22-04-2025
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.'
