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!

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 First Steps

Even before deciding on going for #3, I had seen the fantastic medical care that Japan has to offer. Theo has very knowledgable, kind, and caring doctors (who all seem to speak English at least understandably) and I am always impressed by how quickly and how often he gets ultrasounds of his kidneys or MRIs of his spine when they are needed. In Canada, we often had to wait 6 months for these kinds of tests whereas here, the neurosurgeon was genuinely apologetic when he told me they only had an opening for an MRI the next morning! So, going into this pregnancy I already knew that whatever doctor I found was most likely going to be skilled and that I would have more ultrasounds than my other two pregnancies combined.

After confirming that I was pregnant with a home pregnancy test (they are really easy to find at drug stores here and cost me something like 500 yen for 2 tests) and by the fact that I felt like puking every second, night and day, I started doing some research into hospitals and clinics in our area. Our choice of a clinic was really based on two factors: 1. I wanted to be able to communicate, at least on a fairly reasonable level, with the doctor in English, and 2. I wanted it to be close to our home so that I could bike or walk to appointments and have a short trip when in labour. We don't own a car and don't intend to buy one so this wasn't really just a preference, but a necessity. Having a 40 minute taxi ride at 3 am while in labour is the kind of thing that I would never voluntarily choose. Optimally, I would like to have a very low intervention birth with a midwife, preferably at home, but there are no English speaking midwives in our area and home births are basically unheard of so that option was automatically off the table. It was initially a bit disappointing to realize that I just had to settle for a birth that was most practical and not what I really hoped for, but I have come to realize over the past two pregnancies and births that when it comes down to it, labour is unpredictable and painful no matter what and it is actually over fairly quickly. It is usually just one really bad day in your life that fades away almost instantly with the birth of your baby, no matter where and who delivered it. The pregnancy, however, lasts a long time and if you can have a low stress pregnancy by actually being able to communicate well with your doctor, understand anything that is of concern, and have quick appointments then you are pretty well off.

Through asking around and the internet, I was really fortunate to find a clinic that has a few English speaking doctors and nurses and is only about a 20 minute bike/10 minute car ride from our house. A wonderful Japanese friend of ours made an appointment for me when I was about 10 weeks along, which is when they advise you to come in to confirm your pregnancy. She also came with me to the first two  appointments to help fill out all of the initial paperwork and make sure I knew what was generally expected of me during appointments. I was a bit surprised that they used ultrasound to confirm pregnancy instead of simply doing a blood test as they would in Canada. There are a lot of differences in the use of ultrasound during pregnancy in Japan vs. Canada and I think I will go into further detail about this in a future post. 

All your seat are belong to us! 

Once the doctor was satisfied that I was  pregnant, she filled out a slip of paper with the estimated due date and asked me to come back in two weeks for all of the routine blood tests, initial height and weight checks, and such. With this slip of paper, I  was able to go to city hall and register my pregnancy. This allows you to obtain a Boshi Techo, or Mother  and Child Health Handbook, and book of coupons to supplement the cost of each doctor's appointment during the pregnancy. I also recieved a little dangly tag for my purse which is supposed to serve as a non-verbal message to people on trains and buses that I am pregnant and that they should give up their seat to me if none are available. Either people have no clue what this little sign means, or they just refuse to acknowledge it, because no one has ever given up their seat to me on a full train. Even now when I am very obviously pregnant, people just pointedly ignore me and sit tight as I seethe internally and try to keep my balance when the train rocks. No, I am not at all bitter about this :)

It was all very quick and easy (with the help of my friend) to get a doctor's appointment when I wanted one, register this pregnancy, and get all of the necessary books and coupons. In total it cost me about 4,000 yen (about $41.50 Canadian) to complete these first steps, which is already more than I paid for my other two pregnancies and births combined, but pretty inexpensive in the grand scheme of things.

More about doctors appointments and the Japanese health insurance system to come...