A BIRTH REPORT
This is a journal written by an American woman living in Japan.
She describes her experience at a typical Japanese
birthing clinic, with her husband and
midwives in attendance.
Joshua Tajima Martin was born April 4, 1990 at 5:15 PM at Mikomi clinic, a midwife clinic in Hachioji, Japan. At his birth were midwives Shiga sensei, Nakatomo sensei, Ohtsuri sensei, nurse Sanae-san, our friend/translator/support person, Laura Soseki, and of course, Michael and myself. The following is the story of the labor and delivery leading up to Joshua's birth and of the wonderful first hours of his life at Mikomi (which means "anticipation, hope, promise") Clinic.
Contents
Labor Part I: The Waters Break
Labor Part II: Michael the Wonder Coach
Labor Part III: Off to Mikomi
Labor Part IV: Good News from Shiga Sensei
Delivery Part I: Bean Bag Chair in the Tatami Room
Delivery Part II: The Birthing Chair
Delivery Part III: Josh Arrives
Jizoh
Labor Part I: The Waters Break
It all started Tuesday evening, April 3rd about 11:30 pm. I had just finished my Jane Fonda Pregnancy Workout for the evening and had been asleep for only an hour or so. I felt a slight leaking while lying in bed and thought that it was probably just the "prelude" to labor that can take place days or weeks before labor itself. Over the next half hour, however, the flow of amniotic fluid increased, and I realized that there was no doubt about it: my waters had definitely broken.
At that time, I felt no contractions, and because we knew that labor could begin any time--even 24 hours later--we decided to wait until morning to call anybody. Although 2 1/2 weeks early, Josh had already "engaged" (dropped) into the pelvis 2 weeks prior to that, and 1 1/2 weeks ago, my cervix had already softened and dilated 2 cm. Even so, we had been convinced throughout the pregnancy that we would deliver later than our April 21 due date since late births seemed to run in my family. As we came to the realization that we were going to deliver in the very near future. We decided that a good night's rest was essential. So, although I didn't fall asleep right away, I rested and dozed for the next 2 or 3 hours.
By 2:00 AM I was feeling definite contractions. Labor had begun! They came roughly 12-15 minutes apart and felt exactly like menstrual cramps. I went to the bathroom often and wore a sanitary napkin since I was continuing to leak amniotic fluid. Again, I tried to sleep as best as I could and managed to doze on and off for a few minutes at a time.
By 4:00 AM, the contractions were now 10 minutes apart, and I started timing them. Lying in bed was rather uncomfortable during contractions, and I hadn't slept for a long stretch so I decided to get up. The contractions didn't demand much in the way of breathing but felt quite uncomfortable in the buttocks. I kept busy by packing my bag for Mikomi and copying over directions for registering the baby with the city office, the embassy, and immigration. (Peter later teased me for being so relaxed that I could write directions for registering a child that I was in the process of delivering).
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Labor Part II: Michael the Wonder Coach
By 5:00, the contractions were starting to feel like I could use some massaging during them, and Michael quickly got up to oblige. I eventually tried to get back to sleep and managed to sleep through a round of contractions from about 5:30 to 6:00. Meanwhile, Michael set off to stock up on supplies from the 7-11, and when I woke up, he had miso soup waiting for me--just the nourishment I needed. I took a shower, which felt super, and then managed to sleep for another half hour or so.
Just before 7:00, we called Mikomi, and I spoke to Nakatomo-sensei ("sensei" is an honorific used in addressing doctors, teachers, midwives etc.). I told her that the contractions were about 10 minutes apart and described the night's events. She asked us to call again when they were about 5 minutes apart but to stay at home as long as we felt comfortable. She told us that Shiga sensei, the head midwife who had examined me throughout my pregnancy, was returning from her vacation either late that morning or early that afternoon. We next called Laura Soseki (whom we were certain to surprise), but we must have just missed her since there was no answer.
Confident that we still had many hours before we'd need either Shiga-sensei or Laura, we took the contractions as they came. I focused a lot of energy not on the contractions themselves, but on ways of feeling more comfortable during them. I found it extremely helpful to be able to assess and reassess the effects of each technique. Over the hours I often liked rubbing my own behind during contractions. I also breathed deeply through most of them and almost always stroked and massaged my belly using small circular motions with both hands. Sometimes I wiggled my hips, and then for some contractions I sat in our newly acquired Scandinavian Balans chair in a pseudo-squat. The shower and hot water bottles were lovely when we finally put them to use, and I used the bean bag chair (another recent acquisition bought for labor) for a few contractions--kneeling in front of and into it. The all-fours position didn't seem very helpful, but Michael's massaging was perfect.
Actually, at first, it hadn't helped much to have Michael massage during the contractions, and in fact, it was easiest to deal with them myself. But it was great to have him massage and attend me between contractions. Then gradually it helped to have him just stroking my lower back or gently rubbing it, and eventually I was asking him to press as hard as he could. Michael seemed glad when the initial change occurred so that he could participate during the contractions and not just between them. He massaged eagerly while reading the Active Birth Partner's Book --a last minute brush up since, luckily, he'd read the book the day before.
At 9:00 we got in touch with Laura's husband--somehow we'd get the message out to Laura herself! But at that point, we still felt confident in what we were doing and how things were going. I felt in control completely because I could instantly evaluate how a technique was helping; and because of our extensive preparation in classes, and through books, we had a wealth of ideas available from which to choose.
The contractions themselves really varied depending on what we did. Generally they were 10 minutes apart, although sometimes they were as close as7 or as far as 15. Because I hadn't slept much the night before, I was able to doze through another round of contractions around 10-10:30 while kneeling on top of the bean bag chair. I was very grateful for the training in kneeling I'd had during pregnancy. Heat was wonderful - although lying down made me feel less in control. I loved my electric blanket and was happy to be able to doze under it.
There was still a regular flow of amniotic fluid with a slight pink tint although it was less than there had been in the middle of the night. I re-read in the What to Expect When You're Expecting book that the pinkish tint is the result of the capillaries in the cervix breaking as it dilates. We also knew that when babies are in distress, they often pass meconium or a black stool into the amniotic fluid which can be seen in the flow. Thus, the clearness of the flow (i.e., no sign of meconium) let us know that the baby was fine and the pinkish tint let us know that the cervix was continuing to open.
Michael continually encouraged me with reminders to think of things opening up (a technique learned in child birth class and from books), but I found it most helpful to keep my mind occupied with evaluating how I was helping each contraction. I felt extremely relaxed all morning--perhaps even a bit lethargic as a result of not sleeping regularly and having had a busy day the day before. Michael's reminders and encouragement helped a great deal in providing a morale boost. He kept saying that he couldn't believe how relaxed I was, especially while kneeling onto the bean bag. I think I looked like a very limp rag doll at that point.
All morning there had been only two longer contractions that had been very difficult to deal with. One came while I was kneeling onto the bean bag and I moaned (almost instinctively) to help me through it. The other came while semi-squatting on the Balans Chair--it too was longer than the others and I needed to consciously think of relaxing and breathing while massaging my stomach.
In addition to massaging and encouraging, Michael also kept busy by putting together a picture of Mount Fuji for use when the contractions got really powerful (another idea from child birth class). He ended up being unsatisfied with any pictures in out travel books and drew his own, complete with illustrations in the form of doodles of babies drawn during our childbirth classes.
Around 11:00, Michael set off the Tokyuu Department store and returned with flowers, strawberries and a melon (which I devoured). Because heat was so lovely, we tried the hot water bottle and I loved it. It was a whole new dimension of comfort! We started by having Michael hold it while I sat in the Balans chair and later I stood with it between me and the wall while wiggling a bit.
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Labor Part III: Off to Mikomi
Just after my fruit binge, around 12:00, the contractions seemed to have established themselves at a steady 5 minutes apart. We again called Mikomi, and Nakatomo sensei asked how difficult the contractions were. She suggested that we stick it out at home a bit longer since we seemed to be comfortable and to call when they became less than 5 minutes apart. We wrote down the time at the start of each contraction and we seemed to notice a pattern: one set of six contractions were 6, 5, 4, 3, minutes apart, and then just when we thought we were really on our way, they were back up to 4 and then 5 minutes.
A second shower seemed called for and again the heat and water were a godsend. I had another round of about 3 or 4 contractions while in the shower. They seemed to be coming anywhere from 3 to 5 minutes apart. Then, just as I was changing after my shower, we got a call from Nakatomo sensei suggesting that we come in to evaluate our progress and see how far dilated we were. I quickly dried my hair while Michael took the bags downstairs, including, of course, the bean bag chair. We were all set to go but first, we spent the next few contractions (it was now about 1:00) trying to figure out how to change the message on the answering machine. We wanted to leave a message for Laura to meet us at Mikomi. Finally, we figured it out, and I put in the call to the taxi company.
Then, the unexpected happened: the taxi company said there were no cabs in our area right now and we'd have to try again later! A call to a second cab company yielded the same result. We tried the first company one more time but without any luck. I called Mikomi and told them of our cab trouble--Shiga sensei came on the line. (Hooray! she was back from vacation). She asked how the contractions were and whether I needed to use any "hee hee fuu" breathing with them. When I said, "no", she reassured me with her motherly tone that there was no need to worry, and no need to rush; she said that the cheerful tone in my voice let her know that we could wait until a taxi became available, everything was fine.
Just as we were deciding what to do next, Laura called. She hadn't yet spoken to her husband and was calling just to see how we were. "Are you alright," she asked, definitely not expecting the answer she was about to receive--she'd just seen us yesterday when we were ready for up to a 3-week wait, and, suddenly, we were about to leave for Mikomi with contractions 3 minutes apart! She left right away to meet us there.
We solved the taxi problem with a call to my aunt, Fukahara-san. Since the cab company we were calling serves her neighborhood more regularly than ours, she called a cab to pick her up and then rode over to get us. Hooray! Then, while we were waiting for the cab, we had a round of contractions that we handled differently than the others. I was still standing leaning back against the wall with a water bottle between my back and the wall, but now, instead of breathing deeplly and rubbing my belly, at the beginning of each contraction I clasped my hands around Michael's neck as he faced me, let myself hang a little and told myself to relax. The result was amazing; after a sharp twinge at the beginning of each contraction, I could barely feel them. I noticed, however, that they were coming rather quickly now, and I was starting to feel tired and "out of it."
The taxi arrived and we loaded up the trunk - bean bag chair and all. Although Michael and I had planned to sit together in the taxi, I was more concerned about getting underway and so I sat in back with Fukuhara-san while Michael rode up front. During the taxi ride I had about three more contractions. I sat kneeling facing the back and taking in each landmark that brought us closer and closer to Mikomi. The cab ride seemed to make me even more "out of it", perhaps because I wasn't able to move around, apply heat, be massaged, etc.
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Labor Part IV: Good News from Shiga Sensei
When we arrived at Mikomi, I immediately went to the delivery table and lay down on my side. The next two contractions were very tiring, and I felt like I didn't have much energy at all, but luckily, Nakatomo sensei's gentle manner and expert touch helped a lot. She massaged my lower back with such precision that it was as if I had a sign on my back that said, "massage this spot." Shiga-sensei came in to check to see how far dilated I was. I tried to lie on my back but just then a contraction came--I rolled back onto my side and Shiga sensei told me to open my eyes and look at something. I resisted at first because I was trying to use some visualization to help, but since I wasn't being very creative at the time, I opened my eyes. Opening my eyes and focusing on an object at that point worked wonderfully; it made me feel a little more like I was back and involved.
The contraction ended, I rolled on my back and she checked my cervix. There was a slight delay as she searched for the English to tell me the good news--"Mmm. Good. Very good. Soft. Very soft. Mmm. Shikyuuko , mmm, shikyuuko " "Cervix," I offered. "Hmm. CERVIX...all open" What?!? Michael and I, and perhaps Nakatomo sensei, were all astounded. Suddenly I felt relief, excitement and disbelief. We'd made it through transition, the most difficult part of labor, without even realizing it. We never even needed the Mt. Fuji picture!
I stayed on my side thinking that now we'd just stay in the delivery room until the baby was born, but instead Shiga-sensei suggested that we move to the tatami room so that I could walk and stand and use all kinds of positions until I got some strong urges to push. I was grateful that she forced me to get up because I felt much more energized and ready when I stood compared to how I felt while lying on my side. She first took me to the bathroom to empty my bladder though. The toilet seat was heated and felt great, but after almost10 minutes or so, I still wasn't able to empty my bladder. No matter, she said, let's go the tatami room.
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Delivery Part I: Bean Bag Chair in the Tatami Room
The tatami room was all set up with the bean bag chair in the middle of the room. I started off by kneeling into it. Fukuhara-san left at that point and in her place--hooray! Laura arrived. Perfect timing! I was directed to say "fuu-un" through the contractions and wait until I felt the urge to push became so strong that I had to join in. I kept my eyes open and remember focusing on the casters of a blackboard in the room as Michael, Laura, Shiga sensei, Nakatomo sensei, Ohtsuri sensei, and anyone else who happened to be in the room joined me in a chorus of "fuu un's".
While still kneeling into the bean bag chair, Shiga sensei asked at one point where I wanted to deliver. In my rag doll pose folded over the bean bag I answered, "koko go ii" ("right here is fine"). She laughed and said that was fine. Although I can't say how long I must have been kneeling, I felt again very grateful for having practiced it during pregnancy. Soon, I was feeling the "urge" as well as the sensation that my legs were falling asleep, and thus a new position was called for.
Feeling completely uncreative and ready and willing to take orders rather then express ideas, I was very grateful that Laura was there to make suggestions for new positions. She suggested having both Michael and I sit on the bean bag chair with Michael supporting me from behind. We pushed the bean bag chair up against the wall so that Michael would also be supported. The change itself along with the comfort of having Michael behind me helped to make the position very comfortable - definitely better than kneeling forward.
The position also had the advantage of allowing us to use the mirror we had brought with us to see what was happening. Laura held the mirror up for us for a while until someone remembered the full length mirror in the next room. It afforded quite a view once they set it up!
The "urges" to push were surprising to me in that I had expected to feel more like I "wanted" to push since this was how it was often described in books. Yet, I found that I didn't want to push as much as I felt like I had to push; as if I simply had no choice in the matter.
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Delivery Part II: The Birthing Chair
I soon found that I was sliding forward on the bean bag chair and getting uncomfortable (Michael certainly must have been). So I tried kneeling forward onto the bean bag chair again. Unfortunately, my legs had already taken quite a beating and I found it not especially comfortable. I was gain fairly passive and awaited some directions which Louise obligingly provided without my even asking. She asked Suzuki sensei about the birthing chair that they had and the other midwives went to get it. I wasn't particularly interested one way or the other, but I was willing to try anything. As soon as I sat down, however, I felt so comfortable that I really felt ready to push the baby out. Shiga sensei had told me to "fuu-un" until I felt the urge, and then take three deep breaths and push from the abdomen. I hadn't pushed all that well in the bean bag chair, but now, sitting up, feeling well supported, I was able to concentrate more and do as she instructed. Shiga sensei had me reach down to feel the head, and although things had been moving smoothly, I was still astounded at how close we were to seeing it.
Because the chair was a bit tall for me, Nakatomo sensei and nurse Takeshita sat on either side of me and propped up my feet. They also slipped a cotton leg covering on each leg which helped keep my legs warm. With Michael behind me massaging occasionally and whispering, "yes! yes! yes! yes! yes!" as the head appeared, the midwives on either side of me stroking my thighs, Shiga sensei applying compresses on the perineum, and Laura offering words of encouragement and lightening the mood with photo spots, I felt so relaxed that I was able to rest comfortably between contractions and focus my energy for the crowning (when the largest diameter of the head passes through) that was about to come.
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Delivery Part III: Josh Arrives
Again, the room filled with a chorus of breathers--this time chanting "nuku, nuku, nuku, nuku, nuku" in an effort to keep me from pushing now and to let the baby slide out gently. The head peeked out just a bit more and when I reached down again to feel it, I was surprised by how soft and delicate it felt. Resisting the urge to push was very difficult, and my voice rose higher and higher with each "nuku." At one point I sang at Shiga sensei's request--another ploy to keep me from pushing. The only song that came to mind was the sukiyaki song, "ue o muite aru ko." A few more "nuku's" later and I felt the stretching of crowning. The stinging sensation was quite over-powering and it was at this point that I felt a need to distance myself from what was happening below. I looked away from the mirror and allowed the stinging sensation to take over. From the corner of my eye I saw in the mirror that Josh's head had emerged. Because the stretching was still strong, i joined in with one last urge to push, rather than fighting it, and again out of the corner of my eye I saw his body emerge.
It was with a combination of disbelief and relief that I took in the first sights of Josh. His body was a beautiful pink all the way down to his hands and feet. Laura said he was APGAR 10 for sure, and Shiga sensei confirmed it (10 is the highest rating, babies are assessed on Appearance, Pulse, Grimace, Activity, Respiration). He cried right away with a heart-warming quiver of his lower lip, and he didn't even need to have his airway suctioned. Books had talked about how unattractive newborns are with their long heads, blemished skins, and creamy vernix-covered, slightly bloodied bodies, but Michael and I thought Josh was absolutely beautiful. His delicate skin was a lovely pink, the vernix looked like a nice feeling cream had been applied, and he wasn't the least bit bloody.
While I was still sitting on the birthing chair, Shiga sensei handed Josh up to me right away. The midwives lifted my sweatshirt, helped him latch on to my breast and away he nursed. He sucked so vigorously I thought he might even have teeth already! Michael did the honors of cutting the umbilical cord following Shiga sensei's directions and the placenta came out so quickly that I didn't even notice any contractions.
The midwives attended to me and got me wrapped in a koshimaki (a sash wrapped around my still large waist) and prepared the futon for me to lie down. I was rewarded for my many months of pelvic floor exercises and weeks of perineal massage with the news that I hadn't torn at all (and of course, they had not done an episiotomy either). I was delighted at how healthy and energized I felt, I was only slightly sore and was already doing pelvic floor exercises within the hour.
Meanwhile, Michael and Josh spent a number of minutes in rounds of gazing. It was hard to tell who was more in awe, Michael or Josh. Josh was weighed and measured and dressed in a wonderful soft white flannel kimono. The midwives laid him in my arms while I lay on the futon, and in what seemed like record time, they cleared the room, mirror and all. They quickly and quietly left us alone, turned down the lights, and there we were--a family. Ichimori-san, the cook, brought in the first of many home-cooked meals which I would enjoy during our five-day stay, and Laura brought yogurt and juice from the 7-11 along with warm words of praise before she left. Josh slept soundly on the baby futon next to mine while Michael and I congratulated ourselves and Josh on a job well done. The birth of Josh was now complete and the life of Joshua Tajima Martin was under way.
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Beneath The Wave off Kanagawa
by Hokusai
