Leaking Culture

I have largely chosen to avoid talking about my pregnancy on this blog. I have another space where I write about that, and it seems more appropriate to keep the two separate and to keep the other one somewhat private. However, as my pregnancy progresses and I have more interaction with the medical and cultural aspects of pregnancy in Japan, I am starting to think that it might be fun to share some of what I am learning. I don’t intend to start showing ultrasound photos or anything like that here, but I do think that most of our readers that are interested about our life in Japan might also be interested to hear about the huge cultural divides that we are encountering now as future parents.

The reason I named this post as I did, is because I have been noticing a lot of the ways that culture leaks into medicine and vice versa. Sometimes this leaking and blending can make it difficult for people to separate the two, almost impossible. One very concrete example of this happens in the 5th month of pregnancy, the month I am just completing now.

During the fifth month, pregnant women in Japan start wearing a hara-obi. The hara-obi is a piece of white cloth that is about 32 feet in length and about a half a foot wide. The long cloth is used to wrap the abdomen of the woman. It is often translated as a maternity belt or corset.

When I was initially offered the hara-obi, I had no idea what it was that they were trying to get me to do. Having no experience with such a thing, it was difficult for me to understand why it was used and what the benefit was. The doctor, nurse, and my translator tried their best to explain, but it remained difficult to understand.

However, yesterday, at my first new mothers class, I was given a little more insight into the reasons why women wear the hara-obi in Japan. The class was presented by the clinics nurse midwife. She is a qualified, trained individual and she offered four reasons why the hara-obi is important.

  • To keep the baby small and help ensure an easier delivery for the mother.

    To protect the baby in the event of a fall or accident.

    To support the back of the mother.

    To keep the baby warm.

  • Now, looking over this list I find at least two reasons that are blatantly false. The hara-obi will neither protect the baby in the event of a fall or accident, nor will it keep the baby warm. Let me explain why.

    In terms of protecting the baby, the hara-obi is simply a thin piece of cotton wrapped around the mothers midsection like a mummy. It is nothing more than that. Perhaps if the hara-obi was cast from steel it might protect the baby, but this extra cotton layer will do no more than wearing an undershirt. The baby is protected by the amniotic fluid. To illustrate this point, put a raw egg inside a large jar of water. Shake vigorously. You will notice the egg, much like the baby, remains whole, safe and intact even in the most violent of situations. Wrap the jar in cotton and the same will remain true. The baby is no more or less protected by this extra layer.

    In terms of keeping the baby warm, again, this is simply not true. The baby is housed inside its mothers womb. The mothers body temperature remains at a fairly constant temperature of 98.6 degrees (37 celsius) regardless of choice of clothing and anything but the most extreme external temperatures. The hara-obi certainly might keep the mother warmer, it is nearly 30 feet of extra insulation after all, but it is quite unlikely that it will do anything for the temperature of the baby.

    The other reasons I can grant might have some basis in fact and truth, even if I disagree about their usefulness or necessity. Certainly the baby will be smaller if the mother tightly wraps 30 feet of cotton around her midsection and restricts the ability of the uterus and baby to expand and grow. Yes, this may make the delivery easier for the mother, but I am unsure that it is a good practice for the baby.

    Lastly, it may in fact provide some back support. As time goes on I may find that I need such support, but for now I am doing fine and have no back discomfort.

    For these reasons, I find it absolutely unnecessary for me to wear the hara-obi. And this has been met with some resistance and crooked looks from those around me. I did a little research about the hara-obi to try to find out more about why it is used so frequently here in Japan. Many sources point to the fact that it is more of a cultural tradition than a medical tool.

    Historically, women would receive the hara-obi and take it along with their mother and mother-in-law to a shinto shrine where it could be prayed upon and blessed by the monks to ensure a healthy baby and a safe delivery. Then, wanting to protect their baby, mothers would wrap their midsection in the hara-obi to surround themselves and their baby with prayers and good wishes.

    Additionally, women would usually begin wearing the hara-obi on a “Dog Day.” Each month has a dog day and since dogs generally have large litters and easy deliveries it was said that beginning to wear the hara-obi on this day would bring similar luck to the mother.

    Despite the fact that the roots of the hara-obi lie within the culture, it is such an ingrained tool that many have come to firmly believe that there is a medical reason to do so. The lines between cultural tradition and medical necessity have been blurred and no one seems to be entirely aware of it. Including my midwife.

    Navigating this, along with the other cultural differences associated with pregnancy, childbirth and childrearing, is going to be difficult. These ideas are so ingrained, that it is difficult to see through them, to question them. Since it is only me here, dealing with a clinic staff filled with a lifetime of experience doing things the way they do, it is difficult for them to understand that it could be done any possible other way.

    I know that this offers me the chance to learn, the chance to also question why we in American culture do certain things the way we do, it offers me the chance to see if maybe they do things better here sometimes. But it is difficult to do when those that I am working with seem so resistant to accepting the fact that their commonly held assumptions are based in culture and not medicine. I believe the same would be true in America if the roles were reversed.

    I have tried my best to think of what exists in American or Western culture that is so deeply ingrained that we forget its basis is in culture and not medicine. Perhaps it is because I view the world through my past experiences that I am not able to see the difference, much like the Japanese are not able to see that the hara-obi is not medically necessary. But I wish that I could. The only example I can even come up with is that chicken noodle soup is good for you when you are sick. Yes, I know that there have been some medical studies that perhaps link these two. But, I believe the majority of the reason why we eat chicken soup when we are sick is because this is a tradition that has been passed down over many generations. If a Japanese person were living in America and someone expected them to eat chicken noodle soup when they had a cold, I would imagine they would think the whole thing was ridiculous and crazy. And I am sure there must be other examples out there like this one that are escaping my mind at the moment.

    How about this, if you have another example, can you share it with me in the comments? I am really interested to find out what you think and to remind myself that the Japanese are not just naive and crazy, and that we Americans (or other westerners) do the same exact same things.

    Posted on Friday, November 7th, 2008 at 5:02 pm. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

    10 Responses to “Leaking Culture”

    1. Carrie says:

      What an interesting perspective, thank you for sharing. You are blessed to get to see and reflect on culture and pregnancy. Personally, if something was so ingrained in the culture that I was living in at the time, I would probably do it as long as it wasn’t harmful. The only harm I could see in the hara-obi is if it were wrapped too tightly. But I agree with your rationale on why it doesn’t do 3 of the 4 things. Its just not necessary.

      Where do women and their infants sleep in Japan? Separating infants from their parents during sleep is one of those culture norms I think you are looking for. Americans don’t question it, and believe it is somehow better or safer. Yet there are many studies supporting the safety and benefits of sharing sleep with your baby, and the vast majority of the world does it.

      In fact, most of health care, but especially pregnancy related care, is based on culture and not solid evidence. Many things we do without even thinking have not been proven beneficial and some have been proven harmful. Here are some examples:

      Routine episiotomy
      Routine 20 week ultrasound
      Restricting women’s movement in labor
      Routine, continuous fetal monitoring
      Giving birth on your back with your legs up
      Restricting food/fluids in labor
      the frequency of prenatal visits (they can be far less frequent)
      Individual prenatal visits (see http://www.centeringpregnancy.com)
      Using surgeons (Obstetricians) instead of midwives for the care of most pregnant women
      Training nurses instead of non-nurses to be midwives
      I really could go on…

      I highly recommend the following related resources:

      The Thinking Woman’s Guide to a Better Birth, Henci Goer http://hencigoer.com/betterbirth/

      Pushed, by Jennifer Block

      and the Cochrane Collaboration website which is all about evidence-based healthcare (not just pregnancy-related) http://www.cochrane.org/

      I commend you for your soul searching and wish you the best in your pregnancy.

      Carrie Dickson, CNM (Certified Nurse-Midwife, USA)

    2. Rebecca says:

      I can think of a few others. Actually, most that I can think of are pregnancy related:
      There has never been a study that shows that constant routine fetal monitoring increases positive outcomes for babies or mothers. In fact, when the monitoring machines were first brought out, they were only supposed to be used on women who already had risk factors, not routinely.

      Episiotomies are another one, although they are finally falling out of favor in the medical community. For decades, it was thought that they should be routinely given to first time mothers. Within the past few years, ACOG (American College of OB/GYNs) releases statements that episiotomies should be done on a case by case basis rather than routinely.

      I think the idea that we need pain medication is also cultural. Sure, some people do, but upwards of 90%?

      Denying food and water to women in labor is cultural, not medical. The “medical” justification for it is in case a woman vomits under anesthesia she could aspirate the contents. In fact, it is a carry-over from the “twilight sleep” era, when women were drugged and left alone until the baby was nearly born. In today’s world, a woman is rarely under general anesthesia, and if she is, she has a anesthesiologist/nurse anesthetist right at her head who can turn her head if there is vomit. Plus the damage done by stomach acid alone can be more severe than damage done by food+stomach acid. Birth is hard work; would you deny a marathon runner gatorade during the race?

      The very idea that hospitals are the safest place to have all babies is cultural. If it was based in fact, the US would have the lowest infant mortality rates in the world. We don’t. We have the second highest rate in the world, according to a quick google search and CNN, behind only Latvia. That same article states that a babies in the US are 3x more likely to die in the first month as babies in Japan. In the Netherlands, homebirth is the norm, and they refer to hospitals if there is a need, not the other way around.

      Those are just a few I could think of. This whole idea of how culture influences medical norms is fascinating! Thank you for bringing it up, I look forward to other comments. This really got me thinking!

    3. Red Pomegranate says:

      There are SO many examples of this in the West in regards to pregnancy and birth! As a mother and labor and delivery nurse it’s sad to see the way culture has influenced the way we birth. If you look at Obstetric Myths vs Research Realities and watch an episode of “Baby Story” the disparities are glaring.

      Pregnancy is portrayed as an experience riddled with danger, birth is an emergency, these cultural myths are part of what has created a C-section rate THREE TIMES higher than what is indicated by the World Health Organization.

      From lying on our backs during labor, to the unquestioned use of epidurals, to the separation of mother and baby after birth, we have moved away from what is best practice to that which is culturally acceptable.

      One small thing, not that I wish to criticize, but the tradition you have described is lovely, it’s too bad you have no interest in following, who wouldn’t want to have their baby surrounded by blessings!

      Wishing you a very happy pregnancy and a beautiful healthy birth.

    4. Suzan says:

      One thing I can think of off-hand is all the myths about exercising during pregnancy in the US. Another thing would be the medicalization of labor and delivery- like the idea that home births and midwives are not as safe as giving birth with an OB in a hospital.

    5. Jill says:

      Isn’t this like many other superstitions/old wives’ tales? Like, if you’re carrying high or low, that’s a sign the baby will be a certain sex. Things like that.

    6. Jill says:

      Or going outside with wet hair will cause you to catch cold. Or cats stealing air from a baby’s mouth.

    7. Jess says:

      Hi Danielle,

      I read your post and found it really interesting. I once did a university course about Medical Anthropology, which is exactly what you are talking about here (culture and beliefs about health are intertwined). There are lots of examples, but a common one is the belief that being cold will give you a cold (similar to the wet hair theory). e.g….

      Also, I 100% agree with you that the benefits of the obi sound questionable at best… especially the bit about ‘keeping the baby small’, which to me, actually sounds like a dangerous thing to try to do!

    8. danielle says:

      Hey Jill!

      Those are all decent suggestions, but a bit different. They are all old-wives tales that we hear all the time in our culture, but they wouldn’t be something that a medical professional (at least not most medical professionals that I encountered in the states) would suggest or present as fact.

      Perhaps it is difficult to find them in our own culture because they don’t exist? I still have a hard time believing that, but it seems as though it might be the case.

      I find here that it is much more common for patients to simply follow along and do as the doctors/midwives recommend, without researching on their own (not questioning authority is a cultural mainstay). Many patients in the U.S. are not that way, often times they are more informed than their own doctors. So, if doctors in the states came into the office with some bat shit crazy psuedo-sciencey crap the patients would stomp all over them!

      I wonder….

    9. Christina says:


      I read an article about an epidemic of C-Sections in Brazil, doctors were (are?) telling most women vaginal birth was too dangerous for any number of reasons. But the motivation was actually a combination of convenience for the doctors and profit, since you can charge a lot more for surgery. But this was a recent development rather than a cultural thing

      I also keep getting google target ads about vertical birthing (for some reason) like it’s the hot new pregnancy fad (take that, water births!) but I remember reading some book a long time ago that the whole feet-in-stirrups horizontal table birth deal was invented by some pervy french king who liked to watch his courtesans give birth, and that the old fashioned birthing stools were better because gravity was on your side instead of a thing you had to fight to get the baby out. Alas, I have no sources to cite so I don’t know which parts if any of that is true

      I can’t imagine wrapping yourself so tightly it would stop the baby from growing; I bet most women don’t actually do it that tight. I bet that really isn’t even possible, the fabric has to stretch or something

    10. Stephanie says:

      Years ago, a friend’s brother lived in Japan for about 10+ years, (had married a Japanese woman and had a child there,) blogged about the birth and how different it was than in the US. While it isn’t exactly adding anything to your original question, I found that looking up alternative ways of giving birth (vertical, kneeling on your knees, etc.) very interesting. Since those options are hardly ever discussed or offered here in the west.

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