We thank MumInBermuda for this detailed account of her experience of being pregnant in Tokyo and giving birth in Bermuda!
A first pregnancy abroad… I experienced it not in just one but two different countries! It was not an easy situation; I’m not going to deny it. But this experience made me grow so much and it brought me my daily sunshine, known as my “Little Chicken”. I was lucky enough to have an “easy pregnancy”. It allowed me to travel without any problems. Pregnant in Tokyo, we lived there for the first 6 months of sweet waiting. Then, my husband has been offered a new job in Bermuda. So we relocated, and after spending a few weeks of vacation in France, I gave birth in Bermuda in February 2009.
My pregnancy in Tokyo
Like many expats, we chose the Tokyo Medical and Surgical Clinic for our medical care; it is located just across from the Tokyo Tower (they have general practitioners as well as several specialists, including two obstetricians). All the doctors and nurses speak English, and some of them even speak French. I really appreciated the kindness of the team in this clinic. In addition, there is a pharmacy on the ground floor, with pharmacists who also speak English. I chose Dr B. who works at the Tokyo Clinic and the Aiiku Hospital (in the neighborhood of Hiroo) as my OB. I was supposed to deliver my baby in that hospital, until we learnt that we were going to leave Japan. I had lots of good feedback on the Aiiku Hospital from many expatriate women pregnant in Tokyo and who gave birth there (and from Japanese too – it seems that one of the princesses of the imperial family delivered her baby there!). However, I recently read in a Japanese newspaper that the hospital lacked key personnel (pediatricians and gynecologists), and that they would have to restrict the opening hours of their neo-natal emergencies. Basically, they are not able to perform 24/7 deliveries anymore… But as I no longer live in Japan, I cannot give you more details on that! With regard to my pregnancy check-ups with Dr. B., I’d rather say that I wasn’t really satisfied with them. Most of the time, he was late for our appointments (I mean 1 or 2 hours of delay!). And as my husband had to leave the office during our check-ups, it was quite upsetting when he had to waste 2 hours in the waiting room… Also, I think that Dr B. didn’t reply very well to our questions; we were quite anxious like most first-time parents! And even though I did not have any major problems during the first months, I still had “small pregnancy concerns” and I didn’t find much help in the doctor’s answers! Some moms advised me to contact Dr Sakamoto (who also works at the Tokyo Clinic) but since we left Tokyo, I did not have to change my OB. In Japan, we got an ultrasound at each monthly visit. That was a pleasant surprise! We could watch our baby growing from every angle. It was great! Every month, we were looking forward to seeing the new picture of our “Little Chicken” (well at the time, we called him our “Little Shrimp”). The blood analyses were almost the same as in France or in Bermuda, and you can even request additional blood tests if desired (e.g., toxoplasmosis for the French moms). The nurse who handled the blood samples at the Aiiku Hospital was adorable; she apologized before AND after taking the sample because she was so scared of hurting me! In addition to the monthly ultrasound, there were the usual examinations: urine, weight and tension control. My first months of pregnancy in Tokyo went quite well. I forgot to mention that we have a very good health insurance plan (provided by my husband’s French company). 100% of my medical expenses were covered. I do not know how the refunds work if you are using the Japanese Social Security card. I had one but never presented it at the Aiiku Hospital (by the way, the Tokyo Clinic does not accept Japanese Social Security cards). For consultations at the Tokyo Clinic (which cost around 100 euros for a gynecologist), you can benefit from direct settlement agreements depending on your insurance company. It means that you don’t need to pay anything; the clinic is going to settle your bills directly with your insurer. While at the Aiiku Hospital, I had to pay for each check-up and send the refund forms to my health insurance company afterwards. I don’t know the cost of a delivery at the Aiiku, since I eventually gave birth somewhere else. Likewise, I do not know how are the childbirth classes there. I was offered to attend the classes before leaving, but I refused because they were taught only in Japanese.
The second part of my pregnancy in Bermuda
We relocated to Bermuda around my 28th week of pregnancy, after a few weeks of holiday in France. Moving from a huge urban area of 20 million inhabitants to a tiny island with about 65,000 people is an incredible experience (fortunately, Bermuda is shaped like a long and stretched fish-hook so you don’t really feel stuck on a piece of rock!)… Pregnant in Tokyo, my belly wasn’t “big” yet so I could not really test the reaction of people when they see a pregnant woman (would they let me have a seat in the subway? Or help me with my grocery bags?)… In Bermuda, people are very courteous but it seems that they are considerate to everyone in general, whether pregnant or not! Here, we greet everyone in the street, shops and cafes or in the bus. Can you imagine myself greeting everyone in the subway in Tokyo or Paris? Bermudian courtesy was a very pleasant surprise. Freshly arrived on the island, I had to choose a general practitioner (GP) who wrote me a letter of reference to an obstetrician/gynecologist (OB-GYN or OB). I chose my OB on the recommendations of one of my husband’s colleagues but also a bit randomly (it’s not easy when you don’t know anyone). Well, you can imagine that there are not 36 OBs here in any case… Bermuda comes down to 3 main roads (North Road, Middle Road and South Road) and a tiny capital city with a surface area of 1 square kilometer! Yes, I’m joking off course; Bermuda also has beautiful beaches etc. But enough with this digression… So, I made an appointment with my new OB, Dr. Emery (who graduated in Canada). She was really nice from our first meeting, so I was happy to have her deliver my baby. There are no monthly ultrasounds as in Japan, but a minimum of 3 like in France (3D ultrasounds are available in Bermuda). Then, according to your doctor and how your pregnancy evolves, you can have more frequent ultrasounds. I had two ultrasounds in Bermuda by the end of my pregnancy, one just after my arrival, to see if everything was okay as suggested by my Japanese medical records, and another one to check the position of the baby. After 28 weeks of pregnancy, you have an appointment with your OB every 15 days for a routine check-up. And from the 36th week, you get an appointment once a week until the delivery.
Yes, I wrote “THE” hospital because there is only one on the island. Actually, there are several clinics, but the King Edward VII Memorial Hospital (KEMH) is the only one equipped with a maternity ward. I heard all kinds of feedbacks on this hospital before my delivery. Good and bad opinions… My experience has been rather successful (see below the story of my labor and delivery on “D-Day”). The hospital is located near the botanical gardens in the center of the island. The medical equipment is not very recent (especially compared to Japan) but it is sufficiently modern and well maintained. Whether you are having a natural delivery or a C-section “without too many complications”, there is everything you need at the KEMH. And if necessary, the mothers and their babies can be transferred by air in no time to the United States (usually to Boston). I think it has already happened for very premature babies. Most of the KEMH’s staff was trained in Canada or in England, but not often in the United States. Actually, you must take additional tests for certification, if you own an American degree (apparently, the U.S. degrees are not well recognized because the number of years of medical study is shorter than in Europe or Canada). I found that the doctors and nurses of the hospital were very professional.
You can either take childbirth classes at the hospital (with the nurses of the maternity ward), or with Rita Stevens and Liz Boden, two former nurses who created an association called “The Nurses’ Practice”. There are also some doulas on the island, but their services are quite expensive. So I took classes with Rita and Liz, as they have a very good reputation among the community: Rita is a former midwife and Liz, a pediatric nurse specializing in child development and every issue related to allergies (eczema, asthma etc.). They teach “Lamaze Childbirth Classes” 2 hours per week, during 5 weeks (which cost $350). And they also provide parenting classes, including “The Amazing Baby Care Class” for first-time parents, which takes place on a Saturday morning during 3 hours and costs $120 per family (you can come with the grandparents and/or the nanny). My health insurance company did not reimburse the classes from the Nurses’ Practice, but it’s definitely worth it! Rita and Liz are very friendly and full of enthusiasm. It is a really good start for first-time parents… In addition to the breathing and relaxation techniques, they will give you a comprehensive checklist to be prepared with confidence for D-day and after you return from the hospital. Since the courses are held in the evening (or on Saturdays), all the daddies could be there to coach their partners. Rita and Liz also provide breastfeeding counseling at your own house if necessary. Finally, they gave us lots of activities for babies/toddlers on the island, and a list of books that can be read from birth onwards. Their childbirth courses were really great and very interesting, and we have met many other first-time parents with whom we have kept in touch right now.
“D-Day” and my stay in the hospital
My last appointment with my OB took place two days before my contractions started. She told me that I was 1 cm dilated but there were still 9 days before my due date, so there was no need to worry. But I was experiencing real pains in my pelvis since 3 weeks, so I told myself it must be sooner than later! Two days later, I was taking a walk with my mother-in law in the neighborhood, when I started to feel the pain increasing. The contractions quickly became very close and lasted longer, so I called my husband to come back home from work. It was 2PM. We decided to leave for the hospital around 5PM, even though my water did not break because the contractions were getting really close to each other (in fact, my mother-in law “kicked us” out of the house, I was afraid that the nurse would say it was too early, so I didn’t want to go!).
Fortunately we made the right decision because when we arrived at the hospital, I was already 8 cm dilated! I did not even ask for the epidural because I felt my “Little Chicken” would soon be there! I only asked for the “laughing gas” to help me through the rest of my labor (my husband tried it too!), and I was able to start pushing sooner than expected… I am the first person to be surprised about how “easy” my labor was! Seriously, during my childbirth courses, I have always told myself: “I’ll definitely take the epidural! I’m too scared etc.” And finally my “Little Chicken” was delivered at 9:01PM without any complications, and with the “4 seasons of Vivaldi” in the background (I brought my music in the delivery room)! Pure joy! In general, I would say that I enjoyed my stay in the maternity ward. But there are very different opinions on this matter… My experience was pretty good, but many moms I know did not like at all their stay at KEMH. The food was ok (for a hospital, I thought it was quite good!), but perhaps the quantities were not suitable for all. In any case, you just have to eat extra snacks, especially when you are breastfeeding in the middle of the night. I found the nurses quite welcoming, but I was expecting more help when I started breastfeeding. They are certainly experienced nurses, but if you do not make the effort to ask specifically for their help, they would not have given instructions by themselves. It’s the only downside that I found: not enough support for early breastfeeding. I only stayed 3 days in the end, but I was eager to return home with my family. Regarding the rooms at the hospital, there are only two private rooms (with a single bed) in the maternity ward! Then, there are some semi-private rooms (with 2 beds) and a large common room (with 4 beds). The costs are quite high; the private room is around $1,700 per day if I recall well, but our insurance plan covered that option. Unfortunately, these private rooms are allocated on the “first come, first serve” basis! And since they were already occupied on the day I delivered, we had to go to a semi-private room with my “Little Chicken”. There are specific times for each type of visitors (fathers, siblings, grandparents and others). Dads have the most extensive schedules and they are even allowed to stay during the “quiet time” (from 2 to 4PM), while other visitors must leave. There is a security guard at the door of the maternity ward, and he takes note of all people entering the department. It is quite reassuring, but I do not think there has already been a case of baby kidnapping in Bermuda!
Follow-up care for babies in Bermuda
I chose my pediatrician upon our arrival on the island. I just picked the more experienced one: Dr. Perinchief. To register with him, you just have to call his office. He is a very nice doctor, a bit “old school” but he is close to retirement now. For young parents without experience, he is the perfect match. He came to see my baby twice at the hospital: just after birth and before discharge. Then, we have mandatory visits at 1 week old, 2 weeks, 4 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months and 2 years old. After that, the check-ups are done every year. There is also a pediatric nurse from the Community Health Center (equivalent of the Ministry of Health) who comes to visit at your home the first week after hospital discharge. She came back for a check-up 6 weeks after. And I also went to visit her regularly at the Community clinic to measure and weigh our “Little Chicken” in between the visits at the pediatrician. The Community clinic also provides plenty of information on breastfeeding and meal diversification when needed… Concerning the paperwork, we registered my “Little Chicken” at the Registry General within the week following his birth. But no need to rush, I think you can do it within 30 days or so! We wanted to get a birth certificate as soon as possible because we had to ask for a passport at the French Consulate in New York. It took about 3 months to get the passport!
Giving birth in Bermuda was less expensive than in Japan (but I think Japan is really expensive in this matter). It is – off course – preferable to have a good insurance company that will support all the pregnancy, hospital and baby care costs. And do not forget to send a request for prior agreement to avoid paying your bills upfront! If we add up all my visits to the OB-GYN, the ultrasounds, the hospitalization for 3 days and the pediatrician visits during my hospital stay, the overall cost will be around $ 9,000 to $ 10,000. One thing to note: perineal re-education is not compulsory in Bermuda. You must talk directly to you doctor if you want some postnatal classes. There are a few prenatal and postnatal Yoga institutes that can suit you. And you also have lots of sport associations after childbirth, or just to get together with other moms and babies! My “Little Chicken” will soon be one year old! I took him to various meetings of Meet-A-Mum Association (MAMA Bermuda) in his sling when he was only a few weeks old. It was important for me to meet new people. For several months now, I have been coordinating the baby playgroup; I put up a monthly schedule and send all the information to the moms and babies (between 0 and 16 months) so that we can meet once a week. We either meet at one of the moms’ house or in various locations (at the aquarium, park or beach in the summer time…). I will soon need someone to replace me in organizing the playgroup because the “Little Chicken” has grown so fast and will be too old to attend! But if I cannot find a job this year, maybe he will end up having a little brother or sister?