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A personal experience and her work helping establish the Tokyo Mothers Group and Tokyo Pregnancy Group communities saw Briton Stephanie Kawai, 44, follow her instincts to become a doula. A mother of three boys and permanent resident of Japan, her doula career is part of her mission to contribute to support networks for families and the international community in Japan.

1. What does a doula do? A doula is someone who provides pregnancy, birth and postpartum support to a woman and her partner, providing information, advice, support and reassurance.

2. What kind of support do doulas offer partners? We are an extra shoulder for them to lean on and give advice or suggestions on how they can better support their partner.

3. Are there any differences to being a doula in Japan? Being a doula in Japan adds a cultural dimension, because while labor and birth are the same the world over, from a physiological point of view, cultural differences with what to expect might be surprising to some.

4. What inspired you to become a doula? I was completely unprepared for my first labor. It was by far the hardest thing I’ve ever done in my life, both physically and mentally. After, I started the Tokyo Mothers Group and met a doula. She told me what she did and I thought, “Gosh, if I had known of you, when I was pregnant with my first son, I would have hired you in a heartbeat!”

In between having my second and third sons, rather than return to my previous job I decided to follow what was clearly a passion to continue doula work. Having run Tokyo Mothers Group, I knew there was a need.

5. Who are your patients? I work almost exclusively with international couples in Japan. Occasionally, there may be one Japanese spouse. I’ve also had Japanese couples who’ve lived overseas looking for support.

6. How do you stay up to date with practices? I try to attend online conferences. I’m now taking a course that will give me additional skills to become a birth and bereavement doula to support those going through a miscarriage, stillbirth or other infant loss.

7. What traits should a doula have? I’d say flexibility and adaptability — unexpected things can happen. Being calm is important.

8. How would you describe your own style? It really depends on each client, but I’m empathetic, and forming relationships is a big part of it for me. Building familiarity and trust as we work together can have a big impact on how labor goes.

9. What about birth work most interests you? I love teaching how to breathe for birth. Breathing makes all the difference in labor, mentally and physically, so making sure my clients are prepared with breathing techniques is one of my favorite things.

10. What kinds of birth experiences have you supported? Oh, such a variety. Many different types of hospital births at well over 30 types of hospitals and clinics of all sizes in Tokyo and the surrounding area, as well as in Hokkaido and western Japan.

During the pandemic, doula Stephanie Kawai has had to sometimes support her clients virtually as part of hospital antivirus measures. She says, while not ideal, virtual support is still helpful. | COURTESY OF STEPHANIE KAWAI
During the pandemic, doula Stephanie Kawai has had to sometimes support her clients virtually as part of hospital antivirus measures. She says, while not ideal, virtual support is still helpful. | COURTESY OF STEPHANIE KAWAI

11. Always at a hospital? No, I’ve had the great privilege to attend home births; they’ve been some of my favorite experiences. These births are generally supported by a Japanese midwife. I’ve also been to midwife-run facilities, often referred to as josan’in (birth houses) in Japan.

12. Is there much of a difference? Having either a home birth or one at a midwife facility is extremely free in a way that you can’t quite get in the hospitals. It’s more like they follow the woman, rather than the woman having to follow hospital policies.

13. Has anything changed since the pandemic? Yes, it has had a big impact on childbirth in Japan. Many hospitals have restricted birth support that was previously allowed. Sometimes, even the father isn’t allowed to attend a birth or visit afterward. Fortunately, some places still allow me to support the woman in person. For other places, my support has become virtual. Depending on what your birth preferences are, knowing the rules ahead of time is important.

14. Is virtual support effective? Yes, I’ve found that supporting someone virtually through labor, even if it’s not ideal, still works well.

15. What is your approach to working with doctors and midwives through labor? The doctors themselves aren’t there much until the pushing or unless there’s a complication, so it’s usually the midwives who are present for the typical labor, and they come and go from time to time to check on the woman. If I’m there in person or online, we really focus on our particular roles. I’m not there to replace the doctors or midwives, but to provide additional support that they may not have the time or linguistic skills to do.

16. What are their reactions like? It has actually been very positive. But, like anything, it’s about cultivating relationships. That’s really important in Japan in general. They generally come away feeling it’s a good thing that their patients have someone like me to lean on for advice, help with breathing and emotional support, and talk things through in their native language or a language they’re comfortable with.

17. How do you help your clients navigate informed consent and medical care? I help them understand and know how to navigate their options if something happens outside their birth plan. I provide them with the appropriate questions to ask and inform them of alternatives.

18. Are you an advocate then? Yes. As a doula, I’m there to support my clients and work independently for them, not their caregivers, but I don’t speak directly on their behalf. If something happens in labor that is not in line with their hoped-for preferences, I give my clients questions to ask, or ask if there are alternatives to a course of action that can help facilitate their initial wishes.

19. How connected are you to the Japanese birthing community? There isn’t a huge community of birth workers, but some Japanese women provide support. I’d say that postpartum support is a bigger focus for most of them. I do have a partner doula, a lovely French woman named Celia, and I am in a few Facebook groups for Japanese doulas and keep in touch with a few Japanese midwives.

20. Finally, what can expectant parents get from a doula? For those who are overseas and not in their home countries, a doula can help you navigate some of the cultural differences around pregnancy and birth. Taking the fear out of what the body is going through in labor is vital because there is nothing wrong with the way the body is working. We’ve been going through birth forever, like any mammal. It’s how we view giving birth that’s important, and can shape things, and it’s an incredible experience.

For more information, visit tokyodoulasupport.wordpress.com.

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