May 21, 2011

First Trimester - personal account

Here is a personal account of being pregnant in Tokyo. I decided to share this with you, as even though I have been living in Japan for 8 years, can speak and read Japanese, and my husband is Japanese, there was still a lot that we didn’t know! We even bought the pregnancy magazine “Hajimete no Tamago Club” and asked for advice from my husband’s sister who had recently had a baby, and there were STILL a lot of things that surprised us. Pregnancy is definitely a learning experience, and being in another country can sometimes make it even more challenging. I hope this will help to provide some more information for you all.

First Trimester

1. First step when you are trying to conceive is to check using a pregnancy test kit, which you can buy from drug stores in Japan (the pregnancy test boxes are usually located in the feminine hygiene or contraception shelves of the store). There is a pregnancy test brand available in Japan with English instructions – look for this written in English on the box.

2. If your test result is positive (congratulations!!), the next step is to go to a ladies clinic or hospital to have the pregnancy confirmed. It is good to schedule an appointment about 6 weeks after the start of your last period – then the doctor will be able to conduct a transvaginal ultrasound to confirm the pregnancy. At this stage your little baby will only be a dot on the screen, but you should be able to see the heart moving which is very exciting! Don’t forget to bring your health insurance card to each appointment.

How do I find a Ladies Clinic or Hospital?
- If you have already decided on the hospital you want to go to, you can go there for your first appointment. There is a list on the TPG website
- Alternatively, you may want to confirm the pregnancy before deciding on which hospital you want to give birth at. If this is the case, it is easy to go to a Ladies Clinic.
- There are lots of Ladies Clinics in Tokyo, and one of the best ways to find one in your area is through this website: The website is in Japanese, so if you understand the language or have a friend that can help you, it can be very resourceful. In order to access their database and reviews, you will need to register (no cost).

Can I make an appointment or do I have to wait in line?
- Some clinics and hospitals will allow you to make an appointment by phone, however many do not have this appointment system and you simply have to go and wait for 2-3 hours to see the doctor. Check their website for details. In the latter case, it is highly recommended to arrive at the clinic/hospital at least 1 hour before they open, so that you will be one of the first people to take a number. This should make the whole process much faster.

What happens on the first appointment?
- You will need to give the reception your National Insurance Card and fill out their forms. The form will include various questions including when was the start of your last period, your health condition (frequency of exercise, whether you smoke, drink alcohol, etc), and any family history of diseases.
- When you are called into the doctor’s room, the doctor will ask you some questions (basically confirming what you wrote on the forms), and then ask you to go into the examination room (usually a separate room behind a curtain).
- I will explain the next step in detail as I was really surprised by the whole setup and the automatic chair! There will be a small changing area with some towels and a basket to put your clothes in – take off your pants and cover yourself with the towel. Then sit on the chair – open the towel so it covers your lap. When you are ready, tell the nurse and she will push a button so the chair goes up (and the legs open) and turns around to face where the doctor will sit. In Japan it seems they usually pull a curtain across in front of your face, so that you can’t see what the doctor is doing. I felt really uncomfortable about this and as soon as the nurse went to shut the curtain I reached out to stop her – she asked me what I would prefer (curtain open or shut) and I said open, so she kindly opened the curtain so I could see what was going on. The transvaginal ultrasound is a relatively straight forward process – usually they first do a pap smear (if you haven’t had one recently) and then do the ultrasound. After seeing the little baby on the screen, they then move the ultrasound probe around a little to see the ovaries and check that everything is okay. Then you are finished, and you will receive some photos of the baby scan to take home.

3. After you have confirmed your pregnancy, the next step is to go to your local city hall/ward office to register. Go to the foreign residents counter and they will show you what to do. You will be asked to fill in a notification of pregnancy form - the form includes questions such as how many weeks pregnant you are, and the name of the clinic/hospital and the doctor’s name where you had your pregnancy confirmed. They will give you a Maternal and Child Health Handbook (boshi techo) and the Mother and Child Health Bag. The Maternal and Child Health Handbook is needed for routine pregnancy health checkups – make sure you keep the Handbook as after birth it can be used to certify your child’s vaccination record as well. You will also receive 14 yellow tickets, which you will use at each appointment to receive free pregnancy health checkups, and 2 free ultrasound scan tickets. (Note – ultrasound scans and blood tests are not covered by the National Health Insurance, so you will need to pay for these separately. Only 2 ultrasound scans are provided for free.)

4. Next step – decide on where you would like to give birth. There are a full range of hospitals, clinics and birth houses available in Japan. Check the TPG website and other websites for information. You can also have a consultation – there are consultants listed on the TPG website who can help by talking with you about what kind of birth you would like, and the options available.

Note – it is recommended to decide on a hospital very quickly, so that you can go there for your next appointment. One of the reasons is that hospitals in Tokyo can become fully-booked very quickly, so the earlier you register the better. Another reason is that the pregnancy health check-ups are very routine - I went to a Ladies Clinic for 3 appointments until I was 12 wks before we decided on a hospital, and they insisted on doing a urine test on my last appointment even though I wouldn’t be returning to the clinic again. This meant that we still had to pay for it, even though we wouldn’t receive the results. To save yourself any frustration, it is highly recommended to find a hospital asap and start going there for your checkups.

Some hospitals require a referral letter (if you don't have one it can cost approx. an extra 3,000 yen). If you receive a referral letter from your previous doctor, it can make the whole process much easier when you change over, as it will state all the details of your previous appointments and blood tests – basically gives an up-to-date summary of your pregnancy for your next doctor.

5.  At 12 weeks, you may plan to have a Nuchal Translucency (NT) test and early blood test for genetic disorders. However, in Japan the NT scan is very rarely conducted (it is not approved in public hospitals), and furthermore the early blood test is not approved in Japan. The Quad Test (at 15 weeks) however is approved in Japan, as is Amniocentesis (at 16 weeks). Here are some details of the costs below. (Note - Dr Sakamoto was the only doctor I could find who could do the NT test. He also offers the Quad Test and Amniocentesis. Details are on his website

Costs for Pregnancy Check-ups
The following are an example of the costs for maternity check-ups, as of May 2011. I have Japanese national health insurance, and used the yellow discount tickets received with my boshi techo from the ward office (Kuyakusho) for each checkup after my first appointment.
Note - these costs are only provided as a guide. Actual costs may vary depending on which clinic/hospital you go to.
Also note that ultrasound scan costs approx. 5,000 yen each time, as it is not covered by insurance (you will however receive two free scan tickets with your yellow tickets and boshi techo from the ward office). This 5,000yen is included in the costs below.

6 wks - first appointment and ultrasound to confirm pregnancy: approx. 8,000 yen
8 wks - ultrasound and blood test: approx. 20,000 yen
12 wks - ultrasound and urine test: approx. 8,000 yen

Other Tests
12 wks - Nuchal Translucency test: approx. 10,000 yen
15 wks – Quad blood test: approx. 30,000 yen
16 wks – Amniocentesis: approx. 150,000 yen

Maternity Leave - Doctors Certificate
- If you are working in Japan and will be applying for maternity leave, you will need to provide your company with a Doctors Certificate. The certificate is a simple letter stating your name, how many weeks pregnant you are, and when the baby is due.
- You may also need a Doctors Certificate if you are planning on flying on a plane in your third trimester.
- Cost: approx. 3,000 yen

Well, this is the summary for my first trimester! Hope that it helps with your own pregnancy in Japan. I will post again soon with details of the second trimester, as well as the procedure for applying for maternity leave if you are working full-time in Japan.

Click here for information on all 3 trimesters.

Click here for information on maternity leave in Japan.