Originally published on metropolis.co.jp on April 2014

They say pregnant women glow, but I sometimes wonder if the glow isn’t just the stress radiating from them—stress compounded, for the expat mom, by being pregnant in an adopted country. But Japan is a good place to bring a child into the world. It has low rates of maternal, perinatal and infant mortality, and a lot of this is thanks to fantastic prenatal care. Sure, some things are done differently than “back home,” but the end result is the same: a swaddled little alien with your eyes and your husband’s nose. Knowing a few things going into the pregnancy game, though, will make those nine months (or, as they say in Japan, ten) a little easier.

First off, things to do before you get pregnant. Booster shots—this will save you no end of grief should an outbreak occur. Also have a good long think about what’s important to you in a health care provider: that they’re English-speaking, allow rooming-in, discourage formula, etc. A list will help guide you somewhere well matched, and this will make a huge difference to your overall experience—you’ll be seeing these people every two weeks, after all.

Once you have a doctor’s confirmation that you’re pregnant, you’ll need to visit your ward office to register, because—guess what?—pregnancy isn’t covered by Japanese national health insurance. Ward offices provide coupons so you can recoup at least some of your expenses. You’ll also get your boshi techo, a little notebook that will be your health record during your pregnancy, as well as your child’s health record for his or her entire childhood. Depending on the area, this book is available in several languages, though you might have to fight to get it in your language, order it, or even pay for it yourself. You’ll also get booklets on pregnancy health and the pregnancy keychain, which supposedly gets you preferential treatment on trains and buses—don’t count on it.

When it comes to birthing choices, while lying on your back is still most common, there are options ranging from water birth to squatting to midwives, doulas, and more. Join foreign mothers’ and pregnancy groups and ask members for recommendations and advice. You’ll get near-immediate feedback. Foreign moms in Japan are amazingly supportive; in fact, they provided me with advice for this article, the most important piece being “be your own advocate.” If doctors or nurses hassle you about weight gain, hem and haw over tests and vaccines that you want, push sugar water or formula on your newborn, etc.—don’t sit back and take it. Be polite but firm. With any luck, though, through your early research, you’ll have found a place where advocating for yourself won’t be necessary.

A few differences between Japan and the West to keep in mind: epidurals are the exception, not the rule; VBACs and natural births for multiple pregnancies are not common; and if you’ve had three caesarean sections already, you might very well be out of luck if you get pregnant again, with hospitals refusing to admit you. Post-birth, there’s a tendency to give newborns sugar water and formula to keep their weight up—chalk that one up to strong relationships with formula companies.

Not to be forgotten, the positive differences: terrific care should hospital bed rest be required; copious amounts of ultrasound photos; longer hospital stays after giving birth; and last but not least, your hospital omedetou (congratulations) meal. Whether a piece of cake or a fancy sit-down meal, at some point you’ll be feted for your efforts. Some hospitals even provide spa services. Actually, you might want to add that to your list of requirements when health care provider hunting…

Important vocabulary

• Ninshin (ninpu) = pregnant (woman)

•  Sanfujinka = obstetrics and gynecology

• Tsuwari = morning sickness

• Shukketsu = bleeding

• Jintsu = labor pains

• Juncho = doing well

More vocab pregnancy resources can be found at the Tokyo Pregnancy Group: http://tokyopregnancygroup.blogspot.jp/

Sanity savers and support

Tokyo Mothers Group: www.tokyomothersgroup.com/

K-A International Mothers in Japan: http://kajapan.org/