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.

Sugar and Spice and Everything Nice

Just a short update: I had my 20 week appointment and ultrasound today and found out officially that we have a healthy baby girl! Theo didn't seem surprised at all since he told me that it was a girl from the very beginning. He also told me that William was going to be a boy from day one so maybe the kid has a knack.  

Here is the one token photo that they gave me today showing a profile of her face and chest. 

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...

In With the New

What do I see in store for us in the next year? For the most part I don't know, we haven't planned any career changes, moves, or trips out of the country so it should be a pretty stable, calm year. Except for one not so minor detail.

In the beginning of June, we will be receiving the final (yes, we will be making sure it is final) expansion to our family. I found that making the decision to have our first child was so easy. Probably due to naivety and a love for children, Dustin and I jumped in with both feet and didn't really spend much time obsessing over the details. We thought it would be great to have a baby, so 9 months later we had one. With William, we spent a lot more time stalling, postponing, and getting cold feet about having another child. We knew we didn't want Theo to be an only child but it took a long time before we were ready to jump back into taking care of a young baby again. For this new baby, we spent nearly a year agonizing over whether we should or shouldn't have a third. 

Truthfully, I never really intended on having three children. A family of four is quite simple and neat. You can avoid the self-centered and lonely life of an only child (sorry if I have offended any only children out there) but still fit your family into a small-ish car. Also, you aren't outnumbered by children in your home. Regardless of this logic and all the reasons not to have a third, I felt deep down that we were meant to have one more child. I knew that I would never regret the decision to have a third child but that I might forever regret that we didn't. I know this sounds like over emotional, hormone driven logic and pretty uncharacteristic my normal outlook on the world, but I can't really explain it any other way. Also, the decision to have a third child has absolutely nothing to do with the fact that I have two sons. It absolutely makes no difference to me whether this baby is a boy or a girl. I am actually pretty touchy if anyone implies or assumes that we are only "trying for a girl". We were trying for a baby, not specifically a girl, so there! :) 

Our newest addition at 16 weeks

I will be having the baby here in Fukuyama. I would like to return to Canada for the birth but the complication of having to take the two children back with me, leaving Dustin for a few months, Dustin not being able to be at the birth or see his new child for a few weeks, and the cost involved makes this impossible. 

This week marks the halfway point of my pregnancy and hopefully the second half will be much better than the first. One of these days I will do a post on my experiences being pregnant here and the differences I have noticed between prenatal care in Canada vs. Japan.