Recovery and Post Partum

After being wheeled back to the tiny labour room, my IV was taken out, and my doctor went home. I was left in the hands of the older midwife who I had already taken a bit of a disliking to. She continued to drop in my estimation when she announced that at 10:00 pm (15 minutes from then) she would be taking the baby away to the nursery until 9 or 10 am the next morning. I told her that I would like to keep the baby with me at night time so that I could breastfeed her but she was patronizingly firm that the baby would be going to the nursery. I pleaded with her for a few more minutes but there was absolutely no convincing her. I had been told this might happen and I desperately wished that my Japanese was better so that I could argue my case better. After fifteen minutes of nursing, Rosie was bundled up and whisked away.

Dustin, right before being unceremoniously kicked
out of my room for the night. 

When the midwife returned from the nursery she looked at Dustin uncomfortably and asked when he was leaving, since visiting hours had already ended. I tried not to roll my eyes at her as Dustin gathered up his things and said his goodbyes. I then asked her if, since she demanded that Rosie stay in the nursery for the next 12 hours, I could go there every two hours at night to nurse her or at least have a breast pump. Once again she chuckled and patted me on the shoulder like I was a child and said that using a breast pump would make me become engorged and that I couldn't come to the nursery because I needed my rest. I was pretty incredulous and enraged at this point and being hopped up on post birth hormones was not helping. That is how, only 45 minutes after giving birth, I sat alone, upset, and completely awake in a teeny, dimly lit room trying relax wrap my head around the whole situation. Also, the room was hot as Hades and I couldn't get the A/C to cool it down past 28˚C. I decided to ask for my doctor in the morning and work it out with her. I also took heart in the fact that the old midwife wasn't a robot and had to be off shift sometime. Right?

A side note about pain medication: During the labour, I was not offered any sort of pain relief. I know that having an epidural was not an option but I believe there were a few types of pain medication available if I had wished for them. However, I doubt they would have ever offered me any of this pain medication unless I had specifically asked for it or if the doctor deemed that I was in enough pain. I also was never offered any sort of pain medication during my hospital stay. Come to think of it, not one nurse or doctor ever asked if I was in pain or inquired about how comfortable or uncomfortable I was. I had prepared for this possibility by bringing my own bottles of acetaminophen and ibuprofen.  The first few days after giving birth, I was alternating doses of these pills every 3 - 4 hours. I can't imagine how other women in Japan do it without bringing their own!

The next morning, at 6 am, the midwife came back into my room. How could her shift possibly be this long? Maybe she went home for a few hours and came back for the morning shift? It was a horrifying thought. This woman was immovably rigid and unyielding in her out-dated and counterproductive polices and there was no way Rosie and I could survive a week in her care.

When my doctor showed up an hour and a half later, I'm sure I had a distinctly crazed and desperate look in my eyes. I had spent the night thinking about my baby, how I had been able to hold her for only 20 minutes the night before, about whether she was crying or hungry, about whether I could convince them to let her stay with me, what it would do to my milk supply if they didn't, and about how I wished I could sleep but had too much adrenaline coursing through my veins to be able to. 

Finally getting my baby back! 

The first thing I asked my doctor was if Rosie could room in with me. She said that normally new moms don't want the baby waking them up all night while they are trying to sleep but if I prefered to do it that way it was fine. She went out to tell the nurses and within minutes they wheeled the baby into my room in a bassinet. I was ecstatic. After a my doctor did a check up and deemed that I was healing fine, I was informed that I would need to leave the small labour room and move to a larger room in which I would remain for the rest of my hospital stay.

My next post will be about my five day babycation. Stay tuned!

Labour and Delivery

On June 3rd, at just over 39 weeks pregnant, I had an appointment with my doctor. I was hoping that she would be able to do a membrane sweep to kickstart my labour. I wasn't actually even sure if they did membrane sweeping in Japan, since my doctor and I had never talked about it before. Not that I was terribly uncomfortable or sick of pregnancy, because at least the second half of my pregnancy had been the easiest of all three, but more than anything I was experiencing a restless sort of anxiousness to get labour over with and maximize the time that my parents had remaining in Japan. Also, on a more practical note, I was afraid of going over due, needing a second expensive rH shot, and possibly being induced.

I found out that was only 1 cm dilated and only very slightly effaced but my doctor did a membrane sweep anyway. It hurt like crazy since my cervix was not really that ready and my doctor has always been rough at the best of times, but did make me begin to have small contractions. Dr. Ando was very convinced that I would go into labour that day, even so far as to creepily call herself "gold fingers", and told me to go home and make sure all my bags were packed. I have learned in the past that to make a sweep more effective you have to keep on your feet and try to be as active as possible to keep the contractions going and hopefully make them a bit more regular. So, I decided to walk home from the clinic (about 3 1/2 km) and keep busy all afternoon around the house. I was pretty disappointed when after an afternoon and part of a night feeling small intermittent contractions, they petered away into nothing.

Me on the morning of June 5th looking like
I had a watermelon stuffed under my shirt. 

On the morning of June 5th, I returned to the clinic and had yet another membrane sweep. Within an hour I was having short, slightly painful contractions every 30 minutes or so and by 3:00 I was having them every 15 minutes. When Dustin arrived home from work I was having a contraction about every 10 minutes but they were still relatively painless. I didn't want to jump the gun and show up at the hospital when I wasn't really in labour, so I took a shower and tried to have a bit of a nap and see if they would go away. The contractions continued and became closer together, so after about an hour and a half Dustin and I decided to head over to the clinic. Partially because I wanted to make sure my labour progressed and partially because I am more than a little nuts, we decided to walk to the clinic (for the second time that day!).

We arrived at 7:30 pm and after about 15 minutes or so of waiting we were admitted to a very small maternity room. There was an older midwife on duty who got me to change into a gown, get into bed, strapped me to a fetal monitor, and checked how far I was dilated. The midwife forbade my husband from entering the room for all of this and was made to wait in the hall until I was decently covered with a sheet. I had a very hard time communicating with her, but I did gather that I was still only 1 cm dilated and she thought it would be a number of hours before the baby was born. This was horrible news for me since my other labours were long (22 and 9 hours) and with my boys I was 4 cm before I even knew I was in labour. I had a horrible sinking feeling that I had rushed to the hospital too soon. We asked the midwife if I could return home to labour there for a few hours but she said that once you check in you can't leave until the baby is born. I started to feel like I was in the Hotel California. 

After about 20 minutes in bed strapped to the monitors, my doctor showed up. She invited Dustin back into the room and didn't seem bothered that I wanted him to stay. Because her English is near fluent, I once again brought up the possibility of returning home for a few hours. Confident as always, she told me that she thought I would be having the baby very quickly even if  I was only 1 cm dilated and that I couldn't go home. I then told her that since the baby seemed to be doing fine I would like to get off the monitors and stand/walk around. Once again, a resounding "no". I was pretty annoyed at being confined to bed, which made the contractions hurt about 10x more, when there was absolutely nothing out of the ordinary with my labour. About this time, the midwife returned and put a saline drip IV in my arm. 

The doctor then came and sat on the bed next to me and used her fingers to check my cervix. Without saying a word (until afterward) she pinched my amniotic sac in her fingers and broke my water. I had my water broken in my previous labours too, but it had been done with a knitting needle like amnihook and with my full consent. Needless to say, I was a little shocked when she sprung that on me without asking. She continued to check my cervix with her fingers until I started to have a contraction. Then she asked me to pull my knees up to my chest and push as hard as I could, as many times as could, for the length of the contraction. This hurt. A lot. It took a contraction that what was otherwise a mildly crampy 2, on a pain scale of 1 - 10, and shot it up to a 9. I could only think that she was nuts for making me do this. I had been about to tell her "hell no, I'm not doing that again!" when she announced that I had gone from 1 to 2 centimetres dilated. It seemed to be working, so I gritted my teeth and did what she asked of me. Every five minutes I would have a contraction, pull my knees up, push, and dilate 1 more centimeter. All the while the doctor's fingers never left my cervix. Forty minutes after my doctor arrived, I was still having contractions only 5 minutes apart but I was 9 cm dilated. 

The midwife who checked me when I first arrived  came into the room with a wheelchair and helped me get in. She wheeled me down the hall to a sterile operating room with a massive light on the ceiling and a hard looking gurney bed with stirrups. Once again she tried to keep Dustin out of the delivery room and in the hallway, but he just ignored her and came in anyway. I have never been so happy for his forcefulness as when he blatantly disregarded this outdated and pointless policy. I climbed aboard the bed, laying nearly horizontal, and had my legs strapped into the stirrups. The bed was obviously made for women with much shorter legs than me because the angles were all wrong and my legs felt like they might just pop out of my pelvic joints. It was insanely uncomfortable, the bed was not at all conducive for pushing, but there wasn't much I could do other than deal with it and try to get this over as fast as possible. On the positive side, I was vaguely aware that there was peaceful classical music playing in the background. 

I had another contraction and pushed once again. I had no urge to push and the pain wasn't any different or worse than it had been for the past 40 minutes. I had another 5 minute respite between contractions to breathe and sip some tea before pushing again. This time, almost right away, I felt her crowning. It was so surprising to me, since I hadn't even felt her traveling down my birth canal, but after one or two good pushes she was born. About three minutes later I delivered the placenta with a small push and it was all over. Unlike many doctors in Japan, my doctor prefers to avoid episiotomies if at all possible and allows women to tear naturally. Lucky for me though, I won the lottery for the third time and didn't need any stitches.

For a few minutes it was all business, weighing (the nurses were astounded at how much she weighed), checking her apgar score, and cutting the cord.  Dustin and I were not given the option to cut the umbilical cord, which was okay since Dustin has never had any interest in doing it. Cord cutting is considered a medical procedure in Japan and you would need to have the most understanding doctor in the world for them to hand those scissors over. If you are interested, they did not clamp the cord with a plastic clamp but tied it off. 

The baby was handed over to us for a few minutes while they ran tests on her cord blood. I found out  at this time that she has the same blood type as me (A negative) which means that I didn't need to receive a second rH shot. After the blood test came back normal, I was made to clamber shakily off of the delivery bed, back into the wheel chair and we were all brought to the tiny room I had laboured in. 

I will definitely write about my hospital stay in detail. For now though, here are the facts and measurements of our newest (and last) addtion:

Name: Rosemary Blythe Reimer

Birth Date: June 5th, 2013

Time of Birth: 9:25 pm

Weight: 3890 g (8 lbs 9 oz)

Length: 53 cm (21 in)

Head Circumference: 35 cm (13.8 in)

Welcome Rosemary!

On May 14th, my parents arrived in Fukuyama to spend 6 weeks with us. The plan was that they would arrive about 3 weeks before my due date so that we would have time to enjoy a bit of sightseeing around town, allow them to figure out the boy's routines, and a bit of leeway in case the baby came early.  That would leave us with 3 weeks after the birth of the baby, give or take.

The timing ended up being absolutely perfect, since our little bundle decided to make her appearance three days before her due date. Rosemary Blythe Reimer was born on June 5th,  weighing 3890 g (8 lbs. 9 oz.) and measuring 53 cm (21 in.). My labour was very fast and easy and we are both healthy and doing amazingly well. I will most definitely be writing a more detailed description of my birth experience in the near future, but will probably put it under a separate section of the blog for those of you who have absolutely no interest in reading the nitty gritty details :)

The boys are absolutely thrilled to have a little sister and baby in the house. Theo assumed the role of protective and doting big brother right away. William surprisingly doesn't seem too bummed out that he is no longer the baby but has been shifted to middle child status. He isn't as interested in her as Theo, but always gives a token "aaaaawwwwww!!!!" when he sees her. It really helps that grandma and grandpa are around to shower him with attention and bicycle rides when I have my hands full, so he is not feeling too neglected.

For now I am just trying to survive the demands of a newborn while enjoying the last week and a half of my parents help and company. I sure will miss them when they are gone!

Trust Issues

Early in the pregnancy I had to come to terms with how much I trusted my doctor and the decisions that she made regarding my body and my baby. Don't get me wrong, I thought my doctor was fantastic: very competent, experienced, trustworthy, and with a great reputation, but I am used to being completely informed and allowed to take part in medical decisions. In Canada, I was allowed to choose which tests were preformed during my pregnancy and I could have even opted out of having ultrasounds if I really wanted to. However, from women here that I have spoken with and from what I have read, taking an active role in medical decisions and questioning the doctor's choice is not very common.

My first encounter with this was the extremely quick ultrasounds that I received at the beginning of every appointment. Also, about half way through the pregnancy I went to the clinic to get antibiotics for an infection. My doctor was not in the clinic at the time, so I saw another doctor who spoke a bit of English. She wrote out a prescription for me and I was given a pack of medication as I left the clinic (you don't usually go to a pharmacy to fill a prescription here, they give you the medication at the clinic). When I got home and could actually look at what I was given, I was surprised to find that there were three different types of pills in the package. Purely out of curiosity I decided to google the names, which were all in Japanese, to see what sort of antibiotics she gave me. I was shocked to find that the antibiotic I was given is actually not advised for pregnant women because it has been known to cause birth defects and miscarriages. She also prescribed a medication for gastric ulcers which has never been tested on pregnant women, and a medication to prevent uterine contractions that had been taken off the market in the U.S. during the 1990s because it has been known to cause fetal heart failure. I never complained about any stomach pain, have never had a gastric ulcer, and had been having no contractions whatsoever so I was absolutely uncomfortable with the thought of taking these medications. I decided to go back to the clinic when I could see my actual doctor and ask for a second opinion.

When I saw my doctor, she gave me a lecture about how every doctor in her clinic is an experienced OB/GYN and that I should just trust them next time. She didn't address my fears about the medications at all, but simply said "they are absolutely safe. We would never prescribe something unsafe for you". She maybe had a reason for prescribing what she did, but this reason was never explained to me and I was once again left in a situation where I felt like I needed to follow her blindly against my better judgement.

And you know, she was right. She is a doctor and does know what she is doing, presumably, since women keep having babies at her clinic and most of them seem happy about it. It was then that I decided, as much as I hated it, and no matter how much it went against every fiber of my being, that I would just accept whatever counsel my doctor gave me without too much questioning. It was that or go crazy worrying about every little difference in the advice or care that I was given. Trying to be informed and involved in the doctor's decisions just resulted in stress and frustration on my part so I just gave it up and became flexible.

Submission has never been one of my strong points, but it turned out that adopting this attitude helped me tremendously during labour and delivery where Dustin and I had no idea what was going on pretty much the whole time and had no input whatsoever. I will most definitely be writing about the birth in greater detail in the future.

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.