Japanese birth: one woman's view

NAWO NAGANO was born two emperors ago in a small town in western Japan. Married by age 16, she gave birth to seven children over the next 15 years. Her prenatal care consisted of monthly visits to the midwife and daily visits to a shrine to pray for a healthy baby.

Along with other superstitious cautions, she was warned that, if she ate octopus sashimi, her baby would have a strange shape.

Nagano was also forbidden to cook or even touch the family's rice for several days after each birth, because her family subscribed to a longstanding belief in Japan that a woman who has just given birth is unclean.

THOUGH pregnant women in modern Japan are still admonished daily - as they have been for centuries - to wear extra socks and the protective waist wrap to keep the baby warm (even in the oppressively hot summer months), much has changed. For example, many study LaMaze breathing methods and enroll in maternity swimming or aerobics classes.

Stiff competition to entice the sagging baby market in Japan has brought about attempts on the part of hospitals to please the maternity customer. There are those, however, who question the value of some of the ``improvements.'' For example, monthly hospital visits routinely include the use of sonograms, despite reports that effects on the fetus are not fully known.

In some cases, disgruntled mothers have reported ``assembly line'' methods such as hurrying delivery artificially by chemical means, a process that may make birth more confusing for the mother.

Basically, while the birth industry is presenting its new ways and wares all wrapped up in pretty pink and blue bows, its obstetrical practices tend to leave out some of the personal consideration that Nagano or her forebears experienced.

ONE of the least beneficial aspects of the modernization of birth procedures may be the division between the women giving birth and the women who care for them. All but one of the obstetricians I encountered during my pregnancy and delivery here in Japan were men, although in the past men avoided the baby practice altogether because of the belief that it was ``unclean.'' Though modern nurse/midwives are often in charge of women in labor, those who usually attend to the birth are obstetricians. Most are men.

This major shift in birth attendants - which seems to have been based upon the assumption by modern birth experts that the older, traditional birthing methods in Japan are next to useless - has brought about a corresponding shift in the basic way the birth process is viewed here.

Midwives were traditionally taught to consider the birth process as a natural one that the woman's body usually to a large degree knows instinctively how to handle. Basically they tend to let the birth unfold at its own pace and in its own way.

In contrast, some doctors have been taught to treat pregnancy almost as a form of illness rather than a natural condition, and so some may tend to enter the delivery room ready to interfere with the natural process.

TAKE my case, for example. Like many other young pregnant women in Japan, I often became impatient with admonitions I received almost daily during my first pregnancy here. Still, as an Anglo, I was not worried about being away from my own country at this time.

After careful study of old and new birth procedures in other countries as well as Japan, I had learned that not all of the pregnancy and birth practices in Japan's past were burdensome or laden with superstition.

For instance, in my view one of the advantages of the old ways was the tradition of surrounding the pregnant woman (and later mother and newborn) with nurturing women. In addition, most women benefited from the extended family, receiving encouragement and teaching about giving birth and mothering from their mothers and grandmothers.

If a woman had moved away from the family home, she returned there for the birth and for a month or more afterward. During that time, she was ``mothered'' by her mother and female relatives so that she could rest and focus all of her attentions on the new baby.

Further, though I had not been able to secure a birth at home, as I had wanted, I had been assured that midwives would be delivering my baby at the hospital. I soon began to imagine a labor and delivery during which my husband and I would be surrounded by motherly women, who quietly whispered encouragement. As an added bonus, I thought, we would be close to modern equipment.

But because doctors are in charge of the birth process, midwives can't always advocate that more gentle approach which their profession has usually espoused. I also learned that the aspect of the traditional midwife's training that could make the biggest difference - the personal and intuitive care - is given only when busy nurses have time.

The influx of modern techniques and male caretakers was designed to give mother and child the best. Certainly, Japanese mothers and babies today are fortunate that Japan has moved away from the archaic thinking that prohibited Nagano from sharing her family's rice.

But the nurturing methods of the traditional Japanese midwife may still have their place.