Pregnancy and birth: What to expect- maternity clinics in Japan

Here I share my observations and perceptions based on my pregnancy and birth experiences from 2012 to 2020. These are my own generalizations! Please remember that you own experiences are as valid, even when they are the absolute opposite.

I have had three uneventful uncomplicated pregnancies and gave birth at three different clinics in Kansai area in Japan. Maternity clinics in Japan can greatly vary with some being similar to big hospitals- private or public, that are one birthing option, others similar to smaller midwife-led clinics, another birthing option. There are other options as well, that are less popular.

Generally speaking, the facilities are good and the equipment- up-to-date; the environment- clean and tidy.

The service offered at clinics is usually great and the staff has been trained to treat patients with great care. The other side of the coin being that the numerous rules and terms of service can be restrictive and leave little space for flexibility.

Medical care during pregnancy

Some places take appointments to minimize the waiting time and in others, no appointment is required. Some are open till 7 or 8 pm on weekdays with quite a few open on the weekends, too.

The routine procedures of regular check-ups slightly differ from clinic to clinic. Basically, it is a blood pressure check, taken by yourself at a monitor or by a midwife, weight gain check, and a urine test.

Expect comparatively brief consultations, with ultrasound and sometimes an internal examination, during which there is a curtain between the doctor and the patient (typical for all GYN check-ups).

During my last pregnancy because of COVID19 restrictions, no family members were allowed during the check-ups. Before that, you could be accompanied by a partner or your kids.

The regular pregnancy check-up schedule, with slight variations, is similar throughout the country:

First trimester- check-ups every two or three weeks (or every month)

Second trimester- every month

Third trimester- every 2 weeks; after week 36- weekly

After the due date- every two days

Fetal monitoring is regularly performed after week 36-37 at some places. At my last clinic, where they are devoted to minimum medical interventions, they monitored only once in week 37. Read more about my third birth experience here.

All my babies arrived after their due date. With my first, after the due date passed, I had to go in for monitoring every other day. It was the same with my second.

There is an ultrasound checkup during every hospital visit. At some places, you can get a 4D ultrasound every time, while other places offer them once or twice throughout the pregnancy for an additional fee.

Some clinics offer to keep a record of all of your examinations on a CD or a USB or give you online access.

Doctors

There are Engish-speaking doctors but it may take some research to find one because some may not advertise it. When I first arrive in Japan halfway through my pregnancy I was very lucky that the doctor at the closest maternity clinic, that we liked, agreed to use English with me upon request.

The doctors are usually polite, respectful, a little distant. By the end of my pregnancy, I was feeling a bit more at ease and the doctors warmed up a little, too.

My first doctor was kind, caring, calm, and to the point. For my second pregnancy, the main doctors were more reserved, but always polite.

My third pregnancy doctor was chatty and down-to-earth- a bit different from the typical image in Japan. Sharing a lot of his personal experiences around childbirth and parenting he was truly supportive. I loved him for being himself, though I somehow had a hard time truly connecting to him. Because I had my expectations and wishes for the birth itself, I had a hard time completely relaxing because there was an older doctor at the same clinic that was more traditional and less willing to accommodate my needs. I did trust all my doctors, though.

What bothered me a little during my second pregnancy was that occasionally one of my doctors did not directly address me during the consultations but talked to my husband which made me feel belittled and a bit stressed. 

Choosing a doctor

Seeing the same doctor during your visits or not. It depends on the place- for smaller clinics, with one or two main doctors, most probably you can get the same doctor every time. At bigger places, clinics or hospitals, you may know the availability of your doctor so that you can arrange accordingly. At other places, you may need to resolve to see whoever is on duty.

My second pregnancy was monitored at a big-sized clinic where I saw a different doctor each time- three or four doctors rotating- and I still managed to build up some trust and familiarity. It did feel a little less personal than the first time when I saw the same doctor every time.

Reserving a place to give birth

Usually, people book the place and pay a deposit very early in pregnancy, about 10 w-12w. Different clinics will have different time limits for that -about week 16. The deposit fee varies and may or may not be required. Early in pregnancy, you may be given documents covering the clinic policies and the details around labour and hospitalization. A few people may switch hospitals right before giving birth to be closer to their family of origin for more support. 

Pregnancy weight

The pregnancy weight gain recommendations in Japan are lower than in the western world. My doctors often commented that I should be able to better control my weight. I gained 15 kg during my first pregnancy, which was over the recommended. (I lost 7-8 kg right after delivery and I was able to return to my pre-pregnancy weight after a month, thanks to my mother-in-law’s cooking. Needless to say, my body was different and my body shape has changed.) I gained 14-15 kg during my second pregnancy and about the same with my third. The recommended weight gain for me was 7-8 kg and I was not overweight pre-pregnancy. The pregnancy weight gain debates are numerous and I will only say that comments to control my weight without much follow-up guidance caused some stress.

Birth preparation

Usually, you can attend birth preparation courses and parenting classes. Some places may offer yoga or pilates, swimming, or breathing techniques training. Sophrology is what seems to be popular here- very similar to hypnobirthing.

You can read more about what I did to prepare for birth and labour. Check with your provider what is offered now that things have been changing because of Covid precautions.

Around week 35-37 there may be an organized talk or one-to-one meeting with a midwife to discuss birth preparation, hospital procedures, and you may be given a one-page form with a few questions about your birth preferences (birth plan). It will vary from place to place but this is the time to share your own wishes and preferences. In my experience, people do trust their providers and do not have many requirements.

My own mistake before my first was born was that I did not take full responsibility and expected my medical team to do more for me. In a way, I gave away my own power. I share more about my first birth experience here. For the next pregnancies and births, I did spend more time mentally preparing. Thus I was able to own my own preferences and had more control -the control I had willingly given up during my first labor.

Clinics usually provide a booklet with the clinic schedule, procedures, detailed information on pregnancy, labour, hospitalization, nutrition, etc.- some useful and practical tips. I would also do my own research in case some of the information was outdated.

Basically, you get information in advance about all the services available not only at the particular clinic but also in your city. In the booklet, there is information about the clinic contacts, how to safely get to the clinic, what you need in your hospital bag, etc.

There might be an organized tour of the clinic for you to familiarize yourself with the environment- to see the delivery room, the birthing theater, the rooms. Again, things are different now with Covid precautions.

Induction

As my babies were born after their due date, I needed to discuss induction three times. For my first, my doctor knew I wanted to avoid induction, if possible and he agreed to wait up to 14 days if there was no indication for any issues with me or the baby.

Close to my due date with my second the doctor informed me that they do inductions in week 40-41 without giving me more options, which caused some worries and pressure. I wanted to wait till week 42 but I decided not to start a discussion right away as I wanted to better prepare and negotiate during my next appointment. Meanwhile, they offered acupressure and acupuncture treatments to help labor start naturally, which I was really happy about. I had one appointment at the clinic and got some moxibustion sticks to use at home for a few days in a row. Then my baby arrived before I could have a next appointment so I still wonder how my negotiations would have gone. Read more about my second birth experience.

Labour and delivery

During labour pre-covid partners or anyone you want in was allowed in the delivery room for support, but now there are few places that let partners in. They do exist, though! Visitors used to be allowed to see the babies but that also changed.

Clinics here tend to be more on the conscious side and would admit women earlier, even if labour is not fully established. While I have also heard stories of people in active labour being sent back home to wait, my experience has been that doctors would rather have you in the clinic, in the pre-delivery room to reduce the risk of any unpredictable complications.

Some clinics may offer one room where you will be till the arrival of your baby. In most clinics, however, there is a delivery room to stay in until you are ready to push and a birthing theater to be moved to once you are fully dilated and ready to push. Some places may offer beautifully furnished dim-light rooms with aromatherapy to promote relaxation and an intimate atmosphere, while other places have the well-known sterile hospital look. You may have access to a birthing ball, or some kind of a rocking chair, etc. and you may ask for music/CD to be played.

Once you have been admitted, you can freely move and stay active until fully dilated; the baby is monitored all the time, and the cables make it a little uncomfortable when switching positions for comfort and relief; you may be given routine glucose transfusions, depending on the time of the day, food is served, too.

When you are ready to push, the expected position instructed by midwives is supine, on your back. The bedhead may be raised a little upon request and they may guide you to put your body in C-shape. Of course, there are exceptions- in my humble experience, it is not easy to find places, especially clinics and hospitals that will agree on a birthing position different from the norm. (Though I gave birth on all fours it was not pre-agreed- read more here)

Some midwives will instructions on your breathing, while others will offer little guidance. Usually, there are two nurse-midwives providing care- one being the lead midwife, while the other has a supportive role. Their encouraging words and their energy will mean everything to you at that moment.

When the baby is crowning you may be encouraged to touch the head in an attempt to regain your strength and for reassurance.

The doctor is called for this part and he works together with the midwives. The doctor or the midwife will catch the baby and pass them to you after they make sure the umbilical cord is long enough/not on the way. At some clinics, they place a protection pad/mat under the baby before they place them on your belly or on your chest.

Kangaroo care seems to be controversial here and is not always offered. Early skin-to-skin contact is encouraged but it depends on the clinic’s guidelines how it happens.

The delivery of the placenta- gently pulled by the doctor or waiting for a natural delivery. This is something that can be discussed in advance if the clinic does not provide detailed information beforehand.

They showed me the placenta, the umbilical cord and the sack. A placenta disposal fee is charged.

Two-hour bedrest with ice packs on belly for the mother after they have examined for bruises or tears and done any stitches, if necessary.

While they wipe and clean the mother, the baby may be placed in a cot next to the bed and their measurements- taken. They wipe and wrap the baby, then give it to the mother to hold for a while; first breastfeeding attempts (latching) before they take them to the nursery for a pediatric check-up. With my third son, instead of rushing to measure and wipe him, they just wrap him and we have been given a lot of time together, to hold him and to connect, which was amazing. I was extremely happy about the way they handle it. You can read more details about my third birth experience here.

The nurse-midwives are fast and skillful- everything gets quickly cleaned and tidied, they help you stand up (or wheel you in a wheelchair), and transfer you to a clean bed/your room.

Post-partum

The hospital stay is usually 5 nights for first-time moms and 4 nights for consecutive births. There is a schedule to follow – regular morning visitations, baby daily routine, check-ups, baby bath lessons, life with baby lectures, etc. They would hand you a printout accompanied by a thorough explanation. It is a busy time, a few days in-between life- before and after; days for rest, magical moments of stillness, days to get to know your baby, and an opportunity to receive advice and support from a very supportive staff.

Most clinics count the day of the delivery as Day 0, the next day as Day 1. This is important to know because on Day 0 they normally keep the newborns in the nursery for close observation. Then, from Day 1, they encourage the mother and the baby to room share. You can always drop the baby at the nursery any time you want, during the night, too. For my third, I negotiated to have him with me as soon as the pediatrician checked him.

After my first labour I could take a shower 24 hours after birth (vaginal delivery, with episiotomy). The second time they also mentioned 24 hours but also said I could try earlier if I felt ready (vaginal delivery, mild tearing). After my third labour, I got an ok to take any time unless I was feeling dizzy. They would give you a quick sponge bath right after the delivery.  

Private room vs shared room – most clinics offer private rooms with a separate toilet. Private bathrooms are available, too. I had private rooms the first two times and shared a room the third time (four-bed spaces separated by a curtain with a shared bathroom with a bathtub for soothing bath soaks).

The food is served in the room, occasionally a dinner or lunch together with other moms may be organized.

The food is amazing- four-star if not even five-star restaurant food- a fine attempt to pamper the mother, to make her feel cherished, taken care of, to let her rest and enjoy her stay. There is also a special congratulatory dinner, with the option of your partner joining. A tea-and-snack corner opened through the night. The food is nutritious, diverse, plentiful, served at certain times. Some places offer some options to choose from and they are be accommodating if you have special requirements.

Every clinic has its special treats for mom and baby- you may get gifts and congratulatory messages, flowers, birth videos, and baby first photos, baby first cry recording, etc. Right after my third delivery, a member of the staff came to present me with a cute flower arrangement. Then I got a sweet photo stand with our first photos with the baby. The most sentimental gift we got was our baby hand-and-foot print and a haiku poem written by the veteran doctor. Before going home you may be gifted a special massage or a facial at the site.

The baby may be fed formula in the very beginning and the bottles are usually provided by the clinic in case you want to substitute with formula until breastfeeding is better established. My last clinic was Very pro breastfeeding, even more than the first two. They all encouraged and helped with breastfeeding but it felt like they would completely support anyone who decides to use formula.

Breastfeeding exclusively- Only at one clinic they actually asked me in advance if I wanted the baby to be given some formula to supplement in the beginning or breastmilk only. In the first days, it will be closely observed if the baby is gaining and staying hydrated. They offered amazing support to establish breastfeeding.

Very proactive marketing policies of baby formula companies- we got a free can of the formula for the hospital, two or three free cans when we left. I do not judge anyone who chooses milk formula, I respect you all and the decisions you make. We all make decisions based on love.

Diapers- free packs of diapers may be provided during the hospital stay; at my last clinic, they did disposable diapers for the first 2 days, cloth diapers for the last two days.

You will get samples, coupons, and discounts for various services, formula freebies, etc.

Most probably you will get a booklet with further information on all aspects of the postpartum period (check out my post on postpartum) and the numbers and contacts you may need.

Mom and baby are due to return to the same clinic for two follow-up consultations- at two weeks and a month after birth.

The last clinic I was at takes it further. They regularly organize family activities as your child grows- not only during the first year but beyond. We are to receive a video message from them when my son turns 20.

The nurse-midvives

I have nothing but deep respect for these heroes. They work day and night, making sure all goes smoothly, and if it doesn’t they are still there for you. They offered advice, encouragement, and kind support. The midwives I met on my journey were nothing but supportive and devoted. I truly admire them for their love for what they do.

I hope that what I shared is helpful! I will be happy to answer your questions, so please get in touch!

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