Pregnancy in Japan

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Updated 2022-12-02 09:08

Are you or your partner expecting a baby during your stay in Japan? Congratulations! Well, now you need to know how to choose a maternity hospital, how to take care of your baby, get medical examinations, follow up of your pregnancy, prepare for the birth, and how to nurture the father's role, etc. What should you know about pregnancy and giving birth in Japan? Here's our practical guide to welcoming your baby with peace of mind.

How to handle pregnancy in Japan

Speaking of pregnancy and finances might not sound very pleasant. And yet. After the euphoria of the announcement, it is time to take stock of the situation. Being pregnant in Japan will require you to make proper planning, budget, and subscribe to solid expat health insurance. You should expect to pay between 500,000 and 600,000 yen or more. Prices will vary according to the location. In Japan, unlike in other countries, Social Security does not cover pregnancy since being pregnant is not an illness.

But there is good news! The local government covers a good part of these costs. On average, you can expect to get between 3 and 4 free consultation tickets. Here again, the offers differ from city to city. Some municipalities offer additional services, such as home help after childbirth. Depending on your situation and including the help from your municipality, you might have to pay "only" around 100 000 yen. That's still a lot. And that's not even mentioning all the related costs that need to be incurred, like baby food and clothing, furniture, childcare, etc.

Finding a gynecologist in Japan

If you speak Japanese (which is highly recommended), then no problem. Simply do your research on the Internet, ask at the maternity clinic that you have chosen, and use word of mouth. You will easily find a gynecologist.

In case you do not speak Japanese, check your embassy or consulate website. You will surely find a list of doctors who speak your language. Word of mouth can also help in this case. Visit blogs and join groups on social media to get relevant advice.

In both cases, take the time to choose a trusted practitioner. It is always difficult to make up your mind, so you might want to seek advice from friends and family.

Pregnancy follow-up in Japan

In Japan, pregnancy is monitored in a more medicalized than elsewhere in the world. But in the end, there are only a few differences compared to other countries. There are more checkups and exams that can include a monthly ultrasound, even when everything is going well. This "hyper-medicalization" is appreciated by some women, as they feel reassured that they are well taken care of, especially in their first pregnancy. Others, on the contrary, see it as an over-medicalization that does not leave enough room for the emotions of the mother-to-be. Whatever your opinion on the matter, try to look on the bright side. Do not hesitate to express your feelings to the medical team.

In Japan, pregnancy monitoring is carried out at the maternity hospital. The medical team that follows you is composed of an obstetrician-gynecologist and nurses. There is no midwife, but you can benefit from consultations if you wish.

Routine 1st trimester, 2nd and 3rd trimester tests

Blood test
Ultrasound
Weight check (see paragraphs "a very closely monitored weight")
Blood pressure check
Urine analysis
Measurement of uterine height.

These medical checks are mandatory. In case of a problem, doctors can recommend you the screening examination for Down Syndrome (end of the 4th month of pregnancy). Its price varies according to the maternity hospital. The last ultrasound arrives in the penultimate month of pregnancy. During the last month, the mother-to-be and the child are closely monitored.

Sports and diet during pregnancy in Japan

During the first trimester, sports are forbidden, except for moderate walking activity. After the 4th month, you can resume any physical activity that is adapted to pregnant women. This is always subject to your condition. In general, doctors warn against the two major infections that can affect pregnant women: toxoplasmosis and listeriosis.

Toxoplasmosis is an infection that can cause serious damage to the fetus. To prevent it, one should avoid raw vegetables and salads, raw or insufficiently cooked meats, smoked meats, and poorly washed and unpeeled fruits and vegetables. You should also avoid taking care of the cat's litter box, being scratched by a cat, or being in contact with the bare ground.

Listeriosis is a bacterium that can cause premature birth, infections, and even fetal death. You are advised to avoid eating raw or smoked fish, shellfish, raw or unpasteurized dairy products, undercooked or poorly cooked cold cuts, and expired products.

But Japan seems to adopt fewer restrictions. Doctors do not necessarily ban raw vegetables and fish as long as they are eaten in small quantities and are washed properly. Of course, in all cases, alcohol and tobacco are forbidden.

The gestational period in Japan

In the process of buying your pregnancy calendar? Be aware that in Japan, pregnancies last 10 months and not 9. Of course, babies in Japan do not stay longer in the womb. It's just that the Japanese have a different way of calculating the number of months. In Japan, pregnancy is calculated from the first day of the last period, while other counting systems start 15 days after the last period or as from the last day of the last period, or even 7 days after conception.

There's yet another difference! In Japan, the counting is done in weeks of pregnancy, with 4 weeks for a month. Naturally, this shortens a month of pregnancy to 28 days. (7 days in a week; 4 weeks per month. 4X7 = 28 days). But don't panic! Whether you establish your pregnancy calendar according to the Japanese mode or to another one, you will always come up to the same total: 280 days at the end of your pregnancy, except in case of prematurity, over term birth.

Weight-monitoring for pregnant women in Japan

In general, it is claimed that Japanese women only gain 8kg during their pregnancy. The result is usually due to very strict supervision by the doctors. They tolerate up to 10kg maximum, and they keep reminding you how important it is not to gain too much weight. Other countries are more lenient; pregnant women can gain up to 10 or 12kg without fearing medical impact.

Some women are relieved to be that well monitored. Not gaining a lot of weight avoids complications at birth. They will also have less weight to lose. Others, on the contrary, feel less free and have concerns about the drift of hyper-medicalization. This reminds us also that each woman is unique, that no one is a machine, and that gaining or not gaining weight also has a history.

The underweight issue in Japan

The problem is that there are other issues behind the weight. In Japan, some pregnant women are just overly depriving themselves for fear of gaining weight. In 2021, the Japanese Society of Obstetrics and Gynecology (JOSG) sounded the alarm. While there is a lot of talk about being overweight and its consequences, there is not enough explanation about how being underweight can have an impact on the growth of the infant.

The Japanese Ministry of Health, Labor and Welfare reported that in the 1970s, the average birth weight was 3.195kg. It dropped to 3.005kg in 2019. Some might be tempted to say that it's "only 190 grams", but those missing grams can be a problem. At the same time, more and more women are giving birth to babies weighing less than 2.5kg. According to the OECD, in 2018, Japan was the 2nd country after Greece to have a significant number of underweight babies. A situation that the OECD views as "abnormal" for a rich country.

The worrying concept of women's thinness in Japan

According to the Ministry of Health, 21.7% of Japanese women aged 20 to 29 and 13.4% of those aged 30 to 39 have a BMI below 18.5, the "thinness" threshold. Although BMI alone is not sufficient to evaluate body weight, it provides a first reference point. In Japan, fat-phobia is still expressed freely in magazines, on company corridor walls, on TV, in advertisements, and almost everywhere, women's bodies are particularly subjected to this kind of pressure and are vilified if they do not correspond to the criteria of an ever slimmer beauty. This daily harassment, for a cult of thinness, or skinniness at worst, seriously affects the growth and development of infants. JOSG recommends that underweight women gain 10 to 13 kg to prevent under or overgrowth of the fetus.

Doctors also warn about the potential psychological distress of women who are always under hyper control. They call for more global care of pregnant women and respect for their physical and psychological integrity.

How to choose your maternity hospital in Japan?

Is your pregnancy at risk or not? Are you opting for peridural or not? To choose your maternity hospital, take the time to find answers to your questions and list your expectations and needs:

Is it a risky pregnancy? If the pregnancy is at risk, refer to a maternity hospital that takes care of this type of pregnancy.
What is the distance between your home and the maternity hospital?
Would you give birth with or without an epidural (see paragraph below)?
Should the approach be highly medicalized or not? Is there any room for the mother's and father's feelings?
Will the mother be free to give birth in the position she wants?
What type of labor preparation does the mother want?
Will you and your partner be allowed to visit the maternity ward and meet the staff?
How is the stay in the maternity ward? Is there an accompanying bed for the father? Will both mother and father be taught basic childcare skills? Will the mother sleep with the baby, or will they be placed in the nursery?

How to dress during pregnancy in Japan?

Women who don't fit into Japanese standards will testify. It is difficult to find clothes and underwear that will fit a pregnant woman. In Western countries, the large size starts from 44 or 46, and it is already a problem because these fits are not available in all stores. As for sizes 50, 60 and above, they are almost non-existent. We are slowly progressing on the path of the body-positive (acceptance of all morphologies), but there's still a long way to go. It is even more so in Japan, where only a handful of brands (like the famous Punyus) offer trendy clothes for all body types. Brands like Smile Land and Monster Drops offer cool fashion or kawaii (cute) maternity clothes. Nissen and Grand'Amour offer a more casual fashion. Basically, you will find a lot of loose tops (tunics, dresses, shirts, etc.) in pastel colors. They are timeless Japanese fashion, whatever the size.

There are few physical stores dedicated to the oversize clientele. Punyus has a store in the mythical tower at 108, Shibuya. You will find more offers on the Internet, especially for underwear. Not always convenient when you want to try before you buy. But at least you will have a better choice.

Preparing for childbirth in Japan

Pregnancy and childbirth preparation still tend to be perceived as an exclusively female domain. But things are slowly changing. If you and your partner are interested in training together, be sure to tell the maternity hospital you are targeting. Find out what type of childbirth preparation the maternity hospital provides. Is the approach purely medical and/or technical with diapers or strollers, for instance? Or does it also include a more psychological dimension? What place is there for emotional management? How are the exchange groups with other parents organized?

Good to know:

It's very likely that these sessions will be held in Japanese. Hence the importance of learning the language. Even if you don't know the technical and medical vocabulary (many Japanese women will be in the same case), you will be able to exchange with the other mothers-to-be easily.

Giving birth in Japan

Gone are the days of giving birth at home or in unusual places. In Japan, mothers deliver in a medical environment. A special cab service is available 24/7 to take you to the maternity ward when the time comes. You can even book it. You just need to provide your contact information to the cab company. The driver will come to your indicated address and take you to your maternity ward or hospital. The drivers are trained by midwives and have all the necessary equipment for your comfort.

C-sections in Japan

Are there too many cesarean deliveries in the world? The question has been debated within the medical community for many years. In Japan, like in many other countries, the trend is up. Let's recall that a C-section is a surgical procedure. When it is prescribed, it is always performed to save the mother and the child. When done without urgent reason, it becomes a comfort cesarean section, which is not without risk. In 1985, the World Health Organization (WHO) recommended that 10 to 15% of cesarean sections be performed in a country. That was a controversial and misinterpreted figure. The WHO specified that it took into account all the births made in a country during the year, and not only those carried out in a medical environment. It confirmed its statistics in 2015, when more than 100 countries exceeded the 15% mark. Japan is above the 15% mark but below the 20% mark. Sweden is in the same range. Other countries like the United States, Italy, Poland, and South Korea exceed the score of 30%, and some, like Turkey and Brazil, reach the 50% mark.

Do not hesitate to ask healthcare professionals for information, including when a cesarean section is scheduled.

Giving birth with an epidural in Japan

This is the main question that foreign women who give birth in Japan often ask themselves. The country has the reputation of being not very friendly with the epidural, preferring the natural way and the pain that goes with it. The tradition would like Japanese women to give birth without an epidural. Endure pain now to rejoice soon or after many hours, especially when delivery has taken a long time. What to do? Clench your fists and teeth and endure?

No need to panic. Even though epidurals are still uncommon in Japan, the practice is slowly becoming established in health facilities. We insist on the "slowly". Check carefully that the hospital that will receive you practices epidural. In some hospitals, epidurals are not done on weekends and holidays; in others, there is no epidural at night. Insist on your needs and your relationship to pain. Some hospitals think they are doing the right thing by lowering the epidural dose so that you will still feel a little (or a lot) of pain. And sure, you don't always know that. Regarding the price, count 100 000 yen more, on average.

Good to know:

Some hospitals operate on a dose basis. They offer you a "small dose". If you want more, you will have to pay.

Post-natal care in Japan

Congratulations! Your baby is born. The mother will need to stay another 5 days in the maternity hospital. This is the average in Japan. It ups to 7 days for a cesarean section. The nurses/midwives will guide you through your first steps as a mother, namely with breastfeeding, baby care, good gestures to have, and so on.

Medical follow-up

The nurses/midwives will be able to continue to follow you during the first days of your return home. They will continue to accompany you in your new role while remaining attentive to your needs. Do not worry more! As for Baby-blues, depression, stress, questioning, and difficulties in apprehending your new body post-partum, do not forget that there are professionals who are there to monitor the mother's health.

The role of fathers in Japan

Shinjiro Koizumi didn't know it then, but he caused a small revolution that spread all over the world. On January 17, 2020, the then Minister of the Environment became a father. In order to enjoy his family and his new role, he took a 2-week leave of absence spread over 3 months. He worked from home but shortened his days, and remained available for "important obligations". This is nothing exceptional; on the contrary: the minister continues to work. But this was a very first in Japan. Koizumi wanted to be a "new model" for a new generation of fathers, more focused on their families.

In the Japanese tradition, the father is usually excluded from parenthood and the children's education. But things are changing. The new fathers do not want to reproduce the model of their elders and assert it. The law seems to be on their side too. They are granted 1 year's leave, in the same way as the mother. They can even extend it if they don't find a place for their child in a nursery. But few men take their parental leave. Barely 6% on average, compared to 80% of mothers. Of those who do take parental leave, more than 70% opt for the "Koizumi model" and take a maximum of 15 days off work. In Japan, society is still harsh on fathers who take leave. It looks even harder at stay-at-home fathers. Solidarity is organized around associations to curb mentalities.

More information about pregnancy in Japan

Learn Japanese

Learn Japanese. If you've decided to move to Japan, do your best to learn the language. Some expatriate groups complain about the lack of multilingual resources in Japan. The country is trying to adapt (more multilingual resources can be found in Tokyo). This is a problem in every other country in the world. But on your side, put yourself in the shoes of the medical staff, who are also stressed about not knowing how to explain your pregnancy. Speaking Japanese will make things easier for you and for them.

You will not be asked to know medical jargon. The medical staff will explain everything to you in simple terms, but in Japanese, eventually, and you should be able to understand these explanations. In addition, understanding and speaking Japanese will help you to communicate better with other parents and future parents, and later, better exchange with teachers, and school counselors. Even if your child is not in a Japanese school, speaking Japanese will make it easier for everyone to integrate.

Single mothers in Japan

Life is still hard for single mothers in Japan. Their situation is not always understood, and they are not always provided with suitable arrangements like work schedule adjustment or daycare centers. Those who return to live with their parents receive even less support, even when they explain that their parents cannot take care of their child.

Being a working mother in Japan

It is also difficult for mothers to find a professional activity that matches their skills. Those who return to the Japanese labor market are more likely to experience job insecurity, including part-time jobs, demotion, lower salaries (while gender pay discrimination is already significant in Japan), etc. Some companies are still reluctant to hire mothers, considering them to be less "active and available" than men. An injustice condemned by women's rights activists.

Matahara in Japan

The Japanese term "Matahara" refers to the harassment of pregnant women. Some companies still hold on to the traditional mentality that a pregnant woman has no place in the company. Some superiors still push their employees to resign and even, in extreme cases, to abort. This is the type of social pressure that is difficult to bear for the women concerned. With increased work tasks, accumulation of overtime, isolation, bullying, and control of the "pregnancy flow" (not getting pregnant at the same time as a colleague, a superior) some pregnant women are experiencing working conditions that are deliberately made worse to push them to resign. In 2015, the United States awarded the International Woman of Courage Award to Sayaka Osakabe. The Japanese employee filed a lawsuit against her company after 2 miscarriages caused by the harassment she suffered at work. The justice gave her satisfaction. The company was condemned, and ever since, Sayaka Osakabe has been campaigning for women's rights.

Pregnancy in Japan: more tips

Proudly display your pregnancy badge! Your city hall will give it to you when you go to register your pregnancy. It is supposed to free you a seat in crowded transportation. You can show your badge so that passengers can free their seat for you. Unfortunately, in many cases, people pretend not to see it.