Going through pregnancy and giving birth is difficult enough in one's own country, managing in a foreign place is not an easy thing. The following is a brief description of what to expect if you are going to have a baby in Japan.

It is convenient and cheap to use a home pregnancy test to find out if you are pregnant. These tests ("NINSHIN HANTEIYAKU" in Japanese) are available at any drugstore. The test will show a result within 1-2 weeks after you missed your period. Since the official start of a pregnancy starts at the first day of your last period, this means that you could already be 5 to 6 weeks pregnant at the time of the test. However, an entopic pregnancy and even a miscarriage can also give a positive result. Therefore it's a good idea to have your pregnancy confirmed around 8-12 weeks by an obstetrician or gynecologist. An other good reason to have your pregnancy confirmed until around 10-12 weeks is that this is also a good moment to more accurately calculate the estimated due date, depending on the fetus size.

A doctor diagnoses your pregnancy from the fetus size and the heart beat. Then you will have basic check-ups (protein and glucose in urine, blood pressure) and a routine blood test.
This test usually consists of checking the following items:

blood type; blood cells (number of white cells, number of platelets, hemoglobin level);

• syphilis screening
• hepatitis B screening
• hepatitis C screening
• rubella titer

toxoplasmosis (if you have pets, especially cats);

• HIV test

The total cost will be between 10,000 and 20,000 yen, for an ultrasound scan and routine blood test combined. This is not covered by the standard Japanese insurance. After 2 to 4 weeks, you should visit the doctor or midwife again to receive the results of the blood test. At the time, you will receive the "NINSHIN TODOKE" or pregnancy registration form and your pregnancy certificate.

Take this to the nearest health center and register your pregnancy. The center will give you a mother-child book (boshi-techo), in which will be recorded the course of your pregnancy and the birth, as well as your baby's growth and immunization records. Be sure to take it to each prenatal visit and of course to the birth. You can choose to have bilingual copies of the following 7 languages; Japanese, English, Spanish, Portuguese, Chinese, Korean and Tagalong. At the same time, you will be provided with a supplemental booklet. This booklet includes information regarding immunization schedules and vouchers for various services provided by your local city.

UPDATED

Good News!

From April 1st, 2009 to March 31st, 2011 the government will start a "Temporary financial aid to pregnant women" by providing more funds for local authorities to increase their support for pregnant women but since it varies so very much from place to place, it is impossible for me to write any details here. Please ask at your local city office and health center to find out what is available.
If you have been given some information but can't make any sense out of it, please contact me and I'll try to help you understand at least the important parts.

After registration, you need to think about what kind of birth you want or need and where and how you are going to have it. In choosing the place of birth, you need to consider your physical condition, Japanese language ability, financial situation etc. Developing realistic expectations and making adequate preparations will help you have a safe and satisfying birth. Basically you have 4 choices;

• at home (in your home here in Japan)
• in a midwifery clinic
• in a hospital
• going back to your home country and have the baby there

Quite a number of women decide to give birth in their home country. This can be done for a number of reasons, but probably the most common one is the availability of a bigger support-group, to take care of the new mother and / or older siblings. When planning to give birth in your home country, be aware of the restrictions your airline might have regarding pregnant women. Generally speaking, flying after 32 weeks requires special permission, but check with your airline. Even if you are planning to give birth in your home country, it makes sense to have a “back-up plan", in case of unexpected complications, like a premature birth, etc.

Finding a clinic/hospital that you feel comfortable with is very important. In Japan, fathers are not always permitted at the birth. At some facilities, fathers are allowed into the delivery room, but not the labor room, in others the other way around. In some places he is expected to wait in the waiting room. More and more places though, encourage fathers to participate and sometimes if you have communication problems, they may even allow you to bring a friend who can interpret and assist you.

In Japan, non-medicated, "natural" birth is most common and pharmaceutical pain relief is rarely used. Often, foreigners are looking for the place where epidural-used, "natural" birth is available. If you feel strongly about medicated pain-relief during labor, talk to your doctor in advance. In case you have serious complications during your pregnancy, which may result in a difficult delivery or problems with your newborn baby, you will be recommended to go to one of the larger hospitals with a newborn intensive care unit (NICU).

Most clinics and hospitals have the following schedule for pregnancy check-ups, providing the pregnancy follows a "normal" pattern:

A typical pregnancy will result in 15 check-ups: at 8, 12, 16, 20, 24, 26, 28, 30, 32, 34, 36, 37, 38, 39 & 40 weeks.
A "standard" check usually includes the following;

• Body weight
• Protein and glucose in urine
• Blood pressure
• Measurement of tummy (uterine)
• Fetal heart beats
• Edema on legs and other findings
• Ultrasound scan: from very restricted use to every time use, depending on your doctor.
• Non stress test (NST)

The standard checks preformed might be different from the ones used in your home country. If a test is not routinely done, but is important to you, just explain to the doctor why and ask for this test. Typically, a prenatal visit will cost between 3,500 yen and 10,000 yen depending on the place and on how many tests were performed. An ultra sound scan may be routine and included in the fee or it may be done only once and charged extra. Other tests, such as amniocentesis, can raise the fee as well.

At most birth facilities they have classes to prepare the couple for not only the birth but how to take care of a newborn baby. Although they are most likely in Japanese, it is a good chance to become familiar with the staff. The local health centers (Hokenjo) hold classes too. After your baby is born, you'll have more contact with the Hokenjo. So this is a good opportunity for you to become familiar with the staff there as well.

The cost of delivery and hospital stay is a big concern for many families. In Tokyo, the costs are higher, but there's a wider range of options. Some “brand" hospitals with deluxe facilities cost 800,000 - 1,000,000 yen. In other cities, the hospitals and clinics, public and private alike are more reasonable. The usual costs vary around 300,000 - 450,000 yen, including the fee for 5-7 days postpartum stay. For the pregnant foreigner, it can be of advantage to join the National Health Insurance Scheme. It provides some special benefits for pregnant women. Depending on your taxable income, you may qualify for this help. Some of the most common benefits are free medical care for pregnant women and assistance for childbirth expenses given to the woman after the birth.

So what do you need to do after the baby has come?

First, before the birth, you should contact your embassy and find out the procedure for obtaining a passport for the baby.
A couple of days after the birth, the hospital will give you a birth certificate. The left side of the document will already have been filled in by the hospital and you need to fill-in the right side and submit it to the city office. The document has to be written in Japanese and the person at the city office is forbidden to do it for you. So you need to find someone who can help you write it. You take this document, both parent's passports and Alien Registration cards, the Mother-Child book and go to the City office. Your child will be registered and an A.R. card will be issued. If you have the National Health Insurance, you also need to enter your child's name on to the insurance card, and depending on your income, you can apply for "marufuku" which is free medical care for infants.

UPDATED

Good News!

The "Temporary financial aid to pregnant women" also will include an increase in the "assistance for childbirth expenses".

The "assistance for childbirth expenses" （出産一時金）was changed from 350,000 yen to 380,000 yen per birth from January 1st this year and will increase again to 420,000 from October 1st 2009 until March 31st 2011.

For births outside Japan (if you are abroad on a valid re-entry visa and is continuously enrolled in a Kokumin Kenko Hoken or Shakai Hoken while you are absent, you can claim this money after you have returned to Japan) the amount is a bit less; 350,000 yen until Sept. 30th 2009 and 380,000 yen from Oct. 1st 2009 until March 31st 2011.

You can apply for this at your local city office. Bring your bank book with you, (not just your ATM card) and if you use a "hanko" seal, don't forget to bring that too.

Many cities also provides a child benefit program called "jidouteate" for low income families. Ask at the child welfare counter. All of these procedures can be done in one visit to the city office if you bring all the necessary documents. The city office, however, will not give you any official copies of the birth certificate on the same day that you apply for it. An official copy of the birth certificate costs 400 yen.

Remember to ask your embassy how many they require. The hospital may also, at your request, write a document in English stating that "Ms xxx had a baby girl on month/day". This document has no legal meaning in Japan and the father's name is not included, so make sure you get official copies of the Japanese version since that is the only legal document concerning your child's birth.

After you have obtain a passport from your embassy, you have to go to the immigration office and get a visa. Then you go back to the city office again and they will write the new information on your child's A.R. card.

UPDATED

Not So Good News .....

Lately the immigration office has become very strict with the "apply for visa within 30 days of the birth" rule, so if you can not get your child's passport before the 30 day limit, it is better to go and apply anyway. Bring the birth certificate and alien registration to the immigration office. They will issue a special document and you will have to again go when your child's passport is ready. It may seem like a lot of trouble to go twice but if you don't, there may be even more troublesome consequences so do remember the "30 day" rule.

Good luck to you.

There are a lot of information and writings about giving birth and having a baby in Japan.
Here are just a few:

• Getting Pregnant in Japan, from "Stippy" (a webpage I do recommend)
• A family oriented magazine
• Useful even if you don't live in Tokyo
• Andy and Hitomi Gray's homepage about the birth of their children
• Breast feeding in Japan