A Fish Out of Water

Shuma James

Meet Shuma James Nakazawa. He was born September 20th, weighing 3854 grams and measuring 50 centimetres- a big, healthy boy. He had a little trouble breathing though and had to be taken to hospital, where he was kept for a week. We were sad to be apart but he got lots of love and care from the nurses and doctors, and long daily visits from his mom and dad. And yesterday, on his one week birthday, he came home!

See more pictures of Shuma in his photo album.

Anniversary

A few weeks ago we celebrated our 11th anniversary. I was all set to tell the story of our wedding and took a bunch of pictures of our old wedding photos (we were wed in the pre-digital era, unfortunately, so getting the pictures online is not an easy process) and then I was hit with a bout of lethargy which kept me away from the computer. I don't know if it's directly pregnancy related, or if this summer's endless heat wave finally got to me, or what, but I've stopped loving being pregnant and now just want this baby to come out. So the wedding story (stories actually, as we ended up having four different celebrations) will have to wait, and all you get for now are the pictures.

We celebrated our anniversary in a very small way. Hideaki brought me a little bouquet of flowers, and I cured this year's first batch of ikura (salmon roe), which was put to use in the dinner above. Clockwise from top left: edamame (green soybeans); kyuri no asazuke (quick-pickled cucumbers); nasu to myouga no nimono (simmered eggplants with ginger buds); okura to myouga no misoshiru (miso soup with okra and ginger buds); and umi no oyakodon (mother-and-child seafood over rice).

Oyakodon (mother-and-child over rice) usually refers to a chicken and egg dish, but this seafood version uses salt-grilled salmon and salmon roe, with a garnish of shiso (perilla).

For an anniversary lunch out we went to our favourite local seafood restaurant, Marufuku. Hideaki had the kinmedai furai teishoku (deep-fried alfonsino lunch set). Alfonsino being a high-mercury fish I only snuck a few bites, and man was it ever good. It was also very rich though, and I couldn't imagine eating a whole plate of it.

I chose the sashimi moriawase teishoku (assorted sashimi lunch set), which came with a salad and chawan mushi (savoury egg custard), not shown, and the tray above: pickles, rice, miso soup and a beautifully arranged plate of sashimi. Clockwise from left: suzuki (sea bass); maguro (tuna); sawara no aburi (seared king mackerel); shake (salmon); and buri (yellowtail). It was all excellent, particularly the sawara, which is not a fish I eat often for some reason. Researching it later I discovered that it's very high in mercury, which was a bit of a surprise- I'm pretty careful about mercury but I guess because I don't come across sawara very often it just wasn't on my radar. And here I was worried about the tuna (I gave most of it to Hideaki) and alfonsino.

Actually, I've just checked the the Japanese government's mercury guidelines, and sawara tests as low in mercury (the high mercury listing mentioned above is American). Who to believe? I don't think the very small amounts of tuna, king mackerel and alfonsino I ate have any chance of harming the baby (and all the good stuff from the fish would outweigh any harm anyway), especially given how careful I normally am. But how frustrating to have two official sources give such vastly different information! I swear, once this baby is born I'm going to have the biggest mercury feast ever.

Marufuku
03-3925-1345
4-2-2 Higashioizumi, Nerima-ku, Tokyo
Open weekdays 11:30am-12:00am, Sundays and holidays 11:30am-10:00om, closed Mondays

Cultural Differences: No Sex Please, We're Pregnant

Women all over the world are faced with lists of things to avoid while pregnant, so I wasn't surprised to learn that Japan has a very long list of its own. What did surprise was just how different some of the prohibited items and activities are, with women here banned from doing things that pregnant women back home take for granted. So here is a list of some of the odder restrictions I've come across so far:

Sex

I'm pretty sure that these days no medical practitioner or pregnancy guide in Japan actually prohibits sex during a healthy pregnancy, but the general public apparently doesn't know that. Compared to English language pregnancy websites and books (which will usually have several pages or even a whole chapter dedicated to pregnant sex, perhaps with helpful illustrations of recommended positions), Japanese pregnancy resources have little to say about sex. Basically, the Japanese advice is: yes, it's safe, but be careful. And wear a condom. Seriously, a few posts back I mentioned seeing the condom suggestion in one of my Japanese pregnancy magazines, and since then it's popped up in several other resources. Apparently a naked penis is too filthy to be allowed anywhere near a fetus, and experts (including one doctor) here require it to be sheathed in latex. Which really takes all the fun out of pregnancy sex, as when else can you indulge in unprotected, spontaneous sex? (To be fair, I was able to find a few English websites recommending condoms during pregnancy, but that was only in a few very specific situations, like when having sex with a new partner. Which has to be the funniest English-language pregnancy advice I'd heard yet).

With or without a condom, however, I don't think a lot of sex is being had among expecting Japanese couples. According to my own research, which is admittedly unscientific and completely anecdotal (talking to Japanese friends and acquaintances, skimming through Japanese message boards and Question and Answer type websites, and reading about the experiences of foreigners married to Japanese on English language blogs and message boards) plenty of Japanese couples completely abstain from sex during pregnancy. There seem to  be two main reasons for this: a strong belief that sex can harm the fetus, and embarrassment by Japanese women (who are famously weight-conscious) about their weight gain and big bellies. Of course, given the popularity of the sexless marriage here (an estimated 30% of Japanese married couples don't have sex at all), pregnancy could just be a sensible time to start practicing abstinence.

Work

As with sex, there is no official rule against working while pregnant, but it's still the norm for women to quit their jobs by the second trimester. Most Japanese people are quite shocked to hear that North American women often work throughout their entire pregnancies, and while some women here express envy that women abroad can choose when to quit, most people seem to think women should stay at home while pregnant. I've actually never met a Japanese woman who worked during her pregnancy, but I've heard foreign women in Japan complain of difficulties while working during pregnancy: of not being able to find maternity business wear, of Japanese mothers-in-law nagging them to stop working as it's "dangerous to the baby", and of being scolded by strangers for riding trains during rush hour.

My own job ended this spring (nothing to do with my pregnancy, my contract ended) so unfortunately I don't have much first-hand experience with attitudes towards pregnancy in the workplace. But I do have a few private classes and they ended sooner than I would have liked. My students (all older ladies) decided at the end of my second trimester that teaching them must be too much of a burden for me and thus ended their classes. This after months of them constantly asking if I was really OK to keep teaching and warning me to be careful on the stairs, be careful on the bus, be careful in this heat, be careful at night, etc. These women definitely represent an older generation, but I think their attitude is still fairly typical. Last year I had a private student who quit both her job and our classes due to pregnancy- when she was just six weeks along! To be fair she may have had a good reason that she didn't feel like discussing (like severe morning sickness or a high-risk pregnancy) but the reason she gave for quitting was that she wanted to concentrate on her pregnancy. She may be an extreme example, but it's so rare to see a pregnant working woman in Japan that it's clear that working during pregnancy is still frowned upon.

Bicycles

I'd heard about this one ages ago, but had kind of assumed it was an old-fashioned or rural thing and wouldn't be enforced here in Tokyo in this day and age. But no: cycling while pregnant is officially banned in Japan. Pregnancy resources say no bicycling. My midwife says no bicycling. The old lady behind the counter of a local sushi take-out scolded me for bicycling. The only reason my doctor hasn't warned me of the dangers of bicycling is because he doesn't say anything at all.

As far as I can tell the supposed danger lies in a combination the risk of harming the fetus in case of a fall, and the overly intense physical strain involved in operating a bike. Of course, once the baby is outside that dangerous womb bicycling is just fine: stick a baby seat on a bike and you're good to go. Everyone who has lived in Japan has a story about an outrageous baby-on-a-bike sighting. My personal best was a bike with two baby seats, with baby in the front, a toddler in the back and neither wearing helmets. There were plastic bags full of groceries dangling from both handles of bike, and the mom was riding one-handed while holding an umbrella over herself and the baby (the toddler had a little umbrella of his own). Yes, it was raining, and she was riding on the road (not her fault really as sidewalks are not plentiful here). I'm the only person who even turned my head at the spectacle, but had she been pregnant she would have been in trouble.

Sports

In North America there are a few sports that a pregnant woman absolutely can't do: scuba diving, contact martial arts, skiing and the like. Beyond that, it's left up to the judgment and good sense of the expecting woman and her medical practitioners. In Japan the list of prohibited sports is much longer and has no room for the common sense of the pregnant woman in question. The list may be so restrictive that it includes everything that doesn't involve an official maternity class. There seems to be a lingering belief that physical exertion of any kind is potentially dangerous, and pregnant women are discouraged or even banned from participating in anything more strenuous than walking. Even walking seems to be frowned upon by the older generation: my middle-aged students were very surprised to learn that my midwife ordered me to go for daily walks and told me that in their day they were encouraged to stay home and let their mothers-in-law do the shopping and errands.

These days walking is acceptable and even encouraged, but other light forms of exercise can be hard to do as many gyms, pools and classes ban pregnant women outright. (Luckily the city-run pools in my area allow pregnant women, but judging from the reaction we got when we called to ask about the rules, and from the stares I get from the other swimmers when I go to the pool, I am the first pregnant swimmer anyone has ever seen.) Women who want to keep fit during pregnancy are advised to join a maternity exercise class, most often maternity swimming or maternity yoga (there are also maternity aerobics and maternity pilates classes, but they're pretty rare). I would actually have loved to have tried either, but it seems that the "maternity" prefix allows gyms and studios to charge double, and I couldn't afford it.

My midwife is rather enlightened when it comes to exercise (as long as it doesn't involve two wheels) and now that I'm at the end of my pregnancy she has instructed me to walk for at least two hours a day. She also wants me going up and down stairs as much as possible (which horrifies my older students, who believe there's no bigger danger to a fetus than a flight of stairs) and recommends climbing one of the smaller mountains in the Tokyo area like Takao-san (I did hike Takao-san in my first trimester and it was so tough that I can't even imagine trying it at this point). Yet I am only grudgingly allowed to go swimming, because of the risk of chilling my uterus. Which brings me to the most frustratingly weird restriction of all:

Getting Cold

This category of things to avoid is a huge one, but held together by two uniquely Japanese theories: that certain substances and activities can cool the body, and that a cool body is dangerous for a fetus. I was familiar with the Japanese obsession with body temperature before my pregnancy, and knew that there was a strong belief that keeping the midsection covered and warm was of utmost importance. I'd even bought into it a little, wearing a haramaki (stomach wrap) to bed in the winter (I swear nothing cures my cold feet like a haramaki, as odd as that sounds). But this fear of the cold is brought to new heights of ridiculousness during pregnancy.

The thinking goes that a developing fetus needs to keep warm, which seems sensible enough. Unfortunately, the Japanese believe that a woman's body is incapable of regulating its own temperature and keeping a baby safe, so an expecting women must take all sorts of precautions against chilling her womb. Never mind that the baby is protected from the cold by several layers: skin, fat, muscle, uterine wall and amniotic fluid. Never mind that the human body is designed to direct heat to the internal organs, and that a woman's body is especially good at keeping the uterus warm. Never mind that it's summer (never mind even that this summer is the hottest on record and hundreds of people are dying of heatstroke). Never mind that women all over the world, in all kinds of climates, are capable of safely bearing children without special precautions other than dressing sensibly. Nope, pregnant women in Japan need all the help they can get keeping their unborn babies warm.

The first like of defense is to wear a sarashi, haraobi, haramaki, girdle, or other warm cover over the uterus. The next, for women who believe such things (and admittedly not all Japanese women do), is to keep the temperature-related tsubo (meridian points) warm. These points are at the back of the neck and the ankles, so a high-necked top or scarf and socks or legwarmers must always be worn. Other physically direct ways to stay warm are nightly hot baths (which most Japanese take anyway) and the use of heavy blankets at night. This is all in direct contrast to western wisdom, which says to avoid baths and overly warm clothing and bedding while pregnant as they bring a risk of overheating the fetus.

Actively avoiding getting cold is just as important as keeping warm, so pregnant women are advised to keep the air conditioning set high (or shun it altogether), never drink cold drinks or eat ice cream, and be very careful when getting out of that nightly bath to avoid cooling down too fast- you have to dry off quickly, put on warm pajamas (don't forget the haraobi and socks!) and always, always, always use a hair dryer. Swimming, if it must be done, is allowed only in heated pools (maternity swimming classes are held in pools with a temperature of at least 30C). Never swim in the ocean, unless you're on vacation in Hawaii or Okinawa, and definitely stay out of lakes and rivers.

But the strangest way of keeping the baby warm is not through directly physical means, but through food: namely by eating foods that have warming properties and avoiding those that are cooling. This practice seems to have its roots in Chinese medicine and is certainly not followed by all pregnant women in Japan, but most midwives are major believers in the miraculous temperature-changing powers of food and mine is probably the biggest believer of all.

It's not as simple as eating hot food to keep warm (although temperature is important): foods are actually divided into categories of those with warming properties and those with cooling properties. Some sources add a neutral category as well, and most agree that foods generally keep their heating or cooling properties no matter how they're prepared. The lists vary quite a bit depending on the source (it's not like there's any scientific research to refer to, after all) and one expert may contradict another, so the following lists might not match what you've heard. But according to my midwife, warming foods are carrots, ginger and most root vegetables; asparagus; kabocha squash; onions and garlic; eggs; and meat, especially liver. Cooling foods include all fruit (most other sources only prohibit certain fruit, usually tropical varieties); milk and all dairy products except hard cheese; eggplants, tomatoes, cucumbers; raw vegetables in general; and spicy food.

Needless to say I think this is all ridiculous, but I also think it's dangerous: an expecting mother needs to nurture her baby and keep herself comfortable, and prohibiting entire categories of food places her health at risk and adds unnecessary burdens. Completely avoiding dairy, for example, depletes a woman's body of calcium at a time when she needs it the most (the leafy greens and tiny, bone-in fish recommended in Japan for calcium would need to be consumed in such high quantities that there would be little place at the table for any other food). And banning many of the foods that pregnant women seem to crave the most (like fruit and spicy food) just makes a difficult time even more difficult, especially if morning sickness is a factor.

In Conclusion

There are many other things I've heard pregnant women can't do in Japan, such as flying, watching sad or scary movies and TV shows, using seatbelts, consuming any amount of caffeine, and taking any kind of medicine. But these are ignored, thank goodness, by enough women here that they're not quite universal rules. Plus I've heard the same things back in Canada. In fact, there are probably just as many silly rules back home, and I'm just lucky to be spared hearing about them.

But I get the impression that the things a western woman has to avoid during pregnancy are mostly environmentally based: there seems to be a fear of toxins in the environment invading a woman's body and endangering her baby (this post from Wide Lawns and Narrow Minds offers a nice summary of all the ridiculous things that are said to be dangerous during pregnancy in North America). Whereas here in Japan the fear seems to be of the pregnant woman herself. I detect a subtle mistrust of a woman's body, a belief that the uterus is not fit to nurture a baby by itself and needs outside help. There is no appreciation of the amazing way evolution has designed our reproductive systems to shelter and foster a new life, and rather than being thought of as the protective organ that it is, the womb is thought to need protection. Even worse, women themselves aren't trusted to make their own decisions. She can't choose how to exercise, but must pay to take a maternity class so a professional can tell her what to do. She may crave an ice-cold drink on a hot day, but her midwife knows better. She may need to ride a bike to catch her train, but will pass an old lady along the way who will tell her she shouldn't.

It's this attitude that makes me reject a lot of Japanese pregnancy wisdom. Although I love the position I'm in, observing how two cultures treat pregnancy and being able to pick and choose the practices from each that make the most sense, I definitely lean towards a western view of pregnancy. I think my body is perfectly designed to carry my baby and trust myself to do what's best for both of us.

Cultural Differences: Diet

One of the things that has surprised me the most about pregnancy in Japan is the lack of dietary guidelines for expectant mothers. This is particularly surprising given that the Japanese place a very high value on a healthy diet, and anyone who has spent a little time in Japan will have noticed that people here are obsessed with food and nutrition. But when it comes to pregnancy, there just don't seem to be any official guidelines about nutrition and food safety.

In a way I find this refreshing, as I think the North American guidelines are too restrictive. Pregnancy can be hard enough to endure without a long list of things that you can't eat, and being told that the foods you love are suddenly off-limits is not only stressful, but potentially harmful. The western fear of seafood is especially worrisome, as fish is one of the best things to eat during pregnancy. Yet the tiny (and largely theoretical) risk of food poisoning from raw fish means pregnant women back home completely avoid sushi and sashimi, which is ridiculous. There's a lot I could say on the subject, but this New York Times article does it better than I could. For those not familiar with this western fear of sushi, this article and recipe sums the stupidity up perfectly: the author is so worried about the supposed risks of eating raw fish that she created a "safe" sushi recipe which features mayonnaise and imitation crab meat. Never mind that mayo is far more likely to cause food poisoning than (properly handled) raw fish, or that imitation crab meat is a potential carrier of listeria. And then there's mercury, which is indeed something a pregnant woman should limit her exposure to. But if what I read online is true, a lot of women are scared into giving up all fish rather than just cutting down their consumption of species that are high in mercury, which is a shame.

So I love that in Japan I'm free to eat sushi and sashimi, especially since sushi was one of the only things I could eat during my first trimester. I could also, if I wanted to, feast daily on blue cheese, prosciutto and swordfish without anyone getting on my case (although I do avoid those foods as listeriosis and mercury poisoning are things worth taking seriously).

This isn't to say that pregnant women in Japan don't receive any kind of advice about their diets though. It's just that the advice they get will vary widely depending on who's giving it and will seldom be based on any kind of scientific evidence or widely agreed-upon rules. One midwife may caution against eating sweets; a pregnancy magazine will tell its readers to eat lots of seaweed; a mother or mother-in-law will tell her daughter to avoid all raw food. My midwife has given a very lengthy list of foods I should avoid, which includes all fruit, all dairy, raw vegetables, beef, spicy food, sweets, and mugicha (barley tea, normally a staple for pregnant women). My doctor has given no advice at all. My Japanese pregnancy books and magazines vary widely in their advice, with one cautioning, for example, against eating too much fruit and another saying that if fruit is all you can keep down, then that's what you should eat.

So without a universal set of guidelines, an expectant mother in Japan is free to eat things that would horrify a pregnant North American woman while avoiding an arbitrary set of foods that other pregnant women around the world happily consume. And she very likely won't be taking a prenatal supplement, as whoever is counseling her will urge her to fulfill her nutritional requirements through food alone.

And here is where I think North America is doing a better job. Everybody back home knows about the importance of getting enough of certain nutrients like folic acid and calcium during pregnancy, and many women begin prenatal supplements even before conceiving. Here in Japan not a single doctor, midwife or nurse has talked about folic acid or calcium or even mentioned prenatal supplements. My midwife did urge me to get plenty of protein and iron, but those were the only specific nutrients she mentioned. Likewise, nobody has mentioned the dangers of mercury or listeria. Part of this is that medical practitioners in Japan, especially doctors, just don't give out a lot of advice of any kind, so women get their information elsewhere. And indeed, most pregnancy books and magazines do mention nutrition. Awareness of folic acid has grown in recent years, and although most women still don't take supplements (and those who do start relatively late in their pregnancies) they will often try to get enough folate through diet alone, as recommended in their pregnancy books. A few pregnancy resources also mention mercury in fish, and the Japanese government has recently started setting guidelines outlining exactly how much of each type of high mercury fish is allowable. But few women even know about these guidelines, and awareness of mercury in fish remains shockingly low here (the mercury issue is very well covered in this stippy.com post).

There is one thing that nearly everyone in Japan seems to know about and agree upon though: weight gain. Specifically, it is widely agreed that the less weight gained, the better. A very modest weight gain has been the preference here for centuries, largely because the less one gains the smaller the baby will be, and a smaller baby makes for an easier delivery. This probably made a certain amount of sense before the introduction of modern medicine, when maternal and infant mortality rates were high. But these days the preference for small babies remains, likely for a few reasons.

The easy delivery reason still stands, perhaps partly because epidurals (or any kind of pain relief) are very rarely used, and giving birth naturally to a large baby is understandably a scary prospect. Vanity is another reason, as of course the less a woman gains during pregnancy the faster she can return to her pre-pregnancy body (and Japanese women tend to be very eager to make that return, often donning constricting corsets and hip belts before they even leave the hospital). There are also good medical reasons for not gaining too much weight, as overweight mothers and their babies are prone to a whole host of complications (in fact, America's obesity rate is thought to be the main factor in that country's shockingly high maternal mortality rate). But there is a big difference between "too much weight" in the minds of Japanese health workers and those in the west, and the Japanese preference is still a shockingly small weight gain. In my case, my doctor has instructed me not to gain more than eight kilograms (17.6 pounds), which is far less than the 25 to 35 pounds (about 11 to 16 kilograms) that would be recommended for me back in Canada. That's the same 8 kilograms that he (and most health practitioners) recommends to all of his patients, regardless of their height, body type, and pre-pregnancy weight. So at 178 cm (5'10") I'm expected to gain the same amount of weight that a tiny Japanese woman would.

My midwifery clinic (I go to both a regular doctor and a midwife) is a little more reasonable, with the head midwife urging me to gain at least 10 kilograms and preferably 12 (22 and 26 pounds, respectively). Of course, I see a different midwife at each visit and they all have different ideas, and one of them berated me for gaining too quickly and urged me to keep a food diary and bring it in on the next visit so she could find out what was "wrong" with my diet. Luckily I haven't seen her since and the other midwives are fine with the fact that I've already gained 13 kilograms. Likewise my doctor, after one mild caution, hasn't mentioned my weight in months. Which is lucky, as it's not unusual for health practitioners here to berate their patients mercilessly about their weight gain.

Which leads me to another difference: there is no concept here of "eating for two". I've never quite understood the idea actually, since that second person is so tiny it really doesn't require that much extra food. As much as I dislike the Japanese preference for a very low weight gain, in some ways it's more sensible than the way a pregnancy is treated like a nine-month all-you-can-eat buffet in the west. If not gaining enough weight truly put infants in danger then Japan would have a higher infant mortality rate than that of countries where women are encouraged to gain lots, but it doesn't (in fact Japan consistently has one of the lowest in the world, far lower than Canada or the US, for example). And women in any country who are unable to gain weight due to severe morning sickness still manage to give birth to healthy babies: it's what our bodies are designed to do. So although I never intended to stick to my doctor-mandated eight kilogram weight gain, I certainly don't think I need to gain 35 pounds, and it's nice that my husband, friends and others around me aren't constantly telling me to "eat for two".

All in all, it's hard to say if pregnant women are better served by the strict dietary rules and permissive weight gain of North America, or the lack of nutritional guidelines and strictly enforced low weight gain of Japan. I guess the best thing would be for women everywhere to do their own research and decide for themselves what to eat and how much weight to gain. Here's hoping that all women can access the resources they need to make those decisions.