Stephanie Kawai, Japan
Introduction
Can you give me a little background on yourself?
I’m Stephanie Kawai, doula and breastfeeding counsellor in Tokyo. I’m originally from the U.K, have a Japanese husband and 3 boys.
When did you move to Japan and what inspired your move?
I came to Japan many, many years ago in 2000 (so I’ve been here just over 20 years now). I came on a whim after university to teach English.
What inspired you to become a doula?
After I had my first child, I started a network called Tokyo Mothers Group. Through that, I met someone who said she was a doula (although not very active in Japan) and, when she told me what she did, I immediately said “I would have hired you”. It really struck a chord with me. Prior to that, I’d never heard of the word doula at all. That thought of what an amazing and important service Doula’s provide never left me and was the catalyst for me becoming one.
Can you tell me a little bit about the work that you do and how you support women during pregnancy, birth and postpartum?
As a doula I’m a little bit like a coach, mother, aunt, sister, birth professional all rolled into one. A doula essentially helps guide the pregnant person and their partner through pregnancy, birth and the early postpartum period by offering information, advice, birth preparation classes, emotional support, and - especially in Japan - cultural understanding and language support as not many doctors or hospitals have English-speaking staff.
With my birth clients, we have regular meetings through pregnancy covering things such as their birth preferences taking into account the hospital they’ll be using and policies in place there, birth preparation (with breathing & comfort measures), go through any questions they may have, help find information or resources they are looking for in Japan/Tokyo, and prepare for the early postpartum period. During labour, support is given either in person at the hospital/clinic or virtually. Currently, due to the situation with the coronavirus, many hospitals have stopped allowing support (including support from spouses) so my services have adapted quite a bit to fit this “new norm”. While not ideal to offer labour support virtually, I’ve had positive feedback from my couples who felt much less alone having someone else in their corner guiding them and helping them if any language issues come up, or if any unexpected situations occur in labour snd they need information or advocacy.
Then after birth, I provide a postpartum home visit to make sure everything is going well with the new family and offer breastfeeding support, too, as a breastfeeding counsellor.
In addition to the above fully-comprehensive support, I also offer individual classes and conduits for those who don’t want a full package. They range from breathing classes, birth preparation courses, infant care classes to birth plan consultations, breastfeeding workshops and so on. I also do free monthly meetings - “Doula Cafe” which is a free pregnancy get-together and “Baby Cafe” which is for parents of young babies to come and ask questions, and feel less isolated.
What is your favourite thing about being a doula in Japan?
Definitely the fact that I get to work with so many different nationalities of people. I have worked with couples from The US, U.K., Canada, Australia, NZ, France, Germany, Belgium, The Netherlands, Italy, Pain, Romania, Poland, Czech Republic, Latvia, Ireland, Finland, Sweden, Luxembourg, Portugal, Serbia, Austria, Macedonia, Russia, India, Sri Lanka, Bangladesh, Nepal, China, South Korea, Syria, Saudi Arabia, Turkey, Israel, Egypt, Sudan, Kenya, South Africa, Singapore, Thailand, Vietnam, Philippines, Indonesia, Malaysia, Brazil, Argentina, Colombia, Ecuador, Costa Rica, Mexico - I’m sure I’ve forgotten some! It’s such a wonderfully rich experience meeting so many nationalities!
Through your experiences as a doula, what is one piece of advice that you could offer to other mothers?
Don’t underestimate the importance of connections. Finding a group (either in person or virtually) of other women due around the same time can be very valuable. Going through shared experiences, having people to contact and talk to even if it is just virtual, is more important now than ever before as many of us are having to be more physically distance or isolated than in years past due to corona.
Pregnancy
What type of prenatal care do women in Japan receive?
Women get very regular check ups in Japan with an OB (or midwife for anyone going the less-used “Birth house” route). For the first 2 trimesters, women go for a check up every month, then from the 3rd trimester it’s every 2 weeks, and in the last month it’s weekly. At every appointment there is an ultrasound - although sometimes it’s possible to opt out for some appointments depending on the clinic. There can be a lot of emphasis on weight gain (many places suggest 8-10kg as an acceptable amount, other places are more flexible/understanding). Many non-Japanese feel this is a negative and there have been articles about this suggesting negative aspects towards these weight restrictions. On the plus side Japan has one of the lowest (if not the lowest) rates of infant and maternal child mortality. So clearly the very thorough approach to pregnancy check ups, plus the healthcare system as a whole here, gets a lot right.
What are maternity vouchers and how are they used?
Vouchers are available from the ward office (municipal office) where you live and you are given a set number of them when you register your pregnancy. They offer a bit of a discount against the cost of check ups at each hospital/clinic. Check ups costs can vary from place to place, so sometimes using the vouchers means that you’d only pay a few hundred yen for some basic check ups, while in other places you’d still be paying a significant sum.
Are scans/ultrasounds readily available and how often during pregnancy?
Scans are frequent. As mentioned above, they basically happen at every check up.
I read that women in Japan are given maternity badges to wear so that when they are on public transport, people can give up their seats for pregnant women. Have you found that this “special care” given to pregnant women extends to any other parts of life?
The pregnancy badges are given, yes, but they are not as effective as one might hope on public transport. Even in priority seating areas, you might notice that the badges are overlooked. Of course, there are those who do graciously give up their seats for pregnant women, but sadly not as common as you’d think.
Can you share any traditions or customs that are typical for women during pregnancy in Japan and the significance and meaning of these (for example, I read that women are often told to keep their belly warm and to wear socks at all times.)?
Yes, keeping the belly and feet/ankles warm is huge here. Even in height of summer. Beliefs include that it promotes better circulation, so less chance of premature labour, more effective labour, less likelihood of a breech baby and so on. There maybe some truth from a physiological point of view for some women at least but nothing that has been researched to any degree.
Also, it’s quite common for pregnant women to go to a shrine and get a special amulet (Omamori) for good luck during pregnancy. One such popular shrine in Tokyo is Suitengu shrine. Going during the 5th month of pregnancy on “inu no hi” (a lucky day during that month meaning “day of the dog”) is meant to be best.
Is there any attention given to preparing women both physically and psychologically for birth?
I have found that there are less opportunities for fully-comprehensive childbirth preparation classes/workshops here than back home for both the physical and psychological side of things. Generally speaking, any sessions that hospitals or clinics offer themselves tend to be more informational rather than anything that offers hands-on practical birth preparation, and for the emotional/psychological side, even less emphasis is given.
Are there any foods that are recommended for pregnant women to avoid during pregnancy?
There isn’t such a huge emphasis on avoiding particular foods here (other than being careful of sugar intake, and interestingly this can extend to doctors/midwives telling patients to be mindful of how much fruit they eat). Raw fish is not strictly advised against as it is in other countries for example. In traditional midwife-run birth houses, it’s quite common for vegetarian or even macrobiotic diets to be strongly recommended.
Birth
Is the use of a doula common to support women in Japan?
Doulas are extremely rare here. I’m the busiest doula in Tokyo and there are only 1-2 others who are active. Postpartum doulas are a little more common, but even then not known in the mainstream.
Where do most women give birth (hospital/birthing centre/at home)?
Most women give birth in a hospital or birth clinic (hospitals range from large, general ones with maternity units, to maternity-only hospitals both large and small, to maternity clinics). There are also midwife run birth-houses (which feels like giving birth in a home setting) and home birth is an option, too. These latter two options are kit used so often, especially by non-Japanese people. But both are options that do exist and are available to non-Japanese who are interested.
If hospital, how long do you stay in hospital following birth?
Depending on the hospital/clinic anywhere between 3-7 days. Some places will discharge a little sooner, while others prefer to keep the mother in “to rest and recover” for longer. If a woman has had a c-section then a week or a little longer is common.
Are fathers allowed to be at the birth?
Yes, in general it’s rare nowadays to not allow fathers in if that’s what the couple wants. Although it’s still more common than in the U.K, where I’m from for fathers to be told to wait outside by their wives or to choose to wait outside themselves. Some women also opt to return to their hometowns for delivery leaving their husbands behind working. With this, the dad may or may not miss the birth depending on when he can get there.
With all this being said, unfortunately the coronavirus situation in Japan has led to many hospitals/clinics around the country rather unfairly implementing rules that don’t allow birth support at all, including support from husbands. So finding a hospital recently that allows a woman to have her partner with her is not easy. It’s something that many feel is unfair and don’t agree with, and goes against the WHO, who say a woman has the right to a birth companion of choice.
What types of pain relief are available during birth? Are these encouraged/discouraged?
Pain relief is not common at all. In many hospitals, there are no options at all and it’s a natural labour all the way. In some there is the epidural, but not many places offer the epidural 24hrs a day and some places only offer it during “business hours”, sometimes suggesting booking for an induction is one way to guarantee an epidural for those who want it.
In big cities like Tokyo, it’s more possible to find some hospitals as described above that offer epidurals but it’s still the case that it’s less common.
Gas and air for labour doesn’t exist at all.
Are there any recommended ways to support physical healing of the body following birth?
Wearing postpartum support belts or corsets is quite common here. Some hospitals/clinics also do their own versions of belly binding (although this is less common).
The hospital food in Japan for mothers following birth has received a lot of attention as it looks like a five-star luxury meal. Why do you think such care and importance is taken for a mother’s nutrition following birth?
I think a big part of it is to aid recovery as well as help for mothers who want to breastfeed - that they are being looked after food-wise so they’ll be less depleted.
What type of appointments typically follow birth and will these be in-home or out-of-home visits?
Depending on where you give birth, you have an appointment with that hospital/clinic around the one month mark again. For many women, this is the only post-natal check up they get for themselves or their baby. Occasionally, some hospitals have a 2 week check up and 6 week check up (instead of one month) but this is less common. Each ward or municipal office offers a postpartum visit from a health visitor, too. These visits are less about the health of mum and baby and more informational. The health visitor might weigh baby, ask the mum about how things are going with feeding, day-to-day life etc, and offer local info on resources.
What do you personally believe were the most important things in aiding postpartum recovery both physically and emotionally?
I think it’s a balance between getting some rest and not rushing out to do things too soon, but also not feeling like you have to stay at home the whole time. Going out for a local walk with baby can really help break up the day (especially if things seem to feel overwhelming). And having your network of people - other new mums you can contact & talk to so you feel less isolated and alone. And then once you’re physically ready after about 6 weeks, joining a postpartum exercise class, or Pilates, or Yoga can really benefit new mums too.
Postpartum
Can you share about the confinement days following birth? I read that it is customary for Japanese women to return to their mother’s home sometime during the last trimester, and then after giving birth at a hospital, to return to the mother’s home again for the first month postpartum. Are you able to share any information on this?
Yes, some women do return to their hometowns for delivery. I think it’s becoming less common now, though.
In Japan traditionally, it’s recommended to stay home for the first month and not go out at all, but for some this is simply unrealistic (especially if other children are involved). It’s not a tradition that I feel needs to be followed closely.
Is there government-supported maternity or paternity leave and if so, for how long?
Yes, maternity leave is 14 weeks: 6 weeks before birth and 8 weeks after.
Following on from this, many women are eligible for childcare leave which goes up to the child’s 1st birthday. This can be further extended for up to 6 more months if no public daycare space is available. Both maternity and childcare leave is paid.
Typically who cares for the baby during the newborn stage? Mother? Partner? Extended Family?
Typically it’s the mother.
Can you speak at all to the culture around newborn sleep in Japan, particularly of expectations for co-sleeping, sleeping through the night, self soothing? What are your personal thoughts on this?
Generally speaking co-sleeping/bed-sharing is more common here than back home. It’s not seen in such a negative light. For some, it’s simply a matter of logistics - there isn’t much space and some families sleep together in the one room for many years. For others, it’s preference to be close to baby or sleep with baby.
I personally am a huge bed-sharing fan. I never planned to bed share with my oldest when he was born but soon learned that it was the only way I’d ever get some degree of rest at night. It was one of the best decisions I made for my babies.
Pacifiers are definitely not so common here. I can’t speak to expectations Japanese might have to sleeping through the night. I don’t think sleep training or anything like that is common here.
Breastfeeding
Do you think breastfeeding in public has been socially accepted in your country?
It’s neither accepted nor looked down on to breastfeed in public. I’d say it’s rather neutral and people don’t make a big deal at all about it (as it should be). Overall breastfeeding on the whole is viewed very positively here and I breastfed my babies/children in public a lot. But there are also many wonderful breastfeeding facilities everywhere you go, so finding a feeding room is quite easy in most places (at least in cities).
Is breastfeeding support readily available?
Yes it is - many hospitals offer breastfeeding support from midwives after birth and in the postpartum period...although I’ve found that evidence-based breastfeeding advice and support is not always available. Sometimes the advice might be more according to cultural practices or hospital policy rather than be accurately informed by what research and evidence tells us. So this can be a downside. For example, it’s not unusual here for a mother who wants to breastfeed to be told she has to wait for a number of hours or even a few days before she can get her baby back from the nursery to breastfeed, or to top up with formula after feeds, or to be told that breastfeeds need to be 10 minutes per side at timed intervals etc. There are definitely some places that give better advice than others but it can be a good idea to get help from a breastfeeding counsellor or lactation consultant (IBCLC) if you are unsure of the information or advice given to you by any hospital or midwife.
How long do babies typically breastfeed in Japan?
At least 1-2 years and sometimes more generally. This also includes women who may continue to use formula supplements in addition to breastfeeding, but every drop of breastmilk counts.
Japan
What is your favourite thing about being a mother and raising children in Japan?
I like that my children have a lot of freedom here. They go to school by themselves (from age 6), take themselves to the park or their extra-curriculars and I don’t have to worry about them. This would not be possible to do in the U.K. at all. As they are Japanese/British, they also are being raised bilingually here. I feel this would be much harder to do in the U.K. where opportunities to keep their Japanese up would be much harder to find.
If you think the world could learn one thing about how Japan approaches pregnancy, birth, & motherhood, what would it be?
That birth is in essence natural and that pain during is “normal” and not anything that is wrong with the woman. Keeping this in mind is obviously easier said than done but not approaching labour as a problem that needs to be solved and trusting the body and the process is very important. In Japan, you will not feel rushed or “on the clock” in labour. Most midwives and doctors will let it take the time it needs to take.