Facilitators and barriers in the humanization of childbirth practice in Japan

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.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.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.Childbirth is regarded as one of the most important events in a women's life, and it can, in turn, affect the rest of their life, both physically, and emotionally [1].During the past decades, giving birth has been increasingly medicalized procedures in most of countries [2,3]. Pregnancy and birth were conceptualized as pathological processes that require intensive monitoring by a physician. Medical interventions in childbirth such as use of electronic fetal monitoring (EFM), epidural analgesia, amniotomy, induced labour, episiotomy, and elective caesarean section deliveries increased especially in the North America in the last decade and continue to increase [4-6]. These proced