In Japan, New Pains Suffered at Childbirth

"The lack of obstetricians is one of our gravest problems," said Yoshiko Saito, deputy director of the Health Ministry's Maternity and Child Division. "If we cannot reverse this trend, we will be looking at a collapse in our ability to provide basic care for the pregnant women of Japan."

Local officials have tried virtually everything to boost the birthrate -- including cash payouts to couples who have children. But the difficulties remain.

On Hokkaido and Shikoku, two of Japan's four main islands, the shortage of obstetricians is so severe that some births are now being induced to coincide with times when doctors are available. Although the problem is worse in rural areas, even dense urban zones such as Kanagawa prefecture, home to Japan's second largest city, Yokohama, are feeling the shortage. As dozens of maternity wards have closed, health officials estimate that at least 1,000 pregnant women there are now being forced to make the 60- to 90-minute journey to Tokyo area hospitals for delivery.

Doctors' groups are blaming both the national and the local governments, saying they have not aggressively addressed the key factors behind the shortage. With Japanese women remaining single longer and having children later, incidences of risky deliveries have sharply multiplied -- leading to a big rise in malpractice suits. In Japan, the same obstetrician who attends a woman during her pregnancy is also almost always called in to deliver her child -- meaning relatively longer hours both on duty and on call. But Japan's national medical system does not offer obstetricians commensurately higher pay for their extra hours.

Additionally, obstetrician groups say, hospitals are increasing spending on geriatric care even in regions where the need to boost maternity services is great.

"This is terribly short-sighted," said Ryoichiro Miyazaki, secretary general of the Japan Association of Obstetricians and Gynecologists. "You see a focus on spending for the elderly at the expense of obstetrics. But if you don't provide women with maternity care, you discourage them from having children at all. And if they don't have children, there won't be a future generation of Japanese to grow older. It's a vicious circle."

Alarmed, the government has taken a series of steps this year aimed at addressing the crisis -- including the creation of government arbitrators to review malpractice suits filed against obstetricians. But change is unlikely to come quickly enough to help the women of Oki Island.

Two weeks ago, the 58 expectant mothers on the island community were called together for a meeting at the local hospital. There, they were informed by authorities that the island's only obstetrician was being reassigned to a larger hospital with greater need on Honshu, Japan's main island. Although local officials staged a nationwide search for a replacement, the one willing candidate canceled at the last minute because his elderly parents fell ill.

Yamauchi and the other women are being asked to spend their ninth month of pregnancy off the island, near the hospital where they will now give birth. They are being offered about $1,500 for temporary housing and transportation costs for both themselves and family members. But the Yamauchis, like many of the other young couples with babies on the way, find themselves in a terrible bind.

Unable to take vacation time, Yamauchi's husband is deeply troubled about his very pregnant wife leaving his side. "I won't be there," he said, dejectedly shaking his head. "What if something happens? I won't be there."

The couple hopes Yamauchi's mother can accompany her. But Yamauchi may be away for a month or more, and her mother -- a caregiver to the family's grandparents -- will be unable to stay with her the whole time.

"I am going to give birth soon and I still don't know where and who I will be with," she said. "This is supposed to be a happy time. It is just not fair."

Special correspondent Akiko Yamamoto contributed to this report.