【產科評估產程進展奉為圭臬的產程圖】
當年住院醫師時期值產房班，最重要的功課就是把每個產婦的產程圖畫出來。但是近年連Friedman教授本人接受ACOG（美國婦產科醫學會）訪問時都強調，這在當年只是一個統計數據的呈現，沒想到被拿來當成產程遲滯的判斷標準，每個產婦都該有自己獨一無二的產程進展。
日前接生一個第一胎的產婦，從進入產程到寶寶出生，收縮間隔都是5至7分鐘，有時甚至長達10分鐘，所以從上午9點收住院的1指半到寶寶出生將近一天。若要依照產科教科書的建議，這樣的案例，要不就加催生藥或人工破水，要不就以產程遲滯開刀了。但這就是這個產婦與寶寶獨特的產程進展，「慢慢來」。如何靜心等待不介入，對我而言是很重要的學習案例。
這個1955年的統計數據，當時的產婦生產條件為何？那是大量使用產鉗的年代，而今被真空吸引器所取代。剖腹產率1.8%！讓人嚇到吃手手，懷疑小數點有沒有點錯，認真想想或許這才是自然該有的剖腹產率？阿萍醫師要朝這個目標邁進。催生藥物的介入13.8%不算多，但看了之後很難想像，96%的產婦用了鎮定藥物，在神智不清甚至是睡著的狀態下生孩子。而今雖有硬膜外注射的減痛分娩，不至於影響到清醒程度，但那還是一種藥物介入，對母嬰一定有影響。
Who were the women in Friedman’s Curve?
Dr. Friedman’s study focused on 500 first-time mothers who gave birth at term in 1954. Their age ranged from 13 to 42 years old, and 70% were between the age of 20-30. More than half of the women had forceps used on them during delivery (55%), and only nine people (1.8%) gave birth by Cesarean. There were 14 breech births (2.8%), four twin births (0.9%), and four stillbirths or newborn deaths. The babies ranged in weight from 4 lbs. 9 oz. to 10 lbs. 6 oz., with most babies falling into a normal weight range (5 lbs. 8 oz. to 8 lbs. 13 oz.). Pitocin was used to induce or augment labor in 69 people (13.8% “Twilight sleep” was common practice at the time, and so 117 of the women (23%) were lightly sedated, 210 (42%) were moderately sedated, and 154 (31%) were deeply sedated (sometimes “excessively” sedated) with Demerol and scopolamine—meaning that 481 (96%) of the women were sedated with drugs (Friedman 1955)
參考資料
https://evidencebasedbirth.com/friedmans-curve-and-failure…/
