Japan has many outlets to westernized medicine. Many of their practices within their health care system mimic that of which we are used to or even surpass. With that in mind, I want to take a deeper look into the practice of giving birth in Japan, how the new moms are treated, and how Japan has progressed within the field. It is also important to look at the way women are treated within the culture to start to understand why there is a discrepancy with care. To really grasp the conditions these women face, the main anthropological theory I will take will be the feminist theory. This will also connect to how women are traditionally treated in Japan in order to draw inferences in ways to help the situation. I think it is also important to provide some background information, from an epidemiological theory view point, this will seek to provide a clear cut picture with data surrounding the overall treatment of these women.
The problem really arises within the history of the care of mothers. In 2000, Japan was found to have a maternal mortality rate of 9.5 per 100,000 births. Which was one of the highest rates of maternal mortality in the world at that time. The concerning thing was that Japan was seen as one of the leading places to give birth because of their infant mortality rate being so low (Nagaya et al., 2000). If we fast forward to present day Japan has improved their maternal mortality rate to 5 per 100,000 births (UNICEF, 2010). While there has been a significant improvement in the overall outcome of the new mothers, there have been little strides to improve the overall experience of giving birth.
In Japan there a three different places available for women to give birth, in a hospital, an obstetrician clinics and a midwifery center (Baba et al., 2016). With bed availability being much greater for a hospital, it is most common for women to give birth there, but obstetrician clinics are not too far behind. For women in Japan, it is very rare to take on a midwife during the birthing processing. In addition, Japan limits the amount of care a midwife can give (Behruzi et al., 2010). They do not have any authority when it comes to giving birth. Midwife’s know how to help a mother through the birthing process in a more natural way, but when it comes to medication or even simple procedures – like an episiotomy – they are not allowed to perform those on the moms who may need it.
When it comes to the overall experience of giving birth for women, it is one that I would not care to experience. It is common for new mothers to give birth alone, meaning, they are not allowed a companion of any sorts during the birth process. It is also not uncommon for the mother to spend a whole day away from the new born child (Behruzi et al., 2010). It is a very solitary procedure. This could be due to many reasons, many of which come from the traditional treatment of women. Women are thought to be the keepers of the home. Traditionally they have very little say when it comes to how they wish to be treated. Men are the dominant gender in Japan, no doubt about it. Many women who are independent and fourth right with their thoughts are often shamed. It appears as though men do not want to experience their wife in such a vulnerable state. Almost as if they are shaming them for going through the birth process. The idea that women should not have anyone supporting them while giving birth extends to not just their partners, but friends and family as well. It is a strict rule in many hospitals and birthing centers.
Not only are the women left by themselves during such a scary time, they are also not allowed to make decisions during the birth. It is not common for women to walk into the hospital or birthing center with a “birth plan”. They go in and do what the institution decides is best for the mother. With their being so few midwifes in practice women don’t really have an option but to turn to the knowledge of the obstetrician during this time. They also don’t have anyone that is close to them in the delivery room advocating for their wishes. So it becomes very easy for the voice of the mother to be lost. While sixty-six percent of the obstetrician-gynecologist were found to be women in Japan, they too felt that the societal norms around women even hindered their ability to practice medicine (Ramakrishnan et al., 2014).
Much like the rest of the world, Japan is trying to bring back the practices of midwifery during birth. Many places like Canada and the Netherlands have found great success with using midwifes. Many countries have found that there is no difference in safety for low-risk births to go a more humanistic route and allow women to deliver babies at home or in a birthing center under the supervision of a midwife. With so few midwifes being allowed to practice within the hospital system in Japan there are some who are independent within their work. One study looked at a group of independent midwifes and found that out of the 5477 women giving birth, all of them had vaginal deliveries with no maternal fatalities. There was also a substantially lower amount of average blood loss, accompanied with almost sixty percent of the women having intact perinea (Katoaka, 2013). A finding like this is absolutely crucial when it comes to the traditional practice of giving birth in a hospital. The most common cause of death for women after giving birth, either with a vaginal or cesarean birth, is postpartum hemorrhaging (Hasegawa et al., 2016). With there being proven to be a substantially less amount of blood loss during birth with the presence of a midwife coupled with no maternal fatalities, is a huge step for new mothers to have a choice in how they bring life into the world.
Traditional Japan, had many of their practices centered around Buddhism, which gave the higher roles in society and power to men. While that time period and thinking had its place, it is no longer the main focus for women to stay at home and raise a family. Much like the rest of the world, the women of Japan are wanting to express themselves in their own unique way, whatever that may be. It is not to lessen the women who choose to stay in a more traditional role, but to allow women to have the freedom to make choices for themselves. Many of the women in Japan are wanting to have the choice to have more humanistic care when it comes to giving birth. One woman was quoted in a study exclaiming she just wanted the will to have her baby the way she wanted to, and she wanted others to respect her and her decisions (Behruzi et al., 2010). There are many people that do not want to admit that a woman may know more than a man, or she might even know her body better. Women should be taken seriously during the process of giving birth. While an obstetrician may have delivered hundreds of babies, each birthing process is unique and each mother and her body is unique. Her wants and her wishes should be taken into account.
Another issue surrounding the birthing practices in Japan are with the discrepancies throughout the care that is given. There is specifically a discrepancy between practices that midwives use when compared to clinics and hospitals (Baba et al., 2016). There is also a lack of education and implementation for all three units when looking at methods that can help ease a mother through the struggles of giving birth. While different birthing positions and homeopathic techniques to help a woman’s body during childbirth are not new practices, there is a lack of structure and policy around implementing them on a regular basis. Whether this is because of a lack of care towards the woman, or just purely the lack of education and policy is not known at this time. In order to help a woman through the pain that is childbirth, practitioners should be properly educated in the best way for each unique woman to give birth. What works for one woman might not work for another, so having the different methods available can only help the practice along.
The hard part about the humanization of birth is, it is not something that is going to be changed overnight. These women are wanting to be respected in their values, beliefs and feelings during a very vulnerable time and that goes completely against their current culture (Behruzi et al., 2010). It is almost as if the culture of Japan surrounding the treatment of women needs to change before there are more specific changes. Which seems to be backwards. One would think that by taking small little steps to treat women like they have their own thoughts and wishes would encourage more people to do the same, and while that may happen, it tends to happen on a small scale. Changes that happen within a culture happen slowly and tend to happen by generation. Each new generation brings on its own thought patterns, beliefs and set of struggles. The change for Japan first needs to start with the men. Women are already making leaps and bounds with trying to establish themselves in a predominately male society, the next step is for them to start being respected and honored in the same way. The only way to make a lasting change is to get the male population in Japan to change the way they view women. There is more to a woman than just being a wife and when the majority of the male population recognizes that in Japan, that is when the specified changes in treatment will begin to happen and fall into place.
With Japan being one of the top leaders in medicine across the world, one would think that the same type of quality and care would go into a procedure that many women endure. Japan is often known for taking the best route of care possible regardless of where it steamed from; homeopathic, biomedicine, and osteopathic ways are many times interchangeable throughout the healthcare system. To find out that there is a lack of consistent care for women during child birth is concerning. There is almost more attention on the fetus and less on the mother. Ultimately this is part of a bigger issue, how the women are treated throughout society, not just in the small snippet of when they give birth. There are not many times within Japanese society when women are thought of as equal or close to equal to men. Men rule that culture, and they always have. This old idea then makes it hard for women to make progress in being treated equally and with respect when so many of the men are in power and do not want to lose it. It is also hard when the culture, like in Japan, is so rich with tradition, that many women do not even know that they are being treated unfairly. They are ignorant to the fact that the way they have been treated, and the way their mothers and grandmothers have been treated is not the only way to live a life. Like many other countries throughout the world, if not most of them, Japan has some growing to do when it comes to the practice of treating women with care and respect. Giving birth is a sacred time in a woman’s life. That is the one thing that she can do that a man cannot. She should be treated with respect and allowed to make decisions on how she wants to bring that child into the world. While the outcomes of giving birth have greatly improved over the last twenty years, the choices that women have while giving birth have not, and that is where the movement for humanistic birthing practices is trying to go.
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