title: Facilitators and barriers in the humanization of childbirth practice in Japan.
abstract: BACKGROUND
  Humanizing birth means considering women's values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been identified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres.
  
  
  METHODS
  A qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed.
  
  
  RESULTS
  All the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were women's own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions.
  
  
  CONCLUSIONS
  The Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and beliefs of Japanese women regarding natural birth is an important factor promoting the humanization of childbirth in Japan.
authors.affiliation: Université de Montréal, Faculty of Medicine, Department of Social and Preventive Medicine, Montreal, Canada. roxana.behruzi@umontreal.ca
authors.forename: Roxana
authors.initials: R
authors.lastname: Behruzi
authors.forename: Marie
authors.initials: M
authors.lastname: Hatem
authors.forename: William
authors.initials: W
authors.lastname: Fraser
authors.forename: Lise
authors.initials: L
authors.lastname: Goulet
authors.forename: Masako
authors.initials: M
authors.lastname: Ii
authors.forename: Chizuru
authors.initials: C
authors.lastname: Misago
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel / Q000208:ethnology; D016550:Birthing Centers / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000451:nursing / Q000523:psychology* / Q000639:trends; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006808:Humanism; D006801:Humans; D007564:Japan; D008875:Middle Aged; D009721:Nurse Midwives / Q000458:organization & administration / Q000523:psychology; D036801:Parturition / Q000208:ethnology*; D010344:Patient Advocacy / Q000193:education / Q000523:psychology* / Q000639:trends; D017060:Patient Satisfaction / Q000208:ethnology; D018802:Patient-Centered Care / Q000458:organization & administration*; D011209:Power, Psychological; D011247:Pregnancy; D036301:Qualitative Research; D011795:Surveys and Questionnaires