The Meaning of the Woman–midwife Relationship in Japan: A Hermeneutic Phenomenological Study
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Maternal and neonatal mortality rates in Japan are consistently among the lowest in the world. Nevertheless, many Japanese women suffer from anxiety and depression, and commit suicide during pregnancy and postpartum periods. This indicates that, in the pursuit of saving women’s and babies’ lives, Japan’s advanced medical system may have overlooked the importance of women’s overall birth experience that includes psychological well-being. Midwives are considered key care providers of maternity care, and the relationship between women and midwives has potential to improve women’s birth experience. However, the significance of such relationship has received far less attention in Japan. With the aim of improving Japanese maternity care and women’s birth experience, the study examines the values of the relationship by asking, ‘What is the meaning of the woman–midwife relationship in Japan?’ To address this question, hermeneutic phenomenology inspired by Max van Manen and philosophy based on the Japanese worldview provide the methodological foundation of the study. This methodological approach enables a more nuanced interpretation of women’s and midwives’ lived experiences. Individual interviews were conducted with 14 women and 10 midwives across Japan. The hermeneutic phenomenological analysis revealed four themes; 1) Connection, 2) Presence, 3) Having a voice, and 4) Peace of mind and trust. The women and midwives of the study in the dominant maternity care context, described it as an assembly line care, often struggled to make a connection with one another, leaving women feeling helpless and alienated. However, some women and midwives, especially in a long-term relationship, described that by sharing time, experience, and understanding, they were able to feel present to each other. Such a relationship enabled the women to have a voice, and the mutual understanding established between the women and their midwives allowed the midwives to advocate for the women for whom they cared. Furthermore, the positive relationship always embraced the women and midwives with a feeling of safety (anshin) and trust (shinrai), which were described as key emotions contributing to women’s positive birth experience. The study found the significance of the woman–midwife relationship is that it provides psychological safety for both women and midwives in maternity care. Women requires both clinical and psychological safety to have a positive birth experience, as the experience affects their lives afterward. Further, a positive relationship with a midwife instils confidence in women as mothers. Conversely, it is difficult to ensure woman-centred and respectful care without developing the relationship because the woman–midwife relationship is the foundation of midwifery care. Having a positive relationship should be considered a basic human right for all the women in maternity care. Nevertheless, the current maternity care system in Japan limits many women and midwives from developing a relationship. The study recommends midwifery continuity of care in Japan to ensure opportunities to better develop the woman–midwife relationship. The shift from the current maternity care to the relationship-based care requires radical changes, but it is vital to improve women’s birth experience and foster improved long- term social and psychological outcomes for women in Japan.