So, I have been pretty much silent on this blog for the past month. There are two basic reasons for this. First, one month ago today I gave birth to Ewan and it has been a crazy busy month ever since. Since he was early (by about a month) we were spending a lot of time in the hospital for the first two weeks, after that we have been at home, trying to figure out how to care for him all day every day. Second, the theme of this blog is Japan. All the adventures we have here and all the things we see. Well, for the past month we haven’t really seen much of anything aside from Gifu Municipal Hospital and our apartment. Nothing to see, means nothing to write about.
But, I realized that I do have a few things to write about in regards to birth and childrearing in Japan. A few months ago I talked a little bit about some of the cultural differences surrounding pregnancy, and I thought I would do the same now. We only have 4 months left here in Japan and I promise we won’t stay holed up in our apartment the whole, there are still adventures to have, but until we have things sorted a little bit more, I will try my best to share some of the stories and the interesting differences we have found as we navigate being parents in this foreign land.
Let’s start with prenatal care in Japan.
For the most part pregnancy is not considered a medical condition in Japan. Instead it is considered, simply, a natural state of being for women. It is treated as such. Prenatal care is delivered on the same time line as the U.S., appointments once a month for the first six months, twice a month for the next two months, and once a week for the final month. However, there is a major difference in where this care is delivered and what it entails.
First of all, the vast majority of prenatal care and births do not take place in major hospitals. All around Japan are small maternity clinics, the one that I intended to give birth at had only six rooms and the doctor lived in the house adjacent to it. These clinics are designed to handle normal, uncomplicated, births and they do so quite well. Most of the care is given by midwifes and nurses, but the doctor is on staff to oversee each pregnancy and ensure that everything is going as planned.
In contrast, the major city hospitals are reserved for those births that are complicated and those babies that need extra care. In our case, we were transferred to a city hospital when I went into labor because my clinic did not have the facilities to provide care for a premature infant, the city hospital did. We were glad to have access to top-class care and that the doctor at the clinic had the foresight to know what was beyond his capabilities.
Aside from most of the care surrounding pregnancy and birth being handled outside of the hospital, the prenatal care itself was also a bit different from that in the U.S. For the most part it was just a bit more hands off. They assumed that the pregnancy would, most likely, progress in a normal fashion. They checked enough things at each visit to be responsible, but didn’t go looking for problems.
At each visit they would check my weight, blood pressure, and urine. At one appointment in the beginning and one nearer to the middle of the pregnancy they checked my iron levels. At each visit the doctor would measure the height of my uterus, check for swelling, and do a very quick ultrasound. Yes, unlike in the states an ultrasound is given at every appointment. The ultrasound would last a minute or two, maximum, and they would check the heartbeat, size of the fetus, and development of major organs. This is the one place where I feel the Japan system was a bit more invasive.
Unlike in the U.S. no other tests or procedures were offered or recommended at any point in my pregnancy. Amniocentisis was not an option. Testing for gestational diabetes isn’t routine. As I said earlier, they don’t really go looking for problems. It just seems like a basic, fundamental difference in the way they approached things. In the U.S. it seems that doctors assume that there will be problems and that it is their job to find them, lest they be sued for missing them. In Japan it is the opposite. Doctors assume that the pregnancy and birth will progress normally, as most of them do, and only go looking for problems if there is an indication that one might be present.
Those were two differences that were immediately apparent from the very beginning of our journey into parenthood in Japan and there have been many more since. Next time, I can’t promise when that next time will be, I will talk about a few of the differences we found during the birth.