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The Doula Movement in Japan

The term "doula" means "women's servant" in ancient Greek and doulas are usually trained lay women who support other women from the beginning of pregnancy until postpartum. It was October 2005 when the Doula Laboratory was launched on Child Research Net. In those days, information about doula support in the Japanese language was very limited and people rarely knew the roles and effects of doulas in detail.

Two years later, in December 2007, two doula symposiums were held at Konan Women University in Kobe-city and at the 13th Annual Conference of the Japanese Society for Prevention of Child Abuse and Neglect (JaSPCAN) in Tsu-city. Ms. Rachel Abramson, director of Chicago Health Connection (a non-profit organization that developed the community-based doula model), and Ms. Loretha Weisinger, a community-based doula, were invited as the keynote speakers.

Although the private doula model (doula service-for-profit) is commonly seen in the U.S., I found the community-based doula model especially meaningful because it meets the philosophy of primary health care, "Health for All," declared by the World Health Organization. The model particularly targets socially disadvantaged women and their families. In Japan, economic disparities among people are widening, and health professionals should prevent it from contributing to disparities in people's health care. Health care should be available, accessible, culturally appropriate, acceptable, affordable, participatory, and equal (McElmurry & Keeney, 1999), and so should doula support.

In both symposiums, a documentary film "A Doula Story: On the Front Lines of Teen Pregnancy" in which Ms. Weisinger's doula activities in Chicago were depicted, was screened to give the participants visual and concrete information about doula support and stimulate discussions. The award-winning film was produced and directed by Mr. Daniel Alpert (The Kindling Group) in 2004 and was subtitled in Japanese in 2006. Importantly, the film is a documentary, that is, everything in the film is real. Having audio/visual material and being able to see a real doula, the participants in the symposiums received more immediate and powerful messages, compared to written or indirect information.

After screening of the film, Ms. Abramson, Ms. Weisinger, Dr. Kenji Arahori (obstetrician), and Dr. Noboru Kobayashi (pediatrician) gave presentations.

Ms. Abramson's presentation started with a slide entitled "children are our future": what a coincidence that it was the mission of Child Research Net! She talked about the U.S. situations in which doula support emerged, a summary of the Chicago Doula Project, and keys for success in the community-based doula model. Currently, the model has been replicated in 10 states, in 34 agencies outside Illinois, and funding for the national community-based doula expansion was recently approved as part of the federal budget.

Ms. Weisinger talked about her own experiences as a doula. Her presentation began with "I'm coming to you today not to change your minds but to help change some opinions on the ways to connect the women with the resources." Finally, she gave us advice on how to become successful doulas. The advice had been gathered in a meeting where Ms. Weisinger and her doula colleagues discussed how Japanese people could use this model.

Dr. Arahori presented the mechanism of maternal deaths in health care systems, a JICA project in Kenya, and the cyclical process of child abuse, domestic violence, and parenting. He referred to traditional birth attendants in Kenya and traditional nurse-midwives in Japan. Finally, the use of doula support to create healthy family functions and effective perinatal health care system was proposed.

Dr. Kobayashi has been introducing doula support in Japan for 30 years. Dr. Kobayashi talked about his friendship with Dr. Dana Raphael who originally had introduced the term "doula" in 1970s. Based on the mechanism of biological development of the human brain and cognitive functions, he stressed the importance of emotional support for healthy human development and humanization of perinatal care.

At the conference held by JaSPCAN, Dr. Shigeru Nii (obstetrician) and Dr. Yutaka Atsuta (pediatrician) joined the panel discussion. As the president of Japan Association of Obstetricians and Gynecologists in Mie and that of Japan Association of Pediatricians in Mie, respectively, the two doctors commented on their concerns for the rapidly deteriorating health care system in Mie and their expectations for the new model of perinatal support.

The materials and final report in the symposiums are being prepared to be uploaded on Child Research Net in a few months, so that people who did not come to the events can share the information.

In addition to the two events, Ms. Abramson and Ms. Weisinger met with Dr. Toru Takeuchi, a pediatrician and the translator of "The Doula Book (Klaus & Kennell)", in Osaka. The interview was facilitated by Medica Publication. Dr. Takeuchi feels that Japanese women should play important roles in society. He emphasized the potential that nurse-midwives, who are currently inactive and stay at home, could work as doulas in order to rescue the collapsing perinatal health care system. On the other hand, the differences between doulas and health care providers were mentioned, and roles of doula training were discussed.

The two guests from the U.S. also visited Mori Nurse-Midwifery Clinic in Kobe and Kyogoku Pediatric Clinic in Ashiya. Mrs. Mori and her daughter showed them Japanese-style breast massage and nurse-midwifery practice. There were nursing students at the clinic for their training and study. Dr. Kyogoku showed them a series of his medical and non-medical activities for/with his clients. His participatory approaches to promote culturally competent care are very impressive.

Ms. Weisinger wrote a brief report in the Chicago Health Connection Winter 2008 Newsletter. The below is a part of her report.

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Sharing the Community-Based Doula Message in Japan
By Loretha Weisinger, Doula at Marillac House
I traveled to Japan in December 2007 to help change opinions and help empower women. I went with Rachel Abramson to present on the community-based doula model at two different settings. People were so nice in Japan, but different! But they still accepted us and received us well. They really wanted the doula message. They were impressed by the information we brought to them because it was very much needed there. Although different nationalities are doing the same kind of work as community-based doulas, they hadn't yet put a name to it.
I was so impressed by them being impressed by the idea of the doula. It's going to be easier for them to train lay people as doulas if they approach the idea of doula the way CHC did. It's not going to be hard because similar people are doing that very job already. I was very impressed by their midwifery center and nursing school. I thought that they wouldn't recognize women's intelligence in Japan, but you could tell the times are changing because there are a lot of other programs opening up for women, not only nursing school.

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It is true that Japan and the U.S. are at the different stages in terms of doula movement: we are probably 30 years behind that of the U.S. The wisdoms from American doulas have to be adapted for the social context of Japan as well as its stage. On the other hand, I was amazed at the fact that the messages from the American guests were sincerely received by many, many Japanese people, beyond cultures, languages, and professions. As Ms. Weisinger mentioned in the newsletter report, we had already shared the doula spirits, awareness, experience, practice, and hope with each other.

The next step and continuing steps would be to continue increasing information about doula support in the Japanese language, while cultivating human network. As Dr. Kobayashi mentioned, there can be many ways to actualize doula support, depending on their needs, resources, and cultures. I have no concrete strategy, but I only hope that all the doula movements will be eventually toward a mission "Health for All." Considering the current shortage of maternal health care providers and hospitals in Japan, how could more lay people collaborate with professionals to ensure necessary health care services for themselves?


Acknowledgement
I am grateful to all people who supported and collaborated with us, in particular, to JaSPCAN (Prof. Miyoko Nagae), Konan Women University (Prof. Yuko Inagaki and Prof. Hiroko Tomoda), Medica Publication, Mori Midwifery Clinic, Kyogoku Pediatric Clinic, Prof. Kahoru Kitagawata, Marillac House, Chicago Health Connection, Child Research Net, and American Association of University Women.

Reference
McElmurry, B. J. & Keeney, G. B. (1999). Primary health care. Annual
Review of Nursing Research, 17, 241-268.
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