Issues | THE FOREIGN ELEMENT

Pregnancy and birth in Japan: a cultural primer for foreign mothers

Gems for prospective moms: Cover up your extremities, don’t put on much weight at all — and scrub that toilet

by Louise George Kittaka

While pregnancy and childbirth is a universal experience, having a baby in another culture can be full of surprises. Just ask any foreign woman who has given birth in Japan.

Maternal and infant mortality rates are among the lowest in the world, making Japan one of the safest places to have a baby. However, some aspects of Japanese prenatal care may leave foreign women bemused, bewildered — or even belligerent.

The K-A International Mothers in Japan is an online community for foreign women raising children in this country. More than 130 women whose youngest child is under the age of 15 participated in an online survey for this article. Of these, half gave birth within the past three years. The majority of participants come from Western nations.

Based on the survey results, the biggest single issue for these foreign mothers is the fairly limited weight gain recommended for pregnant women. More than 7 in 10 women received instructions about acceptable weight gain from their Japanese doctor or midwife, with 7-8 kg being the most commonly cited range (by 40 percent of respondents) for a singleton pregnancy. Somewhat alarmingly, at least from a Western viewpoint, 17 percent of the mothers who received guidance were told that the optimal gain was 6 kg or less.

The vast majority of women in the survey put on between 10 and 15 kg during their last pregnancy. This fits in perfectly with current Western wisdom, with weight gain of around 10-14 kg usually recommended for a woman whose pre-pregnancy body mass index (BMI) falls within the normal range. However, some of their Japanese caregivers took a decidedly dim view of such figures.

“I was told I’d have too fat a vagina to deliver vaginally, that my child would be too big and that I’d never ever be able to lose the weight,” reports Laura, who put on 11 kg with her pregnancy.

Kelsey was given a relatively generous 10 kg allowance.

“They said, ‘We can’t deliver the baby if you put on any more weight — the table cannot support you!’ ” she says. “Funny thing is, I ended up putting on 13 kg and they delivered my baby just fine.”

A number of the women resented that medical staff made value judgments based on what they assumed “foreigners” ate, chastising their patients for indulging in too much bread, junk food or sugary drinks.

“The doctor seemed to think my diet consisted of foods seen in U.S. movies and TV shows — potato chips and ice cream. When signs pointed to a raise in my sodium uptake, she accused me of eating sausage, when in fact, the sodium culprits were umeboshi and soy sauce,” recalls Amy, referring to the pickled Japanese-plum condiment.

The staff at Mejiro Birth House in Tokyo are familiar with the needs of Japanese and non-Japanese patients alike.

“While there are some exceptions, a weight gain of up to 10 kg in total is preferable for Japanese women, due to the fact that Asians generally have a smaller build,” explains midwife Yuko Hoshino. “Our non-Asian patients can safely put on a little more than this, though.”

Dr. Hideki Sakamoto, a bilingual Tokyo-based obstetrician and gynecologist, has many foreign patients among his clientele. He supports the more holistic approach currently favored in the West, using a woman’s BMI as a guide for weight gain, rather than adhering to a rigid set of criteria.

“If an expectant woman starts out underweight she should put on a little more, and similarly, if her BMI is in the overweight range, then she should put on less,” he says. “I know of no scientific research that supports the Japanese tendency to promote relatively small weight gains in pregnancy, but the practice is very likely a carryover from the past when smaller babies made for easier deliveries and less risks of complications,” Sakamoto notes. He also points to ongoing research by the International Society for Developmental Origins of Health and Disease suggesting that children of women who put on less than the recommended weight in pregnancy may have an increased risk of health problems later in life.

Although stringent guidelines are a potential source of stress during pregnancy, some women commented that the payback came after giving birth.

“I am glad that my doctors were strict about weight gain, because after my baby was born, I didn’t have to worry about losing weight or buying new clothes,” says Julie. “I was back in my pre-pregnancy jeans in three weeks. My friends from back home usually take months to get their figures back.”

Some of the standard pregnancy advice in Japan can flummox foreign women. Some were discouraged from doing any form of exercise at all, while others were advised to perform strenuous regimens of squats and floor cleaning in order to tone up their muscles for the impending birth.

Among the oddest advice was this gem from Mary: ” ‘If you clean the toilet, you’ll get a beautiful baby’. Can’t help but feel a male made up that advice.”

One of the most commonly mentioned conventions in the survey was to ensure that the belly and extremities stayed warm by covering up.

“I was told to keep my belly covered at all times — with multiple layers even in the midsummer heat — because if the belly cooled off the baby would catch a cold,” says Heidi. “The midwives also said to always wear socks so that the pressure point above the ankle that connects to the uterus is covered and kept warm. After hearing that a few times, I started carrying socks in my bag to put on when entering the clinic for a checkup.”

Brett Iimura of the Childbirth Education Center in Tokyo is well-versed in helping foreign women navigate the Japanese medical system, and offers the following insight on the “Don’t get cold” phenomenon: “There is some evidence that the difference between upper-body and lower-body temperatures is implicated in something called hieshō, in which some women are particularly sensitive to cold, and this is thought to have implications for birth.”

“Traditionally, it is thought that the belly and feet need to be kept warm, especially during pregnancy, which is why pregnant women are often admonished by passers-by — especially by older women — if they are scantily clothed or not wearing socks, even in the heat and humidity of a Tokyo summer,” says Iimura. “Perhaps science will eventually show there is a physiologic basis for this advice, at least for some women.”

Britain’s Duchess of Cambridge may have been out of hospital and in front of the world’s press just hours after giving birth to Princess Charlotte, but women in Japan can expect a much more generous postpartum hospital stay. While 24 to 48 hours is becoming the norm for a regular delivery in many countries in the West, the majority of the survey participants stayed between five and eight days (60 percent). In general in Japan, it is considered that women need ample time to recover and rest from the rigors of childbirth.

Some women thought a compromise between the Western and Japanese extremes was best, suggesting that three to four days would be an optimal hospital stay. Others said it should be up to the mother to decide when she is ready to leave.

“I really think Japanese women need more choice and autonomy,” Rachel says. “They should be encouraged to trust their instincts, to be allowed to go home if they want, or to stay if they feel they need to, and be properly taught how to care for their baby, rather than have it taken off them.”

Xana grew to appreciate the merits of a longer hospital stay with subsequent births.

“The first time,” she says, “I thought, ‘Ugh, I have to stay for a week?’ The third time, I thought, ‘Woohoo! Great food, no cooking, laundry or taking care of kids (other than the newborn) for five days!’ I knew it was the only five-day vacation from chores I’d have for the next 18 years at least.”

Mothers with new babies tend to be magnets for unsolicited advice in any culture, and Japan is no exception.

“I was asked by a kindly lady at the supermarket how old my baby was. When I said ‘Two weeks,’ she proceeded to yell at me about how dangerous it was to have the baby out so young,” Lucy recalls. “What was I supposed to do? I was alone and needed to shop! Japanese mothers traditionally stay with their own mothers for the first month or two after birth and stay in the house with the baby. No chance of that if your mother is in a different country!”

“Stay home with a new baby for the first month” is fairly standard advice in Japan, with the view that the fragile newborn and the new mother should rest and build up their strength. However, few of the mothers in the survey followed this advice, particularly those who already had older children.

Corin, a mother of three, advises other women to trust their own intuition.

“Try not to take all advice to heart,” she says. “People advise out of concern and based on what they are accustomed to. If you don’t agree with the advice, say ‘thank you’ and then ignore it. Do what you are comfortable with and try to listen to your instincts.”

The mothers in the survey said that having someone to discuss their concerns with, either in person or through online forums, was a huge help when experiencing pregnancy in a culture that isn’t their own. In line with this, a small but growing trend is to request the support of a doula — someone who offers emotional and physical support to a woman before, during and after childbirth.

Stephanie Kawai is one of a handful of English-speaking doulas in Japan.

“Every birth experience is unique, but going through labor and giving birth in a country like Japan can add a whole new level to that experience due to cultural practices, expectations and, of course, the language barrier,” she says. “A doula can be a wonderful voice of support, and offer reassurance by guiding you not just through each contraction but also through the Japanese culture of birth.”

K-A International Mothers in Japan’s Facebook page: www.facebook.com/KAInternationalMothersinJapan. Your comments and story ideas: community@japantimes.co.jp