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为什么美国乡村医院纷纷关闭妇产科?
Alisha Alderson is a 45-year-old woman from rural eastern Oregon.
艾丽莎·奥尔德森是一名来自俄勒冈州东部农村的45岁妇女。
In August, she was pregnant and just a few weeks from having her baby.
今年8月，她怀孕了，离生孩子只有几个星期了。
But that month, the only hospital maternity center near to her closed.
但就在那个月，她附近唯一一家医院的妇产科关闭了。
She decided to stay with her brother in the city of Boise, Idaho to be close to a hospital.
她决定和哥哥一起住在爱达荷州的博伊西市，以便离医院近一些。
In the United States, many rural hospitals have been closing maternity centers.
在美国，许多乡村医院一直在关闭妇产科。
The centers are areas of the hospital used only for mothers to give birth to their babies.
妇产科是医院里专供母亲分娩的区域。
Fewer than half of rural hospitals are now believed to have maternity units.
据信，目前只有不到一半的乡村医院设有妇产科。
That means pregnant women might have to travel long distances to have their babies under hospital supervision in specialized centers.
这意味着孕妇可能不得不长途跋涉才能在设有妇产科的医院监护下生孩子。
The Associated Press (AP) reports that birth centers are now increasing in the U.S.
据美联社报道，美国的分娩中心正在增加。
A midwife is a person who is trained to help women give birth but who is not a doctor.
助产士指的是受过培训帮助妇女分娩的人，但他们不是医生。
These centers however still need a hospital nearby in case of serious problems.
然而，分娩中心仍然需要附近设有医院，以防出现严重问题。
More than 2 million women of childbearing age live in places that some observers call "maternity care deserts."
超过200万育龄妇女生活在一些被观察人士称之为“产妇护理沙漠”的地方。
These are mainly rural areas that do not have hospitals with specialized maternity centers or obstetricians.
这些地方主要位于农村地区，那里没有配备专门妇产科或产科医生的医院。
An obstetrician is a doctor who specializes in the health of pregnant women.
产科医生是专门研究孕妇健康的医生。
Some doctors and researchers say that having fewer maternity units makes having babies less safe.
一些医生和研究人员表示，妇产科越少，生孩子就会越不安全。
A 2019 study of information from 2007 to 2015 said that rural residents have a nine percent greater chance of facing life-threatening problems or death from pregnancy and birth "compared with urban residents."
2019年一项对2007年至2015年信息的研究显示，与城市居民相比，农村居民面临危及生命的问题或因怀孕和分娩而死亡的几率高出9%。
Dr. Eric Scott Palmer specializes in helping babies born early and newborns with high-risk complications.
埃里克·斯科特·帕尔默医生专门帮助早产婴儿和患有高危并发症的新生儿。
He used to serve as a doctor at Henry County Medical Center in rural Tennessee before the hospital ended obstetric care in September 2023.
他曾在田纳西州亨利县医疗中心当医生，直到该医院于2023年9月关闭妇产科。
He said, "Moms have complications everywhere. Babies have complications everywhere."
他说：“各地都有母亲患有并发症，各地都有婴儿患有并发症。”
Peiyin Hung is with the University of South Carolina's Rural and Minority Health Research Center.
洪培银（音译）就职于南卡罗来纳大学农村和少数族裔健康研究中心。
She said that there are several reasons why maternity units are closing.
她说，关闭妇产科有几个原因。
Hung said there has been a decrease in the number of births in the United States.
洪说，美国的出生人口数量有所减少。
There are few workers in hospitals.
医院里的工作人员很少。
And there are other reasons.
还有其他原因。
For example, health care providers say government health insurance for the poor, called Medicaid, does not pay them enough for their services.
例如，医疗保健服务提供者表示，政府为穷人提供的医疗保险，即医疗补助，没有为他们的服务支付足够的费用。
The chief of Henry County Medical Center in Paris, Tennessee, John Tucker, said that closing the obstetrics, or OB, unit of the hospital was necessary to save the hospital itself.
田纳西州帕里斯亨利县医疗中心主任约翰·塔克表示，为了拯救医院本身，关闭妇产科是必要的。
Tucker said that 70 percent of the births there were covered by Medicaid.
塔克说，那里70%的新生儿都有医疗补助。
That number is above the national average of 42 percent.
这一数字高于全国平均水平（42%）。
Tennessee's Medicaid program only pays the hospital $1,700 for each baby born.
田纳西州的医疗补助计划每个新生儿只支付医院1700美元。
Private insurance usually pays more.
私人保险通常支付更多。
In the state of Oregon in 2021, the median payment to hospitals for a cesarean section, or C-section, was $16,000.
在俄勒冈州，2021年，在医疗补助网络内进行剖腹产的费用中位数为1.6万美元。
That is five times more than what Medicaid would provide for the same operation.
这是医疗补助计划为相同手术提供的费用的五倍多。
Tucker also said there were problems with having the right number of workers.
塔克还表示，拥有合适数量的员工也存在问题。
He said when there are fewer births, hospitals lose money because their costs are fixed.
他说，当出生人数减少时，医院就会赔钱，因为他们的成本是固定的。
"Whether we've got one baby on the floor or three, we still staff at the same level because you...have to be prepared for whatever comes in."
“无论我们楼上有一个孩子还是三个孩子，我们都需要配备一样水平的员工，因为你…必须为任何可能发生的事情做好准备。
Corina Fitch is a midwife at The Farm Midwifery Center in Summertown, Tennessee.
科琳娜·费奇是田纳西州萨默敦农场助产中心的助产士。
It is an independent center where pregnant women can receive maternity care.
这里是一个独立的中心，孕妇可以在这里接受产妇护理。
Fitch measures women's stomachs, takes their blood, listens to fetal heartbeats, and gives nutritional information.
费奇负责测量孕妇的肚子，采集她们的血液，听胎儿的心跳，并提供营养信息。
These kinds of centers could be an answer to the lack of maternity care choices in rural areas.
这种中心可能是解决农村地区妇产科匮乏的方法。
Many states are now taking steps to support more independent birth centers.
许多州目前正在采取措施支持更多的独立分娩中心。
In Connecticut, Governor Ned Lamont signed a law that will license these centers letting them provide care for low-risk pregnancies.
在康涅狄格州，州长内德·拉蒙特签署了一项法律，允许这类中心为孕期风险低的孕妇提供护理。
A 2020 report from the National Academies of Sciences, Engineering, and Medicine said there is a lack of data about independent birth centers.
美国国家科学院、工程院和医学院2020年的一份报告称，缺乏关于独立分娩中心的数据。
It said researchers do not fully understand the relationship between birth settings and maternal death or complications.
该报告称，研究人员并不完全了解分娩地点与产妇死亡或并发症之间的关系。
That is partly because there are a small number of births at independent centers.
部分原因是在独立分娩中心分娩的婴儿数量较少。
The Farm Midwifery Center reported that fewer than two percent of women decided to get a C-section.
农场助产中心报告称，只有不到2%的妇女决定剖腹产。
Five percent of patients were transported to hospitals in the center's first 40 years.
在该中心成立的头40年里，有5%的患者被送往医院。
Usually, women give birth at the center or at their homes.
通常，妇女在该中心或在家中分娩。
Fitch said, "We always have a backup plan because we know birth is unpredictable and things can come up."
费奇说：“我们总是有备用计划，因为我们知道分娩是不可预测的，任何问题都可能会发生。”
Some doctors told the AP that rural hospitals still need to be part of any answer.
一些医生告诉美联社，乡村医院仍然需要成为任何解决方案的一部分。
They think that state governments need to do more.
他们认为，州政府需要采取更多行动。
This June in Oregon, Baker City hospital announced that it was going to close its maternity center.
今年6月，俄勒冈州的贝克城医院宣布将关闭其妇产科。
Oregon politicians got involved.
俄勒冈州的政界人士也参与其中。
They suggested temporarily using obstetric nurses from the US Public Health Service Commissioned Corps.
他们建议暂时使用美国公共卫生服务军官团的产科护士。
The Corps is a group of military health care workers within the U.S. Department of Health and Human Services.
该军官团是美国卫生与公众服务部内的一组军事医护工作者。
The group usually helps with natural disasters and disease outbreaks.
该组医护工作者通常帮助应对自然灾害和疾病爆发。
However, that did not happen.
然而，这并没有发生。
The public health service sent officials who advised establishing an independent birth center among other things.
该公共卫生服务机构派出了官员，他们建议建立独立的分娩中心等。
Alisha Alderson - the woman who had to go to Idaho for pregnancy care - is married to Shane Alderson.
艾丽莎·奥尔德森——那个不得不去爱达荷州生产的女人——嫁给了肖恩·奥尔德森。
He said that rural communities should not have limited health care because of their size or because of the number of people on Medicaid.
他说，农村社区不应该因其规模或医疗补助人数而限制医疗保健。
Alderson said, "That's not equitable. People can't survive like that."
奥尔德森说：“这是不公平的。人们无法这样活下去。”
I'm Dan Novak. And I'm Faith Pirlo.
丹·诺瓦克、费思·皮尔洛为您共同播报。
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发表于 2023-11-23 15:48:25