Cultural Differences: Pregnancy information

This is the cover of the June issue of Ninsugu, a popular Japanese pregnancy magazine. The cluttered layout is typical of pregnancy magazines here (and Japanese magazines in general), as is the very young, obviously not pregnant (and possibly not even capable of conceiving) foreign model. I didn't buy this issue, as I'd bought the previous one and found it completely useless. At the time I'd been really hoping for some good Japanese information on pregnancy to compare with the very good information I have access to in English. Since I wasn't getting much from my doctor and midwife and couldn't find anything useful online I figured a magazine might help, but it turns out that the one I bought was a big piece of garbage and that useful information on pregnancy in Japan is quite hard to come by.

It's bad enough that much of the pregnancy advice and information in Japan is completely different from western advice. What Hideaki and I find really frustrating though is the relative lack of official health guidelines or common-sense, universally agreed-upon information and advice during pregnancy. I have loads of information available to me in English: my own government, like those of most developed nations, sets guidelines for pregnant women. So do countless official medical associations and private and public organizations. Tonnes of books, magazines and websites are out there, and most of their advice is strikingly similar and based on the latest science. And of course there are certain things that everyone back home knows and takes for granted, without having to consult a book or website (like don't smoke and drink during pregnancy, abstain from fish high in mercury, avoid overheating yourself with hot baths and saunas, eat well, and so on).

Here in Japan, however, there doesn't seem to be any official organization that offers pregnancy advice (or if there is, nobody I know has heard of it). Although there are a few common sense sort of things that everyone knows, some of which are the same as back home (no smoking and drinking), and a few more that are unique to Japan (avoid chilling yourself, stay off your bike), there don't seem to be as many universally known rules. Instead, the advice and information a woman receives during her pregnancy will almost completely depend on who or what she consults.

Google "pregnancy" in English and tonnes of informative, useful websites pop up. Google it in Japanese and you get a mishmash of awful, hard-to-navigate sites (to be fair most Japanese websites are awful and hard to navigate though), many sponsored by private companies with commercial interests. The information they offer will vary widely and depend on who is paying for the site. When searching for something more specific you will likely be directed to a question-and-answer type of website, where the advice will of course be all over the place. Admittedly the same thing happens when searching the internet in English, but at least you'll have a pick of several more official sites before you are reduced to reading Yahoo Answers.

Japanese books and magazines are little better, mostly featuring cutesy cartoons relaying the most basic information, tonnes of profiles and interviews of real mothers and mothers-to-be that reveal what they did during pregnancy, and pages and pages of ads (in fact some pregnancy magazines are just catalogues with a small editorial section at the front). And virtually all pregnancy publications are completely aimed at mothers, with no information whatsoever for fathers- something Hideaki finds really annoying.

The cartoons and interviews make the magazines and books cuter, easier to read, and more accessible and reassuring, and this in itself is not necessarily a bad thing. But for those who want real information, these publications can be quite useless. For example, a pregnancy magazine I bought had an article called "My Pregnancy Rules" (the first two pages are shown above) and showed pictures of real moms (mixed in with models pretending to be pregnant and posing cutely) with their tips for how to deal with the various challenges of pregnancy. These moms offered help with stuff like "keeping warm", "giving up caffeine", "preventing constipation with wheat grass juice", by sharing their personal experiences and advice. But there was no actual medical information offered along with this advice. For example, nowhere in the article did it say exactly why the woman wanted to quit caffeine, or if the reader should follow her example. That caffeine is bad and that everyone should quit it was definitely implied though. Some of the tips were for things that are unquestionably good, like getting enough folic acid and quitting smoking. But for a woman with no other source of information, wading through all of the tips to find real, useful, science-based advice would be difficult indeed, and she would be left with the impression that drinking wheat grass juice and wearing socks at all times is just as important as giving up cigarettes and alcohol.

Books aren't much better, and the few that aren't filled with cartoons are really hard to read, with endless blocks of text and no pictures. I mean, there aren't any books that offer good information in an easy-to-read format. There's no "What to Expect When You're Expecting". The books also tend to reflect the author or editor's personal views or commercial interests rather than relaying established medical information (the wackiest piece of info I've read in a Japanese pregnancy book so far: "Yes, it's OK to have sex while pregnant, but use a condom"). Of course, I'm not completely literate in Japanese and haven't done an extensive search of pregnancy books (I gave up in disgust early on), so I could be missing something, but I suspect not. Stippy.com has an interesting post about Japanese pregnancy books, and I completely agree with the author's assessment.

So if there is little published information out there, can't Japanese women just get advice from their doctors or midwives? Maybe a few can, but most doctors here tend to offer little information and some actually get annoyed by questions, and midwives tend to be long on traditional wisdom and old wives' tales and and short on actual medical knowledge. My own doctor, luckily, is happy to answer whatever questions I ask, but gives no unsolicited advice (except for warnings not to gain too much weight, of course). He hasn't mentioned anything about getting enough nutrients like folic acid or calcium, for example, or avoiding mercury. My midwife (I go to both a doctor's office and midwifery clinic) does offer plenty of advice but much of it is suspect: keeping with the nutrition example, she has advised me to get plenty protein (but not beef!) and iron without mentioning any of the other important nutrients, and has a long, long list of "cooling" foods to avoid, including all fruit and dairy products.

So from what I can see, most Japanese women get most of their pregnancy advice from their friends and family, and when they need something more turn to magazines and books. There might be some good publications out there, but I haven't come across them yet (please comment if you've found one). I'll stick with my What to Expect When You're Expecting, thank you very much.

Now, just for fun, here are some pages from my copy of Ninsugu:

A typical use of cartoons in an article about budgeting.

A guide to undergarments in the three trimesters and after birth. I especially like the alarmed look on face of the second trimester lady as she suddenly notices the size of her belly (see this larger picture for a better look). Thank goodness she can buy gigantic underwear and girdles to cover that thing up!

Here's a guide to the "Perfect Maternity Wedding". Not that there's anything wrong with getting married while pregnant, but I find it hilarious that dekichatta kekkon (shotgun weddings) are now so common that pregnant brides have become a major demographic worthy of magazine articles and ads.

This is an illustrated article about what to expect at your first visit to the ob/gyn. Amazingly, most Japanese women never see a gynecologist until they are pregnant (or trying to get pregnant), so this could actually be quite a useful guide.

Also useful is this picture of a Japanese gynecological exam chair, as it lets me show you the special torture I go through at every doctor visit. As you can see in the picture at top, you start off in what seems like a regular chair, and it feels like you're just sitting normally (except that you are not wearing pants). Then the nurse presses a button, which causes four things to happen simultaneously: The entire chair will rise, the seat back will recline, the seat where your butt was will drop away, and the leg holders that were under your knees will lift and separate. One minute you were sitting comfortably, and suddenly there you are, trapped on your back with your legs up in the air and wide open, and your ass dangling at eye level. It's just awful, and makes me dread every visit.

See the little cartoon uterus at the bottom of the panel? She's saying, in that chipper yet reassuring cartoon uterus way, that this is the same chair you'll be giving birth in. Now, perhaps some idiot out there would find ytat reassuring, but that's one piece of information that I did not want to know.

Comments

[ai]

These might be worth a look!

http://spinshell.tv/report/?expecting1#page3

http://spinshell.tv/report/?expecting2#page3

[Donna]

Do you not need to see an OB/GYN for birth control prescriptions? Or are Japanese woman less likely to use hormonal birth control? That was my main reason to start seeing a gynecologist.

I haven't seen it, but wasn't there a recent Japanese television show about a gynecologist?

I'm not sure if stirrups and "slide your bottom down" are any better than that chair.

I'm trying to separate visits to my doctor from advice I read/got from friends, and I'm not sure my doctor advice was all that thorough. I remember reading to avoid soft cheeses and sushi because of alleged risk of lysteria--now apparently women are told to avoid lunch meat as well--but I'm not sure I remember my doctor specifically saying that.

[kat]

When I got pregnant in Japan the first clinic I went to had one of those chairs and I got the biggest surprise of my life - it totally freaked me out. The clinic where I ended up giving birth had none of that craziness and the midwives were fantastic in providing information. I definitely think Japanese women get pregnancy information from other friends/family and most of the mags are commercial - which was fun when looking for baby items and just for a laugh in general. I actually hated the book, 'what to expect when expecting' because I think it has too much information. I think a weekly update on a fetus's progress was enough for me especially since I was totally obsessed with googling everything in my frist trimester and it turned me into a nervous wreck. The best advice I got when pregnant was to skip the pregnancy books and go straight to baby care books/videos. I think just being a healthy person and staying active are the best things you can do for a growing baby. A lot of babies around the world get born without their mothers doing absolutely anything! I think we all worry too much about something we can't really control. Just my two yen's worth :)

[Sertyan]

What an informative piece on pregnancy in Japan, it's really quite different! It's the first time I've read about the Japanese gynecological exam chair, hehe. And the fact that the pregnancy mags are illustrated cartoons. I have blog-lined your blog for almost a year already and this is me coming out from lurking mode :)
Congratulations on your pregnancy.

[Houdini]

Have you seen the magazines Pre-mo and Baby-mo? While they aren't as great as some of the things from "back home" they are pretty good. The thing I liked the most about both are the occasional sections for dads. My husband really felt clueless while getting ready for the first baby and finding good information in Japanese for him was tough!

[Amy]

Ai thanks, those are great resources and I actually mentioned them both in an earlier post. In this post though I was specifically talking about the lack of Japanese-language information, sorry if that wasn't clear.

Donna, the birth control pill is not widely used by Japanese women, and was only approved here about 10 years ago. Doctors still know little about it (I actually had one doctor refuse to prescribe it for me) and most women are afraid of it.

And I think my description of the chair didn't do it justice, because it's a million times worse than the exam table and stirrups!

Kat, your clinic was actually second on my list of places to check out! I never went because I liked the first place I visited so much, but hearing about your midwives makes me wonder if I chose the wrong place. I like most of my midwives but they do give some odd advice and there are a few I really don't get on with.

I actually really like "What to Expect", but you're right that an overload of information is not necessarily a good thing. I'm not much of a worrier though, so really like having all the info. I'll take your advice and start checking out baby care books and videos. Do you have any recommendations?

Sertyan, thanks!

Houdini, I've flipped through both and wasn't impressed. Maybe I should have paid more attention, or maybe I just happened upon particularly bad issues, but I found them to be the same as all the rest. On your advice I'll have another look though, especially Baby-mo.

[illahee]

i actually rather like the exam chair....

and the last part amused me, because i did NOT give birth in one of those things! LOL

[Things to do in York]

This is the first time i saw a Japanese pregnancy magazine and I learned a lot of different things. I was amused by that Japanese gynecological exam chair. :D Looks like you are having an exciting pregnancy. Good luck!

[Fiddlerchick]

Great post as usual! and “natsukashii...well, not really....That reminded me of my angst-filled experience trying to get access to contraception in Japan and having to go to thee different countries to accomplish that. I may yet one day get around to publishing that debacle if I can rescue it from the near-extinct floppy diskettes the original drafts are stored on, or if I still have the hard copy around somewhere.

Oh, the frustration of trying to get information about stuff there (and here when we’re trying to find out about something there)! And the cutsey/cartooniness of practically everything.....

[joeinvegas]

Looks like an opportunity there for a good informative web site. Are you up to it? (would be a chnge from food)

[Elise]

That post is totally funny!
I'm pregnant with my first child and was in Korea for the first half of my pregnancy and now I'm in China for the second half. I got conflicting advice from doctors on both sides of the Yellow Sea. But for the weird advice and superstitions, the Chinese win hands down... My doctor is cool though, she said: 'just do what you do in your own country.' I guess she's used to have Western patients with Chinese husbands trying to make sense of all the Chinese weird stuff........

[Sara in Austin]

I found this post both funny and alarming, but I guess it works given that Canada's infant mortality is around 50% greater than Japan's (depending on the source). I won't even mention the U.S. - very sad.

I am surprised that in your mention of nutritional concerns you didn't mention prenatal vitamins/minerals. While it is always best to get vitamins and minerals from food, I thought the use of prenatal vitamins was pretty much ubiquitous in first world countries.

[becca]

we don't use prenatal vitamins here in the UK. I was pregnant and gave birth to my daughter in Japan..was quite surprised by that chair thing too! found the curtain very disconcerting! didn't enjoy the transvaginal scans much! I was constantly being told to not ride my bike and to wear socks (even though it was humidly hot sweltering summer) ...not following such advice didn't seem to do me and my daughter any harm though!
now pregnant in the uk and it's quite a different ball game... i quite miss the dr telling me to be careful not to gain any more weight..they don't weigh you at all here..though there is hordes of information about general pregnancy guidelines.
will you be giving birth in a hospital? are there any midwife run places near you? there was a great one near us in rural wakayama-ken.
ganbatte!

[Gina Sawamura]

This is a great post. Both my kids were born in Japan. You are right about the lack of information from doctors and medical staff though. I did get all my advice from English sources - Miriam Stoppard and the like - lots of info which can be quite alarming for a first time mum-to-be. The lack of info for dads is even more worrying as it seems to justify the traditional belief that this is not their territory and they should back off. Hats off to your hub for wanting to be more involved. My Miriam Stoppard bk had a full page photo of a father and new born on the inside cover and no cutsie cartoons!

The Chair! I remember that. The weirdest feeling is when the seat drops down and you are suspended with your legs in the air. I expected to be tilted back and legs akimbo, but no support in the under carriage area was a surprise! lol!

Congratulations on your pregnancy.

[Miki-pon]

I learned loads of stuff that I should do and shouldn't do during pregnancy when I was at my junior and high schools. I think that is why you may not see so much information in those magazines.... (I did not know there are not so much information around. That sounds totally not cool. My aunt and uncles are doctors, so I think I will be all right, though.)

In Japan, many people suggests to keep your belly warm, though. (Since it is still middle of summer, I think you do not need to worry that yet.)

Check those sites:
http://www.tetuzuki.net/life/childbirth.html
http://www.premama.jp/

I hope these sites can provide you some more information.

I heard that many hospitals are providing classes for expecting mothers and fathers, and some of them are especially for men. So, check those classes, too, if you are interested.

Congratulations! Enjoy! And most of all, take it easy!

[Catherine]

J'adore la chaise du gynecologue.....

[kat]

Amy, I totally recommend the Sears Baby Book - it is hefty, big and has heaps of great advice. I still use it when Jake is sick. It definitely leans towards attachment parenting, which tends to be more natural in Japan because co-sleeping is the norm etc. I think it is a good idea to watch and read everything then it prepares you with all the tools and then you'll figure out what is useful for you guys and what is not. Some videos we watched were Happiest Baby on the Block - we didn't end up swaddling hardly at all, but used a swing in the early days and the shushing thing was great! I also watched Dunstan Baby Language, but I dunno whether that was useful. A lot of people love the Baby Whisperer but I really didn't like her, her book or her suggestions. As I said though it is good to read/watch everything with an open mind because when you are about to lose your mind taking care of a newborn you are just about willing to try anything!!! Oh and I think Iona McNab is still in Japan, isn't she??? The only prenatal classes we took were first aid and her breastfeeding class and it was fantastic!! I had absolutely no preconceptions about bfeeding, but here I am nearly three years later and we are mostly done (Jake still asks at night every now and again), but it was a great way for us to stay really close and connected since I went back to work when he was six months old. Anyway don't want to ramble - BTW your road trip to Chiba looked like a great way to enjoy your final days as a 'two-some'!!!!

[Sara]

Amy, has it been hard to find maternity clothing?

[Amy]

Illahee, you do not!! And I'm not giving birth in one either (touch wood).

Fiddlerchick, I'd love to read about the birth control debacle! I actually had a doctor refuse to prescibe birth control pills, but this was shortly after they were approved in Japan and he might not have gotten the memo.

Joe, what an epic job! NOT up to it.

Elise, what a cool doctor. My midwife is somewhat lenient that way, but I get the impression she's rare.

Sara, women are starting to take prenatal supplements, but they are definitely not the norm here. Expectant moms are supposed to meat all their nutritional needs through diet alone, which is too bad because I've never met a Japanese woman who didn't have bad morning sickness for at least part of her pregnancy, and it's hard to get enough nutrition when you can't even eat!

Becca, my doctor keeps the curtain open for me, but I've experienced it elsewhere- do not like! There are tonnes of midwifery clinics in Tokyo, thank goodness. If everything goes to plan I'll be giving birth in a great big tub attended by a couple of midwives, no doctor in sight.

Gina, I agree about the chair- the tilt and splayed legs I can handle (the doctor needs to get in there, after all) but the floating butt was a shock.

Miki-pon, I learned a lot about pregnancy in school too, but it seems strange to have to rely on that- people forget what they learn, and medical information becomes outdated. Oh, and I'm a haramaki fan, just not in the summer!

Thanks Kat, I'll definitely check out that book- attachment parenting is where I'm leaning too. Iona McNab has unfortunately returned to Australia, but I have taken her first aid class and have been to a LLL meeting, both extremely useful.