In the long course of history, women's reproductive health has always been the focus of social attention. From the development of traditional midwifery to modern medicine, from the high risk of childbirth to the innovation of modern medical technology, these advances have not only reduced maternal and infant mortality, but also reflected a shift in society's perception of women's reproductive health. Despite significant advances in medical technology, there are still new challenges to women's psychological and social support during the reproductive process. It is our responsibility to ensure that women are able to make the most informed choices that are best for them and to be happy on the path to motherhood.
When I was doing popular science, I often said that only when a mother is healthy, can a child be healthy. And why should we keep our children healthy? Because healthy children can grow up to be healthy adults, build a healthy world, a world in which you and I are in, a world in which you and I are all affected, whether you get married or not, have children or not, where and how you live. Everything we do affects the growth of the world, and the way the world looks affects our lives.
Most people, including me, spend most of their time immersed in their own lives and have no time to care about the world, even though it is "we" who make up the "world." We naturally take everything for granted, that it existed when we were born, that science is bound to progress, and that wealth is bound to increase.
So, how do we get this "certainty" step by step? On Mother's Day, we might as well revisit the changes in women's fertility in the past 100 years.
■ National Maternal and Child Health Center in Ulaanbaatar, Mongolia, a mother and her newborn baby. Source: UNICEF
In traditional midwifery, female deliveries are mainly done by midwives; And the midwife is naturally not a well-informed lady, relying on ancestral experience, and the tools that can be used are nothing more than strength, some medicines, sharp weapons and knives. During childbirth, Wen Po mainly relied on belly pressing, hand digging, and knife cutting to "help" the mother. Encountering twins, abnormal fetal position, fetal megalom...... and so on, it is very easy to cause damage to women's bodies, resulting in a difficult choice of "protecting the big and keeping the small", and even ...... One corpse, two lives/three lives. The maternal mortality rate will reach "five or six out of a hundred, or seven or eight out of a hundred." Even if the mother and child are safe in normal delivery, behind this "peace", there may be damage to the birth canal, and there is a lack of follow-up anti-inflammatory drugs. In the 1898 Universal Gazette, the scene of the birth of Wen Po was depicted to the extent that it was not suitable to be listed here. "Climb the door hard...... The front and back households were torn into one". There are also a large number of reports on birth injuries and injuries in the "Declaration", and there are even reports that the mother has taken out the fetus with her hands but pulled out the internal organs of the mother...... It makes people hide their faces and can't bear to read it.
Of course, traditional medicine also has some research on dealing with dystocia, but how much can Wen Po, the main front-line executor, learn? How can most of the people get the right doctor in time? Not to mention that this "first aid prescription" is also mixed, because there is no shortage of people who have mixed eyes on the knowledge threshold, and there are even "dystocia women holding two live snails or mothers grasping pen stalks" such content is published in newspapers.
In 1835, foreign missionaries opened the first Western medicine hospital in modern China, and the so-called "Western medicine" midwifery method began to be implemented in China. In 1892, the first caesarean section was widely reported on the mainland, and during the same period, anesthetic drugs were already used in Britain and the United States to relieve labor pain.
It is worth noting that technology has reached this point, but it does not mean that the masses can use it, after all, technology has a cost and needs manpower to implement, which requires a broader foundation.
■ Lilongguikamuzu Central Hospital, Malawi, mother Zenaida Ndawalala and her child. Source: Gates Foundation
In Xiao Hong's book "The Field of Life and Death", childbirth is completely described as a punishment for women, which is written in contrast to the birth of puppies and pigs, and is even more difficult than livestock. The mother took the initiative to put away the mat, and the midwife asked her to roll up the firewood and grass on the kang as well; Her husband, on the other hand, said she was "playing dead". What about children? "The child was born here, and the child died at that time!" And in the dilapidated aristocratic family of Ye Guangcen's "Champion Media", the seventh uncle and grandmother were 44 years old at the time. "The swollen lower limbs, difficulty breathing, and pale face indicate that this elderly woman has the basic symptoms of preeclampsia." And the problem she encountered was also an abnormal fetal position, "the fetus in the womb stretched out a leg. "The seventh uncle and grandmother didn't pass this hurdle in the end, there was blood everywhere in the house and in the basin, but the child survived. In Lao She's "Camel Xiangzi", you can spend 10 yuan to ask a doctor to come to see you, you can spend 20 yuan to hire a doctor to deliver a baby, or you can spend dozens of yuan to go to the hospital. However, "Shoko can't help it, so I'll have to wait for the damn ones to die." At twelve o'clock in the night, the tiger girl took a dead child and died. ”
In New China, we have a "new method of midwifery". The Common Program of the Chinese People's Political Consultative Conference stipulates that "health and medicine should be promoted and attention should be paid to protecting the health of mothers, infants and children". This sentence is very interesting, let's look at its weight: first of all, the health of the mother, with the health of the mother, there is the health of the baby, reduce the "stillbirth rate"; And with the health of the baby, the follow-up is to hope that the baby will grow into a child. And we have indeed done it, the maternal mortality rate in mainland China has dropped from 1,500 per 100,000 live births before liberation to 17.8 per 100,000 live births in 2019, and the perinatal mortality rate has dropped from 200 per thousand before liberation to 47 per thousand in 1975, and in 2019 it has dropped to 5.6 per thousand in the world.
■ A mother and child are being visited by members of the Maternal and Neonatal Tetanus Elimination Confirmation Investigation Team. Source: UNICEF
At the first national symposium on maternal and child health work, the basic task of "reforming the old style of midwives, implementing new methods of midwifery, and reducing the death of umbilical cord wind and puerperal fever" was proposed. In Ru Zhijuan's "The Quiet Maternity Hospital", we see that after the establishment of the People's Commune, there was a maternity hospital composed of three houses, with five beds, disinfection, blood pressure measurement, blood drawing, blood supplementation, pain relief, hemostasis, and anesthetic injections; Although there is no resident doctor, you can call a doctor from the town to perform the operation or call an ambulance to pick up the patient. And this is just a commune under the town, and the conditions have far surpassed Beiping City, where Hu Niu and Seventh Uncle and Grandmother are located. This also reflects the tertiary medical system in rural areas on the mainland: people's hospitals were established at the county level, health centers were established at the commune level, and clinics were set up at the brigade level (equivalent to the current village). In fact, after the liberation of the mainland, the maternal and infant mortality rates in rural areas have declined faster than in urban areas, and the gap between urban and rural areas has been narrowing.
In addition to life and death issues, perinatal care now focuses more on related reproductive diseases, sexually transmitted diseases and chronic diseases, gender discrimination and family violence. Improving women's reproductive safety is not only a medical issue, but also related to the economy, health, education, and the status of women.
With the development of technology and the alleviation of the pain of childbirth, it is gradually difficult to become the protagonist in literature that requires conflict. In "Ordinary World", although He Xiulian said: "If the male doctor delivers the baby, I won't go!" But in the end, she gave birth to her baby in the hospital, and the mother and child were safe. In the novel "Youxi", the process of 4 couples seeking assisted reproductive technology is described, and the main conflict comes from a mother-in-law: regardless of the physical condition of the daughter-in-law and the natural law of fetal growth, she has to give birth smoothly and pick a day, so angry that the mother almost jumped off the building. In "Salt Town", more information is written about women's pregnancy, miscarriage, unmarried pregnancy, divorce and baby-raising...... Choice. Our level of science and technology and medical and health care have indeed made great progress, but women's cognition of their bodies, their knowledge of physiology and diseases, and their way of thinking about how they should choose their lives...... I always feel that there is still a long way to go. As a popular science writer and a mother of a daughter, I have always had this sense of mission.
It is difficult to get a full picture from past reports and literary descriptions of fertility. Because for a long time in history, "women are virtuous if they are not talented", and most of the stories of women's suffering are narrated by men, and it is unlikely that they can "empathize". And any urban story that can be circulated must have a certain drama, otherwise it does not have the value of being told.
As a former obstetrician and gynecologist and a mother, I certainly understand the dangers of childbirth. And in addition to "pregnancy" and "birth", there are also many topics to talk about "raising" and "nurturing". But this article is not intended to "intimidate" people who want to choose to become mothers. I am more convinced that "informed consent" is the better option than the "fearless of the ignorant" attitude. When we grow up to be independent women, we need to consider the services we can receive and our life goals to consider whether we want to become a mother. Once you and I choose to be mothers, we will be mothers for life. Fortunately, we live in an era that, at least in terms of health care, gives us the greatest confidence and gives us the energy to deal with more problems that lie ahead.
■ Nakasek Annette with her three-month-old baby Natasha Kwagara waiting to be vaccinated at Nakaseke General Hospital, Nakaseke District, Uganda. Source: Gates Foundation
Our time has basically solved the physical health problems in the process of "becoming a mother" (although it still requires repeated education), but at the same time as the rapid development of the times, the lack of psychological support and social environment support caused by uneven development will also make mothers confused. Especially now that the unit of the "family" has become smaller, the grand occasion of "raising a child with the help of the whole village" is no longer there, and everyone lacks experience as a mother, even if they communicate on social media, they may fall into an information cocoon. Old problems are solved, and new problems will breed. With health, but also with happiness. As a science popularizer, I do my part to ensure that women make the best choices for themselves – whether you want to be a mother or not – and help people be happy on the path they choose.
Resources
晚清女性身体问题研究The Study about the Female Body Issues in Late Qing Dynasty，暨南大学博士学位论文，曾繁花
"New Law Delivery" in Literature in the 50s of the 20th Century: Recording the Beginning of Life Governance in New China, Wang Yu, He Xiuwen, Journal of Xiamen University (Philosophy and Social Science), 2021(03):162-172
Female Reproductive Health and Perinatal Health, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Huang Xinghua, Commemorating the 100th Anniversary of the Birth of Dr. Lin Qiaozhi, an Outstanding People's Medical Scientist - Proceedings of the National Obstetrics and Gynecology Senior Academic Forum (2001).
Author: Xu Yunyun
Doctor of Clinical Medicine, studied and worked in the Department of Obstetrics and Gynecology of Peking Union Medical College Hospital, is now a popular science author, and a mother of two children. In the process of her own motherhood and childbirth, she once "conceived 8 moonlight pig run" caused concern and controversy, and was committed to promoting a healthy and scientific lifestyle, especially women's well-being and maternal and child health.