Pregnant in Japan: Second Trimester

Around the start of the second trimester, my regular women's doctor asked me if I had chosen a hospital where I wanted to give birth. Her small clinic didn't provide that service. I hadn't decided where to go - the only place I knew of was the place by the train station that had just been refurbished and was located right next door to Russell's favorite bar. I told her I hadn't really looked around, but was kind of assuming she would send me there, since it was so close. Instead, she recommended a different place - the large city hospital out on Port Island (near the university where I work). She told me lots of foreigners like it there. I wasn't sure what that meant, but I assumed she was implying either that they speak English or follow practices more in line with Western hospitals. Regardless of her reason, I certainly trust her advice, so we set up an appointment at the central hospital. It turns out that for larger hospitals, you have to get a letter of introduction from a smaller clinic to get an appointment. They also have to check your due date and make sure they can fit you in. This all needs to happen fairly early - 6-7 months before the due date for a popular hospital - or they may be too full to take you. I have heard horror stories of women in labor being turned away from hospitals because they had no reservation and the hospital was full. We managed to get our appointment and have our reservation made.

After reading online, birth in Japan appears to be an all natural affair. Women can give birth in larger hospitals or in a smaller private clinic that specializes in birth. For the most part, it is assumed that you will be having a natural birth with no epidurals or other pain relief. At small clinics no pain relief is available at all, though apparently some large hospitals will provide pain management if the mother insists. While there are doctors on hand, the bulk of the patient contact and birth process seems to fall to midwives, who act as a support system for the mother before and after the birth as well. Hospitals in Japan typically require a minimum of 4-5 days stay at the hospital after a normal, healthy birth and the time increases if there were complications or a c-section. I have also heard rumors that hospitals often have a chef on duty to provide tailor made, high end meals for new mothers during their stay. Apparently French cuisine is currently trendy way to spoil the new mother. I don't know if that is true at all hospitals, but I have heard it from a variety of people who gave birth in different hospitals, so it seems to be fairly widespread.

The city hospital I will be going to is brand new and very modern. It even has a Tully's coffee shop on the first floor! (I'm pretty sure that's not typical). They are a research hospital and the central hospital in case of emergency (earthquakes, etc), so they are very large and well equipped. So far, I know they are strong proponents of breastfeeding and they practice kangaroo care (barring complications, they have you snuggle the baby right after its born, skin to skin) and rooming in (keeping the baby with the mother as much as possible during the hospital stay - not in a nursery. Though there is a nursery if the mother needs rest). I don't know about epidurals, but I like this place so much, I don't really care. I would probably opt for a natural birth anyway.

My first appointment was on a Thursday (my non-teaching day) and the doctor was very nice. He didn't speak much English, but Russell has been diligently going with me to appointments and is quite fluent in Japanese (it shocks me sometimes the extent of his vocabulary in new settings - like when speaking to an obstetrician) so we had no problem communicating with the doctor. He wanted to make sure I could communicate easily as well, though, so he recommended we come on Fridays, since the Friday doctor spoke very good English. We made the switch, and while I actually liked the first doctor quite a bit, the Friday doctor is a woman and I can easily talk with her in English, which is nice. Russell was sick one week, for example, and it was quite nice to be able to go to my appointment without worrying about communication.

The hospital itself is a whole new experience. Its quite high tech, since it was built very recently. When you first enter the building (once you are established with a hospital card and an appointment) you go to a kiosk, insert your card, and get a print out of where you will need to go. You also get a remote-control looking device with a screen that beeps to give you instructions on what to do next. My typical visit goes like this: I go to the first kiosk and get the remote, then I head to the urine/blood station, and insert my card in another kiosk. After confirming who I am, a cup drops out of the kiosk with my name and information pre-printed on it. After the urine test, I go to another room to get my blood drawn (if its a blood test day - I've only had one of those, but the lady who drew my blood was awesome). After tests are finished I can either go sit in the lobby for the obstetrician, or I can wander around wherever I like.

Once the doctor is almost ready to see me (presumably while she is finishing paperwork for the previous patient), the buzzer goes off and a message tells me to head to the obstetrics clinic. This is super nice since the doctors are almost always running late. If I wanted to, I could be wandering around, having a snack downstairs, people watching, or whatever while I wait. Usually, I just go straight to the obstetrics room, though. When the doctor is ready to see me, I get another message sent to the remote and I enter the doctor's office. The doctor checks in with me to make sure everything is going okay, then we all head to the ultrasound room, where the baby gets measured and we get to peek in and see how he's doing (yes, we're expecting a boy). The doctor usually tries to get a good shot of the face to print off for us, but if he isn't cooperative we go away empty handed. This is unlike my previous doctor who would print off a variety of angles and shots for me. I kind of miss that... but being able to at least look so often is fun.

After the ultrasound, I meet the doctor back in her office and she confirms the readings from the ultrasound and whether there are any concerns. She asks again if I have any questions and then I'm done. My remote tells me to go to accounting to pay. Normally I would pay at a kiosk, but since I'm using the coupons from the city, I have to interact with a real person. After accounting, I do go to the payment kiosk, confirm that I have no additional charges and return my remote. Its pretty slick.

During our first appointment, we got a massive quantity of papers. We had forms to fill out, more books on pregnancy and taking care of a new baby, information about the hospital. All sorts of things. We went out to buy a 2" notebook to keep it all in and the notebook was barely big enough for the first day's worth of paper. Thankfully the following appointments haven't been so paper heavy.

The first appointment included one extra stop, too. We had a meeting with the general hospital staff to talk over three big points. The first was general liability paperwork, but the second two points were more interesting to me. Because this is a big city hospital, we had the option of having our $4,000 insurance money routed directly to the hospital. Basically, they wouldn't charge us for anything until we crossed the $4,000 mark and would instead charge the insurance. This is different than normal, where the new parents have to pay out of pocket up front and insurance sends them a reimbursement a week or two later. The upside is that you don't need to pay so much out of pocket - its all handled for you. The downside is that if you are under $4,000, you have to go through extra paperwork to get the difference sent to you. Interesting.

Another decision we had to make was a room reservation. This was the key part for visiting the new hospital so early. We had the choice of a shared room - 4 mothers together and only husbands can visit, or a private room - just one mother and visitors can include the husband and parents. This was a hard call for us. From what we understood, a normal pregnancy should fall just under $4,000, but if you get a private room, you will likely be paying out of pocket. Add to that the fact that there are no parents in the country until right before the due date, and we decided to reserve the shared room. They did tell us that the shared rooms fill up more quickly and we can request a private room later - though its subject to availability. My mother will be arriving a few days before the due date, so provided there are no early surprises, we will ask to change to a private room once she arrives. Fingers crossed that there's one to change to!

I'm now just starting the third trimester and I graduated from once a month appointments to twice a month appointments about a month ago. I like twice a month better since I get to see the ultrasounds. Oh - and it turns out that expectant mothers are suppose to bring in their own towel to wipe the ultrasound goo off their tummy. I always forget to bring a towel (since I'm always coming from work) but Russell has started remembering for me. Good team!

I'll try to post again soon about my maternity class. I missed the first one - on nutrition - but a midwife met with me to fill in the gaps. The second one was on breast feeding and handy items the hospital recommended new parents buy ahead of time. The third one is in August - and I believe that one will include a tour of the facilities and a discussion of the procedure when you are actually giving birth. Russell is invited to that one - he had to sit out of the first two. Should be interesting!