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| Painless labor pains: the lack of power in public hospitals is expensive |
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| Author：中国铭铉 企划部 Release Time：2017-9-14 10:42:48 Number Browse：989 |
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On September 13, the medical network charged a low fee, used less medicine, and the anesthesiologist lacked the low penetration rate of painless childbirth in public hospitals, while private hospitals were expensive and weak. Under the public and private, the maternal dilemma.
The tragedy of yulin puerpera, let painless childbirth widely discuss. Yin yuzhu, an obstetrician and gynecologist who has worked in the industry for 20 years, is impressed by the lack of awareness and even bias in China's pain.
Unlike other obstetricians and gynaecologists, yu-zhu Yin has two titles: the third affiliated hospital of zhongshan university, deputy director of the maternity and deep implication byrne, deputy director of the center for international maternity is a public hospital, the latter is private medical institutions. Yin yuzhu, a multi-point practitioner, admitted that the two hospitals' environmental, service, charging and patient needs are different, but the common "problem" is that the penetration rate of painless childbirth is too low.
Painless labor has a long history, and the world's first labor and pain has been around for more than 170 years. The famous queen Victoria gave birth to a young prince in 1835 without any pain. Until more than 30 years ago, painless childbirth became a mature medical technology in Europe and the United States.
But in China, due to a lack of anesthesiologists, a lack of anesthesiologists for 24 hours in the delivery room leads to difficulties in the delivery of painless labor in public hospitals. In addition, due to the low birth insurance quota, once the use of painless birth, the use of insurance quota, will result in the insurance coverage, limited the promotion of painless childbirth; The lack of medical education in the public is affected by some traditional ideas, which can affect the safety of pregnant women and the fetus and make it difficult to popularize painless labor.
In recent years, private maternity hospitals have gradually emerged, with high-end hardware, complete teams and 24-hour service to compete with public hospitals. But private hospital painless childbirth is expensive, and medical quality, reliability is uneven, brand building, patient drainage is still in the climbing stage.
Technological maturity is not for everyone
Pain is the most intuitive impression of natural childbirth, and may also be one of the main causes of the mother's choice to end her life.
How much does natural childbirth really hurt? Song xingrong, director of the anesthesiology department of guangzhou women's and children's medical center, said the pain was 0-10, and the late-stage refractory cancer index was 10. "The pain index of natural childbirth is 9.7 to 9.8, which is probably the most intense pain that most women have experienced in their lifetime."
The Chinese medical association has also made statistics, with 6 percent of first-time mothers experiencing mild pain, about 50 percent of first-time mothers experiencing significant pain, and about 44 percent of first-time mothers feel pain and pain and even "pain."
In Yin's view, the hidden dangers of pain have not been noticed but cannot be ignored. "Childbirth pain can lead to a series of neuroendocrine reactions, which can cause blood vessels to contract, blood flow to the placenta, acidosis, and even psychological trauma and postpartum depression," she said.
Pain gave birth to painless labor. The medical technical term for painless childbirth is called analgesic pain, which is one of the hallmarks of modern obstetrics and gynecology that reduces or avoids childbirth pain in various ways.
"Epidural Chinese line" the originator beautiful girl group of people such as mentioned in a paper published in 2013 and 1959 have reported about acupuncture analgesia childbirth, now the Beijing university school of medicine in 1964 the first affiliated hospital guang-bo zhang reported on the first national conference on anesthesia, adopting low concentrations of local anesthetics for epidural, than in 1953 the British use of late childbirth analgesia for over 100 years.
Song was divided into non-drug and drug methods. Among them, non-pharmacological methods include psycho-prophylactic labor analgesic, hypnosis, acupuncture analgesic nerve stimulation, labor analgesic instrument, auricular pressure method, etc., and the pain rate is 10% to 25%.
Drug method contains analgesic tramadol, demerol, stability and general anesthetics nitrous oxide, sodium thiopental, ketamine, regional analgesia of epidural anesthesia, waist hard joint anesthesia, sacral canal anesthesia, pudendal nerve blockade, analgesia effectively reach or exceed 50%. The analgesic analgesia in the mainstream of the present labor analgesia is more than 95 %.
Guangzhou attending physician should be the first people's hospital of anesthesiology YanLu told reporters: the 21st century economic report "not entirely painless painless childbirth, can feel contractions during production, can also be normal, but at least by 85% of the pain. Domestic painless labor intervention time is at the mouth of the two fingers, but international, as long as the woman has regular contractions, to a certain degree of pain can be carried out.
However, not all mothers are suitable for painless births.
Yin yuzhu pointed out that the following conditions can not be used for the analgesia in the spinal canal: the coagulation disorder caused by various causes; Severe spinal deformity or some lumbar surgery; There is a local infection; Have a history of allergy to anesthesia; The expectant mother could not cooperate with the operation due to her nervousness.
"Some women have pain, but the palace is not open, the contractions are irregular, the contractions may be fake, and the premature use of the contractions may inhibit the contractions." She reminded.
Public hospitals: anesthesiologists are underpowered and underpowered
Despite the benefits, in public hospitals, women are often "lucky" to demand painless labor.
21st century economic report reporter interviewed four in 3 armour hospital childbirth puerpera, they share a common experience: early decision to do an epidural, also confirmed that her hospital obstetrics can provide an epidural, but into the delivery room was told, not be able to use!
According to song xingrong, the decision whether to use painless labor is divided into a few steps: after the regular contractions, the delivery of painless labor requirements to the obstetric nurses and midwives; The midwife informs the obstetrician about the feasibility of the assessment; If the assessment is feasible, the midwife notifies the anesthesiologist to re-evaluate (mainly check for contraindications); After the assessment is completed, the woman who can give birth without pain will sign an informed consent to anesthesia.
The anesthesiologist was critical, and miss gao, who had her first child at the end of 2014, did not wait to assess the process: "at the time, public hospitals were more reliable and had been asked to give birth without pain. Who knows that there were two anesthesiologists in that room, and one of them just took a leave of absence on that day, and there was no way to give birth without pain."
Miss Chen, who just became a mother in August, was directly rejected by her doctor: "the number of painless childbirth in the hospital is exhausted."
There are also mothers who have the opposite situation. Guangzhou women and children health care center of introduction, the institute adopts epidural, since 2005 in September 2010, large-scale, epidurals around 70%, epidural newborns up to about 6000 a year.
Delivery of a tertiary hospital in Beijing ms soon using epidural pain, "could be a tertiary hospital maternal quantity is not as much as the top, there are many hospitals provide only working days 8 hours of epidural, but women can't control when it is born."
There is no authoritative statistics on the use of painless births at home, but a widely cited statistic is that more than 85 percent of the U.S. and more than 90 percent of women in the UK are in pain. Hospital births in tertiary hospitals accounted for only 16 per cent of births, while secondary hospitals were 1 per cent.
For a very low penetration rate, most people point to a shortage of anesthesiologists.
Should YanLu tells a reporter, the requirements of the doctor is in cooperation with epidural anesthesia analgesic interventions in time, in the maternal epidural space into a thin catheter, connect a machine continues to pump injection anesthetic, and according to the different maternal labor adjust the dose of drug.
But in recent years, each big hospital for surge, anesthesia doctor shortage of more and more obvious, plus intervention operation, painless endoscopy and epidural quantity increase, the surgery anesthesia needs more and more, outdoor "excessive workload is domestic most of the present situation of the anesthesiologist, not over the surgery, overtime." She said.
The lack of spending makes public hospitals less motivated to promote painless labor.
Yu-zhu Yin to reporters calculated brushstroke zhang, the public hospital for women with doctors, midwives, nurses, tour if you want to use an epidural, still have to increase an anesthesiologist, medical consumables including puncture bag, needle, catheter, and anesthesia and analgesia pump, cost, according to the purchasing floating of hospitals, some purchasing cost nearly one thousand yuan.
But painless birth rates are low. Reporters have learned that the total cost of painless labor is about 1,500 yuan to 2,500 yuan, depending on the time of delivery.
"The caesarean section is not very expensive, but it can be done in a few hours, and it can take up to a dozen hours without pain. At the policy level, the country has taken the painless labor into maternity insurance, but it also has a large share of maternity insurance, which leads to excessive insurance coverage, "Yin said.
Private hospitals: expensive brands
It is also one of the choices for women to go to private hospitals for painless delivery.
"Public hospitals can provide basic health services, personalized, do women single, alone with the medical team, such as childbirth one guard often cannot provide," yu-zhu Yin said, "but in addition to general medical needs, delivery part of this is the service demand, this will bring opportunities to the private medical institutions, can do high-end services."
"In general, public hospitals handle critical situations and difficult diseases with strong medical skills, but poor service and environmental conditions." The "missing" painless childbirth puerpera miss gao second choice to civilian battalion hospital, "the environment and the service is good, but the price is higher, and we want to reconfirm or recommended by acquaintances will choose private hospitals."
The painless childbirth in private hospitals is usually included in the natural childbirth plan, depending on the type of service. With aibo international maternity center as an example, 4 days 3 night's natural birth plans including natural birth and the date 3 night hospital fees, according to the warm type to the luxury to enjoy type package, price 53000 yuan to 53000 yuan.
Yu-zhu Yin said: "hardware, personnel, civilian battalion hospital is the foundation of the service to do a guarantee, but also need to personnel quality, process, quality control, rules and regulations to follow, to ensure service effect, ultimately rely on medical service quality to make a profit."
However, public hospitals are plagued by talent, and private hospitals are unable to avoid it, even extending wage wars.
United family medical founder and CEO lipson earlier told reporters that a lot of new medical institutions by higher wages to attract talent, but the wages not necessarily in line with the industry status quo, ultimately unsustainable.
In addition, the private maternity hospital is mostly in the long-term, the national chain is relatively few, the entry players are increasing.
According to pricewaterhousecoopers released "2012-2016 hospital merger and acquisition activity review and outlook in China, women and children's hospital of domestic investment trading amount from 719 million yuan in 2013 to bluff type after falling to $2014 in 28 million, began to recover in 2015 to 2015 yuan, and seen explosive growth in 2016, the transaction amount is 2.111 billion yuan.
"Private hospitals have not yet been developed, and there has been a lot of negative information in the previous decades, so the whole environment and image is still being reshaped. With higher rates for private hospitals, patients have higher expectations, and how to survive ultimately depends on quality, service and environment. "Yin said.
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