京都，一个产科的消亡

Core Insights - The article discusses the experience of a couple navigating pregnancy and childbirth in Japan, highlighting the challenges faced by the healthcare system, particularly in obstetrics, amid a declining birth rate and financial difficulties for hospitals [29]. Group 1: Hospital and Healthcare System - The hospital mentioned is a church-affiliated institution that has been operating for over 70 years and is the largest comprehensive hospital in the area [4]. - A survey by the Japan Medical Association revealed that over 40% of obstetric departments are operating at a deficit, attributed to population outflow in rural areas and high living costs in urban settings [10]. - The hospital has seen a significant decline in obstetric services, with the impending closure of its obstetrics and newborn emergency departments due to long-term financial losses [29]. Group 2: Obstetric Care and Practices - The hospital performs an average of 260 deliveries per year, with approximately 80 being cesarean sections, indicating a relatively low delivery rate [8]. - The article notes that prenatal genetic testing (NIPT) is not widely recommended by Japanese doctors, with only about 10% of mothers aged 35-39 and slightly over 20% of those aged 40 and above opting for such tests [10]. - The obstetrician, who has experience in the UK, emphasizes the importance of prenatal care and provides clear explanations about genetic testing, reflecting a more modern approach to obstetric care [11][12]. Group 3: Societal Implications - The narrative reflects broader societal issues, such as Japan's aging population and declining birth rates, which are leading to significant changes in the healthcare landscape [29]. - The article suggests that the decline in obstetric services may be an early indicator of future changes in other sectors, including pediatrics and education, as the country grapples with demographic shifts [29].