Non-Hospital Birth Options

Author's Notes
This article about the different types of childbirth methods available in Tokyo was originally written for an issue of Being A Broad that was dedicated to helping women through pregnancy in Japan. While I wrote the original version (and the majority) of this article, sections of it were modified after my submission to reflect changes from the publisher. For more information, please feel free to contact me.

So you've been in Japan awhile now, or maybe you've just moved here. You've signed up for health insurance, or maybe you haven't. Either way, you're expecting. So what are your options? Well, you could go to the nearest hospital — or you could have an alternative childbirth.

Waiiiiit...let's backtrack for a second. An alternative childbirth? In Japan? It's definitely possible, according to Brett Iimura, director of the Tokyo-based Childbirth Education Center. "You have a lot of options when it comes to giving birth in Tokyo," she said. "There are maternity hospitals, doctor-run clinics, midwifery clinics run by one midwife and her assistants, and freelance home birth midwives—these are just a few places where you can give birth."

Iimura offers both birth education classes and private consultations. "Sometimes women change their minds once they find out about the different options because a lot of the information is online now or found woman-to-woman," she explained. "People come to me and it's my job to help them find someone who fits the criteria they are looking for and then to introduce them to each other."

That is exactly what happened when Heather Hopkins, mother of two, enrolled in one of Iimura's birth education classes to learn about her options before giving birth to her daughter at a hospital in Tokyo three years ago. However, while pregnant with her second child, Hopkins chose instead to have a home birth. "I was really worried about my three-year-old daughter because I wanted her to have a positive experience and though my first birth experience at a hospital was great, I didn't want to be away from her for that long, so having a home birth seemed like a nice transition," she explained.

After looking at her options, Hopkins contacted the English-friendly Mejiro Birth House near Zoshigaya Station when she was four months pregnant, but was unable to confirm that she would be giving birth there until later. "I was pretty sure after four months that I wanted to have a home birth, but I couldn't do some of the tests that were required, like checking the baby's position, because sometimes things like that would change," she said, adding that her baby went into breech position at the six-month mark. "When I went to the hospital, he would face upright and so I went to acupuncture and chiropractors to get him to turn again."

Had Hopkins' baby remained in a breech position or had other complications, she may have had to go to Nisseki, her backup hospital, because midwifery clinics and independent midwives are no longer legally able to assist with breech births, according to Iimura. "Even if go with a midwifery clinic, you will still have to make appointments to see other doctors," she said. "Midwives are usually not allowed to do twin or breech births, so they may send you to your backup hospital."

While giving birth through a midwifery clinic or birth house usually means having no interventions, women who choose to do so must also book certain prenatal appointments at doctor-run clinics or maternity hospitals. "If there had been a complication, I would have had to go to a hospital," said Brechtje Zoet-Viasus, currently pregnant with her second child, who had her first in January 2009 at a birth house that offers a birthing pool and specialises in midwife-only assisted natural births.

After researching extensively the birthing methods available in greater Tokyo, Zoet-Viasus chose to have a water birth to "make the transition from the womb to the natural world much more fluid and gentler for the baby."

About five months before she was due, Zoet-Viasus contacted the Matsugaoka Birth Center, an English-friendly midwifery clinic in Nakano City, where she met her midwife Shoko Sou. "Giving birth there was great because of the friendly, homey environment and excellent care," she said. "Sou-san is very experienced and gently coached me through labour. My husband was allowed to be there with me during the entire process as well as the five-day stay after giving birth, and he was able to join me in the birthing pool."

However, like Hopkins and the other women who choose to have non-hospital childbirths, Zoet-Viasus had to visit the hospital for the occasional prenatal checkup and to get her doctor's approval, yet the birth itself took place in Matsugaoka. "I wanted to have an active, natural birth with no anaesthesia, in a home birth-like environment," Zoet-Viasus explained. "Through the birth centre I received treatments such as acupressure, moxa, and aromatherapy massage to help me relax and to balance my body's well-being before the birth. The actual act of being in the water during birth didn't take away the pain, but it helped me deal with it in a more relaxed way."

Hopkins echoed Zoet-Viasus' sentiment about having an intervention-free, natural childbirth. "They gave me antibiotics when my water broke, but other than that there were no painkillers and it was very intense at the end." she said, "but the intensity was manageable."

Antibiotics or not, the "gift money" from the local ward office should cover the majority of the costs of giving birth in some facilities, according to Iimura. Pregnant women must register their pregnancies in order to receive the government-issued vouchers for various prenatal checkups and, more importantly, the Maternal and Child Health Handbook, a bilingual guide that must be brought to each appointment.

After childbirth, while all women must register their newborn child at their local ward office within 14 days of birth, only those participating in Japan's National Health Insurance program will receive reimbursement from the government. "The rules occasionally change, so it is best to check with your local ward office about the amount and policies," Iimura advises. She adds that in the past, the money has sometimes been directly paid to the mther but it is now sometimes remitted to the hospital directly.

Iimura explained that while most clinics and hospitals in Tokyo will accept both government-sponsored reimbursement and prenatal checkup vouchers, most midwifery clinics in the greater Tokyo area do not honour these vouchers and require women planning to have a non-hospital birth to complete certain prenatal procedures at a hospital or clinic. However, most ward offices have a special reimbursement system in place to cover the costs of both the prenatal doctor's clinic visits and the birth itself.

According to Zoet-Viasus, giving birth at Matsugaoka Birth Center was neither significantly more nor less expensive than delivering at a hospital. "We found out that my private insurance provider would cover the midwifery fees, as well as the necessary standard medical checkups at the doctor," she explained. "Regardless of that, I would have chosen to go to the birth centre anyway. And I plan to give birth there to my second baby in a couple of months."

As with any natural birth, if her medical history hints that complications may arise, Zoet-Viasus may not be able to give birth at a midwifery or birth house and may be transferred to her backup hospital.

These extra steps can increase the price of the entire pregnancy, says Hopkins. "I had to have more ultrasounds and tests done because the baby kept turning and entering breech position," she said. "While we had ward vouchers worth ¥2,000 to put towards internal checkups, the cost of the entire pregnancy may have gone up due to my additional doctor visits." After the birth, Hopkins had home visits over the next week and eventually took her then month-old son to his first pediatrician's visit to ensure that everything was developing properly.

So why did these women choose to have home births if they didn't save any money in the end and still ended up going to the hospital for checkups? "There is something so beautiful about doing it yourself with no medical interventions," Zoet-Viasus explained. "The benefit of a water birth is that the baby comes straight from the waters of your womb into a pool with warm water, making the transition easier. The warm water allows the mother's body to relax and her skin to soften, which might prevent tearing—I didn't tear!"

What should you do to convince your husband that a natural birth is right for you? "We watched a documentary about giving birth and that's when my husband understood my belief that the ideal place to give birth would not necessarily be a hospital," Zoet-Viasus said. "It's wonderful for your partner to be involved. He gave me all the support I needed, and he got to experience the birth of our daughter intimately, as he was right behind me when she entered this world, calmly looking at us with her eyes wide open. At the birth centre, my husband also got to cut the umbilical cord, which I was told is usually not allowed at most Japanese hospitals."

And if you already have another child, having a home birth will help you ensure that your older one does not feel any resentment towards the younger sibling. "I wanted my daughter to be there for it," Hopkins said. "I assigned [her] an advocate so she could do what she wanted to do, whether that was being present for the birth, going for ice cream, or taking a nap..."