still practicing, advocate for physiological births and discourage unnecessary interventions. if complications arise that demand cesareans, then cesareans are performed. however, cesarean birth has a negative image in japan, and is often perceived as suggestive that a woman was incompetent or deficient. the rate of c-sections in japan in 2005 was, according to one estimate, 17.4%. other reports suggest the rate is as low as 10% in some locations; nevertheless, rates between 10% and 20% reported throughout japan are significantly lower than north america. of women attempting vaginal birth at a maternity home, about 10.2% are eventually transferred for complications to large hospitals with neonatal intensive care units. use of technology and other interventions use of a continuous fetal monitor is the norm in hospitals and physician-run clinics, but precisely when this is typically applied is hard to discern from existing literature. episiotomies were in 1995 still common in japan: in the hospital the rate for primiparas was 88% and 41% for multiparas. (matsuoka & hinokuma 2009) maternity homes tend to use far less technology and interventions. for example, the rate of episiotomies in maternity homes for primiparas was 5% and for multiparas it was 1%. postpartum time and place most women stay in the hospital for 4 to 7 days after vaginal delivery, and about 10 days after cesarean. this period is a time for ansei, or peace and quiet with pampering. rest is considered very important; it is thought that the long recuperation after childbirth helps explain why japanese women have less uterine disease and need fewer hysterectomies in middle age than american women. some japanese hospitals do not provide rooming in as it interferes with rest, while others do. traditionally, japanese women were expected to stay inside with their babies for the first 100 days after birth, but this is not expected in contemporary japan. different behaviors for primiparous vs. multiparous women while all japanese women are encouraged to rest after birth, primiparous women need only focus on one child whereas multiparous women face additional childcare obligations. therefore, while primiparous japanese women traditionally return to their mother's home for about one month after leaving the hospital to be cared for and receive help with the care of the baby, it is more likely that female family members of a new mother will go to her house to help out if there are additional children to watch. postpartum depression one study of japanese women done in 2005 found that the prevalence of maternity blues and postpartum depression was much less for women who gave birth in maternity homes than for those who delivered in hospitals. the authors attributed this difference to the idea that bodily damage and pain are experienced far less in japanese maternity homes than hospitals. a study by ikeda and kamibeppu found that 20.4% of japanese women have postpartum depression. newborn vaccinations like most newborns in western hospitals, infants are given a series of vaccines and screening procedures, and can be seen as rites of passage. in contemporary japan, the baby is given a hepatitis b vaccine, and is screened for a variety of diseases, including phynylketonuria, and hypothyroid disease. this process is voluntary but there is about 99% compliance. besides frequent health and developmental checks in clinics during the first year, special development checks are required by law for all children at 18 months of age, and again at age 3. caregiver the mother is the primary caregiver in japan. while fathers occasionally help with the baby, their main responsibility is to support their family. it is a traditional japanese belief that contact and interaction between mother and newborn, or "skinship", during the first three years is one of the most important periods of the child's life. it builds the relationship between mother and child. also, because childcare options are limited, working women often rely on their parents for assistance. in fact, 67.2% of working women with children under 1 turn to grandparents for childcare. while attitudes are changing, a survey in the early 1990s showed that 55.6% of women and 65.7% of men agreed that child care and other housework fall entirely in the woman's domain. umbilical cord japanese hospitals typically place part of the umbilical cord that falls off in a traditional box specifically designed for this purpose. when the mother leaves the hospital, the umbilical cord is given to her. this japanese custom is based upon the belief that the umbilical cord has a direct relationship to the health of the baby. maltreating it, therefore, risks causing harm or disease in the child. in some japanese households, a mother may show a child the umbilical cord on certain events like birthdays to recall the day the child was born. in other households, the umbilical cord is given to a child on the day he or she leaves home or marries symbolize separation. also, a preserved umbilical cord is considered to be a cure for the child when he or she is sick. parents would cut a small portion of the cord and feed it to the child. additionally, the japanese believe that the umbilical cord is a symbol of the child's fate. so if one loses his or her umbilical cord, his/her spiritual fate is considered lost as well. bathing bathing the baby is the traditional role of the father, providing a means of "skinship". food and drink japanese women strongly believe in natural childbirth (yeo et al. 2000). this includes eating natural and organic home-cooked meals. as a result, many pregnant women do not take prenatal vitamins or supplements. in the hospital, japanese midwives perform daily breast massage to encourage milk production and flow. women are encouraged to breastfeed their child on a set schedule. according to a 2006 study, 90% of women in japan were breastfeeding exclusively at one week after birth compared to 51% of u.s. women. breastfeeding is officially promoted, but artificial milk is also heavily advertised. (engel 1989) many women in japan breastfeed, but when the baby is in a grandmother's care, for example, formula may be given. when a baby is 100 days old, japanese families celebrate a weaning ceremony called okuizome,（お食い初め） or first food. this ceremony traditionally involves a large shared meal prepared by the mother-in-law. the menu varies by region. during the meal a symbolic stone is placed on plates. this ritual is meant to wish the baby a life of abundant food without hunger as well as good strong teeth. while a people may pretend to feed the baby solid food during these festivities, the baby is usually still drinking exclusive milk. sleep in japan, co-sleeping with newborns is very normal. japanese babies traditionally sleep in the same room or near parents. naming when a baby turns 7 days old, japanese families celebrate oshichiya (お七夜). in this ceremony, the baby is officially named. the mother, the father, and the grandparents are often involved in this process.