Resource: Mom and Baby Friendly Hospitals, Maternity Clinics, and Birth Houses in the Tokyo Area

One of our TPG admin, Jocelyn Saito, has created a list compiling various recommended hospitals, maternity clinics, and birth houses in the Tokyo area! 

All of these caregivers come recommended from fellow mothers in the Tokyo community and promote policies such as:

• supporting skin to skin directly after birth if there are no complications

• allowing for alternative birthing positions/options such as a water birth, birthing off the table or in a position other than your back

• allowing for a birth partner in the room with you during labor and delivery

• allowing your partner and baby to room in with you during your stay (or at least baby)

• promoting breastfeeding directly after birth and provides consultations in the following recovery days

And possibly:

• access to pain relief, such as an epidural 

• English support (although not required for this list)

Check out the post here!

3rd Trimester - Personal Account

Here is a personal account of the 3rd trimester of pregnancy in Tokyo at a Japanese public hospital, continuing on from my previous posts about 1st and 2nd trimesters. Depending on which hospital you go to in Japan, there may not be alot of English available, and also this may be your first pregnancy, so I have tried to explain my experience in as much detail as possible.

As with 2nd trimester, each checkup in 3rd trimester will involve the following routine tests and measurements:
- Urine test
- Blood pressure
- Body weight
- Size of uterus
- Heart beat of baby with a Doppler
- Check for any signs of swelling in ankles and feet
- General questions such as how are you feeling and has the baby been moving, etc

The checkups during third trimester went relatively smoothly. I had a checkup every 2 weeks, and then every week in the last month of pregnancy. At each appointment the nurses helped me get the necessary birth documentation ready and provided information on what to bring to the hospital when the baby comes.

Rh-negative
My blood type is Rh-negative, and my husband is Rh-positive, so I had to receive some extra tests in third trimester. There is alot of information on the internet about this if you are in a similar situation – basically, if you are Rh-negative and your baby is Rh-positive (inherited from father), and your baby’s blood mixes with your blood, your body could respond by producing antibodies which attack the baby’s blood causing serious complications including anaemia. I had received a few blood tests in 2nd trimester to check that I wasn’t developing antibodies, and the doctor also checked on the ultrasound that the baby wasn’t developing anaemia. Then at 28 weeks, after another blood test to confirm that no antibodies had been produced, I was given an injection of Rh-immunoglobulin (to prevent the production of antibodies). If my baby is born with Rh-positive blood, I will be given another dose of Rh-immunoglobulin within 3 days after birth.

Costs for Pregnancy Check-ups in 3rd Trimester
The following is an example of the costs for maternity check-ups at a Japanese public hospital. I have Japanese national health insurance and used the yellow discount tickets from the ward office (Kuyakusho) that were received with my boshi techo.
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 scans cost approx. 5,000 yen each time, as it is not covered by insurance.

28 wks: 3000 yen
- regular checkup
- I didn’t have a scan this week as had one at 27 wks before I went overseas the week before
- As I am Rh-negative blood type, and my husband is Rh-positive, I also had an Rh-immunoglobulin injection (70% covered by insurance at my hospital)

31 wks: 3000 yen
- checkup, scan (my scans after 30 wks were free – I was hesitant to ask the reason why in case they charged me (☺!) but hopefully this is standard for 3rd trimester at all hospitals)

33 wks: 3000 yen
- checkup, scan (free)
- I also had an antibody-screening blood test as noted above

35 wks: 5000 yen
- checkup, scan (free), and streptococcus test

37, 38, 39, 40 wks:
- checkup, scan
- at 37 wks, will have fetal heart monitoring for 20 min to check baby’s heartbeat

I am posting this update on 3rd trimester just in case I don't get the chance to later (!) - I will try and update with the costs after 37 wks at a later date. All the best to you all with your pregnancies!

Click here for information on all 3 trimesters.

2nd Trimester - Personal Account

Here is a personal account of my 2nd trimester of pregnancy in Tokyo at a Japanese public hospital, continuing on from my previous post about 1st trimester. Depending on which hospital you go to in Japan, there may not be alot of English available, and also this may be your first pregnancy, so I have tried to explain my experience in as much detail as possible.

You may be wondering by this stage in your pregnancy what the purpose of the “boshi techo” is?! Well, the hospital finally starts to enter information into it from 2nd trimester. Each monthly checkup from 20 wks pregnancy will involve the following tests and measurements:
- Urine test
- Blood pressure
- Body weight
- Measurement of waist and size of uterus
- Heart beat of baby with a Doppler
- Check for any signs of swelling in ankles and feet
- General questions such as how are you feeling and has the baby been moving, etc

When it was my first time for these tests at 20 wks, it was a bit confusing as I didn’t know what to do and there wasn't any English explanation available. Most hospitals will have their own little routine, and you are basically required to do the routine checkup list above with the nurses before your appointment with the doctor. I stood at the door of the checkup room for a few minutes waiting for the nurses to explain what I had to do, but they didn’t seem to realise and just left me standing there! Luckily my husband was with me and he explained to them it was my first time and then it finally dawned on them and they explained each step to us and that this will happen with every appointment from now on.

The routine at my hospital is:
- When I arrive at the hospital, I put in my hospital card at the ATM-looking machine and it prints out my appointment for the day. I then go straight to take a urine sample (on a different floor of the hospital), and hand it over to the laboratory.
- Then I go to the maternity ward and measure my blood pressure and body weight. I give these results to the nurse (who writes it in my boshi techo) and wait my turn. Then I am called in and the nurse takes me into a separate room closed with a curtain where she asks me how I'm feeling, I hop on the bed and she checks my baby's heartbeat with the doppler, then measures waist and uterus size. She then checks my ankles and feet for any swelling. She writes all this information into my boshi techo, and then I go out to the waiting room to wait for my appointment with the doctor.
- After my doctors appointment, I go down to the hospital front desk to pay my bill and then all finished.

Each hospital will be a bit different, so it is good to ask the nurses about the routine and what you are required to do for each appointment. Once you get to know the routine it is much easier!

At 27 wks I had the test for gestational diabetes. This was another little experience of misunderstanding! The doctor explained the test for gestational diabetes to me at my previous checkup - we were talking in Japanese and I thought he said to drink some softdrink 1 hour before coming to the hospital. So, on the morning of my appointment at 27 wks I drank a can of 7up on the way. This was pretty embarrassing in itself, as I was holding the can of 7up on the bus at 8 o'clock in the morning on the way to the hospital and I was thinking people must think this pregnant lady is not looking after her health!! Anyway, when I got to the hospital, there was a bit of confusion among the nurses when I explained to them that I had done my preparation and drunk softdrink before I came.... after a few minutes it became clear that I had made a mistake! What the doctor had said was that when I come to the hospital, they will get me to drink a glucose drink (which tastes like a softdrink), and then I wait for one hour before they take a blood sample to test for gestational diabetes. I was pretty embarrassed, but I'm sure these types of experiences happen to everyone in Japan!

In terms of weight gain, by the end of 2nd trimester I had put on a total of 10 kg. My baby was estimated to weigh about 1.2 kg, so the other 8.8 kg was extra weight. The nurse seemed to be surprised by my fast weight gain (she actually measured my belly twice just to make sure!) and recommended me to take care and try not to eat too much, particularly fatty foods. I was a bit shocked by her reaction, as I eat relatively healthily and my intake hasn't changed greatly since before I became pregnant. Also, I checked the guideline for weight-gain during pregnancy in Australia, and it seems it is normal to gain 11-16 kg during pregnancy (1-1.5 kg per month in the first trimester, and 1.5-2 kg per month for the rest of the pregnancy). The nurse at my hospital said I should be only gaining 0.5 kg per month, so it seems the Japanese standard is much lower than overseas. Personally I think as long as you eat healthily and feel good, then that is the most important thing for both you and the baby!!

Costs for Pregnancy Check-ups in 2nd Trimester
The following are an example of the costs for maternity check-ups at a Japanese public hospital as of 2011. I have Japanese national health insurance and used the yellow discount tickets from the ward office (Kuyakusho) that were received with my boshi techo.
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. This 5,000yen is included in the costs below, unless one of the free scans provided from the Kuyakusho was used.

15 wks: 8,000 yen
- scan and chlamydia test

20 wks: 0 yen 
– checkup and scan (I used one of the free scans, so no cost)

23 wks: 2,000 yen 
- I had this early checkup just 3 wks after my previous appointment as I was going overseas (usually you have an appointment once a month in 2nd trimester). They did the regular checkup and consultation with doctor. I didn’t have a scan (so didn’t have to pay the 5000 yen), but the doctor did check my cervix by vaginal ultrasound to confirm no problems or signs of labour before I went overseas (apparently the cervix shortens and becomes soft if labour is imminent)

27 wks: 10,000 yen
– checkup, scan, and test for gestational diabetes (this test is not covered by insurance, so had to pay)

See you in another 3 months with my personal account of the 3rd and final trimester! Hopefully all goes well!

Click here for information on all 3 trimesters.

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 http://tokyopregnancygroup.blogspot.com/search/label/Doctors%20and%20Hospitals

- 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: http://women.benesse.ne.jp/maternity/ 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 www.sakamoto-obgyn.mymedfusion.com.)

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.