美国国家公共电台 NPR Twin's Difficult Birth Put A Project Designed To Reduce C-Sections To The Test

 

SCOTT SIMON, HOST:

Women in the United States are more likely to die from childbirth complications than in other developed countries, and the problem's getting worse. One way to stop the deaths is to do fewer C-sections. Martha Bebinger at WBUR in Boston visited a hospital where two women recently died after C-sections. Investigators¹ found no evidence of substandard care, but it spurred South Shore Hospital to make a big change.

MARTHA BEBINGER, BYLINE²: Melisa McDougall is propped³ up in bed, her blonde hair pulled into a neat bun, makeup⁴ still fresh, when her obstetrician drops in.

RUTH LEVESQUE: How are you? You're going to have babies today. Are you excited?

SHAUN MCDOUGALL: Yes. I can't wait.

BEBINGER: Dr. Ruth Levesque says babies because Melisa McDougall is having twins. The boy they've named Brady is head down, ready for a normal vaginal delivery. But brother Bryce is horizontal across the top of Melisa's uterus. That's one reason Melisa might need a C-section. And there's another, says Dr. Levesque - Melisa's last birth was by Cesarean.

LEVESQUE: She has a scar on her uterus, and we've talked about this before, that there's a risk of the uterus opening on that previous site, so there's a risk of uterine rupture⁵ - very rare but there's always a possibility.

BEBINGER: But McDougall, who's 37, wants vaginal deliveries for both boys.

MELISA MCDOUGALL: I just feel like it's better for the kids, better for the babies.

BEBINGER: C-sections can save lives, but they can also lead to blood loss and other severe complications. About half of C-sections are considered avoidable. That's why South Shore Hospital turned to a new system called the Team Birth Project. It's led by Dr. Neel Shah. He says that often during childbirth, it's pretty clear which moms are in active labor⁶ and poised⁷ for a vaginal delivery and which moms must have a C-section.

NEEL SHAH: And then there's this huge gray zone and actually everything about the Team Birth Project is about solving for the gray.

BEBINGER: To avoid unnecessary C-sections when what to do is not clear, this hospital has changed labor and delivery from start to finish. Women are not admitted until they're in active labor. Moms help guide the labor team, and they work together to map the delivery plan on a white board.

LEVESQUE: Should we fill out stuff on our board to make sure we're being thorough of things? Team - that's all of us.

BEBINGER: Dr. Levesque, Melisa, her husband, Shaun McDougall, and their nurses will update the board with Melisa's blood pressure, her medications and the baby's heart rates. Melisa, her labor and the babies are tracked as distinct moving parts during this delivery.

LEVESQUE: Melisa, specific things besides babies your chest, Shaun helping⁸ with delivery, other specific things that are important to you guys?

BEBINGER: Levesque writes it all down with a green marker.

LEVESQUE: So I'm going to write that - so skin to skin, epidural.

BEBINGER: Melisa's doctors insisted she get an epidural. She'll need the pain relief if they have to turn a twin inside her uterus or for a C-section. Seven hours into labor, after many conversations with the team and notes added and erased⁹ on the board, Melisa asks for that epidural.

UNIDENTIFIED PERSON #1: So we're in at 17:12.

BEBINGER: And less than an hour later, nurses rush her into an operating room to push.

LEVESQUE: OK. Are you ready? Grab this hand for me. Ready? Curl down. Push like heck.

BEBINGER: Bent¹⁰ nearly in half, her face beet¹¹ red, Melisa strains for five pushes. She throws up and gets right back to it. Then he's crowning.

S MCDOUGALL: Oh, my goodness, Brady.

BRADY MCDOUGALL: (Crying).

BEBINGER: Shaun steps back, weeping. Levesque reaches into Melisa's uterus for the second baby, but he's still sideways.

UNIDENTIFIED PERSON #2: That's a hand.

LEVESQUE: Yeah. All I got is hands.

BEBINGER: Dr. Terri Marino, a high-risk specialist who has more experience with transverse babies, asks to try. Levesque moves to Melisa's side and uses her forearm to push down. At least six doctors and nurses encircle Melisa. Shaun frowns.

S MCDOUGALL: Babe, are you OK? OK.

BEBINGER: Melisa nods, but there's still no sign of a foot.

LEVESQUE: Want me to hold it down?

TERRI MARINO: Open the table.

LEVESQUE: It's open.

UNIDENTIFIED PERSON #3: Can you see what I have?

BEBINGER: The table, meaning the array of surgical¹² instruments Marino will need for a C-section. Then Marino asks me to stop recording¹³ so she can focus and make one last attempt to avoid a C-section. For 30 seconds, the room is quiet while Dr. Marino twists her arm this way and that. Shaun bites his lip. Then there's Marino's gloved, bloodied¹⁴ hand clenching¹⁵ two teensy legs.

S MCDOUGALL: Oh, babe, here he comes. Here he comes, babe. Here he comes.

UNIDENTIFIED PERSON #4: Good boy.

BEBINGER: Outside the OR, Marino says most doctors would have delivered the second baby, Bryce, by C-section, but the McDougalls happened to choose a hospital committed to fewer C-sections and a doctor who could handle more challenging deliveries.

MARINO: They specifically wanted to have vaginal delivery of both babies.

BEBINGER: And are you thinking that in that moment...

MARINO: Yep.

BEBINGER: ...As you're searching for them?

MARINO: Absolutely.

BEBINGER: Bryce was fine, says Marino, so the deciding factor was that Shaun and Melisa did not panic.

MARINO: They did not flinch¹⁶. They were like, keep going, because sometimes patients say stop, and then you have - you stop.

BEBINGER: Shaun almost did, but he says that feeling that he and Melisa were part of the team made a difference.

S MCDOUGALL: I think it made us more comfortable, that we trusted the decisions that they were making.

UNIDENTIFIED PERSON #5: OK, hold on, hold on.

BEBINGER: Now, 30 minutes after this unusual birth, Melisa is nursing Brady and FaceTiming with the in-laws.

M MCDOUGALL: Hey, Pa.

UNIDENTIFIED PERSON #6: I'm proud of you.

M MCDOUGALL: Thank you.

UNIDENTIFIED PERSON #6: Good job. They're beautiful.

BEBINGER: South Shore Hospital began using the Team Birth approach in the spring and is on track to perform almost 50 fewer C-sections this year as compared to last. For NPR News, I'm Martha Bebinger in Boston.

(SOUNDBITE OF MAEVE GILCHRIST AND VIKTOR KRAUSS' "VIGNETTE")

SIMON: This story is part of a reporting partnership¹⁷ with NPR, WBUR, and Kaiser Health News.

1 investigators   

n.调查者，审查者( investigator的名词复数 )

参考例句：

• This memo could be the smoking gun that investigators have been looking for. 这份备忘录可能是调查人员一直在寻找的证据。
• The team consisted of six investigators and two secretaries. 这个团队由六个调查人员和两个秘书组成。 来自《简明英汉词典》

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 propped   

支撑，支持，维持( prop的过去式和过去分词 )

参考例句：

• He sat propped up in the bed by pillows. 他靠着枕头坐在床上。
• This fence should be propped up. 这栅栏该用东西支一支。

4 makeup   

n.组织；性格；化装品

参考例句：

• Those who failed the exam take a makeup exam.这次考试不及格的人必须参加补考。
• Do you think her beauty could makeup for her stupidity?你认为她的美丽能弥补她的愚蠢吗？

5 rupture   

n.破裂；(关系的)决裂；v.(使)破裂

参考例句：

• I can rupture a rule for a friend.我可以为朋友破一次例。
• The rupture of a blood vessel usually cause the mark of a bruise.血管的突然破裂往往会造成外伤的痕迹。

6 labor   

n.劳动，努力，工作，劳工；分娩；vi.劳动，努力，苦干；vt.详细分析；麻烦

参考例句：

• We are never late in satisfying him for his labor.我们从不延误付给他劳动报酬。
• He was completely spent after two weeks of hard labor.艰苦劳动两周后，他已经疲惫不堪了。

7 poised   

a.摆好姿势不动的

参考例句：

• The hawk poised in mid-air ready to swoop. 老鹰在半空中盘旋，准备俯冲。
• Tina was tense, her hand poised over the telephone. 蒂娜心情紧张，手悬在电话机上。

8 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。

9 erased   

v.擦掉( erase的过去式和过去分词 )；抹去；清除

参考例句：

• He erased the wrong answer and wrote in the right one. 他擦去了错误答案，写上了正确答案。 来自《简明英汉词典》
• He removed the dogmatism from politics; he erased the party line. 他根除了政治中的教条主义，消除了政党界限。 来自《简明英汉词典》

10 bent   

n.爱好，癖好；adj.弯的；决心的，一心的

参考例句：

• He was fully bent upon the project.他一心扑在这项计划上。
• We bent over backward to help them.我们尽了最大努力帮助他们。

11 beet   

n.甜菜；甜菜根

参考例句：

• He farmed his pickers to work in the beet fields. 他出租他的摘棉工去甜菜地里干活。
• The sugar beet is an entirely different kind of plant.糖用甜菜是一种完全不同的作物。

12 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

13 recording   

n.录音，记录

参考例句：

• How long will the recording of the song take?录下这首歌得花多少时间？
• I want to play you a recording of the rehearsal.我想给你放一下彩排的录像。

14 bloodied   

v.血污的( bloody的过去式和过去分词 )；流血的；屠杀的；残忍的

参考例句：

• his bruised and bloodied nose 他沾满血的青肿的鼻子
• His pants leg was torn and bloodied when he fell. 他跌交时裤腿破了，还染上了血。 来自辞典例句

15 clenching   

v.紧握，抓紧，咬紧( clench的现在分词 )

参考例句：

• I'll never get used to them, she thought, clenching her fists. 我永远也看不惯这些家伙，她握紧双拳，心里想。 来自飘（部分）
• Clenching her lips, she nodded. 她紧闭着嘴唇，点点头。 来自辞典例句

16 flinch   

v.畏缩，退缩

参考例句：

• She won't flinch from speaking her mind.她不会讳言自己的想法。
• We will never flinch from difficulties.我们面对困难决不退缩。

17 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。