Just as I was preparing to take my second stint of maternity leave, the COVID-19 situation was reaching crisis point. On March 11 2020, the World Health Organization (WHO) declared the virus a global pandemic, and deemed its risk ‘very high’ particularly in East Asia, the Middle East, Europe and North America. The virus had spread to every continent except Antarctica.
In Japan, at the request of Prime Minister Abe, public schools had started to close. It was no longer business-as-usual for face-to-face meetings and large public gatherings, and the Japanese Government and Tokyo Olympic Committee were considering their options for postponing the Tokyo 2020 Olympics and Paralympic Games.
Life in Tokyo
Against this shape-shifting backdrop, at 36 weeks pregnant, I’d stopped taking public transport and was pulling back from work and social gatherings. There was no evidence to suggest that expectant mothers were particularly vulnerable to the virus, however we were put in the “at-risk” category, for obvious reasons. The stay-at-home recommendations felt a bit strange, but life went on.
Following the Government’s advice, I intentionally avoided the “3Cs” – closed spaces, crowded places, and close contact – which allowed time and space to focus on health, rest and general well-being, during the final furlong of pregnancy. Hand sanitiser and masks quickly became the norm – not all that dissimilar to the usual flu season in Japan.
A changing world
A week before my due date – the day after the pandemic had been declared – I had my final pre-natal appointment at the Japanese Red Cross Medical Centre (Nisseki Hospital) in Hiroo, Tokyo, where I’d given birth to our daughter in November 2016. Some changes to hospital functions made me sense that the escalating pandemic might affect our birthing experience. For example, expectant mothers were being asked to attend pre-natal appointments alone, and could ONLY access the obstetrics floor (3F) via a dedicated lift.
Our OBGYN- the excellent Dr Kasai – did not make any explicit changes to our birth plan at this last leg meeting, so I didn’t pursue the matter. I decided to simply hope for the best – that my husband would be able to attend the birth of our son and that we could welcome family visitors during our post-natal hospital stay. Little did I know!
Parts of the world had begun to go into lockdown, and quarantine restrictions had been announced for visitors to Japan from China and South Korea. We were relieved, then, that my mum could depart Heathrow land at a very quiet Haneda Airport on Friday the 13th (!) of March to begin what would become a 4-month stay in Japan.
Amid the maelstrom of media and social media coverage, I caught some nice news: the UN had designated 2020 as Year of the Nurse and Midwife. Add to this the knowledge that Japan has one of the world’s best maternal and infant mortality rates – as well as an exceptional national health service and high standards of hygiene in general – and I was able to enjoy some semi-normal family time around our Akasaka neighbourhood. For the most part, people seemed to be abiding by the 3C rules.
Going it alone
When I entered the hospital to give birth the following week it was sobering to be met with signs saying that in order to mitigate the spread of the virus, strictly no visitors would be permitted in the birthing centre. This was around two months after the first case of COVID-19 had been identified in Japan (January 16 2020, Kanagawa Prefecture).
There was so much uncertainty flying around and from various social media groups, I could glean that policies about visitor and birthing partners were differing from hospital to hospital.
We were so relieved, then, when a midwife confirmed that my husband would be allowed to attend the birth of our son.
After having his temperature checked, he was also permitted to walk with me to check into our hospital room and chat for 30 minutes while the sun was setting. On the 29 minute mark, a midwife knocked on the door to say our time together was up; I started to face the reality that it might be a strange and isolating week ahead.
A baby boy!
The next day, March 19, my husband returned to the hospital with an extra suitcase which my mum had hastily packed full of snacks and additional toiletries. (I was so grateful for the Dairy Milk and satsuma oranges during the subsequent long, long days and nights of breastfeeding!)
At 09:00 we were separated for the epidural procedure, and around ten minutes later were reunited. At 09:32 we welcomed our beautful baby boy into the world – one that was changing by the minute.
After ‘kangaroo care’, with our new arrival in arms, the midwives said we could stay together as a family of three for a further 90 minutes. My husband would then have to leave the hospital grounds.
It was so strange to say goodbye at such a meaningful family moment.
Life on the ward
In Japan it’s customary for new mums to stay in hospital for between 4-7 nights, so I’d already mentally prepared myself for a relatively long stay. Unlike when I had my daughter 3 years before, though, the Nisseki maternity unit felt oddly quiet.
A midwife noted that ‘traffic’ on the ward had been going down for the past few years, due to Japan’s declining birth rate (which hit a record low of around 864,000 births in 2019). However COVID-19 was seemingly playing a part. Most new mums, like me, seemed to have opted for private rooms; the basic shared ‘quad’ bays, usually for four sets of mothers and babies, housed only two; as well as having no visitors, we were encouraged not to sit in the mum’s lounge, attend the breast-feeding salon, or pop down to the hospital’s first floor convenience store.
Nevertheless, life on the ward continued to run like Japanese clockwork. The room was wiped down and cleaned daily (each time, I was asked if this was OK, lest it be disruptive to the baby). Three meals a day plus an afternoon snack – all specially curated for breastfeeding mothers – were delivered between visits from various doctors and nurses.
Everyone was abiding by the 3Cs; this seemed quite similar to usual practice on Japanese maternity wards and hospitals in general.
Most Nisseki midwives can speak a little English so during this odd time we got by with my limited Japanese and their genuine smiling eyes. We could not, and did not fixate on the virus – only on the baby and my recovery.
As a second-time mum, with breastfeeding well-established from birth, I felt was given a bit more trust and space by the midwives. I found myself ringing less for their help, as they were gliding back and forth to all the new mums, with no families and friends to support day-to-day requests.
They seemed relieved to hear that my mum had managed to arrive safely in Japan, and that I’d be supported by her for at least a couple of months.
Other than more pain relief there’s not much more I could have asked for from the Nisseki care-givers. (For my part, it’s a bit embarrassing to admit that if I could have done one thing differently, it would have been to have taken some change for the ward’s drinks vending machine!)
As our hospital stay drew to a close, the United States and Italy were unenviably leading the world in rising infection rates. Japan, which at one stage had the second-most confirmed Covid-19 cases in the world (after China), was thought to have dropped to number eleven.
On March 26, we received the green light to go home, after six days and nights of video chats with my husband, mum and 3-year old daughter. Between their calls, keeping up with friends around the world 24/7 about COVID-19, and dipping into the Desert Island Discs archive, my wifi data had taken quite a large hit!
The taxi that took us home had a large perspex cover fixed between the driver and the back seats – a new design quirk that would quickly become the norm not only in taxis but also convenience stores, the ward office and many other customer-facing places around town.
Just as we were settling into life as a family of five, the International Olympic Committee announced the postponement of the 2020 Summer Games. A few days after that a State of Emergency was declared for Tokyo (later, for the whole of Japan) and much of the world had entered varying degrees of lockdown. We therefore stayed at home, resting for much of the baby’s first few months – not at all unusual in Asia, where postpartum confinement is considered commonplace during the ‘forth trimester’.
Seeing how the virus then took hold, interfering with countries, and communities and separating families at life-and-death moments, I feel very lucky that my husband could attend the birth of our son and that my mother could stay with us comfortably (thanks to the Japanese Immigration Bureau) for four and a half months. The following week, visitor restrictions in Japanese hospitals became far more stringent, and since then many millions of women across the world have had to bravely go through the birthing and – perhaps even more distressingly – the vulnerable post-partum experience, alone.
For now, at the time of writing, there have been around 1500 recorded COVID-19 deaths in Japan (about 1% of all total cases), meaning that Japan has one of the world’s lowest reported rates of virus fatalities per head of capita.
Over recent months, much has been written about the country’s exceptional ‘success’ in response to the virus, with Prime Minister Abe citing “The Japan Model” and Deputy Prime Minister Aso referring, somewhat questionably, to the superior ‘cultural level’ of Japanese people.
For our part, we are extremely thankful to the country’s exceptional national health service and the Government’s clear messaging around the 3Cs – not to mention a population that generally chooses to do the ‘right thing’ for the greater good. For these reasons and many more, I’m relieved and forever grateful to report that Tokyo was a safe and comfortable place to give birth during this unprecedented pandemic. With thanks to the doctors, midwives and staff at Nisseki Hospital, for incredible care at such an unusual moment in history.
If you are reading this as an expectant mum or dad during the pandemic, I sincerely hope your birth experience goes smoothly, if not exactly how you’d anticipated.
Japanese Red Cross Medical Centre (Nisseki Hospital) HERE
Coronavirus: Japan’s mysteriously low virus death rate HERE
Did Japan Just Beat the Virus Without Lockdowns or Mass Testing? HERE
Japan’s low virus death rates reflect high ‘cultural standards’, says Taro Aso HERE
Coronavirus: Health system overload threatens pregnant women and newborns HERE