Pregnancy and Child Birth in Hiroshima

Hiroshima Oyako Pregnancy and Parenting Blog

Whether you are planning to get pregnant or find yourself whoops somehow pregnant, I hope this article can provide you with some useful information to help make good choices about prenatal care and giving birth in Hiroshima.

Pregnant or not?
To find out if you are or not, you can buy pregnancy tests from the drug stores that are pretty easy to follow even without any Japanese knowledge (just pee on it). But you usually have to wait 6 weeks after conception for it to work.
Incredibly, I went to my OBGYN San Fujinka at just 4.5 weeks and they did a urine test which came back semi-positive, so the doc did an ultrasound and found a little tiny speck and said "Congratulations" omedetou.
In Japan, you then have 6-8 weeks to decide whether you want to remain pregnant or not. There doesn't seem to be any kind of counseling at the hospitals or clinics and the issue of abortion is dealt with in a very matter-of-fact way.
If you are having morning sickness, (some advice from people on the forums) try smelling ginger, eating more often, but small and light meals, eating dry bread or crackers before getting up in the morning, drinking lots of water throughout the day, wearing a motion sickness wristband, aromatherapy and making sure you get lots of fresh air- get outside for walks everyday. If you can't keep food down, talk with your doctor but chances are there is little they can do for you besides give you an IV to help with your fluids. Some women are convinced that it can be controlled with positive thinking and meditation, but others will argue that it is impossible to control. There are chat rooms full of good advice and information from other women suffering from morning sickness, their suggestions and empathy may be the best medicine.

All in all, Hiroshima is a reasonable place to get good prenatal care and have the baby. To choose an OBGYN, first have a look at qq.pref.hiroshima.jp for a list of hospitals and clinics in Hiroshima located near you.

When to tell your workplace? Do you know your pregnancy rights?
A safe time to tell your workplace is around the 3 month mark (12 weeks) when most people start to show anyway and there are less chances of miscarriage. When you talk with your boss- it is best to have a clear plan laid out of how much time you want off, suggest who can cover your work and talk about when you would like to come back to work. Find out what maternity leave you are entitled to and maternity benefits and pay you will get. Legally, you are entitled to 6 weeks before your due date off work and 8 weeks after per baby (16 weeks for twins). However, that is often hard to get unless you have a really amazing job. In my first pregnancy, I was on a temporary year by year contract and when I told my boss I was pregnant and would need 6 months off I was initially told that I wouldn't be able to keep my job. After some negotiation, I worked to the end of term (2 weeks before my due date) and then took 6 months off (only 8 weeks was paid due to my Japanese insurance) and started the following semester with a new contract. On reflection, this was really unfair, but I was in a weak position and really wanted to keep my job.
The second time I was pregnant, I was in a tenured position (same as most Japanese employees) and the situation was completely different. Although they wanted me to teach as far into the semester as I could, I was given the option to take off 6 weeks prior to my due date, but could add any time I didn't use before the due date to extend my paid time off after the babies were born (not an option given to me the first time around). I was also offered a portion of my salary if I wanted to take off longer than I had paid leave (nenkyu) or insurance paid maternity leave (6 weeks before, 8 weeks after).
You can find more information about your maternity and child care rights in Japan here:
wom-jp.org/e/infoJAPAN/maternity1.html

Start taking that Prenatal supplement
To start pregnancy off right, supplements are a good idea for expectant moms, although you can get some vitamins in drug stores and supermarkets, there are specially forumated pre-natal vitamins for pregnant and lactating women available through The Foreign Buyer's Club. FBC is an import food company in Kobe which offers a wide variety of foods and goods from the USA and UK for delivery to people living all over Japan.
Another wonderful resource during pregnancy (and life in general) is an organic online delivery company: Alishan Tengu Natual Foods located in Saitama.
I ordered my prenatal supplements from herbalremedies.com in the US, but don't order any more than a 3 month supply at a time or you will have problems with Japanese customs.

See the Dentist
You receive a dicount coupon for a visit to a dentist in the baby book boshi-tetcho you get from your local ward office Kuyaku-sho. Some Hiroshima dentists were recommended in the forums.
It's a good idea to get a cleaning and check up in the beginning of pregnancy as dental problems such as periodontal disease has been linked to low birth weight and premature births.

Pamper Yourself
Treating yourself right is as important for the baby as it is for you for the next 9 months, here are some suggestions:

• Get a massage: Refresh 15 offers massage for pregnant women (ask if your favorite massage place offers it too).
• Get a facial: not only is it relaxing, but there are a lot of things that go on with your skin when you are pregnant (i.e. pigment changes and new freckles and spots) so its nice to do as much as you can to stay "fresh." Renoma Beauty Gallery has a great full service SPA.

Shop around
Once you have decided to be a mama, go to your ward office Kuyakushou and get your baby record book called Boshi Tetcho.
This book is needed to keep track of all of your prenatal care, labor and birth information as well as the first few years of your child's life. This book also has coupons in the back for discounts on prenatal and dental care as well as free immunization coupons for your infant. An English version is also available for reference. Now it is a good time to start shopping around for somewhere you feel comfortable spending a few hours once a month (and nearer to your due date, every week) getting measured and probed. When I was 3 months along, I went around to all the hospitals and clinics I was considering. First go to the main desk called the uketsuke and ask to see the delivery room and maternity ward: bunbenshitsu o mitai.

If you can't get by in basic Japanese and the help of a dictionary, make sure you take someone along to help you understand and be understood (none of the places I visited had English speaking staff).
Don't feel self-conscious about doing this, they were more than happy to take me around and answer all of my questions. I found this tour a good way for me to see how they treated new mothers and their babies as well as meet some of the nursing staff and midwives working in the maternity ward. If you feel good about the maternity ward, go in for an appointment with one of their doctors to make sure the whole package suits you.

The most important factors differ for everyone, but three of the basic questions you need to answer (and get answered) before you choose where to have your baby are:
* is it close enough to where you live to make it there when you are in labor: take into account Hiroshima's rush hour traffic if you live in town.
* do they offer services and treatments that you deem important? Have a look at the sample list of questions below.
* can you afford it? Private clinics are more expensive that public hospitals for prenatal visits (public hospital: 2,000-7,000 yen per visit; clinic: 5,000-20,000 yen per visit), labor and especially during your stay once the baby is born.
However, you don't have to wait quite as long at a clinic and the waiting rooms are full of other expectant moms with kids instead of sick people. The aftercare is also quite different with more frills like designer rooms and fantastic food.
For either place, insurance only comes into play for emergency procedures like a c-section, there is also a refund of around 300,000 yen from the government after delivery if you pay into the national health scheme.

Recommendations
Here are some highly recommended places to have your prenatal check-ups and delivery:

• Hiroshima University hospital- Daigaku Byoin Located in the Danbara area (English signs lead up to it) about a 10 minute bus ride or a 20 minute walk from the main JR station.
  If you have a high risk pregnancy or complications during pregnancy, the university hospital is the best choice in Hiroshima city. Most of the patients who go here are referred from other clinics and hospitals, but if you want a second opinion or if you are having a complication, it is a good place to come. I spent a month on bedrest in the new building and was so impressed with the OBGYN department and all the doctors and staff that I had contact with were very good.
  They are open to your questions and concerns about treatment and current research and will work with you to create a treatment plan you are happy with. Most doctors speak at least a little English, but if you ask for an English speaking doctor it is likely they will assign you to someone who is very proficient in English.
  (10/2007 update- now rooming in is allowed and fathers and families are now able to hold the baby, not only the mother as in previous years. Great progress!) University hospital has a great NICU, preemie unit that can accomodate babies from 26 weeks, so this is a great options for complicated pregnancies or if you baby will likely need to be in NICU, this would be a good option since you can then be in the same ward as your baby.
  (Most private clinics do not have facilities for babies with complications or health issues so you would be in a different hospital from your baby for a week or more if you baby has to be moved to a general hospital.)
  Read more details following the link above.
• Katsuki Ladies' Clinic
  Mariella has written a great review of this clinic, it really is state of the art with the most comfortable and modern facillities, treatments and pampering available.
  Kangaroo care soon after birth, family participation and facials are highlights. However, you do need to be able to communicate in Japanese or have someone with you who can do so.
  I have heard two reports from western mothers (who speak Japanese well) who had great experiences there. You are given the option of having an epidural komakugai masui for labor pains (only other place that does this is Shinno sanfujinka). They have facilities for a c-section if you need one and you can have a facial and get properly pampered during your stay there.
  The only down side I can see is that you would need to be kept away from your baby if there were complications since there is no NICU facilities there.
  Katsuki's Japanese website
• Masaoka Clinic
  Located in the center of the city with patient, quality care in a high-tech clinic with a hotel-style setting for you to enjoy during your aftercare. The younger Dr.Masaoka speaks a bit of English and you can negotiate how you would like your labor to be handled with him beforehand. (10/2007) Although this is a modern clinic, the emphasis is a bit old fashioned, keeping the mother on a bed to monitor the babies heartrate, yet not giving pain meds. If you are going to insist on no-meds, you want to choose a place that lets you stand up and move around during contractions. This allows for quicker labor, but most nurses and even some doctors still want you to lie down to give them a chance to constantly monitor the baby's heartrate.
• Shinno Ladies' Clinic:OBGYN
  Information in English and a map on the website
  Tel: 082-843-1103/ Fax: 082-843-1104
  Located in Asa-kita-ku (about a 20 minute drive from Hiroshima city/ 12 minutes from Hiroshima station on the Geibi line)
• (10/07 Dr.Nakahara has since moved to "Kouno Ladies Clinic located between Sun Mall and Deo Deo) Dr.Nakahara (Female) is a wonderful doctor who speaks English well.
  At Shinno, the pre-natal care is excellent in this friendly place with the most modern equiptment. During labor, it is possible to get an epidural komakugai masui during labor, c-sections are performed horizontally (bikini cut) if needed, episiotomy ein sekkai is done only if needed, sugar water is not given to infants and breastfeeding is encouraged and well supported. Most rooms are private. The food is wonderfully healthy and delicious Japanese fare which can be catered to special diets (i.e vegetarian). Rooming in with your baby is possible, but nursing staff will also take care of the baby for you whenever you need a break. Unfortunately, as of 2003 Shinno will only accept Japanese speaking patients who want to have their babies here (you could also promise to have an interpreter with you during check-ups and labor).

  More Information about Tsuchiya General Hospital and Shinno Clinic here

• Tsuchiya General Hospital:General Hospital including OBGYN
  Centrally located opposite the Peace Park Museum along Peace Blvd Heiwa Dori.
  3-30 Nakashima-cho, Naka-ku Tel: 082-243-9191

  In response to non-Japanese speaking foreigners being turned away at some clinics, the head doctor at Tsuchiya claims that despite any language barrier, they will be happy to provide their best pre-natal care and labor assistance to anyone who comes to their hospital. A benefit of having your baby at Tsuchiya is if there are complications, as a general hospital they are equipped to handle anything that may happen to you or your baby. Pre-natal appointments and the cost of labor and after-care are cheaper than at a private clinic. As of 2003, there are also new private rooms available for patients staying for 7-12days after the baby is born. Episiotomies are only given if needed. There is no pain medication available during labor. If a c-section is needed, in most cases they do a vertical cut. The waiting time for pre-natal appointments varies between 20 minutes and 1 hour (try to get morning appointments if possible). Woman doctors are on staff, but as with all public hospitals, doctors change (move around the country) every April. The labor and aftercare here is very good, some doctors are trained to do horizontal, bikini cut c-sections (but this has to be planned and approved in advance). If you need an emergency c-section, they insist on doing it vertically at Tsuchiya. Other good points: newborns are not given sugar water, kangaroo care is encouraged directly after birth including in the operating room and breastfeeding is fully supported in every way. The fathers are also very included in the process and rooming-in with the baby is no problem. The staff are open to special requests concerning treatments and procedures for you and your baby.
  Overall, Tsuchiya has great doctors, nurses and midwives; good facilities and supports breastfeeding.

  More about Tsuchiya Hospital

Also not particularly recommended is JR hospital near the Shinkansen exit of the station. Although the offer good care for the mother and baby, the fathers are not allowed to hold the babies and mothers have to visit the baby to breastfeed even if the baby is healthy.

** If you hear of good or bad care anywhere in Hiroshima, please let me know (through the feedback button at the bottom of the page)- so we can keep this page as up to date as possible, thanks.

Read up about what to expect in prenatal care, labor and post-labor care and talk with other moms to make a list of things that you think are important then make sure that the place you choose can support your wishes.

Sample Questions
Here is what I asked the doctors and nurses at the 4 hospitals that I visited:

• 1. Can my husband be with me during labor and/or during a c-section? (All doctors said yes during labor, no during the c-section)
• 2. Is it standard practice to give an episiotomy (cut) or only if it is needed. (The debate on which heals faster: cut or tear is ongoing, but massage and rubbing the perinium with wheat germ oil leading up to delivery should help prepare the area for stretching naturally).
• 3. Will I be allowed to breastfeed directly after delivery and on demand while I am in hospital? (A new mom in Hiroshima was told to wait a week before trying to breastfeed. Sometimes the colostrom- the first milk, is incorrectly dismissed as not being important- of course we know that colostrum is loaded with wonderful immune boosting stuff for the baby.)
• 4. Is there anything given to the baby after s/he is born? (Sugar water is commonly given, but you can request that they don't. Antiobiotic eye-drops are often given immediately after birth. Vitamin K is also standardly given to breastfed babies after 1 week.) C-section babies are kept in a box after birth to monitor their condition closely, kept separated from parents and other babies for at least a few hours- ask if this is the practice at your hospital.
• 5. Can I keep the baby in the room with me whenever I want? (Some hospitals keep newborns in a room together where mothers can "visit" to breastfeed and cuddle, but only during set times in a day. "Rooming in" with your baby and demand feeding are important aspects of successful breastfeeding.)
• 6. How long do you suggest I stay in hospital after a normal delivery and c-section. (Usually, for a normal delivery= 5-10 nights; C-section= 10-14 nights)
  7. Is it possible to get a c-section here if I need one? (many older hospitals or smaller clinics are not equipped for surgery and would need to transfer you mid-labor to a General HospitalSogo Byouin like Tsuchiya, Daigaku Byoin or Kenritsu Byoin.
  And what kind of c-section is done if needed? Side-to-side or up-and-down? (Most doctors still do the up-and-down cut in Hiroshima).
• 8. What drugs are used during delivery and during a c-section? (Although pain medications are not normally given, drugs to strengthen contractions are commonly used and the type of anesthesia used during c-sections differs- I chose a spinal block so I could be conscious during the surgery and was able to briefly see my son when he came out. If you have an emergency c-section they often push for "general anesthesia" but you can still insist on the spinal block instead- there are more complications with the general anesthesia). If you get a spinal, one common side effect is the feeling of being cold and getting the shakes after about 15 minutes into the surgery- this may be due to blood loss or your body's way of reacting to the anesthesia. Don't panic, try to relax and ask for oxygen if it gets bad, breathe deeply and it will go away soon after the surgery is over. An uncomplicated c-section is over in 10-15 minutes, a complicated one lasts between 1 and 2 hours.
• 9. How long do you wait before inducing labor for a late pregnancy? (Most doctors like to wait as long as possible unless it looks like a large or distressed infant or if the mother becomes ill). In some cases if they believe your baby will be large (over 4kg) or if you have complications they may want to enduce before 40 weeks- but you should research your condition, talk with your doctor and make your own decision about this, a baby born as close to 40 weeks is the healthiest baby. Also, bigger babies who are further along in their development eat and sleep and resist infection so much better.
• 10. Is it possible for my husband, friends and family to hold the baby when visiting? Some hospitals are severely strict about anyone holding the newborn, even if they are the infant's father or grandparent. It's not a bad idea to ask your visitors to wash their hands before holding the baby- especially children in school (germ factories). If you are breastfeeding, your baby is well protected, but why take any chances- washing hands is an easy solution.

  If things go wrong
  What happens if my baby dies?

• Sometimes things go wrong in pregnancy and childbirth- often without an explanation or cause. If you miscarry or lose your baby after the 20th week it is considered a baby and a death certificate will be issued that you need to take to your local ward office (kuyakusho). The babies bodies will also need to be taken to a crematorium or cemetery for burial organized by you- this is a lot to deal with and there is nothing offered here by way of grief counseling, but there is a lot of support groups and resources of information for you online.
  On a personal note, in May 2005, I got a bacterial infection at 19 weeks and my water broke (called pprom : premature preterm rupture of membranes) and was hospitalized for 2 weeks while they controlled my infection, but we lost our ID twin boys despite our best efforts.
  If you are have a high risk pregnancy or suffer a miscarriage, please feel free to write to me anytime through this site for support or advice.
• If my baby becomes sick will s/he receive treatment at this hospital or be transferred? Often if you are in a smaller hospital or clinic and the baby needs treatment, the infant will be transferred to a larger hospital while you are kept in the place where you delivered (even sometimes for conditions as mild as jaundice). Its best to be prepared if this were to happen to you and you were separated from your baby at such an early stage, it is very traumatic and frustrating.
  If you know that you are at risk for a premature or complicated birth, it is best to schedule treatment at Kenritsu byoin (prefectural hospital) in the Ujina area as they have the best Neonatal unit for babies with complications. Babies are considered viable from 22 weeks at Kenritsu byoin, but for a child to have a good fighting chance without serious physical and mental handicaps a baby needs to have a gestational age of at least 27 weeks (gestational age is the actual age of the baby from the conception date, not the date of your pregnancy which is calculated from your last period). Every week longer is so important for the babies development, you can find out all the details of your babies development and your pregnancy in detail from: preg.fertilityfriend.com. A baby is considered full term from 37 weeks, but those 3 extra weeks are important for brain and bone development as well as building a protective layer of fat to help the baby keep warm once born, so keep your baby in as long as possible if you are having an uncomplicated pregnancy.

Dread the Scale
Although I doubt this is unique to Japan, during each prenatal visit I began to dread the measuring and weighing and prodding more and more. Most doctors are severe when it comes to weight gain- insisting that all preggos regardless of how fat or thin they were pre-pregnancy fit into the same limitation of 8-10kg as opposed to the 12-16kg recommended in the U.S. Insisting it makes for a more difficult delivery and unhealthy baby. In my book- if you eat a balanced diet, exercise a little everyday and feel good but gain over the limit- you are NOT a bad person and your baby WILL indeed still be healthy!
One of my (young woman) doctors recommended me to DIET! You better believe she got an earful as I demanded for her to show me some research to support that advice and I challenged her to disagree that it was more dangerous to lose weight in pregnancy than to gain more than the average 10kg. No one should ever LOSE weight during pregnancy, and you should also try not to lose too fast while breastfeeding (when you actually need more calories than when you are pregnant).
Diabetes and preemclampsia and other complications are thought to be connected to excessive weight gain, but if you are not retaining water (press your ankles- if an impression from your finger remains for a long time, you may have circulation issues) and your blood pressure is good, you don't have protein in your urine or any other complications then feel free to tell your doctor you are not worried about your weight gain and disregard any crazy advice to diet.

Make it Fun
People may stare at you on the street here more than at home, but just smile and enjoy it! Japan is a country of people who adore children and that often extends to pregnant women. Disregard the nonsense about the danger to your baby if you don't wear an obi (belly belt) or give the baby a chill by wearing sleeveless shirts or short skirts (despite it being summer), or the flack you can get for taking a baby outdoors before he is 3 months old?! Try to enjoy the friendliness of the stranger who is so excited by your baby that she can't help but cuddle him and show him off to all of her friends in the neighborhood/restaurant/park. You may find yourself saying quite calmly after about 10 minutes, "I wonder where my baby is now?" without panicking because you know he is completely safe and will be brought back to you eventually.

Find out More Hospital Stays Information GH Pregnancy and Parenting Blog Online Resources Useful Books for Pregnancy and Beyond More Details about Tsuchiya Hospital & Shinno Clinic

by mamajoyjp (and friends) 2003/2005/2007/2008

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