Giving Birth in Japan: Reflections and Advice

If you haven't yet read Part 1 and Part 2 of the "Giving Birth in Japan" series, it may be helpful to read those first so you have some background in regards to my reflections below. - Ashley

How was it, being pregnant in Japan?

I honestly had a pretty easy pregnancy, and being in Japan really had no effect on my views of pregnancy (aside from even more stares at the sight of my burgeoning belly). At least where I was, people were really kind most of the time about giving up seats so I could sit down, etc. (only in months 7-10, though, when it was obvious). I don't experience that kind of thing much the rest of the time so it was a nice change. I'm sure this depends on where you are in Japan though, so that's just what happened for me.

The main thing I didn't like was how hot it was this summer in Japan (hotter than usual), before we had an air conditioner. Was pretty miserable.

Another thing I didn't like is how difficult it is to avoid smoking when going out. I already have issues with smoke with my allergies, but with a little one growing inside me I was more paranoid about it, which meant there were very few places we could eat out at (we had to get in all the couple time we could, and I'm glad we did, since we get zero time now). [This obviously depends on where you are in Japan, since some places have a lot more non-smoking restaurants and places to go.] Or just walking in certain areas, or things like that, it can be difficult to avoid cigarette smoke and not everyone is very conscious of others when they smoke, which annoys me. This is still an issue now with a baby.

Was it difficult finding a caregiver?

Yes, in the beginning. I mentioned this in Pregnant in Japan: How to find a doctor, hospital or midwife. I currently live in a smaller city in Shizuoka, so the options in my area are less varied than if I was living in Tokyo or another large, urban area. There are plenty of hospitals and ladies clinics around, but those with birthing facilities fill up fast. A few of the places we sought out in the very beginning were actually full (the irony of this is that we live next to a ladies clinic, but the doctor is kind of a jerk, so I didn't want to go through the whole experience there).

Of the places that weren't full, many of them were more strict about visiting hours, outside food being brought in, always performed episiotomies, didn't let the baby room-in with the mother, among other things. I did get to a breaking point, stressed out that we wouldn't be able to find a place to go with a decent doctor that wouldn't completely traumatize me, since I was already nervous enough about the whole thing.

As I wrote in the post mentioned above, I emailed Brett Iimura of the Childbirth Education Center, who sent me a few ideas, and we fortunately found a nice doctor (who even spoke English, something we doubted we would find and weren't looking for), who was very willing to be flexible with us about our birth plan. So in the end that worked out, and though there were a few difficulties here and there, I'm happy overall about the doctor and clinic.

What did you think about the care you received?

Overall, I'm satisfied. There's a few things that bothered me a bit, but my doctor, the nurses and midwives were all really great for the most part.

At the first doctor I received care from (until we found the doctor who delivered our baby), I was annoyed at his comments about me gaining too much weight (though I also knew to expect it, but it was still annoying, especially since I wasn't eating anymore than I normally do). Other than that though, that doctor was pretty friendly, and very competent. Everything was handled professionally.

The doctor who delivered our baby was very friendly, and always was understanding about cultural differences. He said my weight gain was normal. He was open to any questions and concerns I had (some doctors in Japan aren't too keen on that, since it bruises their ego) and he reassured us that they would do what they could to make us comfortable.

The nurses and midwives were always kind and some of them enjoyed practicing their English. Some things about appointments were a little tedious, though expected, such as my husband only being allowed in after I had laid down and had my pants rolled down for the ultrasound and then covered with a blanket. Then he'd have to go out again before he could come back in to talk to the doctor after my pants were rolled back up and I was sitting at the desk. It's just Japan, which we understand, so it's not annoying at all, but it's just one of those things I always think, "do we really need to do this again..." That can happen here in Japan, depending on what you're doing.

As for the birth, you can read about that in Giving Birth in Japan: My Experience - Part 1. Though I didn't enjoy my experience at all, it was primarily because of the pain, fatigue, emotions, etc., rather than the medical care. I wasn't happy that the doctor did an episiotomy without saying anything first to my husband or I, but I do understand they were concerned that our baby wasn't getting enough oxygen (her heart rate wasn't recovering well after each pushing contraction) and felt it was important to get her out as soon as possible. The episiotomy was necessary for a vacuum extraction.

I didn't doubt at all that they would take care of us if something was going wrong, and they did. I have mixed emotions about how things happened, but I think that can happen with any woman going through something like this. Their objective is to deliver the baby safely and keep the mother safe as well, and they did that.

Most of the nurses and midwives were great, some more than others, but that can really happen anywhere in the world so I'm not torn up about it. One nurse was pretty ignorant and made unnecessary comments at times, and also was of no help my second night at the clinic when she was on duty (read more about that in Giving Birth in Japan: My Experience - Part 2, Clinic Stay). On the other hand, one of the other nurses was really hands on, super-friendly, helpful, and very reassuring, so she balanced that out.

Sometimes some of them made comments that I found a bit patronizing, in regards to things like our particular choice of cloth diapers or the way I was breastfeeding (regardless of the fact that every nurse at the clinic taught breastfeeding and pumping a different way - we were warned beforehand that the clinic doesn't have a great breastfeeding program), and using a pump was frowned upon (they believe it causes hyperlactation). They have some valid reasons as to why they say these things, but I think it was more or less because that is what they believe to be normal in Japan and thus things that are different might not be best option.

It goes both ways though, since I felt like if the things we choose to do are normal in North America or something like that, why would what they say be "better"? My best advice is to do your own research, take what they say with a grain of salt (if it's really different from what you know), compare everything and decide for yourself what's best. You may be surprised and prefer something you learned here in Japan that you wouldn't have known about otherwise.

I'm thankful they let my husband stay with me the third night, and thankful we got to leave a day early (was supposed to be 4 days, but a normal stay could be anywhere from 4-7 days or so, depending on the hospital/clinic). I'm also glad they were fine with my husband bringing me food, since most of the food at my clinic didn't look that good to me (but keep in mind food will vary depending on the place you give birth.)

Would you give birth in Japan again?

If I wanted to give birth again, yes, I wouldn't hesitate to do it here in Japan. I think as long as you can find a caregiver you feel comfortable enough with, and who is also flexible with your desired birth plan, then you really have no need to worry or be anxious (although, I know you may still be anxious about the whole "birth" aspect of things - I was). They'll do the best they can to help you and your baby, even if some things are a little different from what you might expect or are accustomed to. Erica summed it up nicely in her post, How to have a baby (and not a nervous breakdown) in Japan.

What should I keep in mind when choosing a caregiver/place to give birth?

Some doctors are more or less flexible than others. Even if many of the ones you visit are NOT flexible, keep trying. I certainly wouldn't advise anyone to "settle," and I would also say to not give up on finding something that will work for you. Also know what you want before you start looking - know what you are and aren't willing to compromise on.

Also keep in mind that you may run into some cultural differences, whether in care, attitude, approach, or otherwise. Be open to them, even if you disagree, and take them in stride. If something really bothers you, make sure you speak up and be very, very clear about it. I noticed this was something we had to be careful of to some extent, even though we could communicate with our doctor in English and Japanese, (though he insisted on using English all the time), we discovered later that some things we thought were clear on our end, were ambiguous on the other end. Even if you think you're being specific, be even more specific. That's what I would do if I could do it again.

What questions should I ask?

This largely depends on what you want, but a few things you might want to ask about:
  • Do they always perform episiotomies, or only when medically necessary?
  • What type of food do they serve? [Make sure to tell them about any food allergies or preferences, though they should ask you sometime prior to giving birth.]
  • Is it possible to bring outside food in?
  • When are visiting hours? When can your partner be there with you?
  • [If you plan to breastfeed only] Do they feed babies formula at all? How much weight loss do they allow before they recommend supplementing with formula? [In Japan it's about 7% weight loss on average (my guess is, probably because the babies tend to be tiny often already) but can go to 10% (this is average in the US). Our baby lost just over 10% because of things that happened and some misunderstandings, so we had to feed her formula a couple times. I wasn't thrilled about it, especially since I had no choice over the formula type, but she needed food and needed to gain weight.]
  • [Related to above] If you don't give formula, do you offer them water/sugar water?
  • [Also related to above] Do they use bottles, or cup/spoon feed? [Some women, like me, want to avoid nipple confusion in the beginning if they are breastfeeding.]
  • Can babies room-in with the mothers?
  • How many days do you have to stay?
  • Can you play music/eat/walk around/etc. during labor?
  • Can you use cloth diapers or bring your own disposable diapers? [If you're planning to go with cloth, or use special diapers like partially-biodegradable or unbleached kinds. This was a concern for me, and though we had to ask a few times, they were fine with it, but made sure that we knew if we used cloth there we would have to take them home to launder.]
  • Can you bring/wear your own clothes? [Many places will typically provide some sort of gown to wear. Though, the packing list they send you home with says you need to bring clothes, but my clinic said I didn't need to. It depends on where you give birth, but if it is a concern you have, feel free to ask them about it. I didn't like the gowns at my clinic; they were uncomfortable and plastic-feeling, so I wore my own stuff.]
  • What kind of pain relief options do they offer (if any - my clinic didn't have any)?
  • Will they allow you to hold (and breastfeed, if you choose) the baby right after birth?

These are just a few, and you may come up with more as you plan and research. The Tokyo Pregnancy Group has a pretty extensive list for making a birth plan.

My final advice (summary): whatever questions you have, whatever you are wondering about, ask your doctor. Get it translated to Japanese somehow if you have to, but make sure you know everything you need/want to know. Be as specific and clear as possible. We wrote my birth plan in English and Japanese and went over it with the doctor/midwife (and even now I wish I had been more specific). If you want them to let you know what's going on during the labor/birth, ask them if they will. Be polite and appreciative, and understanding of them, also.

If you want to share your experience, please feel free to in the comments. Alternatively, if you'd like to share it on the blog, I'd be happy to either link to it if you have a blog or post it on Surviving in Japan.

For more info on being pregnant in Japan, you may want to check out some of the following:

Pregnant in Japan: Resources
Pregnant in Japan: Diet, Nutrition and Weight Gain
Pregnant in Japan: Visiting the Doctor and What to Expect
HOW TO: Find a pregnancy test in Japan

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