美国孕妇面临的隐患

这里是苹果新闻的《深度对话》栏目，我是施米塔·巴苏。今天我们将探讨为何美国的孕产医疗体系正在辜负家庭。几年前，记者艾琳·卡蒙在纽约市参加孩子幼儿园野餐时，一边照看孩子一边与其他妈妈们闲聊，话题突然转向她正在研究的新书项目。

This is In Conversation from Apple News. I'm Shmita Basu. Today, why America's maternal health care is failing families. A few years ago, journalist Irene Carmon was at a picnic for her child's preschool in New York City watching her children and chatting with the other moms when the conversation turned to her latest project, a book that she had just started researching.

有人问我这本书的主题是什么。我说是关于美国如何对待孕妇的。有人接话说‘像对待孩子’，另一个人说‘像对待动物’，而玛吉则说‘像对待幼兽’。

Somebody asked me what my book was about. I said, it's about how America treats you when you're pregnant. And somebody said, like a child. And somebody else said, like an animal. And Maggie said, like a child animal.

我环顾众人，暗自揣测她们各自的故事。

And I sort of looked at everyone wondering what their stories were.

其中一位妈妈玛吉最终成为艾琳新书的主要案例之一。这本书名为《难以承受：五位女性与美国孕产危机》，追踪记录了多个家庭在医疗体系中的遭遇，包括生育困境、怀孕、流产和分娩。每个故事都独一无二，但艾琳指出它们存在共同主线。

One of the moms, Maggie, ended up becoming one of the main stories told in Irene's new book. It's called Unbearable, Five Women and the Perils of Pregnancy in America. And it follows several families through their encounters with the health care system, navigating fertility challenges, pregnancy, loss, and birth. Each story is unique, but Irene says there is a common thread running through all of them.

美国——无论是通过冷漠的逐利医疗体系，还是通过最高法院推翻罗诉韦德案后全面生效的法律体系——都未能将我们视为拥有完整人格的人，而是将我们当作实现目的的工具或容器。

America, whether it was through our uncaring profit driven medical system or through a system of laws that were suddenly unleashed in full force when the Supreme Court overturned Roe v Wade has failed to see us as fully people, as fully human, who are in possession of our full faculties, and instead as a means to an end or a vessel.

艾琳表示，这种系统性失职不仅存在于人们的感受中，更体现在数据上。

That failure, Irene says, is not just something people feel. It's reflected in the data.

无论采用何种统计方式，即使最保守计算，美国仍是发达国家中孕产风险最高的国家。据疾控中心数据，80%的孕产妇死亡本可避免。

Regardless of how you measure it, if you crunch the numbers in the most conservative way, this is the most dangerous country to be pregnant among our Pernusians. And according to the CDC, eighty percent of maternal deaths are preventable.

我告诉过艾琳，现在也告诉正在听的你，我目前怀上了第二个孩子。我一直在思考第一次怀孕的经历，反思为何会与这么多女性进行过如此相似的对话——关于她们在怀孕分娩过程中感受到医疗体系的对待。于是我询问艾琳：为什么在美国，我们至今仍难以完善孕产保健体系？

I told Irene, and I'll tell you listening now, that I'm currently pregnant with my second child. I've been thinking a lot about how my first go around went and reflecting on why I've had so many similar conversations with women about how they felt they were treated by the medical establishment over the course of pregnancy and birth. So I asked Irene, why is this the case? That for so many people in America, we're still struggling to get maternal health care right.

我们的医疗体系存在深层问题，但怀孕有其特殊性。首先当你怀孕时，社会会强加性别化期待——要求你成为完美母亲，过着无可指摘的生活，遵循当下所有规范（尽管这些规范总在变化）。另一方面，怀孕既是极具力量又极度危险的经历，它能触发一个人最深层的情感、宗教、社会、文化和家庭观念，这种体验是肠镜检查之类医疗行为无法比拟的。同时它也孕育着喜悦的可能。

There are deep problems with our medical system, but there is something different about pregnancy. First of all, when you become pregnant, gendered expectations are placed on you to become a perfect mother, to live a blameless life, to be spotless, to follow whatever the rules of the given moment are, even though they shift, you know. And the other thing is that pregnancy is something that can be both deeply powerful and deeply dangerous. And it can bring up somebody's deepest emotional, religious, social, cultural, familial convictions in a way that going in and having a colonoscopy simply cannot do. And it has the possibility for joy.

顺便说，尽管生育率在下降，但人口普查显示现今80%的女性在育龄结束前都会经历分娩。怀孕也是美国女性住院治疗的最常见原因。这意味着许多平日健康的人首次以高强度方式接触医疗体系。研究调查显示，当询问分娩者什么最重要时，最大差异不在于分娩方式或地点，而在于是否受到尊重对待。对许多人而言，分娩经历恰恰暴露了医疗体系中普遍存在的非人化对待。

By the way, despite the fact that people are having fewer children, according to the census, eighty percent of women today will give birth by the end of their reproductive lives. And pregnancy is also the most common reason that women are hospitalized in this country. So it's also the way in which many otherwise healthy people interact with the hospital system and with the medical system in an intensive way that they may not have had experience with before. In research, in surveys, when people who give birth are asked about what mattered to them, the biggest difference was not, you know, what kind of birth they had or where they were, but how they were treated, and whether they were treated respectfully. And the experience of giving birth for many people is actually kind of putting people into contact with a kind of dehumanization in the medical system that others may experience.

或许因为他们是医疗补助患者、低收入者、性少数群体、居住在医疗资源匮乏地区、黑人身份或无证移民。包括我在内许多原本享有特权的人，一旦以孕妇身份接触医疗体系，都可能震惊于自己突然被当作幼兽般对待。

Perhaps if they're Medicaid patients, they're low income, they're queer, they live in a place that's underserved by medicine, they're black, they're undocumented. Many people, and I count myself among these, who otherwise enjoy a lot of privileges in the system, might suddenly be shocked and outraged to be treated like a child animal the moment you come into contact with the system as a pregnant person.

嗯，嗯。你在书中分享的案例让我深受触动。当时我和几位纽约妈妈在一起，其他有过分娩经历的母亲立刻产生共鸣。你描述的情景我也深有体会——作为有个两岁孩子且再次怀孕的人，我经常回想首次分娩时那些令人煎熬的细节。

Mhmm. Mhmm. I was really struck by that anecdote that you shared in the book. We were with a couple of other New York moms, and it seemed immediately recognizable to the other mothers who'd had experiences with childbirth. What you're describing, recognizable to me too, as someone who who has had one child who's almost two and is now pregnant with my second and thinking a lot about childbirth, and the experience the first time around and and what felt really difficult about it, frankly.

祝你平安美好的孕育之旅。另外我想说：谢谢。我学到的另一点是，怀孕期间你或许无法选择医疗结果，但现行体系却将巨大压力转嫁给个人，要求你做好所有研究、实现完美分娩——这本质是系统性问题。关于孕产妇死亡率的惊人研究显示，美国白人与黑人女性之间存在不可原谅的差距，而医院选择正是导致黑人女性更高死亡风险的因素之一。

And I wish you a a beautiful and safe journey, and I think also Thank you. One thing that I have learned is also different about pregnancy is that, you know, you may not be able to choose the medical outcomes, and I think the system puts a lot of pressure on the individual to like do all the research, have the perfect birth, when these are really systemic issues. Yeah. You know, there's shocking research into maternal mortality and the unforgivable gap between white women and black women in America. One of the factors that makes a black woman more likely to die is the hospital that she goes to.

如果黑人女性前往以黑人患者为主的医院分娩，她更可能遭遇致命后果。这揭示了服务有色人种为主的医院遭受资源撤资的现状。新泽西州一项超大规模研究更骇人地显示：医生便利性和利润考量会影响对无急诊指征患者实施剖宫产的决定，且黑人患者比白人患者更频繁遭遇这种选择。研究发现当同一位医生同时面对低风险白人患者和低风险黑人患者时，若医院有空余手术室，黑人患者更可能被实施剖宫产——虽然剖宫产常能救命，但也可能导致包括大出血在内的更多并发症，而产后出血正是孕产妇死亡的主因之一。

So if a black woman goes to a hospital in which the majority of the patients are black, she is likelier to have a fatal outcome in her birth. So what is that telling us about the disinvestment in hospitals that are disproportionately serving people of color? There's also a shocking, very, very large study out of New Jersey that shows that doctor convenience and profit contributes to choosing whether a patient who does not have an emergency indication has a c section, but that those choices are made more often with black patients than white patients. They found that when the same doctor was faced with a low risk white patient and a low risk black patient, and there was a room available in the hospital, the black patient was more likely to have a c section. C sections, while often lifesaving and necessary, can also lead to more maternal complications, including hemorrhage, which is one of the leading causes of maternal death.

因此我认为，造成这一不可饶恕的孕产妇死亡率差距的原因错综复杂。这些原因还与医疗体系的结构性因素有关——甚至在女性怀孕前，她们能获得多少医疗保障。美国35%的县被列为孕产医疗荒漠地区，完全没有任何孕产医疗服务提供者。所以孕妇们不得不长途跋涉求医。

So I think that there are so many interlocking reasons for this unforgivable gap in maternal mortality. And they also have to do with the structural elements of health care even before someone becomes pregnant, how much access they have for health care. 35% of American counties are characterized as maternal health care deserts. Do not have a per any kind of provider of maternal health care. So people are having to travel.

许多情况下，人们只有在确认妊娠检测阳性后才能获得保险，但只有凭医生开具的妊娠证明才有资格申请医疗补助。可如果没有保险，她们又如何预约医生进行检测呢？这些巨大障碍甚至阻碍了她们获得本可以降低孕产妇死亡率和发病率的医疗服务。

People are, in many cases, only getting insurance once they have a confirmed pregnancy test, but they're only qualifying for Medicaid once they have a doctor's pregnancy test. But how do they go in and get that doctor's appointment if they don't have insurance? So there are enormous barriers to even receiving the kind of care that might prevent the maternal mortality and morbidity rates from being so high.

影响美国现代孕产护理的力量早在一个多世纪前就已埋下种子。艾琳在她的书中重点讲述了这段历史中的关键人物——19世纪中叶阿拉巴马州的医生J·马里昂·西姆斯，而该州如今拥有全美最高的孕产妇死亡率之一。

The forces shaping modern pregnancy care in America first took root well over a century ago. In her book, Irene highlights one of the key figures in this history, j Marion Sims, a mid nineteenth century doctor from Alabama, a state that today has one of the highest maternal mortality rates in the country.

他被家乡驱逐出境，因为这位医术拙劣的医生偶然接触到几位年轻女奴的病例。这些患有产科瘘管病的女奴因分娩受伤，而奴役她们的种植园主迫切希望她们能再次生育以提供更多劳动力。J·马里昂·西姆斯得以在没有麻醉的情况下，让她们承受多年剧痛进行人体实验。

He was drummed out of his hometown because he was a very bad doctor who stumbled upon the cases of some young women. They were enslaved women with obstetric fistula, meaning that they had damage from giving birth. And the plantation owners who enslaved them were very in them being able to give birth again to provide more forced labor. And J. Marion Sims was given the opportunity to experiment upon them with no anesthesia, with great pain for years.

现代妇产医学的诞生，是建立在无数女性痛苦之上的——其中三位我们知道名字：阿纳尔卡、贝琪和露西，她们堪称妇产医学之母。

And this was the birth of modern gynecology, was the suffering of countless women, three of whose names we know, Anarka, Betsy, and Lucy, and they were the mothers of gynecology.

当西姆斯的实验性手术被认为足够安全可用于白人女性时，越来越多同行看到了以其诊疗技术为核心创办新业务的商机。这意味着要排挤他们的竞争对手——传统上负责孕产护理的助产士。

Once Sims' experimental procedures were deemed safe enough to perform on white women, more and more of his colleagues saw the opportunity to build new businesses centered on their practices. And that meant pushing out their competition, the midwives who traditionally did the work of maternal care.

他参与了驱逐传统助产士的进程，这些助产士不仅接生，还帮助女性通过当时可行的方法终止妊娠。当美国白人男医生接管生殖健康领域，并承诺为了自身利益和控制权提供更清洁、更体面、更无痛的服务时，我们就把这种等级制度奉为医疗实践的金科玉律。

He was part of a process of forcing out the traditional midwives who had been attending birth and also helping women end their pregnancies through what means they had at the time. When white male American doctors took over reproductive health care and promised that it would be cleaner, more respectable, more painless for their own profit and control, we enshrined that hierarchy into the practice of medicine.

这种等级制度在纽约布鲁克林的伍德霍尔医院清晰可见。这是一家主要服务于高贫困率社区的公立医院。伍德霍尔的助产士项目吸引了许多寻求此类护理的患者。但若产妇需要紧急干预，她们就会陷入资源匮乏的传统医院环境。自2020年以来，已有三名女性在该院分娩时死亡。

That hierarchy is visible at Woodhull Hospital in Brooklyn, New York. It's a public hospital that primarily serves a neighborhood with a high poverty rate. Woodhull's midwifery program draws many patients looking for that type of care. But if birthing mothers need emergency intervention, they might find themselves in the more traditional and as is typical under resourced hospital setting. Three women have died in childbirth there since 2020.

伍德霍尔医院以隐私法为由未公开评论这些死亡事件的具体情况，但家属已向记者发声。艾琳在学前班野餐会上认识的妈妈玛吉，就向她讲述了在那里经历的恐怖遭遇。

Woodhall Hospital hasn't commented publicly on the circumstances of these deaths citing privacy laws, but families have spoken out to reporters. And Maggie, the mom that Irene met at the preschool picnic, told Irene about a harrowing experience she had there.

玛吉来自加拿大，起初她并不了解美国医疗体系。随着认知加深，她越发感到恐惧。她渴望得到人性化对待的医疗护理，但在她就诊的医院始终未能实现。为此他们不惜长途驱车前往布鲁克林生育中心寻求助产士服务。但当玛吉经历两三天滞产后，显然胎儿无法自然娩出，于是被转送至伍德霍尔医院。

Maggie's from Canada, and at first, she did not understand the American health care system. And the more she learned about it, the more horrified she was. She wanted to have a health care practitioner who treated her like a human being, and it was not happening at the hospitals that she went to. So they drove pretty far from their house to Brooklyn Birth Center, which has midwifery care. But when Maggie went into labor after about two or three days of stalled labor, it became clear that this baby was not coming out, and they transferred her to Woodhall Hospital.

医生判定玛吉需要剖宫产。分娩后，丈夫发现她面色苍白、神志不清。她几乎失手摔落婴儿，丈夫未及检查生命体征就大声呼救。医生却坚称一切正常，声称这只是产后正常反应。而丈夫只能在走廊里边跑边呼救。

It was determined that Maggie needed a c section, and after the birth, her husband noticed her looking faint, not being herself. She almost dropped the baby, and he started calling for help without even checking her vitals. The doctor insisted that everything was fine. This is just what happened. She just had a baby, and he's going down the hallway screaming for help.

医护人员闻讯赶来，启动蓝色代码急救。事后发现玛吉的剖宫产切口未妥善缝合，导致内出血。正是丈夫声嘶力竭的呼救救了她——她需要全身换血并留下永久性激素问题。这个故事令我毛骨悚然，我试图理解它如何折射美国孕产护理的系统性问题。玛吉本是为寻求有循证依据的助产士护理而来，但当需要其他医疗干预时，却仍陷入公立医院资源匮乏的困境：医生超负荷、护士人手不足、高需求患者扎堆的压力。听闻玛吉遭遇两个月后，一位名叫克里斯汀·菲尔兹的女性在伍德霍尔医院去世。嗯。

People come running, they call a code blue, and it is later determined that Maggie's c section incision was not properly closed, and she was bleeding out internally. And only her husband's screams being heated saved her life because she needed a full body blood transfusion and had lasting hormonal And I was so deeply horrified by this story, and I was trying to understand how it fit into the broader story of American pregnancy care. She had come to Woodhall through a pathway of seeking midwifery care, which is evidence based to provide better outcomes. But that when she needed a different kind of care, she found herself with the same old crappy public hospital, underpaid doctors, understaffed nurses, the stress of being in an area with a lot of people who need a lot of help. And two months after I heard Maggie's story, a woman named Christine Fields died at Woodhall Hospital Mhmm.

这完全是一起可预防的死亡事件。

In an utterly preventable death.

是的。请讲讲克里斯汀的故事。

Yeah. Tell me about Christine's story.

克里斯汀在伍德霍尔医院出生，在布鲁克林贝德-斯泰的几个街区外长大。整个童年时期，她辗转于31个不同的寄养家庭。而在她分娩前，生活本已出现转机——她正在上大学即将毕业，抚养着两个孩子，遇到了何塞·佩雷斯并与之建立了美好的恋爱关系，两人正计划结婚。

Christine was born at Woodhall Hospital. She was raised a few blocks away in Bed Stuy, Brooklyn. Throughout her childhood, lived in 31 different foster homes. And at the time before she gave birth, things were really looking up in Christine's life. She was attending college, she was about to graduate, she was raising her two kids, she had met somebody, Jose Perez, who she had a beautiful relationship with, and they were planning on getting married.

她赢得了住房补贴抽签，搬进了长岛市一栋美丽的高层公寓，远离童年的痛苦记忆。但当她再次怀孕时，她选择回到伍德霍尔医院分娩，因为之前有位助产士给予过她优质护理。可悲的是，这次她遭遇了截然不同的对待。她多次向医护人员表示感觉异常，却遭到漠视。

She had won the housing lottery, the subsidized housing lottery, and moved into a beautiful high rise in Long Island City, away from some of the bad memories of her childhood. But she wanted to come back to Woodhall to give birth when she got pregnant again, because she'd had beautiful care from a midwife. And unfortunately, that's not what she got. She repeatedly told them that she thought that something was wrong. She was dismissed.

她情绪崩溃离开医院，自行办理出院后又返回就医，反复目睹白人患者受到精心照料而自己却被忽视。最终她在毫无心理准备的情况下接受了紧急剖腹产——这完全违背她的意愿。医院非但没有平静解释医疗方案，反而对她吼叫，将她的未婚夫何塞推出产房。根据我的调查，这种禁止伴侣陪同剖腹产的情况极为罕见。当何塞因她突发焦虑症而抗议时，院方竟叫来保安驱赶他。术后婴儿被送入新生儿重症监护室，何塞跟随孩子而去，克里斯汀的母亲则守在她身边。由于一连串难以解释的疏忽，护士们竟让克里斯汀独处一室，等何塞返回时发现她嘴唇发青，已失去意识。

She became upset, left the hospital, checked herself out, came back later, repeatedly saw that a white patient was being treated with great care while she was being ignored and dismissed, and wound up having a c section in a way that felt like a complete emergency. And she very much did not want a c section, and instead of calmly explaining to her her options, the hospital was screaming at her, they were pushing her husband away, They did not allow her husband her fiance, I should say, Jose, in the Operating Room for the c section, which is very unusual from what my reporting suggests. And when he protested and advocated on her behalf because she was having an anxiety attack, they called security on him. And when she emerged from the Operating Room, the baby went to the NICU, and Jose followed the baby. Her mother went to Christine, and by a completely inexplicable series of events, Christine was left alone by nurses, so that when Jose returned to her, her lips were gray, and she was unresponsive.

事后发现她因神志不清自行拔除了静脉输液管，却无人察觉。

It turned out that she had been disoriented and ripped out her IVs, and nobody had noticed.

天啊。

Oh my god.

调查显示克里斯汀遭遇了与玛吉相同的手术失误——她们相隔四年竟由同一名医生执刀。等到医生终于意识到问题时，已无力回天。更令人愤慨的是，在家属每周坚持抗议的情况下，医院始终拒绝给出解释，何塞甚至要为接回儿子展开法律斗争。

It turned out that Christine had the same injury, the same botched c section that Maggie had. And I learned in my reporting that four years apart, they had the same doctor. Oh. And by the time doctors finally realized what was happening with Christine, it was too late to save her life. Not only in the aftermath was the family not given answers as they were protesting outside on a weekly basis, but Jose had to fight to bring home his son.

尽管公寓也登记在孩子们名下，他却有长达一年时间被拒之门外。如今何塞已成为孕产健康权益倡导者，不仅考取了导乐师资格，更通过培训医学生来防止类似悲剧重演。

He was locked out of their family home, even though it was also in their children's names for over a year. And he has become a maternal health advocate. He's actually trained as a doula, and he's training medical students to prevent anything like this from happening again.

哇。哇。我是说，这故事真是...你确实把何塞描述为克里斯汀及其当时所需权益的坚定捍卫者，那种被排斥在外、完全无人倾听的极度挫败感。在这两起事件中，我相信你一定向伍德哈尔医院寻求过回应或声明。

Wow. Wow. I I mean, it's what a story. And and you really describe Jose as such a fierce advocate for Christine and what she needed in those moments, and the incredible frustration of being feeling like you're being blocked out, and definitely not heard. In both of these cases, for both of these stories, I'm sure that you sought reaction or statement from Woodhull Hospital.

伍德哈尔医院对这些事件有何说法？

What has Woodhull said about these instances?

最初我联系伍德哈尔时，他们同意接受采访——那时克里斯汀还在世。院方表示可以安排助产士和医生接受访谈，但当我提出还要询问2020年6月因该院麻醉师过失死亡的谢雅·森普尔事件后，他们取消了采访且再未回应。尽管我多次尝试联系，何塞目前正代表子女对伍德哈尔提起诉讼。

So I initially reached out to Woodhall, and they were responsive to me coming in for an interview until I said, this is before when Christine was alive. They told me I could come in and interview midwives and doctors, and I said, I'm also going to ask you about Sheaja Semple, who died in June 2020 at the hands of an anesthesiologist at Woodhall. And they canceled the interview, and no one ever called me back again. And I made repeated attempts to reach out to them, and they were not responsive. Jose is in the process of litigation against Woodhall on behalf of his children.

听起来玛吉夫妇也考虑过是否要走法律途径。她在书中描述道：'我现在有新生儿要照顾，难道要把所有时间都花在起诉医院上？'更糟的是，当他们意识到某些长期医疗问题的严重性时，诉讼时效已经过了，对吧？

It does sound like Maggie and her husband also considered whether they wanted to go the route of litigation. And Maggie describes this in your reporting in the book, like, do I really wanna spend my like, I have a newborn now. What am I gonna spend all my time pursuing litigation against this hospital? And not only that, it sounds like by the time they learned the severity of some of the long lasting medical issues that she was left with, they were timed out of taking legal action against the hospital. Right?

这非常美国特色——当你被这个远不止是某个庸医的庞大体系伤害时，受害者还得经历一场折磨人、昂贵、有时甚至造成二次创伤的非人化法律程序。我们的制度要求你主动起诉，而在纽约起诉公立医院的诉讼时效窗口极短，且赔偿金额非常有限。何塞一直在推动《哀恸家庭法案》，因为现行损害赔偿计算方式根本不考虑精神创伤。

So it's a very American way of doing things that when you are harmed this way by a system that is so much bigger than just one bad doctor, it also falls on the person who's been victimized to go through a grueling, expensive, sometimes traumatizing, dehumanizing legal process. The way our system is set up, it's on you to sue. And doing a public hospital in New York City is a very narrow time window of the statute of limitations. But also, the potential settlements in these cases is very limited. Jose has been advocating for the Grieving Families Act, because currently, the way that damages are calculated does not include emotional distress.

只计算收入损失。像克里斯汀这样刚完成大学学业、靠超市兼职完成学业的年轻人，其生命价值会被严重低估——因为精神痛苦不被计入。由于保险公司和医师协会的阻挠，这项法案虽多次通过州议会，却被州长霍楚以医院成本过高为由否决。即便你反复讲述创伤经历、牺牲照顾孩子的时间，最终可能收获甚微。

It only includes lost earnings. And so somebody like Christine, who was in college, who had just completed her degree, who, worked at a supermarket at a dollar store while putting herself through college, would be valued very little because emotional distress would not be taken into account. And it's only through the power of insurance companies and doctors' associations that that has not become law in New York State to take into account damages, because it's passed the legislature numerous times, and it's been vetoed by Kathy Hochul because she said it would cost too much for hospitals. And so even if you do go through this process where you have to tell your story over and over again, retraumatize yourself, spend hours where you could be taking care of your kids or yourself, it may not lead to very much. And what happens?

伍德哈尔医院在克里斯汀死后几个月终于开除了那名医生。但他们解决根本问题了吗？当出现明显痛苦征兆、静脉输液未连接、重大手术后无人查看时，克里斯汀被独自留下失血而亡。书中探讨的核心在于：虽然玛吉和克里斯汀四年间遭遇同一医生犯同样错误令我震惊，但这远不止是某个'坏医生'的问题，更是我们长期容忍的资金短缺问题——有些医院付不起高薪，不敢解雇庸医，因为他们可能招不到替代者，只能依赖医疗补助计划。

What happened at Woodhall is that a few months after Christine died, they finally fired that doctor. But did they fix the underlying problems that would lead Christine to be left alone to bleed to death when there were obvious signs of distress, when she her IV was not hooked up, when nobody checked on her even though she had had major surgery. So I think one of the aspects of the problem that I explore in the book is that although it deeply shocked me that Maggie and Christine had the same doctor making the same mistake four years apart, it's so much bigger than just one quote unquote bad doctor. It's also a level of disinvestment that we've tolerated that surfaces at moments like this, that some hospitals can't pay their doctors as much, are afraid to fire the bad doctors because they might not be able to hire another one. They rely on Medicaid.

我们正面临医疗补助削减的危机，而这个国家尚未完全感受到其全部影响。

We are experiencing a crisis in cuts to Medicaid that we haven't even yet felt the full impact of in this country.

我是说，在你讲述的这些故事中，这些女性伴侣的行为让我深受触动。这让我回想起自己分娩时的经历，当时我丈夫不得不充当我的维权者，在许多情况下甚至要与周围的医疗人员抗争。这对伴侣而言是多么艰难且充满压力的要求啊——从某种角度来说，这对他们本身也是一种创伤。

I mean, in these stories that you're telling, I'm struck by the actions of these women's partners in all of this. And it takes me back to my own birth experience where my husband was put in the position of being this advocate for me and and really in many scenarios fighting with the medical providers around us. And what a difficult and stressful ask that is of the partners. It is traumatic for them in a way in its own way.

研究表明，你受到不当对待的可能性与伴侣的种族有关。嗯。在这些关于分娩期间不当待遇的大规模调查中，任何种族的女性若有黑人伴侣，就更可能遭遇不当对待。另有研究显示，在孕期对医疗护理提出质疑会陷入两难境地，因为有些人会因投诉而受到惩罚——一旦被贴上'难缠'的标签，就会遭到报复。

So there's research that shows that you are likelier to be mistreated depending on the race of your partner. Mhmm. So women of any race were in these surveys, these very large surveys that were conducted about mistreatment and birth, women of any race were likelier to be mistreated if they had a black partner. There's also research that shows that the act of pushing back on your medical care during pregnancy is a kind of catch 22, because some people are penalized for complaining. They're retaliated against once they are perceived as difficult.

这确实是个进退维谷的处境，不仅伴随着大量替代性创伤，还将你置于这种不公的担忧中：'我的抗争会反过来伤害我多少？'何塞说他从入院起就被标记为问题人物，因为他为拉丁裔的克里斯汀维权，且满身纹身，当时还戴着金牙。院方预先将他标注为潜在麻烦分子，以至于每次接触都配有保安在场。

So it's a very tricky position to be in, and it does involve a lot of vicarious trauma, but it also puts you in this unfair situation where you worry, how much will this pushback come back to harm me? Yeah. And Jose said that he felt that he had been marked from the beginning when they came to the hospital as a problem because he was advocating for Christine, and he's Latino, and he has a lot of tattoos. At the time, he had gold teeth. They marked him down as somebody who was a potential problem so that every interaction that they had with him, there was security there.

嗯。

Mhmm.

他现在说：'那晚我真该大闹一场进监狱的。'把这种维权压力加诸个人实在太过沉重。研究显示有导乐陪产能显著改善孕产妇发病率和死亡率，这说明分娩时哪怕只有一个人为你发声、多一双眼睛盯着，都可能决定你是否会遭受分娩之外的重大身体创伤。嗯。

And so he now says, I wish I had gone to jail that night. I wish I had fought harder. It's too much to put on any individual to advocate that way. The research that shows that having a doula leads to dramatically better outcomes in maternal morbidity and mortality, what that's telling us is that just having one person advocate for you and be a set of eyes in birth can make a difference between whether you suffer major physical trauma in addition to what might be involved in your birth. Mhmm.

这反映出我们的医疗系统在人们最脆弱时刻承受着怎样的压力？要知道，你的伴侣（如果有的话）并未受过专业训练。在面对真正紧急的情况时，人们难免会表现出顺从。但如果从一开始就缺乏信任——某些群体因历史原因本就对医疗系统心存疑虑——当你感到自己不被倾听时，若有人告诉你需要某种紧急救治，你会接受还是继续质疑？

And so what does that say about the strain on our systems at this time of deep vulnerability? You know, your partner, if you have a partner, is not trained in any of this. And there's understandable deference in something that really truly can be an emergency. But I think not having that trust built up from the beginning, and there's certain communities who have historic reasons to mistrust the medical system. If you don't have that trust built up to begin with, if you don't feel listened to, then when somebody tells you that you need a certain kind of emergency care, are you going to accept it, or are you gonna ask more questions?

嗯，嗯。你最近在《纽约时报》发表了一篇文章，标题是《关于生育，我想告诉年轻时的自己什么》。以你现在的全部认知，经过多年工作并与无数人交谈后，你会对年轻时的自己说些什么，或者现在会对任何考虑生育的人说些什么？

Mhmm. Mhmm. You recently published an essay in the New York Times, and the title was, what I tell a younger version of myself about having a baby. Knowing everything you know now, and having done this work for years and spoken to so many people, what would you tell your younger self, or what would you tell anybody right now who is considering having a baby?

我书中的故事充满深刻挑战，但我想其中也不乏美好与希望的时刻。何塞努力让分娩更安全的行动深深激励着我。亚希卡·罗宾逊医生——一位在南方出生长大的黑人女性——长期提供堕胎服务，如今在阿拉巴马州为被遗忘的患者争取安全分娩的权利，她的故事也令我振奋。正因为人生这些时刻如此私密、个人化，又可能如此美好欢愉，我们才更需要揭露其中的问题。同时我们也可以探讨如何开辟空间，让生育成为美的源泉。

So the stories in my book are deeply challenging, but there are also moments, I think, of beauty and of hope. I'm really inspired by Jose trying to make births safer. I'm inspired by doctor Yashica Robinson, a black woman born and raised in the South, provided abortions for as long as she could, now is fighting for safe births for the patients who are left behind in Alabama. And it's precisely because these moments in people's lives are so intimate and personal and can be so beautiful and so joyful that we need to expose what's wrong with them. And we can also talk about we can open up that space to say, this can be a source of beauty.

生育可以成为喜悦的源泉。我认为怀孕也让我们所有人都置身于相互需要的网络中。这是你的身体、你的怀孕、你的选择，但同时也存在一种相互依存——那些关心你的人，以及如果你选择生育，将与你共同照料孩子的人。对我而言，这段经历美好而值得，我祝愿所有渴望怀孕并足月分娩的人都能获得安全、快乐与爱，因为现状本可以比现在好得多。

This can be a source of joy. And I think pregnancy is also all of us operating in a web of needing each other. It's your body, it's your pregnancy, it's your choice, but there's also an interdependency in the people who care for you and the people who will care alongside of you if you choose to have a child. And for me, it's been beautiful and rewarding, and I wish for safety and joy and love for anybody who wants to be pregnant and carried to term because it could be so much better than what we have right now.

艾琳，非常感谢你抽时间和我讨论这个话题。

Erin, thank you so much for your time for talking about about this with me.

谢谢，我把所有美好祝愿都送给你。

Thank you, and I am sending you all the good vibes.

艾琳·卡蒙的著作《难以承受》可在Apple Books找到。我们会在节目笔记页面添加链接。每周周末，你都能在Apple News应用中找到《Apple News对话》的新剧集，只需点击底部的小耳机图标进入音频标签即可收听。

You can find Irene Carmon's book, Unbearable, on Apple Books. We'll link to it on our show notes page. And every weekend, you can find new episodes of Apple News in conversation in the Apple News app. Just tap on the audio tab, that's the little headphones at the bottom, to find it.