[Voices of Japanese Parents Abroad_USA vol.1] Why I Chose a Home Birth and the “Survival-Mode” Reality of U.S. Healthcare

Yoriko has been living in the United States for 13 years and is raising her three-year-old daughter in Las Vegas with her Canadian husband. Through this interview, what emerges is a powerful story of parenting shaped by a system vastly different from Japan’s—one defined by “freedom and personal responsibility” in a society with fundamentally different social security and healthcare structures. In this first installment (of a three-part series), we focus on her experience of childbirth in the United States.

Giving Birth in a Country Without Universal Health Coverage

―Yougave birth to your child at home. Why did you choose a home birth?

The biggest factor was the healthcare system in the United States. Unlike Japan, there is no universal healthcare system, and medical coverage basically depends on private insurance. Even relatively inexpensive insurance costs more than $700 (approximately 100,000 yen) per month, and it is common for plans to have high deductibles, such as "benefits do not start until the deductible reaches $5,000."

In other words, for young and healthy people, it is not uncommon to decide that it is more rational to take on a certain level of risk and secure cash rather than continuing to pay high insurance premiums.

I also chose not to have insurance at the time. Of course, if you work for a large company, you can use company-provided insurance, and there is public assistance (such as Medicaid) for low-income people. In the United States, the quality of access to medical care is greatly divided depending on employment type and income level.

―Soyou chose a home birth because you did not have health insurance?

Yes, if you give birth in a hospital, it's not uncommon to receive a bill of around $10,000 for a natural birth, and over $20,000 for a Cesarean section. The problem is that the total cost isn't clearly stated beforehand. Medical expenses vary from one medical institution to another, and in many cases, the final amount isn't known until the bill arrives after delivery.

On the other hand, with a home birth, the contract with the midwife is based on a package fee, including checkups, delivery, and postpartum care, costing around $4,000 to $5,000. The clarity of the cost was a great source of reassurance. Giving birth in a hospital without knowing how much it will cost is a huge mental burden, so a home birth was a very strong option for me. (Of course, I was prepared to pay if the delivery didn't go smoothly and medical treatment was needed.)

“Back to Normal” the Moment You Give Birth — A Spartan Postpartum Reality

―Iunderstand you had a "water birth" at home. What was the actual experience like?

I had a large inflatable pool at home and gave birth in warm water. It was nice to be in an environment where I could relax and go at my own pace. Thankfully, the birth went smoothly, but the hard part was afterward.

In Japan, you usually stay in the hospital for 5 to 7 days, but American hospitals are very strict; if you have a natural birth, you are discharged in 48 hours, and even if you have a C-section, you are discharged in 3 to 5 days. With a home birth, it was "normal" from the moment I gave birth (laughs).

―Did you not receive much support from the midwives after giving birth?

The midwives would say, "We'll come back in two days to check on you," and then they would go home a few hours after the birth. There was no breastfeeding guidance, bathing guidance, or support for the mother's recovery like you would in a hospital. Since it was my first birth, I really didn't know what to do or how to do it.

A midwife advised me that "skin-to-skin contact is best for babies," but I followed that advice so faithfully that I left my daughter naked for about a week (laughs). A friend who came to visit later was surprised and asked, "Why aren't you dressed?" and that's when I realized. I was fumbling around in the dark about everything.

When I hear stories from friends who gave birth in Japan, I realize that my postpartum experience was the complete opposite of the all-encompassing hospital care system in Japan.

*Photo for illustrative purposes only

[Overseas Parenting Column - USA]
Vol. 1: Why I Chose Home Birth and the "Survival" Reality of US Healthcare
Vol. 2: Preschools Reflect Educational Disparities in the USA

Family Dialogue・Column