JAPAN'S BUREAUCRATIC INTRANSIGENCE:
THE CASE OF THE UMBILICAL CORD
(originally sent to Fukuzawa, ISSHO, and Friends Mon, 10 Jul 1995)
My wife (a Japanese) and I will be having our second child (a girl) within the next two or three weeks. We are delivering at the same hospital as before, an above-average place which:
1) doesn't believe in "planned birth" (keikaku shussan, where you decide the date the doc will inject labor-inducing drugs so daddy doesn't have to miss any days of work),
2) allows daddy to be present at the delivery (tachi ai shussan), and
3) has docs who don't mind questions from patients. The previous birth was a very difficult one for my wife (the nurses had to push down on her stomach to force the baby out), so we're hoping this time for something a little less harrowing.
The issue is this:
Should I be allowed to cut the baby's umbilical cord?
When I first brought this up with our doctor two years ago for our first child, his position was basically, "If I'm the one presiding and there are no complications, then okay, you can cut the cord". However, the birth was difficult and a different doc was on duty, so before I knew it, the midwife had severed the cord and couldn't be bothered to tell me why.
When the different doc explained what and where he had cut my wife during the delivery, I made sure to ask him was happened to my request to cut the cord. He said he hadn't heard of anything about it, and called the head nurse over.
The head nurse then offhandedly explained (to the doc, not to me) that my being allowed to handle scissors there was not standard practice and that conditions warranted caution and that this is Japan and--
I cut her off there and, in front of the whole nursing staff, gave their middle-aged head nurse a furious dressing-down for 1) not even bothering to tell the doc about my request, 2) not even bothering to tell me at any stage why they voided my request (I had to come asking, not the other way around), and 3) the subsequent violations of "informed consent" (The doc was kind enough to explain what happened so why couldn't she?) and "cultural callousness" ("If Japan is indeed trying to become an 'international society' as all your slogans claim, you should take into account more the feelings of extranationals like me who did ask nicely and did get a doctor's approval. Not just follow your rules simply because they are rules. The doctor's approval overrides your rules.").
Her face turned an odd cheesy color, and she left me alone with the doctor after a token apology.
I did get an explanation about conditions (there was a danger of complications) from a lower midwife minutes later, which was fine. If I had had that explanation at the scene, I would have gone along and not gotten so livid afterwards. But the fact was that I felt that my feelings were not at all taken into account, and without roaring at somebody they wouldn't have been.
Now, this time around with our second child, I wanted to make sure nothing went wrong. I made the same request again given, of course, that medical conditions permitted.
Our doc, who gave a flippant yes before, gave a qualified one now--it felt like a token one with a built-in escape clause: ("I'll discuss this with the other docs and the staff and we'll see," which to me means he's setting me up for a "sorry, nobody agrees so I can't do it" line. My wife disagrees with that interpretation, but she can't rule out its plausibility.).
But anyway, right after this doctor consultation, the local midwives started giving me the basic "this is Japan and we don't do that kind of thing here so shut up" line yet again. But I was not going to be stonewalled.
I started by debunking the boilerplate "When in Rome..." (go ni ireba go ni shitagae) argument I get all the time in this country ("That type of thinking ignores my standpoint (tachiba) and doesn't take into account my feelings at all, which should not happen in this "thoughtful society" (omoi yari no shakai)), then launched into matters of medical feasibility ("Hey, cutting the cord can be done in other societies, so why not in Japan? Are you saying Japanese bodies are different--that your intestines are longer or something?"), parents' rights ("This is our child, not yours, and as long as I have my wife's approval and I am neither endangering her life or the child's, we should have some say in how the delivery is done."), customer service ("We pay your salaries so you should treat us more like okyaku-san and honor some of our requests, not just give us a flat 'no' as though we were children."), and blind adherence to rules ("It's thinking like this which held up those Swiss St Bernards at Narita quarantine, when they could have been sniffing out Kobe earthquake victims--so you should think more about whether those rules should be so inflexibly followed (junpou suru).").
Believe it or not, I did get all of this out (I talk really fast when I'm angry), and it drew a crowd of perplexed midwives. In the end, I did get an argument from them that did make sense:
Under Japanese law, the hospital is not allowed to permit an untrained person to perform any kind of medical operation (iryou koui). Cutting the cord qualifies as such, and it puts the mother at risk of infection. If something bad should happen and people found out, the authorities would take away the doctor's licence.
I still told them to think it over. I reiterated that I would submit to the doctor's final decision, since he is after all the doctor, and do as he instructs whether or not he grants permission. But I was not going to take a curt "we don't do that here so there" as an answer. They said fine, and that was that for the day.
Why am I being such a stickler about this? To me, being allowed to sever the tie between mother and child has deep symbolic value. Any midwife can make my child autonomous, but I want to have that honor if I can. I could in my own society, and in most European societies, I am told by my European friends. My argument is more emotional than rational, granted, but I still think I have a case worth making.
What do Fukuzawans think? Do I have any rights here, or, this being Japan and all, should I have done as I was told?
The survey results were that Fukuzawans were overwhelmingly in favor of my standing up for my rights--although some expressed reservations about wanting even to be present at the birth, and others noted that many overseas hospitals might have given me the same run-around.
Our second daughter, Anna, was born without complications on July 30, 1995. Despite a different doctor being on duty, I was allowed to cut the cord. To be honest, I felt a personal victory had been won, and to this day am very proud of how much noise I made over my second child. Fatherhood can do that to you.
To see the lessons of this tale as I interpreted them, click here to see a jpeg of a newspaper article I had published in the Asahi Evening News on the subject nearly a year later. I make it into an issue of Japan's bureaucratic intransigence in miniature.
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