Originally published on metropolis.co.jp on June 2010

Illustration by Rob Bracey

At a prenatal clinic in California, Allison Evans saw a poster on a toilet stall that taunted: “Do you know that birth doesn’t have to be painful?” Sign me up, she thought, and soon found herself enrolled in a HypnoBirthing workshop.

“At the time, I didn’t know if it would work for me, but I was able to stay comfortable and calm,” she says. “Actually, because I wasn’t making much noise, the nurse didn’t think I was really in labor.”

Created by award-winning American hypnotherapist Marie Mongan in the late ’80s, HypnoBirthing has been picking up some significant media attention in the US in the last five years. The idea behind the technique is that a relaxed mother is better positioned to have a natural, less painful birth. Statistics seem to support the claim: women who use HypnoBirthing techniques have a lower rate of C-sections.

“It can work with a homebirth or at a hospital, and it doesn’t rule out intervention if necessary,” Evans (below right) says. “Basically, it teaches you to replace fear with confidence. The medical model of birth actively manages pain, whereas the HypnoBirthing model actively manages fear, helping the body relax so that it can do what it naturally wants to do.”

Evans was certified as a HypnoBirthing instructor in 2006, and since relocating to Yokota Air Base last winter has become the only English-speaking teacher in the Tokyo area. Over five two-and-a-half hour sessions, she leads women and their birthing companions through a series of steps that begin with breathing and visualization techniques to encourage relaxation, and build up to learning self-hypnosis methods to numb parts of the body.

“The idea is to short-circuit the body’s stress response and encourage the release of endorphins,” she says. Daily practice, accompanied with use of a relaxation CD, is key to making the technique work.

Kimiko Marshall used the Natal Hypnotherapy CD created by UK hypnotherapist Maggie Howell during her second pregnancy. “I had a doula and used gas and air in the UK to help with the birth of my first son, so I was pretty scared of giving birth to my second son in Japan without these options,” she says. “The CDs were fantastic at helping me to sleep when I felt stressed or uncomfortable at night,” she continues, reporting that her labor was “so quick and smooth because I was really relaxed and happy.”

Courtesy of Allison Evans

Such a story seems at odds with the generally unpleasant impression that foreign women have about giving birth in Japan. Brett Iimura, an 18-year Japan veteran who runs the Childbirth Education Center in Tokyo, has made it her mission to help mothers and couples enjoy the smoothest birthing experiences possible. Through workshops and private consultations, she offers information compiled from on- and off-the-record conversations with doctors and midwives, regular visits to facilities, and feedback from her clients. And her clients are numerous: since 1997, she’s counseled over 1,600 women from 70 countries.

Foreign women in Japan have more resources and options now than they did when Iimura was first grappling for information during her own pregnancy, but that doesn’t necessarily make the choices any easier.

“Women used to come to me as blank slates, with no idea about giving birth in Japan,” says the native New Yorker. “Now people are more aware, but they want to know what is true and what isn’t.” Moreover, with the foreign community constantly in flux, information tends to be colored by whoever is around—something that Iimura’s nearly two decades of experience can overcome.

While the days of fathers being barred from the delivery room are (nearly) over, Iimura notes that some facilities, like midwife-run birthing centers, tend to be more flexible then others. She also urges women to think about their options as early as possible, as maternity wards tend to fill up fast.

“Know the kind of environment that you’re looking for, the medical or midwifery model of care—these choices will impact your actual birth. Giving birth in a foreign country means you have to think about it more.”

And, she concedes, that isn’t necessarily a bad thing.

Contact Allison Evans through www.wisdomchildbirth.com and Brett Iimura through www.birthinjapan.com. The Tokyo Pregnancy Group also offers an abundance of information at http://tokyopregnancygroup.blogspot.com.