Prenatal Care

Disclaimer: This guide is based off of personal experience in 2017; I am not an expert in health insurance or a doctor. This is intended to be a starting point for understanding and using the systems concerning pregnancy care in Tokyo. I strongly suggest that you do your own research and listen to expert advice.

## Does our Japanese health insurance cover pregnancy?

First, it is important to understand that your Japanese health insurance only covers injury and illness. A healthy pregnancy is not an injury or an illness, so it is NOT COVERED by your Japanese health insurance. JET Accident Insurance does not cover a healthy pregnancy either. It is important to note that although prenatal care and natural childbirth are not covered by the insurance, emergency care SHOULD BE COVERED. So if there was a need for an emergency C-section, the cost would be covered as any other emergency surgery would be. Children are also covered by the Japanese health insurance, so any emergency care a newborn might need would be covered by insurance.

Don’t worry! Even though our Japanese insurance doesn’t cover normal prenatal/childbirth, there is a lot of other financial support available through the government to minimize the cost of prenatal care and childbirth in Japan. After a pregnancy is confirmed by a doctor, you can receive a booklet of coupons to help cover the cost of prenatal appointments. After the birth, the city will give you about 420,000 yen to help cover the cost of delivery (it isn’t enough to cover the average cost of a birth in Tokyo, but it helps!). You will have to plan to pay some money out of pocket, but it shouldn’t be a crippling burden if you do a little planning. If you are from the U.S. like me, then the cost of prenatal care and childbirth in Japan will seem very reasonable compared to costs back home.

## Confirmation

If you believe that you are pregnant, make an appointment with a ladies clinic to confirm the pregnancy. A hospital may be able to confirm the pregnancy too if they have an Obstetrics and Gynecology department. Big hospitals usually charge a one time fee of 4,000 - 5,000 yen for new cases/patients in addition to any cost for care. If you are not planning on using a certain hospital for the bulk of your prenatal care or your delivery, then it may be cheaper to visit a clinic. Remember, you pay for all these costs out of pocket. After you have a confirmed due date, you can get your Mother and Child Book and the coupons to cover the remaining appointments. Bring your insurance card to all your prenatal appointments, I know it isn’t supposed to cover anything for prenatal appointments, but they always ask for it.

**Personal experience:**
*I went to Red Cross Hospital in Tokyo at about 6 weeks pregnant to get a pregnancy confirmation.　They didn’t want to see me that early in my pregnancy and told me to go to a ladies clinic for a confirmation appointment and to get my Mother and Child Book before returning for an appointment around 8 weeks.*

Although you can visit a clinic and get an ultrasound really early, the doctor may not “confirm” your pregnancy (give you a due date) until somewhere between 8-10 weeks.

**Personal experience:**
*Getting the Mother and Child Book and the coupons that come with it was my top priority. I didn’t want to pay for any extra appointment without the coupons. I thought I needed some sort of confirmation certificate, so I went to a ladies clinic at 8 weeks. They did an ultrasound and everything looked fine, but since the baby was measuring a little small (I think that was the reason) they wouldn’t confirm the pregnancy. I had to go back 2 weeks later for another ultrasound. This time they said they would confirm the pregnancy. I asked for my certificate….and they said there was no such thing. They just verbally gave me a due date for the baby. THAT WAS IT?! I had been carefully tracking my cycles, so I had figured out my due date even before I had a positive pregnancy test. I was so mad they wouldn’t tell me that all I needed was a due date to get my Mother and Child Book and coupons.*

## Mother and Child Book and prenatal appointment coupons

What is it? The Mother and Child Book is a record book to record all your prenatal appointment information, personal observations and concerns, and the child’s health and development thorough age 6. It comes in both English and Japanese versions, with the Japanese being significantly cuter. It comes along with a booklet of prenatal appointment coupons (they cover about 5,000 yen of each appointment, some tests, a dental checkup, and 2 ultrasounds). You also receive that pink keychain for your bag that lets people know you have a right to the priority seating section on the train.

How do you get it? Go to your ward office. When you find the right desk, they will sit you down to fill out a form about your pregnancy and living situation, what doctor you’ve been to, your due date, where you work, whether or not you’ve made a reservation with the place where you want to deliver, and some other stuff. I think they need your resident card. I can’t remember if you need your insurance card or not, but bring it too.

The office will also give you a handy guide about what paperwork to fill out when (and where) to get your 420,000 yen birth allowance, maternity leave, and other paperwork after the baby is born. Bonus: Some wards give you a gift too.

**Personal experience:**
*One couple I know was offered a choice of two items and walked away with a swanky new diaper bag. Our ward office showed us a catalog, and said they would mail us one for us to choose our gift. We chose a nursing pillow, baby blanket, and burp cloth set.*

## Choosing a care provider

Your options for prenatal care and childbirth in Tokyo are hospitals, clinics, and birth centers. You should probably make a decision about what route you want to pursue very early in (or even before) your pregnancy.

It is said that the big popular hospitals fill up their reservation lists quickly. A hospital will only accept as many patients as they can reasonably have enough beds for in labor and delivery when the women are due. For example, Aiiku Hospital recommends on their website that you make your initial appointment with them within the first 10 weeks. Other less reliable sources have even said that during peak times, Aiiku is so fully booked that only women at 8 weeks can get a slot. If you want to use a big or popular hospital for your care, then you should make a decision quickly.

Hospitals that are recommended frequently to foreigners in Tokyo include Aiiku Hospital, St. Luke’s International Hospital, and Red Cross Medical Center (Nisseki). All of these hospitals have some level of English support, NICU departments (newborn care), and may offer epidurals during delivery if you jump through the proper hoops beforehand. Epidurals are not very common in Japan, so if that is important to you then make inquiries before you choose a care provider. I’ve heard that prenatal appointments are cheaper through the hospitals than through clinics. However, delivery fees are much higher at the big hospitals, I inquired at both St Luke’s and Aiiku and found that a normal labor and delivery would cost about 1,000,000 yen. After your 420,000 yen birth allowance that means you pay about 580,000 yen out of pocket.

(Fun fact: Japan's royal family chose to have Prince Hisahito, heir to the Imperial throne, delivered at Aiiku Hospital in 2006.)

Clinics are much smaller than hospitals and much more numerous. Every clinic will have different pros and cons. Some have English support but it is unlikely that they will offer epidurals. Popularity will vary, but you probably won’t have to reserve a spot quite as early as you do in the popular hospitals. I’ve heard that clinics may charge more for their prenatal appointments than hospitals. Do your research.

Birth centers are much rarer than clinics or hospitals. There seem to be two to three birth centers in Tokyo with English support, but rumor has it that one is no longer running. The remaining birth centers are Matsugaoka Birth Center and St. Luke’s Birth Clinic. St. Luke’s Birth Clinic told me that they do not accept first time mothers. In general, birth centers will NOT ACCEPT high risk pregnancies, twins, or RH- blood type mothers. If your baby is breech or there are other complications you will be transferred to a hospital. Appointments at a birth center are much cheaper than at clinics. They also have the lowest delivery fees, about 500,000 yen. After the 420,000 yen birth allowance from the government you pay about 80,000 yen out of pocket.

**Personal Experience**
*I chose Matsugaoka Birth Center as my care provider, so I can tell you that you do need to go to a regular clinic for blood tests and ultrasounds, but that the majority of your prenatal care and delivery will be handled at the birth center. The center is run by midwives and the labor and delivery room is a traditional tatami room. Yeah, no chance of an epidural here! Prepare to be bombarded with all the traditional Japanese wisdom regarding a healthy pregnancy (it’s 80F outside? Why aren’t you wearing two shirts and covering your arms and legs?). On the plus side your regular appointments include a massage and reflexology treatment – score!*

## A note on blood type

Do you know your blood type? In countries like the U.S., U.K., Australia and New Zealand about 15-20% of the population has an RH negative blood type. That includes types A-, B-, AB-, and O-. In Japan the percentage of people with RH negative blood types is about .5%, it is really low! If your pregnant (or planning to be) and have a positive blood type, then you don’t need to worry about the following. If you have a negative blood type then read on.

Why does blood type matter? Well if a pregnant woman has an RH negative (RH-) blood type and the father has a RH positive (RH+) blood type, then the baby had a 50% of being RH+. The problem is that if the mother’s RH- blood comes into contact with the baby’s RH+ blood (like in childbirth), then it will start forming antibodies to attack the baby’s blood. These antibodies stick around in the mother’s system too, and could cause problems in future pregnancies. If the baby has a RH- blood type then there is no issue, but we can’t guess what it’ll be before birth. The solution is that the RH- mom gets a special shot during pregnancy and again right after birth, to suppress this immune response. Ta-daaa! Easy peasy. So what’s the catch? Since RH- moms are so rare in Japan, usually only big hospitals have this shot available. I know of one case where a small clinic was able to get the shot from Red Cross Hospital for his patient, so clinics may still accept RH- moms. However, birth centers don’t administer shots and so they won’t accept RH- moms who need the shot. The bottom line is that if you have an RH- blood type, be aware that it could limit your choices and don’t be surprised when it creates a fuss at your doctor office.

**Personal Experience:**
*I didn’t want to use a big hospital, but I was very concerned because I have a RH- blood type. We didn’t know what my husband’s blood type was. Instead of going straight to a big hospital from the start, we decided to try a clinic which works with a birth center. We told them about our desire to use the birth center. I knew that if my husband had an RH- blood type too, then the baby must also have a RH- blood type. There would be no medical issue, but even so, I didn’t know if the birth center would accept us. The doctor quickly called the birth center and talked with the head midwife. The birth center agreed to take us on if my husband tested RH-. So the clinic tested both of our blood types, and a week later we found that my husband was RH-. It was like winning the lotto!*