Data shows that at present, the average prevalence rate of labor analgesia in China is about 30%. The shortage of anesthesiologists and midwives, unclear charging standards and other factors hinder the further promotion of labor analgesia, making many women still face this unbearable pain.
investigation
Increased prevalence of labor analgesia
But it is still low
Natural delivery or cesarean section? The reporter from "Xinhua Viewpoint" found that the rate of cesarean section in some areas was still high, and even up to 85% in some areas. In recent years, with the popularization of childbirth knowledge, more and more people will choose natural childbirth. However, the pain of natural birth does make many girls continue to choose cesarean section.
It is understood that the so-called painless delivery is actually labor analgesia, which refers to reducing the pain and adverse stress reaction of pregnant women during delivery through the application of appropriate analgesia technology and analgesic drugs or psychotherapy, so that the fetus can be delivered smoothly.
Qu Yuan, chief physician of the Department of Anesthesiology of Peking University First Hospital, is also a mother. She has personally experienced the tangible benefits of labor analgesia, "which can make more women more dignified and more appropriate to become mothers".
In November 2018, the National Health Commission issued the Notice on Carrying out Pilot Work of Delivery Analgesia. In March 2019, 913 hospitals became the first batch of national delivery analgesia pilot hospitals. According to Mi Weidong, the leader of the expert working group for labor analgesia pilot of the National Health Commission, the prevalence of painless childbirth in these pilot hospitals was about 27.5% by the end of 2017, and after three years of efforts, it reached 53.2% by the end of 2020.
Chen Xinzhong, vice president of the Affiliated Obstetrics and Gynecology Hospital of Zhejiang University School of Medicine, said that the advantages of labor analgesia need to be vigorously publicized a few years ago, and now more and more mothers are actively asking for labor analgesia.
Pain relief in childbirth enables more women to have confidence and physical strength to deliver naturally, and no longer blindly choose cesarean section. Chen Danqing, director of obstetrics department of Zhejiang University Women's Hospital, said that the promotion of labor analgesia has reduced the cesarean section rate of the hospital by about 10 percent.
"In the past, people had some wrong perceptions that anesthesia would affect children's intelligence, leading to maternal memory decline, insufficient milk, etc. Through science popularization in recent years, these statements have become 'past tense', and delivery analgesia has become the first choice for doctors, mothers, and family members." Chen Xinzhong said that about 70% of the hospital's mothers who gave birth naturally will choose delivery analgesia methods.
During the two sessions this year, Huang Yuguang, a professor of Peking Union Medical College Hospital, mentioned that at present, the average prevalence of labor analgesia in China is about 30%. Although this data has greatly improved compared with the national average of less than 10% in 2018, compared with the proportion of 80% to 90% in developed countries, China's penetration rate is still low. At the same time, there are significant differences between the east and the west, as well as between different regions in the same province.
According to the reporter's investigation, the analgesic rate of drug delivery in a third class hospital in Hangzhou in 2020 will be about 45%. The survey of Beijing Ivy Painless Delivery Grass roots Public Welfare Project on 30 hospitals in 10 cities in Inner Mongolia Autonomous Region shows that the average labor analgesia rate in 2021 has increased from 18% in 2018 to 24%, but half of the hospitals are still less than 10%.
Probing into causes
Lack of relevant doctors
Unclear charging standards make it difficult to promote
Many interviewed experts said that the promotion of labor analgesia is still facing some difficulties. The first is the shortage of anesthesiologists and midwives. Mi Weidong believes that the first difficulty in the promotion of labor analgesia is the lack of personnel, especially anesthesiologists.
According to the statistics of the Anesthesiologist Branch of the Chinese Medical Doctor Association in June 2019, the number of anesthesiologists in China is 92000, with an average of 0.6 anesthesiologists per 10000 people, while the average number of anesthesiologists (or anesthesiologists) per 10000 people in developed countries is 2.5 to 3.
In recent years, the demand for anesthesia in China's medical care has continued to rise, and the workload of anesthesia has increased sharply. The demand for painless gastroscopy in the country every year has reached hundreds of millions of people. At the same time, the number of various operations is also increasing at an annual rate of 10%. Although the number of anesthesiologists is increasing, it is still not enough to support the demand for clinical anesthesia.
In addition to drug analgesia, other non drug analgesia methods such as Lamaze breathing method, acupoint massage, aromatherapy, etc. are mainly implemented by midwives, and the shortage of midwives has become another obstacle to the promotion of labor analgesia.
Yin Ling, the chief physician in obstetrics and gynecology of Peking University First Hospital, visited Guangyuan, Sichuan Province, and found that a local hospital did not even have a midwife. Because of the blind choice of cesarean section in the past, many midwives and obstetricians' midwifery techniques have seriously deteriorated.
In addition, Qu Yuan mentioned that the difficulty in promoting labor analgesia is not in technology, but in the way of cross department collaboration. "This is not a department of anesthesiology. It needs the cooperation of obstetrics, neonatology and other departments, as well as management coordination and policy support."
Before making the decision to promote labor analgesia in 2020, the second affiliated hospital of Baotou Medical College of Inner Mongolia University of Science and Technology had a labor analgesia rate of only about 10%, while in 2021 the rate would reach about 60%. Dean Dang Tong said that reasonable benefit distribution is a key step. In the past, the bonus for labor analgesia in the hospital was all allocated to the department of anesthesia. Now, the hospital distributes the bonus equally to the department of obstetrics and anesthesia; At the same time, the bonus will not be redistributed within the department, but will be directly distributed to individual doctors who perform labor analgesia.
The reporter found that the imperfect charging policy also affected the promotion of labor analgesia to a certain extent. It is understood that labor analgesia takes longer and is more technically difficult than ordinary intraspinal anesthesia. However, many provinces, autonomous regions and cities have not yet introduced special charging standards for labor analgesia. Hospitals can only charge according to the standards for intraspinal anesthesia, which does not fully reflect the labor and technical efforts of medical personnel, affecting the enthusiasm of medical personnel.
"The situation in many provinces and cities shows that if the charging standards are well implemented, the proportion of labor analgesia will rise to varying degrees," said Mi Weidong.
expert
Make labor analgesia more popular
Relieve the pain of female fertility
Many experts said that at present, China's labor analgesia technology is very mature, with strong analgesia and high safety factor. The mainstream intraspinal block labor analgesia can help most mothers reduce pain by 60% to 90%, and has a wide range of applications. It can be used by the vast majority of mothers who are evaluated qualified by the obstetrics and anesthesiology departments.
"The anesthetics used for labor analgesia do not go through blood, but take effect through nerve block, and the amount of anesthetics used for labor analgesia is very small, only about one tenth of that of cesarean section, so the impact on the fetus can be said to be minimal, and the safety is very high." Qu Yuan said.
Facing the "shortage of anesthesiologists" in the hospital, Mi Weidong said that it is necessary to accelerate the improvement of the training mechanism of anesthesiologists and attract more young talents to join the field of anesthesiology. At the same time, anesthesiologists should strengthen the learning and updating of labor analgesia knowledge, understand and master new technologies in the field of labor analgesia, develop and expand new drugs and equipment for anesthesia, and improve anesthesia management, Improve the efficiency of anesthesia medical services.
Chen Xinzhong suggested that the number of anesthesiologists and midwives in general hospitals should be increased at present, and a collaborative team led by anesthesiologists, composed of obstetricians, midwives and anesthesiologists should be established. As a service provider, hospitals should think about how to expand their service capacity. At the same time, it is necessary to continue to correct the concept of cesarean section in basic medical institutions.
Li Fang, deputy director of the Talent Exchange Service Center of the National Health Commission, said that at present, Tianjin, Beijing, Hunan, Chongqing, Hubei, Liaoning and other places have clearly issued special charging standards for labor analgesia. With the introduction of charging standards in various provinces, districts and cities, it will further promote the popularization of labor analgesia in China. Hospitals should pay attention to it and provide more than economic support for departments related to labor analgesia. "The promotion of labor analgesia is a kind of medical treatment with temperature and dignity, and it reflects the progress of China's medical philosophy," said Li Fang. This group article/Xinhua News Agency
