Congratulations on your pregnancy. If this is your first pregnancy or first pregnancy in Japan, you may be wondering what it’s like to be pregnant and give birth here, particularly if your Japanese language skills are not so great. This guide will attempt to give you the ins and outs of growing and birthing a baby in Japan. I welcome questions and especially welcome your input and experiences.

Being Pregnant

If you haven’t already, you will probably want to do your own pee-on-a-stick pregnancy test before bothering to see a doctor. To learn more about pregnancy tests in Japan, read the excellent post at Surviving in Japan. Once you are sure you’re pregnant, you are going to want to get it confirmed by your doctor and then make a decision as to who will provide your prenatal care.

After your pregnancy has been confirmed by a doctor, they will provide a slip which you take to your local ward office to fill out a notification of pregnancy form. Once you do this they will provide you with a Maternal and Child Health Handbook, otherwise known as the Boshi Kenko Techo. You will need to take this to all of your prenatal checkups and after the birth it will be used to keep track of your child’s vaccination record as well as other developmental milestones. You can even purchase a zip-up case for it from baby stores like Akachan Honpo in which you can also store your doctor’s business cards and your own medical cards too (each clinic you go to will provide you with a membership card). Your ward office will also provide you with the Mother and Child Health Bag containing two forms which entitle you to two free prenatal checkups, information on pregnancy classes and postnatal services, and a birth registration form.

In Japan there are all kinds of options regarding where to give birth. In addition to hospitals (e.g. University teaching hospitals, private hospitals, etc.), there are literally thousands of small OBGYN clinics (known as sanfujinka) throughout the country, where patients numbers are small and service, personal. Another option is midwife run birth houses which promote natural, active birthing. Where you decide to give birth will depend on whether you have a complicated pregnancy, in which case you might feel more comfortable in a hospital, how much you want to spend (some of the fancier private hospitals can cost upward of ¥1 million yen), your Japanese ability (you are unlikely to be rejected for not speaking Japanese but you might decide being able to communicate in your native language is very important in this situation), and finally very important to some expecting mothers, whether the availability of pain relief such as an epidural is important to you.

Unfortunately pregnancy is not covered by your government health insurance but to help you with your costs, the Japanese government awards between ¥300-350,000 (depending on your local ward) per child (or in the case of a miscarriage or stillbirth, once the foetus has reached 85 days or greater). This “gift money” (Shussan Ikuji Ichijikin) is only available if either you or your partner are employed in Japan and hold Japanese health insurance. You have up to two years following the birth to apply for this payment.

It is therefore not a coincidence that many clinics charge around ¥350,000, though it is important to know that you’ll be expected to pay in advance with cash, and will only be receive the government subsidy after the birth. There are some instances where you can make a special request for a part payment before the birth. You should go to your local ward office and enquire.

Another thing to be aware of is how long your prenatal check-ups can take. In some establishments, rather than conducting all the required procedures/observations in the one go, you may find yourself going from room to room as each is done separately, possibly with a wait in between. This can be after waiting a long time past your designated appointment time! Your first visit can give you some indication as to how the practice is run and whether you should bring a good book!

There are several possible points of difference between being pregnant in Japan and elsewhere.

The extra month issue. One of the first things you need to get your head around is that in Japan, pregnancy is considered to take 10 months, not 9, as they use lunar months as opposed to calendar months.

The weight issue. Many doctors in Japan recommend maximum weight gain that is significantly lower than the weight gain recommended in countries like the U.S. and Australia. While Japan’s Ministry of Health, Labour and Welfare has announced that women of normal weight prior to becoming pregnant should aim to gain 7-12 kilos (15-26 pounds), many doctors and midwives still chastise expecting mothers for exceeding a 7-8 kilo gain. In fact, many foreign women I’ve spoken to say that dealing with this was one of the more frustrating aspects of being pregnant in Japan. While this attitude is less common among medical staff used to dealing with foreigners, it is rife in the smaller, Japanese clinics and hospitals. The best thing to do is to aim for a healthy weight gain and try hard to ignore any negative comments.

The prenatal supplements issue. Another big point of difference will be that prenatal vitamins are not normally recommended by doctors. Having a blood test for iron deficiency also doesn’t seem to be routine practice. It is highly recommended that you do take a folic acid supplement for the first trimester (even better would have been to start a month before falling pregnant). It would be a good idea to get your iron levels tested since with the additional iron required to grow a baby, it is not uncommon to develop a deficiency, particularly if you are unable to eat iron-rich foods. If your levels are low, or you are concerned they might become so, you should take an iron supplement, though be careful to take avoid the kind that are constipating. Kenko.com is an online drugstore which also has a very extensive site in English. If you click on supplements and then minerals, you’ll be able to view some of the Japanese brands available. Even if you don’t wish to order online, you can always go to your local drugstore with some ideas of brands. It may also be a good idea to get your levels checked again in the final trimester, especially if you haven’t been supplementing. You may want to take a prenatal vitamin throughout your pregnancy and also while breastfeeding.

The raw fish issue. One major difference you’ll find in Japan is that women continue eating raw fish when pregnant, something that is absolutely not recommended in most if not any English-language pregnancy guides. Many foreign women have reported that when they have expressed their concerns to their Japanese doctor, the reaction has been one of amusement. Perhaps in Japan with the enormously high consumption of fish and scrupulous hygiene practices, serious food poisoning from eating sushi or sashimi is extremely rare. An interesting article on the subject of eating sushi when pregnant can be found here. You will have to make up your own mind whether to partake or not, but certainly if you do, make sure you eat at establishments that specialize in raw fish (e.g. don’t eat sushi at your local izakaya) and are popular with high customer turnover. Aim for quality.

Another seafood related fear concerns how much fish is safe to eat to avoid high levels of mercury. While this matter is rarely discussed in Japanese pregnancy guides, the Japanese Ministry of Health, Labour and Welfare has in fact recommended that consumption of certain fish by expecting mothers is reduced to avoid mercury poisoning. They have an extensive list of seafood and mercury levels on their website, but their general recommendations are as follows:

Bottlenose Dolphin, 60-80 grams per serving, once per two months or less

Bairdfs Beaked Whale, Short-finned Pilot Whale, Sperm Whale, Shark, 60-80 grams per serving, once per week or less

Swordfish, Alfonsino, 60-80 grams per serving, twice per week or less.

All other fish have not been found to cause adverse health effects to pregnant women and should be consumed. Obviously it is up to you to digest the information they provide and decide for yourself.

The public transport issue. If you live in the cities you are likely to be using trains or buses for the majority of your daily travel. Sometimes all the seats will be occupied, and during peak times, you may struggle to find a ‘standing’ spot, let alone a seat. The Ministry of Health, Labour and Welfare have come up with the wonderful idea of creating a “Maternity Mark” in an effort to help create a friendlier environment for expecting mothers. It basically consists of an image signifying pregnancy (different wards can create their own image) on key chains or badges.

Why is this important in Japan? Firstly, Japanese people tend not to ask for a seat even if they are in need of one (senior citizens, pregnant women or parents with small children), so the idea is that those seated will see the “Maternity Mark” and offer their seat. Secondly, many Japanese women remain quite slim even when pregnant, and combined with a tendency not to wear figure-hugging maternity wear, it can sometimes be difficult to even know when they are pregnant. Unfortunately, there are many people who like to use their travel time to catch up on sleep, so even wearing a billboard announcing your pregnancy won’t help if you’re standing in front of someone with their eyes closed. You can pick one up at various railway stations including any Tokyo Metro station but don’t be shy about asking someone for their seat if you need to sit down, or better yet, go to the courtesy seats as there are usually people using them other than those the seats were originally designated for.

The maternity wear issue. One thing that may surprise you is that despite how devoted many Japanese women are to fashion, much of the maternity wear available in Japan is frumpy to say the least. While in many other Western countries, pregnancy is on full display with figure hugging clothes to show off the bump, this is not as popular in Japan though it is changing among the younger set. But don’t even think about wearing a stomach revealing top if you’re pregnant. Furthermore finding the right size to get you through the entire pregnancy might be challenging though the Maternity Wear in Japan article may help.

The keeping fit issue. Don’t be surprised if your gym expresses concern over you exercising when heavily pregnant, or even bans you from doing so, although with the tendency not to use fans in exercise areas, it may be too uncomfortable to work out anyway. If you ride a bike when visibly pregnant, you can also expect complete strangers to admonish you for doing so, as it is considered dangerous. Not to worry. There are plenty of bilingual prenatal yoga classes you can join in the greater Tokyo area, with some of them even allowing you to bring your baby after you’ve given birth. Additionally, it is not uncommon to experience pelvic pain as your ligaments stretch during pregnancy, and likewise, the increased weight and its position in front of your body can also stress your joints and lead to discomfort and even pain. You might consider seeing a physiotherapist for treatment.

The sex issue. What sex issue? Sex during pregnancy doesn't appear to be an issue in Japan because for a lot of pregnant couples, there is no sex. While in the West pregnancy guides might discuss the most comfortable positions for pregnant sex, or even what to expect sexually when pregnant (for example, it is not uncommon to experience an increase in sexual desire and arousal during the second trimester), sex is not given much attention in the Japanese pregnancy tomes. Feel free to break the 'rules'!

The maternity leave issue. According to Article 65 in the Labor Standards Law, employers are required to give 6 weeks maternity leave (or 14 weeks in the case of multiples) prior to childbirth. Additionally, an employer cannot employ a woman within the first 8 weeks following childbirth, though at her request and with a doctors approval, she may return after 6 weeks. Paid leave therefore is available for 14 weeks at 60% of the salary the employee was on before going on leave. Unfortunately, Article 2 in the Childcare Leave Law places restrictions on who is eligible, with casual employees or employees on a fixed contract of less than one year unable to take childcare leave. Contract employees whose contract has been renewed and who have been employed consecutively for a period greater than a year will be able to take childcare leave.

Working mothers with a child aged under one year may also take 30 minutes of childcare time twice a day to nurse their infant. If your child will be in daycare, you may use this time for pick up and drop off instead. Fathers may take childcare leave immediately after the birth, though unfortunately it is extremely rare that any man working in a Japanese company actually does so.

The language issue. For pregnancy, labour, and delivery related Japanese vocabulary, you should definitely print out the helpful list published on the Nagoya Mothers Group website.

No doubt there are other issues. Do let me know what I’ve missed.

Giving Birth

As mentioned above, there are a variety of options available to you in what kind of environment you'd like to give birth in. It's important you start to think about what kind of birth you want sooner rather than later to ensure you don't miss out if places are limited. There are a couple of good maternity support services in Japan which can help you identify what kind of birth you want and accordingly, point you in the right direction. Some further issues you may want to consider.

The pain issue. If you have made up your mind you want a drug free labor and you are happy to not have the option to change your mind during the labor, you will have the widest choice of places to give birth. If you want an epidural or you want the option to have one, then there will be a lot of places you cannot give birth. The midwives clinics for example do not offer epidurals. The philosophy behind a lof of these clinics is one of empowering the mother to give birth the natural way. Yet for other women, the inability to access pain medication or an epidural would be disempowering. Unfortunately, even among the larger hospitals epidurals on tap are not a given. Some hospitals offer epidurals during certain hours, say 9-5pm Monday to Friday. If you come in outside of these hours and need an epidural, you may not be able to have one. Other doctors may guarantee you an epidural but require you to schedule it in advance, that is, your labor will need to be induced.

The rooming in issue. It's rather surprising this is still an issue in some hospitals given all the attention early bonding has gotten. Despite many places adopting the practice of rooming in, there are still some hospitals that keep newborns in the nursery. Again, you need to consider what you want and ask enough questions to ensure your caregivers will respect your wishes.

The formula issue. It's quite common for new mothers to supplement breastfeeding with formula. If you want to exclusively breastfeed you need to make sure the hospital or clinic will give you the support to do so. Ask them under what circumstances they insist on giving formula, e.g. it is common for newborns to lose up to 5-10% of their weight in the first week and it is not a cause for alarm. Unfortunately some caretakers may question your milk output and try to convince you to supplement with formula. Conversely, if you do not want to or cannot breastfeed, you should enquire about what kind of support they can give you to deal with the engorgement and to stop lactation.

Again, I would love to hear from you experienced mums what other issues need to be considered. And don't forget to check out our Pregnancy & Birth Stories pages.

After the Birth

Within 14 days you are required to notify your local ward office of the birth. Firstly, you will need to obtain the Birth Certificate (Shussei Shomei-sho)/Report of a Birth (Shussei Todoke Sho) which your doctor or midwife will provide. You should take this and your Maternity and Child Health Handbook (Boshi Kenko Techo) to your local ward office or city hall, who will then issue you with a Proof of the Report of a Birth (Shussei Todoke Kisai Jiko Shomei-sho).

Within 30 days of the birth you will need to apply for a status of residence for your baby at Immigration. This will not be necessary if you intend to leave Japan within 60 days.

Within 60 days you will need to visit your ward office or city hall to get an alien registration card (gaijin card) for your child.

Don’t forget to take your own passports (for non-citizens) and alien registration cards.