A Fish Out of Water

Birth Story, Part Two

Shuma turns 3 today. I thought maybe it was about time to finish writing his birth story. I have forgotten so many little details already, and need to get it out while I still have some memory of it left. I actually did start writing it soon after the birth, and have worked on it a few times over the years, but at first I wasn't really ready. It was all so recent and awful and I wasn't finished sorting out how I even felt about it myself. And as time went on I became kind of bitter about the whole thing and just wanted to forget it. And also whenever I'd reread what I'd written I realized it was way too long, and was really just a long boring list of complaints.

I've tried to make it a bit less long-winded and whiney, but since this is a record for myself as much as it is a blog post, I don't want to leave too much out. So be warned: this is very long and self-indulgent. I recommend just scrolling down to see the pictures and reading this short version:

Shuma was taken to the hospital after being born in a midwifery house, due to meconium aspiration syndrome (basically when a baby has its first poop while still in the womb). Like most babies with MAS he was just fine, but needed oxygen and his lungs cleaned out and a series of tests to rule out complications. He was in there for a week, and I stayed in my midwife clinic without him for 5 days before being released. It sucked.

Here is the long version (taking up where we left off, in the first part of the birth story):

 

It was just me and the remaining two midwives, and they busied themselves cleaning me up. I was as limp as a rag doll and remember feeling shame at having to be wiped down and dressed, but I literally couldn't lift an arm to help them out. After a rest I realized I was ravenously hungry and asked for something to eat, and despite still feeling a bit nauseous I was able to sit up and eat a little. I remember finding the food much too heavily flavoured and could only eat a few bites, and I was worried that I wouldn't be able to eat anything during my stay if all the food was this bad.

Eating gave me a good amount of energy though, and I realized if I'd been able to eat during labour I might have been much stronger and gotten the baby out sooner. That's a thought that came after, of course. That night I was too tired to think about anything. During dinner my sister-in-law, Atsuko, and her daughter Marya came for a quick visit, and then I think I called my parents, and then a midwife came in for an exam. She reported that I had a pretty bad perineal tear and we'd have to look after it tomorrow. This terrified me but I was assured that it would be done with anaesthetic and I was too tired to ask for more details so I drifted to sleep until finally the head midwife came back from the hospital and reported everything was going fine. Shuma had been admitted to the NICU and was on oxygen but doing well (as measured by how loud he was crying, which was: very loud). A few hours later Hideaki, who had stayed at the hospital to finish the paperwork, came back. He had taken a few pictures, so I got my first real look at Shuma James Nakazawa:

The next morning I was able to eat a proper breakfast. Traditional Japanese food, on the austere side, and not much of it. It was very lightly flavoured and I realized that the previous night's dinner hadn't been over-seasoned as I thought. It was just lingering nausea that had made my taste buds sensitive. Now I wished I'd brought a salt shaker.

As Hideaki was leaving for work (he'd already used up the one day off he was given for the birth) and a junior midwife came in and announced that we were leaving in half an hour to get me stitched up. At my own midwifery house there is nobody qualified to do that, so we'd have to take a taxi to an ob-gyn. Not the nearby big hospital where by son was though, that would make too much sense. So I had to scramble to get ready, still barely able to stand up, still filthy, still in pain. I had asked what I needed to bring and was told just my insurance card, so that's what I brought, and I hobbled into the taxi- she did the polite thing and let me get in first, and it was so painful having to scoot over that the backseat seemed like it was miles long. It was a long, uncomfortable ride through tiny narrow Tokyo streets, with plenty of swerves and bumps, and it took most of my energy to sit still and not cry out. But I needed even more energy to deal with this midwife, who was a chatty Kathy, and not just a regular chatty Kathy but the kind that sees foreigners as an opportunity to practice her English. Small problem- she couldn't speak English. But she tried, and kept trying, for the entire 20 minute ride. This would have been incredibly annoying under any circumstances, but with me exhausted and in pain and worried about my baby and dreading the upcoming procedure it was torture. I thought at first maybe she was trying to distract me, but if she was thoughtful enough to want to do that you'd think she'd also be able to notice that I did not want to answer her stupid unintelligible questions.

Upon arrival the driver announced the price and the midwife looked at me expectantly. I hadn't brought my wallet, since she hadn't mentioned money when I'd asked what to bring (and I stupidly assumed I'd be billed for everything later). She had to pay out of her own pocket and seemed completely shocked and put-out, and I apologized and promised to pay her when we got back.

Inside the clinic she continued her chatter until I just couldn't take it and lay down on the bench with my arms over my head, and at that point a kindly nurse noticed that I wasn't doing well and brought me to a room to lie down. The silence was wonderful. When it was my turn, the doctor got started right away, giving me a shot for the pain and telling me to let her know if it started to hurt. After a few minutes it did start to hurt, and I told her, and lord knows why she wanted me to tell her because I didn't get any more shots. She said there were only a few stitches left to do, but it hurt more and more and my groans turned to screams and the doctor, nurse and midwife were all telling me "Gambatte!" and "Almost done" and other encouraging things, and it was just like it was when I was giving birth half a day before. Finally the nurse mimed lamaze-type breathing, just like I'd used during labour, so I did that and it helped a little. I was so grateful for that, but why the hell couldn't they have just given me some pain relief? Why did I have to go through all of that again?

I didn't ask how many stitches there were ("I was too tired to ask" is kind of a theme here, and it seems hard to believe now but I really was- too physically tired to talk, or too mentally tired to think of the words in Japanese or to stand up for myself) and it was months before I had the courage to get a mirror and look, by which time the stitches were long gone. But I think I felt about 8 after the anaesthetic wore off, and who knows how many were done before then, so maybe a dozen?

Unbelievably, the midwife was surprised all over again when I didn't have any money to pay the clinic. Idiot. In the cab ride back I just closed my eyes and pretended to sleep, and she finally shut up, thank Jesus. She made the taxi wait when we got back so I could go get my wallet, and it was almost empty. Oops. I guess next time I give birth I'll be sure to stop at the ATM on the way to the hospital. I had just enough to pay the driver and not enough to pay the midwife back for the rest of it so promised her my husband would pay when he came after work that night.

So I managed to eat some lunch and then my mother-in-law came. It was so nice to see her and she held my hand and we both cried for a while. Crying was such a relief. When we'd recovered we took a taxi to the hospital so I could finally see my boy. We got the world's worst taxi driver, an older lady who was both the stereotypical woman driver and the stereotypical older Japanese lady. So she talked the whole time and got lost and had to ask a police officer directions and got lost again and finally got us there without offering any discount for the lost time. I let my MIL pay, I was too excited to care, and after scrubbing up we were brought to the NICU and introduced to my son.

His eyes were open and he looked right at me, and they were grey or maybe blue, it was hard to tell under the harsh lighting and with his eyes just open a crack, but they were beautiful eyes. I was allowed to put my hand in the incubator and touch him, which Hideaki hadn't been allowed to do the night before, so I took that as progress. He gripped my thumb and it wasn't the iron grip that parents describe, but it felt like he was trying his hardest. It felt like he knew me. I wanted to hold him so badly, but was told he had to stay in his plastic box. The doctor came and explained some things to us, which I couldn't really understand but the gist of which seemed to be "he seems to be totally fine but we need to do some more tests and make sure he's feeding well". And he also asked if I'd been able to express any milk. I felt like an awful mother when I said no, but I had asked after the birth and again this morning if I could pump and the midwives had said no, I needed to rest first. It didn't seem right, but you know, I was too tired to question it.

Hideaki had told them that Shuma wasn't to receive any formula. Yay for him, if only he'd been able to be in two places at once and told my midwives to let me pump. I was very proud of him and glad the hospital abided, but since I hadn't provided any milk they were feeding him sugar water. The nurses were just as eager for me to begin pumping as I was, as apparently Shuma cried pretty much nonstop, and he was very very loud. I hadn't really noticed yet, but all the other babies in the NICU were tiny little things, mostly preemies, and their cries were more like the mewls of kittens than the very healthy sounds my son was making. So I was brought to the pump station, haha, and shown how to use their industrial strength breast pumps, and of course I forgot the instructions and did everything wrong. The other mothers all ignored me and each other so I flagged down a nurse and was eventually able to produce a few drops.

I wasn't able to see Shuma again as the daytime visiting hours had ended, so we went back to the midwife clinic. That damned junior midwife from this morning bumped into us and immediately asked my MIL to pay her back. My MIL had no idea what she was talking about, since I hadn't mentioned it to her. Why should I, when I'd already told the midwife my husband would be paying her back that night? What an absolute bitch. But my MIL paid. She had brought thank-you presents, in the traditional Japanese manner. At the big hospital earlier the present had been kindly refused, but the midwife accepted the present with barely a thanks. This is when I started to regret my choice of birth venue.

Here are some pictures Hideaki took on a visit late that night:

The next day Atsuko came to visit (her mother had already flown back to Osaka) and together we went to the hospital. Have I mentioned she was pregnant too? 7 months along at that point, I think, and busy with 5 year-old Marya, but she took so much time to help us out during Shuma's stay in the hospital. With Hideaki so busy, me still kind of out of it (and not very competent in Japanese) and both sets of parents so far away, she was an incredible help.

Big surprise- he was out of his incubator! I was allowed to hold him for the first time.

They brought Shuma and I to the nursing room, I would rather have just done it there with Atsuko to help but they insisted. We weighed him, then the nurse give brisk instructions which were rather hard to follow but after a few tries it worked, and we were left alone with instructions to watch the clock and switch sides after 10 minutes. The nurse came back and I hadn't switched sides, because he was still nursing and I didn't know how to get him off and wasn't sure I could get him back on to the other side, but I was reprimanded and made to switch but he fell asleep right away and wouldn't nurse. So we weighed him and he had drunk enough to satisfy the nurse so we wheeled him back and she showed me how to feed him sugar water in a bottle, then I put him back in his little bed and was brought to the pumping station. I did a little better this time.

We were about to get a taxi to head back to my clinic when I saw that the driver of the first taxi in line was the awful lady from the day before! I told Atsuko we couldn't take that one but it would also be rude to try to take the second taxi so we went back into the hospital and waited in the cafeteria. I ordered iced coffee and an ice cream too and it was the first time since starting labour that I'd had: coffee; cold food or drink; anything sweet. None of those things are allowed by the midwives, cold drinks chill the baby you know, and sweets and cold food reduce milk production. 100% bullshit of course, so I was glad that horrible taxi driver had been there because this unexpected treat was heavenly. I honestly felt so much better after eating, and of course much of that was from being able to hold and nurse my baby but I think the caffeine and sheer pleasure of eating something nice also played a huge part. I felt the best I'd felt in days.

Before we left the doctor had given us another update and asked why I still hadn't brought any pumped milk. He seemed a bit angry about it and it kind of jarred me into standing up for myself a little, so when I got back to the clinic I demanded the pump. It was the head midwife I spoke to and she was actually surprised that I didn't already have it. I'm glad she felt that way but wish she could have trained her midwives a bit better. And I was also kind of disappointed: with the caffeine and my new found courage I was all prepared to argue. So I produced a little and they kept it in the freezer and that night I asked to visit Shuma with Hideaki. It was very late at night and he didn't think it was a good idea but the midwife said it was OK so I went and brought along the milk I'd pumped (they'd managed to round up some ice packs- the hospital only accepts frozen milk).

This was the first time Hideaki held Shuma.

I was eager to nurse him again and asked if I could do it right there in the NICU. Not just to show Hideaki but also because moving to the nursing room was bothersome, he still had an IV so I had to wheel him in his big awkward cart and I was still exhausted. So because it was night and there were few (male) doctors round the nurse said it was OK just this one time. The nursing room nurse was brought and she was even stricter than the one I'd had that afternoon, and she barked a series of orders ("Hold him like this" "Keep your back straight" "Place his mouth on your nipple" "Back straight!") that were confusing and contradictory and he wouldn't drink. I was trying to follow the instructions I'd read in my baby books but they were different from what this nurse was telling me. She was obsessed with posture. I knew that I was supposed to bring Shuma to me rather than bend over to get to him, but I also thought maybe I should just try to get him to latch and the posture would work itself out later. Anyway it just wasn't working and Shuma started crying and so did I and the nurse said our time was up. It was awful, I'd been so proud and ready to show Hideaki and was crushed that I couldn't.

So we fed him some of the milk I'd expressed earlier and we were taught how to change his diaper, and then I went and pumped. Only a few ml's, but the most I'd produced so far. I was so very tired, it was around 3:00 and we had to wait forever for a taxi so I was regretting coming and decided not to visit at night anymore, I'd leave that up to Hideaki.

Back at the clinic things were pretty boring and lonesome between visits. The day after I had Shuma a woman gave birth in the room across from mine with her family present. I heard the kids playing and the midwives coming and going but nothing else, she didn't give so much as a whimper. It was quiet all evening until suddenly I heard a feeble cry and knew she'd given birth. I could hear all the congratulations and happy sounds and it made me feel sad. Over the next 5 days one or two more women gave birth, and they were always surrounded by midwives and everyone looked so happy. But they stayed away from me, maybe because they were busy with the other moms or maybe they thought it best to leave in peace, but I was so lonely. And I had so many questions. This would have been the time to have them teach me how to dress the baby and use my sling and all of that, but they only came in to examine me or massage my breasts or bring my food.

Ugh, the breast massage. That's a thing they do in Japan, believing it helps milk production and prevents blocked ducts, and I hated it. It was painful and felt invasive and just made me miss my baby. I especially hated it when they talked to me during the massage. I don't consider myself a prude, but having a midwife make conversation while her hands are painfully squeezing my sore breasts just felt wrong.

The midwives managed to time their infrequent visits perfectly, and were always catching me doing something naughty. Like reading. "You shouldn't use your eyes too much, you won't be able to make enough milk". Or using my iPhone (same reason). Or eating a mini chocolate bar my husband had smuggled in. "Sweets are bad for your milk". Or pumping "Too much pumping will tire you out". Or using the air conditioning. Or not wearing socks, or not covering up enough with a blanket, or lying down the wrong way, or drinking a cold drink. It was ridiculous, and I started hating them all.

I was having nightmares and also having extremely gloomy thoughts. I'm not sure if it was a mild form of postnatal depression (does it even happen that soon?) or just a result of all the crap I was going through. I wouldn't really even have admitted at the time that I was going through crap, after all my baby was healthy and being well taken care of and isn't it wonderful that I live in this time and place as in other times and other places Shuma would have died. I tried to be grateful but really I think I was hurting from the awful birth, and the separation from my baby and the resentment I felt towards the women who were supposed to be caring for me. I don't know.

There was a large cemetery nearby that I passed every time I took a taxi to visit Shuma. Zoshigaya Cemetery is actually quite famous and is the resting place of a number of notable people, including Lafcadio Hearn, but every time I passed it I thought about death. Vaguely, or specifically, like imagining burying my dead baby and stuff like that. It sounds over-dramatic now, but at the time those thoughts were real and distressing. Especially in the first few days when we really weren't sure if he'd be OK. One of the many nightmares I had involved me witnessing a cat get run over. It flew through the air and landed with a splat and I knew it was dead but I had to hurry on somewhere so couldn't stop. On my way back from whatever dream errand I was on I looked for the cat to bury it properly, and came upon its corpse. It was only bones and a bit of gore, surrounded by fur and bloody disposable chopsticks. I woke up crying and outraged that people had feasted on this poor cat. Such a ridiculous dream, yet I kept seeing it again and getting angry about it for days. Weird, right? I must have been much more stressed out than I realized.

Little by little I heard the details of the birth: Shuma's official birth weight was 3854 grams, but because they'd weighed him after he'd started breathing (by which point they'd suctioned about 200 grams of fluid from his lungs and tummy) and he'd already pooped, they said his real weight would have been over 4 kilograms. Yay me! He was 50 cm in length and had a head circumference of 36cm, which didn't mean much to me but impressed the midwives. My labour had lasted fourteen hours in total, which is about average, but of course it felt much longer. I had experienced heavy bleeding during labour, which probably explained my continuing exhaustion and weakness. I suppose in a real hospital I would have given me an IV and more substantial food to get my strength back, but here the meals were light with a very small amount of protein: like two chicken wings or a tiny slice of fish. Ideal for a small Japanese woman eager to lose weight after a regular birth, but not really what I should have been eating. Luckily I had brought my prenatal vitamins so self-medicated with those, and continued to have treats at the hospital after visiting Shuma. Of course the visits themselves took a toll and I always felt tired out.

Physically tired out, but mentally? The visits were wonderful. It was so obvious that there was nothing wrong with our baby, and I started believing the doctor when he said Shuma was just there as a precaution. He still couldn't say when he's be released, he said it could be up to a month, but I knew he was in a safe place and I wasn't worried about him.

Well, nursing was a bit of a worry, but it was improving every day. When Shuma was 4 days old he was moved to the GCU (Growth Care Unit, for the babies that are too well for the NICU but not quite well enough to room in with their moms). When I fed him that visit we did well, and the after nursing weight so impressed the nurse (this was one of the nice ones) that she stopped everyone on our way back to tell them how much he'd drunk. She was just so excited and that really cheered me up. I think that's maybe one of the jobs of obstetric nurses, cheering up worried parents. I must say that although I had a couple of stinkers, most of the nurses there were excellent. Shuma was well taken care of, so much so that I felt guilty. Especially his first three days in the NICU, with most of the babies half his size and some so tiny and weak-looking it broke your heart. And here is big, pink Shuma with a cry that would seem loud even coming from an adult. I couldn't help but feel bad.

There was a log-in book that visiting parents had to sign, and you could see all the other babies and their visitors. Most had a parent visiting a few times a day, but a few had none or nearly none. Maybe the mothers were in bad shape themselves, or the parents had given up hope, or the baby was so seriously ill that no visitors were allowed, or I don't know. It was just so sad to think about. On one visit I saw a new baby admitted, big and healthy looking like Shuma but with a cleft palate. The parents looked worried, I guess that's just how Hideaki had looked when he came that first night. The baby was totally adorable. It cried every waking moment though, and over the next few days all it did was cry, not as loud as Shuma but just as heartbreaking to witness, and every once in a while a passing nurse would put her finger in its mouth to sooth it, but she'd have to move on after a few moments.

So here we are on day 5, a Friday. I was released from the midwifery house, thank fucking god, and Hideaki managed to leave work early so we could visit Shuma together. Shuma was doing better and better, but one of the nurses was really concerned about his crying and his failure to gain weight. I wasn't worried about his weight, as he was doing exactly as my books said he should be doing and my milk had come in and I was pretty much bursting. But the crying was something I felt bad about, it must have been annoying for the nurses and distressing to the other parents and babies. She urged us to allow them to use formula and I asked them to let us think about it until the next visiting hours. So Hideaki and I went out for dinner (real food, yay!) and I called a La Leche League leader I had met a few months ago at a meeting. She was very supportive and gave me tips on increasing my milk production and dealing with the doctors and nurses, but wisely avoided telling me whether or not to allow formula. So when we went back I told the nurse I'd visit as much as possible and pump like crazy to get my milk production up, and to please continue with the sugar water until I was making enough milk. She agreed, but you could tell she thought we were negligent.

Luckily I had used my time alone in my room to set up a breast pump rental. Hideaki and I went home, and if felt so strange to arrive alone, but we weren't worried. We knew he was where he should be, but we still felt a bit lonely. Every couple of hours I pumped with the crappy little hand-held pump I had been smart enough to buy before the birth, and then the next day the fancy rental pump arrived. I had lots of milk to bring on our visit that day.

On the weekend (which meant Hideaki and I could go together) we did two long visits each day. The hospital is far from our apartment: a bus and two train rides away, and because I was still weak we could only go once a day, but we stayed long enough for two visiting slots with a meal in between. Very tiring for me but rewarding and Shuma was always so content when we left.

About that head. We at first just assumed that it was stretched out from the delivery, like we'd heard (the trip through the birth canal squeezes the baby's head and can stay like that for a few days). But eventually the doctor explained that it was a birth injury called "caput succedaneum". According to Healthline: "A long, difficult labor with a lot of pushing can cause this condition... Scalp swelling may be more likely if the amniotic sac membranes rupture early in labor. In some cases, if the membranes rupture very early or if there is too little fluid in the amniotic sac, the mother’s pelvic bones will put pressure on the infant’s head." Well bingo. I would also find out that I had a bruised tailbone, caused by the same pressure. I found this out when a midwife caught me sitting wrong (naughty me) and I explained it hurt to sit normally and she said "Oh, that's because you have a really bad bruise there". Yeah, thanks for telling me. Anyway, both my bruise and his swollen conehead lasted a few weeks. I stopped feeling sorry for myself when I heard from my sister that her son had actually broken her tailbone during childbirth.

And then it was Monday, and Hideaki went off to work leaving me to pump and dread having to visit by myself. Of course Atsuko had offered to help but I was afraid she was exhausting herself so I was ready to go alone, but then the phone rang and it was the doctor saying Shuma was ready to be released and could I come pick him up today please?

So I entered into a flurry of planning. Hideaki couldn't leave work early enough so Atsuko had to come after all. I tried calling up the special taxi service we'd registered with, whose taxis come with car seats, but they require a reservation a day in advance so couldn't help me. But what could I do, ask the hospital to keep him for another day? We'd have to carry him home in a regular taxi. So I went and Atsuko and Marya met me there and helped me with the paperwork and I was relieved to find out that I didn't owe a million dollars. In fact Shuma's whole hospital stay cost us nothing (as opposed to the midwife clinic, which cost over 600,000 yen- about $6000 Canadian).

Shuma was released and we were allowed to wait in the waiting room until Hideaki to finish work, and there Atsuko taught me how to use my sling, oversaw my first solo diaper change, and watched us nurse for the first time without supervision. I wished I could have taken her home with us because there was so much I hadn't been able to learn, but she had her own birth coming up soon and her own child to care for (who was intently watching everything, in anticipation of her brother's arrival).

Hideaki arrived and we said good-bye to Atsuko and Marya and we caught a taxi home. I was relieved it was all over, but knew that also it was only just starting.

To be continued (maybe in another 3 years?).

Birth Story, Part One

At the beginning of the birthing class Hideaki and I took a few months ago, the instructor asked us to say the first word that came into our minds when she said the word "labour". Predictably almost everyone said "pain" or a similarly negative word, and only three people thought of a positive word. That word was "baby", and I was one of the ones who said it, which shows how optimistic I was about the upcoming birth. I was nervous about it, of course, but mostly really looking forward to meeting my baby. My positive attitude was partly pragmatic- giving birth was going to be difficult no matter what, after all, so worrying about it wasn't going to make it any better. But looking back now I realize I had also idealized the birth and was perhaps a bit naive. I was imagining labour to be a peaceful, joyful event in which I sat in the birthing tub serenely pushing out a beautiful, perfect baby. But as any parent will tell you, childbirth seldom goes exactly according to plan, and if my birthing class instructor were to ask me again what word I associate with labour, a whole bunch would probably pop into my head at once, none of them positive. Words like "exhaustion", "trauma", and, just like everyone else, "pain". And maybe "disappointment", as there were a number of things that left me feeling let down, not least of which was my own weakness. I may be exaggerating a wee bit, and really the birth wasn't that bad as far as births go. But it was just so much more worse than I'd imagined that I can't help but be a bit overly dramatic.

Things started out fairly well. I'd had a very easy pregnancy, managing to escape any major complications and even enjoying the minor ones (or at least finding them more fascinating than annoying). I hardly even had morning sickness, and what I did have was more like a gentle queasiness than full-on nausea. I learned to control it by eating frequently to keep my belly halfway full, but even when that didn't work and my stomach ended up too empty or too full, I'd just have to lie down for a little while to feel better. I actually loved being pregnant and once I was in my second trimester found I had lots of energy and was always really happy. And then getting closer to my due date, my body had been showing signs of preparing for the birth: a softening and slightly dilating cervix, loose stools (and if that's too much information for you, you'd better stop reading right now), increasing Braxton Hicks contractions, and a strange restless feeling that made me completely unable to concentrate on anything. That last one really pleased my midwives and they advised me to go with it and stop trying to use my head for anything: no reading, writing, watching TV or movies, or deep thinking. What was I supposed to do to pass the time? Listen to music, talk to the baby, and walk (my midwives were big on walking and I was supposed to be doing it for at least two hours a day). I would have preferred to have been hit with the nesting instinct, which would have at least resulted in a clean house and a freezer full of muffins, but it wasn't to be. Although the happy feelings and boundless energy I'd been experiencing were mostly gone, at least I knew my body was getting ready.

Despite all those good signs, Ku-chan (that was the baby's nickname when he was inside me) never dropped. He'd been in the head-down position for months, but he rode high and refused to lower himself into position. His due date passed, and the next day (the day before I went into labour) I didn't even bother keeping track of my contractions, although they were pretty frequent and even occasionally painful. I just assumed that until the baby dropped I wasn't going into labour.

That night, Sunday September 19th, both Hideaki and I slept fitfully. Hide had been having trouble sleeping for a few days and had come down with a really bad cold, so knowing he needed some rest before starting his work week he decided to take a sleeping pill. Not a decision taken lightly- those pills work so well they make it next to impossible to wake him up. We joked that I better not go into labour that night, or I'd be going it alone. Haha. Of course that night I went into labour.

Amazingly Hide's sleeping pill didn't work and neither of us slept well, as if somehow we both knew what was about to happen. Around 3:00am I was awoken from my half-sleep by my waters breaking. I'd been worried that I wouldn't know when my labour had actually started, since so many signs of labour are similar to things women already experience in late pregnancy, but there was no way to mistake this- it was like nothing I'd felt before and I immediately knew what it was. Within a split second of waking I was running to the bathroom, feeling like a dam had broken inside me. Often when a woman's water breaks before labour (and only about 13% of women experience rupture of membranes before labour, despite what you see in the movies) very little fluid actually comes out because the baby's head seals off the cervix, but as Ku-chan hadn't dropped yet there was nothing to hold the water back and man, did it gush. When I finally got off the toilet there was a river of amniotic fluid marking the path I'd taken from my bed. I noted with interest that the river started off clear and gradually turned pink.

So it was a big mess but I had little time to worry about clean up, as almost as soon as I woke up my contractions started. Not the wimpy Braxton Hicks contractions I'd been having for the past month, but real ones- again, there was no mistaking them. We tried to time them, but soon I had another thing to worry about- the water in the toilet was brown. I knew that was a potential indicator of meconium (baby poop, which isn't supposed to come out until after birth) in the amniotic fluid so we got on the phone to Mejiro Birth House, our midwifery clinic. We had some trouble describing exactly what shade of brown we were seeing- the classic sign of meconium is a dark green or black colour, and apparently if it was a light beigy brown it might not be a problem. What really got me worried was when my midwife asked how much the baby was moving- in all the excitement I'd forgotten about the actual baby, and now that I thought about it I hadn't felt it move since the evening before. How could I not notice something like that? I felt horrible, and terribly worried for Ku-chan. To be on the safe side we were told to come in straight away, so we finished up our packing and called a taxi.

It was a disappointment to have to go right to the clinic, as I'd hoped to spend as much of my early labour as possible at home. But in the taxi my pain increased and I found myself glad we were going early, as the ride was uncomfortable enough as it was- I couldn't imagine doing it once the real pain had begun. At the clinic we were greeted with another disappointment- the midwife had already been on the phone with the doctor (the clinic has no doctor of its own but works closely with a few), who advised against a water birth as he considered it risky when the waters have already broken (something that nobody had mentioned to me before). One of the main reasons I'd chosen this clinic was their water birth option, and suddenly it was denied me. I tried not to think about it too much, but was starting to dread having a natural birth outside of the tub.

After getting settled in I was checked out and with great relief we heard the baby's heartbeat- it was fast and strong and showed no distress at all. I was only 3cm dilated, and the baby still hadn't dropped, so we were encouraged to go out for a walk to help speed things along (and to get some snacks, since we hadn't eaten since the previous night's early dinner). It was nice to get out at first, but soon the pain became impossible to bear standing up (like most of Tokyo the neighborhood had no benches or anywhere to sit) and we turned around and headed back well before reaching the local convenience store. Once back at the clinic my contractions really started to hurt, and although I'm not totally clear on when each stage of labour ended and the next one began, I think this was when active labour started.

Around this time I experienced a major disillusionment: it turns out that having a baby is very undignified. I don't mean that I had thought labour would be free of yuck and gore, but I didn't expect all the burping. Or the throwing up. But here I was, hit with a sudden wave of nausea, like all the morning sickness I'd never experienced during pregnancy had been saved up somewhere and suddenly unleashed. First I threw up a few times, making my empty stomach even emptier. Then smells started to overwhelm me- the smell of soap, the fumes from a passing car, various other unidentified but thoroughly vile scents. Then the burping started. I stopped being embarrassed by about the 50th burp, but until then it was pretty mortifying.

And then there was the more expected part of labour- the pain. I thought I'd been handling it well up until that point, but I soon realized that was only because it hadn't been very painful yet. I tried a few different positions to see which one was the least painful, including one suggested by the midwife- me sitting on the birthing chair (an awful low stool with no arm or back support, topped with what appeared to be a toilet seat), leaning back into Hide who was sitting in a higher chair behind me. His chair was a cheap, wobbly folding chair with flimsy back support, and with the crappy chair, his cold, the heat (did I mention we were in the last heat wave of the year and the tiny room was kept un-air conditioned?) and all my weight on him, he wasn't doing well. He actually had to leave the room a few times to avoid passing out, poor guy.

I didn't find it much more comfortable than Hideaki did and the other positions I tried were worse, so I requested that the midwife unfold the cot and let me lie down, which she did rather reluctantly. I lay on my side, facing the wall, and this was the nicest position of all, so I stayed there for as long as I could (I think a few hours). Between contractions it was very restful, and during contractions I could get through the pain by using my arms to brace myself against the wall while Hide pushed into my lower back (he tried the balls of his hands, a tennis ball, and a plastic drink bottle, and the latter worked best). The midwife also tried rubbing my back which made it hurt even more, but for some reason I was too nice to say anything directly so just kept asking Hide to do it. That shows that the pain wasn't really that bad yet, because by the end of the birth I had no trouble just shouting "No!" and swatting away any hand that was bothering me.

Around this time my sister-in-law Atsuko and her daughter Marya came to visit. It was nice to have a distraction, and Marya got to see that childbirth wasn't that scary (thank god she didn't come a few hours later), which is important as her mom is pregnant and due in December. Meanwhile Hideaki had gone out to get some snacks and drinks, and the midwives (there were now three) were encouraging me to eat to get my strength back. I still hadn't eaten since the night before, and I'd thrown up again, and they were getting worried that I wouldn't have enough energy to get me through the birth. Unfortunately my nausea made all the food we had seem disgusting, and I couldn't keep down a bite of anything until someone suggested Hide go out and get some jelly drinks (I have no idea what these are called in English, but they're little pouches filled with jelly that you suck out of a screw cap). I'd never tried this stuff before and the sports drink type he bought tasted vile (and was made worse by the fact that they insisted it be warmed up first- wouldn't want to chill the baby with cold jelly!) but at least I didn't have to smell it so was able to keep it down.

The jelly did seem to give me a bit of energy, which I really needed as I was exhausted by this point. I hadn't started pushing yet so I wasn't really physically exhausted, but the pain was really tiring. I was rather proud of myself that I was able to bear it, and bear it quietly- the breathing exercises I'd been taught were working and there was none of the screaming and groaning I thought there'd be. I only panicked once in this stage and was soon encouraged to breathe properly, which calmed me down. Of course if I'd been able to actually speak articulately I would have demanded to be taken to a real hospital and given drugs, but I kept quiet and concentrated on my breathing.

I was still urged to eat real food and also to walk around but neither were possible, and as my labour wasn't really progressing I had to get off the cot and back into the dreaded birth chair to make use of gravity. I think this was also the time they strapped the monitor belts around my tummy (they'd only been doing occasional monitoring up till then), which I hated and kept asking to have taken off, which of course they couldn't and I'm now glad for it, since the meconium and my apparently slow progression made constant monitoring necessary. My contractions were getting more intense and I think I was almost fully dilated- I'd stopped paying much attention to anything by this point- and I'm pretty sure this was the transition phase (the stage of labour that comes before the actual delivery) but Ku-chan still hadn't dropped, so one of the midwives decided to reach in and grab him. This felt exactly as bad as you imagine, and I still don't know if this was a good thing to do. I've never heard of it before, don't know if this is widely practiced in Japan or if it's just something done by my crazy midwives. In any case it didn't seem to help things but still they kept reaching in there for the rest of the birth.

I was now in the second stage of labour and feeling the urge to push. From the very beginning of the birth I had kept being surprised by the escalation of pain, feeling at each stage that it couldn't possibly get any worse but then quickly learning that indeed it could. But pushing brought a whole new different kind of pain, and it wasn't a quiet kind of pain. I don't know how to describe the sounds I made while bearing down, but imagine screeching and grunting and shouting and moaning all at once and you'd probably be close. Just like the burping, it was undignified and for some reason I found it really embarrassing at first. Soon, thankfully, I wasn't even aware of my sounds, and was barely aware of anything except for the pain. Even when the midwives said the head was visible, I didn't think to ask for a mirror to see it, and my only real interaction with anyone was accepting or rebuffing offers of drinks.

I vaguely recall hearing hearing that my contractions were too weak and I needed to push harder, but I was pushing as hard as I could. I also heard the head midwife on the phone a few times, telling the doctor that my labour wasn't progressing. The head kept appearing with each push and then disappearing again, which is expected but it seemed like it was going on for too long.  Hearing the midwife talk to the doctor about it made me start to panic again, and I decided that I had to get that baby out. I used all my strength for each push, and still the baby's head would retreat as soon as I stopped. I don't know how long this went on but it seemed like forever, and I could feel myself getting weaker and weaker with each contraction. This made me even more panicked and I started to doubt that I could make it through. The monitors around my belly became unbearable and I kept trying to tear them off, and I was trying to demand the midwife get her hands out of me. I think all that came out was "NONONONO!", which not surprisingly they failed to understand (or heed, in any case). In fact they made it worse, and if having the baby's head pulled out of my uterus by hand was uncomfortable, having another midwife push down on my belly was ten times worse. The nonono's continued and I was ready to ask to lie back down and take a break, but hearing another phone call to the doctor brought me back. I finally consented to eat a bite of a Snickers bar, and it was the most disgusting thing I'd ever had, especially as it was half melted in the thirty-plus degree room temperature, but I I made myself keep it down.

Amazingly, that one awful bite gave me the strength I needed and with the next contraction I gave a few final, mighty pushes. And at 5:05pm, September 20th, my baby was born. Just like that. One minute the baby went from barely crowning, and the next minute it was ripping though the birth canal and landing in the arms of the midwives. I do mean ripping, by the way. One of the big reasons I had wanted to deliver with midwives and not a doctor is that midwives can't perform episiotomies, which are still routine in many hospital births here. So I guess a perennial tear was my punishment for not wanting to be sliced up.

I keep saying that each stage brought a new level of pain, so I'm sorry for sounding like a broken record but it's true. Despite the tear, I'm glad the baby went through my vaginal canal so quickly, because that was a whole different kind of pain and, understandably, I was getting rather tired of hurting. "Ring of fire" is a really apt name for the baby's journey through the birth canal. But finally I was feeling more than just pain, there was also a very odd sensation- I could actually feel the baby slipping out. I mean, when the baby was crowning I couldn't really feel it and wouldn't have known it unless I was told, but nobody had to tell me now that there was a baby coming out of me. I could feel the head, the shoulders, the butt, the feet, the umbilical cord, everything. It was a strange, slippery, rubbery feeling that I'll never forget and that made me feel instantly better. I was too tired to even look, but knowing the baby was out brought an amazing sense of happiness and relief.

I was helped to lie down on the floor and right away I hiked my dress up to my neck and waited for that slippery brand-new baby to be placed on my chest. And waited. And waited some more. I'd been told that babies usually don't cry loudly after birth like they do in the movies- they are often quiet or will wail a little. But the baby seemed too quiet, and they seemed to be taking too long cleaning it up. I willed myself the strength to lift up my head and look around, and saw that they were suctioning something out of the baby's mouth and nose. I got up a bit more and looked at the sheets between my legs, and they were stained not just with blood but with a huge amount of mucky dark brown liquid- the remaining amniotic fluid was indeed filled with meconium. It was explained to me that the baby had drunk and inhaled the meconium, but I didn't need to be told. Nobody seemed terribly concerned, and the baby was breathing, but the fact that the baby was not in my arms was so worrying.

I was still in labour and still attached to the baby by the umbilical cord. When the cord stopped pulsing (this is what I'm told, I never even looked at it) Hideaki was asked to cut it, something that he had thought he wouldn't be able to do. But he did it, which I'm really proud of him for, and he later reported that it was kind of cool and not gross at all. I was too tired to pay much attention. It took forever to pass the placenta. It didn't seem fair that I still had to work to push it out and that I was still in pain, but all of the distractions made it easier than delivering the baby had been. The pain didn't end when the placenta was out, though- one of the midwives put her hand back inside me and started mucking around in my womb. She said she was removing all the blood, something I've never heard of, and it was pure torture.

Meanwhile the midwife was on the phone again, and it wasn't to the doctor. She was calling her back-up hospital, and then she was calling the ambulance. Apparently the baby was still having trouble breathing and there was too much meconium for them to suction out with their equipment. And now I really was worried. It dawned on me that might be the last I'd see of the baby so I asked to hold it. The baby was placed on my chest, and much to my disappointment it didn't find my nipple and start to suckle- the time for that had passed apparently, but at least it was breathing and at least I could hold it. I could barely lift my head so didn't really get a good look, but I just enjoyed feeling it there and wished it could stay there and that we could be left alone together. I was scared but at the same time I was so happy to be holding my baby and so overwhelmingly tired that I chose to believe everyone when they said the baby was only being taken to the hospital as a precaution and that everything was going to be all right. And it was a choice- I made a conscious decision not to worry, being aware that giving in to my fear would make me lose it and I knew I just didn't have the energy to console myself.

The midwives continued to work on me and to occasionally suction the baby's nose and mouth but it stayed in my arms and just before the paramedics arrived I thought to ask about the gender. They held up the baby for me and I saw it was a boy. A boy! Shuma! I asked for a picture, in case it was our last chance. I look exactly how I felt: exhausted, out of it, and happy. He looks pretty tired too.

And then we heard the siren, and the paramedics were there, and Shuma, Hideaki and the head midwife left for the hospital. I was still keeping my worries and fears at bay, but I had no defence against the emptiness I felt. As the remaining midwives busied themselves cleaning up I allowed myself some tears, then resolved to stay awake until I'd heard some news.

Continued here.

 

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.

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 Asian 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 midsection. 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. Yup, even during a heat wave. 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. Never let your hair dry naturally! 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 where the ocean is warm, 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 or course 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 just 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 an already difficult time even harder, 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 some of 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 be in need of 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.

Cultural Differences: Pregnancy information

This is the cover of the June issue of Ninsugu, a popular Japanese pregnancy magazine. The cluttered layout is typical of pregnancy magazines here (and Japanese magazines in general), as is the very young, obviously not pregnant (and possibly not even capable of conceiving) foreign model. I didn't buy this issue, as I'd bought the previous one and found it completely useless. At the time I'd been really hoping for some good Japanese information on pregnancy to compare with the very good information I have access to in English. Since I wasn't getting much from my doctor and midwife and couldn't find anything useful online I figured a magazine might help, but it turns out that the one I bought was a big piece of garbage and that useful information on pregnancy in Japan is quite hard to come by.

It's bad enough that much of the pregnancy advice and information in Japan is completely different from western advice. What Hideaki and I find really frustrating though is the relative lack of official health guidelines or common-sense, universally agreed-upon information and advice during pregnancy. I have loads of information available to me in English: my own government, like those of most developed nations, sets guidelines for pregnant women. So do countless official medical associations and private and public organizations. Tonnes of books, magazines and websites are out there, and most of their advice is strikingly similar and based on the latest science. And of course there are certain things that everyone back home knows and takes for granted, without having to consult a book or website (like don't smoke and drink during pregnancy, abstain from fish high in mercury, avoid overheating yourself with hot baths and saunas, eat well, and so on).

Here in Japan, however, there doesn't seem to be any official organization that offers pregnancy advice (or if there is, nobody I know has heard of it). Although there are a few common sense sort of things that everyone knows, some of which are the same as back home (no smoking and drinking), and a few more that are unique to Japan (avoid chilling yourself, stay off your bike), there don't seem to be as many universally known rules. Instead, the advice and information a woman receives during her pregnancy will almost completely depend on who or what she consults.

Google "pregnancy" in English and tonnes of informative, useful websites pop up. Google it in Japanese and you get a mishmash of awful, hard-to-navigate sites (to be fair most Japanese websites are awful and hard to navigate though), many sponsored by private companies with commercial interests. The information they offer will vary widely and depend on who is paying for the site. When searching for something more specific you will likely be directed to a question-and-answer type of website, where the advice will of course be all over the place. Admittedly the same thing happens when searching the internet in English, but at least you'll have a pick of several more official sites before you are reduced to reading Yahoo Answers.

Japanese books and magazines are little better, mostly featuring cutesy cartoons relaying the most basic information, tonnes of profiles and interviews of real mothers and mothers-to-be that reveal what they did during pregnancy, and pages and pages of ads (in fact some pregnancy magazines are just catalogues with a small editorial section at the front). And virtually all pregnancy publications are completely aimed at mothers, with no information whatsoever for fathers- something Hideaki finds really annoying.

The cartoons and interviews make the magazines and books cuter, easier to read, and more accessible and reassuring, and this in itself is not necessarily a bad thing. But for those who want real information, these publications can be quite useless. For example, a pregnancy magazine I bought had an article called "My Pregnancy Rules" (the first two pages are shown above) and showed pictures of real moms (mixed in with models pretending to be pregnant and posing cutely) with their tips for how to deal with the various challenges of pregnancy. These moms offered help with stuff like "keeping warm", "giving up caffeine", "preventing constipation with wheat grass juice", by sharing their personal experiences and advice. But there was no actual medical information offered along with this advice. For example, nowhere in the article did it say exactly why the woman wanted to quit caffeine, or if the reader should follow her example. That caffeine is bad and that everyone should quit it was definitely implied though. Some of the tips were for things that are unquestionably good, like getting enough folic acid and quitting smoking. But for a woman with no other source of information, wading through all of the tips to find real, useful, science-based advice would be difficult indeed, and she would be left with the impression that drinking wheat grass juice and wearing socks at all times is just as important as giving up cigarettes and alcohol.

Books aren't much better, and the few that aren't filled with cartoons are really hard to read, with endless blocks of text and no pictures. I mean, there aren't any books that offer good information in an easy-to-read format. There's no "What to Expect When You're Expecting". The books also tend to reflect the author or editor's personal views or commercial interests rather than relaying established medical information (the wackiest piece of info I've read in a Japanese pregnancy book so far: "Yes, it's OK to have sex while pregnant, but use a condom"). Of course, I'm not completely literate in Japanese and haven't done an extensive search of pregnancy books (I gave up in disgust early on), so I could be missing something, but I suspect not. Stippy.com has an interesting post about Japanese pregnancy books, and I completely agree with the author's assessment.

So if there is little published information out there, can't Japanese women just get advice from their doctors or midwives? Maybe a few can, but most doctors here tend to offer little information and some actually get annoyed by questions, and midwives tend to be long on traditional wisdom and old wives' tales and and short on actual medical knowledge. My own doctor, luckily, is happy to answer whatever questions I ask, but gives no unsolicited advice (except for warnings not to gain too much weight, of course). He hasn't mentioned anything about getting enough nutrients like folic acid or calcium, for example, or avoiding mercury. My midwife (I go to both a doctor's office and midwifery clinic) does offer plenty of advice but much of it is suspect: keeping with the nutrition example, she has advised me to get plenty protein (but not beef!) and iron without mentioning any of the other important nutrients, and has a long, long list of "cooling" foods to avoid, including all fruit and dairy products.

So from what I can see, most Japanese women get most of their pregnancy advice from their friends and family, and when they need something more turn to magazines and books. There might be some good publications out there, but I haven't come across them yet (please comment if you've found one). I'll stick with my What to Expect When You're Expecting, thank you very much.

Now, just for fun, here are some pages from my copy of Ninsugu:

A typical use of cartoons in an article about budgeting.

A guide to undergarments in the three trimesters and after birth. I especially like the alarmed look on face of the second trimester lady as she suddenly notices the size of her belly (see this larger picture for a better look). Thank goodness she can buy gigantic underwear and girdles to cover that thing up!

Here's a guide to the "Perfect Maternity Wedding". Not that there's anything wrong with getting married while pregnant, but I find it hilarious that dekichatta kekkon (shotgun weddings) are now so common that pregnant brides have become a major demographic worthy of magazine articles and ads.

This is an illustrated article about what to expect at your first visit to the ob/gyn. Amazingly, most Japanese women never see a gynecologist until they are pregnant (or trying to get pregnant), so this could actually be quite a useful guide.

Also useful is this picture of a Japanese gynecological exam chair, as it lets me show you the special torture I go through at every doctor visit. As you can see in the picture at top, you start off in what seems like a regular chair, and it feels like you're just sitting normally (except that you are not wearing pants). Then the nurse presses a button, which causes four things to happen simultaneously: The entire chair will rise, the seat back will recline, the seat where your butt was will drop away, and the leg holders that were under your knees will lift and separate. One minute you were sitting comfortably, and suddenly there you are, trapped on your back with your legs up in the air and wide open, and your ass dangling at eye level. It's just awful, and makes me dread every visit.

See the little cartoon uterus at the bottom of the panel? She's saying, in that chipper yet reassuring cartoon uterus way, that this is the same chair you'll be giving birth in. Now, perhaps some idiot out there would find ytat reassuring, but that's one piece of information that I did not want to know.

Pregnancy in Japan: Cultural Differences

I've managed to survive my fourteen years in Japan without experiencing much culture shock. That doesn't mean I haven't faced cultural differences: there have been many, many of those, some of them huge, some of them trifling, and most of them interesting opportunities for learning something new. I thought I'd mostly gotten used to things though, and that there was little left for me to learn. But being pregnant has shown me that Japan has plenty of surprises left for me, and I think I might be going through a bit of culture shock, or at least culture surprise.

One early surprise was the lack of pregnancy euphemisms in Japanese. A few posts back I listed a bunch of ways to say "I'm pregnant" in English, and although I thought the list rather impressive I did manage to miss a few (as pointed out in the comments- it turns out there are expressions I've never even heard of, like "up the duff"). So the list was probably just a small sample of what's available in English, but in Japanese there's pretty much just one way to say it.

First, a mini language lesson: ninshin is "pregnancy" in Japanese, and with the addition of a verb or other word becomes "I'm pregnant" (or "she's pregnant") as in ninshin shiteiru, ninshin chuu, or ninshin desu. Those three ways really count as one in my book as they are all just variations of ninshin.

There are a few other ways to say it: a doctor who is reporting that your pregnancy test was positive might say omedeta desu yo or some variation (omedeta roughly translating as "congratulations"). It is a very polite expression and used more to announce another's pregnancy rather than identify yourself as pregnant. There is also the slang word dekichatta (very roughly translated as "I/we did it", with a strong "oops!" nuance), most often heard in the expression dekichatta kekkon (shotgun wedding). It is also used more for the initial pregnancy announcement and is always used in a slight joking or negative way. There may be other slang terms, but they would be used only within specific groups of people and I've certainly never heard them, and even if I had I wouldn't dare use them as Japanese slang evolves so rapidly that it would probably be out of date by the time I managed to remember it.

So because the above two expressions are rather limited in use, everyone just sticks with ninshin. On one hand it's kind of cool that the Japanese don't see any need to pussyfoot around the subject and are fine to just come right out and say it, unlike us prudish English speakers who often find it necessary to use an idiom. But at the same time this lack of vocabulary fits with the dearth of Japanese slang words, especially when it comes to body parts and bodily functions, which is kind of sad (compare the number of terms in English and Japanese for "sex" for example, or "piss", or "breasts", and you'll see what I mean). It really makes me appreciate the rich vocabulary of the English language.

Another cultural difference I discovered early on is that pregnancy is counted differently here. Japanese women are pregnant for ten months, not nine, and I just couldn't wrap my head around that until it was explained to me that those ten months are lunar months. Which means that each month lasts exactly four weeks, and four times ten equals forty: the exact number of weeks a woman is pregnant (by any country's reckoning). It actually makes a lot of sense.

With the western way of counting a pregnancy some months have four weeks and some have five weeks and there is no clear agreement: one baby book may say that the fifth month of pregnancy lasts from the 17th week to the 20th, others might say from the 17th to the 21st, others the 18th to the 21st. This also messes up the trimesters, with few sources agreeing on when each trimester ends and the next begins. But there is no confusion in Japan: the fifth month of pregnancy (ninshin gokagetsume), for example, is from week 16 to 19, and everyone knows it. The first trimester (ninshin shoki) lasts for the first four months, the second trimester (ninshin chuuki) the fifth to seventh months, and the third trimester (ninshin kouki) the eighth to tenth. Simple, right? The only confusion is that it's kind of hard to tell what month you are in just by looking at a calendar, as calendar months are different from lunar months.

One problem: although the Japanese counting system itself is not difficult, using it at the same time as the western system is terribly confusing. Especially for a math-challenged person like me. I actually had to create a chart to try to match up the weeks, so I'd be able to see at a glance where I was in counting system (the picture at the top of the post is my first attempt at a chart) So back in Canada I'd be eight months pregnant, but here in Japan I'm already in my ninth month. This was actually important at one point before I figured out the different systems and I went around saying I was four months pregnant, as per the western system.

Which brings us to cultural difference number three: the Japanese place a huge importance on the "danger" of the first four months, or first trimester, and it is a big, big event to pass safely on to the fifth month. Early in my pregnancy people kept asking me how far along I was, and since I hadn't reached the "safe zone" of five months would look all worried and tell me to be careful. I found this kind of ridiculous and just assumed this obsession with the fifth month was a silly old Japanese superstition, since where I'm from it's the fourth month that brings you into the safety zone (and people don't really obsess about the perils of the first trimester anyway). But I'd just not been calculating properly, and it turns out that this "safe" fifth month roughly corresponds to the beginning of the second trimester on the western schedule (and the risk of miscarriage does indeed go down in the second trimester). So it was a huge relief to my friends and acquaintances when I announced (a few weeks late, thanks to my faulty reckoning) that I was in my fifth month.

Thankfully healthcare professionals in Japan count pregnancy in weeks, just like everywhere else in the world, and there is never any confusion if I stick to weeks. Except that a Japanese pregnancy starts off at week 0 and a western pregnancy apparently starts at week 1. I think.

Is your head spinning too?

Pregnancy in Japan Part One: Resources

As mentioned in my previous post, I'd like to write a little bit about pregnancy and childbirth in Japan. I don't think I'll get around to posting as much as I'd like though, so I thought I'd start off with a list of the information and resources that are already available. You know, let others do my work for me. I hope it's useful for expecting parents in Japan (and for anyone who just has a general interest in pregnancy and childbirth in Japan, if you skip the  first few sections and scroll down to the Articles and Blogs sections you might find some interesting reading).

The following list may not be complete, so if there is anything I've missed please let me know and I'll add it. You'll notice that I haven't included a list of hospitals and birth clinics, and that's because I'm saving that for a separate post. This list is admittedly biased, with much of the information focused on mothers, geared towards English speakers, and specific to Tokyo, so again, if you know of any resources that would be good for dads, non English speakers, and those living other parts of Japan, then I'd love to hear from you.

Childbirth and breastfeeding education:

Childbirth Education Centre (CEC) offers childbirth, choosing a caregiver, and parenting classes by Brett Iimura, a Tokyo-based ICEA certified instructor. Hideaki and I will be taking her childbirth class next month.

Blue Sky, founded by lactation consultant Iona McNab, offered breastfeeding workshops, child and baby first aid training, and other services for new and expectant parents. Sadly McNab has relocated to Australia but the website remains as a useful resource and she continues to offer consultations via Skype.

Wisdom Childbirth's Allison Evans teaches Hypnobirthing, a childbirth technique that uses hypnosis to reduce pain and promote relaxation. Hypnobirthing is quite popular in Japan but as far as I know Evans is the only person teaching it in English.

Birth Education Services in Tokyo (BEST) offers pregnancy and birth preparation classes. Taught by registered nurse Ann Tanaka, the classes are held at the Tokyo American Club but are open to non-members.

Publications:

From Pregnancy to Childcare: How to Prepare for Childcare in Japan is available as a booklet and video in English, Japanese and several other languages.

Japan Health Handbook is a very useful resource for foreign residents of Japan, and has a good section on pregnancy and childbirth.

Being a Broad in Japan is now a bit outdated, but still has lots of good information. Perhaps one reason the book hasn't been revised is that Being a Broad now publishes a magazine, which frequently features articles about pregnancy and childbirth.

Japan for Kids, another book due for an update, has a section on pregnancy and birth.

Tokyo Families Magazine is a free magazine with occasional pregnancy/birth related content.

Weekender is Tokyo's oldest free magazine and frequently has useful information for parents and parents-to-be.

Online Groups and Resources:

Married In Japan (MIJ) is a members-only Yahoo Group for foreign women married to Japanese men (it's also open to women considering marriage to, living with, or divorced from a Japanese man). The discussions are not restricted to pregnancy and childbirth but the topics do come up often. I have received a lot of support and advice from this group over the years and highly recommend MIJ to any non-Japanese woman with a Japanese husband, expecting or not.

Foreign Wives Club, another members-only group, is open to women all over the world who are in bicultural marriages. It has an active message board with many Japan-based members, with pregnancy and child-rearing being a common topic.

Being a Broad has a message board open to all but of interest mainly to foreign women in Japan.

Japan With Kids is unfortunately no longer active but still contains a plethora of information, including lots about pregnancy and birth in the form of articles, links, and an extensive message board.

Child Research Net has information on raising and educating children, mostly translated from its Japanese website. Not much related to pregnancy and childbirth, but the site may come in handy once the baby arrives.

AMDA International Medical Information Centre has a number of useful resources, including printable multilingual medical questionnaires to bring to a clinic or hospital, especially useful for those who can't read and write Japanese and thus are unable to complete their clinic's own questionnaire. AMDA also publishes the "From Pregnancy to Childcare: How to Prepare for Childcare in Japan" booklets and videos mentioned above.

Real Life Groups and Resources:

Association of Foreign Wives of Japanese (AFWJ) has been bringing foreign wives of Japanese men together since 1969. Unlike MIJ, AFWJ requires a paid membership. Members can find others in their area, attend real life meetings and get-togethers, and read the journal published six times per year. Regional chapters also publish newsletters and there are various online groups as well. Paying dues may only be worth it if you actually want to attend gatherings and meet other women, but I am a member and do recommend it.

Tokyo Pregnancy Group brings expecting mothers together for twice-monthly meetings, each of which feature a speaker on a pregnancy, birth or baby related subject. There is also a mailing list which mostly consists of former members giving away or selling their used pregnancy and baby items- very useful for budget-conscious moms-to-be. Many members graduate on to the Tokyo Mothers Group.

La Leche League Japan is an international organization offering support and information to help mothers breastfeed. There are five English-language regional groups in Japan (and many more in Japanese) that meet up regularly and you don't have to already be a breastfeeding mother to join a group or attend meetings: expecting mothers can learn a lot, talk to other moms, and meet lactation consultants who may eventually be called upon to help once the baby arrives (many Japanese hospitals and birth clinics are not nearly as pro-breastfeeding as they claim to be). I've already attended one meeting and have learned a lot, and really feel relieved to know who I can turn to if I need help in the future.

Tokyo English Life Line offers a range of information and services, including a free and confidential telephone counseling service.

Here are a few other groups that are not specifically for expecting or new parents but may be useful, especially if you don't qualify for any of the groups above: Tokyo American Club Women's Group, United for a Multicultural Japan, Field of Mugi, and FEW Japan.

Newspaper and Magazine Articles:

Tokyo International Communication Committee's Pregnancy and Childbirth article outlines the paperwork (and there's a lot of it) involved with having a baby in Japan. 

Care The World has basic information on childbirth in Japan as well as instructions on buying its PDF book "All you need to know about birth in Japan".

Alien Times published the very useful article Pregnancy and Giving Birth in Japan. The focus is on the paperwork and much of the information is specific to Tsukuba residents, but it's worth a read no matter where you live.

Metropolis magazine has published a few useful articles: Local Experts Help Foreign Women Take the Pain out of Labor, Giving Birth in Japan and Birthing's Not For Babies. The latter article was of interest to me as the author had her baby at Mejiro Birth House, the birthing clinic I have chosen (and I agree completely with her assessment of the midwives there, both good and bad).

And speaking of my clinic, its founding midwife is quoted in the Japan Times article Midwifery Practice Seen Finding New Favor. Her comments, especially about eposiotomies, are what originally led me to check out the clinic.

Also from The Japan Times is Don't be Afraid to Ask Questions About Giving Birth in Japan, and Groping Pregnant Women Shouldn't be what it's About.

Weekender has a number of articles, including Birthing in Japan, Choosing a Caregiver Part One and Two, and Support for Breastfeeding.

 

Blog and Website Articles:

Babycafe Japan, although not recently updated, has lots of information on pregnancy and child-rearing.

Stippy.com's Getting Pregnant in Japan series is written from the point of view of a foreign man married to a Japanese woman. I get the feeling that he had lots more to say but his four-post series is quite useful and interesting: Part One: Becoming a Gaijin Daddy in Your Home Away from Home, Part Two: Which Baby Books to Buy, and in Which Language?, Part Three: Handy Internet Bookmarks, Part Four: Do Japanese Mums Need Less Calcium?. He has also started a series on the blog about being a foreign dad in Japan.

Spinshell TV has two really useful videos: Expecting in Tokyo Part One and Two.

Japan Window writes a personal account of Giving Birth, Having a Baby in Japan.

Frugal Japan's article Pregnancy & Childbirth has lots of tips for saving money

10 Tips for Dealing With Pregnancy in Rural Japan is actually relevant no matter where you live.

Yen for Living's Why Doesn't National Health Insurance Pay for Maternity Care? discusses the high cost of giving birth in Japan.

Japan Visitor has an article on Giving Birth in Japan as well as The ABC's of Childbirth in Japan, an alphabetized list of Japanese birthing vocabulary.

 

There is likely much more information available out there, so please let me know if I've missed something.

The official announcement

A student who reads my blog recently commented that the cutesy references (bun in the oven, etc) in my announcement post a few weeks back went right over her head, and even the picture of my enormous tummy might not have clued her in if she hadn't already known me and heard the news (because, you know, some women just have naturally big bellies). So for the benefit of any readers who are not native English speakers, or are used to seeing women with giant beer guts, or are just tuning in, here is the official announcement: I'm expecting. I have a pea in the pod. I'm with child. I'm knocked up, in the club, enwombed, in an interesting condition, full of fetus, eating for two, gestating, in the family way. I'm preggo, preggers, pregtacular, pregsellent. Let me just spill it out then: I'm pregnant.

I hope that clears things up.

Now for the details. I'm due September 18th, which makes me six months pregnant (or seven if you're Japanese- more on that another time). I don't know the gender, nor do I want to. We have a boy name picked out but are completely stumped on a girl name. Whatever it turns out to be, it will be the cutest, smartest, bestest baby ever.

I'll be having the baby here in Japan, hopefully at a midwife-run birthing centre called Mejiro Birth House. If all goes well it will be a water birth, and completely natural. That's not necessarily because I am a crunchy granola earth mother type, it's more because a Canadian style birth (with an epidural, husband present, and the choice to room in with the baby; and without an unnecessary episiotomy and ten thousand dollar price tag) is not available to me. So if I can't have it pain-free, then I'd like as few interventions as possible. I guess I'm an all-or-nothing kind of girl.

I've had an easy pregnancy so far, with only the occasional bout of very mild morning sickness (more like a gentle hint of queasiness) and a few other minor symptoms in my first trimester. I have a healthy appetite and although I have no wacky cravings, I did have a few general preferences and a whole bunch of strange aversions in my first trimester, all of which have gone away. I am full of energy, inexplicably happy and I love being pregnant. In some ways I wish the baby would stay in there forever. It's cute when kicks and hiccups, I can sleep all night (usually), and I don't have to deal with crying, dirty diapers, or sore nipples.

I was hoping to keep working (I only work part-time anyway) until the birth, but for reasons unrelated to my pregnancy my contract ended in April, and it didn't seem like a good idea to go job-hunting while pregnant considering I do want to stay home with the baby for at least the first year. So except for a few private classes per week I'm unemployed, which is the norm in Japan, as most women are expected to quit their jobs early in their pregnancies. I thought I'd be bored to death but am actually loving all the free time I have. I'd also love to have an income, but you can't have everything so I'm just enjoying this time off because I know it won't happen again for many, many years.

Being pregnant in Japan is really different from not being pregnant in Japan. Here's a hint: if you're feeling lonely or alienated in this country, if you hate the lack of human interaction and the way people go out of the way to avoid each other, if your neighbors ignore you and strangers refuse to understand your Japanese, then get yourself knocked up. Seriously. It's an instant ticket to acceptance. My neighbors have become way friendlier. Strangers automatically speak Japanese to me, without even seeming to notice I'm not Japanese. Strangers smile when they see my belly. People offer me seats on the bus and train (well, sometimes). A woman offered me her umbrella on a rainy day last week, "so the baby doesn't get chilled". Shop clerks tell me to be careful on my way home. A few cashiers at the supermarket have carried my shopping basket to the bagging station for me. Everyone is just so nice all of the sudden! It's like before I was just some random foreigner, maybe a tourist or maybe here for temporary a work contract, but certainly not part of the community. And now that I'm visibly pregnant I'm obviously here to stay, and thus a full-fledged member of society.

Of course, this society treats pregnancy quite differently than the one I grew up in. I could fill post after post with all the differences I've encountered so far, but based on my blogging habits of late I doubt that will happen. I would maybe like to write a bit about pregnancy and childbirth in Japan though, as there is not much information out there for people in my situation. I have no intention of changing the focus of Blue Lotus, so please don't worry about this becoming a mommy blog. But since pregnancy has pretty much taken over my life right now, you can expect a few baby-related posts in the future. So please bear with me while I bear this child.