Birthing Around the World

Last night I watched "The Business of Being Born" and found it fascinating. Living in Seattle, we have a lot of options for natural childbirth and medication-free, low intervention births. Doulas and midwives seem to be plentiful and home births aren't unheard of here either. Needless to say, much of the information in the movie was familiar to me.

Having said that, it was still an incredibly inspirational movie about the power of women to give birth on their own terms without medical interventions and without the need of specialists or doctors or hospitals. What I find myself pondering is the cultural implications raised in the movie. For example, the movie suggests that something like 80% of all births in Japan have a midwife in attendance. While I think that's admirable (keeping the tradition of midwifery alive and relevant even in hospital or clinic settings as opposed to what we have in the U.S. where midwives are often unwelcome in hospitals) I wonder how accurate or meaningful this fact really is.

I had the sense from a number of women (both Japanese and non-Japanese) that I've heard from who delivered babies in Japan, that labor and delivery generally involves the pregnant mother lying on a bed while a doctor runs the show. Sure a midwife may be in the room, but I've never gotten the sense that comfort measures or encouraging a less "medical" or standard hospital delivery was part of their job responsibilities. If this is the case, and the hospital stay accompanied by doctor delivery of the baby is truly standard in Japan, then I'd argue that the mere presence of a midwife isn't sufficient to make things different in a meaningful way. It may be true that maternal mortality and infant mortality rates in the U.S. are both worse than the rates in Japan, but isn't it possible that this is because epidurals aren't widely available? (And if epidurals aren't used then the labor is less complicated and "risky" for a variety of reasons.)

All of this just makes me wonder about cultural similarities and differences. Does the fact that doctors and hospitals are seen as "the" place to give birth transcend Japanese and American cultures? Are midwives in Japan truly more influential in Japan than they are in the U.S., or are they simply more visible without any real influence on birth outcomes?