My wife, who is nearing the end of her first trimester, and I are planning to move to Japan (from New York City) very soon. We are desperately trying to find information on (a) whether it is advisable for her to travel to Japan, live there until she reaches term and give birth in Tokyo, and, if so, (b) what type of medical care we can hope to find (preferably English speaking and/or US trained).

By way of additional background, we will have private health insurance through our U.S. employer (Cigna International, or Oxford International); we will be living in Tokyo. She is 36 years old and this is her first pregnancy and is therefore particularly concerned about availability of state of the art medical care for high risk pregnancies. Neither of us speaks fluent Japanese (she speaks no Japanese).

Any information would be much appreciated.

Thank you.

It has been my experience that many of the foreigners who have children in Tokyo go to Dr. H. Sakamoto who works (Mon & Sat morn) out of the Tokyo Surgical & Medical Clinic at (03) 3436-3028. I believe he also has an e-mail address though I've never used it. You can try to reach him at sakamoto@med.nihon-u.ac.jp
He is extremely busy, so there's no guarantee that he can answer quickly, if at all.
He delivered my 2 children. I didn't have a high-risk pregnancy,but I did have some complications during the first one, and he was terrific and highly competent. He studied in the US (at Yale, I think) and he speaks English like a native and Spanish as well. He is quite well known by the ex-pat community in Tokyo. There are other good doctors available as well, including female doctors with training in the US. I'm sure that the person in your Human Resources Dept of your Tokyo office who handles relocation should be able to help you. Good Luck!

I agree with Natalie that Dr. Sakamoto is probably the most 'popular' MD for foreigners in Tokyo. In our 12 years here, we have heard only raves about him.

However, notice that he is only one person in a market of thousands of foreigners in Tokyo, so Natalie's remarks about his availability are also correct in our book.

I would say the number of MDs who you would be comfortable with in Tokyo is less than 10.

Another point is that I notice you are concerned about "state-of-the-art medical care for high risk pregnancies". Our observation is that the Japanese approach to childbirth involves much less technology than we are used to in the U.S. There are probably many reasons for this, but the bottom line for you is that you will probably not see the degree of technology you would - espeically in NYC.

Having said all that, you will also find that 'statistically', childbirth is much safer in Japan. Infant mortality and so on is much higher in the U.S. Some people may feel though, that it is one's own particular circumstance that matters- not the statistics.

(Did I say that we've had two kids here? They are 5 & 8 now.)

One thing I differ slightly with Natalie on is the part about depending on your HR dept. This may be run by Japanese folks who may be well-meaning, but not quite as familiar as we would like with the U.S. feeling about what medical care 'should' look like. Do your own research (with their references) and meet as many people as possible to make your own decision.

It would be great if you could make a scout trip with the intention of interviewing and visiting as many caregivers and hospitals as possible. Again, the number is not that great. Only then, can you have your own impression of what your best course is.

Hope this is helpful.

I am now abt 18 wks & recently started spotting & discovered it is due to placenta previa (partially low lying placenta). Dr Sakamoto has ordered me to rest & said that I would have to be hospitalise if spotting starts again. Can anyone who's had this share their experience with me ? My email is lilyvoon@yahoo.com

Hello!
We are three swedish women who study to become medical doctors. In may this year (2003) we will do a comparing study between Sweden and Japan on pregnancy, birth and post-birth care for children. We would like to come in contact with pediatrics, child-doctors, hospital, women who are going to have a baby or recently have got one.
We are intrested in all experiances.
Please contact us!
Therese, Mirjam, Ylva
t.djarv[at]spray.se

Long term hospitalization for pregnancy in Tokyo

I spent 4 months in Tokyo Daigaku Byoin (Tokyo University Hospital), Bunkyou-ku, for a difficult pregnancy, here is what I can tell about that hospital:
Plus --
* it's a national hospital so it is cheaper than a private one
* it was rebuilt anew 2 years ago and the rooms are both beautiful and comfortable.
* The equipment is extremely modern and convenient (internet access for each bed - so it is possible to send mails or surf on the internet from one's bed!), individual television with headphones, heating toilet... each floor has a washing machine and dryer, a newspaper automatic vending machine, a public phone, a microwave oven, free tea and so forth, all that for less than 300 yen a day (if you have NHI). . Double rooms cost a bit more than 2000 yen a day.
* curtains separate beds so a minimum of privacy is possible (not true in most hospitals in Japan)
* young doctors diffuse medical information more generously than is often the case in Japan
* All the midwives in the obstetrics department were a miracle of competence and kindness.
* A post office, a little supermarket, a coffee shop, restaurants, a barber, a bank ... are to be found on the ground floor, while the last floor boasts a big restaurant
* food was good.

Minus(depending on opinions)
* it is a university hospital so students will try their hands on you sometimes
* there is no epidural available during delivery (at least not in my case!?)
* babies remain in the nursery for 3 nights

I turned up at the emergency room one night with contractions in the 5th month: they keep you if they have a bed available.

If on national health insurance, the treatment in my case was about 10,000 yen per day for the patient's share of the expenses (but eventually the insurance will pay that too if you
remain long enough in hospital as in my case) and a bit more than 2000 yen for the double room. A private room costs as much as 12,000 yen a day (this is generally about 30% of the total, the other 70% being paid by NHI).
In case you have difficulties paying the bills the hospital will let you pay in installments no matter how small (arranged with the help of the welfare worker).

Note from Admin: Martine is quite fluent in Japanese so communication was not a problem for her. However, the odds of being able to speak to doctors in English generally are higher at University hospitals. NHI covers pregnancy emergencies, such as c-sections and un-stable pregnancies such as Martine's.

Also, at any university hospital, if you come in through the emergency room you do not need a letter of introduction.

Hi,
I am pregnant with my fourth child. I think I will be considered a "high risk " pregnancy since I'm 40. After checking out the internet I'm considering prenatal testing such as Chorionic Villus Sampliing (CVS) or an Amniocentesis. The literature on CVS stresses that it is vital to get somone who is experienced with this testing and does at least 50+ per year. Does anyone have first hand experience of this test and know of a Doctor? Also I would be interested to hear of anyone's experiences with an amnio in Japan. Does health insurance cover these tests? If not, what is the cost?
I'm yet to find a doctor in Tokyo but I'm hoping to find a "cost-effective" solution(even though my Japanese is very limited). Again any advice or suggestions on hospital/doctors would be greatly appreciated.

Many thanks

A friend of mine had a nucheal scan done here at an expensive and usually excellent clinic for foreigners. She was told that the results showed that she was in a low risk category. When she got back to the West however and showed the results and the scan to the doctors there, she was told that the doctor at the clinic had measured in a totally wrong place on the scan and so the result she had been given was absolute rubbish and told her that the doctor who had done it hadn't known what he was doing. This goes to show that you can't be too careful. As in other countries, some places here are excellent, and some not and some excellent only sometimes.

Hi! I'm currently 25 weeks pregnant and suffer from recurrent UTIs from 11 weeks on. My doctor doesn't seem to be concerned much, says it's usual complication for pregnancy, although i see a lots of info on internet about UTI in pregnancy associated with developmental delay in babies and premature labour and low weight babies.
I was prescribed several antibiotics, but they all dont seem to work. Can anybody tell me where I can buy D-mannose in Japan (I live in yamaguchi prefecture)? Have anybody taken it and did it help? Have anybody else suffered from UTI in pregnancy and how did you get it cured? Any info is appreciated.

i wonder if anyone can help with this one. I have heard that it's not a good idea to have sauna baths/whirlpool i.e. very hot baths particularly in the first and third trimester of pregnancy. My wife is Japanese and loves her hot spring (onsen) baths as indeed do i but i am worried that this may harm the foetus. My wife is 2 months pregnant at the moment and usually has a hot bath/onsen every day as we have a natural hot spring under our apartment.
Does anybody have any views or knowledge about this?

Every public onsen I've been to has a sign mentioning all the restrictions and it always says that pregnant women should avoid it. Bath at your own risk.

But if I were her, I would consult with her doctor and local hokenjo (health center) and see what professionals have to say. For example, it is a known fact that children shouldn't bath on the night they had a vacination, but when I asked our pediatrician said, "Well, we did let our son have a quick bath."

Another oddity in Japan. Our doctor says the triple marker test is unnecessary and meaningless and is reluctant to do it partly because the Japanese Govt doesn't recommend it. Also he suggested if I wanted it done my wife should come back next week (she will be 12 weeks)which didn't inspire confidence as the test should be done between 15-18 weeks. Has anyone else had this problem?
Also there is a newer test called Quad or Quadruple test which obviously adds one more test (dimeric Inhibin-A) to the original triple test. Does anyone know if this is available in Japan?
p.s.this new test increases total accuracy to around 81%

In 2000 I had the triple marker test with my first child. In 2003 I had the quad test with my second child. Both tests were conducted at Aiiku Hospital in Tokyo. I believe it is recommended to women over a certain age-maybe 30?

Hi, I had my monthly check-up today and found that I have anemia (hinketsu).
Does anyone know what that really is, symptoms and risks, that kind of
knowledge, and also what to do about it. Any firsthand experience would be
welcome. I read on the net that I needed to get more acid folid? I didn't
get to ask the doctor about it because the result was attached to my health
book and returned to me at the reception. I only found out when I got home.
I have another checkup in 2 weeks time, but from now till then I do need
some "senpai" advice to rest my worries.

Hi Mary,

How many weeks are you now?
Folic acid is obtainable from taking very green vegetables such as horenso, brocolli... I did a search several weeks ago and found that in fact uni contains the highest amount of folic acid among other popular food. Pregnant women need to take 0.8mg of folic acid a day, and 100 g of uni has 0.36mg, followed by edamame (0.26), morohea (0.25), asparagus (0.18), soramame (0.12), brocolli (0.12), horenso (0.11) and strawberry (0.09).
I heard it is very difficult to get enough folic acid from natural diet - so most people take vitamin supplement.
As far as I know iron intake will help anemia. (from the book and magazines I read, folic acid is related to development of fetus - haven't seen anywhere about lacking folic acid and causing anemia.)
So I'd suggest you go ask your OB next visit. Just eat healthy and smart these two weeks if you are in doubt. I don't think it will make a big different.

Hope this helps.
Karen

Hi Mike

I read from japanese and English materials which neither recommend too hot bath. It is ok to take bath to relax - esp during the morning sickness period with a comfy hot bath may really help. But not too hot.. since you can imagine the fetus inside may feel the heat too...

May be ask her to do it at milder temperature - I took one at 39C outdoor (not onsen, just normal bath) and it was comfortable.

Karen

Mary, EVERY pregnant women gets hinketsu. They check your blood and if the iron rate is low, it automatically means "hinketsu." Pregnant women need a lot of blood. You can't help it.

Did you ask the doctor or nurse what rate you had, and what you should do about it? I think they will normally say that you just need to try to obtain as much iron as possible from ordinary meals. Otherwise, if the hinketsu was serious, you'll be fainting by now, or they would've prescribed you some medicine.

Food like oysters, clams and spinach contain a lot of iron as well as calcium which is also important in pregnancy. But it's not always easy for a pregnant woman to obtain enough of them, and personally, I think the most important thing for your health is to eat _balanced_ meals.

Btw, if you can't wait until your next check up, your local hokenjo (public health center) can provide you free advise from mid-wives. Give them a call. If you have language problems, I'm sure your local international exchange lounge can help you as well. You can obtain details at the kuyakusho (where you did your foreign registeration). Bon Appetit!

Oh, sorry Mary, you couldn't ask the doctor. Anyway, that was my advise, and I think the hokenjo will be able to tell you the amount of iron a pregnant woman needs, then you can compare the rate with your health book record. It's no big deal. Don't worry about it.

I think mild anemia is pretty much normal in the last few months of pregnancy. If your levels were dangerously low I'm sure you would have been called back by the doctor, but he may well give you iron tablets next time you see him (warning: they can cause constipation...) or if you're worried you could always buy iron supplement tablets from a pharmacy or health-food store.

There are also iron-fortified foods - one of the better ones I have found is a kind of drinking yoghurt with prune juice and extra iron, which they often sell in convenience stores (small purple and white cartons, sold next to the small, one-serving cartons of milk, drinking yoghurt etc). Also most pregnancy multivitamins sold in Europe or the US contain both iron and folic acid, but for some reason Japanese women don't seem to take multivitamins while pregnant so I don't know if they are available here.

I'm 31 weeks pregnant, so if hinketsu in this stage is normal, then what a relief! I got the tablets advised at the drugstore, they gave me the multi-vitamin ones - they took one look at me and automatically brought it out. And I had beef for dinner. Has anyone noticed the cost for really red beef in Japan??!!
I also can't stand milk and yoghurt, so I guess my calcium rate is low too.
Thank you all so much. I feel MUCH better already, knowing what to do until my next checkup.

Hi Mary,
I'm glad to know you're feeling better. And if beef is too expensive, there's always our casual pork which is also supposed to be very nutritious containing a lot of vitamin B. You can also get calcium from a variety of vegetables or best, small fish bones like sardines. I'm sure the hospital and public health center have given you illustrated brochures explaining what food is good for you. If not, you can ask for one. Man does not live on yogurt alone. :)

Protein �ETanpaku?
Hi, I had my checkup today, and yes, the doctor said exactly as Yuko claimed: all pregnant women have hinketsu, and I was not to worry. Then why the results in black and white like that? Do doctors in Japan enjoy scaring first-time preggies or are they playing on the safe side, that is, should anything happen, they could blame it on my hinketsu results. Well, that hurdle over, today they found tanpaku (protein?) in my urine. The doctor said I should lessen my salt intake or else suffer from ninshinchudoku (pregnant poisoning?). However I surfed through AskDrSears.com and found that Fe salt intake was good for the body. I am a bit confused. Of course I will stick to veggies and fruits, but I would really really appreciate some help and advise from you all as to my positive tanpaku results. Please help.

Protein in the urine can be a sign of "pre-eclampsia" which I think is translated into Japanese as ninshinchudoku, a complication of pregnancy which can lead to serious problems for both mother and baby. I think in most cases, a trace of protein in the urine is not a problem, but if it is more than a trace, and is combined with high blood pressure, it can make problems more likely. Salt in general can increase blood pressure, which is probably why they have advised you to reduce your salt intake. I presume your protein level was not too high, or they would be getting worried, but it is quite possible to cut down on salt (less soy sauce, no salty snacks, check salt content of all canned/processed foods, cheese, ham etc) without cutting your iron intake. One other symptom of pre-eclampsia to watch for is severe water retention (puffiness of your ankles, fingers etc).

Have you looked online at sites like the Babycenter pregnancy section?

http://www.babycenter.com/pregnancy

They have lots of useful articles about pregnancy nutrition, complications etc.

Hi Mary,

First of all, I'm really glad your hinketsu problem is settled.

What I'm writing today is not a specific solution to your new tanpaku problem, but a "tip" on how you can avoid the many confusions to come in your pregnancy and child-care days.

Mary wrote;
"Then why the results in black and white like that? Do doctors in Japan enjoy scaring first-time preggies or are they playing on the safe side, that is, should anything happen, they could blame it on my hinketsu results."

Well, personally, I think it's playing on the safe side, that is, should anything happen, they could excuse themselves by saying they did give you a warning in advance. Or a nicer way of analysing it is that, if they mention the results, you have various options like asking the doctor, or asking others for second opinions. Or they may have thought that explanation may have not been necessary if you already knew about all these stuff from mom friends and media.

In any case, from the limited experience of raising one child in Japan (as a Japanese mother), I have the impression that medics in Japan is all about "taking the safe side." Pediatricians warned me about so many things and they made me make frequent visits to the hospital, that it drove me insane. But I guess that's one reason Japan has such a low death rate of infants and children. Oh well...

Anyway, a great thing that saved me from this was words from my mom friends and the hokenjo (public health center) staffs. These were people who valued the fact that relaxing is the best medicine for pregnancy and child care. Plus, with the fact that most of the hospicals are infamous for practicing "3 minute treatment," the times my friends and hokenjo took for me was extremely valuable.

The mid wife at the hokenjo told me, "The first thing you should do is to throw away that weight scale your pediatrician told you to rent." (because my baby didn't have enough weight and I was having difficulty feeding him). She said that if I take it easy, my breast milk will flow better etc.. Actually it didn't, but looking back, the visit to the hokenjo helped me become a generous mother who doesn't get irritated at my baby every time he fails to get that certain number on his medical records.

Also, while internet forums are great tools that I myself utilise to get to know people and information that is not available on the street, I think friends who personally know you will be even a greater help. Because they are people who can give you the right kind of advise just fit for your character and lifestyle.

Sorry for the long lecture. Bottom line, my advise is to (1) keep your hospital records as a "mere but valuable guidance," (2) ask other professionals and experienced friends for second opinions, and (3) finally judge for yourself.

But sometimes, when you can't judge for yourself, you just have to pick one reliable professional and listen to what that person says. And exchanging phone numbers with other patients or giving a call to your old friends would really help, _as well as_ utilizing the World Wide Web.

Yuko,
What great posts you make. You are a wonderful asset to this community. Thank you for taking time to write all that up.

To Scott and Mary,

Thank _you_ Scott for taking the time to encourage me. I know that sometimes I just become a busybody, but if anyone should find my comments helpful in any way, it's really nothing compared to the help I myself have recieved and am still recieving from parents with more experienced than me including members of this Forum. I'm just trying to return the favor, plus, I just don't like to see people wasting their time, energy and taxes :)

Mary, you sound like you're relatively new to Japan, and you seem to be going to a Japanese oriented clinic.

I do hope you don't miss your haha-oya-gakkyuu (mothers-to-be lessons) provided by hospitals and hokenjo, because that's where they give you all the tips like, "You might be hearing this and that from the doc, but that means so and so" or all the how-to's on your delivery and child-care (and compared to that stage, pregnancy is nothing!).

As far as I know, most municipals in Japan should have some kind of public interpreting service free-of-charge.

But I'm not a foreign resident, so people who have actually experienced these things from a non-Japanese pov are welcome to comment.

Dear Yuko and Bethan,
Thanks for all the Common Sense and also the specific advice and the homepage info, it really helps to get concrete knowledge like the linkage between protein and high blood pressure �EI can know what I am dealing with, and how to deal with it. Thank you both.

this thread is a bit old but I hope people are still out there to answer a question. My husband and I are trying to get pregnant. The concern is that in 2005/06 I had two surgeries for Adenocarcinoma on my cervix. First was a LEEP but the LEEP did not get everything so they went back and did a cold-knife conization. Luckily this got all of the carcinoma, but my GP (not my gyno) said that most likely this would leave me with an "incompetent cervix". His advice...don't get pregnant. Well, for me this is not an option. I really want a family and so does my husband. There is a procedure that sews the cervix shut at around 12-14 weeks,and I was wondering if anyone out there has any experience with this or incompetent cervix and in Japan. I live in Aichi close to Nagoya and while I would like to obviously have a hospital close to home I have no qualms about travelling to Tokyo if necessary to have a healthy full term baby. Any advice is greatly appreciated. Thanks so much.

I know this sounds very, very negative, but the truth is that in Japan, if there is something wrong, going in, then you will be discouraged from having babies. I met a woman in May who is partly paralyzed from the hips down due to a poorly executed procedure here in Japan years back (I think it was an epidural for leg or foot surgery). Later, when she and her husband wanted children, her pregnancy was turned away from even such famous (and presumably technically advanced) hospitals as Aiku (in Hiro) and St. Lukes. No one wanted to deal with her specific problem. TWICE! Even the second time after it was clear that she had had a child successfully.

She gave birth to both her beautiful kids in North America. Needless to say it involved a lot of planning and of course added expense, with vacation time, travel time, etc.

So, please look for a doctor that will help you here, but keep an open mind about going a bit further than Tokyo, once at 12-14 weeks and again later to have the sutures removed at birth. You may want to start with the discussion "Finding A Doctor" under Doctors. At the same time you might want to look at Vancouver/LA/Seattle (places with direct flights from Tokyo) too. Maybe even Honolulu...

Oh wow...well it does sound a bit negative yeah. My husband and I have discussed it and if I cannot find a doctor/hospital that I am comfortable with in terms of English ability and ability to deal with my circumstances then I will indeed go home to Canada to give birth and possibly get the procedure at 12-14 weeks in the first place. Where I am from in Canada is a bit farther than Vancouver (the exact opposite actually) but I think it may be just fine to go home if I have to. Anything to have the family we're dreaming of!

I sent an email to the woman I mentioned above, and she wrote back very briefly because she is in the middle of travels. Since she did the rounds at a bunch of hospital from Yokohama up to Tokyo, I though she might have some good suggestions. She did get all of her pre-birth care in Japan. If you could wait a few days, maybe she will have something more to say, after she's unpacked and back in the groove. I'll give her your email. Also, there might be some new things going on (since I think her youngest is already 5 or so). Please do not stop trying to find out what is available here. I wanted mostly to suggest that you keep an open mind about the possibility of extending your research beyond Japan.

Well, what a difference a few months make! I actually am pregnant! While I'm not certain that I will have an incompetent cervix, my doctor here knows of the problem and thinks that I will be able to have a baby....then he did the pelvic exam and said...oh wow, your cervix really is short! (TMI, sorry) MY husband and I asked him about the cerclage (sewing shut) and he flat out dismissed it as "too difficult" and that was the end of that discussion. He expects me to deliver early, but will not perform the cerclage nor recommend someone who will. Of course this is a bit disheartening. That however is not why I am writing today. I need some advice. I am about 6/7 weeks pregnant (5from conception) and on Sunday I started bleeding. Not red or pink but brown blood with small bits in it which (sorry for the info) sometimes look like coffee grinds. I immediately went to the clinic where I have my doctor. He was not there but another doctor saw me, they gave me an ultrasound, baby was still there, then a shot of something...again, no explianation (think it was HcG...though why I don't know, and then some pills for bleeding and pain. The day before (sat) had been my regular checkup and also the doctor did a (very uncomfortable) pap test. Could the bleeding be from the pap test? Did he knock my cervix too hard? It's now Tuesday, and still gross brown blood, so for me I'm almost convinced its a miscarriage, but the baby was there on Sunday. I'm wondering if anyone else has had this situation happen to them? Any advice? I think I will call my clinic again to report that nothings really changed from Sunday, so what should I do?

Any shared stories would be greatly appreciated!

Hi there, I don't think it's anything to worry about! If it was bright red blood, that would indicate a possible miscarriage. I had the same brown type blood you are talking about and as it is early in your pregnancy, it is likely residual or "old" blood that your body is flushing out from when the embryo attached to the wall of your uterus. My Japanese doctor did not give me this info, I researched it and like you, when I went to get an ultrasound, could see the heartbeat. It's very unsettling but everything was fine with me and probably is with you too! If you aren't cramping I wouldn't worry at all. Good Luck!