助产师可大大改善非裔贫困妇女生活质量

 　　纽约市政府出台新政策，政府将向低收入非裔家庭提供免费的助产服务，已改善这些家庭的新生儿高死亡率。

　　Amadoma Bediako is a retired¹ grade school teacher. But she's still dispensing² plenty of information - these days to pregnant women.

　　AMADOMA BEDIAKO: The most important thing is healthy mommy, healthy baby.

　　On this day in early August, Bediako was visiting Jessyca Marshall, then seven and a half months pregnant, at her home in Brooklyn. They discuss issues like pre-natal health and a birth-plan.

　　AMADOMA BEDIAKO: If you can relax and go into this, you're not so afraid you're not so tense because if you're tight and you're tense and you're worried, it slows it down...

　　Bediako isn't a doctor or a midwife, she's what's known as a doula. That's ancient Greek for "a woman who serves." doulas support pregnant women before, during and after childbirth.

　　JESSYCA MARSHALL: Being a first time mother-- I really wanted to take advantage of all the information that I could. And I know that doulas typically are very supportive of mothers' birth plans. So I wanted a doula that was supportive of me having a natural birth.

　　AMADOMA BEDIAKO: The doula serves the woman. We don't work for the hospital. We don't work for the birthing center. We don't work for the midwife. We work for the woman. And we're there for her.

　　The service is provided -- for free -- through a program backed by New York City's Department of Health. It's called the "By My Side Birth Support Program" and it's aimed at women living in low-income, largely African-American neighborhoods in Brooklyn... where there are high infant and maternal³ mortality rates.

　　According to the Centers for Disease Control's latest statistics, nationwide, black women are three times more likely to die of pregnancy⁴-related complications than white women. In New York City, it's almost seven times higher... an average of 63 deaths per 100,000 births for black women compared to 9 deaths per hundred thousand births for white women.

　　MONA ISKANDER: Why do you think there are these high rates of maternal mortality?

　　MARY-POWEL THOMAS: I think healthcare in general is not as good in this area as in others.... The women have a lot of pre-existing conditions, whether it's high blood pressure, asthma⁵, obesity⁶ which also contributes... they just may not be in as good health.

　　MARY-POWEL THOMAS: This is Mary Powel Thomas...

　　Mary-Powel Thomas is the Director of the By My Side Birth Support Program. It was established through a federal grant three and a half years ago when healthcare professionals wanted to address a troubling trend: many women were showing up to the hospital alone when they were ready to deliver. So far, this program has helped more than 240 women give birth.

　　MARY-POWEL THOMAS: It became clear that it was really helpful to have a woman who was experienced in childbirth and to be-- who could be there to support the woman.

　　MONA ISKANDER: But why a doula? Why not concentrate in giving the woman more support through her doctor?

　　MARY-POWEL THOMAS: In a lot of cases the doctor comes in at the last minute to deliver the baby, or maybe comes in a few times to check on the woman but then goes off to do other things. We have doulas who, you know, arrive in the morning, and they meet the morning nurse, and then the night nurse. And then, when the morning nurse comes back the next day, the doula is still there.

　　AMADOMA BEDIAKO: Traditionally women birth with other women. The village comes around when the woman's laboring⁸. You know, she has her mother, her grandmother, her sisters, her aunties. And they encourage her. They let her know she can do it. They tell her stories. They laugh together. They cry with her.

　　But critics question whether it's government's role to finance programs like these. Doula care isn't regulated and doulas aren't licensed⁹ professionals. Although certification is available, it isn't required. The American College of Obstetricians and Gynecologists doesn't take a position on doulas but says that "continuous support during labor⁷ from physicians, midwives, nurses, doulas, or lay individuals may be beneficial for women...."

　　RAYMOND SANDLER: They should work together as a team and they're part of the delivery team and delivery experience.

　　Doctor Raymond Sandler is the Director of Labor and Delivery at the Mount Sinai Hospital in New York. He is a big supporter of doulas and works with them often. However he says that in some cases there can be challenges.

　　RAYMOND SANDLER: They are non medical and should stick to non-medical decisions making. At times and if you interview others you'll find that there is some tension between the doula and the physician because the doula for instance if the physician wants to do certain interventions¹⁰, the doula may feel it's not necessary and injects herself into the decision making process

　　MONA ISKANDER: I think there are some obstetricians that feel this is just an extra person in the room who, they may be getting in the way sometimes.

　　MARY-POWEL THOMAS: There's definitely a range of attitudes I think generally, as-- as there are more and more doulas in a hospital, the staff becomes more comfortable. And it's also important for doulas to be responsible about that.

　　A main source of tension between doulas and doctor is over the use of C-sections.

　　While the world health organization says a C-section is appropriate up to 15 percent of the time. In the United States, nearly 33 percent of all deliveries are done by C-section...

　　Mary-Powel Thomas points to a recent review by the Cochrane Collaboration¹¹ - a non-profit group that studies the effectiveness of health care. After reviewing pregnancy support trials from 16 countries it determined¹² that continuous support in labor, including the presence of a doula, reduces the likelihood of a C-section by as much as 22 percent.

　　AMADOMA BEDIAKO: If a woman is in a situation that is scary, and a medical professional gives her a quick medical-ese answer to a question she asks, we might ask, "Does she need more information?" So in that way we advocate for the mom.

　　It's the power of information that Jessyca Marshall says she is counting on in order to have a natural birth.

　　JESSYCA MARSHALL: I think some of the things that surprised me are-- what-- having a lack of knowledge, how that affects a mother when she goes to actually give birth and deliver. And how that can produce results that she didn't desire, such as a C-section or-- you know, some other health complication.

　　AMADOMA BEDIAKO: We offer free doula services...

　　Despite what program participants believe are the benefits of doula programs and despite the growing popularity of using doulas, there is still only limited insurance coverage¹³ to pay for them. The federal government supports a small number of local programs and Oregon and Minnesota have passed laws allowing Medicaid to pay for doula care. But most women pay anywhere from a few hundred to a few thousand dollars out of their own pocket.

　　MONA ISKANDER: Many people see doulas as a luxury. The services are not included in insurance. And, here you are, providing this luxury to women i in, you know, low-income areas.

　　MARY-POWEL THOMAS: Uh-huh (AFFIRM).

　　MONA ISKANDER: Yes? Yeah? Why--

　　MARY-POWEL THOMAS: Isn't that great?

　　MONA ISKANDER: Why?

　　MARY-POWEL THOMAS: Because it's a proven way to improve birth outcomes. And that's our mission.

1 retired   

adj.隐退的，退休的，退役的

参考例句：

• The old man retired to the country for rest.这位老人下乡休息去了。
• Many retired people take up gardening as a hobby.许多退休的人都以从事园艺为嗜好。

2 dispensing   

v.分配( dispense的现在分词 )；施与；配（药）

参考例句：

• A dispensing optician supplies glasses, but doesn't test your eyes. 配镜师为你提供眼镜，但不检查眼睛。 来自《简明英汉词典》
• The firm has been dispensing ointments. 本公司配制药膏。 来自《简明英汉词典》

3 maternal   

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。

4 pregnancy   

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。

5 asthma   

n.气喘病，哮喘病

参考例句：

• I think he's having an asthma attack.我想他现在是哮喘病发作了。
• Its presence in allergic asthma is well known.它在过敏性气喘中的存在是大家很熟悉的。

6 obesity   

n.肥胖，肥大

参考例句：

• One effect of overeating may be obesity.吃得过多能导致肥胖。
• Sugar and fat can more easily lead to obesity than some other foods.糖和脂肪比其他食物更容易导致肥胖。

7 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。

8 laboring   

n.劳动，操劳v.努力争取(for)( labor的现在分词 )；苦干；详细分析；（指引擎）缓慢而困难地运转

参考例句：

• The young man who said laboring was beneath his dignity finally put his pride in his pocket and got a job as a kitchen porter. 那个说过干活儿有失其身份的年轻人最终只能忍辱，做了厨房搬运工的工作。 来自《简明英汉词典》
• But this knowledge did not keep them from laboring to save him. 然而，这并不妨碍她们尽力挽救他。 来自飘（部分）

9 licensed   

adj.得到许可的v.许可，颁发执照(license的过去式和过去分词)

参考例句：

• The new drug has not yet been licensed in the US. 这种新药尚未在美国获得许可。
• Is that gun licensed? 那支枪有持枪执照吗？

10 interventions   

n.介入，干涉，干预( intervention的名词复数 )

参考例句：

• Economic analysis of government interventions deserves detailed discussion. 政府对经济的干预应该给予充分的论述。 来自辞典例句
• The judge's frequent interventions made a mockery of justice. 法官的屡屡干预是对正义的践踏。 来自互联网

11 collaboration   

n.合作，协作；勾结

参考例句：

• The two companies are working in close collaboration each other.这两家公司密切合作。
• He was shot for collaboration with the enemy.他因通敌而被枪毙了。

12 determined   

adj.坚定的；有决心的

参考例句：

• I have determined on going to Tibet after graduation.我已决定毕业后去西藏。
• He determined to view the rooms behind the office.他决定查看一下办公室后面的房间。

13 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。