With an increasing number of women in Japan marrying late in life, more are seeking advice from local governments about the anxiety or depression they feel at suffering repeated miscarriages or stillbirths during pregnancies.
As consultations pour in from women grieving such losses, municipalities are promoting mental care programs, receiving the backing in March of the Ministry of Health, Labor and Welfare to enhance their support by creating a handbook compiled by a research team of experts for use by local governments and medical institutions.
The counseling office for infertility at Okayama University Hospital receives requests for advice from grief-stricken women. Some speak of being "unable to breathe" when suddenly reminded of their traumatic experience or having "nobody to talk to."
Mikiya Nakatsuka, a professor of reproductive medicine at the university who had been involved with infertility treatments, keenly felt the need for the care of such women and started work on it. In 2004, the Okayama prefectural government established a mental support office.
The office is staffed with birthing assistants, clinical psychotherapists and other mental care providers who counsel people in need directly or by phone.
An endless number of counseling requests come in from people inside the prefecture, as well as those outside and overseas.
The average age of mothers in Japan giving birth to a first child was 30.9 in 2021, up from 26.4 in 1980.
Risks of miscarriage increase with age. According to the Japan Society of Obstetrics and Gynecology, in 2019, the proportion of miscarriages was 14 to 17 percent for women aged 26-30, 21 percent at 35, 33 percent at 40, and 60 percent at 45, respectively.
"Women suffering due to experiences with miscarriage or stillbirth are increasing because of a rise in the average age of childbirth," Nakatsuka said.
There are various causes of infertility accompanied by repeated miscarriages or stillbirths, such as the shape of the uterus, chromosomal abnormalities in one of the parents or internal illness.
But in many cases, women who have repeated miscarriages or stillbirths blame themselves after being told, for example, that it happened because they let their body temperature drop. Other insensitive remarks by family members or others might include asking why they did not visit a hospital sooner or blaming the woman for working too hard.
The woman's grief is often compounded by further comments urging her to forget what happened and get back to her daily routine, or flippant remarks such as "It happens." Such grieving women might be pressed by their husbands not to see the deceased fetus or infant.
The health ministry instructed local governments in May 2021 to provide "grief care" for such women as part of its support for infertility treatment.
If a baby dies after a women's 22-week pregnancy bump, artificial labor is induced for delivery, causing a great deal of physical and mental anguish for the mother, experts say.
The handbook prepared by the health ministry urges birthing assistants and other staff members to listen carefully to the mother and her family before delivery about how they wish to say their goodbyes, such as dressing the fetus in "ceremonial" baby wear.
"Mothers are quite upset and some regret not taking their babies' photos or getting their footprints," said Midori Takao, a birthing assistant in the counseling office at Okayama University Hospital.
For this reason, there are cases when the hospital will take photos of the dead fetus and save them for a fixed period, even if the mother had not made such a request at the time of delivery.
The Oita prefectural government has also set up a counseling center for infertility in the city of Oita, where birthing assistants and other staff members support mothers. The center received consultation requests regarding miscarriages or stillbirths from 27 people in 2020 and 46 in 2021.
A feature of Oita Prefecture is its community-based approach and efforts to provide care through public health nurses who have frequent opportunities to come into contact with pregnant mothers.
In fiscal 2020, the prefectural government added support for women saddened by miscarriages or stillbirths to its training program for public health nurses. In fiscal 2022, it is focusing on specific care methods.
"There are women who talk to public health nurses about their experience of miscarriage. We will improve their skills so that such women are encouraged to visit professional advisory centers," said a prefectural government official.