Seishi Shimizu: The Role of Obstetrics and Gynecology in Supporting Local Childbirth

The number of births in post-war Japan has been on a steady decline since the second baby boom. It fell below 2 million in 1975 and below 1 million in 2016. According to estimates, it is said that the number will fall below 700,000 in 2024.

This trend is also felt on the front lines of obstetric care. At Shimizu Hospital in Sakado City, Saitama Prefecture, where I serve as director, about 700 newborns were born annually until seven or eight years ago, but that number is now decreasing. Looking at regional data published by Saitama Prefecture, the number of births in the western district of the prefecture, which includes Sakado City, has decreased significantly during this period.

At the same time, reports highlight the plight of an increasing number of "childbirth void municipalities" that do not have a single delivery facility. Even in the Sakado-Tsurugashima Medical Association, to which our hospital belongs, seven obstetrics and gynecology departments handled deliveries 25 years ago, but that number has now decreased to five facilities, with only three of those currently handling deliveries.

Precisely because we are in such an era, our hospital works day and night to handle deliveries with a total staff of 45, including two full-time doctors, nine midwives, and 17 nurses, so that as many babies as possible can be born. We have 36 inpatient beds and receive on-call doctors from the university department of medicine to prepare for births 24 hours a day, 365 days a year. Of course, it goes without saying that the presence of excellent staff is essential to continue providing safe and secure obstetric care.

In recent years, an increasing number of local governments are providing obstetric care through an "open system" to address the shortage of obstetricians. In this system, pregnant women receive prenatal checkups at a convenient local facility and give birth at a medical institution with advanced equipment. Since checkups occur once every four weeks in early pregnancy, every two weeks from the sixth month, and every week from the tenth month onwards, this helps reduce the burden on expectant mothers as well as the workload of obstetricians.

In obstetrics, there are rare cases of premature birth, and in such instances, medical facilities request acceptance from a neonatal center. However, the shortage of beds at these centers has also become an issue in recent years. Under these circumstances, the existence of a transport coordinator system is significant; because local government operators now coordinate transport destinations, the burden on medical facilities has been greatly reduced. At Shimizu Hospital, we have had cases where patients were transported through this system not only within the prefecture but also to medical facilities in Tokyo and Gunma Prefecture.

In this way, the support system for childbirth is gradually improving. Nevertheless, the reason the decline in births does not stop is likely not just due to individual factors such as family circumstances or the diversification of lifestyles, including the trend toward staying single. During prenatal checkups, we also hear voices of anxiety, such as "My parents aren't nearby, so what should I do about childcare?"

Currently, discussions are underway to apply insurance to childbirth costs for normal deliveries, but I have some doubts as to whether the voices of those in the medical field are reaching this debate. While childbirth is a major life event with a temporary goal of giving birth and being discharged, childcare is where the real start begins.

Families with small children face a continuous series of challenges. Nighttime emergency medical facilities are constantly visited by mothers with their children. For a family with two children, it would be difficult without childcare facilities where they can leave the other child during an emergency.

Even if the burden of childbirth costs is reduced, I believe it will be difficult to fundamentally resolve the continuously declining birthrate unless the environment for pediatric consultations, especially neonatal care, is improved.

Shimizu Hospital opened in 1957 and has supported local births for about 70 years. I took over as the second-generation director in 2004, aiming for the motto passed down from my predecessor: "Community-rooted medicine, safe and natural childbirth." From that perspective, our hospital has refrained from performing painless (epidural) deliveries until now.

We consider natural childbirth, performed with minimal medical intervention, to be the ideal. I hear that the number of expectant mothers requesting painless delivery has increased in recent years, but painless delivery (epidural anesthesia) uses more anesthesia than a C-section (spinal anesthesia) and requires a specialist in obstetric anesthesia, raising concerns about risks to the mother. This is why our hospital recommends natural childbirth.

Many of the expectant mothers who visit our hospital are those who desire a natural birth. Among the mothers who experienced their first birth at Shimizu Hospital, there was one who chose another hospital for her second child, wanting a painless delivery. When she became pregnant with her third child, she came back to Shimizu Hospital, saying, "I definitely want a natural birth after all." Apparently, it was because with the painless delivery, she "didn't feel like she had actually given birth."

Such feedback is a great encouragement to us. The joy of mothers when a baby is born, the sight of mother and child being discharged in good health, and seeing the belly grow larger with each prenatal checkup all lead to our sense of fulfillment. Obstetric care is a job where one can never relax, but I believe that steadily supporting childbirth is the greatest contribution we can make to the community right now.