What must a property meet to open a midwifery home (josanjo)? Medical Care Act requirements — up to nine in-patients

In short: for a midwifery home (josanjo — birth and post-partum care), three points of the Medical Care Act matter first. (1) Admission is capped at nine — a josanjo may not have facilities to admit ten or more pregnant, parturient or post-partum women (Art. 2(2)). (2) If it handles births, it must have a delivery room of 9 m² or more and in-patient rooms meeting the floor area (6.3 m² for one mother-and-child, and 4.3 m² per additional mother-and-child, all internal measurement) (Medical Care Act Enforcement Regulation Art. 17). (3) A josanjo that handles births must designate a commissioned physician in obstetrics or gynecology and an emergency hospital or clinic (Medical Care Act Art. 19; reg. Art. 15-2). Unlike a clinic, no physician is resident; if a midwife herself opens it, she files a notification within 10 days of opening (Art. 8); a non-midwife operator needs the prefectural governor's licence (Art. 7). Property investigation and the lease are ours (the real estate agent); the filing documents are the administrative scrivener's; the structural-facility check is the public health center's; whether births can be handled is for physicians and midwives.

This is for midwives who want to start a josanjo in part of their home or a leased unit, and for operators leasing out or seeking such property: the structure, size and location conditions you can check on the property side, set out in order from the Medical Care Act and its enforcement regulation from a real estate agent's viewpoint. The opening notification, securing the commissioned physician and confirming structural-facility compliance are the public health center's and the administrative scrivener's; whether births can be handled and medical judgments are the physician's and midwife's; negotiating the lease terms is ours (the real estate agent). These are independent business entities, each engaged directly. What we handle stops at the property; permits go to the administrative scrivener, medical judgment to physicians and midwives. This article does not judge the compliance of any particular case.

How does a josanjo differ from a clinic, and what does the property need?

First, a josanjo and a clinic are legally distinct. A "josanjo" is a place where a midwife carries out her work for the public or specified persons (other than at a hospital or clinic) (Medical Care Act Art. 2(1)) — a facility type separate from a clinic where a physician provides care. A midwife handles normal pregnancy, birth and the puerperium, newborns and health guidance; medical acts (suturing an episiotomy, administering drugs) are the physician's domain. The differences that matter for choosing a property:

Issue	Josanjo	Clinic
Opener	Midwife (a non-midwife needs a licence)	Physician/dentist (a non-physician needs a licence)
Admission (bed) cap	Up to nine pregnant/parturient/post-partum women (ten or more not allowed — Art. 2(2))	Up to 19 patients (20+ beds is a hospital)
Physician	Not resident; a commissioned physician is designated	A physician provides care
Main function	Normal birth, post-partum care, health guidance	Medical care

On the property side, the first thing to look at is "does it handle births, or post-partum care only?" If it handles births, a delivery room and a commissioned physician become requirements, tied directly to the property's size and location. For post-partum care only (residential), no delivery room is needed, but the in-patient-room floor-area standard still applies. The difference from a clinic property is set out at what to check before contracting on a clinic property.

How are the number of in-patients and room sizes decided?

Admission numbers and room sizes are set by the Medical Care Act and its regulation. Before looking at floor area, note the following.

Item	Standard	Basis
Admission	Up to nine pregnant/parturient/post-partum women (no facilities for ten or more)	Medical Care Act Art. 2(2)
In-patient-room floor area	6.3 m² for one mother-and-child; 4.3 m² per additional mother-and-child (internal measurement)	Enforcement Regulation Art. 17
Delivery room	A josanjo handling births has a delivery room of 9 m² or more	Enforcement Regulation Art. 17
In-patient-room floor	In-patient rooms not on the basement or 3rd floor and above (except where the main structure is fire-resistant)	Enforcement Regulation Art. 17
Fire prevention	Fire-prevention equipment where fire is used; firefighting machines or devices	Enforcement Regulation Art. 17

This floor area is measured "internally" (the inside face of the walls). Rental listings often show center-line (wall-center) area, which reads smaller as internal measurement. If you plan to handle births, confirm before contracting — from drawings and on site — that the 9 m² delivery room and the in-patient/waiting/kitchen/toilet/washroom flow work as internal measurement. Actual compliance rests on the public health center's review and a building professional's check.

What in the zoning and neighborhood weighs on choosing a property?

On zoning, a josanjo, like a clinic, can be built across a wide range of use districts including residential-only districts, and rarely gets stuck on zoning as a rule. What weighs more on choosing a property is whether a use-change (building confirmation) is required under the Building Standards Act, and consideration for neighbors.

• Use-change confirmation: when converting from another use to a medical use above a certain scale, a confirmation application may be required. Confirm the need and threshold with an architect and the building authority.
• Neighborhood consideration: a josanjo that handles births has night/early-morning comings and goings, sounds of labor and delivery, and emergency-vehicle access. In residential areas, consideration for noise, parking and privacy matters in practice.
• Utility groundwork: whether bathing, disinfection, laundry and hot-water plumbing, ventilation and air-conditioning can be secured. If there is residential post-partum care, also check daylight and ventilation for the in-patient rooms.

Because zoning and the feasibility of a use-change are the architect's and building authority's domain, run these in parallel while narrowing down properties. Business and investment property in general is at investment and business real estate; office and store property is at office and store real estate.

How do the commissioned physician and transport link to the property's location?

For a josanjo that handles births, Medical Care Act Art. 19(1) provides that "the opener of a josanjo must, as provided by Ministry of Health, Labour and Welfare ordinance, designate in advance a commissioned physician and a hospital or clinic." Enforcement Regulation Art. 15-2 sets this commissioned physician as a physician in charge of obstetrics or gynecology, and further requires designating, for emergencies, a hospital or clinic that has obstetrics or gynecology and pediatrics, can provide newborn care, and has in-patient facilities.

This links directly to the property's location. Securing a commissioned physician and a transport-destination hospital is the premise for handling births, so whether an obstetrics/gynecology hospital is nearby and how long transport takes become practical conditions for choosing where to open. Even if the property is large enough, births cannot start without a link to the region's obstetric medical institutions.

Note that a midwife who works only by house call (opening without a facility) must, under Medical Care Act Art. 19(2), designate a hospital or clinic to handle abnormalities. Whether to set up a josanjo as a facility or to work by house call changes whether a property is needed at all. Securing the commissioned physician and the suitability of the partner are the physician's, josanjo's and public health center's domain; we do not judge them.

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What to check before contracting when starting on a lease?

When starting a josanjo on a lease, beyond the property's own compliance, settle the lease terms first.

Item	What to check
Use	Whether the contract's purpose can include "josanjo (medical)"; not a residence-only contract
Interior/plumbing	Whether there is water-supply/drainage/ventilation groundwork to retrofit delivery/in-patient/bathing/disinfection facilities
Restoration	The scope of installing medical interiors/equipment and removing them on exit; the lessor's consent
Term/early exit	A handover time allowing for preparing the notification/licence; whether there is free rent
Neighbors	Whether the condominium bylaws restrict the use; consideration for sound and access above/below/either side

"Purpose of use" and "restoration" in particular are the points that, if the property turns out unusable as a josanjo after contracting, can lead to eviction. Property investigation, negotiating terms with the lessor, the important-matters explanation (Real Estate Brokerage Act Art. 35) and the lease are handled by us (the real estate agent). Where to read in the contract is set out at where to read a lease contract.

Who should you consult?

Property investigation, checking the groundwork for use and equipment, negotiating terms with the lessor, and the important-matters explanation and lease are handled by Yotsuba Real Estate Co., Ltd. (licensed real estate agent, Tokyo Governor (1) No. 113304). Preparing and advising on the josanjo opening notification (Medical Care Act Art. 8), or the opening licence where a non-midwife operator opens it (Art. 7), is handled by Yotsuba Administrative Scrivener Office. Final confirmation that the structural facilities meet the standards is the public health center's; whether births can be handled, securing the commissioned physician and medical judgment are the physician's and midwife's; building registration is the judicial scrivener's; tax on opening is the tax accountant's.

These are independent business entities. You engage each directly. We neither pay nor accept referral fees or introduction commissions. The structural-facility check is the public health center's, medical judgment the physician's and midwife's; the judicial scrivener for registration and the tax accountant for tax are each consulted and engaged by you directly. Consultation is free of charge.

Frequently asked questions

Q. How many can a josanjo admit (stay overnight)?
A. Up to nine pregnant, parturient or post-partum women. Because Medical Care Act Art. 2(2) provides that "a josanjo may not have facilities to admit ten or more pregnant, parturient or post-partum women," nine is the cap. A josanjo that handles births must, in addition, have a delivery room of 9 m² or more and in-patient rooms meeting the floor area (6.3 m² for one mother-and-child; 4.3 m² per additional mother-and-child, internal measurement) (Enforcement Regulation Art. 17). Confirm before contracting that the property meets this as internal measurement.

Q. Can a non-midwife open a josanjo as an operator?
A. Yes, but the procedure changes. When a midwife herself opens it, a notification within 10 days of opening suffices (Medical Care Act Art. 8); but a non-midwife who intends to open a josanjo needs the licence of the prefectural governor of the location (Art. 7). The actual midwifery work is carried out by a midwife. Preparing the notification/licence documents is administrative-scrivener work, undertaken by Yotsuba Administrative Scrivener Office. The structural-facility check is done by the public health center.

Q. Do you need a link with a physician to handle births?
A. Yes. Under Medical Care Act Art. 19(1), the opener of a josanjo must designate in advance a commissioned physician and a hospital or clinic. Enforcement Regulation Art. 15-2 sets the commissioned physician as a physician in charge of obstetrics or gynecology, and requires designating, for emergencies, a hospital or clinic that has obstetrics or gynecology and pediatrics, can provide newborn care and has in-patient facilities. This is why whether an obstetric institution is nearby weighs on choosing the location. Securing the commissioned physician itself is for the physician and josanjo; we provide property and location information only.

Q. Can you open a josanjo in a condominium unit or at home?
A. Zoning often allows it broadly, as with a clinic, but a rental condominium may restrict the use in its bylaws or the lease's purpose of use. If births are handled, the delivery-room/in-patient floor area, securing the commissioned physician, and consideration for sound and access to neighbors become requirements and practical challenges. Because the rooms needed differ between post-partum-care-only and handling births, fix the plan before narrowing the property, and check the contract's purpose of use and the scope of restoration. Whether a use-change confirmation is required is confirmed with an architect and the building authority.

Sources (primary)

• e-Gov "医療法" (Medical Care Act) — Act No. 205 of 1948. Art. 2 (definition of a josanjo and the admission cap — no facilities to admit ten or more pregnant/parturient/post-partum women); Art. 7 (opening licence for a non-midwife); Art. 8 (notification within 10 days of opening by a midwife); Art. 9 (notification of abolition); Art. 19 (duty to designate a commissioned physician and a hospital or clinic). Accessed 29 September 2026.
• e-Gov "医療法施行規則" (Medical Care Act Enforcement Regulation) — Ordinance No. 50 of 1948. Art. 15-2 (commissioned physician for a josanjo handling births — a physician in obstetrics or gynecology — and an emergency hospital or clinic); Art. 17 (structural-facility standards — in-patient-room floor area, a delivery room of 9 m² or more, in-patient rooms not on the basement or 3rd floor and above, fire-prevention/firefighting equipment). Accessed 29 September 2026.
• MHLW, "On cooperation among josanjo, commissioned physicians, and regional hospitals and clinics" (Notice, 30 Aug. 2013, Iseikan-hatsu 0830001 etc.) — the thinking on commissioned physicians and partners for a josanjo handling births. Accessed 29 September 2026.

The forms, attachments and operation of the josanjo opening notification/licence differ by each municipality's public health center. At the outset, confirm directly the josanjo-opening guide of the public health center with jurisdiction over the intended site. Confirm zoning and the need for a use-change confirmation with an architect and building authority, and whether births can be handled and the commissioned physician with a physician and midwife. This article is general information; it does not guarantee the compliance of any particular property, acceptance of a notification/licence, or medical judgment. Make the final confirmation with the public health center, physician, midwife and architect. Property investigation, the lease and the important-matters explanation are undertaken by Yotsuba Real Estate Co., Ltd. (licensed real estate agent); preparing the notification/licence documents by Yotsuba Administrative Scrivener Office; registration by a judicial scrivener; tax by a tax accountant — independent business entities, engaged separately and directly. We neither pay nor accept referral fees.

About the author

Joji Uramatsu — licensed real estate transaction specialist (Tokyo Governor registration No. 293544) and administrative scrivener (registration No. 25087022). Representative Director, Yotsuba Real Estate Co., Ltd. (licensed real estate agent, Tokyo Governor (1) No. 113304); principal, Yotsuba Administrative Scrivener Office. Kohinata, Bunkyo, Tokyo, about five minutes' walk from Myogadani station. Property and paperwork are put on the same table. Full profile: author page.