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Close ties between obstetric clinics and maternity hospitals are supporting Japan’s top-level safety in childbirths, which has led to very low rates both of perinatal mortality and maternal death.

There is a need for obstetric clinics and maternity hospitals to share the burden between them, said Hideo Takemura, vice president of the Japan Association of Obstetricians & Gynecologists and director of Kosaka Women’s Hospital in Higashiosaka, Osaka Prefecture.

“Normal childbirths are to be done at regional clinics and hospitals, and childbirths with high risk are to be done at perinatal medical centers and other institutions where many obstetricians work,” he said.

Shortcomings in obstetric care have surfaced in the last several years as obstetricians have departed from a number of hospitals. The number of medical institutions handling childbirths in 2008 was down 53 percent from 1984. During that period, the number of births fell 27 percent.

Takemura said 56 percent of babies were born at hospitals in 1990, but the percentage was down to 51 in 2007. Meanwhile, 48 percent of babies were born at clinics, indicating their increasingly crucial role. In rural areas where it is difficult to maintain public hospitals, the number of childbirths at clinics is already higher than at hospitals.

In Europe and North America, many childbirths occur in large hospitals, but in Japan, regional clinics, of which two-thirds have just a single obstetrician, are playing a big role.

Takemura has carried out a survey about the regional gap in obstetric treatment and found that childbirths at clinics in Saga Prefecture accounted for 74 percent of the total, while those in Kagawa Prefecture comprised 27 percent.

The survey also found that the perinatal mortality per 1,000 births in 2007 was seven in Kochi Prefecture and three in Yamanashi Prefecture. The average annual deaths of pregnant women between 2003 and 2007 per 100,000 births ranged from zero to 11. The smaller the population is, the larger the gap in the death rate.

Takemura said that even if the rate of births at clinics was high, there were a number of prefectures where the death rates of mothers and babies were low.

“I cannot recognize the linkage between the birthrate at clinics and the perinatal mortality rate of pregnant women. To narrow the regional gap, it is necessary to create a perinatal care setup conforming to regions, including emergency services,” he said.

The Society to Protect Childbirths in Japan held a symposium in Tokyo in March to make an appeal for the need for closer ties between clinics and hospitals.

Takashi Watanabe, head of obstetrics and gynecology at Haga Red Cross Hospital in Tochigi Prefecture, said, “If obstetrics departments at hospitals operate as anticipated, regional perinatal care will go more smoothly.”

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