15 Things You May Find Different About Being Pregnant in Japan
I was pregnant here in Japan just last year and would like to share some of the interesting experiences I had. This information may be useful for Westerners living in Japan, but I think that anybody reading this will find something interesting about the way of the Japanese.
1. The Length of Pregnancy Is Different
You might be thinking, “How could this be?” Well, technically, the number of weeks is the same. The difference comes when you count the number of months. In the West, we go by the actual months, however in Japan, they count 4 weeks as a month of pregnancy. This means that while you may consider a pregnancy to be 9 months (3 months per trimester), in Japan there are 10 months. The first 15 weeks make up the first trimester, and by 28 weeks, a pregnant woman will be in her third trimester.
2. Once You Are Aware That You Are Pregnant
In Canada, once you know that you are pregnant, you just change your lifestyle habits a bit and adjust to the pregnancy. In Japan there is one extra step. You must notify the Health Office of your pregnancy and pick up your boshi kenko techo (maternity and child health handbook) at the same time. This handbook is handed over to the clinic at each obstetrician visit so that you can keep track of the results of any tests or other important information. It is also filled with forms with which you attach a sticker indicating your registration number and complete the blanks to receive appointment fee reductions or coverage. With the National Health Insurance, you will also be given a lump sum of 420 000 yen after giving birth.
3. The “I’m Pregnant” Sign
Usually you can expect that people will know by your big belly that you are pregnant and they may yield to give you a bit of special treatment or be a bit more careful around you, but what do you do when you’re not showing yet? In Japan, along with the handbook, you also receive a little ornament that will attach easily to your purse. The standard pink colour and cute illustration of a baby will let anyone in Japan know that you are pregnant. It will be particularly useful when you’re feeling the need to sit down on a crowded train during a bout of morning sickness. You can sit on the reserved seats meant for the injured, elderly or pregnant without people looking at you, wondering why you’re sitting there.
4. The Frequency of Ultrasounds
In Canada, depending on your doctor and situation, you may get 5 or 6 ultrasounds done. Here in Japan, I had an ultrasound done at every appointment (transvaginal at first and then abdominal) which meant that I had 7 ultrasounds within the first two trimesters. The appointments started off once every 1-2 weeks in the first trimester and then monthly in the second trimester. If I were to carry to full term I would have had to go biweekly again and then weekly in the third trimester. That's a lot of ultrasounds.
5. The Recommended Weight Gain Is Lower in Japan
In the West, a woman who is at a healthy weight at the start of a pregnancy (BMI 18.5-25) is advised to gain 25-30 lbs. However, in Japan, she would be told to only gain 7-12kg (or 15-26 lbs). Reading a Canadian pregnancy guide while being pregnant in Japan, I was a little confused about what to do. If I were to gain 1 pound per week in my second and third trimesters as was recommended by Western guides, I would have surpassed my whole weight gain allowance in just two trimesters according to the Japanese guidelines. Not to mention my obstetrician here was very strict about weight gain. The clinic had found that in the past there were a lot of difficult deliveries due to excessive weight gain, so at the first prenatal class, all they did was enforce good eating habits and weight watching.
Just as a side note and warning, in retrospect I wish I had strived for the Canadian weight goal. I was trying to keep my weight gain to match the Japanese standards, and although this may or may not have been the cause, I ended up having a premature baby and losing my son after 2 days in the NICU (a sad story which I will leave for another day). Anyways, if you are pregnant and are in Japan, you may want to discuss the weight gain issue with your doctor.
6. The Food Recommendations Are Different
It goes without saying that the diet in Japan differs widely from that of the West. Although the staple foods may be different, the overall number of recommended servings of each food group is comparable. In a few cases, however, these serving sizes maybe different. For example, a cup of milk in the Canada Food Guide counts as one serving whereas half of that is one serving in Japan. Likewise, 2 eggs in the Canadian guide equals one serving while in Japan it is 1 egg. I referred to both guides, as the Canadian one measured servings quantitatively while the Japanese guide measured them vaguely by the amount they are usually served (ie. a bowl of rice or udon, a package of yogurt or a plate of sautéed ginger pork). The Japanese table was useful for when I ate things like a natto (fermented beans), or hijiki nimono (a dish consisting of seaweed simmered in a broth) that would never have been on the Canadian guide. Despite the small differences though, both cultures place importance on balance.
Since the Japanese diet seems to be high in sodium content, with all the soy sauce, miso paste, and Japanese pickles, all of the pregnancy info books stress the importance of watching sodium intake. The amount of sodium in frequently eaten foods is indicated in these books, whereas the Canadian books just touched on the fact that sodium should not be eaten in excess, pregnant or not. In both countries, the total upper limit of daily sodium intake is the same for pregnant women and those who are not, however this number is vastly different between the cultures. In Canada, it is 2.3g, so you may be surprised to hear that in Japan it is 8g.
Another difference can be found in foods that are off limits for pregnant women. In Western cultures it is well known that sashimi (raw fish) should be avoided while carrying. This is to avoid infection-causing bacteria in fish that isn’t fresh and is normally killed during the cooking process. In Japan, although there are many people who avoid sashimi, none of the books I read, nor in my prenatal class, did they mention that eating it was off limits. In fact, one book had a picture of tuna sashimi as a healthy option and a nurse at my prenatal class told me that salmon sashimi was fine to eat. They really do stress that eating fish (raw or not) is important for the DHA content. It surprised me that they didn’t mention the risks of getting too much mercury from fish (In Canada tuna would be on the list of things to avoid for this reason).
Also, in the Western world it is usually recommended to stay clear of any liver due to the high amounts of vitamin A which could potentially harm the growing fetus. In contrast, in Japan they actually say that liver is a good source of iron and should be eaten while pregnant.
7. Intercourse Is Not Exactly a Green Light
While the pregnancy books in Canada say that intercourse does not pose a problem, in Japan, they are more cautious and advise a more ‘once-in-awhile” frequency. They seem to be concerned about the possibility of infection and also pressure on the belly. Of course, this is for regular pregnancies only and for some people with certain conditions, in either country, avoidance of sex is recommended.
8. I Never heard About Kegel Exercises in Japan
These pelvic floor exercises are mentioned in every Canadian and American pregnancy book to help with incontinence and to promote an easier birth. In Japan I did not see anything about Kegels in any of the manuals I was given, nor told about them by anyone at the clinic.
9. The Advice From People Around You Can Seem Odd
There are all kinds of advice you get from people when they know you’re pregnant, but these are some of the consistent differences I found between the two cultures. Just to be clear, these are not things that came from the professionals. In Japan, I was warned to stop my daily jogging routine because it posed a risk. On the other hand, my friends and family back in Canada encouraged exercise and were proud of the fact that they continued running or doing yoga throughout their pregnancies.
In Japan, I was told to keep my body warm, especially the belly. Many people will wear a belly wrap not only to help with back support, but to keep the stomach and uterus warm. It’s a trend here for people who aren’t even pregnant to wrap their stomachs with warm fleece during the winter. They believe it isn’t healthy for the stomach to be exposed to the cold. I was also advised to keep my ankles warm, though I’m not so sure what this does to help a pregnancy.
From my Canadian side, I was often told to eat lots because I’m eating for two. Friends would also say they are jealous that I can eat anything I want because I’m supposed to gain weight anyways. In Japan, I was recommended to eat lots of hijiki (a type of seaweed), and asari (a type of clams).
10. Pain Relief Can Seem Slightly Milder
If you are giving birth in Canada usually you can decide on having an epidural once the pain starts to become unbearable during a long labor. However, in Japan, often times this can not be a spontaneous decision if you’re going to have a vaginal birth. You have to decide ahead of time whether or not you want the epidural (it’s not covered by the national health plan either). The hospital needs to book the anesthesiologist if you opt for the epidural.
Whether it’s the same across the board or just my experience, the type of pain medication given after a cesarean section may be different. After talking to some of my friends in Canada, it seems they were given a narcotic drug to help with the pain. One friend says she doesn’t remember much from the first week because she was all drugged up. Here in Japan I was given a milder anti-inflammatory. Luckily I didn’t feel the need to take it often.
11. In the Hospital, You Have to Provide Your Own Towels and Water
Whether it’s most hospitals in Japan or not, I was surprised to learn that the hospital I was receiving care in, required me to provide my own towels and drinks (even water) aside from the tea and milk given with meals. This might be good to know if you are giving birth by cesarean section because you may not be able to receive the meals for the first 24 hours or so; you will be thirsty.
12. Hospital Food is Good
Again, this probably depends on the hospital, but I quite enjoyed my meals provided to me here in Japan. I always hear about how terrible the food is in North American institutions. Morever, in Japan, a fancy course meal may be included in the birthing package at the hospital and is meant to be a congratulations dinner for mother and father.
13. Before Giving Birth You Decide Which Birthing Package to Buy
In Canada, you can usually choose between semi-private or private rooms for an extra charge. In Japan, there is the same type of option, but regarding extra charges, there are other decisions to be made as well. It all comes down to customizing, or choosing your own package. These packages will usually include a starter set of baby supplies such as diapers, wipes, head warmers, and sanitary napkins and breast-feeding pads for the mother. You may be able to choose to have a special congratulatory meal provided by the hospital, a photographer, a facial and aesthetic products sampler, or a meal voucher for a 5-star hotel. These are just some examples of options; the prices and choices will of course depend on the hospital.
14. The Length of Stay in the Hospital After Giving Birth
Usually you would be out of the hospital after 2-4 days, depending on the method of birth in a Western hospital. In Japan, as long as there are no complications, the standard length of stay is one week, whether the birth was vaginal or a C-section (so you'd better be stocked up with lots bottles of water).
15. The Little Wooden Box
Some people like to save the umbilical stump that falls off the baby's belly button a few days after they are born and some don't see the sentiment in doing so. In Japan, since the baby is in the hospital for at least a week, the hospital saves it and gives it to the parents in a little wooden box to take home. Most people keep this heso (belly button) box as a souvenir of their baby's birth.
There are quite a few small differences between being pregnant in Japan and being pregnant in the West. Many of these differences simply stem from the contrast of culture of each place, but as both have good healthy birth rates, one way does not seem better than the other.
These were just some of my own accounts of the differences between the maternal world in Japan and Canada. Others may have had similar experiences or completely different ones. I’m interested to hear all the various experiences so please leave a comment.