Pregnancy is a whirlwind of hormones, aches and pains, excitement but also fear.
Now imagine being pregnant for the first time and in another country. Sure, you may know the language, understand the culture, and may even be married to a local, but that doesn’t take away the fact that you’re doing pregnancy on hard mode.
Before I was pregnant, my knowledge of pregnancy was based on North American culture, namely family members, literature, pregnancy forums and media (not that media is the most accurate representation). I knew there would be differences between Japan and North America but what these differences were turned out to be a very interesting learning experience.
Every pregnancy is different as is every care provider, so the following is my personal experience with what I found surprising during my pregnancy in Japan. Some things were good, some were bad, but at the end of the day, my baby was born healthy and safe.
1. Short Appointments
Appointments with Japanese obstetricians are over in an instant, or at least mine were. I’m talking within 5 minutes. After weighing myself, taking my blood pressure, and then doing a urine test, the doctor would do a quick ultrasound and then say everything was okay. That was it. I could ask questions and usually that took up most of the time. I felt like there was hardly any explanation about the baby during ultrasounds compared to what my Canadian and American counterparts described and the time spent on the ultrasound was considerably shorter. I felt a bit robbed. Where was my detailed explanation about my baby? Even the anatomy scan was short at around 10 minutes. I had also heard that some ultrasound technicians in North America have the mom to drink something sweet like soda or orange juice in order to get a shy baby to move but that never happened with me. If the baby was covering her face or hiding, oh well (and that happened often).
At the same time, the doctor, not a technician, did the ultrasound, and ultrasounds are much more frequently done than in the West, which may be why the ultrasounds tend to be so short.
2. Keep that Belly Warm
When I first told one of my coworkers that I was pregnant, she asked me if I was wearing a hara-obi (maternity belt).
“The baby will get cold!” she insisted.
I laughed it off until my mother-in-law gifted me with one on Inu no Hi (Day of the Dog), which is an auspicious day that occurs two or three times a month when women who are 5 months pregnant go to the temple to pray for the healthy and safe birth of their baby. Although I wore the hara-obi for support briefly (though it didn’t really help), I never felt I needed it to keep my stomach warm for the baby. Sometimes I would lift my shirt over my belly at home if I was too hot, especially in the third trimester, and my husband would quickly pull it down and scold me for not thinking about the baby despite it being summer and very, very hot.
It’s believed that stomach and overall health problems are associated with a cold belly, which is why keeping the belly warm means having a healthy baby.
3. Soak Away, Onsen are Okay
The belief that it is important to keep the stomach warm during pregnancy may also be why women are not only allowed to take baths and dip into onsen (hot springs) in Japan, they are encouraged to do so. My doctor seemed surprised when I asked her if it was okay for me to go on an onsen trip and told me that I should be taking baths more often as it was good for the baby. (She did say to be careful, though, when getting in and out of the tub as I could slip and fall, and to stay hydrated.)
This goes against Western beliefs that it is dangerous to soak in a warm bath as it raises your core temperature and may put the baby at risk. However, this may not be true after all as a recent review assessing various findings has shown that the core temperatures of pregnant women who soaked in hot baths or enjoyed saunas never exceeded 39 degrees Celsius, which is the recommended limit.
(Due to my paranoia, though, I still stayed away from baths and onsen during the first trimester.)
4. Prenatal Vitamins in Japan? Take It or Leave It
I had been taking folic acid before I became pregnant so I didn’t realize until a few weeks into my pregnancy that my doctor never brought up prenatal vitamins. When I asked her about it, she said it was recommended but up to me and gave me samples for a (very expensive) prenatal vitamin called elevit.
Prenatal vitamins are not pushed by doctors in Japan and mainly consist of folic acid and iron, unlike prenatal vitamins in the West that have a variety of additional vitamins and minerals. In fact, in my third trimester, I attended an event on pregnancy and a doctor said that he discouraged women from taking folic acid after the first trimester. (I continued taking my prenatal vitamins until I gave birth.)
5. Eat (Almost) Anything You Want…
I had read online and in various books that raw food, mainly sushi, was a no-no for pregnant women. So imagine my surprise when I asked my doctor about it and she said that most sushi was completely okay! That went for things like salads and fruits, too, as well as deli meats. In the West, raw food can contain bacteria and parasites, which can seriously harm the baby, but at least at my clinic that wasn’t that much of a concern.
There wasn’t really anything my doctor said I couldn’t eat, although she did say to watch my sugar and caffeine intake, not to drink alcohol, be careful about eating tuna (which is found to be high in mercury) and to stay away from rare or medium-rare meat.
I was still cautious, though, and didn’t eat too much salad or deli meat during my pregnancy, and only had sashimi and sushi after the first trimester. If you feel like eating or drinking something that’s traditionally on the “Do Not Consume” list during pregnancy will cause you to worry afterward, just don’t do it.
6. …But Eat in Moderation
Japanese obstetricians are infamous for regulating women’s weight gain during pregnancy. In other countries, doctors do monitor this as well but Japan does it to another level. At the beginning of my pregnancy, I had a BMI of 18.5, which is considered underweight. Therefore, I was surprised when the doctor said that I should only gain 10 kg in total. Western pregnancy calculators online recommended that I gain far more than that! I ended up gaining 13 kg throughout my pregnancy and was told only once that I had to watch my weight after I gained one kilogram in a week. A single measly kilogram. It was only one time but it was enough to make me feel embarrassed, insecure, and worried about my weight gain rather than happy and proud of my growing belly and baby.
It’s believed that women who gain too much weight during pregnancy will have complications during pregnancy and childbirth, such as high blood pressure, edema, or difficulty giving birth because their baby is too big. (Newborn babies in Japan are also some of the smallest in developed countries.) Therefore, doctors and nurses in Japan are very strict about weight gain, admonishing women who have gained “too much.” This sometimes leads to women dieting and malnourishment.
However, babies born underweight may have health problems that continue into adulthood, leading the Japan Society of Obstetrics and Gynecology (JSOG) to revisit their strict guidelines regarding weight gain in pregnant women in Japan. The new guidelines may be in place as early as Spring 2021.
7. Baby Showers in Japan
I was quite saddened to learn that baby showers aren’t really a thing in Japan. Although this Western tradition is starting to appear in Japan, many pregnant women do not have any sort of celebration, even after the baby is born. Women may receive presents, such as diaper cakes, from friends and family but it’s considered bad luck to give a gift before the baby is born. It’s more customary to give new parents congratulatory money. (And to be honest, I was quite happy to get money, which all went to the diaper fund.)
However, the good news is that you can still sign up for a baby registry in Japan, and your friends and family in both Japan and abroad can buy you gifts from that registry for your baby if they wish to do so. (You’ll also get a lot of free samples of newborn diapers, wipes, etc., when you sign up!)
8. Reserving Your Birth in Japan
Choosing an obstetrician and clinic or hospital in Japan is very important as it not only means you will go there for all of your prenatal checkups, it also means you will give birth there (unless you decide to go back to your hometown to give birth). Women have to book a clinic in advance to give birth, usually by 20 weeks, as they have limited availability in terms of beds and birthing rooms. This means that popular clinics (especially ones that offer epidurals) fill up fast. In fact, some people book a clinic or hospital to give birth at right when the pregnancy is confirmed! You also need to pay a deposit to reserve a spot, which can start at around 100,000 yen.
9. Epidural in Japan? Better Also Book That, and It’ll Cost You
Although it’s becoming more common, the use of epidurals is still not that widespread in Japan, with a majority of women giving birth without any pain relief. (Ouch.) Not many hospitals and very few clinics offer 24/7 access to epidurals as they do not have anesthesiologists on hand to administer it, which is why most clinics that offer epidurals require that you make a reservation and be induced if you want that sweet, sweet pain relief.
At my clinic, the anesthesiologist was only available on Tuesdays, so I would have to book an induction on a Tuesday before or after my due date and hope the baby didn’t come before then. I was also told that I couldn’t get the epidural until after I was induced, which meant going through the pain of induction without pain relief. That seemed silly to me so I decided against it. (I ended up having to be induced anyway, which you can read more about in my birth story.)
Epidurals are also not covered by Japan’s National Health Insurance and can cost a pretty penny, starting from around 100,000 yen.
10. Paid Time Off in Japan
There are numerous horror stories about the treatment of pregnant women in Japan who continue to work, to the point that there is a term for it: matahara, which is short for maternity harassment. Pregnant women are given more than the usual amount of work, forced to do hours of overtime, and treated so badly by their boss and colleagues that they end up quitting from stress.
This was why I was quite worried about telling my company about my pregnancy. However, I was surprised that my Japanese company really took care of its pregnant employees. I was able to leave an hour early every day without any cuts to my salary in order to avoid a crowded train (this was a lifesaver) and I could also take paid time off to go to my prenatal appointments and take a week of bed rest if recommended by the doctor. All of my colleagues were very understanding and it made working throughout my pregnancy much easier.
11. The “I’m Pregnant But Magically Invisible to You” Maternity Mark in Japan
When you register your pregnancy at your local municipal office, you’ll receive a bag filled with materials about pregnancy as well as one or two tags called a maternity mark. The maternity mark is something you put on your bag to inform others that you are pregnant and hopefully get someone to offer you their seat in the priority section on the train. However, it usually doesn’t work this way.
Instead, able-bodied people in Tokyo sitting in priority seats tend to ignore standing pregnant women. I was offered a seat only a handful of times, usually by older and likely retired men who should probably be sitting down themselves. What usually happens is that people suddenly fall asleep the moment a pregnant woman stands in front of them (I guess we’re like sheep or visual sleeping pills) or are so busy concentrating on their smartphone game that they don’t notice the badge practically in their face.
There have also been cases where pregnant women were attacked by people or harassed, which has caused some women to not use the pregnancy badge altogether. I still used it, though, because it was helpful to show when I asked someone if they could kindly offer me their seat. It also made me not feel like a jerk for sitting in the priority section, signaling to others that I had a reason to be there.
12. Bye Bye, Husband (Satogaeri Shussan)
Some Japanese women leave their husbands behind to go to their parents’ home near the end of their pregnancy to give birth, which is called 里帰り出産 (satogaeri shussan). This allows for a new mother to have 24/7 familial support while learning the ropes about caring for a newborn from someone who’s been there and done that.
A Japanese friend of mine went to her parents’ home a few train stops away for about two months after she gave birth and she was incredibly gutted when she went back to her own home. Her husband worked long hours, which is the norm in Japan, so living with her mother and not being the sole caregiver was very helpful for her.
In some cases, though, going back home may mean the father misses the birth, and sometimes the first few weeks of the baby’s life, altogether. But I guess in workaholic Japan, this isn’t such a big deal. I remember a former colleague, whose wife had just given birth in her hometown of Osaka, attending a nomikai, saying he would get on the shinkansen tomorrow. The baby could wait.