Birth, Having a Baby in Japan
We moved to Japan in
March, 2002, and confirmed one month later that we were pregnant.
We already had a two year old daughter, so we had some idea what we
were doing and what to expect. But having a baby in a new
culture is bound to offer challenges and surprises. We would
like to share our story with others, so you can benefit and learn
from our experience. I want to be clear that our story is just
ONE example. You can have a variety of birth experiences in
Japan, and there are different kinds of doctors and hospitals.
However, I will risk making some generalizations starting with this:
If you want a particular type of birth experience in Japan, you may
need to work hard to make it happen.
UPDATE: Our kids are growing up! For the latest see my ongoing blog at
I (Andy) am writing
this article because my wife, Hitomi, doesn't have the time.
Neither do I, but that's life now. I wish you could see all of
this through her eyes directly, but I'll do my best to share our
You also should know
that I arrived in Japan with zero language ability, but
Hitomi is Japanese. Obviously, her ability to speak Japanese
helped a lot. It helped us to better understand the process we
were going through, the cultural stuff and the choices we had to
We actually suspected
we were pregnant before arriving in Japan, but there was no time to
think about it for the first three weeks. We found an
apartment, a language school, moved in (to the apartment) and
handled countless logistics. Sometime during the whole process
Hitomi went to a drugstore and bought a pregnancy test, and it was
positive. She tried to take it easy throughout the whole
moving process, but even
"taking it easy" was hard work.
A few days after
moving in to our apartment, we took a short walk to use a pay phone.
Hitomi suddenly said we needed to go home, because she might be
having a miscarriage. That evening we sat around in shock and
regret. The next morning she went to a nearby women's clinic.
When she came out of her appointment, she had an odd look. The
doctor told her that we had not one, but two healthy babies in
there. That's how we learned we were expecting twins.
Choosing a Doctor
and a Hospital
We live near a train
station about 30 minutes outside of Tokyo. It's a newly
developed area, so we have many services nearby. As we got to
know our area, I was surprised that we could easily walk to several
clinics and small hospitals. There was even a "famous"
maternity clinic about five minutes walk from our place.
We learned a lesson
when we had our first daughter. If you have expectations about
how childbirth should be handled, then choose your doctor and
hospital carefully. If you want to simply put yourself into the hands
of a doctor and do whatever he/she tells you to do, then that's
different. In our case, we wanted a
good doctor who would work with us on the
We didn't have a long
list of particulars, and I don't think we are radical by any means. Here
are the things we wanted most, if possible:
Natural delivery (not
a C-Section) unless there was a danger to the child or mother.
For us that meant not
using painkillers, not inducing labor unless medically necessary and
not delivering from the old fashioned "flat on the back, feet in
The father in the
the baby starting immediately after birth.
Total rooming in
(meaning the baby doesn't sleep in the hospital nursery but in the
room with the mother, so the two can bond naturally and the baby can
nurse on demand).
The ability for me to
sleep in the hospital room, which is basically necessary in order
for total rooming in to work.
In order to make a
list like this work, we knew we would need good communication with
doctor and the hospital nursing staff, and the hospital would need
matching facilities and policies.
We figured we had a
lot going for us. We lived near several maternity
hospitals, and at least one birth clinic. Plus, we had the
impression (from things we had heard in the USA) that the Japanese
medical profession is much more natural in their approach to birth
than their counterparts in the USA. On the other hand, having
twins complicated our situation. Doctors and hospitals are
more cautious with multiples, and we realized we might have to be
The first thing
Hitomi did was to make an appointment at the "famous" maternity clinic
near where we live. The clinic was founded by Catholics many
years ago. The current doctor is the son of a "famous" doctor.
The clinic looks like a large, converted home. It's a brick
building that looks like someone's dream house. Inside it
feels homey, too, except for the reception desk, packed waiting room and the
glass window where you can always view a row of newborn babies.
As you may have
noticed, I'm enclosing the word "famous" in quotes. In virtually every
category of life here, people will say, "So and so is famous."
There are "famous" stores, resorts, soaps, towels, ramen, cream puffs,
loaves of white bread and much more.
I have tasted and experienced a number of famous things, though, and I'm
convinced the label is often either randomly assigned or (more
likely) the result of clever marketing. In the case of this
birth hospital, it had been featured on a TV show that many people
watched. In particular, the TV show highlighted the building's
architecture and history, the elegant furnishings, the doctor's "famous"
father and the excellent cuisine served to new mothers.
(Actually, you can hardly watch a TV show on any subject that
doesn't highlight food, and I've never seen
anyone eat a bite of food on TV that didn't throw him/her into
contortions of culinary ecstasy.)
So on with the story.
Hitomi had an appointment with the doctor. He was in a hurry
(more on that later) and didn't appreciate her questions.
His brief answers communicated that she would give birth
according to his routine and schedule. She would be on her
back in the old fashioned position for the delivery. If the babies weren't coming out
naturally by the 36th week, then he would induce delivery.
Twins often come out early, but routinely inducing birth for twins
in the 36th week was shocking to us. She could
start nursing the babies right away, but they would be confined to
the nursery for most of the first three days. He was genuinely
irritated at her questions, so my wife didn't press much further
That was enough. We started looking elsewhere, although
to see this doctor for routine checkups. At this point, we
started to learn that we had few options. Several hospitals
declined to handle twins at all, including the one natural birth
our area. We have a large hospital at the next station.
When Hitomi called and briefly interviewed the head nurse, the nurse
said that she was the first person who had ever asked such
questions. That hospital has a policy to completely separate newborns from their mothers
for the first three days, although they might allow short visits for
nursing. The point is for new mothers to rest and recover,
leaving the babies in the care of the hospital.
We eventually learned
that the hospital in my wife's hometown (two hours away by train)
was open to most of our priorities. Many Japanese women go to
their hometowns to give birth. They leave their husbands for
about three months, and then return with the baby. We never
intended to consider this strategy, but we were desperate to find a
hospital that would work. In the end, we all moved to Hitomi's
parent's house. We get along well with her parents, and they
have a big house, so that was not a problem. We moved in early
October with the twins due in mid-November.
Doctors, Hospitals and Nurses/Mid-Wives
I feel like I have left
much already. It would be impossible to
condense our insights into a short narrative, so I want to pause
here and summarize a few thoughts. Keep in mind that hospitals
and doctors vary. There are a few large, teaching hospitals in
Tokyo and Yokohama where many internationals like to go. I
assume that the experience at those hospitals would be quite
different, though not necessarily better.
Doctors are addressed as "Sensei" in Japanese. That's the same
term used for teacher, professor and priest. Traditionally,
people with the title of "Sensei" are not questioned. They
are the keepers of knowledge, and their students/followers/patients
are passive recipients. Patients who ask questions may be seen
as offensive or irritating. Non-Japanese patients may think
their doctors are secretive or even rude. For this reason,
internationals tend to identify and seek doctors who are culturally
sensitive to their needs, and some clinics specialize in treating
internationals. We didn't take that route, primarily because
we didn't have a car and don't live near to such a place.
One more thing worth
understanding is that the medical profession does not have the
social standing in Japan that it enjoys in some other places.
In Japan, social status is determined by the group you belong to.
If you are in a more solitary profession, such as doctors or
dentists, you don't have a group to belong in that gives you status.
You may earn lots of money, but you don't have the social rewards
that go with it. In short, doctors may try to preserve their
authority and respect in their clinics and hospitals, because they
lack status outside their own environments.
doctors we saw were incredibly busy. They were seeing patients
and delivering babies all day. We have
never been asked to schedule an appointment to see any doctor in
Sometimes Hitomi would show up and see the doctor right away.
Other times the waiting room would be packed with thirty or more
women. Once when we were visiting the "famous" maternity
clinic, a nurse announced to a
packed waiting room that the doctor would not see anyone for the
next half hour, because he was delivering a baby.
a doctor is seeing over a hundred patients a day, and delivering five or
more babies in between consultations, he/she may not have time to
answer questions. Our doctor didn't even dispense basic advice.
He didn't say anything about nutrition. There was no mention of calcium intake,
and he discouraged taking vitamins.
His number one response to inquiries was, "Don't worry about it."
The next doctor, in my wife's hometown, was easier to talk to and more forthcoming.
However, he also gave no substantial suggestions beyond his plans
for the actual delivery. We had
one appointment in which we spent about 30 minutes asking him
questions. When we left there was
a line of women waiting in the hallway. We felt a bit guilty, but it was a relief
to finally talk with him about the process.
There are many small hospitals in Japan, including maternity hospitals that specialize
in nothing but childbirth. The hospital that
we eventually chose was named "Nagai Maternity Hospital." Our
doctor was Dr. Nagai. His father had built the hospital, and
now the son owns and operates it. This is pretty common. His
hospital is a fairly large
facility, so he has another doctor working with him. That
makes two doctors handling the entire hospital, including pre-natal
care, birth and post-natal care (the hospital did not have a
pediatrician). About five babies were born every day.
The doctors were assisted by a number of nurses and support staff.
Compared to hospitals in the USA, this hospital seemed small.
But it was considered somewhat large and modern by Japanese standards. The
big teaching hospitals in Tokyo and Yokohama probably feel more
familiar to Americans, which is why many Americans prefer them.
If you don't have a
car, you may have to choose from the hospitals and birth clinics
near where you live. Our city hall gave us a helpful guide for
our local clinics and hospitals, containing a survey of mothers
describing the maternity hospitals. This would have been very
useful, except the hospitals we liked most (the ones with the most
natural approaches to birth) wouldn't accept twins.
- When we started looking at our options, we noticed that most of
the hospitals worked with mid-wives. In the USA, mid-wives are
virtually synonymous with "natural delivery." But that's not
necessarily so in Japan. In the nearby hospitals, mid-wives
worked with mothers prior to the delivery (mainly making them
comfortable), but doctors delivered all the babies. We have
spoken with other mid-wives who have confirmed that doctors
monopolize control of the birth process in most situations.
The lack of empowerment can really weaken the role (and, in some
cases, the abilities) of mid-wives.
In our experience,
the nurses also worked under the doctor's firm authority. Once
Hitomi was checked into the hospital, she asked the nurses a lot of
questions about the birth process. Some of the answers were
alarming, because they completely contradicted what we had heard
from the doctor. For example, she was told that she wouldn't
be able to nurse the babies right away, that the babies would be fed
formula, and that they would have to stay in the hospital nursery
for three days. We had been assured quite differently about
these things, but the nurse said these were all hospital policies.
Then Hitomi noticed that the nurses contradicted each other on these
points. After we spoke with the doctor, he apparently gathered
the nurses all together and informed them of the policies that would
apply in our case. That resolved all the inconsistencies right
away. Despite their confident show of authority, it went to
show how little the nurses were actually empowered.
The Birth Story
Moving ourselves over
to Hitomi's parent's house was a major event, although we have
gotten pretty good at these things by now. She scheduled an
appointment with Dr. Nagai later that week. We enjoyed a
peaceful week, and then all our plans changed in a day. When
Hitomi saw the doctor, he said that one of the babies was in the
breach position. He recommended that Hitomi go on bed rest in
the hospital for the remainder of the pregnancy as a precaution.
At first, we rebelled. First of all, it seemed overly
cautious. Doctors know that most Japanese mothers work hard
in their homes, and the only way to force them to rest is to check
them in to the hospital. At least that's my theory. I
also suspect that Japanese doctors are just very cautions in
general. I couldn't imagine an American doctor giving the same
advice. Or could I??
Hitomi on bed rest for 4 weeks (Andy
goes hiking on nearby mountain...)
The problem when
you're living in another culture is that you lose perspective, and
then it's hard to think straight. Hitomi's parents clearly wanted us
to follow the doctor's advice, and she didn't want to do anything
that might endanger the health of the babies. We made some
calls. My father is a doctor. He thought the doctor was
being extremely cautious, but that bed rest itself was not a bad
idea. To make a long story short, my wife checked into the
hospital a couple of days later.
Initially she was
placed in a room with five other beds. Each of the beds was
behind a curtain in a small space, with a television and food tray.
Three of the other beds were occupied, but you could hardly hear a
sound from the women. This culture values personal space so
highly, and making noise in public places is considered rude.
So everyone kept their curtains shut, and they didn't talk to each
other. The thought of her being confined there for a month
seemed awful, so after a few days we asked for a private room.
We wondered about the economics of this decision, but no one seemed
to know the details of what insurance would and wouldn't cover --
I'll say more about that later. At any rate (pun intended),
the private room was a huge relief. We have a two year old
daughter, and we were all able to be a normal family together during
visiting hours each day (about 4pm to 8pm).
I didn't mention this
before, but Japanese doctors tend to discourage mothers from gaining
much weight during pregnancy. American doctors, especially the
ones who seem to speak with the most knowledge, recommend at least a
minimum amount of weight gain. We had learned basic principles
from our previous pregnancy, like eating well, getting lots of
calcium, and drinking LOTS of water. We also learned that with
twins, you should concentrate on eating and drinking even more.
But in the hospital
Hitomi was on a low calorie diet, and her meals each came with a
small cup of tea. We started bringing two liter bottles of
water, and she was drinking about one per day. That's the
recommended amount for mothers expecting twins (from the best books
we could find) . But the growing pile of empty two liter
bottles really worried the nurses. They told Hitomi that if
she drank too much water, she could retain water and develop Edema.
But that's just wrong. Edema isn't caused by drinking too much
water, but by other dietary and physical factors (the very things
that no one talked about with us). In the end, we carted off
the empty bottles every night.
Although one baby
remained in the breach position, Hitomi and the babies remained in
great health. When we finally had our long (30 minute) consultation
with the doctor, he told us we would have to have a C-Section due to
the position the babies were in. We accepted this advice.
It was probably a conservative opinion, but we weren't going to
argue with our doctor over something he thought was medically
appropriate. Anyway, we really didn't have a choice at that
We did have a choice
about when to schedule the operation. The doctor suggested two
dates: the beginning of the 36th week and the beginning of the 37th
week. The doctor said that waiting would increase the risk of
an emergency C-Section (and the risk that he would have to interrupt
his busy schedule at an inconvenient time). We chose the
latter date, in order to give the babies as much time as possible to
develop in the womb. Considering the good health of Hitomi and
the babies, I think even the 37th week was a bit early.
The date arrived.
Sometime before the operation Hitomi was given her first round of
drugs, and then they dressed her in tight leggings to prevent blood
from clotting in her legs. This was all outside of visiting
hours. I arrived about an hour before the scheduled time.
She had been wheeled into another room, and she was feeling really
good because the drugs were working. When the time came, the
nurses came and wheeled her across the hall and through some double
doors. I wasn't allowed inside that room. I caught a
look through the door and I could see why. It was a strictly
utilitarian operating room, with a cleaning bucket (for who knows
what) sitting unceremoniously in the middle of the floor. Later, Hitomi confirmed that the atmosphere inside was all business.
I waited outside,
pacing and feeling like I was living out a scene from a movie.
I prayed a lot and kept trying to hear something through the doors.
After about a half hour, a nurse indicated that a baby was coming.
I grabbed my video camera and zoomed in through the window to catch
each baby getting bathed in a side room. Then they were carried
out and placed in incubators next to the nursery window. I
alternated shooting video and pictures until Hitomi came out, and
then I followed her up to the room.
We had two healthy
twin girls. The first, Mari, weighed 2644 grams; the second,
Maika, weighed 2712 grams -- good sized babies considering they were
born three weeks early.
Mari and Maika in incubators immediately
If they had been born
naturally, they could have gone straight to our room. As it
was, the hospital requires 24 hours in the incubator after a
C-Section. The doctor had agreed to our request not to feed
them sugar water or other supplements, so that we would have the
best chance of getting them started with nursing when the time came.
By the way, in most cases, it's no problem for a baby to wait 24 hours for the
first feeding in a case like this. Most babies can go for up to three
days with little or no actual intake (that's about the amount of
time it takes for most mothers to start producing a strong flow of
milk). The exception is if the baby's blood glucose level is
low (usually measured using a heel stick soon after birth). In
that case, there is a danger of hypoglycemia, and feeding the
baby a supplement can help prevent serious, long term complications.
Again, you need to be in the care of a doctor you can communicate
with and trust, so that you'll be ready to follow his/her advice in
situations like this.
Following the Birth
Hitomi continued to
feel quite good for the rest of the afternoon. Having the babies in
the nursery was not ideal, but we took advantage and rested.
Sometime during the night, the pain began to hit her. A nurse
came and gave her some pills, which helped a little.
The next afternoon
they finally brought the twins to our room. Hitomi was able to
nurse them right away, and they latched on even better than our
first daughter did. We were so grateful! I'm sure my wife's experience helped a
lot. After that, the babies only left our room for a morning
bath and a daily weight check. We were a bit nervous about
having them weighed. Newborns who are being nursed always lose
a little weight in the first few days, and then they gain it back.
We were afraid that the hospital staff would make an issue of this.
Just before the babies were born, we heard that another mom wasn't
allowed to take her baby home right away because it's weight was too
low. Anyway, they did lose some weight, but it was ok.
The hospital staff were quite impressed at their birth weight and
how quickly they started gaining weight again.
Hitomi in her room after the delivery;
Mari and Maika in our room on day three
We had supporters and
detractors from the start. The mid-wives at the hospital also
doubled as lactation consultants. They were very neutral at
first, and didn't provide the kind of push Hitomi really would have
appreciated. But when they saw we were determined to nurse the
babies, they were more encouraging. A couple of nurses had good
intentions, but they weren't that helpful. One told Hitomi
that nursing would be too painful and difficult. Another said
or hinted similar things, as if to let Hitomi off the hook. In
both our minds, nursing the babies was one of the best gifts we
could give them. Ultimately, it was Hitomi who endured the
pain and sleeplessness to make
The C-Section itself
was easy compared to delivering our first daughter naturally with no
pain killers. But a great thing about natural childbirth is
how quickly the body recovers. The contractions during birth
start the process of returning the uterus to its former size.
Nursing provokes further contractions, which continue the process.
The pain may be intense during labor, but it's quite bearable
because your baby is being born.
In the case of a
C-Section, you usually have the operation before your body goes into
labor. So you skip the contractions, especially the really
strong ones that push the baby out. But the real pain comes in
days two through four. That's because the uterus still needs
to contract to it's original size. Hitomi was given a Pitosin
IV to stimulate contractions. In addition, she was nursing,
which naturally stimulates contractions. Finally, she had
twins, so her uterus was the size of a basketball (or so). The
point is that it was very painful. The worst pain was when she was
nursing AND on Pitosin, which provoked the strongest contractions.
That's the pain the nurses were warning her about, and it's the
reason why many new mothers give up and send their babies to the
nursery. Hitomi thought this pain was worse than when she
delivered our first child naturally.
We had a HUGE
advantage over the other mothers -- me. I stayed in the
hospital the entire time and helped Hitomi nurse the babies day and
night. It was a lot of work, and I can't imagine how she could
have done it otherwise. Maybe she could have handled one, with
the help of the nurses, but not two. Another advantage is that
Hitomi knew what she was doing, because we had great support with
nursing when our first daughter was born. The hospital had
some posters in various places that advocated nursing, but the staff
didn't provide much help.
On the other hand,
all the new mothers were required to attend a seminar taught
by marketing reps from a formula company. These reps briefly
extolled the values of nursing, and then they talked about formula for
the rest of the time. Each mom got a bag of goodies, including
baby clothes, bottles and formula, of course.
I don't want to wrap
this up without mentioning the morning routine. Every morning
at 8am sharp, the elevator doors opened and both doctors came out.
They were each carrying clipboards and followed by two nurses
pushing carts of supplies. Each doctor went to a door, burst
in, and then burst out two or three minutes later. They
quickly checked the moms and babies. The hospital did not have
a pediatrician on staff, just these two doctors who provided 100
percent of any doctoring that was done before, during and
I never got to see
what went on during the morning checkups, because I was exiled to
the snack room where I sat and watched them move through the
hallways. During one of those mornings, it occurred to me that 90
percent of the time these two doctors were the only males in the
entire building, always surrounded by female nurses and patients who
completely accepted their authority. They were immersed in
this reality for most of their waking lives and couldn't have had
much time or energy for anything else.
Andy and Reia hold a baby (on Andy's
couch/bed); and friends visiting
By the time we
checked out, I think we had attained legendary status. We
stuck out and gave the staff many reasons to remember us.
First, there was my wife's big, blue inflatable nursing pillow
(special ordered from
www.twinstuff.com for nursing twins). Then there was her
incredible perseverance to keep nursing, after a C-Section, through
the pain and lack of sleep. I think most of the staff expected
her to give up, but she kept going. Then there was the babies'
healthy birth weight and weight gain, not too mention their
cuteness. Finally, if all that wasn't enough, there was this
blond, blue eyed 6 foot 3 inch American man living in the hospital,
roaming the halls late at night and riding
off to Starbucks every day on a giant mountain bike.
By the way, we stayed
in the hospital for ten days. That's a pretty
standard amount of time following a C-Section. It could be
more or less depending on the hospital. I don't remember the
expected length of stay for natural deliveries, but it was several days.
The Bill and
I'm not going into
great detail here. I just think it's worth saying a little
about the finances. We have Japanese health insurance.
If you are covered by Japanese health insurance, your policy and
payment amounts may vary depending on where you live. We live
in Yokohama. Even though we gave birth in Odawara, the amount we received was affected by the
system in our city.
In our case, we
received a lump sum of for several thousand dollars. It came
in two parts, with the first payment coming a couple of months after
the babies were born. That means we needed to pay the hospital
up front, and the payment was a reimbursement. We paid the
hospital a large deposit in advance, and then we were expected to
pay the rest when we checked out.
In addition to this
lump sum, our insurance eventually sent another payment for some
expenses covered separately.
Since we had twins,
we received a larger amount than you would receive for a single
baby, and it seemed like a lot of money. In fact, some
people told us we would make money off the whole thing.
However, Hitomi spent an entire month in a private room. The
difference in cost between the private and group rooms was not
covered, so we had to pay that ourselves. In the end, we ended
up paying a significant amount. But the charges for the
private room were absolutely NOTHING compared to the what a similar room would
have cost in the USA. When you consider what we pay for
insurance here, our medical care has been quite inexpensive.
On top of that, we
learned that the city of Yokohama pays a monthly subsidy to families
with young children in order to help with the extra expenses. They pay
5000 yen per month for the first and second children, and then
10,000 yen per month for each child after that. You have to
apply at your local city hall to receive these payments, and they
continue until a child is five years old. We're very grateful
-- every bit helps.
My wife is also Japanese. After your twins were born, were
they registered in your wife's family registry? I would like are
children to have my Family Name. Were you able to register your
twins in your name or did they have to be registered with a Japanese
family name? We would really appreciate your insight in this.
It is a little difficult to get straight answers.
When we got married, my wife changed her name in her Japanese family
registry to my last name spelled in Katakana.
All of our kids are likewise in the family registry under the same
name. If you want to register their names in Romanji (English letters), that may be a problem. On their
passports, they have a choice of either Katakana or Romanji.
Keep in mind that you can register them differently in the two home
countries. For example, in the USA our daughters each have
middle names, but in Japan they are officially registered with
just first and last names. They don't use middle names in
Japan, so we chose not to register them with one here.)
Comment: (from Cornelia Kurz of TokyoWithKids.com)
readers might find the following link useful: Japan With Kids -
Forums: Immigration/visas/re-entry permits: Baby born in Japan --
Great job on your webpage. I agree with about 90% of your opinions
and recommendations. There is only one I take issue with and would
suggest you add a caveat. Regarding intake by the newborn in
the first days after birth. It's true the baby won't starve or be
harmed by minimal intake. However blood glucose must be monitored,
this is done with a heel stick. It is particularly important in
cases where the mother either had gestational diabetes or a family
history of diabetes. Babies who are either small for gestational age
or large for gestational age (over about 3,500 grams) are also more
likely to see a drop in blood glucose levels. The research on this
is very clear, there are serious long term implications from
hypoglycemia in newborns (learning disabilities, lower IQ, etc). I
agree it's best to only offer the breast, with the only exception
being evidence of lowered blood sugar in a baby who cannot (or will
not) latch on. In US nurseries the standard of care is to do a heel
stick on all newborns approximately 4 hours after birth, and if they
show clinical signs of hypoglycemia (most commonly jitteriness).
I reply to this both as a mother (son born in Sicily 1993, daughter
born in England 1997) and a nurse/family nurse practitioner.
Congratulations on your lovely twins and older daughter. Started the
college and wedding fund yet? :)
Thanks for the correction. I used this information to edit the
part of the article that you were referring to. Thanks to
anyone who takes the time to point out errors or parts of this story
that need clarification.)