Birth in Japan
Encyclopedia
This article deals with Birth
in Japan, and the specific details of childbirth exclusive to Japan in relation to beliefs, attitudes and healthcare.
to a sun goddess from whom the original emperors are said to be descended beginning in 660 BC. Japan was, for the next one thousand years, a largely heterogeneous culture with diverse regional social patterns. Contact with Korea
and China
during this time brought aspects of both cultures to Japan, including rules of rank and etiquette, the Chinese calendar
, astronomy, and a healing system based on traditional Chinese medicine
. Military dictators, or ‘‘shoguns,’’ ruled for roughly the next seven hundred years, culminating in military reunification, and widespread implementation of civil order consistent with the ethos of the samurai class, eg. rules of loyalty, social hierarchy, and filial piety.
Western attempts at trade with Japan were largely unsuccessful until 1853 when an American fleet led by Comadore Perry arrived in Japanese waters and forced Japan into unfavorable trading agreements. This event coincided with the fall of the ‘‘shoguns’’ and the subsequent Meiji restoration that ended a system of feudal landholders, and helped unify the nation. Japan quickly transitioned to a modern power with an imperial army. Japan then began to extend its empire and seize various Pacific islands and parts of Russia
. This militarism carried over to the 1920s when Japan invaded China, to the 1930s when Japan joined the Axis powers, and finally into the 1940s when Japan attacked Pearl Harbor. In 1945, the historic drop of two atomic bombs by the US on Hiroshima
and Nagasaki
resulted in the disastrous outcomes that ultimately forced retreat.
The US then occupied Japan from 1945 to 1952 under General Douglas MacArthur. A new constitution took effect in 1947 according to which the emperor became largely a symbolic head of state. Japan regained its sovereignty in 1952, and in 1972 the US gave back some islands, the Ryuku, that included Okinawa. Japan’s economic growth was swift, relying on new technologies, manufacturing and a protectionist attitude. In 1998, Japan – like much of the region – suffered the worst recession since World War II
, which led eventually to the resignation of the prime minister. Since then the economy has improved, but is still plagued by stagnation, a fact that the recent 23-foot tsunami
and the largest earthquake
in Japanese history that struck on March 11, 2011 did not help.
In 2005, 20.1% of the population was over 65 years old. This figure is projected to increase to 31.8% by 2030, higher than any other industrialized nation. The fertility rate, at 1.21, is below the replacement level. The percent of three-generational households has steadily declined since the 1970s while the proportion of one-person and nuclear households has increased steadily in the same time period.
Social interactions in Japan are traditionally guided by the opposing dynamics of intimacy and hierarchy. In social situations, a commitment to group harmony, solidarity and intimacy must be balanced by deep respect for hierarchy. Rules of hierarchy are guided by age, social status and type of employment. Appropriate behavior therefore depends on a person’s ability to assess the relative hierarchical distinction between individuals. Distance naturally decreases intimacy, and appropriate language must be used to communicate deference and avoid offending the other party. Traditionally, any behavior that fosters conflict or suggests deviance is not acceptable in Japan.
is hereditary while the prime minister must be elected by the Diet, or a bicameral legislative branch consisting of the House of Councilors and House of Representatives. Japanese local administration is by prefecture. The country is divided into 47 prefectures, each of which is further subdivided into cities with respective wards and blocks. Suffrage is granted at age 20
Japan boasts the fourth largest GDP in the world after the European Union, the United States, and China. While Japan was for centuries a largely agricultural economy, the percentage of the total labor force shifted dramatically in the twentieth century from agriculture to industrial occupations. Consequently, Japan must import about 60% of its food. Japan is one of the world’s largest, most technologically sophisticated producers of automobiles, electronic equipment (including digital cameras), machine tools, steel and nonferrous metals, ships, chemicals, textiles, and processed foods. The unemployment rate is stable at less than 5%. Nevertheless, the economy is challenged by Japan’s huge government dept, exceeding 200% of the GDP, unrelenting deflation, reliance on exports, and graying, diminishing population.
A classic “M-shaped curve” notably marks female employment as many women drop out of the labor force to raise children. Three times as many women are employed part-time as men.
(2%), and other (7.8%). Total adherence exceeds 100% because many identify with both Shintoism and Buddhism. Shinto shrines, honoring gods and goddesses of ancient Japanese mythology, decorate the landscape of Japan. Shintoism is based on earlier animistic and shamanistic traditions, and contains many concepts crucial to daily Japanese life today including cleanliness of the body and home. Shintoism was for a long time considered the “people’s religion” while Buddhism was adopted originally by the elite. Fundamental to Zen Buddhism are values such as personal effort, personal sacrifice, dedication, exertion, attunement to the body as well as meditation centered upon daily activities such as tea drinking, flower arrangement, and gardening. Confucian philosophical traditions, while not specifically religious, are also embedded within Japanese culture. The five essential relationships according to this philosophy are father-son, ruler-son, husband-wife, older brother-younger brother, and between friends. Clearly this system leaves out woman-centered relationships (eg. mother-daughter).
’’ The government granted Kampo official status in the 1950’s, a landmark event which came with both government regulation as well as national insurance coverage for certain types of treatment. Kampo is centered on establishing balance of physical, mental, social, and emotional states. An imbalance may be due to changes such as heat (eg. overactivity), poor diet, dampness, or pathogens. Balance and imbalance are understood according to three main sets of contrasting states: hot/cold, excess/deficiency, and internal/external. A practitioner of ‘‘Kampo’’ gathers extensive personal information about physical and emotional experience and focuses on restoring balance. Treatments include moxibustion
and acupuncture
. Kampo treatment is generally considered appropriate for chronic conditions, when multiple organs are affected (eg. immune disorders or age-related decline), or when biomedicine cannot diagnose or effectively treat a condition.
The availability of the birth control
pill in Japan is a highly contentious issue due to the government’s concern for its many potentially negative systemic side effects and worry that it may contribute, through lack of condom use, to a rise of HIV
. While the pill is now available, usage continues to be lower than many other countries. A 2001 survey of 1500 women, for example, found that only 4% of Japanese women use this method compared to 87% in the US and 93% in Germany.
Abortion has been legal in Japan since 1948. A 1982 survey by the Kyodo News Service reported than 75% of women in their fifties had undergone abortions at some point in their lives. Abortion became legal during the postwar period when the needs of survival limited the number of mouths a family could feed. Nevertheless, abortion is not taken lightly and is traditionally marked by various Buddhist rituals in which parents express regret and gratitude to their aborted children for their sacrifice for the family.
Women’s health related figures in Japan are inspiringly positive. Japan boasts one of the longest life expectancies for women in the world at 82.25 years. And the infant mortality
rate is 2.78 deaths per 1,000 live births, one of the lowest in the world. Whether these two facts are related to a final figure, the 2011 estimate of fertility rate of just 1.21 children, is as yet undetermined.
Japanese women are advised to have prenatal visits every 4 weeks through 23 weeks gestation, every 2 weeks from 24 to 25 weeks, and every week after 36 weeks, for a total of 14 prenatal visit for a low to medium risk pregnancy. Ultrasound
is used routinely to monitor the development of the fetus; most women have at least five fetal ultrasound exams during their pregnancy, a heavy use of technology considered necessary to assure a healthy baby and safe birth. Screenings for domestic violence
and maternal depression are not often conducted during prenatal visits in Japan, while in the US 35% of women are screened for domestic violence and 47% for maternal depression.
Genetic screening tests, such as amniocentesis
, are available in Japan but rarely used. Contrary to US culture, the idea of having a “normal” or “abnormal” fetus is not as much a part of the traditional Japanese conception of pregnancy. Rather, the Japanese paradigm sees a fetus as inherently a work in progress, or “perfectible.” Ob-gyns rarely initiate open discussion of the possibility of undergoing amniocentesis or triple marker tests with pregnant patients. In fact, the Health Ministry issued guidelines in 1999 according to which ob-gyns have no obligation to inform patients of these tests. Having an abortion due to fetal abnormalities is very rare. Some theorize that the reason for this is because the role of mother is so highly valued, while others suggest that women, freed from the pressure of holding down a job during motherhood, are less daunted by the time required to care for a child with additional needs.
Men are considered to be far removed from pregnancy because it isn’t occurring in their bodies; they are therefore often exempt from maternity courses, medical visits, as well as sometimes the birth event itself.
analgesia, and independent midwifery homes never use analgesia. Most Japanese women use nondrug methods to alleviate labor pain, namely: breathing techniques, position changes, movement, and hands-on techniques such as massage, stroking, or acupressure.
Many Japanese women believe that the mother child bond is built through suffering from labor pain together. Others fear that pain medication will make the fetus groggy. Safety is a primary concern. Some Japanese women who do not use pain medication for the first labor decide to use it in subsequent births.
Professional midwives had a national midwifery
association in Japan from 1927 until it was dissolved by U.S. occupying forces after WWII. Since 1948, the education system for midwives was combined with nursing education, both of which require three years of training. Interestingly, the word for midwife also changed after 1947. The original word ‘‘sanba’’ (‘‘san’’ meaning birth and ‘‘ba’’ meaning old women) was changed to ‘‘josan-pu’’ (‘‘josan’’ meaning help delivery, and ‘‘pu’’ meaning woman). And in 2002 it was changed again to ‘‘josan-shi’’ (‘‘josan’’ meaning help and ‘‘shi’’ meaning teacher) to avoid gender connotations.
In 2006 there were 25,775 midwives in Japan: 88% worked in hospitals and clinics, 6% were independent, and 6% were employed by universities, and government institutions. Independent midwives attend birth in one of the 388 practicing maternity homes nationwide.
Medical education in Japan lasts six years, and begins directly after high school. The first four years of training are considered preclinical, and the final two years are clinical. In 2006, there were 79 medical schools in Japan, and the students were 32.8% female. A recent law now requires training for an additional two years after graduation. The field of obstetrics in Japan differs from the US in the high value placed on normal physiologic birth, and in the concept of obstetrics as a field largely distinct from surgery.
The care provided by independent midwives at maternity homes or in home births is traditionally woman centered, the locus of decision-making power remains with the laboring woman.
position, is still used.
Without pain medication, birth becomes a final demonstration of the maternal responsibility, maturation, and hard work a woman exemplified throughout her pregnancy. Some believe that not experiencing pain during birth hinders bonding between mother and baby. A birth educator in Japan may tell expecting mothers that birth hurts and there’s nothing to be done about it, or share a well-known Japanese proverb: “The child that made one’s belly hurt is lovable.”
If a Japanese woman would like an epidural during labor, she must give birth at one of the few private and expensive hospitals that provide them. Pursuing this option is still relatively rare in Japan today.
Many midwives practice perineal massage to promote stretching, ease birth, and minimize maternal trauma.
, stroking, and acupressure.
If complications arise that demand cesareans, then cesareans are performed. However, cesarean birth has a negative image in Japan, and is often perceived as suggestive that a woman was incompetent or deficient. The rate of c-sections in Japan in 2005 was, according to one estimate, 17.4%. Other reports suggest the rate is as low as 10% in some locations; nevertheless, rates between 10% and 20% reported throughout Japan are significantly lower than North America. Of women attempting vaginal birth at a maternity home, about 10.2% are eventually transferred for complications to large hospitals with neonatal intensive care units.
was much less for women who gave birth in maternity homes than for those who delivered in hospitals. The authors attributed this difference to the idea that bodily damage and pain are experienced far less in Japanese maternity homes than hospitals.
that falls off in a special box specifically designed for this purpose. When the mother leaves the hospital, the umbilical cord is given to her. This tradition relates to ancient Japanese customs based upon the belief that the umbilical cord is connected to the health of the newborn baby. Maltreating it, therefore, risks causing harm or disease in the child. In some Japanese households, a mother may show a child the umbilical cord on a happy event, or on birthdays to recall the day the child was born. In other households, the umbilical cord is given to a child on the day he or she leaves home or gets married to symbolize separation.
is officially promoted, but artificial milk is also heavily advertised. (Engel 1989) Many women in Japan breastfeed, but when the baby is in a grandmother’s care, for example, formula may be given.
When a baby is 100 days old, Japanese families celebrate a weaning
ceremony called ‘‘okuizome,’’ or first food. This ceremony traditionally involves a large shared meal prepared by the mother-in-law. The menu varies by region. Traditionally, a small pebble is placed on each plate and the adults symbolically bite down on it. This ritual is meant to wish the baby a life of abundant food without hunger as well as good strong teeth. While a father or grandfather may pretend to feed the baby solid food during these festivities, the baby is usually still drinking exclusive milk.
with newborns in the norm. Japanese babies traditionally sleep in close proximity with their parents on an adjacent bamboo or straw sleeping mat.
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
in Japan, and the specific details of childbirth exclusive to Japan in relation to beliefs, attitudes and healthcare.
History
Legend attributes the creation of JapanJapan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
to a sun goddess from whom the original emperors are said to be descended beginning in 660 BC. Japan was, for the next one thousand years, a largely heterogeneous culture with diverse regional social patterns. Contact with Korea
Korea
Korea ) is an East Asian geographic region that is currently divided into two separate sovereign states — North Korea and South Korea. Located on the Korean Peninsula, Korea is bordered by the People's Republic of China to the northwest, Russia to the northeast, and is separated from Japan to the...
and China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...
during this time brought aspects of both cultures to Japan, including rules of rank and etiquette, the Chinese calendar
Chinese calendar
The Chinese calendar is a lunisolar calendar, incorporating elements of a lunar calendar with those of a solar calendar. It is not exclusive to China, but followed by many other Asian cultures as well...
, astronomy, and a healing system based on traditional Chinese medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
. Military dictators, or ‘‘shoguns,’’ ruled for roughly the next seven hundred years, culminating in military reunification, and widespread implementation of civil order consistent with the ethos of the samurai class, eg. rules of loyalty, social hierarchy, and filial piety.
Western attempts at trade with Japan were largely unsuccessful until 1853 when an American fleet led by Comadore Perry arrived in Japanese waters and forced Japan into unfavorable trading agreements. This event coincided with the fall of the ‘‘shoguns’’ and the subsequent Meiji restoration that ended a system of feudal landholders, and helped unify the nation. Japan quickly transitioned to a modern power with an imperial army. Japan then began to extend its empire and seize various Pacific islands and parts of Russia
Russia
Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...
. This militarism carried over to the 1920s when Japan invaded China, to the 1930s when Japan joined the Axis powers, and finally into the 1940s when Japan attacked Pearl Harbor. In 1945, the historic drop of two atomic bombs by the US on Hiroshima
Hiroshima
is the capital of Hiroshima Prefecture, and the largest city in the Chūgoku region of western Honshu, the largest island of Japan. It became best known as the first city in history to be destroyed by a nuclear weapon when the United States Army Air Forces dropped an atomic bomb on it at 8:15 A.M...
and Nagasaki
Nagasaki
is the capital and the largest city of Nagasaki Prefecture on the island of Kyushu in Japan. Nagasaki was founded by the Portuguese in the second half of the 16th century on the site of a small fishing village, formerly part of Nishisonogi District...
resulted in the disastrous outcomes that ultimately forced retreat.
The US then occupied Japan from 1945 to 1952 under General Douglas MacArthur. A new constitution took effect in 1947 according to which the emperor became largely a symbolic head of state. Japan regained its sovereignty in 1952, and in 1972 the US gave back some islands, the Ryuku, that included Okinawa. Japan’s economic growth was swift, relying on new technologies, manufacturing and a protectionist attitude. In 1998, Japan – like much of the region – suffered the worst recession since World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
, which led eventually to the resignation of the prime minister. Since then the economy has improved, but is still plagued by stagnation, a fact that the recent 23-foot tsunami
Tsunami
A tsunami is a series of water waves caused by the displacement of a large volume of a body of water, typically an ocean or a large lake...
and the largest earthquake
Earthquake
An earthquake is the result of a sudden release of energy in the Earth's crust that creates seismic waves. The seismicity, seismism or seismic activity of an area refers to the frequency, type and size of earthquakes experienced over a period of time...
in Japanese history that struck on March 11, 2011 did not help.
Social structure and organization
The population of Japan in 2009 was 127.51 million. It is the tenth largest population in the world with the fifth highest population density. The country is increasingly urban. About 45% of the population was, in 2005, centered within 50 kilometers of the three largest cities in Japan: Tokyo, Osaka, and Nagoya.In 2005, 20.1% of the population was over 65 years old. This figure is projected to increase to 31.8% by 2030, higher than any other industrialized nation. The fertility rate, at 1.21, is below the replacement level. The percent of three-generational households has steadily declined since the 1970s while the proportion of one-person and nuclear households has increased steadily in the same time period.
Social interactions in Japan are traditionally guided by the opposing dynamics of intimacy and hierarchy. In social situations, a commitment to group harmony, solidarity and intimacy must be balanced by deep respect for hierarchy. Rules of hierarchy are guided by age, social status and type of employment. Appropriate behavior therefore depends on a person’s ability to assess the relative hierarchical distinction between individuals. Distance naturally decreases intimacy, and appropriate language must be used to communicate deference and avoid offending the other party. Traditionally, any behavior that fosters conflict or suggests deviance is not acceptable in Japan.
Political and economic system
Since its constitution was adopted in 1947, Japan has been a parliamentary government with a constitutional monarchy. The monarchyMonarchy
A monarchy is a form of government in which the office of head of state is usually held until death or abdication and is often hereditary and includes a royal house. In some cases, the monarch is elected...
is hereditary while the prime minister must be elected by the Diet, or a bicameral legislative branch consisting of the House of Councilors and House of Representatives. Japanese local administration is by prefecture. The country is divided into 47 prefectures, each of which is further subdivided into cities with respective wards and blocks. Suffrage is granted at age 20
Japan boasts the fourth largest GDP in the world after the European Union, the United States, and China. While Japan was for centuries a largely agricultural economy, the percentage of the total labor force shifted dramatically in the twentieth century from agriculture to industrial occupations. Consequently, Japan must import about 60% of its food. Japan is one of the world’s largest, most technologically sophisticated producers of automobiles, electronic equipment (including digital cameras), machine tools, steel and nonferrous metals, ships, chemicals, textiles, and processed foods. The unemployment rate is stable at less than 5%. Nevertheless, the economy is challenged by Japan’s huge government dept, exceeding 200% of the GDP, unrelenting deflation, reliance on exports, and graying, diminishing population.
A classic “M-shaped curve” notably marks female employment as many women drop out of the labor force to raise children. Three times as many women are employed part-time as men.
Religion
Religion, as practiced in Japan today, includes Shintoism (83.9%), Buddhisim (71.4%), ChristianityChristianity
Christianity is a monotheistic religion based on the life and teachings of Jesus as presented in canonical gospels and other New Testament writings...
(2%), and other (7.8%). Total adherence exceeds 100% because many identify with both Shintoism and Buddhism. Shinto shrines, honoring gods and goddesses of ancient Japanese mythology, decorate the landscape of Japan. Shintoism is based on earlier animistic and shamanistic traditions, and contains many concepts crucial to daily Japanese life today including cleanliness of the body and home. Shintoism was for a long time considered the “people’s religion” while Buddhism was adopted originally by the elite. Fundamental to Zen Buddhism are values such as personal effort, personal sacrifice, dedication, exertion, attunement to the body as well as meditation centered upon daily activities such as tea drinking, flower arrangement, and gardening. Confucian philosophical traditions, while not specifically religious, are also embedded within Japanese culture. The five essential relationships according to this philosophy are father-son, ruler-son, husband-wife, older brother-younger brother, and between friends. Clearly this system leaves out woman-centered relationships (eg. mother-daughter).
Physical environment
Japan is a country of islands with Korea to the west, China to the southwest, and Russia to the north. Most of the population lives on the four main islands located between the Pacific Ocean and the Sea of Japan. These islands are called Hokkaido, Honshu, Shikoku, and Kyushu. The entire land mass of Japan is slightly smaller than California, but the climate varies dramatically from cool and temperate in the north to tropical in the south. This mostly mountainous country is, based on its location, vulnerable to a variety of natural hazards including volcanoes, earthquakes, tsunamis, and typhoons.Health and illness theories
Japan’s primary medical system is biomedicine. In the late 1800s, the Japanese government formally adopted the German system of medical training and medical care delivery. This system of health care exists side by side with a uniquely Japanese system of healing called ‘‘KampoKampo
, alternatively shortened as just , is the Japanese study and adaptation of Traditional Chinese medicine. The basic works of Chinese medicine came to Japan between the 7th and 9th centuries. Since then, the Japanese have created their own unique herbal medical system and diagnosis...
’’ The government granted Kampo official status in the 1950’s, a landmark event which came with both government regulation as well as national insurance coverage for certain types of treatment. Kampo is centered on establishing balance of physical, mental, social, and emotional states. An imbalance may be due to changes such as heat (eg. overactivity), poor diet, dampness, or pathogens. Balance and imbalance are understood according to three main sets of contrasting states: hot/cold, excess/deficiency, and internal/external. A practitioner of ‘‘Kampo’’ gathers extensive personal information about physical and emotional experience and focuses on restoring balance. Treatments include moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...
and acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
. Kampo treatment is generally considered appropriate for chronic conditions, when multiple organs are affected (eg. immune disorders or age-related decline), or when biomedicine cannot diagnose or effectively treat a condition.
Women’s health statistics
While the social status of women is relatively low, the status of mother is very high in Japan. The concept of ‘‘ryosia kemp’’ (good wife and wise mother), while contributing to the positive perception of and respect for the mothering role, has been the focus of some resistance by women in the past 25 years. The mean childbearing age is 29.7, an approximately four-year increase since 1979. Mean age of first marriage is 28.6 for women, representing an over five-year increase since 1950. Marriage rates have decreased since 1970; divorce rates, while remaining low, have slightly increased since 1970. Nevertheless, most women in Japan still have one or two children and devote enormous amounts of time and energy into raising them. Citizenship is notably guarded: a child born in Japan does not receive Japanese nationality if both parents are non-Japanese, or if a Japanese father denies paternity of a child born to a non-Japanese woman.The availability of the birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
pill in Japan is a highly contentious issue due to the government’s concern for its many potentially negative systemic side effects and worry that it may contribute, through lack of condom use, to a rise of HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
. While the pill is now available, usage continues to be lower than many other countries. A 2001 survey of 1500 women, for example, found that only 4% of Japanese women use this method compared to 87% in the US and 93% in Germany.
Abortion has been legal in Japan since 1948. A 1982 survey by the Kyodo News Service reported than 75% of women in their fifties had undergone abortions at some point in their lives. Abortion became legal during the postwar period when the needs of survival limited the number of mouths a family could feed. Nevertheless, abortion is not taken lightly and is traditionally marked by various Buddhist rituals in which parents express regret and gratitude to their aborted children for their sacrifice for the family.
Women’s health related figures in Japan are inspiringly positive. Japan boasts one of the longest life expectancies for women in the world at 82.25 years. And the infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
rate is 2.78 deaths per 1,000 live births, one of the lowest in the world. Whether these two facts are related to a final figure, the 2011 estimate of fertility rate of just 1.21 children, is as yet undetermined.
Prenatal care
The vast majority (or, approximately 99%) of women who carry pregnancies to term in Japan are married. The majority of these women stop working once they become pregnant. Japanese women are required by the Maternal Child Health Act to register their pregnancies with the local government, and encouraged to be vigilant of their pregnancy by utilizing the Maternal and Child Health Handbook (‘‘boshi techo’’) distributed upon registration. Over 90% of pregnancies are registered before the 20th week of gestation, suggesting that most women are visiting a doctor and receiving support from public health services.Japanese women are advised to have prenatal visits every 4 weeks through 23 weeks gestation, every 2 weeks from 24 to 25 weeks, and every week after 36 weeks, for a total of 14 prenatal visit for a low to medium risk pregnancy. Ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
is used routinely to monitor the development of the fetus; most women have at least five fetal ultrasound exams during their pregnancy, a heavy use of technology considered necessary to assure a healthy baby and safe birth. Screenings for domestic violence
Domestic violence
Domestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence , is broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, or cohabitation...
and maternal depression are not often conducted during prenatal visits in Japan, while in the US 35% of women are screened for domestic violence and 47% for maternal depression.
Genetic screening tests, such as amniocentesis
Amniocentesis
Amniocentesis is a medical procedure used in prenatal diagnosis of chromosomal abnormalities and fetal infections, in which a small amount of amniotic fluid, which contains fetal tissues, is sampled from the amnion or amniotic sac surrounding a developing fetus, and the fetal DNA is examined for...
, are available in Japan but rarely used. Contrary to US culture, the idea of having a “normal” or “abnormal” fetus is not as much a part of the traditional Japanese conception of pregnancy. Rather, the Japanese paradigm sees a fetus as inherently a work in progress, or “perfectible.” Ob-gyns rarely initiate open discussion of the possibility of undergoing amniocentesis or triple marker tests with pregnant patients. In fact, the Health Ministry issued guidelines in 1999 according to which ob-gyns have no obligation to inform patients of these tests. Having an abortion due to fetal abnormalities is very rare. Some theorize that the reason for this is because the role of mother is so highly valued, while others suggest that women, freed from the pressure of holding down a job during motherhood, are less daunted by the time required to care for a child with additional needs.
Local conceptualization of pregnancy
Pregnancy is considered a period of mental and physical discipline for women, a process during which women literally make their babies. The outcome of a pregnancy is deeply tied to a woman’s conduct; women are considered responsible for minimizing miscarriage and premature birth. There are many theories as to why this may be. Primarily to understanding this idea is the Japanese principle of ‘‘ganbaru,’’ a fundamental notion that can be traced to many aspects of Japanese lifestyle. It means a general ability to “try as hard as possible at whatever one does.” For example, women are often reprimanded by their doctors to try harder if they are gaining what is considered too much weight (eg. no more than 22 pounds is recommended, while some doctors advise less). If a pregnant Japanese woman is gaining too much weight, she may be instructed to take daily weights until she meets the goals set by her ob-gyn.Men are considered to be far removed from pregnancy because it isn’t occurring in their bodies; they are therefore often exempt from maternity courses, medical visits, as well as sometimes the birth event itself.
Preparation for birth
During the fifth month of pregnancy (which is the American fourth month because in Japan, one starts counting from the day of the last menstrual period) women often go with a mother or grandmother to a Shinto shrine that is dedicated to safe childbirth. Here the women pray for a safe childbirth and purchase a special pregnancy sash, or ‘‘obi’’ to wrap around the abdomen of the pregnant woman. This sash is mean to protect the uterus from the cold, keep the fetus stable and prevent it from growing too large. The ritual also aids in creating maternal identity.Food
Environment, or ‘‘kankyo,’’ is also a key concept in the Japanese theory of gestation. This idea surpasses the Western concept of what you feed yourself you feed your baby by encompassing ideas about certain foods being related to coldness or heat. Sweets, for example, are considered a cold food that should be avoided in pregnancy as the womb is meant to be warm. Also promoted is the idea that a pregnant woman should eat foods native to Japan. The concept ‘‘moto ni nodouru’’ suggests that in regard to food, one should go back to the origin when pregnant. In other words, Japanese babies are made of Japanese food which comes from Japanese soil. Traditional thoughts about proper food to eat in pregnancy relate to the idea that women are not just vessels, but active vehicles working toward creation.Emotional behavior
Emphasis is also made in prenatal care on keeping a tranquil heart, limiting stress, and trying to elevate your spirits, becoming spiritual (even if you’re usually not), and stroking the baby from time to time. This concept of mental wellbeing is called ‘‘shinkyo’’ and many doctors will be more lax on nutrition if they feel the food pressure is stressing out a woman and putting her spirit in danger.Sexual activity
Topics not typically covered with the physician during prenatal visits for which Japanese women may turn to popular magazines include: sex during pregnancy, information regarding the birth experiences other women, unusual methods for delivery, as well as explanations of many medical terms.Rest, activity, and movement or personal behavior
Stress and physical difficulty are considered harmful to the healthy development of pregnancy. Work is considered one of the many environmental factors women are supposed to control. The Maternal and Child Health handbook details for women acceptable “postures for physical activity in daily life.” They are also instructed in this book to keep their bodies warm at all times, stabilize their bellies, and protect themselves against bumps.Location
‘‘Satogaeri shussan,’’ or going back home, is a traditional custom in Japan according to which pregnant women return to their natal homes for labor and childbirth.This tradition, though waning in contemporary Japan, reinforces family ties and also reflects the practical needs of the mother to be. Often a woman will switch doctors at this time. It is more common today for a mother to stay at home and have her mothers, sister, or mother-in-law come to look after her, especially in the case of a second pregnancy, than to go to her parents’ house.Food and drink
Eating and drinking during labor are usually encouraged by medical providers in Japan. Japanese women tend to eat voraciously in labor, which counters common practice in American hospitals. Eating is encouraged, especially by midwives, so that the laboring woman will have energy to push.Movement, activity, and emotional behavior
Walking is encouraged during labor by most medical providers in Japan. But making loud sounds is not considered acceptable during labor.Pain
In Japan, primary and secondary level maternity hospitals and clinics do not use epiduralEpidural
The term epidural is often short for epidural analgesia, a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space...
analgesia, and independent midwifery homes never use analgesia. Most Japanese women use nondrug methods to alleviate labor pain, namely: breathing techniques, position changes, movement, and hands-on techniques such as massage, stroking, or acupressure.
Many Japanese women believe that the mother child bond is built through suffering from labor pain together. Others fear that pain medication will make the fetus groggy. Safety is a primary concern. Some Japanese women who do not use pain medication for the first labor decide to use it in subsequent births.
Attendants during labor and supportive behavior
Female relatives traditionally help Japanese woman through labor. While men traditionally do not help in labor, one recent 2011 cohort study revealed that about half of Japanese women now have their partner in the laboring room. Massage, stroking, and acupressure by female relatives are commonly utilized techniques to help a woman in Japan through labor.Birth attendant and assistants
Births in Japan are attended by either physicians or midwives with nurses assisting. While statistics suggest that only 2.8% of births in Japan are attended by midwives, it is estimated that closer to half of all births in Japan are midwife-attended. The discrepancy is likely because of a legal provision that doctors must sign his or her name when both a doctor and midwife are present at birth. In actuality, it is a frequent occurrence in hospitals that a midwife attends an entire labor and birth, and a doctor is only called in at the final pushing stage.Professional midwives had a national midwifery
Midwifery
Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding....
association in Japan from 1927 until it was dissolved by U.S. occupying forces after WWII. Since 1948, the education system for midwives was combined with nursing education, both of which require three years of training. Interestingly, the word for midwife also changed after 1947. The original word ‘‘sanba’’ (‘‘san’’ meaning birth and ‘‘ba’’ meaning old women) was changed to ‘‘josan-pu’’ (‘‘josan’’ meaning help delivery, and ‘‘pu’’ meaning woman). And in 2002 it was changed again to ‘‘josan-shi’’ (‘‘josan’’ meaning help and ‘‘shi’’ meaning teacher) to avoid gender connotations.
In 2006 there were 25,775 midwives in Japan: 88% worked in hospitals and clinics, 6% were independent, and 6% were employed by universities, and government institutions. Independent midwives attend birth in one of the 388 practicing maternity homes nationwide.
Medical education in Japan lasts six years, and begins directly after high school. The first four years of training are considered preclinical, and the final two years are clinical. In 2006, there were 79 medical schools in Japan, and the students were 32.8% female. A recent law now requires training for an additional two years after graduation. The field of obstetrics in Japan differs from the US in the high value placed on normal physiologic birth, and in the concept of obstetrics as a field largely distinct from surgery.
Locus of decision making power
Doctors are often addressed as ‘‘sensei’’ in Japanese, significant because people with the title of ‘‘sensei’’ are typically not questioned. Other positions that share this title, eg. teacher, professor, and priest are – as keepers of knowledge – traditionally obeyed. (Engel 1989) Patients who ask too many questions risk seeming offensive or irritating, and a good patient is a passive one. Consequently, mode of delivery is thought to be best decided by obstetricians, not by laboring women (Matsuoka & Hinokuma 2009) For example, requesting a cesarean without medical reason is perceived as unacceptable.The care provided by independent midwives at maternity homes or in home births is traditionally woman centered, the locus of decision-making power remains with the laboring woman.
Location of birth
In 2005, 51.5% of Japanese babies were born in hospitals, 47% in private physician-run clinics with fewer than nineteen beds, 1.0% in maternity homes, and 0.2% at home.Birth position
Japanese women predominantly give birth in a semisitting position, though some literature suggest the lying down, lithotomyLithotomy
Lithotomy from Greek for "lithos" and "tomos" , is a surgical method for removal of calculi, stones formed inside certain hollow organs, such as the kidneys , bladder , and gallbladder , that cannot exit naturally through the urinary system or biliary tract...
position, is still used.
Pain
Painkillers are thought to complicate deliveries and women are discouraged by ob-gyns from taking them during childbirth. Therefore, Japanese births tend to be without pain medication. Furthermore, a strong image of women as physiologically capable of giving birth vaginally is widely shared by the general public, midwives and doctors in Japan.Without pain medication, birth becomes a final demonstration of the maternal responsibility, maturation, and hard work a woman exemplified throughout her pregnancy. Some believe that not experiencing pain during birth hinders bonding between mother and baby. A birth educator in Japan may tell expecting mothers that birth hurts and there’s nothing to be done about it, or share a well-known Japanese proverb: “The child that made one’s belly hurt is lovable.”
If a Japanese woman would like an epidural during labor, she must give birth at one of the few private and expensive hospitals that provide them. Pursuing this option is still relatively rare in Japan today.
Many midwives practice perineal massage to promote stretching, ease birth, and minimize maternal trauma.
Activity and movement
In facing birth without pain medications, many supportive techniques are used such as breathing, position changes, movement, massageMassage
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...
, stroking, and acupressure.
Emotional behavior
Japanese women are expected to experience labor and birth in silence. Any verbalizing by a laboring or birthing women may be met with a reprimand such as, “no voicing” from an attendant.Behavior for complications
Obstetricians, especially the older generation still practicing, advocate for physiological births and discourage unnecessary interventions.If complications arise that demand cesareans, then cesareans are performed. However, cesarean birth has a negative image in Japan, and is often perceived as suggestive that a woman was incompetent or deficient. The rate of c-sections in Japan in 2005 was, according to one estimate, 17.4%. Other reports suggest the rate is as low as 10% in some locations; nevertheless, rates between 10% and 20% reported throughout Japan are significantly lower than North America. Of women attempting vaginal birth at a maternity home, about 10.2% are eventually transferred for complications to large hospitals with neonatal intensive care units.
Use of technology and other interventions
Use of a continuous fetal monitor is the norm in hospitals and physician-run clinics, but precisely when this is typically applied is hard to discern from existing literature.Episiotomies were in 1995 still surprisingly common in Japan: in the hospital the rate for primiparas was 88% and 41% for multiparas. (Matsuoka & Hinokuma 2009) Maternity homes tend to use far less technology and interventions. For example, the rate of episiotomies in maternity homes for primiparas was 5% and for multiparas it was 1%.Time and place
Most women stay in the hospital for 4 to 7 days after vaginal delivery, and about 10 days after cesarean. This period is a time for ‘‘ansei,’’ or peace and quiet with pampering. Rest is considered very important; it is thought that the long recuperation after childbirth helps explain why Japanese women have less uterine disease and need fewer hysterectomies in middle age than American women. Some Japanese hospitals do not provide rooming in as it interferes with rest, while others do. Traditionally, Japanese women were expected to stay inside with their babies for the first 100 days after birth, but this is not expected in contemporary Japan.Different behaviors for primiparous vs. multiparous women
While all Japanese women are encouraged to rest after birth, primiparous women need only focus on one child whereas multiparous women face additional childcare obligations. Therefore, while primiparous Japanese women traditionally return to their mother’s home for about one month after leaving the hospital to be cared for and receive help with the care of the baby, it is more likely that female family members of a new mother will go to her house to help out if there are additionally children to watch.Postpartum depression
One study of Japanese women done in 2005 found that the prevalence of maternity blues and postpartum depressionPostpartum depression
Postpartum depression , also called postnatal depression, is a form of clinical depression which can affect women, and less frequently men, typically after childbirth. Studies report prevalence rates among women from 5% to 25%, but methodological differences among the studies make the actual...
was much less for women who gave birth in maternity homes than for those who delivered in hospitals. The authors attributed this difference to the idea that bodily damage and pain are experienced far less in Japanese maternity homes than hospitals.
Rites of Passage
Like most newborns in Western hospitals, the first rites of passage are a series of vaccines and screening procedures. In contemporary Japan, the baby is given a Hepatitis B vaccine, and is screened for a variety of diseases, including phynylketonuria, maple syrup disease, and hypothyroid disease. (Ivry 2010) This process is voluntary but there is about 99% compliance. Besides frequent health and developmental checks in clinics during the first year, special development checks are required by law for all children at 18 months of age, and again at age 3.Caregiver
The mother is the primary caregiver in Japan. While fathers occasionally help with the baby, their main responsibility is to be a breadwinner. It is a traditional Japanese belief that close physical contact and interaction between mother and child, or “skinship,” in the first three years of life has long-lasting importance. Also, because childcare options are limited, working women often rely on their parents for assistance. In fact, 67.2% of working women with children under 1 turn to grandparents for childcare. While attitudes are changing, a survey in the early 1990s showed that 55.6% of women and 65.7% of men agreed that child care and other housework fall entirely in the woman’s domain.Umbilical cord
Japanese hospitals typically place the dried up part of the umbilical cordUmbilical cord
In placental mammals, the umbilical cord is the connecting cord from the developing embryo or fetus to the placenta...
that falls off in a special box specifically designed for this purpose. When the mother leaves the hospital, the umbilical cord is given to her. This tradition relates to ancient Japanese customs based upon the belief that the umbilical cord is connected to the health of the newborn baby. Maltreating it, therefore, risks causing harm or disease in the child. In some Japanese households, a mother may show a child the umbilical cord on a happy event, or on birthdays to recall the day the child was born. In other households, the umbilical cord is given to a child on the day he or she leaves home or gets married to symbolize separation.
Bathing
Bathing the baby is the traditional role of the father, providing a means of “skinship” and also taking advantage of a man’s typically larger hands.Food and drink
In the hospital, Japanese midwives perform daily breast massage to encourage milk production and flow. Women are encouraged to breastfeed on demand or every four hours. According to a 2006 study, 90% of women in Japan were breastfeeding exclusively at one week after birth compared to 51% of U.S. women. BreastfeedingBreastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
is officially promoted, but artificial milk is also heavily advertised. (Engel 1989) Many women in Japan breastfeed, but when the baby is in a grandmother’s care, for example, formula may be given.
When a baby is 100 days old, Japanese families celebrate a weaning
Weaning
Weaning is the process of gradually introducing a mammal infant, either human or animal, to what will be its adult diet and withdrawing the supply of its mother's milk.The process takes place only in mammals, as only mammals produce milk...
ceremony called ‘‘okuizome,’’ or first food. This ceremony traditionally involves a large shared meal prepared by the mother-in-law. The menu varies by region. Traditionally, a small pebble is placed on each plate and the adults symbolically bite down on it. This ritual is meant to wish the baby a life of abundant food without hunger as well as good strong teeth. While a father or grandfather may pretend to feed the baby solid food during these festivities, the baby is usually still drinking exclusive milk.
Sleep
In Japan, co-sleepingCo-sleeping
Co-sleeping is a practice in which babies and young children sleep close to one or both parents, as opposed to in a separate room. It is standard practice in many parts of the world, and is practiced by a significant minority in countries where cribs are also used...
with newborns in the norm. Japanese babies traditionally sleep in close proximity with their parents on an adjacent bamboo or straw sleeping mat.