Subsidies for Pain-Managed Childbirth: Safe Childbirth System Should Get First Priority

Editorial

13:59 JST, January 27, 2025

The Tokyo metropolitan government will begin subsidizing pain-managed childbirth, which uses anesthesia to ease the pain of giving birth, as part of measures to tackle the declining birth rate.

However, there are many issues to be addressed, including a shortage of anesthesiologists. A system must be established that allows people to give birth with peace of mind.

Pain-managed childbirth is said to reduce the anxiety and stress of women during their delivery, as well as reduce postpartum fatigue and speed up the mother’s physical recovery.

In recent years, the rising age of women giving birth has increased the need for this type of delivery, and it now accounts for over 10% of all births in Japan. It is common in Europe and the United States — pain-managed births account for 70%-80% of overall childbirths in the United States and France.

Starting in October, the Tokyo metropolitan government will provide up to ¥100,000 to pregnant women living in Tokyo who give birth at medical institutions in the capital.

The national average for childbirth expenses is nearly ¥520,000, and it exceeds ¥640,000 in Tokyo. The central government pays ¥500,000 as a lump-sum childbirth and childcare allowance, but in many cases this is not enough. If a woman chooses a pain-managed childbirth, it will cost an additional ¥100,000 to ¥150,000.

Now that the number of births in Japan is expected to fall below 700,000 per year, it is understandable that the metropolitan government is trying to reduce the burden on women and support childbirth. The subsidy program was one of the promises made by Tokyo Gov. Yuriko Koike during her campaign for the Tokyo gubernatorial election last year. This may be the reason for the rush to introduce it.

However, at present, concerns remain about the ability of medical institutions that will provide pain-managed deliveries to secure the necessary personnel and implement safety measures.

In 2017, a series of serious accidents came to light across the nation, including the death of a woman after a pain-managed delivery. Some key facts behind these incidents are that unlike other developed countries, many childbirths take place in clinics in Japan, in which a single obstetrician both delivers the baby and administers the anesthesia.

There is concern that more medical institutions will perform pain-managed deliveries without sufficient safety measures, as the number of women seeking such deliveries may climb rapidly due to the introduction of the subsidy.

The metropolitan government said that one of the conditions for receiving the subsidy is that the birth must take place at a medical institution with an anesthesiologist or a doctor who is proficient in anesthesia. The metropolitan government should keep a close eye on the matter to ensure safety.

Recently, there have been cases in which anesthesiologists are dispatched from cooperating hospitals when pain-managed childbirth is performed at clinics. It is essential to strengthen safety measures, such as training for obstetricians and midwives.

Pain-managed deliveries tend to take longer, leading to an increasing number of vacuum extraction deliveries. It has been argued that there is also a risk that it may be difficult to notice abnormalities because the pain is eased. It is important for this kind of information to be shared among medical professionals.

Outside of Tokyo as well, there are people who want to have pain-managed deliveries, and this number is likely to grow in the future. How to establish safe obstetric care and expand support for people who want to have babies are common challenges throughout the country.

(From The Yomiuri Shimbun, Jan. 27, 2025)