Alice is originally from Australia. She gave birth to her daughter Melody last fall at the Tokyo Iryo Center in Tokyo. Alice will share with us her birth story and also how she
advocated for herself at the hospital, emphasising what was important for her and how she handled Japanese authoritarian doctors.
Alice is also a translator (English/Japanese). For a limited time she offers her translation service for pregnant foreign women in Japan who need help to communicate with their Japanese doctors. She also offers to exchange with other women about the IVF (In Vitro Fertilisation) process in Japan.
Birth Preparation
What were your reasons to pick Tokyo Iyro Center?
My husband works there (though not in any department related to pregnancy or birth) and it is the closest hospital to our house (a 10/15 min walk – 2 min drive).
What was important for you?
Originally, I was looking for a clinic run by midwives as I prefer that environment to a hospital one but in the end I decided to go with this hospital because the most important thing for me was to have my husband with me during labour and after, so it would be easier and more likely that he could be with me if we chose his hospital as he would not be restricted by visiting hours and could duck home for a bit if he needed and be back quickly. Ironically and unfortunately the COVID restrictions then came into effect and he was not allowed in the L&D room with me anyway.
Did they speak English? Do you speak Japanese?
They didn’t seem to speak English but as I speak Japanese that wasn’t a problem.
Does Tokyo Iyro Center offer epidural? What made you feel confident that you didn’t need an epidural?
They do not offer epidurals but I didn’t want one anyway so this was not an issue for me. Before getting pregnant I remember thinking that I would probably get an epidural but after getting pregnant and educating myself more about my body, pregnancy and birth and the different medical interventions available to women these days I believed that my body was built to do this and felt no need for an epidural. Of course, I don’t think there is anything wrong with someone getting an epidural but I knew it wasn’t what I wanted.
How did you prepare for birth?
I loved being pregnant and learning all about pregnancy and birth so I watched hundreds of videos of women talking about their birth experiences as well as many of the videos offered by two doulas on separate Youtube channels (Sarah Lavonne [Bundle Birth] based in LA and Bridget Teyler based in the San Francisco Bay area). They had so many great tips regarding mindset, coping techniques, etc. and answered many of the common questions women have when getting pregnant for the first time.
I also like listening to audiobooks while I do other things so I downloaded a few on pregnancy, birth and also on babies to help me prepare for those first few weeks after birth too.
How far was the ride for you? How did you get there?
It was only a 2 min ride in a taxi to get me to the hospital. I actually intended to walk if my contractions came during the day and were 10 mins apart but that didn’t work out so we called a taxi.
How early did you book the facility? Did you feel at any point rushed to book a facility?
I actually got pregnant through IVF so I found out about my pregnancy at the fertility clinic at week 4 day 6 and I had my first few ultrasounds there. My first ultrasound at the hospital was in Week 11 and that was also the day I registered my due date with the hospital and received all the paperwork regarding payment and hospital guidelines etc...
I do remember being told to book a place sooner rather than later as beds can fill up quick but to be honest I don’t think that was the case with this hospital. It might be more so at hospitals with English speaking staff as there are less of them.
Was it possible to visit the facility before registering?
I think the hospital did usually offer pregnancy trimester-related classes and a guided tour of the facility but they were all cancelled due to COVID.
Check-ups
Were the check-ups always with the same doctor? How was the atmosphere?
Yes, I had the same doctor for all my check ups though mostly it was the nurses and midwifes who checked my weight, looked at the Pregnancy Booklet, checked the baby’s heart beat etc.. I saw the doctor at the very end of the session where he would ask me how I was feeling, tell me how things were looking based on my data and if necessary would check my cervix for dilation. The ultrasounds you always see people have in movies was done in a different department in a different location in the hospital so I would have to go there before going to the obstetrics and gynaecology department.
The waiting times in hospitals always take ages. On average I would say I was at the hospital for 2 hours or so every time even if I had no ultrasound that day. I remember it used to frustrate me how frequently I would have to go in for check-ups even though my pregnancy was going smoothly. I am not sure if that is something I could have spoken up about as I don’t know if this is a nationwide rule or just the hospital’s rule, but I was glad I had chosen a hospital close to my house as I would have hated to have to travel on a train or bus every time.
The nurses and clerical staff were extremely kind and friendly, and always remembered me when I came in.
How did you experience doctors in Japan? And how are they different from Australia?
I was not a big fan of my doctor as he gave me the impression that he was not really interested, though sometimes I think that was just his natural demeanour.
In general, I am not sure how it is in Australia as I have never been pregnant in my home country.
I felt I was able to ask questions but the doctors’ answers were always just a reiteration of the hospitals rules.
They would assume a lot and I think they don’t often take into account the natural differences between Japanese people and people of other races. I understand that doctors are professionals and relative experts in their field but I also believe that we know our bodies best.
They did give me a 1 page birth plan questionnaire which I wanted to talk through thoroughly but the doctor didn’t seem to do that. I was shocked when I passed it over and he just got someone else to take a copy of it and that was that, like it was just another piece of paperwork. So, at the next check-up I brought it with me again and asked for confirmation on each area I was particularly concerned about, such as the hospitals policy on C-sections, episiotomy and other interventions as I wanted to avoid all of these as much as possible. I also made sure to clearly convey what was important to me by confirming things again when my due date got closer.
Japanese people have a generally quiet and reserved demeanour so when you want to discuss things openly with them it can seem difficult. I find that the way you say something, both in tone and choice of words, can have quite an impact on how willingly they will listen. They are not as direct as we are in the west so that is how I approach them with my concerns and they seemed much more open to considering my opinion when I did not state things as forwardly and bluntly as we usually do in the west.
Did you have any concerns during your pregnancy?
I had horrible morning sickness pretty much all day every day for the first 4 months but fortunately I otherwise had a very smooth pregnancy; no complications like preeclampsia etc.., and was able to fully enjoy being pregnant J
I was concerned that the hospital would try and force me to get induced if I got to week 41 as my doctor had been mentioning it during my last few appointments but thankfully Melody came at week 40 day 4.
What rooms (private /common) were available there? Are husbands allowed to stay overnight?
The hospital does offer private rooms as well as rooms with a max of 4 people per room. (I think there are also rooms with 2 beds instead of 4 but I did not see those) The private rooms were a little expensive per night but the 4-person rooms were free (no additional fee to the usual hospitalisation fee). I chose the 4-person room so I don’t think husbands can stay overnight as you are sharing with other mums, but I assume they would be able to if you booked a private room (though meals would not be included for him) and if there were no COVID restrictions.
Giving birth
Tell us a little bit how your labor started- At what point did you go to the hospital?
We went to bed around 12am after a very normal day and suddenly, at about 1am I felt something that I thought could be contractions starting.
Everyone says that labour usually takes ages as a first time mum so I had prepared myself for that and intended to stay home as long as possible so that I could be with my husband as he was not allowed in the L&D room due to COVID.
However, my contractions immediately came quite fast, not even 2 minutes apart. I remember thinking 'this can't be right, there should be more of a gap.' I started throwing up every 10 mins or so and felt the need to empty my bowels constantly. After an hour of this I conceded that I could stay home no more and so I asked my husband to call the hospital to let them know we were coming.
How did you get to the hospital? How was the ride?
My husband then called a taxi and thankfully, as we live so close, I didn’t feel the need to throw up while in the car.
How was your labor and the birth process?
It was around 2:30-3am when we got there. My husband registered me and took me to the birthing ward before he went home. I was checked for dilation (3cm) and taken to the L&D room. I originally wanted to walk around and move freely but as I was already getting such fast and strong contractions I was told to get on the bed and felt no need to object.
They checked me again and I had already dilated to 6cm. I have no idea when or if my water broke but they began monitoring my baby. Her heart rate and oxygen were very low so they immediately hooked me up to a drip and gave me an oxygen mask. I was at 10cm dilation within the hour. I had my eyes closed almost the entire time. I remember being shocked when they told me she would be here soon and I opened my eyes for a moment to see 10 or so people around me, though I had been alone moments before.
The doctor who delivered my baby was the on-call doctor, so different to the one who usually did my checkups. I liked this doctor as he kept me informed of what he was doing and why. He told me that she had to come out quick and that, as I was dilating so quickly and contractions were still coming fast and strong, we could avoid a C-section as a vaginal birth would be quicker, which I was extremely grateful for.
She was still in a distressed state and wasn’t coming down so the doctor apologised for not being able to follow my birth plan as he would be performing an episiotomy. The fact that he kept me so well informed made a big difference to being able accept the interventions I was given. I did find out later that they also used a vacuum on her head to help as well.
The doctor and nurses told me not to ‘run-away’ from pressure, which was just what I needed to hear at that moment.
My beautiful baby girl was born at 4:19am after 3 hours of labour on Sep 20.
It was not the birth I had envisioned but birth is unpredictable and I think having a birth plan, preparing yourself and having a positive mindset helps greatly in accepting the experience no matter how it goes.
What happened when your baby was born? Was kangaroo-care allowed?
When did you breastfeed the first time? How important was breastfeeding for you?
When she was born it was a few minutes before I heard her cry and even then it was just a tiny second. She was blue and had a very low APGAR score of 2 and so was admitted to the NICU for 3 days. In my birth plan I wrote that I wanted to hold her immediately and breastfeed before she got cleaned up, weighed etc… but I didn’t get to do this. They did however wrap her up once she was stable and held her next to my head for around 10 mins so I could touch and see her. After that she was taken away and I did not get to see her again until later that afternoon as I had to stay in the L&D for a while due to significant blood loss.
I wanted to raise her just on breastmilk rather than formula (not that there is anything wrong with formula but this is my preference) so it was very important to me that I be able and allowed to breastfeed. I didn’t get to breastfeed her for the first time until the following day however and I could only go in to see her once a day due to strict COVID regulations. I am not sure how often I would have been able to go in otherwise. Though Melody wasn’t with me for those 3 days I made sure to express every 2 hours (night as well) and take it to her so that my supply would come in.
How long did you stay in the hospital? How was care? Could you room in with your baby?
I was in the hospital for 6 days which is the policy of the hospital (9 days for a C-section).
The care was very good. They came and checked on me a few times a day, which got less and less as the days passed. The hospital’s policy is to take the baby for the first night after being born to allow the mother to rest and recuperate and then room in with the mother from then on. In my case however, Melody was discharged from the NICU around lunch time on the 3rd day and so roomed in with me from then on.
Did they help you with breastfeeding?
Yes, they showed me how to express colostrum while Melody was in the NICU and once she was finally out and rooming in with me they helped me get her used to breastfeeding instead of the bottle as she had been having my milk in a bottle (substituted with addition formula I believe if there wasn’t enough) up to that point.
Was your husband allowed to visit you? What were the visiting hours?
How was the food? How much did you end up paying?
My husband was allowed to come and see me in the L&D room after Melody was born and then to go and visit her in the NICU as he is a staff member of that hospital, but if he was not then this would not have been allowed due to COVID.
Usual visiting hours at Tokyo Iryo Center are from 3pm to 8pm on weekdays and from 1pm to 8pm on weekends, but during COVID visitors were only allowed for brief scheduled visits and were not allowed into the rooms.
I was given 3 meals a day as well as a little snack in the morning and afternoon. It was pretty nice food, not as lavish as I have seen some hospitals provide but still healthy and yummy. I do prefer Japanese meals to the ones I have heard are often offered in western hospitals.
I believe the total cost was about 420,000 yen but the Japanese government covers about a third of that so we paid about 280,000 yen.
Advices
What was the most challenging part for you during your pregnancy / labor?
How do you feel about having a second baby?
What would you recommend other pregnant women in Japan?
The morning sickness was actually the toughest part for me as it lasted so long and I am the type of person that likes to be up and about all day so I did not like having to lay down so much. I also wonder how I will go with my second pregnancy if that happens again because I will no longer just be able to lay down as Melody will be with me…
Still, I am looking forward to getting pregnant again. :)
For other pregnant foreign women in Japan, especially if it’s your first, I would recommend educating yourself during pregnancy so that you can be confident in yourself and the strength of your body.
I also believe that just because you are in a different country does not mean you need to sacrifice what is important to you because “that is not how it is done in Japan.” Decide what is important for you, find a hospital/clinic that best supports that and do not be afraid to question the doctors and confirm with them anything you are unsure about.
I understand it can be particularly difficult to advocate for yourself with a language barrier so please feel free to contact me via the email address below.
I am not a nurse or registered childbirth educator, but I am a translator and have a keen interest pregnancy and birth so would be happy to help you with any concerns regarding communicating with your doctor.
In your email please include your name, a brief description of your situation and why you chose to contact me. I will then send you two options for a 30 min zoom call and you can reply with which ever option best suits you. During the zoom I welcome any questions about Japanese hospitals, how to handle the Japanese approach to pregnancy and birth, or even about IVF in Japan or Japanese husbands and mothers in law.
Currently I am offering my services completely for free as I am just starting a business and am looking to see what the interest is like.
Eventually I would like to offer an option where I attend check-ups with you throughout pregnancy if you have trouble with Japanese or would like help advocating for yourself.
Unfortunately, I am not offering this at the moment due to COVID, but hopefully I will be able to in the not too distant future. Check out Alice's website: https://alicenakae.wixsite.com/website
Here are the links for the mentioned birth preparation videos:
Sarah Lavonne: https://www.youtube.com/c/Sarah-Lavonne/videos
Bridget Teyler: https://www.youtube.com/c/BridgetTeyler/videos