http://birthinternational.com.au/dia...s/2005_12.html
Giving birth in Japan
I have arrived in Japan, to present three separate programs over the coming days. Today I have been re-orientating myself to the Japanese birth scene and coming to grips with Tokyo - an amazing place!
My hosts, the Birth-Sense Institute an the Japan Birthing Association (more of these later) have given me some useful background, ahead of the weekend events, which will be for two different groups of health professionals. Today I will be working with childbirth educators on teaching strategies and activities, so this will be different, but it is always helpful to have an idea of how maternity services are managed when working in any new country.
What I have discovered so far is that Japanese women on the whole chose private obstetric care and give birth in one of the 2,500 maternity hospitals around the country. However, there is a strong tradition of local community based midwifery, with independent midwives offering services at their own “birth houses” and at present there are 350 of these in Japan. These are quite separate from the hospitals and are supported by the community - home birth is rare here (perhaps because of the style of houses and general living conditions?). There is a hospital in Yokohama that has a birth centre with tatami mats and a Japanese tea room and I will be visiting this unique service in a few days, so more on this later.
Midwives and obstetricians are aging here, as everywhere else and 52% of obstetricians are over 52 years old, which is of concern. Finding replacements for both midwives and doctors as they retire is an issue that will need to be addressed, just as it is everywhere, it seems.
Pregnancy care follows familiar patterns and in recent times an emphasis on weight gain has returned. Where once weight gain was not considered important, now an arbitrary limit of 8 kgs is often recommended and women are being scared into limiting their weight gain with the threat of problems if the baby is bigger. This is also happening in the West, although given that westerners are often much larger than the Japanese, the suggested limits are probably a little higher than 8 kg. This seems like a ridiculously small amount of extra weight for a pregnancy and must surely be producing unnecessary anxiety in the minds of pregnant women (as well as setting the stage for unnecessary caesareans).
The way births are managed in hospitals is not very different from anywhere in the West where medical care dominates. There are some differences, however. For example, women usually labour, in first stage, in shared rooms with three beds and only curtains for privacy. Fathers are generally allowed in, but in some places with is not possible and women labour alone. Japanese women labour very silently, and the only medication for pain is the epidural. I asked about pethidine and nitrous oxide use and was pleased at the mystified and puzzled looks I received - these are not drugs used in labour here at all, as far as I can tell.
All labouring women will have a monitor (CTG) attached and labour will be expected to proceed at a dilatation rate of 1 cm per hour with no more than 2 hours in second stage. There are no restrictions on food and drink in labour, unless it is known that the woman is to have a caesarean birth.
Most of this will be familiar, as these are routine procedures in most part of the world.
However, in Japan, shaving and enemas are standard and every woman will be given an episiotomy. It seems the research on these basic interventions has not reached these shores, even though these practises, especially shaving and enemas, were abandoned in the West 25 or more years ago.
Second stage requires a move to another room, and women give birth on their backs on the beds. All breech babies are delivered via caesarean. I asked about oxytocics for third stage and was told that these are routine, and given before the placenta arrives. It is also still routine to give every woman prophylactic antibiotics immediately after birth, even when there are no indications of infection.
Postnatally, most women breastfeed, and there are around 40 BFHI accredited hospitals in Japan.
This is the results of my initial research in birth in Japan. Later in my stay I will be visiting some birth houses and independent midwives and I am sure to get a very different story from them. I know that they aim for completely natural births and I am looking forward to finding out how this is achieved.
