BACKGROUND:
The International Childbirth Initiative was created by ICM with partner institutions for the implementation of respectful, evidence-based care. In Japan, where midwives are leading change in maternity practice, ICI has been launched as an appropriate strategy for health facilities seeking to strengthen midwifery care.

OBJECTIVES:
Provide perspective on Japanese women’s experience of childbirth and postpartum mental health. Describe first stage of introduction of the International Childbirth Initiative as an intervention to advance midwifery models and addresses concerns of women and midwives.

METHODS:
To gain greater understanding of women’s childbirth experience and postpartum mental health in Japan, 821 women who had given birth in the past year were surveyed using the International Childbirth Initiative birth experience questionnaire in March-April 2025. To assess their mental health, the PHQ-4 was also administered. Focus groups with the general community and midwives were also conducted.

RESULTS:
First-time mothers accounted for 43.7% of the sample. While women overall reported satisfaction with their experience in labor and delivery, we note high rates of interventions (episiotomy (51.3%), cesarean section (20.3%), and challenges around breastfeeding (15.1% inadequate support to breastfeed, 13.9% reported inadequate milk production). Additionally, women reported that 11% of episiotomies were performed without their consent. Midwifery centers account for only 3.7% of the births reported. Only 56.8% of women felt that their care providers always treated them with respect throughout labor, delivery, and postpartum. Using the PHQ-4 tool, 20.3% of women scored positive for anxiety (n=748) and 16.% of women scored positive for depression (n=722).

CONCLUSIONS:
Our findings around intervention rates, consent, respect, and postpartum mental health suggest that the ICI tool effectively identifies challenges that may be addressed by strengthening midwifery models of care.

KEY MESSAGE:
Midwives and women in focus groups found the ICI framework effectively represented necessary change in maternity care and allowed women to validate their desires during childbirth. Poster session 4 (Group B)