Homebirth options in Japan

This post is written for anyone researching homebirth and/or freebirth in Japan. Please note that I am speaking of my personal experience only, and make no claims that because it happened this way for me it will be the same for others. However, I am sharing my experience so that anyone interested can see what's possible for themselves.

The focus of this post is freebirth, also known as unassisted birth. I wasn't very interested in having a Japanese homebirth midwife for a couple of reasons which I will explain in a moment, although I did briefly investigate this option. As it was impractical for me to go back to Australia for the birth, I also attempted to find an Australian midwife willing to come over to Japan to attend me. However, my efforts were unsuccessful, so freebirth was it. I did have a doula in attendance, who came over from Australia. (As far as I can tell, doulas do not exist in Japan.)

The reasons I chose not to have a Japanese homebirth midwife are: 1) I wanted an attendant who could speak fluent English, because communication difficulties were not something I was prepared to put up with while in labour. Very few Japanese midwives speak English, let alone fluently. 2) Homebirth midwives in Japan are not independent practitioners, which means they are required to have a back-up doctor and hospital, and are therefore bound by that doctor and hospital's birth policies. This means that the pregnant woman is obligated to pass a whole lot of tests and submit to a whole lot of antenatal appointments and procedures in order to be considered "low-risk" enough to give birth at home. I am opposed to the routine use of medical procedures and tests during pregnancy and birth, which is why I knew having a Japanese midwife was not in my best interests.

Another factor I needed to consider was that I wanted to have a waterbirth. Waterbirths are not available in Japanese hospitals. Women who choose homebirth with a midwife in Japan may be able to have a waterbirth if the midwife is comfortable with the idea (not all of them are) and they are willing to organise a birth pool for themselves. Most women who take this option simply use their bath. This wasn't possible for me, because our bath wasn't large enough. I ended up borrowing a La Bassine "Made in Water" birth pool from a friend back in Australia, and we set it up in our lounge room with a hose running from the kitchen tap to fill it.

An important thing to know that freebirth is legal in Japan. It's rare -- I know of only one other planned freebirth to have occurred here, and even in that case it's only hearsay, I have not been in direct contact with the couple involved. But just because it doesn't happen very often, doesn't mean it's not an option, either from a legal or practical standpoint.

Of course, any intelligent freebirther is going to take careful steps to ensure she has an appropriate back-up plan in case transfer to hospital during or after birth becomes necessary. In most cases, calling the emergency ambulance number (119) is sufficient. You don't actually need a back-up booking at a hospital, because when you call for an ambulance they will just send you to the nearest available hospital.

For the administrative side of things, the documents required are:

* The boshi techo, or mother and child health handbook.
Strictly speaking this is actually not necessary, however it makes things run a lot more smoothly if you do have it. Ordinarily you collect a boshi techo from your local city health centre after receiving a pregnancy confirmation certificate from your doctor. Since I was having an unassisted pregnancy, I didn't have a doctor or pregnancy confirmation certificate, so I didn't collect a boshi techo until week 34 of my pregnancy by which time it was extremely obvious that I was pregnant. (Anecdotally, I know someone who turned up to her city health centre at 8 weeks pregnant and told them she was still looking for a midwife, and that was good enough for them.)

* The shussei shomeisho
* The shussei todoke
It's a dog's breakfast trying to understand what these documents are if you google them. Every single website seems to have a different (often contradictory) explanation of what they actually are, and what the difference is between them, etc. I still don't get it either. All I know is that they're required for registering your baby's birth, and are equivalent to a birth certificate. To add to the confusion, some websites refer to a single document called the shussei todoke juri shomeisho or shussei todoke kisaijiko shomeisho. So all I'm going to do is explain what I did to get hold of them:

I went to the city office at 34 weeks with a Japanese friend who explained to the staff that I was freebirthing but would have a doula in attendance, and that I needed a copy of the shussei shomeisho. They handed over the document, which was actually the shussei todoke and shussei shomeisho together on an A3-sized sheet of paper, with no questions asked. I'm not sure if I was just plain lucky and got an open-minded staff member that day, if having a Japanese friend with me helped, or if it was of no concern to the city office what kind of birth I was planning anyway. My friend was pleasantly surprised that it was as simple as that to get hold of the form, because it is ordinarily issued by the hospital you give birth in. In any case, the important thing is that the shussei shomeisho has provision on it for someone other than a doctor or midwife to sign that they witnessed the birth. This made registering my baby's birth a piece of cake since I had a doula who signed it for me. I'm not sure what you would do if you go totally unassisted, or just have your partner there. I was told by a nurse early on in my pregnancy that the form had to be signed by someone other than the baby's parents (although it would certainly be worth verifying this for yourself if that's the option you wish to take, because one thing I learned through this whole experience was "don't just take a nurse or doctor's word for it").

The shussei shomeisho needs to be lodged in person at the city office within 14 days of the birth. They wave their magic wand over it and hand it back to you in the form of a stamped photocopy (there's a small fee involved). That document becomes your all-important shussei todoke, or birth certificate. You might want to consider obtaining more than one copy of it. Fortunately if you ever need another one, you can just rock up to your city office and they'll give you a copy for another small fee.

After the registration process is done, all other documents you need (alien registration card, visas, re-entry permits, registration with your own country, passports, etc) are processed exactly the same way they'd be processed if your baby was born in hospital, and information on how to go about organising all of that is readily available via your city office and embassy or consulate.

If you have any questions, please contact me by leaving a comment here.

A day trip from Numazu to Hakone

In June last year we took a day trip to Hakone. It's a very touristy area and a favourite haunt of Tokyoists wanting to get away from the big smoke for the weekend. I'm not going to say too much about it because the link I've provided here already says it all and then some. However, I will say one thing you won't read in the tourist brochures: Don't bring a pram/stroller/pusher. It's not a pram-friendly place. (It was the first time we'd taken Cassia anywhere without the Ergo, and it was such a pain not having it.)

You really need two or more days to see everything there is to see at Hakone, but here are some photos from the highlights of what we saw in our single day outing.

There's a ropeway that takes you to various stations around Hakone with some interesting scenery along the way -- this is a quarry in the mouth of an old volcano, complete with steaming bursts of sulphur, just near the Owakudani station.

At Owakudani you can walk (sans pram) around stinking sulphurous pools of hot water just for kicks, and eat eggs that have been boiled in sulphurous water to turn the shells black.

The view of Lake Ashi as the ropeway makes its descent to Togendai station.

You can get a ride on a pirate ship at Lake Ashi. Yes, it's as corny and tacky as it looks, but given that the very optimistically named Hakone Free Pass gives you access to them, you'd be loath to pass up an opportunity to go on one. Besides, it's a very long walk if you go around the lake.

After going through the Hakone Checkpoint, we kept walking and found this track leading to Moto-Hakone. Told you it wasn't pram friendly. But the walk itself is nice.

*****     *****     *****
How to get to Hakone from Numazu:

Get a train from Numazu to Odawara (you can do this via the local JR Tokaido line or you can take the Shinkansen from Mishima to Odawara), and then another train from Odawara to Hakone-Yumoto, which is the usual place people begin their exploration of the area on the Hakone Round Course.

An alternative is to get the train from Numazu to Mishima and then a bus from Mishima to Moto-Hakone if you want to start exploring Hakone from the other end. Sorry I can't remember the name or number of the bus, but someone at the JR ticket office in Mishima could tell you. It might even be covered by the Hakone Free Pass (not sure about that for the trip to Hakone, but I do know it applies for your journey home).

Cultural differences

There's a pediatric "hospital" (we'd call it a clinic) on our block. Knowing that at least one of its doctors speaks English, I went there today to find out if they would be willing to endorse Elliott's passport and Australian citizenship certificate photos. It means they have to write and sign a statement that this is a real photo of a real person.

I went up to the reception desk, where at least four young women were working. One of them greeted me. I smiled. "Do you speak English?" I asked.

Hesitation. They all paused what they were doing and looked at me. One of them said she understood a little. So I tried to explain as best I could. This is my son. He was born five weeks ago. We are Australian. I need to get his passport and Australian citizenship certificate. I need a doctor to sign the photos...

They all looked totally lost. I sighed. "Do you understand?" I asked.

"More slowly?" said one.
"Oh!" said another. "Chotto matte." She scurried around the desk and out into the busy waiting room. She asked a woman there to come over to me. The woman laughed shyly and looked embarrassed (well that's what her body language said anyway; like 95% of the people in the room, she had a mask on). They came towards me. "Engrish titcha," the receptionist beamed, and ran back to her desk. The Engrish titcha continued to demur. I repeated my explanation.

Pause. "Do... you... need to... see a doctor?"
"Yes. But not for health. Just for signature."
"Oh. For signature?"
"Yes. For signature."
"Not for health?"
"No. Not for health."
"Ah!" This seemed to clarify things. The Engrish titcha spoke animatedly in Japanese to the receptionists. They spoke back to her. She spoke to me.

"This... is... small hospital. You need big hospital for signature."
No. No I don't. Come on peeps, can you just forget you're Japanese for a moment and dare to make a decision for yourselves without consulting a higher authority just this once? Please? As a favour to me? I just need a signature. It's not that hard. Really, I promise.
The Engrish titcha explained where the big hospital is. I pretended I understood, because I couldn't be bothered continuing the negotiation and I had a rough idea which hospital she was referring to anyway. I gave up, said arigato a few thousand times, and left.

Now before you assume that this is an isolated event not necessarily typical of the culture here, the same thing happened to me yesterday when I went to a different medical centre and they told me their doctor couldn't sign, and that I should go to the pediatric clinic.

I wanna go home.