Japan by the Numbers: Birth is Too Painful

Japan has one of the lowest rates of pain-free delivery in the developed world: only 5.2 percent of mothers were given epidural anesthesia in fiscal 2016. Compare that to estimates from France (77.8 percent), the United States (61 percent), the United Kingdom (33 percent), and Norway (26 percent), and it’s clear Japan is an outlier.  

Many Japanese doctors say that number is too low. Yet a string of recent deaths and injuries to mothers who received epidurals and their children threatens to further demonize the already unpopular procedure.

Last week, the Asahi Shimbun reported that police were preparing to press charges against the head of an Osaka clinic where a 31-year-old woman died after receiving an epidural in January. A mother who lost her daughter and grandchild after the daughter received an epidural called for a nationwide government investigation The industry paper Medical Confidential has a good rundown of the individual cases in Japanese. Then-health minister Yasuhisa Shiozaki pledged in a press conference on August 1 to put together a group of external experts to study the issue.

Why is the rate of epidural anesthesia so low in Japan in the first place? Several studies have pointed to the fact that Japan puts importance on pain experienced during childbirth as a necessary step to become a mother. Other doctors say that birth in Japan is basically seen as a “natural,” “non-medical” event with few risks. If birth, and the pain of birth, is “natural,” why would anesthesia – a medical procedure – be necessary? 

The Japan Society for Obstetric Anesthesia and Perinatology lists only 160 hospitals and clinics in Japan offering epidurals or combined spinal epidural anesthesia.  

Despite this history, Japanese doctors say that increasing availability of epidurals could be helpful as women in Japan give birth later in life due to increased risks with later birth. Others, such as anesthesiologist Serabi Tanabe, note that it can help moms recover faster. 

Dr. Tanabe and other medical professionals argue that the recent string of accidents have been caused by a lack anesthesiologists or staff prepared for emergency situations.

Epidurals “should be a valid way of safe, comfortable birth for mothers and children. We shouldn’t thoughtlessly criticize. It’s precisely now that we should debate how to have secure the human resources necessary to make ‘painless birth’ more available,” Yuto Maeda, resident at Kobe City Medical Center General Hospital’s obstetrics and gynecology department, wrote last month. 

The same lack of staff and emergency care capabilities has been blamed for the rising number of cesarean sections in Japan. Nearly a quarter of women who give birth in hospitals have a cesarean section, up from about 10 percent in the 1980s, according to the most recent health ministry statistics. The WHO recommends an ideal cesarean section rate of 10-15 percent. 

Japanese doctors and health officials should debate methods of giving birth from the point of view that childbirth carries risks, and give patients the best information about risk possible. Both cesarean sections and epidurals carry risks – however far more cesarean sections are performed in Japan. Coverage of the tragic accidents involving epidurals has steered the conversation away from a rational discussion of the risks of epidurals versus other methods.

Japan needs to give women who want to have children as many options and services as possible to fit how they want to have a baby. If they want to have a completely natural birth, that’s fine. If they want to have an epidural, they should be able to have that procedure done safely.

*There does not exist good, internationally comparable data about rates of anesthesia use during childbirth. Most figures are based on surveys. 

*Small medical facilities being unprepared to deal with emergency situations during childbirth is not just a Japanese problem. The Wall Street Journal profiled the heartbreaking case of a rural Tennessee woman who died recently after giving birth. 

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