Breast feeding at a Baby-Friendly Hospital in Japan

Has your wife already chosen her Obstetrics & Gynecology (Ob/Gy) Doctor in Japan? Have you met him? (I use “him” as unfortunately the vast majority of Ob/Gy’s in Japan are males) Did you go along to help scrutinize him? Call me paranoid but we went and interviewed 4 different doctors before we decided on who we wanted to deliver our baby. It’s astounding how different one Doc’s perspective can be to the next.

This is the sixth installment in a series about my personal experience of being pregnant in Japan (or perhaps I should say, of my Japanese wife being pregnant). I decided to start writing this series when I realized that there must be a significantly large population of gaijin dad’s out there who are making all of the mistakes that I have and wished there was a bank of information somewhere to save them some of the pain. In that respect, this installment might be most relevant to Dad’s who haven’t even gotten pregnant yet or are in the early stages. If you’re too far along in the pregnancy, it’s likely that your wife has already decided on which hospital she wants to use. That could be fine, but I don’t want you to overlook how important such a choice can be. With a bit of balanced information from an international perspective you might want to rethink your priorities. There doesn’t seem to be very many independent, balanced sources of information for Japanese people, let alone gaijin parents so hopefully I can shed a little more light on the Japanese hospital situation here. If you haven’t already, you might like to catch up on the first, second, third, fourth and fifth installments of the series before reading on.

Although it might seem painfully obvious, choosing the right hospital is a very important decision in your wife’s pregnancy. Most people just focus on the size of the room, the kind of food that is served and the price but there are a whole lot of other things that you need to take into consideration when choosing a hospital for delivery. Although the private health system is almost non-existent in Japan, Ob/Gy is one of the few areas where you have a pretty wide choice and certainly don’t have to rely on the large scale 総合病院 (general hospitals / Sogo Byoin) if you don’t want to. There are thousands of tiny Obstetrics & Gynecology clinics (called 産婦人科 / sanfujinka) dotted around the country which specialize in nothing but pregnant mothers. Many of them have a limit on the number of patients (often a single digit one) and so can provide a very personal service compared to what you might have expected if you have ever needed emergency treatment at a regular hospital in Japan.

Although you often have to pay up front in cash for Ob/Gy services in Japan (remember, credit cards generally aren’t accepted in Japanese hospitals at all), the Japanese government will give you a cash payment of 350,000 yen per child as long as either you or your partner are working in Japan and paying some sort of government insurance. (While it’s nothing to celebrate, you are actually even eligible for the cash in the case of a miscarriage as long as the fetus reaches 85 days or more!). While most clinics structure their fees so that you are charged spank bang 350,000 yen, some in remote areas with aging populations are proactively charging less (so that you can profit from the birth) in order to attract young couples from the cities. By the way, if you’ve recently had a baby and you haven’t applied for the government subsidy, it’s called “出産育児一時金” (Shussan Ikuji Ichijikin) and you can apply for it up until 2 years after the date of birth of your child.

Check out the price. Check out the size of the steaks they serve you to celebrate the birth of your child, but more importantly check out the philosophy and policies of the doctors, nurses and midwives. And this doesn’t just refer to being organic or having/not having an epidural. If you need a list of questions to ask, there is a great template in the book, “The Expectant Father” that I introduced in part two of this series (it is still my favorite book on this subject matter by the way). But if you’re hoping to breast-feed your baby exclusively, I recommend that you add the following few questions for Japan:

• What percentage of children born in your hospital last year drank formula at least once?
• Under what circumstances will a baby be fed formula? (especially focusing on if nurses ever feed babies formula without consulting the parents)
• Do you have, or can you recommend a lactation consultant?
• If the mother is deemed to have a low supply of milk or the infant is not putting on weight fast enough, what countermeasures do you recommend and after how many weeks?

One of the big problems is that although many hospitals claim that they are all natural/back to basics, or that they encourage breast feeding, this often means little more than them giving private breast massages to your wife for the few days after her delivery. The reality is that many of these doctors were educated a long time ago and aren’t up to date with the most recent academic thought and they are more likely to trust what they hear from the visiting salesmen from the major pharmaceutical companies (who also, strangely enough, leave plenty of samples of their products). Hell, it is so hard to keep a hospital profitable in Japan that you don’t have time to do your own extra research.

So, I ask you this question? Who do you trust more? The quack down the road from you who operates a small scale clinic that is only viable because of government subsidies and strategic bribes from pharmaceutical companies? Or the World Health Organization (WHO) and UNICEF? Yes, there is a better way of judging how reliable your Ob/Gy really is.

It turns out that WHO and UNICEF have developed a global criteria for what they consider to be a Baby-Friendly Hospital (BFH), under the BFHI (Baby-Friedly Hosptal Initiative), which encourages and recognizes hospitals and maternity centers that offer an optimal level of care for breastfeeding babies, which includes protecting, promoting and supporting breastfeeding.

The BFHI Ten Commandments
of Breastfeeding

The concept stemmed from the fact that (almost) all Mothers use a hospital when giving birth to their baby and almost all of those Mothers are heavily influenced by the practices of that hospital and the teachings of their Ob/Gy and/or midwife that delivers their baby. If the hospital is so focused on the bottom line that they skimp and cut corners when it comes to education or even worse give misinformation to their customers due to a lack of continual independent education then there can be serious repercussions for the long-term health and welfare of the babies born there. Pretty simple, eh. Well WHO and UNICEF have now designated over 20,000 hospitals in 152 countries as being Baby Friendly Hospitals. How many do you think exist in Japan? 48. Yep. Japan has less than one quarter of one percent of all of the BFH’s in the World. What are the criteria that the WHO and UNICEF use to judge hospitals? It turns out that they have 10 simple rules for becoming a BFH and they center on making your birth natural and giving your baby the best chance it can have for a healthy birth and to reduce the probability of allergies and other medical risks developing in later life. They cover everything from giving the child a chance to bond with it’s mother on the breast immediately after the birth to not accepting free or low-cost substitutes for breast milk (ie. Powdered milk). You can read the details for yourself on their official website entitled, “The Baby-Friendly Hospital Initiative” which also has a link to all of the 10 commandments of breastfeeding. Perhaps most interestingly, it gives you an insight into what so many of the world’s hospitals are messing up.

Perhaps you might think that BFHs aren’t for you, but please let me try one more time to convince you. We were lucky enough to find a BFH that also met our other needs (including geographical) and I’m convinced that it made a huge difference in terms of emotional support and acceptance (from the midwives to my wife and I) and was key to a flawless entry to the world for my child. Before you finalize your hospital, please see if there are any Baby Friendly Hospitals near your home. If there is one, give them a visit and find out how they’re different to your current hospital. You might be pleasantly surprised.

Below is a list of all of the BFHs in Japan (as at July 2008). As far as I know, this is the only English language list of Japanese BFHs. As you’ll notice, the biggest problem is that there just aren’t that many BFHs to choose from (Damn, even Burma has more!) but by spreading the word to your local Ob/Gy you might be able to help change that. If there are any readers out there who have actually been to one of these BFHs, we’d love to hear your thoughts in the comments section (at the very bottom) so other gaijin parents can benefit, too.

List of Baby-Friendly Hospitals (BFH) in Japan:

(Click on the Japanese name to jump to the homepage of each one):