Tohoku J. Exp. Med., 2020 January, 250(1)

A Nationwide Survey of Obstetric Care Status on Japan's Islands, with Special Reference to Maternal Transport to the Mainland

SHIHO SUMIKAWA,¹ KAZUHIKO KOTANI,² TAKAO KOJO,² SHIGEKI MATSUBARA³ and SANAE HARUYAMA⁴

¹Department of Maternity Nursing, Jichi Medical University School of Nursing, Shimotsuke, Tochigi, Japan
²Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
³Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
⁴Department of Community Health Nursing, Jichi Medical University School of Nursing, Shimotsuke, Tochigi, Japan

Safe obstetric care is a worldwide requirement. In Japan, a reduced number of obstetricians has prompted the centralization of obstetric facilities, and Japan's islands are expected to experience problems in handling deliveries. Although many pregnant women “move” to the mainland at later gestational weeks, “transport” from the island to the mainland may be occasionally needed when disorders manifest before the “move.” Other women plan within-island deliveries; however, transport is required when complications arise. Managing delivery- or pregnancy-related problems may differ in transport by the population size of islands. We investigated the following issues in relation to the population size of Japan's islands: 1) How were deliveries handled on islands? 2) How many pregnant women were transported to the mainland? 3) What was the reason for and what affected transport? A total of 142 municipalities were selected to participate in a questionnaire survey, and 108 institutions from 106 municipalities responded. A comparative analysis by island size was performed using 2014 data: small-sized (population < 1,000), mid-sized (1,000 to 5,000), and large-sized (ge; 5,000). The percentage of women transported to the mainland from small-sized islands was significantly higher than that from large-sized islands (6.8 vs. 2.6% of all births in a year, respectively, P < 0.01). Transport was mainly in response to threatened preterm labor. Adverse weather was the most frequent factor affecting transport reliability. Our findings may contribute to a more detailed understanding of the state of obstetric care on Japan's islands.

Keywords —— obstetrics; preterm birth; remote islands; rural medicine; transport system

© 2020 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2020, 250, 25-29

Correspondence: Shiho Sumikawa, Department of Maternity Nursing, Jichi Medical University School of Nursing, 3311-159 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.

e-mail: sumikawa@jichi.ac.jp