Monday, June 24, 2013

Childbirth and Infant Mortality Abroad: Japan

By: Marley Phillips,
ANM Intern
Japan has the 2nd lowest infant mortality rate in the world. Japan. This is not some unpopulated country full of billionaire babies, this is Japan. Japan is huge! Gargantuan, actually. So let’s look into how Japan could have possibly achieved such an amazing feat.

Japanese culture holds the social status of the mother EXTREMELY high. Get that baby out of her, and she is back to being a rather unvalued member of society. But, for our purposes she does have a baby inside of her, and the Japanese do not take that lightly. The Japanese culture encourages women to get prenatal care very early into the pregnancy. Pregnant women are supposed to stay off their feet for the first 3 months (
FYI, Japanese pregnancy is 10 months), and be very active for the rest of her term. There are many exercise classes offered by hospitals, maternity centers, and gyms specifically for pregnant women. 

Since Japan is the technology capital of the world, there is a lot of emphasis on using technologies in pregnancy. Ultrasounds are done at every appointment. Japanese women have a visit at least every 4 weeks through 23 weeks gestation, every 2 weeks from 24 to 35 weeks, and every week after 36 weeks. That’s a total of 14 doctor’s visits and a total of 14 ultrasounds. And this is a minimum. This was a little surprising to me in light of the research that has come about in recent years pertaining to ultrasound usage.

With obesity rates at just 5% and smoking rates among women 15 years and older at 11%, the Japanese maintain an overall high level of health. The customary diet, which is strictly monitored to only include the healthiest of foods for the baby during pregnancy, can certainly only help the pregnancy and subsequent baby thrive. Side note: the Japanese do not cut out fish while pregnant (even raw fish) and actually encourage eating it multiple times a week.

While these statistics are great, I found something is my research that kind of shocked me, and apparently shocked the citizens of Japan, as well. The (true) poverty rates were released for the first time in a number of years, only to find that 15.7% of the Japanese population is living below the poverty line. That’s not much lower than the United States’ 17.1%. We frequently link  poverty to things such as poor health and being uneducated; in our country, that is often the case. However, if the U.S.A. strived to help women be better educated about pregnancy and childbirth the way Japan government and culture does, our women would make better, educated decisions. Just a thought.

Prenatal Coupons
Like Monaco, Japan has a universal healthcare system that every citizen is entitled to. Unlike Monaco, it does not cover prenatal or postnatal fees. However, when you pay for your services out of pocket, the government will give you a “birth sum allowance” of up to 420,000 yen ($4,417). I also found out via a YouTube channel dedicated to birth in Japan that you get a ton of coupons redeemable for prenatal visits and such. Pretty stinkin’ cool.
            There are 3 options for giving birth in Japan: #1) in a hospital, #2) in a maternity clinic, and #3) in a birthing house. All of these places offer pre and postnatal care to women. I should also mention, the minimum stay in any Japanese birthing facility is 5 days for a normal birth. 5 days. Let’s allow that to sink in for a minute… 5 DAYS. That is so amazing. In these 5 days, you will be able to relax with your baby, learn some basic baby maintenance skills such as bathing and swaddling, 
and get breastfeeding support. (Oh yeah, those guys LOVE to breastfeed! More on that later)

The hospital stay will cost you anywhere from 450,000-470,000 yen ($4725-$4935). This is for a vaginal delivery with no drugs, seeing as the Japanese don’t take too kindly to epidurals and cesareans. If a woman wants either of these services, she will have to request it very early in the pregnancy and find a hospital willing to provide such services, which are few and far between in Japan. The cost of a cesarean birth is in between 500,000 and 600,000 yen ($5142-$6170).

The maternity clinic is a physician and midwife run clinic with fewer than 19 beds. This is a little more expensive, but they are little more lenient about position, in room stay, family, visitors, etc. Giving birth in a maternity clinic will cost roughly 480,000-550,000 yen ($5040-$5775), but you’ll have to pay an extra 2,000 yen ($21) to have an adult stay with you. Not a big deal. They’ll also give you tons of goodies when you leave, such as an audio recording of your baby’s first cry, a copy of your baby’s footprints, and pictures of your baby’s birth, and a certificate of your baby’s blood type. And, just for a good laugh, check out this Hello Kitty Maternity Hospital.
          Last, but certainly not least, there’s the birthing house. These little houses are run completely by midwives who will conduct your prenatal and postnatal appointments and, of course, catch the baby. Water births are very popular at birthing houses, and they also have plenty of accessories to help make birth comfortable such as a stool shaped like a horse shoe so that you can sit for the birth, and a rope hanging from the ceiling so that you may hold on to squat during delivery. The cost is 496,000 yen ($5208) and 40,000 ($40) extra for a water birth. For the midwives to attend home birth is anywhere from 480,000-500,000 yen ($5040 -$5250).

Now let’s talk about breastfeeding. If you’re reading this post, you probably already know breastfeeding is so much better for a baby than anything else that a baby could possibly be fed.  If you didn’t know, do some research. I have seen some conflicting stories about breastfeeding in Japan. Apparently the hospitals are not very BF friendly. But the Japanese society is so dang supportive of breastfeeding that the lack of hospital support usually won’t deter mothers from at least exclusively breastfeeding for the first month. Exclusive breastfeeding rates in 2010 at one month were 51.6%. At 3 months, 56.8%. The rate of any amount of breastfeeding was 95.4% at one month and 86.8% at 3 months.
The last topic I want to touch on is co-sleeping. Sleeping with a baby is the norm in Japanese culture. Most children sleep with the parents until around age 6. This may be in the bed or on a separate mat or sleeping surface beside the bed. The Japanese technically sleep on futons, but I digress. Japan has one of the highest co-sleeping rates in the world, yet one of the lowest SIDS rates in the world. Interesting, huh? See James McKenna for some interesting research about co-sleeping and much, much more.

So, here it is, a country comparable to the United States that has an extraordinarily low infant mortality rate. And this is how they’ve managed it. Japan has many of the same social and national issues that our great country has, yet they’ve seem to overcome them for the betterment of their mothers and babies. Maybe we, as a society and as a government, can look to Japan as a guide in implementing maternal education and providing better care to improve America’s staggering infant mortality rate.

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