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  3. The premises are as spick-and-span as any health centre. But unusually for somewhere full of newborns and mothers, a quiet calm

The premises are as spick-and-span as any health centre. But unusually for somewhere full of newborns and mothers, a quiet calm

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问题    The premises are as spick-and-span as any health centre. But unusually for somewhere full of newborns and mothers, a quiet calm prevails. Setagaya Postpartum Center in Tokyo is a rare place. Mothers with babies four months old or younger can stay the night to receive support from midwives and therapists. Some want help breast-feeding; a good few need counselling; others want to recover physically from giving birth, says Kumiko Nagamori, a midwife and director of the center.
   Kaori Ichikawa, who heads the Association for Antenatal and Postnatal Care Promotion in Tokyo, says that Japan is slowly realizing that it needs to do more to support women after they give birth. A few years ago the government improved the postnatal care it offers. That was prompted by a fall in the number of births and a rise in reported cases of child abuse. Now, she says, the focus is on the women themselves. Alarm grew this year, when it was revealed that suicide was the leading cause of death among pregnant women and new mothers in 2015 and 2016.
   Japan is not alone in waking up to the inadequacy of care in early motherhood — "the fourth trimester", as it is sometimes called. Women are suffering, but feel that they have to act as if everything is fine, says Sarah Verbiest, a public-health expert in North Carolina who runs a research project on the fourth trimester. The system in America, as elsewhere, she says, tends to focus on the health and well-being of the baby, rather than that of the mother.
   The needs are glaring. Some 10%—15% of women in America and around a quarter in Brazil are reckoned to suffer from postpartum depression. The physical toll of giving birth is less well studied, but some 90% of women may tear their pelvic-floor muscle during birth, and 6% of them suffer a serious injury, according to Britain’s Royal College of Obstetricians and Gynaecologists.
   The growing focus on postpartum care is in part a consequence of good news: childbirth itself is safer than it has ever been. From 1990 to 2015 the number of maternal deaths around the world fell by almost half, to 216 per 100,000 women, thanks in large part to women delivering their babies in proper medical facilities. Nearly all of these deaths (99%) are in developing countries. However, this article focuses on the rich world, where, with the notable exception of America, maternal mortality has fallen.
   A second reason for the new attention being paid to care for new mothers is that women, including famous ones, have been speaking out about their unhappy experiences. Serena Williams, a tennis player, has written of the "funk" of postnatal depression. Keira Knightley, an actor, wrote about her experience of childbirth: "Hide. Hide our pain, our bodies splitting, our breasts leaking, our hormones raging." Ali Wong, a comedian, delighted and shocked Netflix fans by yelling about women’s "demolished-ass bodies" and her horror at finding out that new mums who advised her to steal nappies from hospital meant not for the baby but for herself.
   The importance of the postnatal adjustment has been implicitly recognized in traditional rest periods such as China’s zuoyuezi ("sitting the month") when new mothers follow timeworn practices such as refraining from washing their hair or consuming cold drinks, or la cuarentena, a 40-day rest, observed in Mexico and other Hispanic countries.
   Yet this is poorly reflected in modern health systems, which tend to offer plenty of check-ups during pregnancy, but very few after it. It is usual for women in countries including America and Britain to receive just one visit from a health worker when their babies are six weeks old. American federal law does not even oblige employers to give women paid time off work.
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答案 和所有医疗中心一样，这些地方非常干净整洁，但对于一个满是新生儿和妈妈的地方而言，它们却有点特别：这里一片寂静。位于东京的世田谷产后中心(Setagaya Postpartum Center)就是这样一个特别的地方。妈妈们可以带着四个月大或更小的宝宝在此处过夜，并接受助产士和治疗师的帮助。中心主任兼助产士永盛美子(Kumiko Nagamori)称，有些人想要寻求母乳喂养方面的帮助；有些需要心理咨询；还有人则想要在生育过后恢复身体。 市川香织(Kaori Ichikawa)是东京产前和产后护理联合会(the Association for Antenatal and Postnatal Care Promotion)的负责人。她说，日本正在慢慢认识到要给予产后女性更多帮助。因为出生人数减少，虐童事件报案数量有所增加，几年前，政府改进了产后的护理服务。如今的关注点集中在女性自身。据透露，在2015和2016年，自杀是导致孕妇及新妈妈死亡的主要原因。时至今年，人们的恐慌仍与日俱增。 日本不是唯一一个意识到初产妇需要照顾的国家。产妇所经历的这个阶段常被人称为“第四个三个月”①。北卡罗来纳州的公共健康专家莎拉-韦贝尔茨(Sarah Verbiest)负责“第四个三个月”的研究项目，她说女性明明遭受着痛苦，却感觉自己不得不表现得跟没事儿人一样。她还说，美国的医疗体制和其他地方一样，更倾向于关注宝宝而不是新妈妈的健康和幸福。 女性的产后需求显而易见。大约10％到15％的美国女性和约1／4的巴西女性遭受着产后抑郁的折磨。很少有人深入研究生育所带来的身体伤害，但据巴西皇家妇产科学院(Royal College of Obstetricians and Gynaecologists)称，在生育过程中，约90％的女性，其盆底肌会被撕裂，其中6％的女性身体会遭受严重损伤。 人们对于产后护理愈发关注，部分原因得益于生育本身比过去安全多了。而主要原因则是女性在生育时选择了恰当的医疗机构，从1990年到2015年，全世界的孕产妇死亡人数下降到每10万名中有216名死亡，数量减少了将近一半。几乎所有生育死亡病例(99％)都发生在发展中国家。不过，本文主要关注发达国家，除美国这一特例外，发达国家的孕产妇死亡率都有所下降。 人们对新妈妈产后护理愈发关注的第二个原因是，女性包括知名女性在内，都在谈论自己不愉快的产后经历。网球运动员塞雷娜-威廉姆斯(Serena Williams)曾写到产后抑郁所带来的“恐慌”。演员凯拉-奈特莉(Keira Knightley)也曾写到自己的分娩经历：“忍受……忍受着痛苦，我们的身体被撕裂，乳房溢奶，激素水平飙升。”令网飞(Netflix)迷们又惊又喜的是，喜剧演员黄阿丽(Ali Wong)也大声讲述女性分娩时“被摧毁的身体”，当其他新妈妈建议她去医院为自己而不是为宝宝偷尿布时，她感到很惊恐。 中国有“坐月子”的传统，在此期间，新妈妈会遵照老规矩，比如不洗头发、不喝冷饮。在墨西哥和其他拉美国家，新妈妈有“拉奎雷纳”(la cuarentena)，其本意是四十的意思，也就是说，她们有40天的休息时间。这些传统的产后休养阶段都说明了产后调整的重要性。 然而，上述这些措施在现代医疗体系中鲜有体现。现有体系倾向于在孕妇怀孕期间为她们提供大量检查，但提供的产后服务却寥寥无几。在美国和英国等国家，新妈妈通常在产后六周时才能接受专业医护人员的上门体检。美国联邦法律甚至未规定雇主为女性提供带薪产假。 ①准妈妈在怀孕的时候，我们经常会用“trimester”(三个月)将其妊娠期划分为孕早期、孕 中期和孕晚期这三个阶段，而“the fourth trimester”指的是宝宝出生到三个月的这个时 间段，即宝宝出生的头三个月，和前三个三个月相连，就是“第四个三个月”。
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