Through Pain and Perseverance: Liminality, Ritual Consumption, and the Social Construction of Gender in Contemporary Japan

ABSTRACT - Consumption during rites of passage have been relatively ignored in consumer behavior scholarship. This study addresses this void by examining the avoidance of pain medication by Japanese women during the hospital birth ritual. This contemporary practice of consumption avoidance is used by Japanese women to Anegotiate@ the liquid terrain of liminality during childbirth. Participant observation, depth interviews, and a review of cultural and historical texts are used to reveal two emergent themes: the cultural privileging of Anatural@ over Aartificial@ birth and the existence of a mother-child dyad that is central to the cultural machinery of Japan.

Citation:

H. Rika Houston (1999) ,"Through Pain and Perseverance: Liminality, Ritual Consumption, and the Social Construction of Gender in Contemporary Japan", in NA - Advances in Consumer Research Volume 26, eds. Eric J. Arnould and Linda M. Scott, Provo, UT : Association for Consumer Research, Pages: 542-548.

Advances in Consumer Research Volume 26, 1999      Pages 542-548

THROUGH PAIN AND PERSEVERANCE: LIMINALITY, RITUAL CONSUMPTION, AND THE SOCIAL CONSTRUCTION OF GENDER IN CONTEMPORARY JAPAN

H. Rika Houston, California State University, Los Angeles

ABSTRACT -

Consumption during rites of passage have been relatively ignored in consumer behavior scholarship. This study addresses this void by examining the avoidance of pain medication by Japanese women during the hospital birth ritual. This contemporary practice of consumption avoidance is used by Japanese women to "negotiate" the liquid terrain of liminality during childbirth. Participant observation, depth interviews, and a review of cultural and historical texts are used to reveal two emergent themes: the cultural privileging of "natural" over "artificial" birth and the existence of a mother-child dyad that is central to the cultural machinery of Japan.

Since rituals tell us "the right way to do things," the consumption that takes place during the performance of rituals can help us to understand the cultural values that are important in a society, as well as the rules through which those values are conveyed (Levi-Strauss 1962). While consumer behavior scholars have begun to address the study of rituals, the role and meaning of consumption during rites of passage have been relatively ignored (Belk et al. 1989, Fischer and Gainer 1993, Rook 1985, Schouten 1991). Nonetheless, Schouten (1991) has emphasized the importance of learning more about the consumption behaviors of "liminal" people during the major role transitions which are the cornerstone of rites of passage.

This study directly addresses this void in consumer behavior scholarship by examining and clarifying the role and meaning of consumption to one special group of liminal people, new mothers, during the major rite of passage known as childbirth. Since this particular rite of passage is one that unequally impacts the lives of women compared to men, it provides the unique opportunity to understand the complex process of culture as it contributes to the social construction of gender. In addition, since this study examines childbirth in a Japanese context, it helps us to understand those aspects of it that are germane to Japanese culture and the experiences of Japanese mothers.

Specifically, this study examines the avoidance of pain medication during the hospital birth ritual in Japan. This contemporary practice of consumption avoidance is both consciously and unconsciously used by Japanese women to construct a "natural" birth experience within the seemingly "unnatural" context of the biomedical hospital. This socially-constructed experience, in turn, serves to create a unique, Japanese version of gendered consumption. Accordingly, it is used by Japanese women to "negotiate" the liquid terrain of liminality during childbirth. At the same time, it is used by them to foster the cultural ideals of motherhood that are deeply embedded within their own psyches, as well as within the very psyche of Japanese culture itself.

RITES OF PASSAGE: A CONCEPTUAL FRAMEWORK

A rite of passage is one class of ritual that accompanies major role transitions. During this critical time in the life of a human being, it is viewed as a symbolic device for changing their identity within a social structure. Rites of passage include such major social status transitions as birth, baptism, graduation, marriage, childbirth, retirement, and death (Van Gennep 1960).

In his seminal study, Van Gennep (1960) proposed that rites of passage consist of three stages: separation, transition, and reintegration. Separation involves the physical removal of an individual from his or her "old" life. Transition, a liminal state, occurs when a person passes from one role or status in society to another one. During reintegration, the final stage, the person is absorbed into ther new social status through various rituals of incorporation. One of the most significant features of rites of passage is liminality, a stage of being "betwixt and between" in which "the ritual subject passes through a realm that has few or none of the attributes of the past or coming stage" (Davis-Floyd 1992). Van Gennep (1960) describes this experience as a boundless, marginalized one often accompanied by isolation and the suspension of social status.

In an earlier study, Fischer and Gainer (1993) explored baby showers as a form of gendered consumption that serves as a rite of passage for women in North America. In that study, Van Gennep’s (1960) conceptual framework was applied to categorize baby showers, an activity associated with the major role transition of childbirth, as a possible contribution to the transitional phase of that rite. For the purposes of this study, however, childbirth, the rite of passage itself, will be examined within the context of Van Gennep’s (1960) framework. In doing so, pregnancy is classified as the separation stage, childbirth as the transition stage, and the postpartum period as the reintegration stage. The physical removal from one’s old life is exemplified during pregnancy as a woman’s gradual yet distinctive change in appearance generates a range of new behaviors, both internally as she modifies consumption patterns such as eating or smoking and externally as other people change their behavior toward her. The process of passing from one role or status in society to another becomes evident during childbirth as a woman progresses through labor then delivery, thus moving from the role of a woman to the role of a new mother. Finally, a woman is absorbed into her new social status as mother through various rituals of incorporation such as those that take place at a hospital after giving birth, as well as those that take place in the days, months, and years after leaving the hospital.

METHODOLOGY

In keeping with the tenets of the interpretivist research paradigm, this study utilizes participant observation, depth interviews, and an extensive review of cultural and historical texts as the primary methods of data collection. Immersion in the natural setting of the Japanese hospital offered the opportunity to hear, see, and begin to experience reality as the participants did (Marshall and Rossman 1995). Depth interviews with Japanese mothers allowed me to enter their mental worlds and look at the cultural categories and logic by which they saw the world (McCracken 1988). Finally, an extensive review of cultural and historical texts on Japanese religion, health beliefs and systems, and social organization provided the contextual background important for understanding the rituals and related consumption practices that take place in contemporary Japan.

This article is part of a larger study which explores the intersection between culture, gender, and consumption. These specific findings are derived from a small subset of data collected during my field work in Tokyo, Japan during the spring of 1996. The complete set of source documents include 950 pages of handwritten field notes, 498 visual ethnogrphic accounts (photographs), 680 pages of translated and typed interview transcripts, and a large collection of cultural artifacts including maternity magazines, maternity undergarments, childbirth amulets, and related items. Following the initial phase of field work which included four months of participant observation in the maternity ward of an American hospital, the field work from which the results of this study are derived consisted of two additional months of participant observation in the maternity ward of a comparable Japanese hospital. Both phases of field work were conducted at large, urban, university-affiliated, biomedical hospitals. During the observation period conducted in Japan, I observed a countless number of women while they were in labor, giving birth, recovering from birth, and completing their extended postpartum stay in the hospital. Visual accounts (photographs) of relevant physical settings were taken at random throughout the observation period to capture the specific cultural context of the natural setting. While they were not included in this article due to space constraints, they were nonetheless used extensively to enhance the process of interpretive analysis and provide a deeper understanding of the insider’s perspective of Japan (Ball and Smith 1992).

Using a purposive sampling method, sixteen Japanese mothers were interviewed in the greater Tokyo area. Their ages ranged from 24 years old to 45 years old and the number of children per woman ranged from one to three. The occupations of the informants were varied and the sample included seven homemakers, one magazine writer, one bookstore clerk, two business consultants, one rehabilitation counselor, one registered nurse, one medical doctor, one school teacher, and one department store clerk. Five key informants who were either personal or professional friends, or identified through such sources, were utilized to recruit informants. All key informants met the criteria of being native speakers of Japanese who were also mothers themselves. According to McCracken (1988), the resulting sample size of sixteen informants is more than adequate for the nature of the study at hand. Indeed, for long or qualitative depth interviews of this kind, eight informants are considered to be a sufficient quantity to identify existing cultural patterns. Twelve interviews were conducted in Japanese and four were conducted in English, all according to the preference of the respective informants. All interviews were semi-structured and informants were basically asked to share their experiences and insights regarding the four topical areas of pregnancy, childbirth, the postpartum period, and motherhood. Interviews lasted from two to five hours in duration and all informants received both personal gifts and the cash amount of 5000 yen (approximately $50) for their participation. All interviews were taped and transcribed verbatim and handwritten notes were taken during the interviews as well.

Depth interview transcripts were analyzed according to the systematic, grounded theory procedures developed by Strauss and Corbin (1990). Field notes and visual accounts were analyzed in a systematic manner using observation and visual analysis documents developed by this author for the purposes of this and future ethnographic studies (Houston 1997). Coding documents for each respective observation, interview, and visual account were analyzed independently for cultural categories and interpretations, as well as collectively for general emergent themes.

BRIEF HISTORICAL AND CULTURAL CONTEXT

While both Japan and the United States "successfully" adopted the German biomedical model, the historical and cultural forces which have shaped Japan’s biomedical system are drastically different. The following paragraphs provide a brief overview of how such forces and the resulting "biomedical" culture have impacted the theater of childbirth in Japan., as well as the rituals through which it is performed.

Before and during the Tokugawa era (1600 to 1868 A.D.), women giving birth in Japan were usually assisted by a lay midwife (toriagebaba) whose primary function was to protect the community from the "pollution" of childbirth and infanticide (mabiki) (Steger 1994). During the Tokugawa era and until the early 1900s, lay midwives, organized at a community level, continued to assist in the delivery of most of the babies in Japan (Maruyama et al. 1995, Steger 1994).

These practices began to change fundamentally during the Meiji era (1868 to 1911 A.D.). During this time, the newly empowered Meiji government began an aggressive campaign to "modernize" Japan under the slogan "rich country, strong army" (fukoku kyohei) (Lock 1980). Included in this campaign was the formal adoption of the German biomedical system. Under the influence of this action, the Meiji government "modernized" Japanese midwifery by adapting it to the German biomedical model (Steger 1994). For the first time in history, midwifery became "biomedical" in focus and was organized at the national rather than the community level. Also, for the first time, the government began articulating an interest in public health. Consequently, the German concept of hygiene (eisei) was aggressively promoted. The new agenda it proposed forced a radical change in philosophy about illness, birth, and death in particular. Instead of relying upon the traditional Japanese Shinto notion of pollution and purity as categories of causation, diagnosis, and treatment; midwifery was completely reconceptualized under the concept of hygiene. In other words, according to Steger (1994), the "medicalization of childbirth" took place for the first time in Japanese history.

Under the new Meiji government, a system of "modern" midwives (sanba) was established that mandated biomedical training and examinations for every midwife, as well as a restricted set of activities which they could perform only under the supervision of a medical doctor (Steger 1994). Most importantly, such modern midwives practiced and disseminated the biomedical philosophy of hygiene. Thus, as the German biomedical model, with its underlying philosophies and "modern" midwifery system grew to become the dominant medical model in Japan; it radically changed the nature of childbirth. The end result is a biomedical model of childbirth which is supported and perpetuated by rituals such as hospital birth. Since 1990, for example, 99.9 per cent of all births in Japan have taken place in a hospital or clinic and were assisted by nurse midwives under the supervision of a biomedically-trained obstetrician (Ministry of Health and Welfare 1996). However, the veneer of hospital birth is a deceptive one. At first glance, it suggests the western, or perhaps American, notion of "technological birth" as described by Davis-Floyd (1992) is the same one that exists in Japan. A deeper gaze, however, reveals the notion of "natural birth" supported by ritual consumption practices within the very ritual of hospital birth itself.

THE TRANSITION TO MOTHERHOOD IN JAPAN

While certainly there are many culture-bound rituals associated with pregnancy and childbirth in Japan, this article will focus only on one specific consumption ritual, the avoidance of pain medication, that is practiced almost exclusively during hospital births in Japan. For the purposes of this article, the term "natural birth" is used to describe "birth without the consumption of pain medication" as it applies to the Japanese context. While this restricted definition refers specifically to a process of labor and vaginal delivery without the use of pain medication, it is important to note that it may and often does include the use of "unnatural" medical interventions such as the use of intravenous catheters, fetal monitors, and episiotomies all within a biomedical hospital setting. As an added note, the terms "transition" or "transition phase", are used in this article to describe the period of liminality during which a pregnant woman undergoes labor and delivery in order to give birth to her child. During my field work at a Japanese hospital, the observations associated with this transition phase involved all of the processes and activities that took place between the time women arrived at the maternity ward in an active state of labor until the time they gave birth.

True to biomedical culture, the physical environment of the Japanese hospital where I conducted field work was "clinical" in appearance. The hallways, examination rooms, labor rooms, delivery rooms, and postpartum rooms were brutally austere in nature. Furniture was sparse and gleamed of metal bright to the eyes and cold to the touch. The German biomedical concept of hygiene thoroughly permeated the atmosphere in both smell and appearance. Walls and bedding were typically white in color. Floors gleamed from constant, routine scrubbing during the wee hours of the morning. On many mornings, I would arrive at the hospital just in time to feel the cool breeze of fans blowing air down the hallways to dry the just-mopped floors. Doctors and medical interns, both male and female, sported stereotypical white lab jackets as official attire over their regular street clothing. Nurses paraded down the halls in carefully-starched white uniforms complimented by comfortable white shoes of several varieties. The only exception in work attire was that of the midwives. Rather than wearing white uniforms that symbolized the hygienic cleanliness of the biomedical "world," they instead dressed in clean and carefully-starched pink or sometimes blue uniforms denoting their special training in matters pertaining to maternal health.

Upon entering the maternity ward, patients and visitors first encountered a large nurse’s station staffed by sturdy, professional nurses and midwives. Here, with seamless efficiency and dedication; the medical staff maintained patient charts, dispensed medication, and served the endless needs of expectant and new mothers. A short hallway behind the nurse’s station led to the labor and delivery department of the maternity ward. As if to symbolically signal the sacredness of childbirth, two large double doors separated the "outer world" of the maternity ward and the "inner world" of the labor and delivery department. No "outsiders" were allowed to enter beyond the double doors. In other words, only doctors, nurses, midwives, and laboring women were allowd to enter into this sanctuary of birth. Since this was a university teaching hospital, medical interns, carefully dressed in official white lab jackets, were also a common sight. My acceptance into this "inner sanctuary" came from two primary sources. Officially, the starched, white lab jacket that I wore on a daily basis became a symbolic cloak that represented and therefore awarded me with the authority and status of a medical intern or doctor. However, while this symbolic cloak was important for gathering medical information and interacting with the medical staff, it often created a visible social barrier between me and the new mothers. Therefore, after the first few weeks of my field work, I crossed the boundary between the land of the doctors and the land of the mothers by openly declaring my own status as a mother. The doctors and nurses seemed to take the information in stride, but the new mothers suddenly viewed me in a different light. Pictures of my son became instant "barrier breakers" and stories of my own "natural" birth experience served to eliminate any remaining barriers. And thus, through these two very different mechanisms, I was openly allowed to enter and participate in this sanctuary of birth. Within the confines of this "inner world," observation rooms, the newborn nursery, labor rooms, delivery rooms, another nurse’s station, and a neonatal nursery provided the stage for the drama of childbirth. The following paragraphs describe my observations within this intense social and physical setting.

The drama of birth typically began with a fixed routine strangely similar, yet starkly different to the one described in detail by Davis-Floyd (1992) in her intense account of childbirth as a rite of passage in America. This biomedical script started with an expectant mother, deep in the passion of labor, arriving at and then entering into the labor and delivery department behind the double doors. Usually accompanied by her mother, and sometimes her mother-in-law or her husband, the woman would be greeted at the entrance to the labor and delivery ward by one or two midwives ready for action. In this particular hospital, and in the majority of hospitals in Japan, family members are not allowed to participate in the labor and delivery process alongside the mother-to-be. I observed many such family members waiting in the halls into the wee hours of the night or morning. Husbands, if present, would usually have to leave for work. However, the mothers of the laboring women waited around patiently for hours on end unless they were called upon to care for other (grand)children waiting at home under the care of a neighbor or friend. Upon entry into the labor and delivery ward, the laboring woman would remove her shoes and replace them with those provided by the hospital. (See Houston 1997 for a more detailed explanation of this symbolic act.) After changing shoes, she entered the observation room and received an internal examination from one of the midwives. The interactions between the laboring woman and the midwives were generally focused on medical efficiency and little conversation took place. The mothers rarely asked questions and the midwives moved about briskly in a crisp and authoritative manner, sprinkled occasionally with warm smiles and general encouragement. (Doctors were usually not present during this early stage of transition.) If labor had progressed to a certain point, the laboring woman was admitted to the hospital as a patient. If so, she would typically change from her street clothes into a pink hospital gown. Shortly thereafter, she would proceed on foot into the labor room. Davis-Floyd (1992) found similar identity-stripping rituals in the American hospital birth ritual. Needless to say, such rituals are a distinguishing characteristic of the "loss of identity" inherent in the transition stage of a rite of passage. Symbolically speaking, the laboring woman is stripped of her identity and demoted to a state of liminality by the seemingly innocent act of taking away her personal clothing and other belongings and replacing them with a hospital gown that provides little opportunity for modesty. This process serves to "break down" the existing social identity f the woman in order to prepare her for her new social identity. Literally and figuratively, she is "naked" before everyone, including herself.

The labor room contained three beds, each surrounded by curtains that served as temporary walls of privacy. While the laboring woman usually remained in bed in a reclining or semi-reclining position, it was quite common to see her walking up and down the hall or walking to the restroom, sometimes with an intravenous cart in tow. The reclining position is an important "controlling process" during the transition stage and, at least in a symbolic sense, it serves to further subjugate a woman who is normally able to move about as she feels necessary. However, "allowing" the laboring woman to walk the halls or go to the bathroom, sometimes without assistance, was rather atypical of a biomedical setting.

Another interesting aspect of the labor "script" that I observed involved the intake of food. In the American hospital birth ritual, laboring women are not typically permitted to consume food during labor. The most common reason provided for this restriction is that one must always be prepared for the possibility of general anesthesia that may be administered in the event of an emergency cesarean delivery. In such cases, recent food consumption can present great difficulties to the medical team and may even cause maternal death in rare instances.

In Japan, quite the contrary was true. Time after time, I observed laboring women eating full meals throughout the entire process of labor. Such meals included fish, rice, soup, salad, tea, and milk. Quietly rolled into the hallways outside the labor rooms by hospital nursing staff, the heaping bowls of simmering food carefully graced the tops of gleaming metal utility carts offering contrasting textures of coldness and warmth. When the carts of food arrived, the midwives would just as quietly wheel them into the labor room and attempt to coax the laboring women into eating by pointing out the appealing menu of the day. Many of the mothers gave in to the pleas of the midwives, but many found their hunger masked and intimidated by the ever-growing pain of labor. When questioned about the consumption of food, the midwives all stressed the importance of food throughout the labor process so that the laboring woman could maintain the energy level she needed to deliver her baby safely. When women chose not to eat due to their great discomfort, I observed a number of midwives dutifully encouraging laboring women to eat in order to keep up their strength. The symbolic difference in the Japanese case cannot be overemphasized. By encouraging and permitting the consumption of food during labor, it was clear that the assumption being made was one of birth as a "natural" process rather than one that was potentially pathological. It was assumed that general anesthesia would not be required. It was assumed that an emergency cesarean delivery would not take place. It was assumed that a laboring woman would be able to give birth naturally with little or no technological intervention.

Once delivery became imminent, the laboring woman would walk the short distance from the labor room to the delivery room. She was not carried there or carted there as is true in the case of the American hospital where I conducted observations. She would walk, sometimes with the assistance of a midwife, but she would walk nonetheless. The delivery room was strikingly bare of the technological apparatus that is typical in that of an American hospital. It contained three adjustable delivery beds separated by curtains. While the delivery beds were starkly clinical in appearance, the only major medical equipment present was an intravenous cart and an infant warmer for newborn babies. In addition, the room contained one metal cabinet filled with medical devices such as forceps and one metal cart displaying sterile packages of scissors, bandages, and drapes. Once in the delivery room, the laboring woman would mount the delivery bed with the assistance of one or two of the attending midwives. With the midwives providing back support and verbal encouragement, the woman would then proceed to push hr baby out of her body while sitting in a semi-reclining position. Since this process often took anywhere from thirty to sixty minutes depending upon the circumstances, the minutes often seemed to last for hours. During these trying moments, the silence in the room, tempered only by the slow ticking of the clock, was unbearable beyond belief. The laboring woman would push and push as she was instructed by the midwives. The doctors, who usually arrived at the last minute, typically interacted with the laboring woman at a minimum level. Sometimes they would ask the woman if she wanted pain medication, but always the woman would refuse. If any medical intervention was required, such as an episiotomy (a common surgical procedure to enlarge the birth opening), the doctors would perform it swiftly with great surgical ease. Although this particular procedure was not always performed during the births I observed, the mothers who did receive one submitted to it without question. Finally, in one last gasp of air, the exhausted and triumphant mother would push out her baby and look down anxiously for the result of her hard work. The newborn infant would then be carefully handed to the exhausted new mother for a visual inspection and sigh of relief. Minutes afterward, the baby would be whisked away to the infant warmer and subsequently to the newborn nursery for a bath and extended "warming" period. In the meantime, the new mother would remain on the delivery bed for a minimum of two hours while she recovered from the ordeal of childbirth. The doctors had already disappeared by this time, but the midwives would still be present and busily engaged in giving the new mother a sponge bath then wrapping her in extremely thick blankets to keep her warm. The new mother, physically exhausted at this point, would have little trouble falling asleep until she was nudged awake several hours later.

It was during this last stage of childbirth that I repeatedly observed the avoidance of pain medication in the spirit of "natural birth." In spite of the widespread availability of all forms of anesthesia and pain medication in this particular hospital, as well as all hospitals throughout Japan, non-medicated childbirth is the cultural norm (Maruyama et al. 1995). The laboring women I observed in the hospital delivery room, in keeping with this cultural norm, actively chose to not consume pain medication during labor and delivery even when it was offered to them by an attending physician. Furthermore, not only did women choose to not consume pain medication during labor and delivery, but also they chose to give birth in complete silence. Over and over again, with rare departure, I observed this culture-bound phenomenon of "perseverance" (gaman). While conducting observations in the labor room, the fetal monitor was often the only discernible noise that I could hear even when all of the labor beds were full. In the delivery room itself, I repeatedly observed women pushing through the final stage of labor with barely a word or a sound. When and if the pain became so unbearable that they involuntarily groaned or whimpered, they quickly followed with an apology for their behavior. Even so, the midwives were quick to verbally scold them and just as quick to "encourage" them with repetitive comments such as "please persevere" (gambatte kudasai). One informant who cried out in pain while delivering her baby began to apologize profusely to me and the midwives moments later when her baby was born. When I visited her the next day, she was still apologizing. This ritual of "gaman" was also revealed by the following informants as they describe the birth of their first child:

I wanted a natural birth...I was so embarrassed. I had a difficult labor then they had to do vacuum extraction to get my baby’s head out...it was so painful..I had to scream..the midwives tried to keep me quiet..please persevere, please persevee, they kept saying...it is bad for the baby..I was ashamed about the vacuum extraction...I really wanted a natural birth. (34 year old homemaker and mother of one child)

...I wouldn’t have used drugs and anesthesia had I been given the choice...childbirth is not an illness, you know...it (the pain) eventually passes, you see...everyone will say at the time that is so hard that I am going to die, but it’s only temporary...I thought, if that is the case, I will endure it. (40 year old business consultant and mother of two children)

The labor pain as one hundred times as bad as the menstrual cramps. I screamed "ouch" when the nurse wasn’t there, but I restrained myself when she was there...I felt inhibited. I am Japanese, after all. (24 year old homemaker and mother of one child)

It was extremely painful with the first child...I made a lot of noise...yeah, I screamed and screamed...it was like when I quarrel with my husband...they asked if I could be a little more quiet...the nurse scolded me...she told me to be composed because I was becoming a mother. (44 year old magazine writer and mother of two children)

Repeatedly, my informants expressed the need to have a "natural" birth and to do so in silence. When this "script" did not take place, they were not only embarrassed at a personal level, but also reminded by the attending midwives to "persevere." Childbirth was viewed as a painful experience, but one that was the natural process of becoming a mother. While subsequent births were decidedly less challenging from both a physical and emotional level, mothers still avoided the consumption of pain medication and embraced the practice of giving birth in silence. "Natural" birth in silence, therefore, was deemed as the "right way to do things" and the avoidance of consumption with regard to pain medication was central to this script.

Lebra (1984) discusses the Japanese preference for "natural" delivery and the show of stoicism during labor. Japanese women, she states, are overwhelmingly in favor of "natural" delivery (shizen bunben) over "artificial" delivery (jinko bunben). It is through natural delivery that women believe the mother-child bond intensifies. If a mother does not suffer through the "natural" bodily experience of pain when she gives birth, it is believed that she is too self-oriented to gain the empathy required of a "true" mother. The display of stoicism during labor and childbirth thus becomes the ultimate test of maternal discipline. Giving birth with pain is not only viewed as more "natural," but also viewed as an important step in consciously experiencing the act of becoming a mother. Consequently, childbirth is not only viewed as a physical or biological transition into motherhood, but also a psychological and social one. The maturity and strength expected of Japanese mothers is believed to be fostered by the experience of great pain during childbirth, as well as the ability to tolerate it in silence. And so, while it may or may not be consciously apparent to the mothers who participate in this transition ritual, the cultural significance of motherhood in Japan may nonetheless prove instrumental in shaping their behaviors and resulting consumption practices.

EMERGENT THEMES

Both the ritual consumption practices observed in the Japanese hospital context and those revealed through the lens of history and culture point to two dominant, emergent themes regarding liminality nd ritual consumption during childbirth in contemporary, urban Japan. First, it is clear that a "natural" experience, however that is defined in reality, is preferred to an "artificial" one. And second, at least in Japanese culture, numerous rituals and consumption practices seem to exist to cultivate and reinforce the notion of a mother-child dyad. This social relationship, it seems, has a significant impact upon the social construction of gender and therefore bears significant implications for consumer research.

The Superiority of "Natural Birth"

Regardless of the obvious use of invasive biomedical interventions such as intravenous catheters, fetal monitors, and episiotomies during the so-called "natural" birth ritual in Japan, the preference for "natural" birth compared to "artificial" birth is without question. So powerful was the need for laboring women to avoid the consumption of pain medication and yet still give birth in silence that those women who could not do so felt the need to apologize for their behavior. Coupled with the cultural belief that "giving birth with pain and in silence" is an important step in consciously experiencing the act of becoming a "true" mother, the avoidance or "unconsumption" of pain medication during labor and delivery serves a special role. Unlike the symbolic act of rebellion against the "supremacy of technology" that has been described in the natural childbirth movement in the United States, it instead signifies a symbolic act of discipline for the new social role which lies ahead (Davis-Floyd 1992).

For the informants in this study, the culturally-sanctioned social role of "mother" requires strength, maturity, and the ability to empathize with your child. By persevering through a painful childbirth experience in silence, the liminal woman tests the limits of this role through direct experience. Symbolically speaking, then, if a woman commands the ability to experience "natural" birth in silence, she earns the medal of honor awarded only to those bestowed the special title of "true mother" in Japanese culture. And so, even though the cultural ideal of motherhood is a rather recent one in Japanese history, it has become deeply entrenched in the symbolism of childbirth as a rite of passage in Japan and in the patterns of ritual consumption that have evolved accordingly. (See Houston 1997 for a more detailed explanation of the cultural ideal of motherhood in Japan.)

Food consumption during the hospital birth ritual further substantiates the privileging of "natural" over "artificial" consumption. Since birth is viewed as a natural process, laboring women are encouraged and permitted to consume full meals throughout the process of labor. This ritual symbolically acknowledges the assumption that birth is not only a natural process, but also that women are quite capable of performing this process. In other words, the assumption is that everything will progress normally. Therefore, laboring women need to consume food throughout labor in order to maintain the amount of energy required for this taxing performance.

The physical environment of the delivery room itself provides even more evidence for the preerence and importance of "consuming pain." When childbirth is viewed as a natural process, one of the many assumptions made is that technological intervention in the form of consuming pain medication or medical machinery will not be required. As a result, "natural" births take place in the comparably "low-tech" setting of the delivery room. This setting, while it is nonetheless clinical in form and appearance, removes the possibility of "artificial" birth by eliminating the literal and symbolic presence of technological apparatus. In doing so, it reinforces the symbolic notion of natural birth as "the right way to do things." The alternative, the "high-tech" operating room, provides the stage for "artificial" birth or "the wrong way to do things." All "artificial" (i.e., cesarean) births take place in the operating room. Located on an entirely different floor from the delivery room, the operating room possesses the physical environment typical of a regular American delivery room. Specifically, the operating room contains an overwhelming number of psychologically-intimidating medical devices, including a state-of-the-art infant incubator, a large assortment of machines fully equipped with blinking lights and beeping noises, and a large overhead lighting system that provided ample lighting for doctors during surgical procedures. Technological intervention, surgical (cesarean) delivery, and pain-relieving anesthesia are immediately available and typically administered in this context. Women who experienced complications while they were in the regular labor and delivery ward were quickly subjected to either an epidural or general anesthesia then whisked away to the operating room for cesarean deliveries. Such women were therefore physically isolated from those giving birth under "natural" conditions. And so, as these examples illustrate, the symbolic message that continues to resonate in Japanese society is that childbirth is a "natural" event and the ritual consumption associated with it privileges that which is "natural" over that which is "artificial."

The Mother and Child Dyad

The uniqueness and intensity of the mother-child bond in Japan is so deeply ingrained that it has been identified as one of the key dependency relationships in Japanese culture (Lebra 1976). Because of the intensity of this bond, Japanese mothers tend to regard their children as "part of themselves" (jibun no ichibu) even when such mothers have assumed other social and professional roles outside of the home (Iwao 1993). The continued contemporary importance of this mother-child bond is further illustrated by the great significance placed upon "the consumption of pain" (or the consumption avoidance of pain medication) during childbirth in order to understand and gain "true empathy and compassion for another human being." Informants in this study repeatedly described the importance of following this consumption ritual, even when epidural anesthesia was readily available to "mask the pain" from the process of childbirth. Both my observations and my interview data confirmed this strong cultural preference for the avoidance of pain medication during labor and delivery. Those informants who, because of circumstances beyond their control, were not able to experience "the consumption of pain" during childbirth expressed lingering doubts bout their competence as a mother for months after their babies were born. In essence, they had internalized the cultural ideal of motherhood to the extent of devaluing themselves as mothers because they had not given birth in pain and in silence.

Informants further expressed their belief and tendency in cultivating mother-child intimacy through skin-to-skin contact (hada to hada fureai) through the contemporary practices of co-sleeping and co-bathing, as well as through the practice of breastfeeding for the first year of an infant’s life. In the hospital setting, the assumption of the new mothers and the medical staff was that all new mothers would commence with "natural" feeding (breastfeeding) rather than "artificial" feeding (formula feeding). While I did observe formula feeding in the hospital setting, it was clearly used as a supplemental feeding mechanism so that new mothers could get physical rest during the first few days after giving birth. During their postpartum hospital stay of one week, however, they universally received breastfeeding instruction from the staff midwives.

A final example once again reveals the deeply-ingrained notion of the mother-child dyad in Japan. As soon as she knows she is pregnant, every woman in Japan registers her "pregnancy" at her local government office (Maruyama et al. 1995). Upon registration, she receives the Mother and Child Handbook (boshi kenko techo) in which detailed events of her pregnancy and birth will be recorded by her physician. This registration system and handbook are fundamental components of Japan’s remarkable public health accomplishment of universal, early prenatal care. The interesting aspect of the Mother and Child Handbook is that, in addition to documenting the expectant mother’s prenatal care, it also documents her baby’s growth and immunizations from birth through the age of six. (After the age of six, such information is documented through school health records.) With this practice in mind, therefore, it would further appear that a mother and child are symbolically viewed as an inseparable dyad at least until the child enters elementary school.

DISCUSSION AND CONCLUSIONS

In contemporary Japan, the ritual consumption practices that take place during the rite of childbirth give us the unique opportunity to gaze into a world of gendered consumption as it is performed in an extraordinary cultural context. Here, against an historical and cultural background of sometimes opposing external influences and imposing internal ideologies, we can peer onto the complex stage of contemporary rituals that define the realities of women as they become new mothers. This major transition in social status, especially when one considers the cultural significance it warrants in the Japanese context, is certainly a life-altering one. The role and meaning of consumption, or even consumption avoidance during this challenging transition should be of great interest and importance to consumer researchers. In spite of this fact, however, we know almost nothing of its tribulations and even less of its impact upon the daily lives of Japanese mothers. This study beginsthe arduous process of conducting this distant gaze, although perhaps it only tugs at the immense task that lies ahead.

At a fundamental level, this study demonstrates that ritual consumption during childbirth must be viewed within the context of its unique historical and cultural circumstances. These forces are powerful mechanisms in the cultural machinery for producing the social products of a mother, a mother-child dyad, and a family. These products are all critical, cultural institutions in Japan. They determine the very texture of the social fabric that weaves throughout contemporary Japanese society. Ritual consumption practices seemingly void of cultural symbolism are instead deeply tied to these very notions. Even within the dominant cultural institution of Japanese biomedicine, this study reveals evidence of significant forces and counterforces at play. The avoidance or "unconsumption" of pain-relieving anesthesia during childbirth, for example, is an act brimming with cultural and symbolic meaning. The informants in this study were not merely consuming "natural" birth. Symbolically speaking, they were also consuming a culturally-idealized notion of motherhood. Thus, liminality, typically a marginalizing experience, is symbolically balanced by the culture-bound elevation in social status achieved by the informants in this study.

Geertz (1973) has proposed that culture is a "complex control mechanism consisting of systems of significant symbols that shape our experiences and give order to our lives." This study provides an intriguing gaze into such "systems of significant symbols" as they play an important role in the consumption experiences of Japanese mothers. In doing so, it demonstrates how products and services are consumed, or not consumed, to ease the process of transition and negotiate the resulting liminality. It also demonstrates that the analysis of such systems, as also proposed by Geertz (1973) should be "an interpretive science in search of meaning, not an experimental one in search of laws."

Last, but perhaps most important of all, is the notion of gendered consumption and the social construction of gender within that context. Costa (1994) describes gender as a social construct that exists in all cultures, even though the distinctions and behaviors associated with it vary from one culture to another. Because men and women hold disparate, culture-based world views, she continues, an assumption of differences rather than similarities should be assumed with regard to consumption and marketing practices. Undoubtedly, cultural notions of gender as constructed through such constructs as womanhood, manhood, motherhood, or fatherhood are instrumental in shaping the behavior of human beings. How products and services are used to create and support these notions are important considerations for consumer research. This study, in its interpretation of the behaviors, strategies, and consumption rituals of women experiencing the transition from womanhood to motherhood, contributes to a small but growing body of consumer behavior scholarship which examines gender from the perspective of its cultural participants (Costa 1994). Future research should seek to expand our understanding of that convoluted but ever intriguing intersection at which gender and culture collide with consumption. Furthermore, it should fully embrace those spirited journeys into the frontier of interpretivism which serve to foster our understanding beyond a merely superficial level.

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