[Voices of Japanese Parents Abroad_Cambodia vol.2] A Birth Environment Where You Can Only “Pray”

Sayaka is raising five children in Phnom Penh with her Cambodian husband. Her two oldest children were born in Japan, and her three youngest were born in Cambodia. This time, we spoke to her mainly about the local childbirth situation

No support, all out of pocket

―What were some of the differences you noticed between giving birth in Cambodia and Japan?

There are many differences, but first, in terms of cost, all expenses related to childbirth are borne entirely by the individual. In Japan, there is a lump-sum payment for childbirth, but there is no such system in Cambodia, so delivery fees, hospitalization fees...all are out-of-pocket expenses. Apparently, there is a very small subsidy for Cambodian citizens, but to receive it, you have to prepare complicated paperwork. For foreigners, it is basically out-of-pocket expenses.

―How much does childbirth cost?

When I gave birth at a local hospital, it was around 70,000 to 80,000 yen. At a well-equipped local hospital, it's around $1,000 or more (approximately 150,000 yen or more). A Cesarean section costs twice as much, around $2,000 or more (approximately 300,000 yen or more). At a large hospital used by Japanese people living here, childbirth costs are over $2,000 (approximately 300,000 yen or more).

Checkups are also out-of-pocket expenses, costing $15 to $50 per visit at local hospitals, and sometimes over 10,000 yen per visit at hospitals catering to Japanese people. However, checkups are only held once every two months, which is not as frequent as in Japan.

—So, it could easily lead to a situation where "you can't have a baby if you don't have money."

That's right, even giving birth at a local hospital is a considerable burden for the average Cambodian family. In fact, many families give up on having children or limit themselves to one or two children for economic reasons.

Cambodian cityscape

The reality of the workplace where lives are entrusted to

―What was the quality of medical care during childbirth like?

I think that's the biggest difference from Japan. Because the medical facilities aren't well-equipped, if something happens to the mother or baby, they often can't do anything about it. For example, I was told that if the baby is born before 38 weeks, it's "a real problem." So the doctors and midwives strongly told me to "rest and absolutely not let the baby come out" until I was 38 weeks pregnant. If something went wrong, Cambodian hospitals couldn't handle it and would have to transfer the patient to a neighboring country. It's not like in Japan where they try to fix things with medical treatment, but rather "pray that the

baby will be born safely." ―That must have been quite worrying.

Really. I was lucky enough to give birth safely, but I always had in mind that if something went wrong, it could be life-threatening. Until I gave birth safely, I was restless every day. And I lived my life praying to my ancestors and to heaven for help (to give birth safely).

*Photo for illustrative purposes only

"Technology and culture" different from Japan

―What was your experience with medical care during checkups and childbirth?

It was a mixed bag. Interestingly, the hospital where I gave birth used surprisingly good medical equipment. They said they used machines from a Japanese university, and the ultrasound images were clearer than in Japan, and I could see the baby's face clearly in 4D.

Some of the veteran midwives had incredible skills, like being able to tell the baby's position and condition just by touching the stomach, which surprised me.

―There are amazing midwives in every country, aren't there?

Yes, but on the other hand, the doctors were terrible at suturing, and it sometimes took 40 minutes to suture after an episiotomy. All three doctors were so bad that I had to complain every time.

Also, the postpartum uterine cleansing was incredible. In Japan, they wait for the blood to come out naturally, but in Cambodia, they stick their hands in and scrub it with gauze. It felt like they were mopping the floor! It was really painful.

However, I think this is probably because, based on their experience, they felt that leaving blood in could make the mother sick and was unsanitary. But it was so painful that I begged my husband every time, "Can't you tell the midwife that it's okay because the blood will come out naturally and she'll stop bleeding so much?" but my pleas went unheard.

*Photo for illustrative purposes only

We need to be prepared to face life

―Compared to Japan, there are fewer things to feel secure about when giving birth. It must have been mentally tough, too?

Certainly, there isn't the same sense of security as in Japan. But there was a different kind of feeling of being protected. It's hard to explain, but it's about trust, hope, and something more on a sensory level.

In Japan, the premise is that everything goes according to plan while safety, security, and cleanliness are ensured, but in Cambodia, it's more of a feeling of "letting things take their course"... In the end, I had a strong feeling that "the baby was born through its own strength."

―Is it because medical care is incomplete that you confront "life" more directly?

Exactly. Because there is no convenience or precise management, you are required to be prepared to confront nature. That's why the sound of the baby crying after birth feels so precious. "Ah, it's alive, it's healthy."

―Have you experienced any changes within yourself through that experience?

Yes. Before, I used to think more like, "I have to do it right, I have to give birth to a good baby." But now I've come to think, "As long as the baby is alive, that's OK." The most important thing is that children grow up healthy and happy.

Of course, I wish the medical system were better. But it's precisely because many things aren't perfect that I've learned the importance of gratitude and relying on others.

Raising children in a culture of "leaving things to nature"

―How long after giving birth do you usually stay in the hospital?

In Cambodia, it's usually a maximum of 4 nights and 5 days, and in some places, it's as short as 3 nights and 4 days. My younger children were at home, so the short hospital stay was a huge help. It varies from hospital to hospital, but at the hospital where I went, they give a check-up at the same time as the vaccine that is given a week after discharge. In Cambodia, the one-month check-up and subsequent check-ups that are standard in Japan are almost non-existent. Japanese hospitals apparently offer check-ups at the patient's expense. Routine vaccinations are given, but they are out-of-pocket and surprisingly expensive.

―What is baby food like?

They sell convenient baby food packs like in Japan, but they are expensive. So, I think most people make it themselves. Babies drink a lot of soup here, so we often mix rice into it. Also, porridge is sold quite a lot, so many people probably feed their babies that. Baby food packs are a popular souvenir from Japan.

There are few places in Cambodia that offer detailed nutritional education, so the situation varies greatly from family to family. Some families in Japan introduce solid foods gradually, while others continue to feed their children pureed foods even after they turn one year old. Perhaps due to a lack of knowledge about picky eating in children, some parents only let their children eat what they like, or their children refuse to eat solid food and continue to rely on formula milk as their main food even as they get a little older.

In our family, with our third child and beyond, we haven't followed the gradual weaning process that is common in Japan. The advantage was that there were no health checkups or anything like that, so no one told us what to do, and we were able to introduce solid foods at our own pace without rushing. In any case, we came to the conclusion that it's best to raise young children on a mild diet.

Cambodian home cooking

[Overseas Parenting Column - Cambodia]
Vol. 1 Raising Five Children in Phnom Penh
Vol. 2 A Birthing Environment Where "All You Can Do Is Pray"
Vol. 3 The Reality of Balancing Housework, Childcare, and Work
Vol. 4 An Overly Flexible Education System and a Lack of Emotional Education

Family Dialogue・Column