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Japanese Culture and Breastfeeding

Cynthia D. Payne, IBCLC
Williamstown MA USA
Report from the 2003 LLLI Conference
From: NEW BEGINNINGS, Vol. 20 No. 5, September-October 2003, pp. 181

One of the best panels I attended at the Conference was "Birth and Breastfeeding in Mothers of Japanese Heritage," given by Hiroko Hongo, MSW, IBCLC and Kazue Nakamura MD, IBCLC, two Japanese women who have lived in the United States and are very aware of the cultural differences between the two countries.

The session began with a brief history of breastfeeding in Japan. Historically, Japanese mothers gave birth in their own homes with midwives, and co-sleeping was the norm. After World War II, the Occupation Forces brought Western medicine to Japan and forced Japanese women to give birth in hospitals, where they kept the newborns in the hospital nursery and gave them formula. Breastfeeding became rare. Midwives moved into the hospitals.

In current-day Japan, women typically stay in the hospital up to a week after the birth. When the mothers are discharged, they go to their own parents' homes to recuperate. There, the new grandmother helps care for the baby, but now most grandmothers have no breastfeeding experience and can't help the new mother.

In 1974, Japan began promoting breastfeeding again. In 1991, Japan had the first Baby-Friendly hospital in any developed country, and there are now 25 Baby-Friendly Hospitals in Japan and 40 board certified lactation consultants (IBCLCs).

The traditional Japanese method of breast massage has been reintroduced, but has become medicalized. It is believed that mothers need breast massage to produce adequate milk. Some of the new massage techniques are painful and the mothers also have to pay for the breast massage. The official opinion of LLL of Japan is that breast massage is neither discouraged nor recommended.

One of the most fascinating parts of the sessions was on counseling the Japanese mother. The speakers pointed out that Japanese people are uncomfortable with personal questions. Japanese people avoid discussing their honest feelings in order to keep harmony in the society. Even asking "How do you feel?" may make a mother feel awkward and pressured. When information is given to the mother she may nod and say "Yes," but that doesn't mean she agrees. It just means she's listening and acknowledging that she heard. When a Japanese person smiles, it doesn't necessarily mean she's pleased. It may just be a "smile of self control." They also avoid direct eye contact because this is considered staring and is rude.

The speakers recommended that when a breastfeeding counselor works with Japanese mothers, the counselor should be careful to ask how the mother prefers to be called (first name or Mrs.). Be respectful of the mother. Many Japanese mothers are uncomfortable with being touched, especially hugging. Use concrete breastfeeding suggestions and give simple written instructions (depending on the mother's facility with English). Many Japanese people are very respectful of authority, so a breastfeeding counselor should provide additional reassurance and information from authorities such as the AAP, the World Health Organization, and books written by breastfeeding experts with titles and degrees.

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