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Tuesday, Dec. 11, 2012
THE ZEIT GIST
Childbirth in Japan: Plan, prioritize for a smooth delivery
By LOUISE GEORGE KITTAKA
Emotions during pregnancy and childbirth run the gamut, from excitement and trepidation to joy and even fear. Foreign women who find themselves pregnant in Japan may experience additional stress as they cope with cultural differences, language issues and being away from their own families. Add in talk of no pain relief typically being offered during labor and it is enough to make an expectant mother want to jump on the next plane home.
However, while some aspects of Japanese maternity and obstetric care may seem confusing, Japan is actually a great place to give birth, says Brett Iimura, an American childbirth educator and founder of the Tokyo-based Childbirth Education Center. Since 1997, CEC has been helping expectant couples navigate pregnancy and birth in this country. "Japanese maternal and infant mortality rates are among the lowest in the world, and you have a wide variety of options here," Iimura stresses.
Broadly speaking, these options can be divided into three main categories: the OB-GYN department of a large hospital (which may be private or public), a smaller specialized maternity clinic, or a birthing center with midwives.
For some foreign residents, especially those who are not fluent in Japanese, a large hospital may be the most attractive choice if there is English-speaking staff on hand. There is also peace of mind in knowing there will be specialists available if complications arise.
Frances from the U.K. gave birth to all three of her children at Seibo Hospital in Shinjuku, and liked the fact that they offered language support (English, French and Spanish) and were used to foreign patients. While doctors attended each of her births, it was the midwives in the labor ward who "basically ran the show."
When her first labor turned into a marathon effort lasting 70 hours, they sat with her and supported her throughout the ordeal. "I really don't have the words for how moved I was by their dedication," she says.
New parents Tony, an American, and his bicultural wife, Alicia, who was raised here, chose the Japanese Red Cross Medical Center in Hiroo, in Tokyo's Shibuya Ward, for the recent birth of their son.
Alicia cites the hospital's baby-friendly stance, in line with WHO and UNICEF policies, as one of the main reasons for their choice. "They were also flexible about letting me see my own midwife at a small clinic for checkups until my 34th week," she says.
A long-term resident of Japan, Tony speaks fluent Japanese and didn't need the hospital's language support services. However, he advises foreigners not to try and muddle through if their Japanese skills are weak. "If being able to communicate in English with your health-care provider is important to you and your partner, don't just say 'daijōbu' when they ask if you can speak Japanese."
Major hospitals might be used to foreigners, but there are also many smaller facilities that can provide a positive experience. CEC's Iimura notes that while the Internet has made it relatively easy to get information in English through email groups and blogs, expectant parents should be aware that much of the information is specific to an individual birth and is thus highly personal.
"As they weigh up their options, it can be helpful for women to identify what aspects of care are most important to them," she advises.
First-time mom Skye wanted a clinic small enough to be flexible and caring but large enough to offer the choices she was seeking. Based on friends' recommendations, the New Zealander chose Seijo Kinoshita Hospital in western Tokyo, "I gave them my birth plan and I was impressed with their willingness to support me. The doctor always took the time to answer my many questions." She was also pleased she could have an epidural if she wanted. "While I didn't necessarily intend to have one, I wanted to leave my options open."
Despite the best-laid plans, however, Skye's labor took an unexpected turn when her blood pressure shot up, and her baby was delivered by caesarean section. "The C-section wasn't as bad as I had expected. It was all over in 38 minutes," she recalls. "The midwives were very helpful with breast-feeding, too. All up it was a very positive experience!"
Options may be more limited away from the main centers. Tammy, a Canadian living in Oita, Kyushu, was in the delivery room having her first child before she realized that epidural anesthetic wasn't available. However, overall she was satisfied with the care she received at Okawa Women's Clinic, a maternity hospital run by four doctors. She couldn't guarantee who would deliver each of her two babies, but was pleasantly surprised to learn that several of the staff spoke reasonable English.
Her advice to expectant mothers is to try and form a bond with a midwife you trust. "Mine gave me her number and email, and told me to call her as soon as I went into labor, in case she wasn't at the hospital." And while meals may not be the top consideration, Tammy notes that her clinic is well known for serving delicious French cuisine. This trend to pamper new mothers with a touch of luxury is becoming quite common.
Along with large hospitals and smaller maternity clinics, Japan has a third option in the form of birth centers run by midwives. Nationwide, only about one to two percent of births take place outside a hospital setting, but birthing centers may be an attractive alternative for women looking for a more personal approach to childbirth.
An interest in water birth led Rachel W., an American mother of two boys, to the Inada Josanin birthing center near her home in Kawasaki. Although she was seen by a regular ob-gyn for initial checkups during her first pregnancy, she was turned off by the doctor's imperious attitude and the unsanitary conditions she observed at his clinic. The birthing center, on the other hand, offered a serene atmosphere and caring staff in tune with her needs.
"I got wonderful breast-feeding support and my babies never left my side for a minute," she recalls. "When my second child was in a breech position in the second trimester, the head midwife turned him with a few quick, painless moves. Truly amazing!"
A birthing center will not accept high-risk births, and may set an upper age limit for first-time mothers. Except in emergencies, Japanese midwives are legally prevented from performing medical interventions, including administering shots and performing episiotomies (surgical cuts to the vagina to allow easier delivery and prevent rupturing). (The latter could be a point in the midwives' favor, as many Japanese ob-gyns still routinely perform episiotomies on first-time mothers.) In the event of complications beyond their scope, birthing centers have arrangements for backup care at a local hospital.
As the number of babies being born in Japan is decreasing, so are the numbers of maternity specialists. According to a 2007 study, medical students revealed a growing reluctance to work in the OB-GYN field, citing the long hours, on-call shifts and high risk of malpractice suits among the reasons. Bearing this in mind, Iimura warns expectant couples that popular clinics may fill up quickly. "If you're even thinking of becoming pregnant, it is a good idea to think about birth options and have a look around. If your first choice is full, you may end up settling for something different."
Rachel T. from Singapore knew she was taking a risk by changing providers halfway through her second pregnancy. Her first child was born at a large hospital in the U.S., following a long labor and epidural. Satisfied with the care she received, she selected a similar type of facility in Tokyo. "But after just one visit, I knew it wasn't for me," she says.
The first doctor she encountered was "impatient, brusque and rough." She was appalled to be told that everyone got an episiotomy and that unless she managed to secure one of the few private rooms after delivery, she would not be allowed to keep her baby with her. "The message was clear: 'You're not the only one here; do as you're told.' "
Some of the other hospitals she had considered were already full or would not take someone several months into her pregnancy, but after emailing other mothers, she began receiving positive feedback about birthing centers. Her previous long labor had left her hesitant to give birth without pain relief, but after visiting a birthing center in her area, Sakamoto Josanjo, she felt at ease. "It was as different from a hospital environment as you could get. I was very confident that this was where I wanted to give birth."
Unlike in some countries, prenatal care and childbirth are not free in Japan, but government allowances have become more generous over the last few years. Once her pregnancy is confirmed, a woman can apply at her local city or town office to receive a mother-child health handbook (boshi techō) and 14 coupons to cover much of the cost of her prenatal visits (as opposed to a paltry two coupons in the recent past). Even so, some of the standard prenatal tests are not covered.
Regardless of where the baby is born, or whether the facility is public or private, the government pays a standard reimbursement of ¥420,000 to mothers enrolled in the country's national health insurance scheme. This amount is actually very close to the average cost for a normal delivery. As might be expected, costs are generally higher in Tokyo than elsewhere, and you will pay more for extras such as a private room or epidural. Some municipalities offer additional financial support when fees go over a certain amount.
After having three babies in Japan, Frances shares some tips for other foreign women: "If you can accept that you are not likely to have exactly the same setup you might have expected in your own country, it leaves you free to explore what is available here." She credits birth education classes at CEC for helping her come to terms with a lack of pain relief during labor. "Just work out what is really important to you and focus on that."
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