In Japan’s Rural Areas, Remote Obstetrics Fills the Gap

Since losing its last obstetrician five years ago, this city of nearly 32,000 in rural northern Japan has been desperately seeking a replacement. So desperately, in fact, that it recently promised a horse to any obstetrician willing to come here.

When a patient in Tono goes into labor, she has to go to Kamaishi.

There have been no takers yet. In the meantime, the city has adopted a high-tech measure that may portend the future of child delivery in Japan: pregnant women are examined remotely by obstetricians using real-time data transmitted to the doctors’ cellphones. When the doctors judge that a patient is about to go into labor, the woman heads to the nearest city with a maternity ward — usually Kamaishi, a 40-minute drive east of here, reached by a winding, mountainous, two-lane road that can be treacherous in the winter.

Japan, with a rapidly aging population and a declining birth rate, is grappling with a severe shortage of working obstetricians and places for them to work. With a death of babies, hundreds of hospitals and clinics in Japan have shuttered their maternity wards since the beginning of the decade, turning their attention to potentially more lucrative elderly care.

Since 2000, the number of obstetricians in Japan has declined by more than 5 percent to 11,282 in 2004, the most recent year for which figures are available, according to the government. But that figure masks the severity of the shortage, experts say. The number of doctors actually delivering babies was fewer than 8,000 in 2005, according to an estimate by the Japan Society of Obstetrics and Gynecology.

Roughly half of all obstetricians are 50 or older, and overworked; many have given up delivering babies and are focusing only on gynecology. At the same time, the number of medical students choosing obstetrics as their specialty has plummeted since 2004. Turned off by long hours, average pay and a rising risk of malpractice lawsuits in obstetrics, young doctors are gravitating instead toward specialties like dermatology and ophthalmology.

“Young doctors nowadays won’t work just out of a sense of vocation,” said Dr. Kiyoo Tanabe, director of the Japan Association of Obstetricians and Gynecologists. “You have to give them quality of life, a good income and their private time.”

What is more, women make up a majority of obstetricians in their 20s and early 30s. Many retire when they themselves have children, Dr. Tanabe said, because the medical field remains unfriendly to working mothers.

The crisis, he said, “began in rural Japan and reached the major cities in the last year.”

Even in Tokyo, maternity wards are being closed or consolidated, creating a sense of anxiety among pregnant women who are warned to make an appointment for delivery as soon as they learn their due date.

“I was told that places where you can give birth are limited and that everybody is flocking to them,” said Eri Miyasato, 35, who is eight months pregnant and lives in a suburb of Tokyo. “You have to make an appointment for the delivery, and a lot of people are having trouble finding a place.”

Things have changed since the birth of her first child two and a half years ago. “Back then,” she said, “it was all right.”

But the hinterland has been hardest hit as maternity wards have closed one after another. The shortage is so severe that those obstetricians who still practice have few days off. In emergencies, women have been transported by helicopter to maternity wards with available beds. And some women who live far from a maternity ward, as their due dates approach, move to hotels near the hospitals where they are scheduled to give birth.

Tono, once a prosperous trading post known for its horse breeding, is an agricultural municipality that sprawls across a valley and is mostly forestland. As is the case in much of rural Japan, one-third of its residents are over 65.

Each year, 210 to 230 women have children here, said Eisai Kikuchi, a city health official. Since the prefectural hospital here closed its maternity ward in 2002, pregnant women have had no choice but to make the long drive to Kamaishi, or another city with a maternity ward, to give birth.

For Yukie Kikuchi, 38, the city’s sole practicing midwife, that has created worries. A year ago, during a snowstorm, one of Ms. Kikuchi’s patients wondered whether she was going into labor and asked the midwife whether she should go to Morioka, a city more than an hour away.