Pregnancy in Japan

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Updated 2024-02-28 17:46

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, take care of your baby, get medical examinations, follow up on your pregnancy, prepare for the birth, and 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

If you think you might be pregnant, schedule a visit with an OBGYN to verify your pregnancy. Japanese Health Insurance does not cover pregnancy tests. Typically, fees range around 10,000 yen and can differ based on your situation and the location you choose. You can also find home pregnancy test kits (Ninshin Kensayaku/妊娠検査薬) at pharmacies easily, with prices starting at approximately 1,000 yen.

Speaking of pregnancy and finances might not sound very pleasant. Yet, after the euphoria of the announcement, it is time to take stock of the situation. Japanese Health Insurance does not cover prenatal check-ups. You will have an average of 14 check-ups during pregnancy in Japan, which costs around 5,000 to 10,000 yen or more each without insurance, depending on your chosen clinic.

However, there is good news! You can use discounts or free coupons from your local city or ward office. So, don't forget to report your pregnancy to your local ward or city office. You will receive a Mother and Child Health Handbook and prenatal check-up coupons. With these coupons, the cost of check-ups will be free or significantly reduced. If any additional tests are needed or requested, the price could be higher as coupons only apply to regular check-ups.

You may have to pay an additional fee if you receive check-ups outside the town or ward in which you are registered as a resident. If you have private health insurance, contact them and ask about their pregnancy coverage. If not, you should consider subscribing to solid expat health insurance. Besides, some companies cover all the check-ups, hospitalization, and delivery costs.

Health insurance does not cover childbirth costs in Japan, which typically range from 500,000 to 1,000,000 yen, since pregnancy is not considered a disease. However, you will receive a lump-sum allowance for childbirth if you are under Japanese Health Insurance. Since April 1, 2023, this amount has been increased to 500,000 yen for deliveries at medical institutions enrolled in the Japan Obstetric Compensation System and 488,000 yen for deliveries at non-member institutions.

Remember to show your Health Insurance card and sign the Direct Payment System consent form during hospitalization for delivery to receive the full allowance directly to the hospital. If your expenses exceed 500,000 yen, you will need to pay the difference to the hospital. If your expenses are less than 500,000 yen, the health insurance association will refund the remaining balance without even taking into account all the related costs that need to be incurred, like baby food and clothing, furniture, childcare, etc. Being pregnant in Japan will require you to make proper planning and budget (source: Pregnancy and childbirth in Japan).

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 way than elsewhere in the world. But in the end, there are only a few differences compared to other countries. Some more checkups and exams 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, 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 first, second and third trimester tests

If your first checkup is scheduled between 6 to 8 weeks, you will have 14 checkups.

In the first trimester (early pregnancy to 23 weeks), there will be four checkups, one every four weeks. Necessary medical tests include:

Blood test, blood type (ABO blood type, Rh blood type, irregular antibodies), complete blood count, blood sugar, hepatitis B antigen, hepatitis C antibody, HIV antibody, syphilis serum reaction, rubella virus antibody (one time);
Cervical cancer screening (cytology) (one time);
Ultrasonic examination (two times).

In the second trimester (24 weeks to 35 weeks), you will have a total of six checkups, once every two weeks. Necessary medical tests include:

Complete blood test to check your blood count and blood sugar levels (one time);
Test for Group B hemolytic streptococci (one time);
Ultrasonic examination (one time).

Additionally, you will need to do two specific checkups before reaching 30 weeks of pregnancy, including a blood test to check for HTLV-1 antibodies and a test for genital chlamydia.

In the third trimester, there will be four checkups, once every week. Necessary medical tests include:

Blood test CBC (one time);
Ultrasonic examination (one time).

These medical checks are mandatory. In case of a problem, doctors can recommend 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 [source: Prenatal checkups (Japanese)].

Sports and diet during pregnancy in Japan

During the first trimester, sports are forbidden, except for moderate walking activity. After the fourth month, you can resume any physical activity 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.

However, 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 nine. 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 is 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, 4 × 7 = 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 Japan, the appropriate amount of weight gain during pregnancy has been recommended as 10 to 12 kg for thin pregnant women with BMI less than 18, 7 to 10 kg for normal pregnant women with BMI 18–24, and 5 to 7 kg for obese pregnant women with BMI 24 or greater than 19 (source: Optimal Weight Gain Chart for Pregnancy - Japanese).

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. On the contrary, others feel less free and are concerned 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 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 2021, Japan was the third country after Colombia and 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 insufficient to evaluate body weight, it provides a first reference point.

In Japan, fatphobia is still expressed freely in magazines, on company corridor walls, on TV, in advertisements, and almost everywhere; women's bodies are mainly subjected to this kind of pressure and are vilified if they do not correspond to the criteria of an ever-summer 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 hypercontrol. They call for more global care of pregnant women and respect for their physical and mental 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 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. Finding clothes and underwear that will fit a pregnant woman is demanding. In Western countries, the large size starts from 44 or 46, and it is already a problem because these fits are only available in some 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. Smile Land and Monster Drops offer cool fashion or kawaii (cute) maternity clothes. Nissen and Grand'Amour offer a more casual fashion. 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 oversized clientele. Punyus has a store in the mythical tower at 108, Shibuya. You will find more offers on the Internet, especially for underwear, which is only sometimes convenient if 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.

Insurance does not cover natural (vaginal) childbirth as it is not considered a disease or injury. Therefore, you will be responsible for paying all the delivery expenses. However, insurance does cover cesarean section births since they involve medical intervention. In this case, you will only need to spend 30% of the costs (around 60000–65000 yen) for anesthesia, medication, surgery, hospitalization, and other related expenses.

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 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, thus enduring pain to rejoice soon or after many hours, especially when delivery takes a long time. What to do, in this case?

No need to panic. Even though epidurals are still uncommon in Japan, the practice is slowly becoming established in health facilities. The "slowly" must be emphasised here. 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, fees might be around 150,000 yen for primiparous women and around 100,000 yen for multiparous women, on average (source: About childbirth costs).

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 takes up 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 worldwide. On January 17, 2020, the then Minister of the Environment became a father. To enjoy his family and new role, he took a 2-week leave of absence over three 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 the 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 want to refrain from reproducing the model of their elders and asserting it. The law is on their side, too. They are granted one 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.

However, 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 more challenging for 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 do place 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 communicate better with other parents and future parents and, later, exchange better 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 only sometimes 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 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 or 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 two miscarriages caused by the harassment she suffered at work. The justice gave her satisfaction. The company was condemned, and Sayaka Osakabe has been campaigning for women's rights ever since.