FOCUS: Clinics are backbone of safe childbirths in Japan+

TOKYO, May 22 Kyodo -
Close ties between obstetric clinics and maternity hospitals are supporting
Japan's top-level safety in childbirths globally with very low rates both of
perinatal mortality and maternal death.
Hideo Takemura, vice president of the Japan Association of Obstetricians &
Gynecologists and director of Kosaka Women's Hospital in Higashiosaka, Osaka
Prefecture, said there is a need for burden sharing between obstetric clinics
and maternity hospitals.
''Normal childbirths are to be done at regional clinics and hospitals, and
childbirths with high risk are to be done at perinatal medical centers and
other institutions where many obstetricians work,'' he said.
Shortcomings in obstetric care have surfaced in the last several years with the
departure of obstetricians from a number of hospitals, and the number of
medical institutions handling childbirths in 2008 showed a decrease of 53
percent from 1984. During the period, the number of babies born fell 27
percent.
Takemura said 56 percent of babies were born at hospitals in 1990, but the
percentage was down to 51 in 2007, while 48 percent were born at clinics,
showing their increasing roles. In rural areas where public hospitals are
difficult to be maintained, the number of childbirths at clinics has already
become higher than at hospitals.
In Europe and North America, many childbirths are done at large hospitals, but
in Japan, regional clinics, two-thirds of them with one obstetrician, are
playing a big role in childbirths.
Takemura has carried out a survey about a regional gap in obstetrical treatment
and found that childbirths at clinics in Saga Prefecture accounted for 74
percent of the total, while those in Kagawa Prefecture comprised 27 percent.
The survey also found that the perinatal mortality per 1,000 births in 2007 was
seven in Kochi Prefecture and three in Yamanashi Prefecture. The average annual
deaths of pregnant women between 2003 and 2007 per 100,000 births ranged from
zero to 11. The smaller the population is, the larger the gap in the death
rate.
Takemura said that even if the rate of births at clinics was high, there were a
number of prefectures where the death rates of mothers and babies were low. ''I
cannot recognize the linkage between the birthrate at clinics and the perinatal
mortality rate of pregnant women. To narrow the regional gap, it is necessary
to create a perinatal care setup conforming to regions, including emergency
services,'' he said.
The Society to Protect Childbirths in Japan held a symposium in Tokyo in March
to make an appeal for the need for closer ties between clinics and hospitals.
Noboru Hirashima, director of Hirashima Women's Clinic in Ageo, Saitama
Prefecture, who has handled about 10,000 births for 23 years, said, ''I have
been supporting community-based childbirths with assistance from
anesthesiologists and obstetricians in the neighborhood in carrying out such
risky operations as C-sections.''
Many pregnant women and their families favor childbirths close to their homes,
but in case of risky childbirths, hospitals have an upper hand because there
are more than two obstetricians and high-quality medical treatment is
available.
Takashi Watanabe, head of the obstetrics and gynecology department at Haga Red
Cross Hospital in Tochigi Prefecture who has restored the obstetrics department
at the hospital, said, ''If obstetrics departments at hospitals operate as
anticipated, regional perinatal care goes more smoothly.''
==Kyodo