Birth Options in Japan

I was inspired to write this by a comment over on Lulu's blog. It reminded me of how ill-informed I was about what kind of choices I had for my births. Mostly that's because of the language barrier, but also because before I popped my chili peppers out, I didn't have any mommy friends to talk about birth choices with. I have been lucky enough to have two totally different births, and have gathered a lot of information on other choices.

In Japan, you have 3 main choices; a major hospital birth, a clinic birth, or a midwife-attended birth in a midwife clinic or at home. I guess you always have the choice of an unattended birth as well but you'll have to ask someone much braver than me about that! Of course, where you live is a deciding factor for all of these. But even I, in a small city in southern Japan, had more choices than I'd thought.

Hospital births are usually reserved for high risk births, but not always. The pros of a hospital birth are; specialist doctors are right there, you can have more interventions if necessary, and if either mom or baby need specialist care after birth, you can stay in the same hospital rather than mom or baby being transferred alone. The cons are; more regimented care, rooming in is probably discouraged or outright banned (because you'll be staying with 5 other women), babies are likely to be given sugar water or formula before mom's milk comes in (this affects breastfeeding), short visiting hours meaning less chance for daddy to meet the baby, more interventions for the doctor's convenience, and long waits for prenatal appointments with rushed doctors. Also, if there are no beds available you can be denied a place. My pregnancy with Little Fish was difficult and it looked like I was going to have to give birth in a big hospital in the city, but I was able to avoid that. I was pretty disturbed by the impersonal nature when I went for checkups on my pregnancy. I also got some very outdated information about breastfeeding and mastitis at 3 different big hospitals which was very concerning.

Most women in Japan give birth in private clinics. The care at these clinics can vary greatly depending on the philosophy (or ego) of the doctor who runs the clinic. Usually these hospitals are pretty nice, focusing on a long and relaxing stay for the moms (5 days after a vaginal birth is standard, at least 10 days after a cesarean). You can usually pay extra for each night stay to get a private room so daddy /other kids can stay overnight.

Little Fish was, luckily, born at a private clinic which was pretty nice, rather than the big hospital where I was going to have to give birth if things didn't go well. They let me go home after 3 days (I do not like staying at hospitals), the food was decent, the lactation consultants were very helpful, and I could room-in or have the baby in the nursery, as I chose. When I got a very bad case of mastitis (made worse by bad advice at a hospital), Little Fish was able to stay with me at the clinic (at 8 months) so he could continue to nurse (the best way to get rid of mastitis) while on an iv drip. The down side for me was that I felt pressured into an induction and that led to a long uncomfortable labour because I couldn't move like my body was telling me to, and I wasn't ready for labour. Other than that my experience was good- but it really depends on the type of clinic it is. There is a WHO-introduced standard for care which promotes breastfeeding called the Baby Friendly Hospital Initiative. You can search for a clinic/hospital that has been given a BFH designation here.

The midwife-assisted birth option is the one I personally like best, but you need a healthy pregnancy to do it. It's also the cheapest option. You need a backup doctor as well. If you give birth at the clinic they will have a backup doctor, but you need one near(ish) your house (or your mother's!) for a homebirth. Also, you can only have a midwife-assisted birth from Weeks 37-42. Midwife clinics are rarely fancy, but the give really good care. Usually there are a few large tatami rooms and the whole family rooms together. Mom can give birth there or in a labour room. Midwives can give pitocin if necessary and have all sorts of other things to help you out, they don't just show up with a couple towels and put the kettle on! What I liked about the midwife-assisted birth was that I was never rushed. Each appointment included an ultrasound and was at least an hour long. I felt that they always listened to me, and that they were truly excited to help me get the birth I wanted. Cupcake's birth was long but nowhere near as painful as Little Fish's, just because my body was ready, I didn't have a heavy heartbeat monitor around me at all times, I could move how my body told me to, and the midwives were there for just me so I didn't feel bad about asking them to apply counterpressure. Being in the bathtub was great for managing the pain too.

Very few women in Japan choose homebirths, but I'm sure it's the same percentage of North American women. Everyone I talk to in Japan about homebirth is interested but worried about their small houses. I think that homebirths will start to be chosen by more and more women the world over in the future.

If you are looking for a midwife clinic or someone who will attend a homebirth, the Japan Midwives' Association has a list of members and what they provide on this page.

The one constant in Japan is that you get an ultrasound at every appointment. They don't do blood hcG checks or anything, just ultrasounds. Normally it is the doctor (or the head midwife) that does it rather than a trained sonographer. Also, there is a focus on unmedicated births. Although there are more places now that offer epidurals (my backup clinic for Cupcake is one), it is still a rare choice. The costs are pretty high, between ¥50 000 and ¥90 000 (USD 500 - 900).

The other big thing that is different in Japan is that most women stay at their mother's homes during their confinement, from about 36 weeks until the baby is about 6 weeks old. I think that is very helpful, but honestly, I think that recovery takes longer if you aren't allowed to exercise during pregnancy or eat anything for fear of gaining more than 5kg in 40 weeks, and you are supposed to stay laying down for a month after birth. We went out a few hours after Cupcake was born to buy a watermelon juice at the department store next to our house and it was fine. I thought we might have given the old women there heart palpitations though!

I found my best resource is the health centre in my city run by the municipal government. That's probably where you will go to get your mother-child handbook at 8-12 weeks. Of course, if you want to choose a provider before then you can totally call yours and ask for information. The nurses who work at mine were very helpful and looked up all the information I needed to know about homebirth regulations and even got 4 different doctors to agree to be homebirth backups for women in my city. They have all the info on playgroups and kindergartens and other resources for babies and toddlers. If you are looking for area-specific information, definitely call your local health centre.