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...