Background:Subtle cultural differences in the childbirth experience for expatriate Japanese couples living in southeast Michigan can sometimes cause conflicts between them and American health caregivers. The purpose of this study was to examine Japanese couples' perceptions and experiences of prenatal care and childbirth in a region of the United States, and to explore the implications for providing culturally competent care.Methods:In this qualitative study, in-depth interviews of 11 Japanese couples (n= 22) were conducted at an outpatient primary care clinic in southeast Michigan by a team of researchers fluent in the Japanese language and knowledgeable about the culture. Participants also completed a short questionnaire.Results:The major themes that emerged comprised perceptions related to a language barrier, ultrasonography, prenatal vitamin supplementation, episiotomy, epidural anesthesia, and practitioner-patient relationship. Throughout these six themes it was evident that Japanese health care professionals had difficulty accepting health care that was different from the care provided in their home country.Conclusion:The most striking finding of this study was the difficulty for health caregivers to provide culturally competent care. Although the program has strongly invested in health professionals and support staff who were fluent in Japanese and knowledgeable about Japanese culture, conflicts still occurred.