Edit as of March 2023: I AM NOW ALLOWED BACK AS A DOULA IN AIIKU!
Edit as of February 16th: Visitation has been upped to 1 hour for husbands/partner (between 1-5pm). Partners are also able to attend appointments. No changes on skin to skin yet (still 5ish mins).
Edit as of November 28th: Visitation has been reduced to just 15 mins for husbands/partner. No partners allowed at hospital appointments.
Edit as of October 11th: Birth support from husband/partners is allowed again (finally).
Edit as of September 26th: 1 hour of visitation is allowed for husbands/partner only between 1-5pm. No birth support yet.
Edit as of July 25th 2022: Birth support from husbands/partners has been suspended again. No one is allowed in during labour, or in c-section operations, and no visitation afterwards. Skin to skin contact has also, again, been restricted to 5 mins (with no first breastfeeding during this time in principle).
Edit as of July 15th 2022: Since July 13th, partner visitation has unfortunately been stopped again. No visitation is allowed during the hospital stay.
Edit as of May 30th 2022: 1 hour of visitation is allowed between 1-5pm (husband/partner only)
Edit as of May 16th 2022: 1 partner is allowed to attend prenatal appointments at the Aiiku Clinic (the hospital also allows 1 partner to attend).
Edit as of March 22nd 2022: With the end of the quasi State of Emergency, husbands are allowed to attend labours again (no visitation afterwards, though). Skin to skin is 5 minutes only – masks are to be kept on and no breastfeeding at this time (but after baby returns to mum a few hours later, it’s fine). Scheduled c-section support is allowed, and emergency c-section on a case-by-case basis.
Edit as of Feb 5th 2022: Due to the coronavirus pandemic (thanks Omicron), Aiiku have stopped all husband support at labours, and also there is no more visitation. Skin to skin contact at birth has also been removed. If anyone feels anxious about this, please get in touch! I’ll update if things change.
Aiiku is perhaps the most well-known hospital for birth amongst English-speakers living in Tokyo, primarily for the open system Aiiku International Unit. As a doula, I have had extensive experience in Aiiku over the past 8 years (including the old Aiiku hospital, which is now the Aiiku clinic, back in 2014) in countless births (somewhere approaching 200 just with Aiiku), supporting couples both through the International Unit as well as the general unit. In this post, I’ll talk a little bit about about Aiiku, the differences between the IU and the general unit, and general hospital policies (both pre and during pandemic times).
Aiiku hospital was originally opened in the late 1930’s and soon after established the Obstetrics unit for which they have become very well-known for. It has a “royal reputation” due to some members of the Japanese royal family having given birth there and this has made it a popular choice for Japanese families in Tokyo. Aiiku hospital used to be in Hiroo – the building that currently operates as the Aiiku Clinic is. In 2015, the hospital moved to the location it is now in (Shibaura), a short walk from Tamachi and Mita stations.
Aiiku hospital is exclusively for pregnancy, childbirth, gynecological issues and pediatrics. It has both a NICU (neonatal Intensive Care Unit) and MFICU (Maternal and Fetal Intensive Care Unit) and can, therefore, manage certain high-risk patients and pregnancies as well as very straightforward and uncomplicated ones.
There are 2 pathways to having a baby at Aiiku:
- Through the regular/general unit (i.e directly as a hospital patient).
- Through the International Unit (an independently-run clinic, whose doctors have privileges -permission – to deliver babies out of Aiiku as part of the Open System). *Please note that this unit is sadly ending births in April 2023 as the doctors retire from deliveries*
- For those who choose the regular/general unit and go through the hospital directly (either at the hospital or at the Aiiku Clinic general unit), you may see the same doctor for all your prenatal appointments. Some of the doctors have very good English while others a little less so, but generally it doesn’t seem to be a huge issue with prenatal appointments. When it comes to labour, the doctor who’ll be overseeing the care at that point will be whichever doctor is on-call at the time. This is very typical in most hospitals in Japan with labour.
- For those who choose the Aiiku Clinic International Unit, it is a separately run clinic within the Aiiku Clinic building in Hiroo. This particular clinic is exclusively English-speaking – all the doctors, clinic midwives, and admin support speak English, and Spanish & Chinese can also be supported there language-wise. Dr Sakamoto heads up the International Unit along with Dr Sen (his female partner doctor) and there is also Dr Yuzawa. With the International Unit, you can choose either the open system or semi-open system. If you use the open-system, it means you can choose to use either Dr Sakamoto or Dr Sen (not Dr Yuzawa as she doesn’t do births) as your delivery doctor as well as for prenatal appointments. Essentially, you are hiring them privately and they have permission from the hospital to deliver babies there. So you end up with that continuity of care of having a doctor you become very familiar with for both pregnancy and delivery. If you use the semi-open system, you can choose to see Dr Sakamoto, Dr Sen or Dr Yuzawa for most of your prenatal appointments but then switch over to the general Aiiku hospital unit in the last few weeks of pregnancy and for the delivery (in other words, you’d have an Aiiku hospital doctor for the last few weeks of pregancy and on-call doctor during labour).
The International Unit is popular among English, Spanish and Chinese speakers as Doctor Sakamoto speaks fluent English and Spanish, and Dr Sen speaks fluent English, Chinese & Taiwanese. They have extensive experience of women of so many different nationalities and therefore have more cultural understanding around different expectations and preferences. However, using Dr Sakamoto or Dr Sen as a private doctor for labour & delivery comes with a cost. Not only do you pay for the usual hospital fees for labour & delivery but also their private doctor fees. Depending on other choices you make (type of room you stay in after birth, whether you have an epidural etc), this can also add to the total costs. For those with international insurance, it may not be an issue if your provider covers most or all of these costs. But for those with Japanese health insurance, this is all out-of-pocket and is considered the most expensive option in Japan for having a baby. You can get a breakdown of costs in advance from them at one of your initial appointments to give you a rough idea of what to expect, and then you can decide whether it’s something that both works for you and suits what you’re looking for in terms of a care provider. For those who are with the general Aiiku unit, there are no additional costs other than hospital costs (including room fees & epidural fee for those who opt for that).
Whether you choose the general unit or International Unit, all births take place in Aiiku Hospital in Shibaura (not the Aiiku Clinic in Hiroo). And the hospital staff are the same for everyone. It’s important to note that while Aiiku Hospital is familiar with non-Japanese patients, it’s still a Japanese hospital and not all staff have fluent or good levels of English. Some do, some don’t and it just depends on who is on duty (with midwives, nurses, or doctors). Obviously, those who use Dr Sakamoto or Dr Sen for delivery will know that at least there will be no language issues with them. But for all other members of staff, each patient will have a very different experience language-wise. If any staff don’t speak English or other language much at all, then they do try to use translation support apps or devices (although these can also be a bit strange). I always feel this is important to be reminded of as for those in the international unit, the English in the hospital will be different to what they’ve been experiencing in the clinic.
All the labour rooms (9 in total) in Aiiku are on the 3rd floor and they are all LDRs, which means Labour, Delivery, Recovery. So you go through labour, birth and 2 hours of “recovery” time in the LDR before being moved up to other rooms for the rest of your stay. Women are free to move around in labour and can make use of exercise balls, active chairs, and the bathtub. Waterbirth isn’t possible but women can use a bath for relaxation assuming their waters haven’t broken. Walking around the hallways is fine, although currently with the coronavirus you have to wear a mask. Monitoring isn’t continuous unless you have an epidural or an induction, or some risk factor, although there will be times where you’ll be attached to the monitor for some length of time. Midwives may prefer you to be on the bed for monitoring but you can say that you’d prefer to move around or be upright if it’s more comfortable – it’s ok to advocate for these kinds of preferences. The monitors can also be detached from their units and become portable, so you can still move very freely (although it can end up being rather annoying when you are walking and a midwife is often readjusting the monitor as it slips around).
If all is going smoothly in your labour and taking a bit of time, you will see the midwives intermittently as well. Generally they will come in and out of your room to check how things are going, do monitoring, do any other clinical checks, and vaginal checks as and when needed. They may be a bit more present if things are going much more quickly and birth is soon. In Aiiku, midwives typically don’t spend hours with patients in labour doing massage or coaching with breathing, positions etc, but from time to time they may do a bit of a back rub or make some useful suggestions. If you’re with the International Unit, the midwives will be updating Dr Sakamoto or Dr Sen about how things are going and if everything is straightforward and uncomplicated, you won’t see them much at all until the delivery. It’s similar with the general unit, too, that a doctor would only come if necessary and at delivery.
Epidural is possible in Aiiku 24 hours. For those who are with the International Unit, Dr Sakamoto will come and do the epidural for his and Dr Sen’s patients. Depending on the time of day what he’s currently doing, and where he’s coming from, patients may need to wait before they can get the epidural. For those who are with the general unit, one of the hospital’s anesthesiologists will come to do the epidural as soon as they are able to. Again there may be a little wait. While I won’t go into details about the epidural in this post, if anyone does have questions about it: when to get it/best timing, pros and cons, etc, from an evidence-based standpoint, please let me know.
Here are some other aspects of birth relating to Aiiku:
There is a pre-labour room that is sometimes used. This room has a few beds and women may be placed in here if their water has broken (for example) but labour hasn’t started yet, or if they are starting an induction and have had a cervical dilator (balloon catheter) placed inside – they will stay in the pre-labour room overnight and then get moved to an LDR room in the morning for the start of pitocin (husbands/partners cannot be in this room).
Pushing is generally on the back with legs spread open (lithotomy position) – this is the hospital’s go-to birthing position and the delivery bed actually spreads apart into this. If you think you’d prefer a different position for birthing, please discuss this. It’s sometimes possible, both with the general unit and International Unit doctors, but it’s often something you have to say directly.
Episiotomy rates are not *too* bad in Aiiku. That being said, it’s still important to discuss this in advance, too, to write on your birth plan form, and mention (or have your support person mention) in the moment if it’s brought up. If you need any help in learning the right questions to ask or helpful ways to advocate for your preferences about episiotomies or other delivery interventions, please get in touch. I offer such preparation.
Skin to skin – known as Kangaroo Care in Japan – is possible but only after initial check-ups are done on the baby. In some instances, it is a very short separation of just a few minutes, while in other cases it could be a longer separation. Initial check-ups are done in your LDR on the warming cot next to your bed. There is a pink form to submit in advance for it (where you sign that you understand the “risks”). Also, you may notice on the form that it says skin to skin is for 15 minutes after which they check the baby again. There will be a few instances like this where baby is taken off the mother to be checked. During initial skin to skin time in the LDR, it’s a good time to try and initiate breastfeeding for those who want to. *Edited to add (as mentioned at the top of this post) that skin to skin was completely removed in January and has been reinstated since end of March for a short period of 5, sometimes 10 minutes, and then reinstated back to 15 minutes in May which was the pre-pandemic time – baby is taken to the nursery 1 hour after birth for a couple of hours or so. As of July25th, Skin to skin has been restricted to 5 mins again as mentioned at the top with baby going to the nursery for a period of time after this and not later*
Once 1 hour has passed after baby has been born, baby is taken up to the nursery for approximately 1-2 hours of observation time. This is non-negotiable, unfortunately. Pre-corona, the dads/other parent used to be able to go up to the nursery, too, but currently that’s no longer allowed (hopefully at some point in the future it will change).
The mum gets taken up to another room for the rest of the stay after around 2 hours in total in the LDR. If all is fine, baby is usually brought to the mother’s room soon after. Rooming-in is allowed and encouraged but there’s also flexibility – if you’d like the midwives to have baby in the nursery for a bit of time here and there, that’s fine. For breastfeeding parents in particular, rooming-in is, of course, recommended and it is the biological norm to want to have your baby close. But preferences do differ in this regard, and the option is there of having baby in the nursery.
There are 4 different types of rooms you can stay in after baby is born. You cannot pre-book any room but you can state a preference. If your preferred room is available, that’s great. If not, they will ask you for a second or sometimes third choice. This will happen after baby is born when they know which rooms are currently open. Again, these rooms are all the same whether you are with the general unit or international unit:
- Shared room of up to 4 people per room (no additional costs)
- Private room without toilet & shower (20,000 yen per night)
- Private room with toilet & shower (35,000 yen per night)
- Special private room – suite style (70,000 yen per night)
If the room of your choice is unavailable, you may be able to move into it the following day when other patients are discharged (they usually don’t allow you to move down a tier, but up a tier is fine).
During your stay, they will give you a schedule of what to expect on each day. As with every other hospital in Japan, they won’t allow you to take a shower until the day after you’ve given birth (the day of birth is counted as day 0). There will be various check-ups for mum and baby and some instruction on topics like bathing. They typically don’t give you a class on baby care but staff are on hand to show you how to do things and point a few important things out, and if you are in any doubt you can always push the “nurse call” button in your room to get some extra help. Breastfeeding help is not too bad at Aiiku but everyone will have different experiences there (and not all breastfeeding support is necessarily evidence-based…it really depends). So if anyone does need more breastfeeding support or is unsure if what they are being advised in hospital is actually evidence-based support, please get in touch with me as I’ll be glad to help (breastfeeding support forms a big part of the support I offer post-partum).
With the general unit, you stay approximately 5 days for a vaginal delivery or 7 days for a c-section. With the International Unit, Dr Sakamoto or Dr Sen can discharge you a couple of days early (day 3 or day 4) if all is well. If you are discharged early via the International Unit, certain tests may not have been done for baby yet at the hospital in which case one of the international clinic midwives would arrange to visit you to do these tests.
For those who have a scheduled c-section at Aiiku, you are often asked to check in the day before your surgery. They also request that you buy a special “belly wrap” that will be put on you post-surgery. With Aiiku c-sections, photos and skin to skin are not allowed in the operation room. This is not unusual in Japan and similar policies would be in place in most hosptials. Pre-corona, husbands used to be able to be in the c-section operations but since corona this is no longer allowed (there was a short 2 month period from November 2021 to mid-January 2022 where they allowed the other parents in c-sections again, but this stopped again from January 11th 2022). They allow the other parent to visit the mum-to-be for 15 minutes before she gets taken down to surgery, and there is a waiting area to wait in to be updated. The other parent can briefly see baby after the operation as baby is taken up to the nursery (literally 1-2 minutes in front of the elevator while the baby is in the cot), and the same for the mum (a very, very brief meet). If midwives tell the other parent to leave before they’ve had a chance to see baby or mum, then tell them you won’t go until you’ve seen them – that is fine to do. If anyone wants more info about c-sections: how to prepare, what to expect, and recovery, please join my special workshop for that held every 1-2 months. *Edited to add (as at the top of this post) that partner support during c-sections has been reinstated since end of March for scehduled operations and in some unplanned/emergency ones depending on the urgency*
Visitation is, understandably, a very important thing for couples after birth. Sadly, because of corona, Aiiku is not allowing this. There was a short window of visitation being allowed between June-August 2020 and December 2021 -mid-January 2022, but at the time of writing this post that has been removed. However, the other parent is currently allowed to attend the birth (there was a period of time in 2020 where this was also not allowed) and the other parent is allowed to stay in the LDR for approximately 2 hours after birth, too. They also allow the other parent to drop off any needed items during the day at a specially-designated time and place (3-4:50pm Mon-Sat). Pre-corona, visitation used to be from 1-8pm every day, and having the other parent stay overnight in certain private rooms also used to be allowed. When this will be allowed again is anybody’s guess.
The hospital does have a convenience store and restaurant on the 9th floor. Patients are able to go up there to get snacks or other items that they may need. The opening hours are a bit short, though. The shop is open 9am-6pm on weekdays and 10am-3pm on weekends, but is closed on national holidays. The restaurant is open 11am-3pm on weekdays but closed on weekends and national holidays.
For anyone who would like a better look inside the hospital, you should take the Aiiku Hospital Virtual Tour. It’s only being offered to patients of the International Unit as the video was made by them for their patients. You’ll see me in the video as I lead the tour. As it was filmed pre-corona, some of the info will be different but it still gives you a good glimpse into the hospital, LDR rooms, other rooms and so on.
Also, for any couples who want to be fully-prepared for having a baby at Aiiku hospital, please take my Aiiku Birth Skills class – we go through labour, more details about the hospital, breathing, positions & massage, interventions, the hospital stay and more. I hold these classes every month as a small group class for 2-4 couples, so please ask me about dates. Private options are also available.
You can see the main Aiiku Hopsital website here. The banner at the top outlines the current corona policies/restrictions:
English-language info on restrictions can be found here:
You are also welcome to contact me anytime to see if anything has changed, too, as it can sometimes be unclear as to what rules are currently in place in any hospital.
I hope this information is helpful to anyone who is considering having a baby at Aiiku either with the general unit or International Unit!