Pregnancy in Japan during a pandemic

Happy New Year 2021 also from my side!
May this year be a fresh chapter with the hopeful fast end of the pandemic…

Today I want to write about my experience of being pregnant in Japan. Even though unrelated to kimono and a little more personal, some of you said they were curious as to how it is being expecting a baby as a foreigner in Japan.

The confusing start

As in probably any country I found out that I am pregnant by taking a pregnancy test at home in the end of March. I had planned to have a cycling tour with my hubby and a social distance hanami (花見 = cherry blossom viewing) with my friend as the flowers were in full bloom.
So this was a wonderful day full of excitement.

Naturally I had no clue about anything pregnancy related, so was super glad to have had my best friend Anika (big thank you!!) to guide me a little. She already had a child in Japan and also wrote about it on her German blog – so I’d like to pass on the knowledge and experience to whomever doesn’t have that close friend as I did ♡

Since I generally am a little weirded out by the medical system here, I never went to a ladies doctor in Japan. In fact, every year when returning to my home in Germany, I had a checkup there at my previous doctor (and pre-pregnancy would also get my pill there for a year and bring it back to Japan…).
Therefore the first question to solve:

Which hospital / birth place to choose?

Following options are available:
Hospital (総合病院 – Sogo byoin bzw. 大学病院 – Daigaku byoin)
Birthing clinic (産婦人科病院 – Sanfujinka byoin)
Birthing centre (助産院 – Josanin)
Home birth with midwife support (自宅出産 – Jitaku shussan)
Gynecologist (産婦人科 – Sanfujinka)

To be honest I felt a little overwhelmed by all these new vocabulary I had never used or heard before… Being pregnant also improved my Japanese a little as there were a lot of new words I learned during the journey. (So I will include some terminology here and in the bottom of the blog post as well to prepare whomever also never heard these Japanese terms before).

After a little research and suggestions from my mother in law / word of mouth I chose a modern and popular birthing clinic in my area for my first checkup and also birth.
Since the pandemic was full on – there wasn’t the chance to get a tour of the birth room etc before making the decision, however my hospital was very modern so I wasn’t worried.

In Japan, you first have to register yourself with any hospital you visit. They take your insurance info and you will have to fill out a long questionnaire about health etc. in order to receive a kind of hospital “members card” with patient number and name.
This card is also used to pay your hospital fees via a computer terminal in the hospital.
That being said – being a spoiled German with free healthcare and coverage – being pregnant in Japan is not cheap! As it is not covered by your insurance..

Pregnancy is not a sickness…

That is a common excuse for the non existent health insurance coverage.
HOWEVER – once you get your pregnancy certified, you can get coupons from the government to partial cover payments. More on that below.

Due to the coronavirus pandemic, the hospital was not allowing any men in the area of the gynecologist (waiting room & check up rooms). Me being there for the first time and not understanding some new vocabulary, convinced them that I needed my man as a translator, so they allowed him to join me for only the doctors consultation. During me sitting in the waiting room as well as the actual ultrasound / checkup, my husband had to always wait outside in the garden until I could call him in just to talk results with the doctor.

Once the pregnancy is determined by the doctor, you can visit your local town hall and register your pregnancy with the government. In return you will receive the “Mother Child Notebook” (母子手帳 – Boshitechou) and this cute sign for your bag which says “there is a baby in my tummy” which signalizes people on the train that you are pregnant – in hope that they will offer you their seat on public transport.
Also a coupon booklet and various information from the city regarding pregnancy and raising a child etc. in your area.

Mind you – even with the discount coupons for every check up, it will still cost you around 2,000 to 7,000 JPY ($20 -$70) per visit. (Price varies depending on what is checked and the hospital you are in) Ultrasound only is cheaper, complex examinations including blood test etc. are more costly.
Also the coupons only cover the common scheduled checkups, so if you have any problems during pregnancy and have to visit more often you have to pay from your pocket (like I did).

Frequency of checkups in Japan is set to:
4th – 11th week of pregnancy: weekly or bi-weekly
12th – 27th week of pregnancy: once per month
28th – 35th week of pregnancy: every two weeks
36th – 40th week of pregnancy: once per week
past 40th week: every 3 days

In my case I unfortunately had a rough start and the doctors found something they couldn’t figure out so I was told to come in every week from the first checkup to check, therefore I ended up paying a bit from my pocket.. Everything stabilized after two to three months though so I went as per regular schedule after.
During each visit you first hand in your “mother passport”, then submit an urine sample in the toilet as well as your blood pressure (taken with an automized machine, which prints out the result) and take your weight, before sitting down in the waiting room.

What I find very irritating in Japanese hospitals is the whole curtain and automatic chair situation. Whilst in Germany you are face to face with your gynecologist, here you can’t see what they are doing to avoid a “shameful situation” I guess? But I am not a fan. Apart from that my whole experience was quite pleasant and the doctors were very nice and explained everything well during ultrasound as well. Some printed me a lot of photos even writing down the body part haha.

My pregnancy in all was quite normal. I did not have many problems, felt same as my “non-pregnant” self. No mood swings, no cravings or aversions, no bladder infection and a very very light morning sickness only in the first 3-4 months. The only thing that made me gag was brushing teeth or even thinking of brushing my teeth haha. I tried different sizes of toothbrushes and many different toothpastes but still no much improvement. Had to just get over it brushing quickly and rinsing my mouth thoroughly.

From around week 20 the first movements in my belly could be felt and it was very exciting as they grew stronger over the following weeks. My absolute favorite part of the pregnancy to feel that there is a little living human inside of you moving around and constantly having hiccups..
Around this time they can also usually tell the gender quite well, however in our case they always said it might look like a girl but not sure, lets see next time. So until quite late I had no much certainty. To be honest I barely told people because I wasn’t sure and kind of wanted to wait to confirm it myself after birth ahah.

Birth expectations during COVID-19

In my 8th month of pregnancy (pregnancy week 30) I finally got to talk to a midwife about the birth. She informed me that the hospital still didn’t allow husbands to join for birth (not before not after) and that he was only allowed one visit some days after birth.
Of course that was the case with many hospitals across Japan and many women had to make do with the situation. However for me it was absolutely scary to give birth alone in another country and just the thought of it made me shiver and cry. Especially since I am with my husband almost 24/7 and we shared all kinds of moments together, it is just absurd that the one time which is probably the most important event in our lives, he can’t be with me…
(I know its a pandemic and many had to endure, but I just could not bring myself to it.)

So here started the search for other hospitals or birthing options which would allow my hubby to be with me. Now during the pandemic the rules kept changing, as the numbers of infected people rose or fell, so there was no much certainty but I needed to try!!
We found one other birth hospital which allows the husband briefly for the moment of birth itself but no before or after visitation. Another option was the transfer to a birth house, which allowed the husband for the full birth but no visitation after. So after a phone call we visited to look at the place and have a talk and see if they would even take me just a few weeks away from my due date. After consultation and getting my records transferred from the hospital I transferred to:

The birth house

A birth house is a place where only midwifes are present. That means no doctor and no cuts or any unnatural interference like inducing or epidural to rid yourself of the pain. It is basically like natural home birth in a larger house or institution. If there were complications during birth, the midwifes would usually be able to tell at an early point or in the worst case you would get a ride in the ambulance to a nearby hospital to complete birth. In order to avoid any troubles in the first place, the birth house has to oblige a large set of rules by the government to ensure safety. (Some factors are position of baby, no pregnancy diabetes, no pregnant women over 35 years, heart rate of baby being not well enough etc. etc.)

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Another big big thing pregnant women in Japan have to go through is “weight bullying”. While the standard in overseas is quite more relaxed, in Japan most women are being told by their doctors to only gain 10-12kg during the pregnancy. That might sound a lot to a person who has never been pregnant, however the truth is that most of this mass is the actual baby (approx. 3kg), uterus (1kg), placenta (700g), amniotic fluid (1kg), increased blood volume (1.4-1.8kg), enlarged breasts and other fluids (1-3kg) and actual fat stores go on top of that – which are needed to have enough energy to breastfeed.
In the hospital they never mentioned my weight much apart from “1kg per month weight gain would be fine” but once I changed to the birth house things changed.

During the first consultation they calculated my BMI and told me I should not gain much more than 2kgs further until birth – at the finale where the baby doubles its weight… According to the safety rules, I would not be allowed to give birth there if over a certain BMI index. And that stressed me out so so much. Further the birth house I chose was rather strict as the owner has a strong mindset when it comes to health etc. and therefore I was also told to:
– go to bed early and get up early
– eat healthy (which I did anyways already), eat warm and slowly
– drink lots of fluids
– eat a Japanese diet
– eat rice and miso soup in the morning
– keep warm
– exercise
– don’t sit in front of PC or smartphone too long

In the beginning I was asked about my sleep times (I still went to bed 1-2 am and slept in) during checkup and I was so stressed about being weighted. From many foreigners but also Japanese I heard similar stories about being pressured and stressed by doctors about weight gain. Apparently some try to always get appointments in the morning without eating and in light clothing for the weight check. Similar story here haha.
Probably due to me transferring to the birth house at a late stage in pregnancy they were a little worried too, so I had to come in for personal training class and had things told extra strict… The exercises and stretches learned I was supposed to do every day, even received a check list. In the beginning it made me really dreadful and I resented going for checkup and constantly being pressured to do exercises while still working and being active myself anyways.

After talking about the weight issue and knowing my maximum weight possible for delivery as well as communicating a little better with the midwifes eventually we got used to each other and I started feeling more comfortable. Everyone was very lovely and I enjoyed that people were very straightforward and warm which isn’t the case usually in Tokyo region. My master midwife even hugged me several times when I was crying or for farewell.
That being said they were super cautious about the coronavirus otherwise, cancelling their classes, not allowing men for checkup (my hubby always had to wait an hour in the garden) and a strict regime of temperature check and disinfectant when entering. Also 1-2 weeks before birth I had to measure mine and husbands temperature every day and log it down in preparation for birth.

Since the birth house can’t take blood or do some other certain examinations, one is required to go to a thorough checkup in a hospital the birth house partnered with in certain stages of the pregnancy. The hospital doctors also have the final say when it comes closer to the delivery date.

The finale

For safety of baby and mother, the birth house is only allowed to deliver the baby around two weeks before and 10 days after the estimated due date. Hence I was super nervous every day if the baby would come in the time frame to deliver in the birth house as planned.
I kept stretching, working out and going for walks for about 1 hour per day – besides still lightly working until the end.

In the birth house I received massages to help relax muscles and encourage a good body posture for smooth delivery and also a … “massage” of my cervix to soften and open it further. (That hurted like a mofo, I’m not going to lie!!) Once my due date surpassed (pregnancy week 40) I got super nervous about the timing and it stressed me immensely as I was so afraid to give birth alone in a crappy hospital in the end.

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At first I had to come in for monitoring of the baby’s heart rates every 3 days, but then one day the heart rate tanked for a short time which was unusual. At this point I had been laying on my back which is usually not recommended for pregnant women. So I switched to laying on my side and the rates were fine, but the midwifes were a little alert, so the next 2 days I had to come in as well to check the rates.
The next day the rates were quite fast, and the baby very active.
My midwife suspected this was a little weird and asked me if I had been drinking enough fluids on the day. I had not and was actually a little dehydrated. Instantly I was given a lot of tea and after a break was hooked up on the heart monitor again. This time the heart rates were fine again. But another point they had consider. The third day the heart rates were totally fine – however for safety they needed to report this to the doctors in the hospital, so there I had to go to said place the next day with my midwife. After a checkup they discussed the matter and the doctor decided that it was just because of unfortunate circumstances and the baby healthy, so I could still deliver at the birth house. What a relief that was.

At this point I was so stressed out from daily visits at birth house or hospital and the commute – eating up most of my day and draining my energy. Further I had to exercise and stretch. What was this about “Enjoy your pregnancy and relax” everyone was talking about? I hadn’t been this drained in a long time.

Now a almost a week overdue, things got really stressful. I walked more, climbed the stairs up and down in our apartment, tried all things everyone recommended to speed up the birth (sex, spicy food, squatting, talking to bump, etc. etc.) but nothing seemed to work. My midwife was also worried, so I had to come in for a sport session. She made my climb the staircase 100! times. (It was so tough omg!) Bouncing on a gymnastic ball, “walking” down the corridor while sitting with legs stretched to the front, squatting walk like a gorilla, nipple and body massage etc. Needless to say that I had the muscle ache of the century in my calves, that I could barely walk for the next 3 days haha. I was so mad and tired at this point.

On a Friday I had to go the hospital again for a last checkup on the baby and the hospital said they wouldn’t wait any longer though the baby seemed healthy. So I got loads of paperwork and instructions to be hospitalized after the weekend to be induced to deliver the baby. Obviously that would have meant to do that alone without my husband.
As the cherry on top of all, the hospital had a small cluster infection of the coronavirus a few days before, so I also needed to get a PCR test to make sure I was negative when being hospitalized. (And there was construction works progressing on the birthing floor…)

When we left the hospital I bursted out in tears again. This is not how I pictured my birth to be.
To calm our nerves my husband and I got some Vietnamese food. As a last attempt to avoid me having to give birth alone in the fairly aged hospital a little far from our home, my husband called our former birth hospital to see if they would take me back. They did not at this point of me being overdue. Another hospital would have agreed to take me on, so we also called my midwife to see if she would give us the medical records to get a second opinion / transfer to another hospital. She was not happy and my husband and her were discussing the matter for a long long time on the phone. We decided to give up for the day and go home…

In the end we did not need a transfer as I had my water break later that night, but that will be another story.

Finally

Due to the coronavirus and me not wanting to give up on the dream of having this baby in presence of my husband, I had to endure a lot of stress. Of course I brought that on myself, but I at least wanted to fight for this important moment in life. Apart from the beginning and the end I had a pleasant pregnancy looking back. I was still working carefully until the end (self-employed life during a pandemic) and I was active and felt great.

Oh and throughout my pregnancy I used this Baby App called Baby+ which has many interesting facts about the development of the baby in the womb, tips for your pregnancy and you can log in your weight gain etc. and log in baby names and many more functions. Loved it!

Next I will write about my birth experience and stay at a Japanese birth house if you are interested.
Let me know if you have any questions about pregnancy or birth in Japan.

Useful Japanese vocabulary during pregnancy / birth

Sorry for the personal post with no relation to kimono on here..
xoxo Anji