Factors affecting the provision of analgesia during childbirth, Japan

Abstract

Japan’s universal health-care system means that it is a very safe country in which to give birth. Perinatal outcomes in Japan are excellent, with low infant mortality and neonatal mortality. However, childbirth remains a challenge for many Japanese women, who are faced with a scarcity of places to give birth, limited availability of analgesia and social norms that favour natural birth. The number of birth facilities in Japan continues to decrease as fewer children are born. The numbers of qualified medical staff remain inadequate, with a continuing lack of female physicians, perpetuated by a pervasive negative gender bias. Recruitment efforts are underway, but few doctors want to specialize in obstetrics or gynaecology. Furthermore, around half of female obstetricians and gynaecologists in Japan’s male-dominated medical system stop practising when they have their own children. The difficulty of obtaining analgesia during labour is another problem. Although low uptake of labour pain relief in Japan is said to be due to cultural influences, the root of the problem is a lack of qualified anaesthesiologists and the inflexibility of a system that will not allow other staff to be trained to administer labour analgesia. Problems with labour anaesthesia have been linked to 14 maternal deaths since 2010. Japanese policy-makers need to act to renovate the nation’s obstetric facilities, reorganize regional perinatal care systems, train more obstetricians and anaesthesiologists, promote task-shifting and better integrate biomedical and traditional, non-medical care for pregnant women.

Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study

“…28 Analgesia is rarely used for routine vaginal births in the public health system in the focus countries assessed here, as is the case in many Asian countries. 30 Future studies to examine these factors in detail in the East Asia and Pacific region may be warranted. In addition, this study did not include preterm babies who were not the focus of EENC until after 2017.…”

Intrapartum Analgesia—Have Women’s Preferences Changed over the Last Decade?

“…The choice of EDA can be influenced by different factors, including cultural beliefs-as labor pain is considered a virtue in Japan, the rate of analgesic delivery in Japan is very low, at the level of 6.2% in 2016. The low rate of labor analgesia in Japan is also influenced by the difficulties in access to birth facilities and shortage of anesthesiologists [12]. Shishido et al found Decision Aids (algorithms prepared to facilitate the decision about EDA in labor) useful in assisting informed decision making, and found a significant increase in patient's satisfaction with their choice when compared to a group of women who received only informative pamphlets [13].…”

Postpartum Opioid Use among Military Health System Beneficiaries

“…An example of this cultural difference is that women in Japan are less likely to have an epidural in labor compared with American women. 26 The MHS provides universal health care coverage regardless of education or economic status. This population may be ideal to study how socioeconomic status plays into opioid prescription patterns.…”