)反應(yīng)，并且開(kāi)始血崩。當(dāng)我到達(dá)房間，里面有各種醫(yī)生和護(hù)士，而病人生命跡象微弱。復(fù)蘇組嘗試使她恢復(fù)意識(shí)，但是盡管每一個(gè)人都盡力了，她還是走了。我對(duì)那一天記憶最深刻的 是那位父親撕心裂肺的哭聲。那哭聲刺激了我的心，以及那層樓所有人的心。那一天本應(yīng)該是他 生命中最快樂(lè)的一天，但是最后卻變成了最糟糕的一天。

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.

我希望我可以說(shuō) 這場(chǎng)悲劇是一個(gè)個(gè)案，但遺憾的是，并不是這樣的。在美國(guó)，每一年 有700至900名婦女 死于與妊娠相關(guān)的原因。這個(gè)故事令人震驚的部分在于 我們的產(chǎn)婦死亡率實(shí)際上 高于其他高收入國(guó)家，并且這個(gè)概率在有色人種 的女性身上更加糟高。在過(guò)去一個(gè)世紀(jì)我們的 產(chǎn)婦死亡率實(shí)際上增加了，與此同時(shí)其他國(guó)家降低了。這里最大的悖論是什么？ 我們?cè)卺t(yī)療保健上有著 比其他所有國(guó)家都要高的花費(fèi)。

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.

當(dāng)然，幾乎與在住院時(shí) 那位新母親失去生命的同時(shí)，我成為了一名母親。盡管我有著這個(gè)領(lǐng)域 所有的背景和培訓(xùn)，我仍然對(duì)無(wú)法保證一個(gè)高質(zhì)量的 孕期保健而震驚。我思考著這意味著什么，不僅僅是對(duì)于我，而是對(duì)于許許多多的婦女們。也許因?yàn)槲业母赣H 是一名民權(quán)律師，并且我的父母非常具有社會(huì)意識(shí)，并且要求我們要堅(jiān)持自己的信仰?；蛘呤且?yàn)槭聦?shí)上我的 父母出生在牙買加，移民到了美國(guó)，并且能夠?qū)崿F(xiàn)他們的美國(guó)夢(mèng)。又或者是我的住院醫(yī)師培訓(xùn)，使我直接地看到了 醫(yī)療系統(tǒng)是多么惡劣的對(duì)待 許多有色人種的婦女的。不論是因?yàn)槟囊粋€(gè)原因，我感覺(jué)到我有責(zé)任站出來(lái)，不僅僅為我自己，而且為了所有的女性，尤其是那些被我們 醫(yī)療系統(tǒng)所邊緣化的。所以我決定將我職業(yè)的重點(diǎn) 放在改善孕產(chǎn)期醫(yī)療。

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.

那么是什么殺害了母親們？ 心血管疾病，大出血，高血壓引發(fā)癲癇和中風(fēng)，血栓和感染 則是我們國(guó)家孕產(chǎn)期 死亡的部分主要原因。但是孕產(chǎn)期死亡僅僅是冰山的一角。每一類死亡，超過(guò) 100名女性都遭受了 嚴(yán)重的與懷孕和分娩 相關(guān)的并發(fā)癥，導(dǎo)致了每年有超過(guò)6萬(wàn)名 女性有其中的一個(gè)癥狀。這些并發(fā)癥，被稱為 嚴(yán)重的產(chǎn)婦發(fā)病率，在美國(guó)呈現(xiàn)上升的趨勢(shì)，并且這些并發(fā)癥會(huì)改變?nèi)说囊簧?。?jù)統(tǒng)計(jì)，我們國(guó)家每年 的四百萬(wàn)次分娩中，有1.5%到2%都與這些癥狀相關(guān)。也就是每小時(shí)有五到六名女性 患上了血栓，癲癇，中風(fēng)，接受一次輸血，患上終末器官損害比如腎衰竭，或者其它突發(fā)癥狀。

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.

現(xiàn)在，這個(gè)情況明顯 不能原諒的部分在于 60%的死亡和并發(fā)癥 被認(rèn)為是可以避免的。當(dāng)我說(shuō)60%是可以避免的，我的意思是有一些具體步驟 和標(biāo)準(zhǔn)程序我們可以實(shí)行，以避免這些糟糕的結(jié)果出現(xiàn)，并且挽救這些女性的生命。而且這并不需要高級(jí)的新技術(shù)。我們只是需要將 我們知道的付諸于行動(dòng) 并且確保醫(yī)院之間的同等標(biāo)準(zhǔn)。

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.

比如說(shuō)，當(dāng)一名正在分娩的孕婦 有著非常高的血壓 如果我們及時(shí)給她正確的 抗高血壓藥物，我們就可以避免中風(fēng)。如果我們可以準(zhǔn)確的觀測(cè)到 分娩中的血液流失，我們就會(huì)及時(shí)察覺(jué)到出血 并挽救孕婦的生命。那么明天我們就可以從根本上 降低這些災(zāi)難性事件發(fā)生的概率，但是這需要我們重視 孕婦在孕前、孕中和產(chǎn)后 治療的質(zhì)量。如果我們將治療的質(zhì)量普遍 提升到我們認(rèn)為的“標(biāo)準(zhǔn)”，就可以將死亡率和 并發(fā)癥發(fā)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.

當(dāng)然了，也有一些好的消息。有一些成功的案例。有一些地區(qū)已經(jīng)落實(shí)了這些標(biāo)準(zhǔn)，并且出現(xiàn)了實(shí)質(zhì)性的改變。幾年前，美國(guó)婦產(chǎn)科學(xué)院 聯(lián)合了其他醫(yī)療機(jī)構(gòu)，研究員們，比如我，和社區(qū)組織。他們希望在整個(gè)國(guó)家 的醫(yī)院和醫(yī)療系統(tǒng)里 實(shí)施標(biāo)準(zhǔn)治療工作。他們采用的方法則是一個(gè) 叫做孕婦保健的聯(lián)盟創(chuàng)新計(jì)劃，即AIM計(jì)劃。他們的目標(biāo)是通過(guò) 質(zhì)量和安全新舉措 在全國(guó)范圍內(nèi)降低孕婦死亡率 和嚴(yán)重產(chǎn)婦并發(fā)癥發(fā)病率。這個(gè)組織已經(jīng)開(kāi)發(fā)了一些安全方案，針對(duì)一些最可預(yù)防的孕產(chǎn)婦死亡原因。AIM計(jì)劃現(xiàn)在有覆蓋 超過(guò)美國(guó)百分之五十 出生人數(shù)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？ 將這些情境作為目標(biāo)所需要的 循證實(shí)踐，習(xí)慣做法，步驟，用藥，設(shè)備，和其他物品。以出血的安全方案為例。在病人出血時(shí)，你需要一個(gè)手推車，準(zhǔn)備好醫(yī)生或者護(hù)士 可能在急救中會(huì)用到的所有東西： 靜脈注射管線，氧氣罩，藥物，清單，其它儀器。然后你需要測(cè)量血液流失的儀器： 海綿和襯墊。醫(yī)生和護(hù)士收集 這些海綿和襯墊，稱出重量，或者是 用新技術(shù)來(lái)準(zhǔn)確的評(píng)估 到底流失了多少血，而不是一直盯著它們。出血安全方案也包括需要 大量輸血時(shí)的危險(xiǎn)期醫(yī)療方案 和常規(guī)培訓(xùn)和教學(xué)。

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.

現(xiàn)在，加州已經(jīng)成為應(yīng)用 這種安全方案的領(lǐng)導(dǎo)者，這也是為什么加州實(shí)施 這種安全方案的第一年，醫(yī)院里因出血而 瀕臨死亡的人數(shù)就降低了21%。但是這些方案在全國(guó)范圍內(nèi)的 應(yīng)用是參差不齊或者不完整的。比如說(shuō)，即便使用循證實(shí)踐 和對(duì)安全的重視，每一個(gè)醫(yī)院都是不同的，治療的質(zhì)量也不盡相同。

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.

而且對(duì)有色人種的女性，治療的質(zhì)量則區(qū)別更大。在這個(gè)國(guó)家，黑人女性分娩時(shí) 可能遭受的與妊娠有關(guān)的死亡 是白人女性的三到四倍。這個(gè)統(tǒng)計(jì)對(duì)于所有在這個(gè)國(guó)家 分娩的黑人女性是真實(shí)有效的，不管他們是出生在美國(guó)，或是出生在其它國(guó)家。很多人愿意相信是因?yàn)?收入差異導(dǎo)致了這些不同，但是這超出了階級(jí)的范疇。一個(gè)有著大學(xué)學(xué)歷的黑人女性 死亡的可能性是一個(gè) 不到高中學(xué)歷的 白人女性的兩倍。并且她有兩到三倍的 可能在分娩的時(shí)候 經(jīng)歷嚴(yán)重的妊娠并發(fā)癥。

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.

現(xiàn)在，我總是被教導(dǎo)著認(rèn)為 教育是我們的救世主，但是在這種情況下，這根本不是真的。根據(jù)疾病控制中心所說(shuō)，黑人-白人的差異 在所有人口圍產(chǎn)期健康措施中，是最大的。而這些差異在一些城市中 則更加顯著。比如，在紐約，黑人婦女因?yàn)槿焉?相關(guān)原因死亡的概率 是白人婦女的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.

我想你們大部分人都可能很熟悉 謝綸·歐文博士那令人 撕心裂肺的故事，她是一名疾病防治中心 的流行病學(xué)家，死于后來(lái)的分娩。不到一年前她的故事 被ProPublica和NPR報(bào)道。最近，我在一個(gè)會(huì)議上 有幸聽(tīng)到了她母親的演講。整個(gè)觀眾席都被她的 演講感動(dòng)到熱淚盈眶。謝綸是一名杰出的流行病學(xué)家，立志于研究種族和人種 在醫(yī)療方面的差異。她才36歲，那是她的第一個(gè)孩子，她是一名非裔美國(guó)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得了妊娠并發(fā)癥，但是她分娩了一名健康 的女孩，然后出院了。三周之后，她死于高血壓并發(fā)癥。謝綸在那三周里 與醫(yī)療專家見(jiàn)了四五次。她的話被當(dāng)作了耳旁風(fēng)，她情況的嚴(yán)重性也沒(méi)有被認(rèn)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.

謝綸的故事只是在美國(guó)的 眾多關(guān)于健康和醫(yī)療的 種族和人種差異故事的其中一個(gè)，并且越來(lái)越多人認(rèn)可健康的 社會(huì)決定因素，比如種族，貧窮，教育，隔離住房，都是導(dǎo)致這些差異的因素。但是謝綸的故事 使另外一個(gè)潛在的因素凸顯出來(lái)： 治療的質(zhì)量。缺乏產(chǎn)后治療的標(biāo)準(zhǔn)。謝綸在那三周里見(jiàn)了 好幾次臨床醫(yī)生，但是她仍然去世了。在美國(guó)，妊娠死亡和嚴(yán)重并發(fā)癥中，分娩環(huán)境中的治療質(zhì)量 是導(dǎo)致種族和人種差異的 一個(gè)潛在因素，并且這是我們現(xiàn)在 就可以處理的問(wèn)題。

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.

我們團(tuán)隊(duì)的研究員和其他人 已經(jīng)書(shū)面記錄了這些狀況，因?yàn)椴煌脑?，黑人女性傾向于在一些 特定的醫(yī)院進(jìn)行分娩，而不考慮病人的風(fēng)險(xiǎn)因素，這些醫(yī)院的黑人和白人女性 都時(shí)常有更嚴(yán)重的預(yù)后不良。這樣的情況在全美國(guó)比比皆是，在美國(guó)大約四分之三的黑人女性 在一些特定醫(yī)院進(jìn)行分娩，而同時(shí)只有不到五分之一的 白人女性在同樣的醫(yī)院分娩。在紐約，一名婦女在一家醫(yī)院里 進(jìn)行分娩時(shí)患上威脅生命 的并發(fā)癥的風(fēng)險(xiǎn) 可能是另外一家醫(yī)院的六倍。也難怪，黑人女性在醫(yī)院 分娩時(shí)遇到不良結(jié)果 的可能性更大一些。事實(shí)上，不同分娩醫(yī)院的區(qū)別 解釋了接近一半 黑人-白人差異的原因。

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.

如果我們要在這個(gè)國(guó)家 真正實(shí)現(xiàn)公平的醫(yī)療保健，我們就必須解決健康 的社會(huì)決定因素，而這些因素大部分都是根深蒂固的，解決它們需要一些時(shí)間。同時(shí)，我們可以處理 治療質(zhì)量的問(wèn)題。在整個(gè)連續(xù)的治療中 提供高質(zhì)量的治療 意味著在婦女的整個(gè)生殖周期 提供安全而有保障的避孕。在孕前，這意味著提供孕前保健，這樣我們就可以控制慢性病 并且維持最佳健康狀態(tài)。在孕中，它包括了高質(zhì)量的 產(chǎn)前和分娩治療，讓我們可以有健康的 媽媽們和寶寶。最后，在產(chǎn)后，它包括了 產(chǎn)后和懷孕間的治療，讓我們能夠幫媽媽們康復(fù)，為生育下一個(gè)健康的寶寶，和擁有一個(gè)健康的生活做準(zhǔn)備。

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.

它可以從字面上來(lái)分辨 生命和死亡的區(qū)別，就像瑪麗亞的案例中一樣，瑪麗亞在孕前檢查時(shí)，發(fā)現(xiàn)有高血壓之后去了醫(yī)院檢查。她40歲了，這是她第二次懷孕?，旣悂喸趦赡昵暗谝淮螒言袝r(shí)，她在懷孕的最后幾周 感覺(jué)并不是很好，她有一點(diǎn)高血壓，但是并沒(méi)有人注意到。大家只是說(shuō)，“瑪麗亞，別擔(dān)心，你沒(méi)事的?！斑@是你第一次懷孕 所以你有一點(diǎn)緊張?！?但是情況并沒(méi)有變好。她在分娩時(shí)癲癇發(fā)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.

不過(guò)這一次她的團(tuán)隊(duì)聽(tīng)進(jìn)去了。他們?cè)儐?wèn)了一些巧妙的探索性問(wèn)題。她的醫(yī)生和她討論了 關(guān)于子癇前期的跡象和征兆，并且向她解釋如果她感到不適，她需要去醫(yī)院檢查。然后這一次瑪麗亞去了，她的醫(yī)生立刻將她送去了醫(yī)院。在醫(yī)院，醫(yī)生立刻安排了 緊急的實(shí)驗(yàn)測(cè)試。為她連上了不同的監(jiān)控器，并且認(rèn)真觀察她的血壓，胎兒心率，并且給她注射靜脈 藥物來(lái)防止痙攣。當(dāng)瑪麗亞的血壓高到 令她有中風(fēng)的風(fēng)險(xiǎn)時(shí)，她的醫(yī)生和護(hù)士立刻行動(dòng)。他們將她的血壓重復(fù)了15分鐘，然后宣布了高血壓急癥。他們根據(jù)最近的正確規(guī)程 給了她合適的靜脈注射藥物。他們作為一個(gè)合作的團(tuán)隊(duì)，工作進(jìn)展的很順利，并且成功降低了她的血壓。

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.

結(jié)果就是，一個(gè)潛在的悲劇 變成了一個(gè)成功的故事。瑪麗亞危險(xiǎn)的征兆被控制住了，并且生下了一個(gè)健康的女?huà)?。然后在瑪麗亞出院之前，她的醫(yī)生又和她討論了 子癇前期的跡象和征兆，特別是產(chǎn)后第一周 檢查血壓的重要性，并且給了她關(guān)于產(chǎn)后健康和 可能出現(xiàn)的情況的說(shuō)明。然后在接下來(lái)的幾個(gè)月里，很自然地，瑪麗亞和她的兒科醫(yī)生 進(jìn)行了幾次術(shù)后隨訪 來(lái)檢查寶寶的健康。但是一樣重要的是，她也在婦產(chǎn)科進(jìn)行了術(shù)后隨訪 來(lái)檢查她本人的健康和血壓，以及作為一名新手媽媽的 謹(jǐn)慎和憂慮。

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.

這就是貫穿整個(gè)過(guò)程的連續(xù)性 高質(zhì)量治療的樣子，這就是它應(yīng)有的效果。如果每一個(gè)社區(qū)里的每一名孕婦 都可以接受這種高質(zhì)量的治療，并且在使用標(biāo)準(zhǔn)治療 實(shí)踐的機(jī)構(gòu)里分娩，我們的產(chǎn)婦死亡率和嚴(yán)重的產(chǎn)婦 發(fā)病率將會(huì)驟然下跌。我們的國(guó)際排名再也 不會(huì)讓人覺(jué)得尷尬。

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.

但是事實(shí)是，我們 已經(jīng)有了幾十年的 高產(chǎn)婦死亡率和在分娩時(shí) 威脅生命的并發(fā)癥高發(fā)率，以及幾十年來(lái)母親、嬰兒 和家庭的毀滅性后果，我們并沒(méi)有任何實(shí)質(zhì)性行動(dòng)。

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?

最近媒體對(duì)我們?cè)?產(chǎn)婦死亡率上表現(xiàn)不佳的關(guān)注 已經(jīng)幫助公眾來(lái)了解： 高質(zhì)量的產(chǎn)婦醫(yī)療是伸手可及的。問(wèn)題則是： 我們的社會(huì)是否準(zhǔn)備好 從每一個(gè)社區(qū)開(kāi)始重視孕婦？

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.

對(duì)我來(lái)說(shuō)，我做了一切來(lái) 確保當(dāng)我們開(kāi)始做了，我們已經(jīng)準(zhǔn)備好了 技術(shù)和證據(jù)基礎(chǔ) 繼續(xù)前進(jìn)。

15:09

Thank you.

謝謝大家。

15:10

(Applause)

（鼓掌）