Navigating maternity care in Japan - Caitlyn's Story
Caityln, author of the Little snail...inching along blog (https://inchbyinchlittlesnail.com), has generously allowed me to share her experience of maternity care in Japan. Check out the previous post to read her birth story.
When you find out you’re pregnant in Japan, one of the first things you’ll want to do is “shop around” for hospitals. Despite living in Tokyo, where you might assume there is loads of information on this process available in English, I actually had a difficult time finding out much about hospitals at all. (I will say, however, that had I learned about the Tokyo Pregnancy Group earlier on, I could’ve gotten loads of advice from other pregnant ladies in the city.)
After trying my best to inform myself on a good hospital, I ended up choosing one which is known for being an excellent hospital with great English accessibility. It’s also known for being expensive, but at my first appointment a nurse told me the due amount at birth would be around 90000 yen (somewhere near $900 USD) and I thought that sounded super reasonable. As I mentioned before, this hospital doesn’t offer epidurals unless there is a case of severe pain or other extraneous circumstances, but the quality of the hospital seemed to outweigh my lack of a choice in the matter. No English documents about the price were ever provided to me, so I went along merrily until I was about 37 weeks pregnant. Then came the day in which we got a big shock: when we went to book our room we were told the price before government assistance after birth would be 1200000 yen (over $10,000 USD). It seemed the nurse who I talked to when I first chose this hospital made a serious error in her English. We were speechless, and after leaving the appointment decided immediately that we needed to transfer to a different hospital. Over the next day and a half we were on an incredibly stressful and difficult mission to change hospitals.
At one of the choices the staff said we would need an interpreter to be with us during the entire labor and delivery. This started the process of calling several translation services, but there are no interpreters available on-call. Additionally, we couldn’t find interpreter services that were medical-related (they were all for business). The staff also said that my husband would have to be fluent in Japanese in order to be in the room during labor and delivery (which he’s not). The positive side of this choice would be that after government assistance, the entire fee would be covered. Our boss kindly offered to attend as an interpreter, but we didn’t know when I would go into labor, how long it would be, etc., so that–in addition to the unfriendliness toward non-Japanese speakers–led us not to opt with this choice.
Another choice we were given was to go to a birth clinic, which is connected to our original hospital, but significantly cheaper. However, we were warned that 1 out of 3 women are transferred to the hospital from the clinic and then have to pay the hospital fee anyway. Reasons for transfer could be as small as needing an episiotomy (which I did, in the end). The possibility of being transferred to the main hospital seemed risky to us, so we decided to keep looking.
Ultimately, after getting loads of helpful advice from some friends and from the ladies in the Tokyo Pregnancy Group, we decided to transfer to another hospital. We were very lucky the hospital accepted us as it is generally very difficult to transfer (hospitals in Japan require “booking” early in pregnancy and are super reluctant to accept patients later on in pregnancy). I cannot express how rough the hospital search and transition was, but on the bright side, our overall experience at here was positive.
Above you can see photos of the shared rooms. The private rooms were a little bigger, but much more expensive and (in my opinion) not really worth the extra cost.
Once we switched hospital, I wanted a maternity ward tour as soon as possible. Unfortunately at our new hospital there are group tours scheduled twice a month, and if you can’t attend them, well, you’re out of luck. I’ve since learned that there is an English tour available, but no one told me that at the time, so I was left to do my best with my limited Japanese. This was a little stressful, but not nearly as stressful as trying to make phone calls to the hospital in English.
I had three really rough experiences with calling the hospital. First, a few days before I went into labor, Lillian was putting pressure on some nerves that gave me such horrible leg cramps I couldn’t walk. I was in a lot of pain, and I read online that some women experience contractions through their legs. After several hours, I decided it would be best to call the hospital, but when I called and asked for someone who spoke English, the person speaking just said she would “try her best.”
After about ten minutes of trying to explain my concern without any comprehension on the other end of the line, I started to get really upset and negative (I asked myself why I had to be giving birth in Japan, was getting really frustrated with my Japanese skills, and had started to get scared because I had no idea what I was experiencing as a soon-to-be mommy). With a shaky voice I finally said, “I know you’re trying your best to understand me, but are you sure there is no one else who might be able to speak more English that I could talk to?” And seconds after a “chotto matte” (just a moment), a fluent English speaker hopped on the line. Why she wasn’t put on immediately is beyond me, but it would have really saved me a lot of stress!
The next day I had to call again to make sure of my appointment time for the day after that. Once again I was greeted with mediocre English, and was told that I didn’t seem to have an appointment anymore. I asked if they could please make one as I was already 40 weeks pregnant. The woman said yes, and that I could see the same doctor I saw last time but that he couldn’t speak English. I responded, “Um, I saw a female doctor last time, and she could speak English.” I was then put on hold before she came back on the line and said, “Okay, you can see the doctor you saw last time who can speak English. Is 11:30 okay?” I said yes and then asked if I should come at 10:30 for the NST that the hospital requires for all pregnancies after 37 weeks.
She said, “Why do you need an NST? You are 14 weeks pregnant, right?” “No! I’m FORTY WEEKS. Do you know which patient I am?” I was starting to get pretty frustrated, not to mention surprised and concerned. I had already given my ID number, name, birthday etc., so how were all of these issues arising? She said she knew who I was and that she was sorry because it was her first day (not particularly encouraging…). Then I was told to come early for the NST.
The last difficult phone call was when I was in labor. Long story short, there wasn’t anyone around who spoke basic English when I called to report my contractions, and I ended up having Chad take over because it was too hard to talk anyway. One thing that would have been tremendously helpful to know about is the Himawari Translation Service free for medical interpretation. I think using Himawari could have saved me a lot of headaches (though I still would have been concerned about the mix-ups when I called to confirm that appointment!).
After your baby is born, you stroll them around in little mobile cots when going from your room to the nursery, etc.. Mine was labeled “Dykehouse Caitlyn baby.” Having difficulty communicating was probably one of the hardest parts of pregnancy in Japan, but in the end we got our beautiful girl so it’s been easy to let go a bit with time. After Lillian was born we were able to spend time recovering in the LDR, and I was brought lunch. I heard some hospitals bring a meal for the husband, too, but Chad was left to run up to the hospital restaurant, which was closed for some reason. Sadly, all he could really scrape together was a granola bar and some canned coffee. Our sweet girl at the hospital in one of the super cute robes they provide during your stay. She has already changed so much! My meals were overall really tasty, and were always healthy and balanced. Unless you choose the most expensive private room option (I believe it’s about the equivalent of $700 per day), even your spouse has to adhere to the 1:00-8:00 visiting hours, so I usually was only able to eat with Chad at dinner time. The visiting hours were one of the toughest parts of being at the hospital after Lillian was born.
Spaghetti dinner with tea, soup, yogurt, kiwi, salad and a sweet/savory cheese bread. The other tough parts of my hospital stay were mostly related to being a new mommy than to anything to do with the hospital, though I did have a couple encounters that were unique to foreigners, I think. For example, when breastfeeding, Lillian liked one side better than the other, so I asked if I could pump on one side and dump the milk out (I didn’t want her to be bottle fed before the first month). The midwife looked at me like I was foolish and said, “In Japan we don’t care how the babies get the milk as long as they get their food, but foreigners just want to breastfeed.” Of course ultimately that’s what foreigners want, too, but many mommies value exclusive breastfeeding and don’t want to interfere with that in the first month. I just did what I thought was right, and ignored her comment.
Chicken, tomato, okra and mushroom dinner plate with tea, rolls, crackers, salad and apple slices. Overall the nurses/midwives were helpful, but they weren’t always friendly. Sometimes I wondered if their lack of warmth was from the language barrier, or perhaps because they were just tired like me. (Or…perhaps I was just tired and I was imagining their coolness.) I did think it was strange that staff frequently insisted on having tests I didn’t feel were necessary, like doing NST’s before I was overdue even though everything in my pregnancy was fine, doing all my blood tests again (even though they had gotten the results for the exact same tests a week prior from my previous hospital), and telling me I should get checked for diabetes a month after birth because Lillian was bigger than Japanese babies tend to be (even though my entire pregnancy I was completely normal–at a healthy weight with healthy blood pressure, urine samples, etc.).
Breakfast of yogurt, tea, warm bread slices, salad, milk and orange slices. One nice thing is that the hospital is very up-front about pricing, unlike my previous hospital where no pricing information was given to me in English. At Aiiku, you are given thorough information in English that breaks down the cost of giving birth and the fees for hospital stay. The strange thing is that since pregnancy isn’t covered by insurance in Japan, the fee for giving birth actually decreases if you have any emergency procedures like an episiotomy or a C-section (because those are covered by insurance). So a completely natural birth is cheaper than one that requires more medical attention!
This was one of my favorites: a lunch of potato soup, tea, pizza toasts, mixed nuts, a savory/sweet cheese waffle, yogurt, milk, salad and pineapple. Since we never ended up getting an oven this time around in Japan, we’ve taken to making these pizza toasts in our broiler 🙂 In the end I am glad we were able to transfer. Language barriers happen all over the place in Japan, even in Tokyo, so we’re still dealing with that, but on the bright side now that I’ve gone through pregnancy in Japan I know I can really handle a lot. Often in life you’re tougher than you think, and in my case I ended up with the best gift I could ever ask for: our darling daughter.
I hope this has been helpful to anyone searching for information on giving birth in Japan, or at least of interest to anyone in general!