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Open Access Research article

Facilitators and barriers in the humanization of childbirth practice in Japan

Roxana Behruzi1*, Marie Hatem2, William Fraser3, Lise Goulet4, Masako Ii5 and Chizuru Misago6

Author Affiliations

1 Université de Montréal, Faculty of Medicine, Department of Social and Preventive Medicine, Montreal, Canada

2 Department of Social and Preventive Medicine, Montreal, Canada

3 Université de Montréal, Faculty of Medicine, Department of Obstetrics and Gynecology, Montreal, Canada

4 Université de Montréal, Faculty of Medicine, Department of Social and Preventive Medicine, Montreal, Canada

5 Hitotsubashi University, Department of International and Public Policy, Tokyo, Japan

6 Tsuda College, Department of International and Cultural Study, Tokyo, Japan

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BMC Pregnancy and Childbirth 2010, 10:25  doi:10.1186/1471-2393-10-25

Published: 27 May 2010

Abstract

Background

Humanizing birth means considering women's values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been indentified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres.

Methods

A qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed.

Results

All the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were women's own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions.

Conclusions

The Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and beliefs of Japanese women regarding natural birth is an important factor promoting the humanization of childbirth in Japan.