Mrs. H., now 76 years old, first gave birth when she was 20 years old.  She had four children within a period of five years and worked on the family’s vegetable farm on the Big Island, right up to the end of all four pregnancies. 

Although her prenatal care advised a midday rest, she was unable to comply because she was out working in the field.  Prenatal nutritional recommendations were to drink milk and eat a regular Japanese diet, including fish, vegetables, stir-fry, and daily miso soup.  Rice intake was to be restricted to achieve a recommended weight gain of no more than two pounds a month.  By the time her last child was born, she was skinny, drained, and had lost her hair – she thought she would die.

Unlike her mother who gave birth at home with midwives, Mrs. H. gave birth in hospital.  She accepted labor as a natural event, so she was not afraid.  During delivery of her first three babies, her arms were strapped down and her legs in stirrups.  She was told by an older woman not to dare scream when she had the baby, so she suffered in silence during all four labors.

Mrs. H. explained that once married, you belonged to the husband’s family.  Her mother-in-law was mean which created much stress in her life.  She emphasized that being in hospital for three days after the birth was a vacation; she enjoyed the food and being able to stay in bed reading and smoking.  She felt at peace because someone was watching her baby in the nursery.  The nurses brought the baby to her every four hours and advised her about breast-feeding.  She said that a relaxed mental state was important for successful breast-feeding. Once she returned to her stressful home situation, she was no longer relaxed, and her milk dried up after about two months.

Her mother-in-law told her that she should not reach up with her arms over her head during pregnancy so as not to strangle the baby.  However, laundry was done by hand, and Mrs. H. hung clothes on the line to dry throughout pregnancy with no ill effect.  For one birth, a first generation Japanese woman gave her a piece of rice paper that if swallowed, would facilitate an easy birth.  Mrs. H. said that traditionally women stayed home in bed for about thirty days after childbirth, enabling the baby to have a quiet time.  She wanted to follow this tradition but had to work.

Mrs. H. said that she would have really liked to have had someone with her for company and to help with little things, such as opening a window and the back pain.  She was comfortable having just the doctor and nurses present for the birth.   She would have liked to have been more American with modern conveniences and babysitters, rather than washing diapers in cold water and only getting a break when there was a funeral or she was in hospital giving birth.

She advised her children to keep their newborns at home longer, away from bright lights, to protect them from excessive stimulation.  She emphasized to her children the value of a balanced diet, the importance of intent and always being honest with oneself, and that being steeped in dogma was contra-progressive.

Mrs. C. is 63 years old and had one child when she was 34 and the second child at 36.  When she was five months pregnant with the first child, the Department of Education forced her to go on leave from her teaching job because it was considered improper for school children to see pregnant teachers.  She described how during the sugar plantation days, her father’s aunt in Hilo worked in the fields until the day of birth.  Early in the morning, before he had to leave for work, the woman’s husband went to fetch a neighbor to help.  The baby was born, and by the afternoon the woman was back in the fields working.

Mrs. C. said that she experienced nausea throughout both pregnancies and only gained eleven and nine pounds in each of the two pregnancies.  After both births, she lost a lot of weight and ended up ten pounds below her pre-pregnant weight.

When labor began, her husband dropped her off at the hospital.  She remembered a nurse saying to another patient, who was screaming, “You had your fun nine months ago, and now you suffer for it.”  Consequently, Mrs. C. tried not to make noise.  Her husband was there when she came out of the delivery room, but he could not visit for another two days because their house had arrived in a container and had to be unpacked quickly.

When Mrs. C. first went home, she was frustrated and in tears because her mother had disrupted her careful preparations and taken all the clean linen off her bed and the crib. She had been told by her family to stay in bed for one month after giving birth, but she ignored the advice.  She and her husband and the first baby went out to dinner ten days after the birth.

She wanted her children to feel secure, so after nursing, she would lay their stomach against her stomach and let them sleep for awhile.  She began to read to them when they were a few weeks old.  Now, she wants to pass on to her children the importance of making children feel secure and the value of reading in child development.

Although each woman’s story was unique, there were some common threads linking their experiences. For example:

• Each woman first told her husband that she was pregnant.
• Prenatal care was begun early in pregnancy.
• Prenatal visits were attended alone.
• Confidence and trust in physicians and nurses was expressed, together with a willingness to comply with medical instructions, rather than paying attention to advice from relatives.
• All the babies were delivered by a physician in a hospital.
• No husband or family member was present at the birth, only the doctor and nurses.
• Since other Japanese women advised that emotional expression of pain was considered shameful, the women who were interviewed labored quietly.
• Each woman demonstrated a positive mental attitude and independent thinking.
• Differences in expectation and beliefs between the interviewed women and female relatives – mother or mother-in-law – created considerable stress.
• Each woman demonstrated a positive attitude and independent thinking.
• The women had low weight gain during pregnancy, compared to the current recommended average weight gain of 25 to 35 pounds (Pillitteri, 2007, p. 302) and lost considerable weight after childbirth.

Beliefs and Traditions from Several Interviews:

• During pregnancy, don’t cut cords or ribbons that wrap around gifts and don’t wear necklaces or leis –affects position of umbilical cord and may cause distress to baby.
• Eating plenty nori may cause the baby to have an abundant amount of hair.
• Cleaning toilets all the time produces a healthy baby.
• Eating from a big spoon means that the baby will have a big mouth.
• After giving birth, avoid going out for one month to:
• Let womb heal
• Avoid over-stimulation
• Avoid wetting hair for one month after giving birth.
• Drink lots of miso soup after birth to help produce enough milk.
• Name baby after mother / father, relative, close friend, or season.
• Rubbing the baby’s nose prevents it from becoming flat.
• Rubbing the baby’s legs will make them look “nice”.

Nursing Care Suggestions:

• Be professional and knowledgeable and respect each woman’s choices.
• Use every opportunity to teach.
• Provide a comfortable environment during labor – decrease lighting and noise; provide privacy.
• Be alert for stoicism during labor pain.
• Assess pain frequently and assist with pain management interventions, such as repositioning, focused breathing and visualization.
• Respect preference for no labor attendants, if woman so chooses.
• Support and facilitate breast-feeding.

References

Pillitteri, A. (2007). Maternal & child health nursing: Care of the childbearing and childrearing family. (5^th edition).  Philadelphia: Lippincott Williams & Wilkins.

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