Birth practices in modern Japan differ markedly from those currently observed in the United States and the outcomes are among the best in the world. A fundamental question is whether such practices could be exported apart from the underlying system of cultural values. While autonomy is cherished in America, birth practices in Japan directly and indirectly reflect the values of order and harmony in social groups. Strict adherence to traditional gender roles is seen as promoting the social order. I used a participant-observer approach to study this phenomenon, teaching on a maternity nursing faculty in Japan for two years, providing childbirth counseling in the foreign community, touring various birth facilities, interviewing health professionals and Ministry of Health officials, and bearing my first child in that country.