Why do Japanese doctors expect birth exactly on time?

“One hospital even required all women to give birth by induced labour on a fixed schedule. This, I supposed, was an offshoot of the just-in-time inventory method that made Toyota so successful.”

About Face by Clayton Naff pg 232

Hopefully this is just a joke, because he also points that Japan has one of the world’s lowest infant mortality rates, and that is partly because of doctor’s obsession with birth weight and therefore inducing birth before it would become too difficult. Like most Japanese, they are also free of the irrational Western love of the “natural”.

10 Comments

  1. Rachel said,

    June 13, 2011 at 1:41 am

    Wow, I don’t think I’ve ever seen so many misconceptions crammed into one short paragraph!

    Induction carries risks to the mother and baby. It’s a drug, all drugs have side-effects. Even the main effect, of stimulating contractions can be hazardous to the mother and baby by over-stimulating the uterus. Since the leading cause of maternal death in Japan is hemorrhage, a side-effect of induction, and since Japan’s maternal death rate is relatively high, this is important.

    Small babies are not necessarily easier to birth, nor bigger ones harder. It’s a false association. Low birth weight is a problem; smaller babies are less healthy and more prone to problems. The Japanese doctor’s obsession with weight. has led to Japanese babies birth weights plummeting so much that international agencies have noticed it with concern. So it’s not based on science, but on a cultural belief that fat people are selfish, and therefore not showing the right attitude toward becoming a ‘good’ mother.

    Japanese have an obsession with ‘natural’ as far as pain-killing drugs go, which are strongly discouraged. But they have no qualms about giving out all manner of other drugs. This is similar to other areas of Japanese health care.

    ‘Natural’ is not irrational in childbirth. It’s very simple logic: drugs and other interventions have side-effects, so if you avoid them when they are not necessary. The result is a healthier mother and baby.

    I actually think the guy was not quite joking about Toyota! In a modern, time-managed, technological society, people expect nothing less than for everything be precisely managed by clockwork, and they trust technology over nature and their own bodies (except for making the babies, most people still like to do that the natural way!).

  2. alexcase said,

    June 13, 2011 at 2:04 am

    I must admit that my personal reaction to Japanese healthcare matches that of you and the author, and like the author I regularly throw most of the drugs away when I get back from seeing a Japanese (or Korean, or Thai) doctor. However, if you look at the statistics they have to be doing something right, and even as someone who finds it impossible I have a sneaking suspicion that people actually listening to their doctors is, in balance, probably that good thing.

    Surely you must admit that the Anglo-Saxon love of the natural is at least as irrational and cultural as most of Japanese healthcare? There are loads of examples in the UK of things in health food shops later having to be controlled or banned because they turn out to be at least as harmful or addictive as the “unnnatural” equivalents, and don’t get me stared on homeopathy…

  3. Rachel said,

    June 14, 2011 at 3:31 am

    Not much of a fan of homeopathy myself, and yes, I do find the touting of ‘natural’ products to be illogical sometimes (often?) .but I don’t think it has anything to do with natural birth. I think you’re assuming women go for a natural birth for the same reason they buy the cheese with ‘natural’ written on it, a preference for the term itself. But I thin it’s the opposite – women start out wanting to know what it safest for them and their baby, and by that research are led to choose a birth with few or no interventions. Just leave out that pesky word ‘natural’, it just confuses things! Nor is this kind of birth necessarily in opposition to doctors, in many places it’s just the standard practice. Including Japan.

    Japan has a low infant mortality rate, but it’s the first time I’ve heard induction, normally considered a risk factor, listed as a reason. Usually people point to universal health care coverage, women giving birth younger and not being overweight as the main reasons. Actually Japan is often cited as a reason why natural birth is superior (health-wise) as they have a lower incidence of early induction (it’s actually standard everywhere to induce after 41 weeks, it’s not even a Japan thing), low use of pain-killing drugs and low cesarean rate. So, no, I don’t think it’s because of the inductions!

  4. crella said,

    June 15, 2011 at 3:50 am

    I agree with Rachel. Any kind of intervention increases the risk of something happening, induction is probably the intervention which has the most potential to cause problems. Induction causes stronger than normal contractions which last longer, tiring out the mother. The birth is precipitated, often requiring an episiotomy, or causing tears. Induction is usually thought of as something to avoid.

    I think Rachel’s reasons are spot-on.

  5. alexcase said,

    June 15, 2011 at 11:10 pm

    I bow to your greater knowledge!

    My main point is that I think part of the reason for this being so in Japan (if indeed it is more prevalent here, which I don’t know) is the Japanese doctor’s obsession with birth weight. Do you think that is true? I certainly think it has more influence than Toyota, and anyway expecting modern technology to make everything happen on time is hardly peculiar to Japan nowadays…

  6. crella said,

    June 16, 2011 at 1:02 pm

    Not greater, but maybe a bit more varied, due to 12 years or so volunteering with breastfeeding mum’s groups in Japan…I’ve known a lot of pregnant ladies and new mums!

    I think it may be related to doctors’ weight concerns, although whether Japanese doctors’ weigh restrictions on mothers are for the best or not is open to debate. I see it as more a obsession with mother’s weight gains, rather than birth weight. The limit is generally 8 kg, as opposed to no weight limit in other countries. I think 8 kg is a bit severe, but mothers may well be in much better shape. it’s my impression that Japanese mothers get back into shape quickly. Restricting mothers’ weights reflects on babies’ birth weights too, of course. Healthier mothers = healthier babies. One other thing is the longer hospitalization. It makes sure there is no placental retention, and mothers get practical breastfeeding help in that first week. I remember being discharged in less than 48 hours in the US, and really struggling until my milk came in, wondering if I was doing things right.

  7. alexcase said,

    June 16, 2011 at 9:25 pm

    I was very impressed with the post-birth care in Japan too. Apparently in Korea it is now becoming quite standard amongst the wealthier classes to move into another kind of clinic after you come out of hospital to get more help and rest before you move home, though I think in that case there might be a danger that you never learn to cope yourself…

  8. Rachel said,

    June 18, 2011 at 1:29 am

    Regarding your last comment, Alex, I don’t think women were ever supposed to care for a newborn alone, that’s why humans developed society – to support women giving birth to basically premature infants. This is the reason behind ‘satogaeri’ of course.

    As for the real reason for induction (starting off a birth) I think it’s the same as in Western countries, there is a fear of complications after 41 weeks. Not just size. There is also ‘augmentation’ which is giving a woman the induction drugs during a labor that began naturally to speed it up, which is very common in Japan. This is mostly for convenience, get those mums and babies off the conveyer-belt and the next pair on!

    And back to the weight: It’s not just because of baby size. The biggest risks for being overweight are gestational diabetes and pre-eclampsia, both of which make a pregnancy very high-risk. And Japan does have better stats regarding those conditions.

    Why the obsession with weight – well, like everything, Japanese like to take things to the absolute extreme. If it’s worth doing, it’s worth doing 150% – wrapping a gift, train timetables, beautifully presented food.. and interminable meetings, crazy work hours, bullying fat people. Japanese women are told to watch their weight, and go to it with typical Japanese attention to detail. Mothering is self-sacrifice in Japan, and this is their first opportunity to show how they can come up to the plate.

    And as I mentioned before, I think there is a prejudice against fat people in Japan that gets wrapped into the mix as well. Fat people are not showing the right gaman/gambaru attitude, they are ‘wagamama’ (the worst insult you can throw at a Japanese). They are not Japanese enough, if you like. And nowhere is this more important than when they are producing the next generation of Japanese people

  9. alexcase said,

    June 18, 2011 at 5:27 am

    Thanks everyone, very perceptive comments. I’ll have to do completely wrong-headed blog posts like this more often!

  10. induced risk said,

    December 4, 2011 at 3:49 pm

    Hello,
    I wanted to share my own personal history on indiction in Japan.
    I am 10 weeks pregnant and looking for a satisfactory delivery option, as I am forced to decide on the place ASAP. One of my concerns is having access to epidural. I have been told by e\all the three hospitals I have visited so far all that they only offer epidural from 9 am to 5 pm, when they have enough personnel. after-hours deliveries have to be managed without that form of pain relief. They told me that if I want an epidural they recommend elective induction, that is, I go between 9 to five after 37 weeks to induce labor. So it seems that the Japanese system is putting economic concurs before health concerns; having enough anesthesiologists 24/7 is expensive!I am quite disappointed after knowing about this.


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