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.