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.

A tour de force of birth

I finally saw On The Business of Being Born (OTBOBB). Ricki Lake and Abby Epstein have created a film that will make you experience what feels like a lifetime of emotions in the short span of 85 minutes. Navigating the streets of New York with a lone midwife on a mission to bring birth back into the home, OTBOBB draws on the experiences of pregnant women as they navigate the bureacracy of the American maternity system. In between providing a brief history of medicalised birth, the most profound and ultimately moving feature of this film is the up close and very personal view of birth---something which most women have never witnessed until their own. Babies are born throughout this film in some of the most humbling and beautiful footage I have seen on the subject to date.

Whilst the American and Australian maternity are relatively similar, the glaring lack of midwives in the American system is where the cracks in the foundation begin to show. The overwhelming use of 'pit' or pitocin in New York hospitals where an astounding 90% of births are induced is the trigger for the cascade of interventions to which American women are subject in contemporary maternity wards.

Thus, it is easy to see how the production of oxytocin, the naturally occurring hormone in women's bodies that triggers birth and is also described as a 'love' hormone to help with bonding when the baby is born, is stifled in this environment. The use of 'pit' or syntocinin (in Australia) is a synthetic form of oxytocin. However, when women are induced with this synthetic form of oxytocin, contractions are much stronger. When contractions are stronger, there is more pain and it is no wonder that the obstetric residents in certain NY hospitals were shoving epidurals in womens' spines as soon as the pain started to increase. However, epidurals slow labour right down. Ironic, eh? Women are induced to speed labour up in order to keep more beds open and the turn-over high in American hospitals. Yet, induction = pain = epidural. This slows labour down and puts baby at a higher risk for complications. The naturally occuring oxytocin? Replaced with adrenalin, the 'fight-or-flight' hormone which is produced when women are afraid or feel unsafe. No natural endorphins, no oxytocin. Just fear, shame and 'failure'. And you know what happens next? Caesarean. NY state hospitals have some of the highest caesar rates in America, hovering at 46%. Birth centres are closing faster every day due to the daily battles against insurance companies, rising costs and the inability to compete with hospitals. Homebirths? Only 1% of all births in America.

OTBOBB portrays modern birth as a battle being waged on women's bodies. There are no 'choices' when birth is left in the hands of 'experts' and midwives are nowhere to be found. Australian women are lucky in the respect that 'normal' birth is largely left up to midwives. However, the intervention rate is still extremely high in Australia and there is a growing lack of trained midwives available to all of the women that need them. Hospitals are increasingly reluctant to hire midwives because it is a competition for their obstetric business. Moreover, private midwifery care is rarely covered by insurance but this is most likely changing.

I had chills watching this movie. There were times when I felt so angry watching women in hospital being moved around like cattle, being told they had to be induced without any information provided to them as to the risks of the procedures being performed on their bodies. Informed consent is pretty much non-existent in the American system. America has one of the worst infant and maternal mortality rates in the world despite being one of the richest countries. Why? Birth has been taken out of the hands of women and their bodies are used to line the pockets of insurance companies, hospitals and obstetricians who don't care about the process but only about the product. As long as a baby comes out alive, it doesn't matter how it got there.

YOU MUST SEE THIS MOVIE.

NOW.

YOUR LIFE DEPENDS ON IT.

On giving birth

Interesting post about the closure of birth centres in the States from the Huffington Post;
http://www.huffingtonpost.com/louise-marie-roth/on-giving-birth_b_52048.html?view=screen