Elizabeth Howell: How we can improve maternal healthcare -- before, during and after pregnancy
伊丽莎白·豪威尔: 我们如何改进孕产妇保健 ——孕前,孕中以及孕后
Elizabeth Howell is working to address maternal mortality in the United States. Full bio
Double-click the English transcript below to play the video.
眼前一片混乱。
as a resident physician
of doctors and nurses
一大群医生和护士
to save a woman's life.
挽救一名产妇的生命。
a few hours before I arrived.
生了一名健康的男宝宝。
became unresponsive,
and the patient was lifeless.
而病人生命迹象微弱。
tried to bring her back to life,
was the father's piercing cry.
是那位父亲撕心裂肺的哭声。
and the heart of everyone on that floor.
以及那层楼所有人的心。
the happiest day of his life,
生命中最快乐的一天,
to be the worst day.
was an isolated incident,
这场悲剧是一个个案,
is actually higher
for women of color.
的女性身上更加糟高。
actually increased over the last decade,
产妇死亡率实际上增加了,
than any other country in the world.
比其他所有国家都要高的花费。
that this new mother lost her life,
那位新母亲失去生命的同时,
and training in the field,
所有的背景和培训,
by how little attention was paid
maternal health care.
not just for myself
不仅仅是对于我,
was a civil rights attorney
是一名民权律师,
for what we believe in.
were born in Jamaica,
父母出生在牙买加,
the American Dream.
women of color were treated
I felt a responsibility to stand up,
我感觉到我有责任站出来,
by our healthcare system.
医疗系统所边缘化的。
on improving maternal health care.
放在改善孕产期医疗。
causing seizures and strokes,
of maternal mortality in this country.
死亡的部分主要原因。
is only the tip of the iceberg.
suffer a severe complication
100名女性都遭受了
相关的并发症,
having one of these events.
女性有其中的一个症状。
called severe maternal morbidity,
严重的产妇发病率,
and they're life-altering.
并且这些并发症会改变人的一生。
between 1.5 and two percent
that occur every year in this country
having a blood clot, a seizure, a stroke,
患上了血栓,癫痫,中风,
such as kidney failure,
that's frankly unforgivable
不能原谅的部分在于
of these deaths and severe complications
and standard procedures
these bad outcomes from occurring
fancy new technology.
我们知道的付诸于行动
between hospitals.
in labor has really high blood pressure
有着非常高的血压
antihypertensive medication
blood loss during delivery,
分娩中的血液流失,
and save a woman's life.
并挽救孕妇的生命。
of these catastrophic events tomorrow,
降低这些灾难性事件发生的概率,
the quality of care
to what is supposed to be the standard,
提升到我们认为的“标准”,
and severe complications way down.
并发症发生率大大降低。
actually adopted these standards,
of Obstetricians and Gynecologists
healthcare organizations,
and community organizations.
standard care practices
的医院和医疗系统里
throughout the country.
is a program called
in Maternal Health, the AIM program.
即AIM计划。
and severe maternal morbidity rates
质量和安全新举措
across the country.
和严重产妇并发症发病率。
a number of safety bundles
preventable causes of a maternal death.
has the potential to reach
出生人数的可能性。
protocols, procedures,
循证实践,习惯做法,步骤,
these conditions.
of a hemorrhage bundle.
你需要一个手推车,
might need in an emergency:
可能在急救中会用到的所有东西:
to measure blood loss:
这些海绵和衬垫,
collect these sponges and pads
用新技术来准确的评估
assess how much blood has been lost.
crises protocols for massive transfusions
大量输血时的危险期医疗方案
in the use of these types of bundles,
这种安全方案的领导者,
saw a 21 percent reduction
这种安全方案的第一年,
this bundle in the first year.
across the country is spotty or missing.
应用是参差不齐或者不完整的。
of evidence-based practices
for women of color in the United States.
治疗的质量则区别更大。
to suffer a pregnancy-related death
who deliver in this country,
分娩的黑人女性是真实有效的,
in the United States
drive these disparities,
收入差异导致了这些不同,
as compared to a white woman
不到高中学历的
to suffer a severe pregnancy complication
可能在分娩的时候
that education was our salvation,
教育是我们的救世主,
这根本不是真的。
perinatal health measures,
are even more pronounced
more likely to die
相关原因死亡的概率
than is a white woman.
are probably familiar with
of Dr. Shalon Irving,
撕心裂肺的故事,
who died following childbirth.
的流行病学家,死于后来的分娩。
in ProPublica and NPR
of hearing her mother speak.
演讲感动到热泪盈眶。
racial and ethnic disparities in health.
在医疗方面的差异。
this was her first baby,
a complicated pregnancy,
and was discharged from the hospital.
的女孩,然后出院了。
from complications of high blood pressure.
by healthcare professionals
was not recognized.
is just one of many stories
in health and health care
that the social determinants of health,
社会决定因素,
segregated housing,
an additional underlying cause:
使另外一个潜在的因素凸显出来:
by clinicians in those three weeks,
好几次临床医生,
in the setting of childbirth
of racial and ethnic disparities
and severe maternal morbidity
就可以处理的问题。
for a variety of reasons,
因为不同的原因,
in a specific set of hospitals,
特定的医院进行分娩,
outcomes for both black and white women,
都时常有更严重的预后不良。
of all black women
deliver in those same hospitals.
白人女性在同样的医院分娩。
of having a life-threatening complication
进行分娩时患上威胁生命
in one hospital than another.
are more likely to deliver
分娩时遇到不良结果
of the black-white disparity.
黑人-白人差异的原因。
social determinants of health
真正实现公平的医疗保健,
equitable health care in this country,
的社会决定因素,
and they will take some time to resolve.
解决它们需要一些时间。
we can tackle quality of care.
治疗质量的问题。
across the care continuum
提供高质量的治疗
and reliable contraception
providing preconception care,
and optimize health.
并且维持最佳健康状态。
high-quality prenatal and delivery care
产前和分娩治疗,
妈妈们和宝宝。
postpartum and inter-pregnancy care
产后和怀孕间的治疗,
to have a healthy next baby
为生育下一个健康的宝宝,
between life and death,
生命和死亡的区别,
after having an elevated blood pressure
was her second pregnancy.
that had happened two years earlier,
in the last few weeks of her pregnancy,
感觉并不是很好,
elevated blood pressures,
don't worry, you'll be fine.
“玛丽亚,别担心,你没事的。
You're a little nervous."
所以你有一点紧张。”
for Maria last time.
the signs and symptoms of preeclampsia
关于子痫前期的迹象和征兆,
if she was not feeling well,
sent her to the hospital.
ordered urgent lab tests.
紧急的实验测试。
to multiple different monitors
to her blood pressure,
to prevent a seizure.
药物来防止痉挛。
so high it put her at risk for a stroke,
令她有中风的风险时,
blood pressure in 15 minutes
according to the latest correct protocol.
给了她合适的静脉注射药物。
as a coordinated team
工作进展的很顺利,
lowered her blood pressure.
a tragedy became a success story.
变成了一个成功的故事。
were controlled,
from the hospital,
the signs and symptoms of preeclampsia,
子痫前期的迹象和征兆,
her blood pressure checked,
postpartum health and what to expect.
可能出现的情况的说明。
with her pediatrician
进行了几次术后随访
her blood pressure,
as a new mother.
谨慎和忧虑。
across the care continuum looks like,
高质量治疗的样子,
standard care practices,
实践的机构里分娩,
maternal morbidity rates would plummet.
发病率将会骤然下跌。
would no longer be an embarrassment.
不会让人觉得尴尬。
of unacceptably high rates
已经有了几十年的
complications during delivery
威胁生命的并发症高发率,
for moms, babies and families,
和家庭的毁灭性后果,
our poor performance on maternal mortality
产妇死亡率上表现不佳的关注
is within reach.
pregnant women from every community?
从每一个社区开始重视孕妇?
to ensure that when we do,
确保当我们开始做了,
技术和证据基础
ABOUT THE SPEAKER
Elizabeth Howell - Maternal health reformerElizabeth Howell is working to address maternal mortality in the United States.
Why you should listen
Elizabeth Howell is a physician, researcher and advocate committed to improving the health and well-being of women. She is an expert in quality-of-care and racial and ethnic disparities in maternal and child health. Her research focuses on the intersection between quality-of-care and disparities in maternal and infant mortality and morbidity, as well as postpartum depression and its impact on underserved communities.
A graduate of both Harvard Medical School and the Harvard Kennedy School, Howell is a pioneer in research in health equity. She has conducted extensive research on maternal morbidity and mortality in New York City and the significant racial and ethnic disparities that exist. She is a professor in the Departments of Obstetrics, Gynecology, and Reproductive Sciences and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. In addition, as the founding Director of the Blavatnik Family Women's Health Research Institute at Mount Sinai, Howell is building a competitive research program that advances the science of women's health across the life span. She has served on several expert committees for organizations including the National Academy of Medicine, National Institutes of Health, the Joint Commission and the American Congress of Obstetricians and Gynecologists.
Elizabeth Howell | Speaker | TED.com