Abstract The purpose of this study is to investigate which kinds of stress women experience during childbirth in a foreign country and to explore whether childbirth in a foreign country influences women’s mental health. The study was a quantitative and qualitative mixed study. Forty-five Japanese women, born and raised in Japan and who gave birth in Hawaii, USA, were telephone-interviewed within 1 year after childbirth. The stress factors that emerged were: language barrier, distance from family and friends, different culture, and health-care attitude about childbirth. Half of the participants experienced emotional dysfunction during their pregnancy. All primiparas experienced postpartum depression. The participants who had the maternity blues tended to have postpartum depression. Help from the participants’ mothers after childbirth decreased postpartum depression. The importance of mental health for foreign-born primiparas emerges during the perinatal period.