Pregnancy in Japan

Baby Steps

By Rosie Blakely
June 11, 2016
Families

It’s amazing how two little lines popping up on a stick can produce such a range of conflicting emotions in a person. Hopefully, that range tends more toward elation rather than the shock-filled-terror end of the scale. Whatever the scenario, there is sure to be a healthy dose of fear in the mix somewhere. For expats living in Japan, aside from the realization that you are expecting, that fear may be compounded even further by having to figure out prenatal care, doctors, official registration and the like. I can relate.
Not to worry, Savvy Tokyo is here to help! After you’ve done your little happy dance, a few fist pumps and taken some deep calming breaths—read of the following tips.

Confirming the pregnancy

If you suspect you may be pregnant, you’ll be happy to know that simple, pee-on-a-stick type home pregnancy tests (ninshin kensayaku) can typically be found at any drugstore for a few hundred yen. To confirm your pregnancy head to your local hospital or ladies’ clinic for a checkup.

Hospitals and birth centers book up very fast, so you will want to get onto this fairly quickly.

I went for my confirmation appointment when I was six-weeks pregnant amid much ribbing from my husband—who thought I was being a little overeager—only to find that the delivery suite at Kawasaki Municipal Tama Hospital (my local) was already fully booked for anyone beyond the eight week mark. Note that you don’t need to go to the facility where you wish to give birth for this initial checkup, but depending on the hospital, it may mean your name gets pencilled in even before confirmation.

Your doctor will confirm your pregnancy via transvaginal ultrasound. This can be a blessing and a curse. While it’s exciting to have a scan and possibly see your tiny, flashing bean straightaway, it can also be unnecessarily concerning if no heartbeat can be found, since it’s not always possible at such an early stage. So if not, try not to worry—your doctor will likely ask you to return the following week to try again.

Once your doctor spies a heartbeat, you will be issued with a certificate declaring the pregnancy confirmed (ninshin todoke).

Registration at your local health center

After confirmation, take the ninshin todoke and your foreign residence card to your local health center to register the pregnancy. Upon registration you will receive a pregnancy goodie bag which includes:

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  • Boshi kenkou techou (mother and child health handbook)

You will need to take this to all of your prenatal appointments, child’s health checkups and vaccinations in the future for medical staff to record and refer to your medical information. Many foreign language translations of the handbook are also available.

  • Ninshin kenkou shinsa jushin hyou (pregnancy health checkup coupon book)

Prenatal care in Japan is not covered by the National Health Insurance. However, according to your ward’s policies, you can receive discount coupons for checkups. Note that (at my hospital, at least) the fees for your initial confirmation appointment(s) can be reimbursed after the pregnancy is confirmed and the coupon book is obtained.

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  • Mataniti māku (maternity mark, or pregnancy badge)

This badge, which charmingly reads “there is a baby in my belly,” provides you with an all-access pass to priority seating areas on public transport and disabled car parks. Attach it to your bag so that other passengers know you are pregnant and will (in theory) offer you their seat. In reality, I found that its efficacy varies according to the time of day and crowdedness of the train or bus.

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  • Lots of booklets and other goodies

This will depend on where you live. In my bag, I found guidebooks about child health and facilities specific to Kawasaki City as well as other sponsored booklets and coupons for baby products. In Minato Ward, residents are issued with a free bus pass for use on Chii buses until the end of the month in which the child turns one.

Checkups

Generally speaking, your prenatal checkup schedule will look something like this:

  • First and third trimesters—appointments every other week
  • Second trimester—monthly appointments
  • Beyond 40 weeks/10 months—appointments every two days

This corresponds to around 15 checkups total—heaps compared to that in other countries. Additionally, ultrasounds are performed each time, which means you end up with quite the collection of pictures of your child from long before he/she is born. While it’s nice to have the constant reassurance, it also adds to the cost and can be a little inconvenient, especially if you are working (although employers are required to allow you the time off for appointments). If you find it too much, you may be able to request to space the appointments out more.

While you might find your first appointment pretty daunting with all the people scurrying about, hospital noises and forms to be completed, be assured that each checkup will likely follow the same pattern so you will quickly get the hang of it. If your Japanese abilities are limited, I would suggest bringing a translator with you on your first visit at least.

At my hospital each checkup took the following course, and took between one to 2 1/2 hours:

  • Electronic check-in at reception.
  • Urine test and (if previously requested by the doctor) blood test at the laboratory department.
  • Self weigh-in and blood pressure check using the machines at the OB/GYN department.
  • Doctor’s examination including ultrasound and brief discussion (about 10 minutes total). My husband was not allowed in the examination room for the ultrasound, although he could come in for the discussion afterwards. Instead we could book a one-off comprehensive ultrasound in the radiology department.  
  • Payment.

Maternity leave and notifying your workplace

According to Japan’s Labor Standards Act, employers are required to allow mothers maternity leave from six weeks (for one baby and from 14 weeks for twins and more) prior to the due date until eight weeks after delivery. In addition, the Act on Childcare Leave provides for childcare leave until the child turns one (and until the child reaches one year and six months of age, if the parents take turns). During this time, labor and social insurance will cover up to 66 percent of the mother’s base salary, but every company will have their own regulations—so please make sure you confirm all details with your employer.

The best time for announcing your pregnancy to your employers will, of course, depend on your company’s culture, size and your relationship with your direct supervisors. You will also want to factor in whether you will need time off for prenatal appointments, morning sickness and when your precious baby bump starts to show. It goes without saying that your boss should find out privately and directly from you—this is particularly important in Japanese work culture.

I worked at a tight-knit office of seven workers and was the only person in my role. I also suffered from terrible morning sickness, so I told my boss quite early on—at around 13 weeks as soon as the initial “danger zone” of the first trimester had passed. He was very gracious and quick to give me time off as necessary, saying that I needed to prioritize my health.

In future articles on giving birth in Japan, we will provide an overview of birth options and the birth experiences of a number of other woman in Japan. If you have any specific questions, please leave a comment and we’ll be happy to address it.