Birth Models That Work

8. Maternity Homes in Japan: Reservoirs of Normal Childbirth

213 Chapter 8 Maternity Homes in Japan Reservoirs of Normal Childbirth Etsuko Matsuoka and Fumiko Hinokuma Hospital birth is the norm in almost all industrialized countries, including Japan, where only 1.2% of births take place outside of a hospital. But the significance of this small number is far greater than it appears, for the potential of normal births achieved in maternity homes and at home is so influential that it contributes to maintaining the quality of the rest of the births in Japan. Moreover, research conducted through a grant-in-aid from the Ministry of Health, Welfare, and Labor in 1999 demonstrated that women who gave birth in maternity homes felt more satisfaction and comfort with their births than those who gave birth in hospitals (Watanabe 1999). Since then, maternity homes have been acknowledged by policymakers and medical communities as a valid choice of birthing place, and the concept of satisfaction has gained acceptance as an important aspect of childbirth for birthing women. This chapter shows that maternity homes in Japan function not only as reservoirs of normal births, but also as training and educational facilities for both young and student midwives. Furthermore , independent midwives working in maternity homes are perceived by other midwives to exemplify how “real midwives” should behave—thereby providing an ideal standard for midwifery practice. We first describe general attitudes toward childbirth in Japan, contrasting them with those in the West: in Japan, cesarean section is negatively valued, and the use of pain-relieving drugs in labor and delivery is kept extremely low. We then provide a brief history of Japanese maternity homes and describe two of them in detail, along with a vivid depiction of one woman’s experience of giving birth in a maternity home. In our analysis, we focus on four features characteristic of Japanese maternity homes in general: the importance of waiting for the baby to be born, the value of labor pain, mothering the mother, and birth as a family event. Finally, we 214 e. matsuoka and f. hinokuma present the average transfer rates of maternity homes in the pre-, peri-, and postnatal periods to evaluate their overall safety. We are convinced that the maternity home as a birth place is a model that works because babies are born there under healthier conditions than their hospital counterparts. Maternity homes function to keep childbirth from becoming too medicalized and to provide models for optimal midwifery practice. OVERVIEW OF CHILDBIRTH IN JAPAN Let’s first of all look at where babies are born in Japan. Figure 8.1 shows the yearly changes in the number of births by place of delivery. In 2005, out of 1,062,530 babies born in Japan, 98.8% were born in hospitals or private clinics, 1.0% in maternity homes, and 0.2% at home. Births in the latter two places are conducted by independent midwives who, according to the wishes of their client, deliver the baby either in their client’s home or in the maternity home, which they run and which is usually their own home. In Japan in 2006, there were 25,775 midwives: 88% worked in hospitals and clinics, 6% were independent, and 6% were employed at other working places such as universities or government institutions. Independent midwives either own facilities with beds for delivery, or deliver babies at women ’s homes and have no inpatient facility of their own.1 In 2005 the number of practicing maternity homes was reported to be 388 nationwide, and the largest number of births taking place annually at one maternity home was 100 90 80 70 Deliveries (%) 60 50 40 30 20 10 1945 1950 1955 1960 1965 1970 1975 Hospital and Clinic Maternity Home Home and Others 1980 1985 1990 1995 2000 2005 Figure 8.1. Trends in place of delivery. maternity homes in japan 215 around 250.2 In Japan 47% of babies are born in small, private, doctorrun clinics with fewer than nineteen beds, which means that births are handled, more or less, in small-scale facilities, with the average number of births being about 342 per clinic or hospital.3 It is estimated that midwives actually deliver about half the babies born in Japan, although government statistics show only 2.8% of births with midwife attendance (Shimada, M. 2001). This inaccurate representation comes from a provision on the birth certificate stating that the doctor has priority...