Pregnancy and Birth in Japan - Mary's Story
Mary is a military Mum and so she has given birth in three different countries. I'm so grateful she is happy for me to share each of her experiences, which she posted on her blog (www.threetulipsandatexan.com) and I'm so interested to read about the differences in the care she received in each of those countries. Read about Mary's birth in the US here and her birth in Germany here!
In July 2019, two months prior to Flynn’s arrival we had a permanent change of station (PCS) from Camp Zama, Japan to MCAS Iwakuni, Japan. We packed our 2 dogs, 2 girls, and some luggage into our 2 vehicles for a 2 day drive south toward Hiroshima. When we arrived, we stayed in temporary lodging for a few weeks until we moved into our house on base. During those weeks, we spent lots of time at the outdoor pool on base, going to movies on post, and becoming familiar with the local area. I was also attending prenatal appointments at the health clinic on base.
While I was being seen on base for prenatal care, there was not a labor and delivery ward at the base health clinic. Therefore, we toured two off-base hospitals in order to make a decision where I’d give birth to our baby boy. The first clinic, which has supported the American base for many, many years, was very small, and also very dated. The second clinic was a newer and bigger hospital which has recently worked closely with the military base clinic but operates very differently from the older hospital. Ultimately, we decided on the bigger hospital, because it was more typical of an American hospital and had all the supports we would need if something did not go as planned. Once that was determined, I received my referral to be seen at this hospital and contacted a translator to schedule my appointments. My translator accompanied me to a couple of my appointments. At my first appointment, I received my hospital identification card which looks similar to a credit card with my identifying information in Japanese. The process for most appointments was to swipe my card at a machine and wait to receive a number. The number was used to track me throughout the hospital that day and for paying at the end of my hospital visit. Once I received my number for that day, I would either make my way to the laboratory for a urine sample and/or blood work or I would head upstairs to the OB-GYN office. At the lab, I would swipe my ID card in a machine and a paper cup with my information would be dispensed from the machine.
At my appointments, I would have my blood pressure taken by a machine. Then I would go into a separate room to have my baby’s heart rate and movement monitored for twenty minutes. After this, I would meet with the doctor and midwives in another room where I would have an ultrasound. I wish I had taken a picture of the chair they used for obstetrics and gynocological examinations. It was electric. With the press of a button, it would lay you into the correct position and part of the seat would fold down for everything to be inspected. Think of it as the Ferrari of examination chairs.
This was typically how my appointments went. My visits were fairly normal, but I was measuring larger than I should have been due to having too much amniotic fluid. Therefore, the doctor and midwives monitored me closely. The doctor was also concerned that Flynn’s shoulders might be too wide to fit through the birth canal, and because of this, they often took many measurements during the weekly ultrasounds.
As I mentioned earlier, my translator did not attend every prenatal appointment with me. But, she did attend the initial appointment and the appointment in which I spoke with the doctor about options for pain management during labor. Since I had one birth with an epidural and one without, I was able to make an experience informed decision for this birth. I let the doctor know that I did not want an epidural. This was a good decision on my part, because the anesthesiologists only work Monday through Friday during typical hours, 8:00 a.m. to 5:00 p.m. I was told that if I was in labor at night or on the weekends I would not be able to have an epidural. This was because they do not have an anesthesiologist on call and they typically live farther away from the hospital. However, I was told that there were two other options, one which was a low dose painkiller shot. At the time, I was not interested in either option.
Still waiting for baby brother to arrive. Also, this is an amazing fried cheese and rice ball with a sparkler!During this time frame, Jake’s mom had arrived in Iwakuni to stay with the girls while we were at the hospital and to meet her newest grand baby. Each weekend we continued to explore the local area off-base, but stayed close to post in case I went into labor. And then, the night before Flynn’s due date around 11:00 p.m., I woke up with the urge to urinate. Similar to my second birth experience, I went to the bathroom and noticed that my water had broken. But this time, it was gushing and not trickling. I quickly woke Jake up from a dead sleep and told him it was “go time”. He woke his mom to tell her that we were heading to the hospital. We arrived at the hospital just before midnight and before I was admitted into a labor and delivery room, I was checked in an examination room by a midwife. That night and into the early morning I had fairly strong contractions. However, they stopped completely by sunrise.
My name on my hospital bracelet and the sign with my name outside my labor and delivery room.
The fetal heart rate and my contractions were being monitored. And since I was not having contractions and my water had stopped gushing and leaking, I was able to take a shower. After the shower, I still wasn’t having any contractions and there was no progression of labor. I spent many hours walking up and down the labor and delivery hall trying to get things moving along. Similar to my German birth experience, they did not monitor the baby or my contractions at this time. The Japanese like to allow labor and delivery to take the natural course as much as possible and because of this they were not planning to induce me. While I was happy that I wasn’t being pressured into induction, Jake and I were growing increasingly impatient to get the labor and delivery processes moving and to meet our sweet boy.
The view outside my labor and delivery room.While we were waiting in our labor and delivery room, Jake would “sleep” on these tiny Japanese chairs that would lay completely flat. He would put two of them together in order to rest somewhat comfortably. Additionally, there were only two labor and delivery rooms in the hospital. We were in one of them and the other one was on the other side of the wall. This proved to be quite interesting as we literally heard two other women giving birth. It was definitely nerve-racking.
One of my meals of Japanese food I was offered while in the hospital.Later in the evening, my contractions did return and eventually I was actively laboring. I did not receive an epidural and while I was laboring, the midwives pretty much left us alone. They checked on us very infrequently. As my contractions grew stronger and were more frequent, they hooked me up to all the appropriate monitors.
At one point, I began to have contractions across my front lower abdomen. They did not feel like your typical contractions, and I felt very exhausted from them. They were also causing a lot of pain…think about how you feel when you have not worked out in forever and you do sit-ups. The next day it burns so badly when you try to move, even when you try to roll out of bed. When this occurred, I became worried that I would be too tired to push once it was time to deliver Flynn. When the midwife came into the room to check on me, I was dilated to a 5, and I explained what was happening. Keep in mind that my translator was not with us, but I felt that I was able to communicate my concerns and needs to the midwife. I asked the midwife for the pain reliever shot that I had been told I could have if needed. The midwife told me I was too dilated and that I could NOT have it. Since I had asked a lot of questions via my translator during my prenatal visits, I knew this wasn’t accurate information.
At this point, I might have lost it a little bit. I “nicely” held the midwife’s forearm and begged her to stay and help me… and to give me pain medicine. But she would NOT give me the shot, so we called our translator just in case there was a language barrier issue. My translator shared my concerns and needs with the midwife via my cellphone and received the same response I had. We asked our translator to come to the hospital to help us and she quickly showed up.
Again, my translator relayed my concerns and needs to the midwife. The midwife continued to provide the same response to us. While I was having contractions or spasms in my front lower abdomen, I was also having the more typical labor contractions that begin in the back and wrap around to the front to move the baby downward. The problem was that in between my true contractions I was not able to rest or relax because my front abdomen felt like it was in a constant contraction. I really doubted my ability to make it through labor and delivery at this point. I looked at my translator (Jake was behind me rubbing my back) and I crazily told her that if I couldn’t receive the shot, that I wanted her to call the doctor and let him know that I wanted a c-section. It probably didn’t come out quite like that….
If you ask Jake about my behavior at this point, he would tell you that I went crazy and that he saw a side of me that he had never seen. While I had lost my mind, I vividly remember every moment of this interaction and I felt that it was the only way I could get my point across. My translator, who knew my birth plan, told me that she knew I didn’t want a c-section. I let her know that I really thought I wasn’t going to make it through delivery. And for what felt like the 200th time, my translator explained my concerns and needs. Then she told the midwife that I wanted a c-section because she would not give me the pain relief shot. Within minutes, the midwife had called the doctor and he was in my room. For the 50 millionth time, my translator explained what I wanted to the doctor… and then he looked at the midwife and told her to give me the shot. And just like that, she gave me the shot. Within 15 minutes I was feeling very relaxed. My typical labor contractions continued and I could no longer feel the spasms in my front lower abdomen (Thank goodness!!!).
About 5 minutes later, I felt an immense amount of pressure on my tailbone, and I let my translator know that I was ready to push. She let the hospital staff know….they were surprised at how quickly I had dilated after receiving the shot…and the doctor and two midwives entered the delivery room. They checked to see how dilated I was and they could already see Flynn’s head. One of the midwives climbed onto the delivery table in between my legs and was all up in my business stretching it out so Flynn could enter this world. And while I was totally caught off guard by how much she was in my business, it worked. Three pushes later, Flynn was out and I did not have any tearing. This was surprising because Flynn was my biggest baby out of my three children. Jake was able to cut the umbilical cord and Flynn was placed on my chest immediately so I could breastfeed him.
Proud big sisters!!! The green chairs fold back to lay flat. Jake would use two chairs to make a short bed!Before beginning the rest of the story about my Japanese Birth experience, it is important to note that this hospital have many, many rules that they did not have at the hospitals I delivered at in Colorado and Germany. One rule was that they do not allow children to visit the newborn in the labor, delivery, and maternity wards. Not only was this very different from our previous experiences, but it was even more strange because the pediatric unit was just on the other side of the same floor and hallway. Thankfully this was a rule we knew about from the beginning, and we asked questions about our girls and Nana being able to come meet baby Flynn while he and I were still in the hospital. We found out that the girls were allowed to be in the room during labor and delivery and up to an hour after his birth. We did not want the girls to be in the room for labor and delivery, so we had a plan to have Nana and the girls come to the hospital within the allotted time frame. Keep reading to see how this played out in reality versus our expectations.
After Flynn’s birth and having the opportunity to breastfeed him, the midwives took him to the nursery to take his vitals and have the doctor check him. Flynn spent most of the immediate hour after his birth in the nursery so even if the girls and Nana had been at the hospital when he was born, they would not have been able to hold him and spend much time with him. Luckily for us, one of the midwives extended the time an extra hour so Jake could pick up the girls and Nana, and the could return to the hospital to meet Flynn. While they got a very limited amount of time to see him and hold him, we were happy that they did not have to wait until we brought him home to meet their baby brother.
Also after Flynn’s birth, I was given a traditional gift from the hospital staff. I received the Kotobuki Bako, the umbilical cord box. It is one of the most common birth rituals practiced in Japan in which the umbilical cord is saved in a wooden box. The midwife handed me the open box that included a piece of gauze on which a part of Flynn’s umbilical cord was placed. I was told to wait to put the lid on the box until after the umbilical cord had completely dried. Kotobuki means celebration or longevity and Bako means box. It is thought that by preserving the umbilical cord this way there will be a positive relationship between the child and mother.
Kotobuki Bako-The Japanese birth gift ritualTypically after this hour or two following Flynn’s birth, I would have moved to a maternity room. Most mothers share a room with 3 other mothers. The babies do not stay in the shared room, but in the nursery. For nursing/feeding the babies, the mothers go to the nursery lactation room on a set schedule. (I’ll explain this in more detail in just a bit.)
I did not want to share a room, and I had asked for a private room, so that I could have some privacy and so that Flynn could stay in the room with me. Fortunately, they had a private room that would be available to me, but not right away. Therefore, they had me stay in the labor and delivery room until they were able to move me into the private room. And since I was not in the private room yet, Flynn stayed in the nursery. This also meant that I was granted the privilege of experiencing the Japanese nursery lactation room. As mentioned earlier, there was a set time that all mothers would head to the room to breastfeed or formula feed their baby.
And so here is how that experience went down…once all the mothers came into the lactation room, the babies were brought to their mothers. The mother would change the baby’s diaper, weigh the baby on a scale, and mark the baby’s weight on a tracking sheet. Then, the mother would feed the baby. While I am not modest about breastfeeding, it was definitely a unique experience sitting in a room full of about 8 women all breastfeeding our babies. The room was set up so that the seating was against the walls and you faced inward. The babies’ bassinets were placed in the center of the room. I was also thrown off by this experience because it was not mentioned at any point during our hospital tour or during my prenatal visits. Plus, I was the only American and English speaker in the room. Once the mother finished feeding the baby, she weighed the baby again, and noted the baby’s weight on the tracker. I was able to experience this twice before my private room was made available to me.
When it was time for me to move into the private room, a midwife came into the labor and delivery room, where I was waiting, to explain the various rules such as the limited times for visitation and what I should expect during the rest of my stay. In order to receive this information, I called my translator on the phone to help with communication. Visitation was limited to family members ONLY and during specific times. However, I was not eating the Japanese hospital food, and I asked if Jake could bring me food daily at various times that were not during the scheduled visitation hours. The staff kindly made this accommodation for us. Shortly after signing off that I understood the many rules in place, Flynn joined me in our private room where we would spend three and a half days.
Flynn and I settled into our new room, while Jake had taken Nana and the girls back to our house. Later that evening, he dropped Nana off at the hospital so she could enjoy time with Flynn. It was a good thing she was able to be there because at one point in the evening, I stood up and realized I was having a lot of bloody discharge that I had not experienced after my previous births. I immediately buzzed the midwife and let her know. They called the doctor to examine me and sure enough I was hemorrhaging because my uterus was not contracting correctly. Thankfully this was an easy fix and they hooked me up to an IV with medication that would cause my uterus to contract and stop the excessive bleeding. During this time, Nana was able to watch and love on Flynn while I rested. Eventually Nana went home for the night.
That night Flynn woke up often to feed. I had a hard time falling asleep because the midwife asked me to keep an overhead light on….I never understood why she wanted me to do this. And once I was asleep it was hard to stay asleep because they had an oxygen and heart rate monitor on his foot. It beeped constantly!
The beeping monitor.Our daily routine during our stay was nothing exciting. Jake would bring me breakfast in the morning and spend time with Flynn. I would shower daily when he was taken to the nursery for vitals checks in the morning. Jake would usually bring me lunch and in the evening, he would drop his mom off at the hospital, with my dinner.
Eventually after 6 days of being in the hospital we were discharged and went home.