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Childbirth in Japan

Michele Kriegman
 1993, 'A Japanese Birth', Midwifery Today, no. 26, summer:32-40. Also appeared as 'Childbirth in Japan', in April/May 1993 KIDStoday: 22-29.

On the eve of the birth of my first daughter, some Japanese friends were trying to make my farewell party as American as they could, so they ordered pizza from the first Domino’s franchise to open in Tokyo. As the deliveryman rode up with our box of pizza strapped to the back of his motor scooter (the only way deliverymen can navigate the residential alleyways of suburban Tokyo), we settled in for an evening of “baby talk.” Our host had just had a baby, two of us were pregnant for the first time, and all of us had gone to college together in the United States, so we talked about birth in our two countries, Japan and the United States.

I was leaving in a few days to have my baby back in my native United States, so we talked about American traditions. In the United States there are female-only prenatal parties called baby showers. Then there is that medieval European attitude called chivalry that leads men to open doors for and offer subway seats to pregnant women. On Japanese buses and trains it was only older women who offered me a seat once I was visibly pregnant.

Three babies later, I look back on that conversation and get a chuckle when I realize how my perspective has changed. The American style of prenatal and post-partum care has become the familiar one to me, but the once familiar Japanese style has become worthy of reconsideration.

Japan has national health insurance that makes prenatal care like a tightly woven hammock: though it might take some twisting and elbowing to find a position you like, at least no one fell through the cracks. I started out using the prenatal clinic at my nearby teaching hospital where I remember only a thin curtain separated my doctor and me from the long line of other patients waiting their turn. An identical curtain blocked my view of the doctor when he gave me a pelvic exam. I soon switched to a more typical arrangement, called a sanfujinka, which is a small private birth center operated by an obstetrician and assisted by midwives.

After my first visit to the sanfujinka, the doctor gave me her business card, wrote a request on the back of it, and stamped it with her personal seal (which Japanese use in lieu of a signature). I took it to my local ward office (Tokyo is divided into several administrative wards) where a clerk took down my name, address and due date and then handed me a detailed sheet on nutrition and a boshi-techo, a “mother-child handbook.” Every pregnant woman in Japan receives one to record the findings of each prenatal visit and then to record her child’s growth, pediatric visits, and vaccination dates.

The doctors at the hospital clinic and the obstetrician at the sanfujinka all questioned me about my diet and talked about the importance of nutrition rather than prescribing prenatal vitamins. I did purchase some on my own, over the counter, but by and large, the medical establishment didn’t use them.

The same year that Jane Fonda was releasing a pregnancy work-out tape in the States, none of my caregivers in Tokyo encouraged exercise. Instead, at every visit I was asked if I was getting enough rest – the boshi-techo mandated two one hour naps a day.

Medicine and the municipal government are not the only public institutions that get involved in prenatal care; so does organized religion. At temples and shrines throughout Japan you can purchase thumb-length amulets that consist of a piece of wood wrapped in a patterned rectangular silk cloth on a knotted satin cord. The cloth is printed in gold or black with the Chinese characters for “a safe labor.”

In Kamakura, a city full of ancient temples, one of my favorites is a smaller one on the outskirts, built on the side of a steep hill. All up and down the slopes around it are hundreds of Barbie-doll size stone Buddhas called jizo. Each has been lovingly tended by someone, wrapped in tiny blankets against the cold, offered tiny candies on doll dishes, or decorated with plastic toys. The hillside has been terraced like a small stadium to accommodate these stone children. Their poignancy only became apparent to me once I learned that each one had been placed there by a mother in memory of her miscarried, aborted or stillborn baby.

I also visited a shrine consecrated for pregnancy and childbirth in a working-class section of Tokyo known, oddly, as “Doll-town.” From the train station it is easy to find: just follow the streets lined with maternity dress shops and you come to a small courtyard raised above street level. The shrine is typical of Shinto, Japan’s nature centered religion. Behind an offering box hangs a thick rope you pull to ring a bell summoning the spirits to hear your prayers. But it was the courtyard itself that fascinated me.

Here official Japan gave way to unofficial Japan among the multigenerational families and vendor stalls. There were people hawking birth amulets. Several old women sold maternity girdles and socks. The girdles were traditional sashes that an expectant mother tied under her tummy to support the muscles. The socks reflected a Japanese folk belief that it is especially important for an expectant mother to keep her feet warm in order not to chill the baby up above.

Like many older societies, a lot of folk beliefs and taboos in Japan center around food. Before you even miss your first period, a sure sign of pregnancy is not being able to stand the smell of cooking rice. And morning sickness is supposed to be double if you are double female – that is, carrying a baby girl. During pregnancy you are supposed to avoid eating certain Japanese staples like squid or octopus because, the thinking goes, if you eat an animal without a spine the baby won’t have a spine either.  (Okay, I know. But this taboo interestingly enough, only applies to the first couple of weeks of pregnancy when the embryo’s spine really is forming.)

The richness of unofficial Japanese prenatal culture becomes more apparent, however, when you compare how the borders are drawn around childbirth education in Japan and the United States. In America most mothers-to-be do take childbirth classes, usually sponsored by their hospital, and often  take prenatal exercise or parenting classes along with buying related books and tapes; birth wisdom comes from “the experts,” not our own mothers.

In contrast, the kind of teaching that goes on in Japan is informal. Most Japanese women I know rely on the advice of female relatives and friends. The difference, I think, is because most Japanese women, both this generation and their mothers, faced labor head-on without the painkillers and amnesiacs that blurred the experience for many of our American mothers.

I remember hearing stories of Western women, intent on a natural birth, marching into the office of their Tokyo ob-byn demanding that no drugs be used during their labor only to be met with bemusement. Japanese doctors wouldn’t dream of using pharmaceutical pain-killers.

It’s not that Japanese are non-interventionist when it comes to childbirth; episiotomies are routine. What is different is the Japanese concept of facing pain, summed up by the word gaman. The dictionary defines it as forbearance, patience or endurance. An adult who can’t gaman is seen as self-indulgent or undisciplined.

Not surprisingly, childbirth is seen as a test of gaman. Enduring pain is supposed to make you a better, more fearless mother. There’s an old Japanese saying that pretty much sums it up: “Women are weak, mothers are strong.” (Onna wa yowai, haha wa tsuyoi.) While I disagree with the first part, the recognition  that “mothers are strong” does do just honor to childbirth.

It’s important to consider, however, that while gaman is a positive sort of endurance, there can be a negative side. I heard how one friend lay in a hospital bed and grit her teeth through a 48 hour labor until she couldn’t move her jaw the next day. The Japanese medical establishment, it seems, is not without it’s faults. I’ve heard of scheduled “inductions of convenience” to keep the ration of patients to clinic beds even.

This samurai stoicism expected of laboring women gives way to a much gentler nurturance during the postpartum period. In fact, my Japanese friends expressed pity for new American patients who are expected to somehow muddle through those first months on their own.

After giving birth, the new mother moves back to her childhood home to be taken care of for two or three months, even if that means traveling hundreds of miles away. Where his job permits it, her husband moves with her. In the few instances I know of where the new mother’s parents were not available, she moved in with her mother-in-law.

When I tell Americans this, the reactions range from envy to “Isn’t there any way they can get out of that!?”

Relationships between mothers and daughters are no less complex or ambivalent in Japan than anywhere else. But with that as a given, these postpartum months together help new mothers and new grandmothers adjust to their roles and create at least a working relationship.

Just as drug-free childbirth is the norm in Japan, so too are breastfeeding and the family bed. Bottle-feeding never caught on there, and most Japanese women learn to breast-feed from their own mothers.

Most homes don’t have cribs, let alone separate nurseries (although this has as much to do with lack of space as any mother-infant bonding theory). Babies sleep either on the same mat as their parents or on a small one pushed  next to the mother’s (most couples sleep on separate “twin” mats, side by side, while some do share “double” mats).

And while strollers are making inroads, as it were, most moms still nestle their infants in packs on their backs when running errands or doing housework. Coats are designed with extra room in back to cover mother and baby together.

I’m not sure which is cause and which is effect, but with these sleeping and waking arrangements I was never warned in Japan, as I have been many times in North America, to “just let the baby cry, she’s got to learn to be independent.” Japanese only train their children to gaman after they’ve outgrown helpless infancy.

Finally, the postpartum period ends on the hundredth day with a ceremony called Mana Hajime. A special dish of white rice that is colored pink by steaming with red beans is served to both mother and baby. Mana Hajime means “Beginning Food.”

“It’s nominally just introducing the baby to solids,” explained Elizabeth Andoh, an expert on Japanese cooking and dietary customs. “The new baby tastes a grain or two of rice off the mother’s chopsticks but the celebration is really for the mom. The baby’s made it through.” The mother has also made it through the transformations of pregnancy, childbirth, and finally, the return to her own childhood home as an adult.

Related letter in New York Times, 2002.

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