Tetsuya Yoshioka’s scientific contributions

Cultural views are purported to be critical barriers to the use of epidural anesthesia during childbirth in Japan, even though it is not routinely available. We sought to understand the importance of the asserted cultural barriers for Japanese women living in Michigan in the United States where access to epidural anesthesia is routine. We used a mixed-methods approach including self-administered, cross-sectional mail surveys and semi-structured qualitative interviews. Participants were Japanese women who received prenatal care at the University of Michigan Japanese Family Health Program. Of 78 participants in the mail survey, 63% used epidural anesthesia. Positive influences to have epidural anesthesia came from friends (58%), husbands (42%), and knowledge of the epidural anesthesia experiences of others (50%). Seventeen respondents participated in qualitative interviews. Most had learned little about epidural anesthesia while living in Japan, and some respondents had heard unsettling rumors. Many mentioned obtaining their first detailed knowledge about epidural anesthesia from friends in the United States, and expressed fear or concerns about the side effects of anesthesia. Thirteen out of fourteen interviewed participants who used or wanted epidural anesthesia expressed a desire to use it for the next childbirth. While Japanese women in this United States setting considered previously reported cultural barriers to epidural anesthesia for birth pain, many chose to have it during their labor. This finding implicates limited access as a barrier at least as important as cultural barriers to epidural anesthesia use in Japan.

The authors developed advance consent in Japanese for epidural anesthesia for pregnant Japanese-speaking women. Their explanatory, sequential mixed methods design involved a survey (QUAN) and telephone interviews with Japanese women (QUAL). An e-mail survey of health professionals (quan/ qual) was conducted concurrently to the QUAL arm. Japanese women and health professionals found advance consent as helpful, though minor problems were identified. Advance consent helped lower communication barriers, and the women wanted more information about pain control. This mixed methods study of Japanese women suggests that bilingual advance consent offers an innovative tool to help overcome the language barrier for non-English-proficient women who predictably needed interventions (e.g., epidurals) under unpredictable circumstances.