17 June 2010

Japan: the best place to give birth?

Japan is one of my most favourite places to travel. After this morning, I feel a little more in love with the country upon reading an article about the increase in pregnancies among 'older' women. When I first started reading, I expected that the article would turn into a rant about why 'older' women are 'high risk' and need to be managed medically more so than other women. But then I read something that caught my eye: Japan has one of the lowest maternal mortality rates in the world: 6 per 100,000 births (lower than the US, Britain, Finland and Canada).

Why is it so low?

Well, the picture is complicated. Much like other developed countries Japan has a technologised/medicalised approach to pregnancy and birth. Women who are 35 years + are seen as 'older' mothers. Birth choices for women are still circumscribed by the limitations placed upon them by health professionals in hospitals, however, not to the same extent as in other countries like the US.

Surprisingly, use of epidurals is much lower in Japanese hospitals. This is in part due to the more practical reality that there is a shortage of anesthetists. As you might know, the use of epidurals has been linked with an increased risk for caesarean section.

While most Japanese women give birth in hospitals, there is a small proportion of women who give birth in birth centres, called josan-in. These centres are set up like a traditional Japanese home and offer women care by a team of midwives. Centres offer maternity yoga, cooking classes for post-birth diet and nutrition counselling as well as a pool for water births.

What I found most interesting, however, was that this article, whilst couched in the language of 'women over 35 are high risk' blah blah blah, in fact, the piece ended up being about the importance of women over 35 being IN CONTROL of their pregnancies. As one obstetrician notes, the worst thing women can do is let a doctor be in control of their decision making. This is vastly different from what I perceive to be the perception of health professionals in other parts of the developed world. Women ('older' or not) are so often viewed as incapable of making decisions when it comes to birth that in a conservative environment like Japan, it is refreshing to see that obstetricians do not shove tests on women and whilst operating in a medicalised system, see the importance of women doing pregnancy and birth on their own terms.

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