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美国国家公共电台 NPR To Keep Women From Dying In Childbirth, Look To California

时间:2018-07-31 02:27:01

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(单词翻译)

 

RENEE MONTAGNE, HOST:

And for more than a year now, we've been bringing you stories about a disturbing national trend. For an American mother, giving birth can be fatal. She is three times more likely to die than a woman in Britain or Canada. This morning's story, wrapping up our NPR-ProPublica series Lost Mothers, offers some good news - how one state, California, bucked1 that trend beginning in 2006 when public health officials there realized they had a big problem on their hands. Debra Bingham is a registered nurse. She was working on her doctorate2 in public health when she was invited to a meeting where officials unveiled a startling statistic3. The rate of California women dying in childbirth had recently doubled.

DEBRA BINGHAM: Oh, it was unexpected and disturbing - very disturbing.

MONTAGNE: What it did, though, was shock the state into action.

BINGHAM: We needed to understand and really dig into why.

MONTAGNE: Soon, Debra Bingham was tasked with bringing together major players - nurses, doctors, midwives, hospital administrators4. They would go on to launch a massive, statewide effort to keep as many mothers as possible alive. A co-founder of California's Maternal5 Quality Care Collaborative was Elliot Main, a professor of obstetrics and gynecology at Stanford. He says they were able to access, for the first time, details on how every mother had died over the previous five years.

ELLIOT MAIN: We began reviewing cases. And it became very clear that there were cases in which - if care had been performed differently, there would have been a high likelihood of better outcomes.

MONTAGNE: They discovered that two well-known complications stood out, offering the best opportunity for saving mothers - hemorrhage and the pregnancy7-induced high blood pressure called pre-eclampsia. Dr. Main estimated that the vast majority of deaths from those two complications could be prevented not with a magic pill or new high tech equipment but with early recognition, teamwork and a list of well-rehearsed treatments. It would be the equivalent of instituting a Code Blue for, say, obstetric hemorrhages.

MAIN: The analogy would be if you had a cardiac arrest, and everybody had their own way of doing CPR. We've made big advances in emergency care by having some basic standardized8 approaches to emergencies. And that's what we're bringing to maternity9 care now.

MONTAGNE: And that's what brought me to Pomona Valley Hospital Medical Center. What it's been doing as a member of the collaborative illustrates11 how California has been able to cut its rate of maternal deaths to a third of the national average. It's about an hour east of Los Angeles and is one of the top birthing centers in the state. Seven thousand babies are born here each year. Obstetrician Maria Helen Rodriguez is the medical director of maternal fetal medicine and happy to show me around.

MARIA HELEN RODRIGUEZ: Today, we're going to take a look at some of the measures that we have taken here at Pomona Valley Hospital to improve the outcomes of women in terms of our approach to obstetrical hemorrhage. Of course, every single woman is at risk for hemorrhage if they're going to deliver.

MONTAGNE: That idea that all mothers are vulnerable is a new kind of thinking here. The longstanding belief among medical professionals and mothers is that when giving birth, everything will be OK. And it mostly is. But being prepared for the worst is key to saving mothers.

RODRIGUEZ: You know, I always look at how - you know, with race cars, how they have the pit stop. And you have those 10 or 12 people come together to perform about 90 or 100 tasks. And they have to do it under 12 seconds. And they practice it and practice it and practice it. So that is the very same thing that we do with all of our emergencies, actually.

MONTAGNE: One early innovation in California - toolkits - a kind of how-to for tackling a potentially fatal complication. That includes lists, medications, equipment. When it comes to obstetric hemorrhage, that includes an actual cart patterned after the crash cart used for cardiac arrest.

JO DUTTON: All right, so this is the hemorrhage cart we came up with. Like I said...

MONTAGNE: Jo Dutton is the clinical nurse supervisor13 at Pomona Valley Hospital. She proudly wheels over the cart she designed.

DUTTON: And, of course, I picked red because it's obvious - hemorrhage. And it really stands out.

MONTAGNE: There are five drawers, the top one containing the all-important checklist.

DUTTON: Then we have something in here called a Bakri balloon. And this is a balloon that you can put into the uterus. And it puts pressure on the vessels14 in the uterus to stop it bleeding, like putting pressure on a wound.

MONTAGNE: In another drawer, oxygen masks, which can act as an important visual cue for the nurses.

DUTTON: Every room has oxygen masks at the head of the bed. But I put them in here so people would open the drawer and go, oh. Have we given her oxygen?

MONTAGNE: Other drawers contain a kit12 to start an IV line, a special speculum and more. In a real emergency, this hemorrhage cart is rushed down the hall to a patient's room. On this day, Jo Dutton has brought it to a simulated emergency, where nurses and doctors play different roles.

RODRIGUEZ: OK. This is Mrs. Sims - Jane Sims.

MONTAGNE: The patient in the bed, Jane Sims, is an anatomically correct mannequin. The scenario15 begins with a shift change and nurses exchanging vital information.

UNIDENTIFIED PERSON #1: She's post-vaginal delivery about an hour ago. She was induced because of her elevated blood pressures.

MONTAGNE: Minutes later, the patient complains that she's nauseated16 and dizzy. And the nurses discover she's bleeding. Jo shouts into the hallway.

DUTTON: Hello? Can I get some help in here? I've got a postpartum hemorrhage.

MONTAGNE: And quickly, a team with diverse specialties17 descends18 on the room.

RODRIGUEZ: Do you have a second line, Jo?

DUTTON: No, could - Maxine, will you start a second line for me? OK. I'm going to get the check list.

RODRIGUEZ: I have the second line, Jo.

MONTAGNE: To illustrate10 just one important low-tech innovation, traditionally, and still in most hospitals, nurses and doctors eyeball the amount of blood a woman is losing. That estimate can easily be wrong. This team uses something far more accurate. The medical pads and sponges that have been collecting blood are gathered and weighed on a scale. The nurses know exactly how much the dry pads weigh, so they subtract the dry weight in order to gauge19 how much blood has been lost.

DUTTON: We need to weigh these pads, please. Is the scale here? Yes, it is. Could you weigh that for me, please, Edna?

MONTAGNE: This drill is not the end of it. When the simulation is over, there's a de-brief.

RODRIGUEZ: OK, so now we're going to go about things that are going to help us in the scenario that you need to make sure that you kind of work into your muscle memory, so it happens every time you take care of a patient.

MONTAGNE: Dr. Rodriguez begins a rapid Q&A.

RODRIGUEZ: We want to avoid open-air commands. What do we mean by that?

DUTTON: So you didn't tell me to do it, so I think Nancy's going to do it, so Nancy thinks I'm going to do it. And then neither of us do it.

RODRIGUEZ: So it's important to state the name of the nurse that you want to do a specific task.

MONTAGNE: One thing that really stands out in this drill and de-brief is that nurses are on the frontline of these obstetric emergencies. And part of the state's initiative is about empowering nurses like Jo Dutton.

DUTTON: Years ago, there was more of a pyramid type of style where the doctor was at the top. And the nurses sometimes would feel intimidated20 or wouldn't want to speak out if they thought something. And we had occasion where we had some bad outcomes. And then afterwards, they kicked themselves because people said, well, I thought it was so-and-so. But I didn't say it.

MONTAGNE: The message delivered again and again is that each team member has the potential to change the outcome. It's a concept that Pat Croskerry has spent a lifetime studying. He's an emergency room physician who, from his perch21 teaching critical thinking at Dalhousie University in Nova Scotia, has published dozens of papers on how doctors think. Some years ago, he coined the term zebra retreat.

PAT CROSKERRY: In medicine, there is that statement when you hear hoof22 beats, think of horses, not zebras, right? So common things are common. But now and again, uncommon23 things come along. And it really is a zebra. So what tends to happen sometimes is that physicians back away from the zebra because they don't want to be accused of thinking of esoteric things and losing the big picture.

MONTAGNE: Dr. Croskerry remembers well when he experienced that kind of resistance. It was in the middle of the night in the ER. A woman came in who had given birth a couple of weeks earlier. Her symptoms were vague. She complained of aching from head to toe. The nurses settled quickly on a not-too-far-fetched diagnosis24 - postpartum depression. But Dr. Croskerry noticed one very unusual symptom.

CROSKERRY: Gradual loss of reflexes as you go from the feet up the body.

MONTAGNE: He thought he'd spotted25 a true zebra.

CROSKERRY: This was something called Guillain-Barre Syndrome26.

MONTAGNE: That's a rare disorder27 where one's immune system attacks the nerves.

CROSKERRY: And I had never seen it in my life. But, you know, this odd finding did actually fit the diagnosis. So I made a consult to the neurology department and said, I've got a woman here that I'm very worried about. I think she might have Guillain-Barré Syndrome. As soon as I said that, I could hear the person's eyes rolling from the other end of the phone. You know, here's a guy calling me at midnight with a diagnosis of Guillain-Barre Syndrome in a woman who's probably got a postpartum depression. Eventually, reluctantly, they agreed to accept the patient in transfer.

MONTAGNE: Dr. Croskerry turned out to be right, of course.

CROSKERRY: If we'd sent her home, she would have died.

MONTAGNE: One reason California has been so successful is that obstetrics departments across the state are on the alert for zebras, like placenta accreta.

CAYTI KANE: I didn't know what placenta accreta was. I had never even heard of it until I was diagnosed here.

MONTAGNE: When Cayti Kane arrived at Pomona Valley Hospital, she was pregnant with her sixth baby after having to deliver five babies by cesarean section. Yet through all of those pregnancies28, she did not know she was at great risk for developing this dangerous complication, placenta accreta. Every C-section makes that more likely because the scar tissue that builds up on the uterus after each surgery can allow a placenta from a new pregnancy to grow through that scar tissue and attach to other organs. That can lead to an out-of-control hemorrhage. Placenta accreta used to be exceedingly rare in the US. In the 1950s, it appeared in one in every 30,000 births. Today, the rate of C-sections is six times what it was 50 years ago. Now 1 in every 3 births is cesarean. And placenta accreta - it now shows up in every 500 births.

KANE: If I had known that this was a possibility, there's no way I would have ever done this.

MONTAGNE: You wouldn't have gotten pregnant again?

KANE: No. No, not a chance - not knowing that I could have lost my life and risked my children losing their mom.

MONTAGNE: Cayti Kane did not expect to deliver at Pomona Valley Hospital. She lives more than an hour away in the high desert of rural Apple Valley. But in her 30th week, she started having contractions29.

KANE: I went into preterm labor6, so I went to that hospital that I delivered all my other babies at. And my OB was actually out of town, so the on-call OB did not want to touch me because of my five previous C-sections, so they had me transported down here to Pomona.

MONTAGNE: So someone made a really good decision?

KANE: Yes, extremely good decision.

MONTAGNE: And this illustrates one of the positives of the California Collaborative. Smaller hospitals, like the one in Apple Valley, also have clinicians trained and on the alert for trouble. And if they can't handle it themselves, they're ready to send the mother to a hospital that can. At Pomona Valley Hospital, Dr. Rodriguez immediately diagnosed placenta accreta. Two weeks later, Cayti Kane did hemorrhage during her cesarean surgery. But she was surrounded by a team of specialists that included a gynecological oncologist because accreta can spread like a cancer. Cayti Kane named her healthy baby boy Iokua, Hawaiian for God delivers. And looking back, she's still puzzled but has an idea of why, given the high odds30 of a fatal complication, her own obstetrician cleared her to have a sixth cesarean.

KANE: I mean, he's a high-risk OB, so I know he knows about this. I think he is just such a confident person, such a confident doctor that he was convinced it wouldn't happen.

MONTAGNE: Which brings us back to the philosophy that underpins31 California's initiative. Tragedy can happen to any mother. And this collaborative is not only saving women from dying. It has also proved that it can bring down the rate of women who nearly die. A study in the American Journal of Obstetrics and Gynecology found hospitals that signed up to implement32 the toolkits - those lists and carts and drills and teams we just saw in action in Pomona - lowered the rate of severe, life-threatening complications due to hemorrhage by nearly 21 percent. In hospitals that did not participate, the rate dropped by just over 1 percent. As of this summer, nearly all of California's birthing hospitals have joined the Maternal Quality Care Collaborative. They now account for 95 percent of the babies born in that state.

(SOUNDBITE OF WAKING AIDA'S "MATTED FUR")


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点击收听单词发音收听单词发音  

1 bucked 4085b682da6f1272318ebf4527d338eb     
adj.快v.(马等)猛然弓背跃起( buck的过去式和过去分词 );抵制;猛然震荡;马等尥起后蹄跳跃
参考例句:
  • When he tried to ride the horse, it bucked wildly. 当他试图骑上这匹马时,它突然狂暴地跃了起来。 来自《简明英汉词典》
  • The plane bucked a strong head wind. 飞机顶着强烈的逆风飞行。 来自《现代英汉综合大词典》
2 doctorate fkEzt     
n.(大学授予的)博士学位
参考例句:
  • He hasn't enough credits to get his doctorate.他的学分不够取得博士学位。
  • Where did she do her doctorate?她在哪里攻读博士?
3 statistic QuGwb     
n.统计量;adj.统计的,统计学的
参考例句:
  • Official statistics show real wages declining by 24%.官方统计数字表明实际工资下降了24%。
  • There are no reliable statistics for the number of deaths in the battle.关于阵亡人数没有可靠的统计数字。
4 administrators d04952b3df94d47c04fc2dc28396a62d     
n.管理者( administrator的名词复数 );有管理(或行政)才能的人;(由遗嘱检验法庭指定的)遗产管理人;奉派暂管主教教区的牧师
参考例句:
  • He had administrators under him but took the crucial decisions himself. 他手下有管理人员,但重要的决策仍由他自己来做。 来自辞典例句
  • Administrators have their own methods of social intercourse. 办行政的人有他们的社交方式。 来自汉英文学 - 围城
5 maternal 57Azi     
adj.母亲的,母亲般的,母系的,母方的
参考例句:
  • He is my maternal uncle.他是我舅舅。
  • The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。
6 labor P9Tzs     
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 pregnancy lPwxP     
n.怀孕,怀孕期
参考例句:
  • Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
  • Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。
8 standardized 8hHzgs     
adj.标准化的
参考例句:
  • We use standardized tests to measure scholastic achievement. 我们用标准化考试来衡量学生的学业成绩。
  • The parts of an automobile are standardized. 汽车零件是标准化了的。
9 maternity kjbyx     
n.母性,母道,妇产科病房;adj.孕妇的,母性的
参考例句:
  • Women workers are entitled to maternity leave with full pay.女工产假期间工资照发。
  • Trainee nurses have to work for some weeks in maternity.受训的护士必须在产科病房工作数周。
10 illustrate IaRxw     
v.举例说明,阐明;图解,加插图
参考例句:
  • The company's bank statements illustrate its success.这家公司的银行报表说明了它的成功。
  • This diagram will illustrate what I mean.这个图表可说明我的意思。
11 illustrates a03402300df9f3e3716d9eb11aae5782     
给…加插图( illustrate的第三人称单数 ); 说明; 表明; (用示例、图画等)说明
参考例句:
  • This historical novel illustrates the breaking up of feudal society in microcosm. 这部历史小说是走向崩溃的封建社会的缩影。
  • Alfred Adler, a famous doctor, had an experience which illustrates this. 阿尔弗莱德 - 阿德勒是一位著名的医生,他有过可以说明这点的经历。 来自中级百科部分
12 kit D2Rxp     
n.用具包,成套工具;随身携带物
参考例句:
  • The kit consisted of about twenty cosmetic items.整套工具包括大约20种化妆用品。
  • The captain wants to inspect your kit.船长想检查你的行装。
13 supervisor RrZwv     
n.监督人,管理人,检查员,督学,主管,导师
参考例句:
  • Between you and me I think that new supervisor is a twit.我们私下说,我认为新来的主管人是一个傻瓜。
  • He said I was too flighty to be a good supervisor.他说我太轻浮不能成为一名好的管理员。
14 vessels fc9307c2593b522954eadb3ee6c57480     
n.血管( vessel的名词复数 );船;容器;(具有特殊品质或接受特殊品质的)人
参考例句:
  • The river is navigable by vessels of up to 90 tons. 90 吨以下的船只可以从这条河通过。 来自《简明英汉词典》
  • All modern vessels of any size are fitted with radar installations. 所有现代化船只都有雷达装置。 来自《现代汉英综合大词典》
15 scenario lZoxm     
n.剧本,脚本;概要
参考例句:
  • But the birth scenario is not completely accurate.然而分娩脚本并非完全准确的。
  • This is a totally different scenario.这是完全不同的剧本。
16 nauseated 1484270d364418ae8fb4e5f96186c7fe     
adj.作呕的,厌恶的v.使恶心,作呕( nauseate的过去式和过去分词 )
参考例句:
  • I was nauseated by the violence in the movie. 影片中的暴力场面让我感到恶心。
  • But I have chewed it all well and I am not nauseated. 然而我把它全细细咀嚼后吃下去了,没有恶心作呕。 来自英汉文学 - 老人与海
17 specialties 4f19670e38d5e63c785879e223b3bde0     
n.专门,特性,特别;专业( specialty的名词复数 );特性;特制品;盖印的契约
参考例句:
  • Great Books are popular, not pedantic. They are not written by specialists about specialties for specialists. 名著绝不引经据典,艰深难懂,而是通俗易读。它们不是专家为专业人员撰写的专业书籍。 来自英汉 - 翻译样例 - 文学
  • Brain drains may represent a substantial reduction in some labor force skills and specialties. 智力外流可能表示某种劳动力技能和特长大量减少。 来自辞典例句
18 descends e9fd61c3161a390a0db3b45b3a992bee     
v.下来( descend的第三人称单数 );下去;下降;下斜
参考例句:
  • This festival descends from a religious rite. 这个节日起源于宗教仪式。 来自《简明英汉词典》
  • The path descends steeply to the village. 小路陡直而下直到村子。 来自《简明英汉词典》
19 gauge 2gMxz     
v.精确计量;估计;n.标准度量;计量器
参考例句:
  • Can you gauge what her reaction is likely to be?你能揣测她的反应可能是什么吗?
  • It's difficult to gauge one's character.要判断一个人的品格是很困难的。
20 intimidated 69a1f9d1d2d295a87a7e68b3f3fbd7d5     
v.恐吓;威胁adj.害怕的;受到威胁的
参考例句:
  • We try to make sure children don't feel intimidated on their first day at school. 我们努力确保孩子们在上学的第一天不胆怯。
  • The thief intimidated the boy into not telling the police. 这个贼恫吓那男孩使他不敢向警察报告。 来自《简明英汉词典》
21 perch 5u1yp     
n.栖木,高位,杆;v.栖息,就位,位于
参考例句:
  • The bird took its perch.鸟停歇在栖木上。
  • Little birds perch themselves on the branches.小鸟儿栖歇在树枝上。
22 hoof 55JyP     
n.(马,牛等的)蹄
参考例句:
  • Suddenly he heard the quick,short click of a horse's hoof behind him.突然间,他听见背后响起一阵急骤的马蹄的得得声。
  • I was kicked by a hoof.我被一只蹄子踢到了。
23 uncommon AlPwO     
adj.罕见的,非凡的,不平常的
参考例句:
  • Such attitudes were not at all uncommon thirty years ago.这些看法在30年前很常见。
  • Phil has uncommon intelligence.菲尔智力超群。
24 diagnosis GvPxC     
n.诊断,诊断结果,调查分析,判断
参考例句:
  • His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
  • The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。
25 spotted 7FEyj     
adj.有斑点的,斑纹的,弄污了的
参考例句:
  • The milkman selected the spotted cows,from among a herd of two hundred.牛奶商从一群200头牛中选出有斑点的牛。
  • Sam's shop stocks short spotted socks.山姆的商店屯积了有斑点的短袜。
26 syndrome uqBwu     
n.综合病症;并存特性
参考例句:
  • The Institute says that an unidentified virus is to blame for the syndrome. 该研究所表示,引起这种综合症的是一种尚未确认的病毒。
  • Results indicated that 11 fetuses had Down syndrome. 结果表明有11个胎儿患有唐氏综合征。
27 disorder Et1x4     
n.紊乱,混乱;骚动,骚乱;疾病,失调
参考例句:
  • When returning back,he discovered the room to be in disorder.回家后,他发现屋子里乱七八糟。
  • It contained a vast number of letters in great disorder.里面七零八落地装着许多信件。
28 pregnancies 2fedeb45162c233ee9e28d81888a2d2c     
怀孕,妊娠( pregnancy的名词复数 )
参考例句:
  • Since the wartime population needed replenishment, pregnancies were a good sign. 最后一桩倒不失为好现象,战时人口正该补充。
  • She's had three pregnancies in four years. 她在四年中怀孕叁次。
29 contractions 322669f84f436ca5d7fcc2d36731876a     
n.收缩( contraction的名词复数 );缩减;缩略词;(分娩时)子宫收缩
参考例句:
  • Contractions are much more common in speech than in writing. 缩略词在口语里比在书写中常见得多。 来自《简明英汉词典》
  • Muscle contractions are powered by the chemical adenosine triphosphate(ATP ). 肌肉收缩是由化学物质三磷酸腺苷(ATP)提供动力的。 来自辞典例句
30 odds n5czT     
n.让步,机率,可能性,比率;胜败优劣之别
参考例句:
  • The odds are 5 to 1 that she will win.她获胜的机会是五比一。
  • Do you know the odds of winning the lottery once?你知道赢得一次彩票的几率多大吗?
31 underpins 998953e540e369bb5f54bfcdaf83d62f     
n.基础材料( underpin的名词复数 );基础结构;(学说、理论等的)基础;(人的)腿v.用砖石结构等从下面支撑(墙等)( underpin的第三人称单数 );加固(墙等)的基础;为(论据、主张等)打下基础;加强
参考例句:
  • A powerful sense of mission underpins everything he does. 一种强烈的使命感支撑他所做的一切。 来自《简明英汉词典》
  • His presence at the crime underpins the case against him. 案子发生时他在场对他更不利。 来自辞典例句
32 implement WcdzG     
n.(pl.)工具,器具;vt.实行,实施,执行
参考例句:
  • Don't undertake a project unless you can implement it.不要承担一项计划,除非你能完成这项计划。
  • The best implement for digging a garden is a spade.在花园里挖土的最好工具是铁锹。

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