Prenatal Ultrasounds in Japan

In my clinic, and I have heard that it is the same in almost every OBGYN office in Japan, there is an ultrasound machine in the exam room and you receive an ultrasound at the beginning of each appointment by your doctor. In Canada, ultrasounds are preformed by an ultrasound technician, by appointment from your doctor, and usually only done at 20 or so weeks of pregnancy. If all looks good with the baby, this will most likely be the only ultrasound you receive during your pregnancy.

The ultrasound I received while pregnant with Theo and William in Canada took over an hour while the technician pored over every inch of my baby, measuring organs and bones, explaining exactly what each body part was, giving me ample time to enjoy this first glimpse of my baby and taking lots of great shots of the hands, feet, face, and profile. I was also asked if I wanted to know their gender at this time. My ultrasound with Theo was at a larger hospital so they offered to put all of the 150 or so images and videos on a disc for $50 Canadian. William's ultrasound was preformed at a smaller hospital so they burned a CD of the images for free. All of the photos and measurements taken by the tech are then sent to your doctor who makes the final say about the health of your baby and chats with you about it at your next appointment.

Meanwhile, in Japan, my doctor spends about 15 - 30 seconds at the beginning of each appointment preforming an ultrasound. From what I can tell, all she is doing is checking what position the baby is in and taking measurements to estimate the baby's size. At first I thought it was fantastic: I had never been able to see my babies during the early months of pregnancy and it was awesome to see her little hands and legs busily exploring her world when I couldn't even feel her moving yet. After a few appointments though, especially when 20 weeks had come and gone, and the ultrasounds weren't getting any longer or more intensive, I started becoming a bit concerned. I couldn't possibly see how her whirlwind tours of my baby could check the specifics of the stomach, urinary tract, kidneys, spine, heart valves, etc., even if she was doing it once a month. Perhaps I sound a bit paranoid, but Theo was born with a very rare condition known as a VACTERL association. Even though this condition is not known to be genetic, it is impossible to not be eternally edgy after you have a child born with any kind of congenital condition.

At my 24 week appointment, I expressed my concern to my doctor, and her response was "It is far too early in the pregnancy to do any of those kinds of measurements". I silently disagreed, but there was really nothing I could do about it. She probably thought it was rude that I was even concerned about her ability to assess my baby in the first place. At around 30 weeks she did a slightly more intensive ultrasound (about 3 minutes long) in which she made no measurements, but did point out that her heart, kidneys, spine, and umbilical cord looked absolutely normal to her.

Most Japanese women I have told about the way we do ultrasounds in Canada are horrified at the thought of only having one, maybe two, ultrasounds during the course of a whole pregnancy. It makes them feel very unsafe that the doctor isn't actually seeing their baby at each appointment and making an estimate of the baby's growth. On the other hand, I have kind of felt that the amount of ultrasounds I have been given are absolutely unnecessary considering that I barely receive any kind of feedback when they are preformed. I actually had an ultrasound at 30 weeks to make sure the baby had flipped from breech to a head down position. I am not sure why she couldn't have just felt my stomach to see where her head was!

Also, for all the amazing amount of technology available in hospitals and clinics and their reliance on it, I have been surprised by the low quality of ultrasound images. Looking back on Theo and William's ultrasound photos and comparing them to the ones I have received this pregnancy, I have noticed a very big difference in clarity. For comparison: here is a profile shot of William at 20 weeks and our newest addition at 20 weeks:

William

#3

In all the ultrasounds here, at two different clinics, I have received blurry, grainy photos where you can barely make out what you are looking at. The photo above is actually the best one I have from this whole pregnancy. The rest of them are relatively unrecognizable jumbles of blur and bones. I am just working under the assumption that she has toes, fingers, a nose, or lips, since I have never actually seen them on any ultrasound image during this pregnancy. I am not too sure how much of it has to do with the machines or doctors that I have encountered not trying very hard to take a nice photo. 

Another semi-related, side note complaint was finding out the gender of the baby. My doctor informed me that it is "impossible" for her to tell the gender of the baby before 28 weeks pregnancy. Considering that I found out that I was having boys for both of my previous pregnancies at 20 weeks and have access to the internet, I am not sure how she was expecting me to swallow this one. In Canada, there are private businesses that specialize in 3D/4D ultrasounds where you can book a session to get photos of your baby and find out the gender if it wasn't possible during your 20 week anatomy scan. Unfortunately, there are none of these private ultrasound businesses here, or at least in Fukuyama, so I had to book a secret appointment at a different clinic and pay out of pocket for the extra ultrasound. Secret, because I am almost certain my doctor would have been offended if she found out that I booked an ultrasound with another doctor. We were lucky that she was in a good position for this extra appointment, because we did get to find out we were having a girl at 20 weeks after all. The funny thing was, my doctor didn't even end up telling me the gender of the baby at 28 weeks, but waited until 32 weeks to confirm that I was having a girl. I am almost certain that this is not normal practice in Japan, but just one of my doctor's idiosyncrasies.

End of pregnancy rant for now...

The Personal Side of Pregnancy

I have realized that my experience here might be meaningless for others in the same position because every clinic, doctor and city in Japan treats these things differently. Also, since this is my third child, most doctors leave me to my own devices when it comes to what I eat, how I exercise, and how much weight I should gain. I think they have the impression that I will just do whatever I did last time, regardless of what they say and they would be right in assuming that. I am pretty sure I would have a different experience altogether if this had been my first baby. That being said, this post has nothing at all to do with those Eastern/Western differences in prenatal care.

This pregnancy has by far been the hardest for me. Actually, my pregnancies have followed a sort of pattern with each getting exponentially worse.  With Theo I had a super easy pregnancy, virtually no morning sickness, and I felt really comfortable and normal the whole time. With William I was moderately sick and exhausted for about 6 weeks and had a few other unpleasant symptoms but for the most part, once the first trimester was over it was smooth sailing.

For some reason, Dustin felt the need to snap a picture of me
looking as crappy as I was  feeling at that moment.

This time I was basically floored with intense nausea from 4 weeks, actually before I even knew for sure I was pregnant, until 18 weeks. Those weeks were a discovery for me in how horrible and debilitating nausea can be. I could only do what was absolutely necessary to feed and clothe the children and make sure that the bare necessities of house work were done. For the most part, everything was left up to Dustin while I felt extremely guilty, sick, and useless. My skin was completely broken out and I was having multiple headaches every week. If we weren't already sure that we didn't want any more children, this pregnancy would have cleared the matter up!

Those weeks sucked away almost all of my joie de vivre. The weirdest part was, either due to hormones or a survival mechanism of the brain, as soon as the nausea and fatigue subsided I forgot how horrible it really was, almost over night. I was just left with this eerie feeling that three months of my life disappeared into thin air.

Here is a photo of me at 18 weeks (the first week of January) marking my turning point from puddle of self-pity and misery into a normal(ish) human again. I think I look less pregnant and more like I have eaten a very large meal at this point.

This photo was taken about a week and a half ago when I hit 27 weeks. Things should be smooth sailing from here on in. Unlike most women, I actually enjoy the third trimester. I guess being tall has the benefit of preventing you from feeling like a walking house!

My Flesh and Blood

At a recent appointment with my doctor she told me the results of the routine pregnancy blood tests that were taken in November. The only thing of note was that I have a negative blood type, and she seemed to be genuinely surprised and interested in sharing this tidbit of information with me. She went on to tell me that in people of European descent about 10% of the population have a negative blood type, while in Japan about half a percent of the population has a negative blood type. We have a Japanese friend here who is AB- and he had to bank a supply of his own blood before a recent surgery. Let's just hope I am not needing any organ donations or transfusions while we're here!

My blood type was not news to me by any means, since I donated blood regularly while a student in university. Mostly because, though not insanely rare, my blood type is only shared by 3% of Canadians and can be donated to anyone with A or AB +/- blood (sorry all you O's and B's, you're out of luck). For both of my previous pregnancies I received a shot at 28 weeks to prevent my body from attacking the baby's blood if it were Rh positive. In the case of Theo, who turned out to be A- like me, it wasn't actually necessary. For William, who is A+ like Dustin, I had to receive an additional shot within the first 72 hours of his birth.

The creepiest part of this drawing are the little Pacmans
eating away at the + sign...

It is amazing how little affect my blood type has on my pregnancies due this wonderful medication. It must have been quite tragic for women back in the days before blood type had been identified and the Rho(D) immune globulin shot was created. My grandmother on my father's side, who must have also been Rh- but lived at a time when doctors were still clueless about this, had a child or two that died in early infancy and quite a few stillbirths and never knew why. I actually visited the graveyard once where there was a whole line up their tiny tombstones.




An interesting side note about blood type in Japan is that it is believed to be a personality predictor. This belief is popular enough that my phone has an option to put the astrological sign and blood type of each person in your address book and I noticed that many of the boy's clothing have a tag inside where you can write their name and blood type. If you are interested in what your blood type says about you, here is an article that takes the subject much more seriously than I do.