I'm often asked where it was easier for me to give birth, Japan or France? While my experience was surprisingly similar in both countries, it was definitely much more of a struggle in Japan. In this post I'll share with you all that you need to know in a step by step guide on giving birth in Japan.
Table of Content
Overview on Giving Birth in Japan
Japan is a developed country with a high standard of health care and a low maternal and infant mortality rate.
Pregnancy and childbirth in Japan are not covered by the general health insurance, but there are various subsidies and allowances that can help reduce the cost.
For example, there's the “childbirth lump-sum allowance” (出産育児一時金, shussan ikuji ichikin) which amounts to ¥420,000 ($2,929). However, it does not cover the whole sum of delivery-related expenses, so prepare to pay at least extra 100,000-200,000 Yen out of pocket.
Expecting mothers need to obtain a Maternity and Children Health Handbook (母子健康手帳, boshi kenko teccho) from their local city office, which contains important information and records of their pregnancy and child's health. Together with the book, expecting moms also receive an envelop with coupons which covers part of the planned screenings and check-ups fees (although it seems that the Japanese government is currently in the talks to cover birth expenses fully.)
Moms also need to choose a hospital or clinic where they want to give birth, and book a bed as early as possible. Please keep in mind that some hospitals may refuse accepting you if you book later than 33 weeks and the general rule is to book before 20th week. Another thing to keep in mind is that once you are booked into a hospital, you will need to attend the check-ups there. So, if your hospital of choice is at a lengthy train commute, you might want to reconsider (I've stuck to my choice and it was not an easy deed to have to spend 1 hour in trains each way + 4 hour at the waiting room for each check-up, especially at the final weeks of pregnancy).
Speaking of check-ups, the prenatal check-ups in Japan are frequent and thorough, and include various tests and scans, such as ultrasound, heartbeat measurements, blood tests, etc. The delivery options are mostly natural, with epidural anesthesia being rare and expensive. The postnatal care is usually longer than in other countries, with mothers staying in the hospital for about a 5 -7 days after giving birth. They can also receive home visits from midwives or nurses, as well as free massages and house cleaning services from the local government (services may differ depending on your area in Japan).
Epidural and Natural Birth in Japan
One of the challenges that many foreign women face when giving birth in Japan is the difficulty of getting epidural anesthesia or other forms of pain relief during labor and delivery. Epidural anesthesia is a procedure that involves injecting a local anesthetic into the lower back, which numbs the nerves that carry pain signals from the lower body to the brain. This can help reduce or eliminate the pain of contractions and pushing, and make the birthing process more comfortable and manageable.
I've had natural births in Japan and and one natural and one epidural birth in France, and, while epidural does carry certain risks, I must admit that my birth experience was the most pleasant and relaxed with the epidural.
However, epidural anesthesia is rare and expensive in Japan, and not all facilities or doctors are qualified or willing to administer it. In other words, it's very rare.
Japanese people value comfort a lot (I'm thinking of you TOTO toilets, but not just), yet the fact that epidural availability is almost non-existent in Japan deeply puzzles me. It's not a complicated procedure and doesn't require any special equipment. I could think that it's due to personal preference, but to form a personal preference, one must first have the choice between several options. Often, there is no such choice, so even if a mother educates herself about epidural and wants it - she can't get it.
Personally, I find it cruel, anti-women and inhuman. I know I'm using very strong words here, but there's no justification as to why women should go through excruciating pain that can be avoidable. Don't get me wrong - giving natural birth, which I did 3 times, can feel very rewarding. But it can also feel very traumatic, exhausting, painful, and frankly, remove women's will to go through it again (and maybe that's why birth rates in Japan are falling record low year by year?)
As a result, only about 5% of women in Japan receive epidural anesthesia during childbirth, compared to about 60% in the United States or 40% in the United Kingdom. Most facilities in Japan only offer natural birth without anesthesia, and even without the "laughing gas" (nitrous oxide) that can provide some mild pain relief. Some facilities may offer epidural anesthesia as an option, but they likely to charge extra fees (up to 200,000 yen or 1,800 USD), have limited availability (only during certain hours or days), or have strict criteria (only for low-risk pregnancies or first-time mothers).
Therefore, if you are planning to give birth in Japan and you want to have epidural anesthesia or other forms of pain relief, you should research and ask many questions before choosing your place of delivery.
Step 1: Confirming Your Pregnancy in Japan
If you suspect that you are pregnant in Japan, you can buy a home pregnancy test kit from any pharmacy or convenience store. If the result is positive, you should visit a doctor to confirm your pregnancy and estimate your due date. You can go to any hospital or clinic that offers obstetrics and gynecology services, but I advise to choose one that is close to your home or workplace, as you will need to visit it regularly for check-ups. The first visit will cost about 5,000 to 10,000 yen, and will include a urine test and an ultrasound scan.
*Important note: many, if not most, clinics and hospitals won't have English speaking personnel and doctors. The ones who do, usually cost more and may not be covered by the coupons you will receive from your ward, so please always check ahead.
Step 2: Getting your Maternity and Children Health Handbook
Once your pregnancy is confirmed, you should go to your local city office to register your pregnancy and get your Maternity and Children Health Handbook (Boshi Kenko Techo). This is a small booklet that contains important information about your pregnancy, such as your blood type, medical history, test results, weight gain, fetal growth, etc. You will need to bring this handbook with you every time you go for a check-up or a hospital visit. You will also receive some maternity vouchers (Ninsanpu Hoken Hiyō Hojoken) that can be used to reduce the cost of your check-ups at the hospital or clinic. The number and value of these vouchers vary depending on where you live, but they usually cover about half of the cost of each check-up.
Step 3: Choosing your place of delivery
One of the most important decisions you need to make is where you want to give birth. There are different types of facilities that offer maternity services in Japan (more on them below), such as general hospitals, maternity hospitals, maternity clinics, or birth centers. Each facility has its own advantages and disadvantages, such as the level of medical equipment, staff qualifications, availability of emergency care, delivery options, cost, atmosphere, etc. Join ProMaman moms community to discuss which place is most recommended and will best suit your needs or contact the experts on ProMaman (Douala, nurses, etc.) for a professional opinion.
The options in facilities and differences in giving birth in Japan are:
• Clinics with obstetrics/gynecology facilities: These are small and specialized clinics that offer prenatal care and delivery services. They usually have a cozy and homely atmosphere, and a close relationship between the staff and the patients. They may also offer some natural or alternative birthing methods, such as water birth or aromatherapy. However, they may not have advanced medical equipment or emergency care, and they may not accept high-risk pregnancies or complicated deliveries. They may also have limited beds or availability, and they may charge higher fees than other facilities.
• General hospitals with obstetrics/gynecology departments: These are large and comprehensive hospitals that offer a wide range of medical services, including prenatal care and delivery. They usually have modern and well-equipped facilities, and a high level of emergency care. They can handle high-risk pregnancies and complicated deliveries, and they can perform cesarean section if needed. However, they may not have a personal or intimate atmosphere, and they may have strict rules or protocols that limit the choices or preferences of the patients. They may also have long waiting times or crowded wards, and they may charge lower fees than other facilities.
• Maternity hospitals: These are hospitals that focus on maternity care and delivery, and they may also have other departments such as pediatrics or neonatology. They usually offer a balance between medical safety and personal comfort, and they can provide various services such as prenatal classes, breastfeeding support, postnatal care, etc. They may also offer some extra amenities such as private rooms, baths, TVs, Wi-Fi, etc. However, they may not have all the medical specialties or equipment that general hospitals have, and they may not accept very high-risk pregnancies or very complicated deliveries.
• Birth centers: These are facilities that are run by midwives who provide prenatal care and delivery services. They usually emphasize natural and holistic birthing methods, and they have a family-oriented and relaxed atmosphere, with some literally looking like (or being in!) someone's private home, therefore some home-like amenities such as kitchens, living rooms, gardens, etc may be available. However, such facilities do not have doctors or advanced medical equipment on site, and they do not offer any pain relief options or interventions. They only accept low-risk pregnancies and normal deliveries, and they transfer any complications or emergencies to nearby hospitals. They may also have very limited beds or availability, and they may charge higher fees than general hospitals.
Home-births in Japan are not popular (975 for total of 811,622 births in 2021 with overall decline from1,138 home births in 2015, according to Japanese government statistics), however you may search for midwife services that provide it.
The factors to consider when choosing your place of delivery:
• Location: You should choose a facility that is easily accessible from your home or workplace, especially if you plan to have a natural birth, without anesthesia. Don't forget to take into account, the traffic conditions during various hours of the day and the availability of public transportation or taxis in case of an emergency.
• Cost: The cost of giving birth in Japan varies depending on the type of facility, the length of stay, the delivery method, the use of anesthesia or pain relief, etc. The average cost of giving birth in Japan is about 500,000 yen (about 4,500 USD), but it can range from 300,000 yen (about 2,700 USD) to over 1 million yen (about 9,000 USD). The lump sum birth allowance (Shussan Ikuji Ichijikin) from the government covers a good chunk or most of it, though. This allowance is usually about 420,000 yen (about 3,800 USD), but it may vary depending on where you live. You will need to apply for this allowance at your local city office after giving birth.
• Service: The level of service and comfort offered by different facilities can vary greatly. Some facilities offer hotel-like amenities such as private rooms, baths, TVs, Wi-Fi, etc., and some even offer water births. Others offer basic facilities such as shared rooms, communal baths, etc. Some facilities also offer extra services such as prenatal classes, breastfeeding support, postnatal care, etc. You should choose a facility that meets your needs and preferences.
• Staff: The staff at the facility can make a big difference in your experience of giving birth. You should choose a facility that has qualified and experienced staff who can communicate with you in a language you understand. You should also check the staff-to-patient ratio and the availability of doctors, midwives, nurses, etc. Definitely ask about the staff's attitude and philosophy towards childbirth, such as their views on natural birth, epidural anesthesia, cesarean section, etc.
• Delivery options: The delivery options available at different facilities can also vary. Most facilities in Japan encourage natural birth without anesthesia, but few may offer epidural anesthesia or other forms of pain relief. However, epidural anesthesia is rare and expensive in Japan, and not all facilities or doctors are qualified to administer it. You should also ask about the possibility of having a water birth, a birth ball, a birth stool, or other tools or methods that can help you during labor. You should also ask about the policy on induction, episiotomy (which is widely practiced in Japan), forceps, vacuum extraction, cesarean section, etc.
Book your place of delivery as early as possible, preferably before the 20th week of your pregnancy. Some facilities may have a waiting list or limited available spots. You may need to pay a deposit or sign a contract when you book your place of delivery.
Step 4: Attend regular check-ups
You will need to attend regular check-ups throughout your pregnancy to monitor your health and your baby's development. The frequency and content of these check-ups vary depending on your condition and the facility you choose, but they usually follow this schedule: • 4 to 10 weeks: First visit to confirm pregnancy and estimate due date • 10 to 16 weeks: Second visit to check blood pressure, weight, urine test, blood test (including HIV test), ultrasound scan • 16 to 22 weeks: Third visit to check blood pressure, weight, urine test, ultrasound scan • 22 to 28 weeks: Fourth visit to check blood pressure, weight, urine test, blood test (including glucose tolerance test), ultrasound scan • 28 to 34 weeks: Fifth visit to check blood pressure, weight, urine test • 34 to 36 weeks: Sixth visit to check blood pressure, weight, urine test • 36 to 38 weeks: Seventh visit to check blood pressure, weight, urine test • 38 to 40 weeks: Eighth visit to check blood pressure, weight, urine test • After 40 weeks: Weekly visits until delivery. Each check-up will cost about 10,000 to 20,000 yen (about 90 to 180 USD), but you can use your maternity vouchers to reduce the cost by about half. You will also receive some documents from the doctor after each check-up that you will need to keep in your Maternity and Children Health Handbook. Step 5: Prepare for delivery
There are many things to prepare for as your due date approaches. Arrange your transportation (If you don't have a car, I recommend using a taxi service) and inform your employer: If you are working during your pregnancy, you should inform your employer about your due date and your maternity leave plans. If you won't be receiving salary during your maternity leave from your employer, apply for the maternity allowance (Shusan Teate) from the government. Maternity allowance covers the period of 42 days before the birth, to 56 days after the birth of your child.
You may be able to negotiate a longer or shorter period of maternity leave at your company, depending on your situation and your employer's policy, with some cases extending the maternity leave to 1 year.
Paternity leaves are also possible, although culturally very few fathers actually take them.
If you're a first-time mom, it's a good idea to attend prenatal classes to learn more about pregnancy, childbirth, and parenting. Some hospitals and clinics offer these classes as part of their service (some are free), or you can find them at community centers or online. Some of the topics that they usually cover are:
• Stages of labor and delivery
• Signs and symptoms of labor
• Pain relief options and their pros and cons
• Breathing and relaxation techniques
• Positions and movements that can help during labor
• Possible complications and interventions
• Postnatal care and recovery
• Breastfeeding basics and tips
• Newborn care and development
Hospital Bag Essentials- What To Pack in Your Hospital Bag For Delivery/Birth:
Pack your hospital bag: You should pack a bag with everything you will need during and after your stay at the hospital or clinic. Some of the items to include are: • Your Maternity and Children Health Handbook • Your health insurance card and/or your My Number Card • Your passport and residence card • Your bank book or cash card (for paying the hospital fees) • Your phone and charger • A change of clothes and underwear for yourself • A nursing bra and pads • Toiletries such as toothbrush, toothpaste, shampoo, soap, etc. • A towel and a bathrobe • Slippers or socks • Snacks and drinks • A book or magazine • A camera or video camera • A gift for the staff (optional) • Clothes and diapers for your baby • A baby blanket and hat • A car seat or baby carrier (if you plan to go home by car) Step 6: Delivery Day - Stages of Labor and What to Expect When you go into labor, you should call your hospital or clinic to let them know that you are coming. Follow their instructions and bring your hospital bag and all the required documents with you. When you arrive at the hospital or clinic, you will be checked by a doctor or a midwife to confirm that you are in labor and to assess your condition and your baby's position. You will be likely asked to fill in some forms and pay a deposit for the hospital fees. You will then be taken to a labor room where you will be monitored and assisted by the staff. The labor process can vary depending on your condition, your baby's position, and the facility's policy. "Birth Plans" are not a common thing in Japan and likely be ignored, but you can still try and negotiate certain things (like being able to play music, etc).
The labor and delivery usually consists of three stages: • The first stage: This is the longest stage of labor, lasting from several hours to more than a day (38 hours, in my case with my eldest). It involves the dilation of the cervix from 0 to 10 centimeters. During this stage, you will experience contractions that become stronger, longer, and closer together. You may have some bleeding, mucus discharge, or water breaking. You can cope with the pain by using breathing and relaxation techniques, changing positions, moving around, taking a shower or, if your water hasn't broken yet and the facility has this option- a long soak in a bath. You can also have some snacks and drinks to keep your energy up. • The second stage: If you don't have complications/don't need C-section, this is the stage when you push your baby out through the birth canal. It can last from a few minutes to a few hours. During this stage, you will feel a strong urge to push with each contraction.
Regardless of whether you've taken epidural, you will be guided by the staff/doctor on when and how to push effectively. You may also use some tools or methods such as a birth-ball, a birth stool, or a water birth (if available). You may also have some interventions such as an episiotomy (a cut in the perineum), forceps (metal instruments that help pull the baby out), or vacuum extraction (a suction cup that helps pull the baby out) if necessary.
Once the baby is out, the baby will be immediately cleaned and dressed by the staff (in the same room).
• The third stage: This is the stage when you deliver the placenta (the organ that nourished your baby in the womb). It can last from a few minutes to an hour. During this stage, you will have some mild contractions that help detach the placenta from the uterus wall. You will be asked to push gently to expel the placenta out of your body. You may also receive an injection of oxytocin (a hormone that helps contract the uterus) to speed up this process and prevent excessive bleeding.
After delivering your baby and the placenta, you will be checked by the staff for any injuries or complications. You may receive some stitches if you had an episiotomy or a tear in the perineum. You will also receive some medication to prevent infection and pain. You will then be able to hold your baby ("Kangaroo Care") skin-to-skin and breastfeed him or her if you wish. Your baby will also be checked by the staff for his or her health and vital signs. He or she will receive some treatments such as eye drops, vitamin K injection, hepatitis B vaccine, etc.
After delivery you will be moved to a recovery room or your own room. You will be monitored by the staff for any signs of bleeding, infection, or other problems and receive some advice on how to care for yourself and your baby.
Step 7: Receiving Postnatal Care in Japan The postnatal care in Japan is usually longer and more comprehensive than in other countries. You will stay in the hospital or clinic for almost a week after giving birth, during which you will receive medical care, nursing care, and parenting support from the staff. There will be some tests and check-ups for yourself and your baby, such as blood tests, urine tests, weight checks, hearing tests, etc. Guidance on how to breastfeed, bathe, change, and soothe your baby will be also provided. After leaving the hospital or clinic, you will continue to receive postnatal care at home or at the facility. You can have home visits from midwives or nurses who will check your health and your baby's health, as well as provide you with some advice and support. Certain check-ups and procedures will require your visits to the facility. Be sure to check with your city ward office about the free or subsidized services from the local government, such as massages, house cleaning, babysitting, etc. Register your baby's birth at your local city office within 14 days after giving birth. For this procedure, bring your Maternity and Children Health Handbook, your health insurance card and/or your My Number card, your passport and residence card, and your baby's name and date of birth. Additional documents may be required so check with your city office in advance. Conclusion About Giving Birth in Japan + Useful Links.
Japan has a high quality of health care and the several subsidies and allowances to mothers. The downside is that hospitals that provide epidural are rare, but still possible to find.
You can overcome the cultural differences and languages barriers by preparing in advance and adjusting expectations. Talking to fellow moms and relevant experts will help you in your preparation, so be sure to register your interest to join ProMaman.
I hope this guide has been helpful to you. I wish you all the best for your pregnancy and childbirth in Japan!
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