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Low-risk pregnancy cases are being urged to avoid hospital birth under new NHS guidelines Photograph: Katie Collins/PA
根据英国国家医疗服务体系指引，低风险孕妇敦促避免住院分娩
Women with low-risk pregnancies are to be encouraged to have non-hospital births under new NHS guidelines, which could see almost half of mothers-to-be planning to deliver their baby away from traditional labour wards.
根据新的NHS指引，鼓励低风险孕妇不在医院分娩，这就意味着半数左右的准妈妈们将不在传统的产房分娩。
Guidance from National Institute for Health and Care Excellence (Nice) says that midwife-led care has been shown to be safer for women and recommends that all women with low-risk pregnancies – 45% of the total – should be advised that giving birth in a midwifery-led unit, whether attached to a hospital or not, is “particularly suitable”.
Nice（国家临床医学研究所）指引表明由助产士护理更安全，建议那些占总数45%的低风险孕妇在助产士机构分娩是极为妥当的，无论这些助产士机构是否附属于医院。
The changes, published on Wednesday , have been made because women who give birth under midwife-led care have less chance of being asked to undergo medical interventions such as episiotomies, caesareans and use of forceps or ventouse.
星期三发布了新的指引，由于在助产士的护理下分娩的女性，被询问实施诸如会阴切开术，剖腹产，产钳产以及吸引产的医疗干预的机会较少。
Susan Bewley, professor of complex obstetrics at King's College, London, and chair of the Nice advisory group, added that infections were more common on hospital wards.
伦敦国王学院综合妇产科教授兼国家临床医学研究所咨询小组主席Susan Bewley补充道，感染在医院病房更常见。
"We're supporting an individual calm conversation about what is right for each individual in her circumstances," Bewley said. "They may choose any birth setting and they should be supported in those choices as that's their right."
我们支持那些根据自己的情况做出适合她们的选择。Bewley说道，应该支持她们选择分娩环境的权力。
The NHS body also advised midwives not to clamp and cut a baby's umbilical cord until at least a minute after birth in the absence of complications, and generally within five minutes.
NHS还建议在没有并发症的情况下，助产士应在一分钟以上五分钟内剪断婴儿的脐带。
The announcement reverses decades of NHS policy and its own advice from 2007 recommending "early clamping and cutting of the cord".
这条指引的宣布颠覆了数十年来的NHS制度以及2007年推崇尽早剪断脐带的建议。
Research suggests that early clamping and cutting may leave newborn babies deprived of vital blood from the placenta, risking anaemia.
研究表明尽早剪断脐带会使新生儿过早失去胎盘血，导致有贫血的风险。
In separate guidance on postnatal care, Nice said parents should also be informed about the association between falling asleep with their baby on a bed, sofa or chair and sudden infant death syndrome until the baby is 12 months old.
关于产后护理的指引，NICE指出父母应知晓在婴儿满12个月之前，和婴儿同睡与婴儿猝死综合征之间有关联。
The change represents another significant change to the guidelines, issued in 2006, which only applied to babies up to the age of six to eight weeks. Parents should also be informed that the association may be greater if parents use drugs or have recently drunk alcohol, or if the baby was of low birth weight or premature.
这项新的指引对2006年公布的适用于6-8周大的婴儿身上的指引作出了显著的修改。应告知父母，在孕期服药或饮酒，还有婴儿出生时体重过轻，早产和婴儿猝死综合征的联系更大。
Nine out of 10 of the 700,000 babies born in England and Wales each year are currently delivered in hospital under the supervision of obstetricians. Nice added that commissioners should ensure that women have all four possible options for giving birth available to them: hospital care, midwifery units in hospitals, midwifery units based in the community and at home.
每年有700，000的婴儿在英格兰和威尔士出生，其中90%的婴儿在产科医生的监护下出生。NICE补充道 应确保女性有四种分娩环境的选择，即选择在医院，医院附属助产士机构，社区助产士机构以及在家中分娩。
Professor Mark Baker, Nice's clinical practice director, said: "It's very difficult to explain why this is happening but the closer you are to hospital, and indeed if you are in hospital, the more likely you are to receive hospital care and surgical interventions."
Nice临床实践主任Mark Baker教授说道“离医院越近以及已入院，接受医院护理以及外科手术的可能就更大，很难解释为什么会这样。”
"Surgical interventions can be very costly, so midwifery-led care is value for money while putting the mother in control and delivering healthy babies."
因为外科手术费用昂贵，当产妇在可控范围内分娩健康宝宝时，助产士护理会物超所值。
The outcome for the baby is the same in different settings except in the case of first-time mothers giving birth at home, where there is a "small increase" in risk of serious complications – nine in every 1,000 compared with five in every 1,000 in the other settings – which the guidance says mothers should be advised about. Home births are the cheapest, followed by midwife-led units and then hospitals but Bewley said costs did not come into the equation.
在不同环境分娩婴儿结果是相同的，但不包括初产妇在家分娩，因为会有小部分人有严重的并发症-千分之九的概率，而在其他环境分娩的概率为千分之五- 在家分娩花费最少，其次是助产士机构，医院花费最多，但是Bewley说费用不是作出选择的关键。
Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said: "For low-risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions."
皇家助产士学会首席执行官Cathy Warwick说：对低风险孕妇来说，在助产士机构或在家分娩是安全的，减少医疗干预。
“We hope this will focus commissioners' and providers' of maternity services attention on ensuring that women have a real choice about where they give birth.”
我们希望这会使妇产科机构的管理层关注于确保女性能选择适合他们分娩的环境。
The RCM has been campaigning for about 5,000 extra midwives to be recruited. Warwick said the new guidance would not stretch existing medical staff further but ensure they were better employed, as more women would have births without interventions, which require more resources.
RCM正致力于再招收5000名助产士。Warwick说：在新的指引中，现有的医务人员不再扩增，但会被安排在更合适的岗位，因为更多的女性将在没有医疗干预的环境中分娩，这将需要更多的资源。
Elizabeth Duff, senior policy adviser for the NCT (National Childbirth Trust), welcomed the advice and urged the NHS to "put these guidelines into practice as soon as possible and make home and community birth, a real, not just theoretical, option".
国家剩余信托基金会高级策略顾问Elizabeth Duff对这个指引表示欢迎并敦促NHS尽早将指引落实，在家和社区分娩将会是个真实的选择而不光是理论的。
Community midwife units have lower medical intervention rates and rates of transfer to obstetric wards than those in hospitals but many have been closing recently. For women not giving birth for the first time they also have a lower rate of transfer to an obstetric ward than mothers who planned to give birth at home.
相对医院来说，在社区助产士机构中医疗干预和转到产科病房发生率较低，但是最近很多社区助产士机构已经关闭。比起那些打算在家分娩的孕妇来说，经产妇转移到产科病房的发生率更低。
