Cases of epidural use in labor rise in Japan alongside concerns
The number of women opting for epidurals during childbirth is on the rise in Japan, with Tokyo even kickstarting a subsidy program from this fiscal year. However, there is a notable disparity in availability around the nation, with new data showing that in some prefectures, there has not been a single case of an epidural-assisted birth. The cost of an epidural, which is not covered by national health insurance, could also prove to be a barrier for some women, while sudden increased demand for epidurals might exacerbate an anesthesiologist shortage the nation is already facing.
According to numbers the Japan Association of Obstetricians and Gynecologists (JAOG) released earlier this month, out of the total 721,000 childbirths reported in 2024, 13.8% involved the use of an epidural, which provides pain relief during labor via the use of local anesthesia. This is a significant increase compared to six years ago, in 2018, when the rate was 5.2%.
The increase, however, is mainly centered in metropolitan areas, with Tokyo surpassing the 30% mark in 2024 and prefectures like Chiba, Kanagawa and Kumamoto close behind at nearly 25%.
Meanwhile, the rates of epidural use remain low in more regional areas — many well under 10%. In Kochi Prefecture, for example, not a single case was reported between 2018 and 2024. There have also been no epidural-assisted births in Iwate Prefecture since 2020.
The disparity stems from a lack of facilities in more rural areas of the nation that can accommodate requests for an epidural.
According to data an expert panel at the health ministry released last week, less than half of the hospitals in the country offered epidural labor as an option.
Epidurals are standard in many Western countries, with about 70% of women who give birth in the U.S. opting to use them. However, usage in Japan has remained low, partially due to a culture that promotes natural births.
Under the current system, public health insurance also does not cover epidurals, meaning they can cost anywhere between ¥100,000 ($710) and ¥200,000. The same survey by the health ministry showed the average price of epidurals at hospitals around the country was around ¥120,000.
The Tokyo metropolitan government has taken steps to make epidurals more accessible in the city and reduce the burden on women looking to have children, launching a subsidy program starting this fiscal year that offers women up to ¥100,000 to help cover the medical costs of choosing to use one.
While some women in metropolitan areas are encouraged by epidurals becoming more readily available, concerns with safety due to staff shortages have been raised as well.
Bigger demand for epidurals may exacerbate the dire national shortage of anesthesiologists, who are desperately sought after for procedures besides child delivery.
Quickly increasing the use of epidurals without the number of anesthesiologists also going up means that, inevitably, the complicated procedure could be hastily conducted or done by a doctor with little experience, which could lead to unwanted side effects in the mother or cause injury.
'Many of the obstetric anesthetics in Japan are managed by obstetricians who lack the training and resources to recognize and properly manage anesthesia-related complications,' said Ayumi Maeda, an anesthesiologist at Brigham and Women's Hospital in Boston who specializes in obstetric anesthesiology. 'It is completely different from other developed countries, where obstetric care is centralized and anesthesia care is primarily provided by anesthesiologists.'
According to survey results the JAOG also released on Monday, an anesthesiologist administered the epidural in 37.2% of the cases recorded in 2023, while in 10.6% of the cases, an OB-GYN licensed in anesthesiology administered it. A whopping 52.8% was done by OB-GYNs who had no such license.
The same survey found that in 12.7% of the epidural-assisted births recorded, mothers faced complications from anesthesia that, in some cases, led to aftereffects, including high spinal anesthesia — where the numbing effect spreads higher than intended — and local anesthetic toxicity.
'Even a specialist like me, who practices at a quaternary care facility with 7,000 annual deliveries, is constantly fighting the fear of causing complications,' Maeda said. 'I think it is a misguided approach to expect obstetricians, who are the specialists in pregnancy and childbirth, to care for anesthetic complications.'
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The Mainichi
3 days ago
- The Mainichi
New Tokyo clinic helps elementary school girls, teens tackle period pain, symptoms
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Yomiuri Shimbun
07-06-2025
- Yomiuri Shimbun
U.K. to Cut Foreign Workers, the ‘Backbone' of British Nursing Homes
Tori Ferenc for The Washington Post Jeremiah Akindotun helps Edna Barnett with her crossword puzzle at Hammerson House, a 116-room nursing home in north London where 58 percent of the clinical staff come from 49 different countries. LONDON – The 23-year-old Nigerian man handed the 78-year-old British woman her noon pill and, on a sunny June day, sat down for a little chat amid the family photos lining her wall. 'Will you miss me if I leave?' Jeremiah Akindotun asked with a smile. 'Oh, I think it's too sad, Jerry,' said Suad Lawy, sitting back in her chair. 'You get so attached. What's going to happen to our carers?' Akindotun is a health assistant at Hammerson House, a 116-room nursing home in north London where 58 percent of the clinical staff come from 49 different countries. Across the United Kingdom, foreign workers commonly provide intimate care to elderly Brits, with nearly a third of care staff coming from overseas. But maybe not for long. 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The Mainichi
21-05-2025
- The Mainichi
Japan university under fire for offering courses in pseudoscientific 'healing therapies'
TOKYO -- Speaking positively to water creates beautiful ice crystals; sugar pellets infused with highly diluted minerals and other substances can heal disease: These are typical claims associated with controversial "hado" vibrational healing and homeopathy, respectively. Despite scientific-sounding descriptions, experts have long identified such methods as pseudoscience -- practices lacking scientific credibility, evidence or the capability for rigorous testing and validation. Yet, at Kanagawa Dental University's graduate school in Yokosuka, Kanagawa Prefecture, such questionable therapies feature prominently in the syllabus of an integrative medicine course for working adult students, attended by individuals who already hold national medical credentials such as doctors and nurses. Lecturers include representatives and senior leaders brought from organizations promoting these methods. Academic experts warn that the situation carries substantial risks. "The fact that a university offers such courses could grant pseudoscience and its promoting bodies undeserved legitimacy, potentially misleading more people," cautioned one scholar. Moreover, university sources indicate the courses themselves are not actually funded or run by Kanagawa Dental University. Methods rejected by Japan's Science Council The course in question began in academic 2022 on the top floor of a five-story building near JR Takanawa Gateway Station in Tokyo's Minato Ward. The tuition fee for the one-year course is 1.2 million yen (around $8,300). This year's lectures -- totaling around 180 hours -- cover more than 30 controversial self-proclaimed therapies. Hado once sparked controversy when it was adopted into elementary school moral education classes, criticized as pseudoscience creeping into classrooms. Homeopathy was formally rejected by a 2010 statement from the Science Council of Japan, explicitly denying its therapeutic effectiveness. The university's syllabus even covers "Edgar Cayce therapy," which is claimed to have been started by a psychic with clairvoyant abilities. According to people involved, the course was originally proposed to the university by Akira Kawashima, a medical doctor frequently appearing on television. When contacted, Kanagawa Dental University representatives replied that "Kawashima will respond directly." Kawashima himself commented, "Integrative medicine includes the good and the bad alike. It's essential to train medical professionals, after mastering Western medicine, to get accurate insights into various techniques so that, when patients ask about them, they're able to distinguish legitimate treatments from fraudulent ones." Who manages the university course? Although billed as a university offering, the course is actually funded and administered by a general incorporated association through a service contract with the university. The association's head is a doctor who runs a psychosomatic internal medicine clinic in Tokyo. She promotes procedures involving "hand power healing," claiming on her own website: "Invisible energy definitely exists," adding that "the delicate energy changes in body and mind can be perceived and rebalanced through one's palms." Responding to inquiries, the doctor acknowledged her organization's role in operating the course. She explained that the company initially tasked with administrative duties withdrew, prompting Kawashima to ask her to take over. Last December, she organized a public lecture featuring a leading representative of an Edgar Cayce promotion group at the same Tokyo building. Flyers advertising the event prominently mentioned her group's role managing the university-related courses. Experts convey concern Attempts to introduce unscientific concepts such as hado, the "gaming brain" theory and EM (effective microorganism) bacteria into educational settings have previously caused public concern. However, experts pointed out that cases of universities proactively teaching these pseudosciences in a positive light have been extremely rare. Professor Masato Ishikawa of Meiji University, an expert in cognitive science, explained, "There are scenarios where universities teach pseudoscience -- for example, studying 'witches' from a cultural or anthropological perspective. But actual proponents presenting lectures cannot respond to scientific criticism." In 2014, Meiji University planned a course for the general public featuring promoters of pseudoscience like hado and EM bacteria, but canceled it due to faculty opposition. Professor Ishikawa further warned of the risks posed because students already have medical qualifications. "Course participants pay fees and receive official certificates of completion. Thus, it raises the likelihood they'll offer these practices themselves," he said, expressing concern about an increase in medical clinics providing treatments lacking scientific validity. Comments from the education ministry Upon completion of the one-year program, participants receive official certificates issued under the School Education Act. A representative from the education ministry's university promotion division, which manages the law in question, stated, "Ultimately, universities hold full responsibility for the content of their certified programs." However, regarding dubious therapies suspected as pseudoscience being taught within the courses, the ministry representative explained, "We, as an administrative body, are not in a position to determine if particular course contents qualify as pseudoscience." Professor Satoru Kikuchi, a psychologist at Shinshu University who is knowledgeable about pseudoscience, criticized what he sees as the universities' irresponsibility: "It seems universities play down the responsibility involved in teaching positively about therapies without a scientific basis." Kikuchi further argued that the education ministry's approach is problematic as well, declaring, "Entrusting universities alone to check their course content mimics the situation with the functional food labeling system -- where responsibility for confirming the safety and efficacy of functional foods was pushed onto private industry, resulting in health problems. It's essentially equivalent to the ministry abandoning its supervisory responsibilities."
