In part three of this series, I wrote a bit about travelling with a baby in Japan on planes. The big form of transport that I didn’t mention was cars. I’d never felt the need for owning a car in Japan until I had a baby but recently I’ve been starting to think that it would be a nice addition to the family. Besides the fact that it would make bringing nappies home from the local supermarket a lot easier, it would make domestic travel just that little bit smoother. We’ve been able to get around a reasonable amount with a combination of rent-a-cars and taxis when we haven’t been able to use trains (or boats or planes), but the reality is that it is just not as safe or convenient as having your own car with a fitted baby seat.

We knew that we would be using a taxi every so often (coming home from the hospital, visiting the in-laws, etc) so bought one of those 5-in-one baby cars (ベビーカー, pram/stroller) that brushes your teeth and also turns into a car seat when we need to take our child in a car. It seemed like a great idea. We could save space by attaching the car seat to the frame to form a pram and yet still fit the frame easily in the back of a taxi. You attach the baby’s car seat to one of the back seats using the chest harness already in the taxi. So you’re thinking, most taxis in Japan don’t have a back seatbelt – well… that was the least of our problems. Generally if you hunt around the back seat you can find a seatbelt, what we didn’t budget for was the length of the seatbelts not being long enough. Yes. This is a seat for babies made and designed by a Japanese company to be used in Japan, yet there are actually many taxis that don’t have seatbelts long enough to attach it. My word of advice to you? Read the fine print on your car seat before you buy it. Ours required a minimum seatbelt length of 210cm. While you’ll be right with a new kojin taxi (個人タクシー, privately owned and operated taxi) in the big cities, you might not be so lucky in regional centres were the car models of taxis are a little bit older. Indeed, we had to wait a very long time (and say “No Thanks” to several empty taxis) in both Kyushu and Shikoku in order to find one that we could attach our safety seat to.

You can’t rely on taxi drivers to help (or understand) the issue as they will often say “not to worry” or ridiculous things like “you’ll be alright if you hold him in the back”. Somebody really needs to educate taxi drivers that it is actually illegal to take an infant (or any child up to the age of 6 for that matter) in a car without a child safety seat. For some reason it seems as though the broader population missed the passing of that law, not to mention the one requiring seatbelt usage for adults in the back seat, too, last year. The stats for child auto safety in Japan is quite eye opening. Perhaps it is because most Japanese are not regularly drivers but for some reason (tell me why!?) people just don’t seem to realise how dangerous a car can be.

A survey of nearly 13,000 people by JAF and the police (チャイルドシート使用状況全国調査全国調査) in 2007 found that less than half of parents used a baby seat for their child in their car and a whopping 11.5% felt that hugging their child was adequate protection in case of a car crash (in America this is known as the “child crusher position”). These numbers have gotten significantly better in the 2010 survey, where 56.8% of children under 6 were fastened in child seats, however a staggering 40+% were still “protected” using other means, such as the child crusher position.

Even amongst parents using child seats, only a scary 36.5% were able to fasten it correctly to their car seat (most of them had intentionally fitted it loosely and some had just placed it on top of the back seat! 2 out of 3 parents who own seats don’t even use it every time their child is in the car. The probability of your child dying when you don’t use a child seat is 4.3x higher than when you use one.

All of these ridiculous stats are in spite of the fact that it was made compulsory for children under the age of 6 to use child-seats in cars way back in 2000 （道路交通法第71条の3）. That said Japan has got to be the only country in the world that has an official exception to this law stating that children who are in the middle of every-day baby related activities (ie. Feeding, nappy changing, etc) are exempt from this law. How ridiculous is that? Surely you can stop the car in order to change your kid’s nappies!? Surely you’d want to! I mean, think of the mess if you did crash with a crappy nappy lying on the back seat because you hadn’t finished changing your child yet. yuck..

In order to be able to use our car seat in a variety of different cars and taxis, I went to several auto-shops to see if I could purchase a seatbelt extender. The idea is that you attach the male and female parts of a seatbelt to a short piece of seatbelt that you can plug into both parts of the seatbelt in order to add a few inches of length to the belt. No matter how many shops I tried, the answer was the same. They don’t exist in Japan. (I’ve seen them overseas and they are normally used by over-weight people to help them lock their seatbelt.) By my third visit, I found a man who was quite clued up to the Japanese auto-laws. Apparently there is a clause in the Japanese seatbelt laws that states that obese people are exempt from wearing a seatbelt and hence there is no need for such a seatbelt extension in Japan. After all if it isn’t required by law, who would want one? Damn it. How much more obvious could it be that the government is enforcing these rules in order to help us and that seatbelts protect our lives. And yes, while we’re at it, there is a safe way for pregnant women to attach a seatbelt so there is no reason why they shouldn’t wear one either! In case you haven’t noticed, I have had this discussion with many Japanese taxi drivers but every time it has been in vain. I’d love some advice on this matter. How do you rebut the comeback “don’t worry I’ve never had an accident before” or better yet “but the customer looks so uncomfortable with that tight seatbelt on”.

Do you have any seat belt in Japan stories? Tell us in the comments!

Breastfeeding: Baby formula product marketing and your doctor may make you blind to the benefits

It really frustrates me the number of heart-ache stories that I hear from friends who’ve been totally convinced by the Japanese mass media that their breasts aren’t good enough for their babies. Just as depressing are the number of stories that I’ve heard where mothers in Japan who had previously believed that breast is best, have been convinced by their doctors (after only a few weeks of trying) that they’re not making enough milk and switched to formula or a mix of formula and breast milk. Whereas 90% of Japanese mothers when surveyed before giving birth suggest that they want to raise their child on breast-milk, only 3~40% of them are still exclusively feeding their babies breast milk by their three month check up. That is lower than most countries in Asia, and is extremely low when compared even with developing countries – what makes Japanese mums feel so unhealthy/unqualified that they can’t breastfeed properly? It’s not because they are rushing back to the work force, the vast majority are dedicated (and motivated) stay-at-home mothers. It’s because a combination of dated medical practices and an advertising dollar focused publishing industry has lead Japanese mothers to believe that there is a good chance that their breasts won’t be making enough milk. If you introduce me to another Japanese mum who cries to me that her breasts are 出が悪い (degawarui, don’t make enough milk) then I think I will take to her doctor with a knife! While I profess to have no official medical background, I’m hoping that my views as a novice Daddy-san in Japan will be able to save a few couples from resorting to an unnecessary evil. (This is the second article in this “Daddy-san” series. Make sure to also read part one).

To be very clear, I have absolutely no qualms with mothers using formula for lifestyle reasons: because they want to go back to work, because they want more freedom or because their husband wants to be a stay-at-home Dad, etc. I know many people who were raised exclusively on formula and they have been able to function as normal human beings. I’m angry because there is a significantly large number of mothers out there who want to feed their babies breast milk but are actively discouraged by (a) their pediatrician, (b) mass market literature claiming to offer information on bringing up babies, (c) stealth marketing by infant formula companies and (d) their parents (who grew up in a time where formula was erroneously thought to be better than breast milk.) Let’s be very clear about this. There is absolutely no doubt that breast milk is the best thing that your baby should be drinking. Your baby can and should be fed exclusively with breast milk (that also means no water) for approx. 6 months. Even after you gradually introduce real foods from 5~6 months onwards, your baby is best drinking breast milk at least until 12 months of age if not longer. The list of the benefits of breast milk over formula is very long and growing. My favorite is that despite it being totally free, it also provides higher immunity and hence lower medical expenses for the child’s entire life. You can find a long list of the benefits all over the web and in most English books on child rearing.

The Japanese deception starts the moment your wife begins reading the pregnancy magazines by Benesse and the like. Have you ever wondered why these publishers can afford to publish so many magazines on pregnancy so regularly despite Japanese mothers giving birth to less and less children every year? A healthy advertising budget from the infant formula companies help. Whereas English books often focus on the potential difficulty of breast-feeding and the need for support from the father, Japanese magazines seem to paint the world as if it is totally normal for a mother not to be able to make enough breast milk and that to top-up with formula is the norm. This is called kongo (混合, mixed) and refers to feeding your baby part breast milk and part formula.) Perhaps it works because of the perennial Japanese complex of having small breasts (which is known to be totally irrelevant) or perhaps it is just because first time mothers are lacking in confidence and hence willing to believe what they read in a magazine written by a company that runs English language schools (Benesse owns Berlitz remember!). Someone please explain to me – If the human race has survived for so many thousands of years, why on earth would breast milk not be enough to raise your child? Needless to say, I’m yet to see a Japanese book written by an academic that doesn’t paint the picture accurately. For some reason, it’s the colourful magazines written by editors – not academics – that survive on advertising and sales of other products to their readers, that have become the trusted source of information for Japanese mothers. If you are a new gaijin Daddy, I definitely recommend that you come to your own conclusions about breast feeding after reading a book or two written by an academic. Here are some great ones:
The New Father: A Dad’s Guide to the First Year by Armin Brott or
Baby Love: Everything You Need to Know About Your Baby’s First Year by Robin Barker

Unfortunately, “information” magazines are only the tip of the stealth marketing iceberg when it comes to Japanese formula companies. Most of the professionals that you have trusted (yes, your sanfujinka too) are probably on their pay-rolls. One of the key conditions for becoming a baby friendly hospital (BFH) is not to accept free samples or other forms of financial assistance from infant formula companies. Given that 70% of Japanese public hospitals are loss making, I guess you can’t blame them for seeking out private sector subsidies like this but is it fair to sacrifice the health and well being of our children while doing so? (See our article on BFHs in Japan for where to find one – they’re few and far between).

Take a look at these pictures taken in our nearby hospital (you can click to see a large version of them).

I guarantee you that there is not a single mother (or father, or grand mother or 3rd cousin twice removed) who doesn’t check out the photo of their loving little baby who’s just been born into this world. Better yet, this sign is right near the front entrance so even patients coming for other illnesses are likely to have a peek. What better subliminal messaging could you hope for than a rather unsubtle add from Meiji for their infant formula called hohoemi (ほほえみ) when you first see the face of the newest member of your clan? This hospital is known in our area to be highly respected for its sanfujinka (産婦人科, Ob/Gyn). With a reputation like this, why does it have to stoop to paid advertisements from one of Japan’s major formula manufacturers? Or is this hospital just like many other hospitals in Japan where the male Ob/Gyn’s claim that they can stimulate breast milk production through special Zen breast massages before resorting to formula when they proclaim that it is the mother’s fault as her breasts don’t produce enough milk. Rather than focusing on the joys of breast massaging, we need Japanese doctors to spend more time explaining how difficult breast feeding can be. Let’s face it, it’s not easy and it doesn’t come naturally to the baby or the mother.

Historically mankind have had grandmothers around to teach breastfeeding to the rookie Mums. But because the baby boomer generation decided that formula was “better” than natural breast milk, we can’t necessarily rely on the elder generation anymore. While America was just as guilty of throwing out the breast in the 70s, they’ve also come to the rescue of the younger generation with lactation consultants to take their place. We had a lot of trouble with breast feeding. My baby refused to grow in line with the pediatricians expectations for most of the first month of his life which was very stressful. Ironically, this is not that uncommon. It takes different babies (and mothers) different lengths of times to get into the swing of breast feeding – very few people get it right in the first week or so. We were lucky enough to have the support of two lactation consultants who helped my son and wife latch better. There is a vast shortage of internationally accredited lactation consultants in Japan so if you’re expecting or have just given birth you should book one ASAP (see the link below).

I’ve heard of some very unsettling stories in Japanese hospitals that have even resorted to giving formula to babies within the first few days of their lives. Even perfect breasts do not manufacture milk for 2~3 days after the baby has started suckling. You’re lucky if you get more than a teaspoon of a liquid called colostrum during that time. That is totally natural and your baby can survive for a few days on the fat stores that he built up in the womb. More to the point, the colostrum has vital nutrients to boost your babies immunity that are sacrificed if the Mother gives up breast feeding from day one (reference). While none of this is obvious, it only takes some caring advice from a responsible midwife to calm the first-time mother who is worried that it’s taking “too long” for her milk to come in. Then, except for a very small percentage of women, the amount of breast milk slowly increases as your child suckles on the breast, creating oxytocin. Oxytocin not only stimulates breast milk production but it also speeds up the recovery of the Mother’s body which is why mothers of formula fed babies are less likely to have a smooth and quick physical recovery.

Ironically, when your baby isn’t growing “fast enough” in the first few weeks of his life, your pediatrician is not necessarily the best person to rely on for information. He is there to ensure that your baby meets certain growth targets which are deemed to be “normal.” He’s not a lactation consultant and he hasn’t studied very much about the female body. It’s no surprise that he’s going to be quick to suggest a “boost” of formula to help your baby hit his growth targets. When we were in that situation, our lactation consultant kindly explained to us that we could sakunyuu (搾乳, express) milk from my wife’s breasts and feed it to him via a bottle or syringe (we actually elected for a blunt syringe as we didn’t want to promote nipple confusion). Unfortunately, in the vast majority of cases in Japan, the doctor is more likely to portray a “now or never” need of urgency and bully mothers into adding formula to boost their babies weight. Sure that is the easy option but it is rarely the only option. Less than 2% of the population actually have breasts that cannot produce “enough milk”. Make sure that you’re wife is seeing a lactation consultant from day one so you have the option to express before you’re forced into using formula. While it is a tiring process, expressing gives your baby a few more weeks to learn how to suckle independently. Better yet, you don’t have to worry about your babies weight-gain in the interim. If you are going to try it out, make life easy and go straight for the automatic ‘milking’ machine (for want of a better term). We rented ours from Medela after battling with a manual pump for way too long (you can find your closest rental agent on their homepage). I can’t stress enough, you should be able to supplement your babies milk intake with expressed breast-milk before you have to resort to formula top-ups. You’re wife is only going to have the confidence to do so if she’s been talking to a lactation consultant from day one.

The stealth marketing of the formula companies does not end there. One of my friend’s mother works at the local shopping center. She visits the baby section once a week or so to hold sessions for mothers on baby nutrition. If you’ve ever been to a Jusco or a big shopping center, you’ll know what I mean. In the area where they have the nappy changing tables and the baby scales, they often have a room which is used for these nutrition seminars. Sometimes it is once a week, sometimes once a month but local mothers come to get a free checkup on their baby’s health and to “learn” about how they should be feeding their child. What a great idea, huh? Apparently the advice that my friend’s mother give ranges from how many mls of miruku to feed your child each day and how to prepare solids for slightly older babies. Hold on a second. Did you say miruku? Yes, and that is specifically miruku (ie. formula milk) and not the natural stuff (母乳, bonyu). On further questioning, it turns out that my friend’s mother is not even employed by the local supermarket, she is employed (and trained!) by Otsuka Pharmaceutical Co. (大塚製薬). Yes, the company that makes the biggest selling brand of formula in Japan, Beanstalk (for some reason pronounced beanstark (ビーンスターク) but don’t get me started on that). How stealth is that? I guarantee you that every week, huge numbers of innocent, unsuspecting mothers around the country are being fooled into believing by their local “baby nutritionist” that they should be substituting their own breast milk for formula. Not only are the hospitals and the publishers working against us, but the supermarkets are, too. I guess it makes sense. The supermarkets get a free “entertainment act” that not only attracts shoppers but also promotes shopping, not to mention that this likely boosts formula sales right after the deed. Who can we trust?

Good book for your Japanese partner: 「母乳の方が楽だった？！おっぱいでらくらくすくすく育児」

So as a new-chum gaijin parent in Japan, what should you do? The simple answer is education. Read up a lot in English yourself and do your best to subtly pass on the more important messages to your Japanese partner. Try to find a lactation consultant and better yet find some decent literature in Japanese written by a medical professional. If you’re wife is struggling with breast feeding or not totally on board with the idea, I personally recommend this book (cover pictured here):
母乳の方が楽だった？！おっぱいでらくらくすくすく育児
(Bonyuu nohoga raku data? Oppai de rakuraku sukusuku ikuji, “Breast feeding is easier?! Raising your healthy child on the breast with a minimum of effort”)

It’s written by an internationally accredited lactation consultant (Kitano Sumiyo, 北野寿美代) who realized one day after retiring as an official 助産婦 (josampu, midwife) that she’d spent her entire life focusing on babies and how the baby could get more nutrition while ignoring the mother completely. She then decided that there must be an easier way of breast feeding that was enjoyable and rewarding from the Mother’s perspective. That lead her to studying more about international standards of lactation and her ultimately coming up with this book which mixes the best of both Japanese and Western methods.

Finally, let me leave you with a list of the ingredients of Meiji’s Hohoemi formula – yes the one that advertises in my local hospital (See baby pics, with ads above). This is just taken from the back of the pack, I’m not sure if it includes the 30 different additives that the Japanese government approves for including in infant formula. (source: オーガニック食品最前線) or not. While I know that thousands of Japanese babies drink this every day and still grow up to be strong and healthy adults, I ask you – do you really think that this could be better than breast milk? Ironically, hohoemi means smile. I wonder who it is that is smiling.

Hohoemi Milk Formula Ingredients: Lactose (乳糖)、adjusted edible oils (調整食用油脂)、refined soy bean oil (大豆白絞油)、palm kernel oil (パーム核油)、fractionated pig fat (yummo!) oil (豚脂分別油)、refined fish oil (精製魚油)、milk serum protein (乳清たんぱく質)、butter milk(バターミルク)、casein (カゼイン)、fructooligosaccharide (フラクトオリゴ糖)、dextrin (デキストリン)、salt (食塩)、milk phosphatide extract (乳リン脂質抽出物)、yeast (酵母)、iron pyrophosphate (ピロリン酸鉄)、calcium phosphate (リン酸Ca).

If you have any stories about breast feeding in Japan, either happy or sad ones, we’d love it if you could share it with us in the comment section below so that hopefully the broader community of gaijin Dads (and Mums) can benefit.

Here are some more handy links and contacts that might help your breastfeeding challenge:
• La Leche League Japan (English), ラ・レーチェ・リーグ日本 (Japanese)
• Japanese Association of Lactation Consultants (NPO法人日本ラクテーション・コンサルタント協会)
• Japan Breast Feeding Association (日本母乳の会)
• Japanese Midwives’ Association (日本助産師会)
• Unicef: Ten Steps to Successful Breastfeeding (English), ユニセフ:母乳育児成功のための１０カ条 (Japanese)

Bringing up a bi-cultural kid - it can be confusing

It turns out that while the world knows a lot about bringing up babies, maybe there aren’t as many universally agreed upon facts as I’d thought. Almost one year down the track from becoming a Dad, I’m wondering if there is any topic that isn’t disputed from one culture to the next. But I guess that is one of the things that makes bringing up a baby – your baby – so eye opening when your partner is from another culture. Generally what we believe is best for our children is a concentrated version of the kool-aid that we drunk as a child, or at the very least, what the society that we were brought up in led us to believe. I can tell you now, you will learn more about Japanese culture by having a baby than you ever will by taking the class of the similar name in first year University!

Maybe you didn’t fall into the same trap as me, but I never got around to reading the 9th chapter of any of the “month by month” books on pregnancy. In fact, I didn’t even bother buying any books on bringing up an infant. I was too focused on the pregnancy and on how big my baby was after X number of weeks. I wish someone had have sat me down and just said: “Stop reading the pregnancy books. The baby will pop out regardless of what you do! Start reading up on what you’re gonna do after the big day now because as a sleep deprived Dad you won’t have the time or the energy to be reading anything for months after your baby arrives!” In fact, just like most of the stuff that I wrote in the pregnancy series is most relevant to Dads who aren’t pregnant yet, I have a funny feeling that a lot of this series will be most relevant to Dads who aren’t Dads just yet.

Even mono-cultural Dads don’t have an awful lot of time to recover after the birth before the reality of your new life sets in, but you, the newly Knighted bi-cultural Dad, are in for twice the onslaught. The differences will start to slap you in the face from the first few days in the Hospital. Whereas most English (language) academics are now recommending a more natural environment for your newborn, Japan interestingly chooses to focus on cleanliness and often puts this before many other considerations when it comes to your baby’s health. Take your baby’s belly button stub for example. Whereas you’d probably be encouraged to ensure it was clean with warm water back home, the standard in Japan is to regularly sterilize it with alcoholic swabs. (This used to be the norm in the West, too, but recently Doctor’s are discouraging it as they don’t understand the potential side-effects for the baby from the alcohol). The desire for sterilization doesn’t stop there, most nursing Mums are encouraged to rub their nipples with alcohol before breast feeding. I guess they deem a little grog to be better for the baby than what other potential germs could be on its Mummy’s breast. Clearly babies have been breast feeding without sterilizing breasts for thousands of years so I’m not sure why we’d want to start now. I’m guessing that this must stem from the poor hygienic conditions in war-time Japan but I’m not sure. (If anyone knows the real reason, I’d love to hear about it in the comments section below.)

If you’re lucky enough to learn how to bathe your babe at the hospital, you’re probably wondering why you can’t let water in your baby’s ears or whether you really do need that gauze on his/her stomach at all times. Then there is the perpetual desire to feed him/her mugicha (麦茶, wheat tea) from 2 months onward or the Japanese book that insisted that if your baby doesn’t eat rice regularly during infancy then they won’t grow up to be a real Japanese person. (Yes I really read that in a book about rinyushoku (離乳食, solids)! The list goes on…

Believe it or not, we’re not much better. Have you ever tried explaining the nursery rhymes that you sing to your child to your Japanese spouse? How do you go about explaining why you dance to and laugh about a song about Tuberculosis? And what about rationalizing poor Georgie Porgie’s pedophilic tenancies? Even better, why on earth a dead man in a ditch and the flaws of the judiciary system shows it’s face I don’t know. Don’t get me started on teapots or people with four names. (Sorry for the Windows media stuff, couldn’t find mp3s..)

But most of these differences are just cosmetic. The last thing your baby wants is a tense house because of small difference in opinions and most of these you just have to wash under the bridge as being interesting and educational. My intention is for this series to focus on areas that I found either confusing, frustrating or educational while bringing up my son in our bi-cultural household. For most gaijin like me, living in a foreign country, it can be difficult to get balanced information with your family living in another country and the local medical staff speaking another language (in more ways than one). Hopefully this series will serve to be a bit of a resource for foreign parents in Japan who are keen to share their questions, worries and advice with out parents. I’ll be writing from a Dad’s perspective but there is no reason to limit it to just men. In fact, I have a funny feeling that there should be a whole separate series for Gaijin Mum’s in Japan married to Japanese guys and their experiences. In the meantime, this will be the story of how I endeavored to become a balanced Daddy-san. If you have any requests or worries to begin with- don’t hold back – share them with us in the comments section below.