Last year saw the approval of the Health, Midwifery and General Nursing Legislation, during an extraordinary session of the Diet, and with it the change of the Japanese title for midwife, from the female “jyosanpu” to the neutral “jyosanshi”. Immediately after this, Ms. Yuko Minami, President of the Japanese Nursing Association, declared the need to “move with the times, and propose the introduction of male midwives”. For February's regular meeting, JCLU invited 5 members of the Japanese Midwives' Association to discuss the question of the introduction of male midwives.
The meeting was opened by JCLU Director, Yoko Hayashi, who explained the reasons behind the choice of this subject for discussion: “Whether or not to open the possibility of gaining a midwife's license to men, is an extremely difficult question. It is not something that should be decided without deep and careful discussion. As Professor Mutsuko Asakura of Tokyo Metropolitan University Law Department has argued in her writings, “careful thought is necessary before accepting the proposition that, from the point of view of equal opportunities in employment, it is self evident that men should be allowed to practice as midwives. This is because this question is not one that can be correctly answered while ignoring the very particular nature of this work.”
Junko Asahina
First to address the audience was Ms. Junko Asahina, a home midwife in Shiga Prefecture, who explained why she had decided to join the movement against the introduction of male midwives. “In March 2003, when the Japan Midwives' Association's policy on male midwives changed, the press was full of headlines such as “Lift the Hundred Year Ban”, with the assumption that if the organizations concerned were for introduction, it must be good policy. A closer look however, reveals major problems with the Japan Midwives' Association's decision making procedures in reaching this standpoint. Most of the Association's members first learned of the Association had turned in favour of the introduction through media reports. The decision to change the Association's policy was made solely by the Directors, ignoring the Association's principle of democratic decision making and going against its articles of association. It is therefore invalid.” She went on to explain the activities of those involved in the movement against the introduction of male midwives, including the petitioning of the government, and the carrying out of surveys of Japan Midwives's Association members. 63% of those members questioned were against male midwives, the outcome of the survey reflecting a feeling of unease regarding the way in which the 2001 bill had been introduced without consulting interested parties.
Yukako Yajima
Next to speak was Ms. Yukako Yajima, a practicing midwife at a maternity home in Kokubunji City. While showing slides of childbirths that had taken place at the maternity home, she talked the audience through a natural birth, and explained the role of the midwife during the birth. “If a woman gives birth comfortably, she feels like she could do it all over again even though it's only just over. To help a woman give birth comfortably, we must respect and understand her wishes to be treated with kindness and care.”
Every year, many young trainees join the Yajima Maternity Hospital, with the aim of becoming midwives. They are always told the same three keys to practicing warm and caring midwife. “First, during labour, the expectant mother is never alone. Second , to establish a rapport with the expectant mother, the midwife should always place one hand on her body. Finally, a midwife must accept the behaviour of the expectant mother towards her during childbirth, without judging or criticizing her.” She went on to quote the words of an expectant mother, “If a male midwife came into the room, one would have to somehow change one's state of mind for the birth. This wouldn't happen with a female midwife.”
Taeko Mouri
Ms. Taeko Mouri, who practices as a midwife in the maternity home run by her mother in Kobe City. She reported the results of an urgent survey conducted last year, as part of the campaign against the change of the midwife title from “jyosanpu” to “jyosanshi”. “Despite the fact that the cost of sending back the survey was left as the burden of the questionnaire, the survey had some 4453 replies. The results showed that about 70% were against the change in the midwife title, and those for the change didn't even make up 10% of those questioned. Many women expressed the opinion that “the title “jyosanpu” gives a feeling that midwives can empathise with expectant mothers” and thus were against the change. Last year, Ms. Mori attended the Committee on Health, Welfare & Labour under the House of Councillors as a expert, reporting the results of this survey and describing her experiences at the maternity home. The survey not only covered the change of the midwife title, but also the introduction of male midwives, and the unification in professions. In Japan to be qualified as a midwife, a nurse has to take one year specialist course for midwifery. There is a move to unite midwife and non-midwife courses. It found that 70% of women were against the introduction of male midwives, and 60% were against the unification. In Japan to be qualified as a midwife, a nurse has to take one-year specialist course for midwifery. There is a move to unite midwife and non-midwife nurses. The opinion that it wasn't right to be able to obtain a midwife's license after just four years of university study was also expressed.
Motoko Okazaki
Next to speak was Ms. Motoko Okazaki, a midwife from the Shiga Prefecture. She that the role of the midwife extends beyond the actual birth, to the role of councillor during the child raising process. “ feeling of motherhood is not necessarily something that comes naturally, but is something that develops through giving birth, and raising children. These days, young mothers often miss out on knowledge from older relatives or local people, that they may have had the benefit of in the past. If they experience problems in child-raising, this can be a source of unhappiness and stress. But babies do cry, it's completely natural. It is the role of midwives to let mothers know this.There is a need for a place where mothers can come together and share their experiences and troubles of child-raising. To finish, Ms. Okazaki read a poem of her own composition, describing the empathy they give while caring for the mother during child-birth.
Yes, breath in slowly
Yes, that's right, slowly, slowly
Yes, ride on that wave and pu-sh
That's it, and again
Pu-sh
Yes, that's perfect
Kimiko Kayashima
The last speaker was Professor Kimiko Kayashima, of Jikei Medical University Nursing and Science Department. She spoke on her own teaching experiences. The fact that male students are now attending child-birth practicals has led to many mothers refusing to take part. Professor Kayashima then referred to papers from Ishikawa Prefecture showing that male student nurses did not observer do practicals concerning internal examinations, clysis, external genital tonsure, urethral catheterization or external genitals. Moreover, the paper specified that if male student nurses were to take part in assisting at practicals, it must always be under supervision.
After a break, the second half of the seminar was devoted to a panel discussion. Inspired by JCLU director, Yoko Hayashi's opening speech, the first question asked was what the respective arguments of those who were for and against the introduction of male midwives were. The answer from the panel was that, although the arguments in favour of the introduction varied, they commonly included the equal participation of men and women in society, equal employment opportunities and the right of male to education. It was suggested however, that these arguments were put forward just to lay the ground for the unification of the professions. Real equal participation of men and women in society is not achieved by one sidedly forcing women to put up with something against their wishes. Furthermore, it was a worry that many of the male students wishing to become midwives, were ultimately aiming to work overseas. With the limited experience they gain, because of women's reluctance to receive their assistance, it was argued that their skills would not be up to standard.
Leading on from this Director Yoko Hayashi asked who was really going to benefit from the introduction of male midwives, while it was making progress under the pretext of gender equality. The responses from the panel and the audience included comments such as “It is obstetricians who would gain the most from the unification of the professions. If the professions are unified. Obstetric nurses will be able to perform midwifery, without being told that they don't have a license”, “If they all become nurses, the management of hospitals and the staff reassignment will become much easier”, “The directors of the Japan Midwives's Association were at first dismayed when they were approached by the Health, Welfare & Labour Ministry with the strong suggestion that it was about time to introduce male midwives. It is the nursing department of the Ministry that has been putting the pressure on behind the scenes, so the Ministry must have something to gain.” and “Although there is the mistaken belief that the status of the nursing profession will improve with the introduction of male midwives and the unification of professions, in reality no one will benefit from these changes.”
The question of the rights of those men who wish to become midwives was then raised by a member of the audience. In response, the speakers explained that “in the case that the right for men to choose their profession competes with a woman's right to integrity, women's rights must naturally prevail. The right for men to choose their profession should not be asserted to the extent that it violates women's feeling of shame.”
Encouraging words were then spoken by Fumie Saito, Secretary to Mizuho Fukushima, the only Member of the House of Councillors to have voted against the bill changing the midwife title. She advised that “most male Councillors are in favour of the introduction of male midwives, while knowing very little about childbirth. If the reasons why it is important that midwives be female were explained and asserted more forcefully, male Councillors may begin to understand. There is a possibility that male Councillors will become opposed to the introduction.”
Finally the opinion that the question of male midwives should be approached from the perspective of the rights of the prospective mother, and her right to choose, was expressed by a male member of the audience.
In Japan, the violation of women's rights during childbirth and medical treatment is becoming more and more common. This has been highlighted by the Prof. Kasai's incident, and the Fujimi Hospital incident, involving an unlicensed doctor performing unnecessary hysterectomies. The introduction of male midwives is not an issue that should be approached solely from the viewpoint of gender equality but also concerns gender differences and women's rights, and therefore requires deep delving into legal theory. Either way, a proper understanding of a women's state of mind during childbirth, and what midwifery really entails, is vital before tackling the issue.