Facilitators and barriers in the humanization of childbirth practice in Japan

Abstract

BackgroundHumanizing birth means considering women's values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been indentified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres.MethodsA qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed.ResultsAll the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were women's own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions.ConclusionsThe Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and beliefs of Japanese women regarding natural birth is an important factor promoting the humanization of childbirth in Japan.

Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies

“…[50,52–54] Some midwives expressed similar concerns where midwifery confidence, skills and support were low within specific organisations [46,50,52–54] and systems. [46,47,49,52–54] As explained by this midwife in Chile, “ Neither midwives nor women are empowered enough to question a medical prescription . ” ( [49]: p.1153).…”

“…[27,36,42–44,46,47,55] This could simply be a consequence of different financing structures, clinical policies, and the working environment. However, it could also be due to the power of the predominant philosophy of pregnancy and childbirth, based on perceptions of the purpose of the particular kind of unit.…”

Challenges in implementing continuous support during childbirth in selected public hospitals in the North West Province of South Africa

“…It can be difficult to implement continuous support during childbirth if this practice is not specifically mentioned in policies and guidelines. According to Behruzi et al (2010), the most important barriers identified in providing humanised birth care (including continuous support) were institutional rules and strategies that restricted the presence of birth companions.…”

Components of Care Quality during normal hospital delivery: bibliographic revision / Los Componenetes de la Calidad Asistencial en el parto normal hospitalario:revisión bibliográfica

“…En Japón, la principal barrera identificada son las reglas institucionales que limitan la presencia de un compañero en el parto (21) , mientras que en el Reino Unido, ha sido el uso inapropiado de la tecnología sin tener en cuenta el nivel de riesgo de las mujeres, la falta de preparación médica en el parto normal y los bajos niveles de dotación de personal (22) . Una Cohorte, realizada en un hospital sueco, demuestra que en gestantes de bajo riesgo si se reducen los procedimientos obstétricos durante el parto no se pone en peligro la salud materno-infantil y los resultados son mejores, como menor índice de cesáreas urgentes, menor número de partos instrumentados, menor necesidad de uso de analgesia epidural y menor índice de distrés respiratorio fetal (23) .…”