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.

Tokyo preggos go nude

It's hard to believe that back in 2006, the image of Britney 'doing a Demi' for Harper's Bazaar was actually banned from display in Tokyo subway stations for being 'too stimulating'. A censored version with a big black band hovering over Brit's bump was used instead.

Being naked and pregnant, however, has suddenly become more popular with Japanese women. Apparently, a Japanese pop star called Hitomi posed naked and pregnant in an album photo in June 2008. According to local media, the picture was displayed on large billboards over busy streets in Tokyo and the related photo book became a bestseller, selling more than 10,000 copies in its first week of publication.

Now mums-to-be pay around 35,000 yen ($368.20) for a studio photo shoot, which takes less than two hours in "Ixchel."

"Before this boom, women didn't know where to go to take these kinds of pictures even though they wanted to. Because of media attention, they easily found our studio," said Natsuko Takada, the owner of photo studio "Ixchel."

This is really interesting because when I was in Tokyo in January 2007 I found absolutely no images of Japanese pregnant women who were showing skin. Maternity clothes were really dowdy and all of the parenting/pregnancy magazines targeted to young women used cartoons and other really childish images to talk about being a mother. Being a 'sexy' mum was definitely not culturally appropriate. Interestingly, as I noted in a post at the time, the only images of motherhood that were even remotely 'racy' were of Euro-American pregnant models.

Japanese pregnant dolls

I've just come across these 19th century pregnant dolls used to train Japanese midwives how to deliver babies. Aside from being a useful teaching tool, the dollls were also used for public entertainment in sideshows that aimed to educate people about the human body. The pregnant doll's abdomen opens to show foetuses at different stages of development.