Doula Services in Japan - Honorary Director's Blog

Author:	Noboru Kobayashi, M.D. Honorary Director, Child Research Net
Issue Date:	July 6, 2012
Category:
Related tags:	Japan, Noboru Kobayashi

Keywords: doula, Emotional support, pregnancy, childbirth, childcare, perinatal care, postpartum care, Noboru Kobayashi

I am sure that all our friends of CRN are familiar with the term "doula." I have written about doulas a number of times, and Dr. Rieko Kishi, who is a nurse and midwife writes on doulas in a column entitled "Doula Research Room" on CRN Japanese site.

For those who have not heard of it before, let me repeat that "doula" is originally a Greek word referring to a woman who assists other women before, during, and after childbirth, in particular, by providing emotional support. It was Dr. Dana Raphael, a medical anthropologist and student of Margaret Mead who was the renowned cultural anthropologist and professor at Columbia University, that began using the term after many years of research on pregnancy, childbirth and child-raising. In all ages, there has been some kind of system for women to emotionally support each other in pregnancy, childbirth and child-raising for the next generation. In ancient Greece, these functions were carried out by the doula, who was similar to what we call a midwife in Japan today. At a time when medical knowledge and care was not advanced, the doula was central to bring the next generation into the world.

I bought a book by Dr. Raphael when I visited London in the late 1970s at a medical bookstore near the children's hospital where I had studied in the early 1960s. It was my first encounter with the word "doula" and it taught me the importance of emotional support during pregnancy, childbirth and child-rearing. As a physician, I knew full well that during pregnancy and postpartum, women often experience psychological conditions that include the maternity blues, but I did not realize just how effective emotional support could be. Reading the book, I was deeply moved and wrote an article introducing doulas to Japan in The Journal of Pediatric Practice in late 1977 and again in Perinatal Medicine in 1981. That was about 35 years ago, and unfortunately, there was little response. It is something that I am even at a loss to explain.

Around the year 2000, however, I began to hear from some midwives who had read the article. One of them was Dr. Rieko Kishi, a nurse and midwife who had actually experienced and participated in the doula movement that had begun in the 1990s in the United States. This meeting became the immediate impetus to launch the abovementioned Doula Research Room on the CRN Japanese website for which she began to contribute articles.

Recently, some independently practicing midwives in Tokyo consulted me about starting a doula business. I was surprised to see that their project outline referred to "postpartum doulas," in other words, doulas who are not directly involved in the stages of pregnancy and childbirth. I wondered if they would simply offer help with child-raising, which would then mean that they could not really call themselves "doulas."

When I asked about this, however, I was told that obstetric wards and maternity hospitals are strongly opposed to allowing anyone who is not a direct relative into the delivery room. This indicates one way in which obstetric medicine defines itself. When I was writing my article, I remember hearing criticism that emotional support would hardly make childbirth easier or get rid of complications to the mother's health or the newborn. Excellent research was being conducted in the United States, but unfortunately, I had yet to see anything similar in Japan. The criticism in Japan was based on the assumption that because emotional support was not considered a medical expenditure, it could not be allowed in the hospital.

As Dr. Kishi reports in her Doula Research Room, doulas in the United States are becoming integrated into obstetric medicine. I hear that in Shanghai, China, expectant mothers can contract a doula of their choosing to provide warm emotional support beyond the standard medical care in the maternity ward and thereby make childbirth less difficult and more enjoyable. I would like to see doulas become a part of obstetric medicine in Japan as they already have in China and the United States so that women in Japan can also experience birth with joy and enjoyment.