In 1868, after years of domestic political turmoil in Japan, the Meiji period (1868-1912) began and Japan launched itself as a modern nation state. The modern nation geared itself to mobilize people for modernization, a term that implied enlightenment and industrialization. 1
As part of this scheme, the Meiji government also set out to modernize medical practitioners, a group they perceived as essential for national prosperity. In 1868, the government officially declared that Japanese medicine was to be modelled on modern Western, and especially German, medicine. Obstetric experts, including midwives, were part of this modernization programme and an early government directive of 1868 banned midwives from practising abortion and trading in drugs. In 1874, the officials implemented a Medical System (isei) in three major cities, which included three regulations that applied to midwives. These are thought to be the first regulations for midwives in Japan that defined midwives as modern medical professionals. From then on, local authorities developed their own midwifery regulations, which were later consolidated in the national Midwives Ordinance promulgated in 1899; this Ordinance made midwifery training, examination and local registration obligatory for all future midwives.
Under these conditions new obstetricians and midwives emerged slowly during the Meiji period. In the first half of the period, up to c. 1890, elite medical students interested in obstetrics travelled to Germany to study Prussian obstetrics and gynaecology. On their return to Japan, from the late 1880s onwards, they taught German scientific midwifery to female students. Graduates of these formal midwifery training schools were commonly known as shin-sanba ('new-midwives') or seiyô-sanba ('Western midwives') to distinguish them from indigenous kyû-sanba ('old-midwives') or the old-style toriagebaba, who conducted midwifery based on skills they had acquired through experience, not medical training.
Toriagebaba, or the 'old woman who pulls and lifts the baby', were survivals of pre-modern Japan. In this earlier period, the Edo period (1603-1867), a Japanese version of scientific obstetrics was in place, and obstetricians were primarily involved in the management of difficult childbirth and births among noble or court families. Among the remaining population, toriagebaba attended almost all non-problematic childbirths. These attendants were usually senior members of the community, experienced in childbirth and the traditional duties of birth