Survey
Pain relief in labor and delivery increased in popularity
But still at a low level
According to the understanding, we often say that painless labor and delivery is in fact labor and delivery analgesia, refers to the application of appropriate analgesic technology and analgesic medication or psychotherapy to reduce the pain and adverse stress reactions during labor and delivery of the fetus smoothly.
Qu Yuan, chief physician of the Department of Anesthesiology at Peking University First Hospital, who is also a mother, has personally experienced the tangible benefits of labor analgesia, which "allows more women to become mothers in a more dignified and decent manner."
In November 2018, the National Health and Wellness Commission (NHSC) issued the Notice on the Pilot Work of Analgesia in Childbirth.In March 2019, 913 hospitals became the first batch of national pilot hospitals for analgesia in childbirth. According to Mi Weidong, head of the National Health Commission's Pilot Expert Working Group on Analgesia in Childbirth, the prevalence rate of painless childbirth in these pilot hospitals was about 27.5% at the end of 2017, and reached 53.2% at the end of 2020 after three years of efforts.
Chen Xinzhong, vice president of the Obstetrics and Gynecology Hospital affiliated with Zhejiang University School of Medicine, said that in the first few years it was necessary to vigorously publicize the advantages of analgesia in childbirth, and now more and more mothers are taking the initiative to request the use of analgesia in childbirth.
Labor analgesia allows more women to have confidence and physical strength to give birth, no longer blindly choose cesarean section. Chen Danqing, director of the Department of Obstetrics at Zhejiang University Women's Hospital, said that the promotion of labor analgesia has reduced the cesarean section rate in the hospital by about ten percentage points.
"In the past, people have some wrong perceptions, that anesthesia will affect the child's intelligence, leading to maternal memory loss, lack of milk, etc., through the popularization of science in the past few years, these statements have become the 'past time', labor analgesia has become the preferred choice of doctors, mothers, and families. " Chen Xinzhong said, the hospital about 70% of natural birth of women will choose labor analgesia method.
During the two sessions this year, Huang Yuguang, a professor at Peking Union Medical College (PUMC) Hospital, mentioned that the average labor analgesia prevalence rate in China is currently about 30%. Although this data has been greatly improved compared to the national average of less than 10% in 2018, but compared to the proportion of 80% to 90% in developed countries, China's prevalence rate is still on the low side, and at the same time, the difference between the east and the west is significant, and there are obvious differences in different areas of the same province.
Probe
Shortage of related physicians
Charging standard is not clear to the promotion of difficult
A number of experts interviewed said that the promotion of analgesia in labor is still facing a number of dilemmas. The first is the shortage of anesthesiologists and midwives. According to Mi Weidong, the first difficulty in the promotion of analgesia is the lack of personnel, especially the shortage of anesthesiologists.
According to the June 2019 statistics of the Anesthesiology Physicians Branch of the Chinese Medical Doctors Association, the number of anesthesiologists in China is 92,000, with an average of 0.6 anesthesiologists per 10,000 people, while developed countries are able to provide an average of 2.5 to 3 anesthesiologists (or anesthesia practitioners) per 10,000 people.
In recent years, China's medical demand for anesthesia has continued to rise, the anesthesia workload has increased dramatically, the national annual demand for painless gastroenteroscopy reached hundreds of millions of times, while the number of various types of surgery is also increasing at a rate of 10% per year, although the number of anesthesiologists is increasing, but it is still not enough to support the demand for clinical anesthesia.
In addition to pharmacological analgesia, other non-pharmacological means of analgesia, such as Lamaze breathing, acupressure, aromatherapy, etc., mainly rely on the implementation of midwives, and the shortage of midwives has become another constraint on the promotion of analgesia in labor.
Yin Ling, chief physician of the Department of Obstetrics and Gynecology at the First Hospital of Peking University, found in Guangyuan, Sichuan Province, that a local hospital did not even have a midwife, because many midwives and obstetricians have been seriously degraded in their midwifery skills due to the blind choice of cesarean section.
In addition, Qu Yuan mentioned that the current difficulty in promoting analgesia in labor is not in the technology, but in the way of interdepartmental collaboration. "This is not a matter for one department of anesthesiology, but requires multidisciplinary collaboration between obstetrics, neonatology, and other departments, as well as management coordination and policy support."
Before the determination to promote labor analgesia in 2020, the rate of labor analgesia in the Second Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology was only about 10%, while in 2021 the rate reached about 60%. According to Dang Tong, the director of the hospital, a reasonable distribution of benefits is a key step. In the past, the hospital to carry out labor analgesia bonus all to the anesthesiology department, now the hospital will be equally distributed to the obstetrics and anesthesiology department; at the same time, the department is no longer within the secondary distribution of this bonus, but directly to the implementation of labor analgesia physician individual.
"The situation in many provinces and cities shows that if the charges are well implemented, the proportion of labor analgesia will rise to varying degrees." Mi Weidong said.
Experts
Let labor analgesia further popularize
Solve the pain of women's childbirth
A number of experts said that at present, China's labor analgesia technology is very mature, analgesic strong, high safety coefficient, the more mainstream intrathecal block labor analgesia can help most of the mothers to reduce the pain by 60% to 90%, and the scope of application is very wide, the vast majority of mothers who have qualified for the evaluation of obstetrics and anesthesiology department, the majority of mothers who have qualified for the evaluation of obstetrics and anesthesiology department. The vast majority of women who are evaluated by obstetricians and anesthesiologists can use it.
"The anesthetic drugs used for labor analgesia are not through the bloodstream, but work through nerve block, and labor analgesia anesthesia is a very small amount of medication, only about one-tenth of a cesarean section, and the effect on the fetus can be said to be minimal, the safety is very high." Qu Yuan said.
In the face of the hospital's "anesthesiologist shortage", Mi Weidong said that the need to accelerate the improvement of anesthesiologist training mechanism, to attract more young people to join the field of anesthesiology, at the same time, anesthesiologists should strengthen the study of knowledge of labor analgesia and updating, to understand the grasp of the field of new technologies in the field of labor analgesia, the development and expansion of the new anesthesia drug At the same time, anesthesiologists should strengthen the learning and updating of knowledge about labor analgesia, understand the new technology in labor analgesia, develop and expand new anesthetic drugs and equipments, improve anesthetic management, and improve the efficiency of anesthetic medical services.
Chen Xinzhong suggests increasing the manpower of anesthesiologists and midwives in general hospitals, establishing collaborative teams led by anesthesiologists and consisting of obstetricians, midwives, and nurse anesthetists, and hospitals, as a service provider, should think about how to expand their service capacity, and at the same time, it is necessary to continue to correct the cesarean section concepts of the primary healthcare institutions.
Li Fang, deputy director of the Talent Exchange Service Center of the National Health Commission, introduced that Tianjin, Beijing, Hunan, Chongqing, Hubei, Liaoning and other places have clearly issued a special fee for analgesia in childbirth, and with the introduction of provincial and municipal fee standards one after another, it will further promote the popularity of analgesia in childbirth in China. The hospital side should pay attention to it and provide more than just financial support to the departments related to labor analgesia. "The promotion of labor analgesia is medical treatment with temperature and dignity, which is a reflection of the progress of China's medical concept." Li Fang said. This group article/Xinhua News Agency