A quiet child who wants to see the world in 2022 seems like a wise choice. At least in the first few days of life, they will enjoy more quiet than their previous newborns.
In 2014, Xiangyang, Hubei Province, ushered in a wave of fertility peaks. Courtesy of Visual China
In 2021, 10.62 million babies were born in China, 3.4 million fewer than in 1960, when famine went down in history, the lowest number of births since the founding of New China, and the fifth consecutive year of decline in the number of births in the country after reaching the peak of the new century.
Many people use the term "wet market" to describe the maternity ward 5 years ago, but now, due to the decline in fertility rates and the impact of the new crown pneumonia epidemic, obstetrics departments in many hospitals have become quieter to varying degrees. The obstetric director of the Chaoyang District Maternal and Child Health Hospital in Beijing said that before the epidemic, the outpatient hall at 7 o'clock in the morning was always like a railway station during the Spring Festival, and this situation is no longer the case. Staff at the integrated service desk of the Tongzhou District Maternal and Child Health Hospital in Beijing told the consultants that there were plenty of filing places and "not like in the past." Obstetricians and nurses at Peking University Shenzhen Hospital are no longer overloaded, and obstetricians at Shulan Hospital in Hangzhou, Zhejiang, sometimes can't perform a single operation a day.
Dongcheng District Maternal and Child Health Hospital, the head nurse of the delivery room stands next to the wall of newborn photos. Guo Yujie/Photo
Beijing Dongcheng District Maternal and Child Health Hospital, a public secondary hospital that undertakes basic medical functions, welcomed an average of more than 200 new lives per month in the second half of 2016, and now only 20-40 babies are born every month. The delivery room nurse station writes a "delivery room daily" every day, and records the information of the baby born on the day, "xxx son/daughter, vaginal delivery/caesarean section". On April 11, 2022, the daily newspaper said the number: "0".
1
Liang Hong, head obstetric nurse, was only 19 years old when he came to Dongcheng Maternal and Child Health Hospital (formerly Dongsi Maternity Hospital). The matter of having a child is far from her. In her early 20s, she often worked the night shift, made up for sleep during the day, and ran to the banquet hall of the Beijing Hotel in the evening to dance ballroom dances. It was fashionable, there were thousands of people in the ballroom, dressed in ordinary clothes, accompanied by a band, able to jump from 7 p.m. to 10 p.m., and then ride to the hospital for the night shift at 12 o'clock.
Courtyard of the obstetric ward area of Dongcheng Maternal and Child Health Hospital. Courtesy of respondents
In the blink of an eye, she was about to retire. The freedom to be single, the sweetness of a new marriage, the hardships and satisfaction of raising a daughter, all overlap with 35 years of obstetric life.
A 1992 photograph of her five months pregnant sitting in her hospital's maternity ward, the walls made of white and green, bright red letters marking the bed number on the green window frame. In addition, it is a white bed, a white hospital gown, and a dark wood nightstand.
In 2022, pink and blue replaced it all. Walls, pillows, duvet covers, sheets, curtains, are all blended with a soft, milk-like pink color, and the dark blue of the anti-bacterial cloth is harmonized with it. For a long time, the maternity ward was 8 people, and each person brought several family members. Liang Hong said that the ward was always mixed with the smell of "blood and excrement, and various foods sent by family members", and the air was somewhat dirty. Women can't blow convective winds, and they will carefully close the curtains and open the windows for ventilation.
Now, the ward is converted into a double room, but usually only one person lives, and there is a faint smell of disinfectant water in the air. Even so, only one row was used in the two rows of wards.
The hospital is located in a Chinese-style building more than 600 meters away from Nanluoguxiang, surrounded by old hutongs, and the building area is only one-half of that of the Chaoyang District Maternal and Child Health Hospital. The hospital was closed between 2005 and 2013 and was renovated when it reopened. The maternity ward area is a renovation of 3 courtyards, two courtyards open-air, planted with pomegranates, magnolias, peach blossoms and holly. One yard was replaced with floor tiles and a glass roof was added for leisure activities for patients. In the second half of 2016, the number of deliveries in the hospital reached the highest peak in Liang Hong's memory. In addition to the ward corridor, they also put 6 beds in this "sun room".
Chengdu neonatal family ward is put into use, and parents can accompany them 24 hours. Courtesy of Visual China
Time has left its mark in this obstetrics.
The double-open wooden door that connects the delivery room to the nurse's station and the ward was sharpened in three obvious scratches at the door gap, and the patent leather faded, revealing brown wood. Around 2016, the amount of delivery was large, and they had to constantly change rooms and beds for women every day, and the door was worn by the flat cart pushing the mother. At first there were several rows of anti-wear iron sheets, sharp edges and corners, and the people of the bulldozer were always scratched, so some of them were removed, and the remaining row of silver-white bright and dangling iron sheets, the edges and corners had been rounded and blunt.
Xu Min, the head nurse in the delivery room, said that in 2022, the age of the first mother is mostly in her early 30s, she has worked for 30 years, and watched this age slowly postpone from 27 and 28 years old.
Correspondingly, several obstetricians say that the proportion of high-risk women is increasing. After the pregnant woman is filed, according to her pregnancy risk, the obstetric examination book will be labeled with different colors of round labels. Green is best, indicating no pregnancy comorbidities and complications, and low risk of pregnancy. Yellow, orange, and red, the higher the risk. In the Chaoyang District Maternal and Child Health Hospital and the Dongcheng District Maternal and Child Health Hospital, the two secondary hospitals that cannot accept "red" grade pregnant women have the highest proportion of pregnant women holding the "yellow" label, more than half.
In the traditional view, pregnant women lack nutrition and need to be supplemented. But in 2022, that narrative is outdated. The Dongcheng District Maternal and Child Health Hospital opened a pregnancy nutrition clinic, and Dr. Zhu Peijing found that there were very few anemia and malnutrition problems encountered, and most of them were overnutrition. This will lead to an increase in the incidence of macrosomia, and the "eight-pound fat boy" will increase the risk of dystocia, which is not good for both babies and mothers. She felt clinically that the incidence of macrosomia increased by 20% over a decade.
2
Life in obstetrics leaves a different impression on everyone. Some say the baby's umbilical cord is blue-gray, some say it's white. This is actually related to the time of umbilical cord cutting. The first cry of a healthy baby, some midwives felt no difference, others heard the difference: "continuous or intermittent". In the eyes of many people, the newborn baby looks the same, but the obstetrician doctor and nurse can easily see the baby's facial features and say where he or she resembles the mother.
After the baby is delivered, the midwife cuts the child's umbilical cord from two centimeters, makes a standardized knot, drys the amniotic fluid, allows him or her to snuggle up on the mother's chest, and covers the towel with a quilt. Examine the body, weigh it, and press his or her footprints on the medical record book.
During this process, midwives are often grabbed by the baby's fingers. The moment of warmth seemed to them to be nothing more than the usual grasping reflex—healthy babies clutching everything at hand, fingers, umbilical cords, forceps. Xu Min, head nurse of the delivery room of Dongcheng Maternal and Child Health Hospital, said that the feeling of fingers being caught was soft but very powerful. Doctor Zhu Peijing said, "If he (she) grabs you like this, you will suddenly become gentle." ”
When he first started working, Xu Min felt that the picture of production was a bit bloody, and sometimes dreams of giving birth to a child, that kind of "bald birth" (referring to giving birth before being ready). It's either someone else or yourself. Geng Kaiyang of Chaoyang Hospital, a rare male midwife in the delivery room, put great enthusiasm into it. He would press the child's footprints on a card, write a sentence to him or her, and pay the "midwife who once helped you come to the world." Working long hours, he no longer writes for every child. For most people, the story of those hours after birth, along with the knots in the umbilical cord, turns brown and then falls off two weeks later.
Single delivery room of Dongcheng District Maternal and Child Health Hospital. Guo Yujie/Photo
Pain is the deepest impression that many women have on the birth process. It was a physiological rather than pathological pain caused by uterine contractions, which was medically defined as a grade 9 second only to burn pain. In pain, some women cried and screamed, and some whimpered. Zhu Peijing saw a pregnant woman in a general hospital holding a hanging bottle naked, kneeling and begging the doctor to give her a caesarean section, Zhang Qiang, a nurse at the Dongcheng Maternal and Child Health Hospital, would be used by the mother as a gripper in pain, and after the other party released, she left a clear handprint on her arm, which would disappear for a long time. But the individuals with fertility pain vary greatly, and someone's contractions are like a dysmenorrhea.
After a pregnant woman in Yulin, Shaanxi Province, jumped off a building in the pain of contractions, in 2019, the mainland implemented a painless delivery pilot in 913 hospitals. This is a mature technology that has been applied abroad for more than 100 years, and the anesthesiologist injects anesthetics from the spine of the mother to reduce the pain of contractions. One doctor described that if the pain index before the delivery analgesic injection was 9, and the pain index after the analgesia was about 4, a tolerable degree - some people will feel completely painless.
The degree of application of labor analgesia is related to the resource status of anesthesiologists in hospitals. According to statistics, as of 2021, the overall application rate of childbirth analgesia in the mainland is only 30%, and the penetration rate of childbirth analgesia in many hospitals in the central and western regions is less than 10%. At the Dongcheng Maternal and Child Health Hospital in Beijing, the application rate of childbirth analgesia rose from about 40% in 2013 to 70%.
In the case of abundant resources, it is necessary to face outdated ideas. The delivery analgesic injections of women need the signature of themselves and their families, and nurse Zhang Qiang sometimes sees the anesthesiologist running back and forth without getting a signature. She once saw a woman crying in pain all the time, and after evaluation she was eligible for the use of childbirth analgesia, but the husband listened to her mother-in-law's advice and "did not fight". On the phone, the lady was crying and gradually stopped talking. The husband said, "I know you hurt, but my mother said that the painless needle is still not to be hit." ”
The pain of caesarean section is mainly after childbirth. After a cesarean section, the woman experiences severe uterine contractions, which allow the woman's uterus to contract to its normal size and reduce bleeding. The nurse will help the woman press her stomach and check the degree of contractions. When nurse Zhang Qianggang works, she will feel that "the mother is really pretentious, she will push your hand, will pull your hand, and will not let you press." When she gave birth to her own child, she realized that it really hurt, and the pain was so painful that she broke into a cold sweat, and it was better to hold her breath. "I really said don't press it again, because it has a wound on the womb, it always contracts, it always moves."
After the pain is forgotten, what is left is a scar. Most of the scars of vaginal births come from lateral incisions, which are made by midwives to prevent the perineum from being torn to a greater extent during childbirth difficulties. Zhu Peijing said, "In the past, there was a period of time when it was basically necessary to make a lateral cut", and now in order to protect the maternal body, they will not cut sideways until they have to do so and have clear indications. The wound in the lateral incision also becomes intradermal suture.
Liang Hong underwent a cesarean section, leaving a dark vertical incision scar on his stomach, and now, obstetricians will be surprised to see this scar when they do surgery. The longitudinal incision is more pronounced and darker in color than the scar of the transverse incision, and for aesthetic purposes, the vertical incision has almost disappeared, and the position of the transverse incision is constantly moving downward. The position of the cross-cutting in the industry is 3 cm above the pubic bone. Liu Jiangang, an obstetrician and gynecologist at Hangzhou Shulan Hospital, has developed a more invisible incision in recent years, moving down to almost equal to the pubic bone, and in order for the scar to be hidden under the bikini in the future, he needs to carefully avoid the bladder.
3
Obstetrics is a woman's world. The "2021 China Health Statistics Yearbook" shows that in 2020, 14.9% of the health technicians in the national maternal and child health hospitals will be men and 85.1% of women. Childbearing for these women is not only work, but often life.
Some media did a survey on Mother's Day, and among more than 700 people, more than 40% of them chose "if you choose again, you won't be a mother". Head nurse Liang Hong said, "Why do you regret it?" I don't regret it. She felt that if the policy allowed, she might have more than one child. Nurse Zhang Qiang has a three-and-a-half-year-old daughter, and she does not regret giving birth to her, but is determined not to want a second one. Xu Min, the head nurse in the delivery room, is a Dinkist. In her more than 30-year career, she has helped countless babies come into the world and witnessed countless moments of motherhood, but did not strongly want to experience the past. "Maybe you're more self-aware."
A stroller for newborns in the ward of Dongcheng Maternal and Child Health Hospital. Guo Yujie/Photo
Liang Hong felt that the identity of her mother brought her endless happiness. She had a daughter in her fifth year of work. Now that she sees pregnant women breastfeeding in the ward, she always recalls the warmth of breastfeeding her child 29 years ago, "You have her, she has you." ”
Twenty-nine years later, their relationship is as close as ever. Daughters often slept with her, they took selfies face to face, chased stars together, went to 3 cities to see Mao's hard-won concerts, and waved to the stage with glow sticks. She and her husband worked black and white shifts, and they relayed the baby. She often rides a bicycle with a child seat to take her daughter to a kindergarten near the hospital, picks her up after school, and comes home together after work. Once the screws of the seat came loose, and her daughter fell backwards with a plush hat and cotton cloak, and she still thinks about it and is afraid.
Xu Min is 4 years younger than Liang Hong, and the two have known each other for 30 years. In the past, Liang Hong's daughter often pestered Aunt Xu Min to paint for her. Liang Hong saw that Xu Min always had kitten scratches on her hands, and she liked cats and had several. Xu Min learned about the concept of Dink at a young age. When she fell in love with her current husband, she expressed this idea, and the other party did not object.
Around the age of 50, both of them still have the look and posture of a young man. Xu Min spoke quickly and vividly, and her midwife clinic had photo albums of children born in the delivery room. She recently watched the hit drama "Dear Little Child", which depicts chickens flying and dogs jumping before and after childbirth, which she thinks is quite real. When she was young, she felt that she always had to work the night shift, it was not good to take the child, there was no condition for finding a nanny at home, and the desire to have a child was not strong, "the consumption will pass.".
She felt that the ultimate way of social care was in a nursing home, and she did not think about who would help her to retire. However, she heard that "children are treated differently in nursing homes with children and no children", and only then did she "have a little regret". She does not feel that the child should be born for whom, and when she is born, she must be fully responsible. "If I had children, I should try my best to do those things, but you can't do it, the expectations may be too high, and I can't meet it, and finally choose to give up." 」
After having children, Liang Hong and Zhang Qiang's feelings about work changed. Liang Hong knows the difficulty of getting up and walking around when going to the toilet after giving birth, "at that time, I hope that someone can help me." As the head nurse, she often told everyone that it is not easy to treat the mother as a family member, but to treat the mother as her friend. Colleagues said that nurse Zhang Qiang's personality has changed, he used to be grinning, not a "very feminine person", and now he has become more understanding and gentle.
Recently, Zhang Qiang's daughter suffered from bronchitis, she had to take her daughter to see a doctor, feed medicine, and always hold and measure her temperature at night. "It's good to have kids, but it's hard to have kids."
When her daughter was not in kindergarten, Zhang Qiang could not make up for sleep after the night shift, and only when her daughter slept, she could sleep for 3 hours. Even with her mother's help during the day, she still had a lot to worry about when she came home: her daughter's clothes were dirty, her shoes were covered in mud, her school bag had to be packed, and it was time to learn to draw. In the past three and a half years, she has not gone shopping or eating with her colleagues. In the first year of the child's birth, she had to take the title, put the child to sleep at 9 o'clock every night, read until 11 o'clock at night, and then use the time to study back and forth on the subway every day, which is only this time.
The fertility rate is reduced, she can understand, "Raising a child now is really not as simple as when we were children." The pressure on education is too great, and she is always thinking about what kind of thinking she wants to develop at this stage, and "painstakingly" communicates with her. Colleagues talked to her about how to guide children to share their lives when they went home, "I want to say that my mother was born with two small babies in the hospital today, one is what it is, and what the other is like." What about you, what happened in kindergarten? ”
Zhang Qiang wants to make his "teammates" more powerful. Although her husband can take on all the tasks of "washing, studying, and sleeping with her children" during her night shift, more anxiety remains with her. "A lot of women are also looking at their teammates and really can't use it, and then they give up, slowly getting used to it, it's our own life." She also saw too many fathers-to-be at work, and when the child was born soon, she didn't know what to prepare when she came home.
4
Even after fully appreciating the happiness of being a mother, Liang Hong gladly accepted when her daughter said that she would not have children in the future. She said that the choice was her own.
The changes in society's concept of fertility washed over obstetrics and gynecology like a tide. Popular science blogger "Six Floors" was once an obstetrician and gynecologist in a third-class hospital in Beijing, often discussing women and fertility topics on social media. How to create a better fertility environment for women? He felt that the first thing was to give them the right to choose not to have children. He remembers that in the diagnosis of adenomyosis, in the past, doctors would say, "This is very important and will affect your future fertility." But gradually some girls said, "I don't have a birth plan." Slowly, just like AI language learning, the doctor's language became, "If you have a fertility plan later, then..." Previously, when a girl came to the gynecology department for medical treatment, she would be persuaded by the doctor to treat it as soon as possible with the statement that "this problem may affect fertility", but now, the doctor's words have become "This will lead to dysmenorrhea and anemia, and it is necessary to treat it early."
He's also in his 30s, and his parents will post articles urging him and his wife to have children, mostly about the optimal age to have children. But he has his own understanding of the "optimal age for childbearing.". "A 25-year-old young man who has just graduated from college, has no house, has an unstable job, and is in a bad financial situation, and a 35-year-old, stable career, and psychological maturity, who is at the optimal age for childbearing?" "What kind of child can be raised is a combination of factors, not the so-called physiological optimal reproductive age."
He once released a popular science video to talk about the harm caused by childbirth to women's bodies, hoping that everyone will fully understand before making a choice. There is a saying that "fertility is more harmful than beneficial to women in the short and long term," whether it is short-term or long-term." To this end, a middle-aged mother specially registered a Weibo account to accuse him. She said her daughter was reluctant to have children and forwarded the video to her as an argument for infertility. The anxious mother felt that "six floors" "teach bad young people".
But "six floors" are not Dinkists, nor do they advocate for young people not to have children. He just felt like he was like a lot of people and wasn't prepared. He thought that when he first worked, once in the office, the director looked at him and sighed, if his children were left behind, he would be so old. But at that time, to choose between a career and a child, she chose a career.
The "six-story" themselves live in a traditional family. The father did small business, did not often come home, and the responsibilities for housework and childcare fell on the mother. He plans to wait until he can devote half of his time to his family before choosing to procreate. Because since they are all family members, they must participate in family affairs equally, "I am a human being, and my wife is also a human being, why should I have a reason to do less?" "I'm not happy with less involvement." But now he feels that he has to spend five or six hours a day on popular science work, and his wife has a lot of things she wants to do, and it is not time to raise children.
Liang Hong knows that the pressure of parenting is greater today than it was more than 20 years ago. The daughter's state was different from when she was younger, and the daughter worked at the bank and often worked overtime until 10 o'clock at night. Zhang Qiang would chat with older mothers and ask them why they chose to give birth at this age. They often say that the work pressure is very high, they have to pay off the mortgage and car loan, and they have to pay a lot of money to raise their children. They believe that if they do not plan in advance, their children will not be able to raise well when they come, and education is also a big problem.
She observed that these people have a strong sense of enterprise and responsibility, and they are afraid that they will not be responsible for their children after giving birth. An obstetrician at Peking University Shenzhen Hospital said that he observed that Shenzhen's "white-collar workers, backbones, elites" want a daughter more because they are both busy and think that girls are less naughty and more energy-saving.
Whether people choose, and when they choose to come to the obstetrics department, the stories in the obstetrics are still happening. A midwife at Chaoyang Hospital had worked in the emergency department, and at midnight, on the way to the hospital for the night shift, he always thought that in such a small space, someone in the rescue room would lose their lives tonight, and there would be new life options in the obstetrics department.
In mid-April, at the Dongcheng Maternal and Child Health Hospital, a newborn baby shared a ward with his mother, and in the courtyard outside the corridor, peach blossoms and magnolias fell to the ground. The corridor was quiet, and only the warm, humming sounds of new life could be heard.
(Liang Hong and Xu Min are pseudonyms in the text)
China Youth Daily, china youth network trainee reporter Guo Yujie Source: China Youth Daily
Source: China Youth Daily