Sunday, January 17, 2010

Maternity Care in a Foreign Land

My Japanese isn't especially good. I've made no secret of that. Despite my attempts to go to Japanese language classes while living here in Japan, my Japanese is just barely functional in say, a convenience store. "Could I please have one newspaper?" might be manageable.

Thus, when it was time for my OB appointment here in Japan (because of our travels I haven't been able to see a doctor for maternity care for just over 2 months) I took my husband with me knowing full well that I couldn't possibly follow a medical conversation with a doctor. I'm glad I took him. First off, it was nice to have some company while I spent over 2 hours in the hospital being shuttled up and down, back and forth to the lab for urine samples, blood work, what I'm told was an EKG (never had one so I couldn't say for sure), a brief meeting with the doctor who whipped out the Doppler (Yes! a heartbeat!) and finally the doula. We don't need a doula for birthing services as we will be back in the U.S. for labor and delivery. But apparently this doula's responsibilities also include maternity services much like a nurse in the U.S. might provide, such as nutritional counseling, information about weight control, etc.

This conversation with the doula was not my favorite part of the visit. She was shocked when I told her that my pre-baby weight was probably around 54 kg. and I'm now up to just over 60 kg. "54?!!" she yelled. I was so startled and confused by her yelling, that I thought maybe I was wrong. I refigured in my head and said, yes, 54. If you're not accustomed to metric terms, (and I'm not really) this means that I've gained about 12 pounds in my first 18 weeks. Not ideal by American standards but even more out of line by Japanese standards. As a result, I was given a chart with a request to weigh myself at home once a week and record it for future review by the doctor. They would like to see me every few weeks while I'm here. I don't know if that's standard, but I appreciate their thoroughness.

The doula went on to say that she isn't too worried since I'm not Japanese (I'm nearly 5'8" tall for heavens sake and as a result, bigger and heavier than most Japanese women). Still, by most American standards on was on the very low end of the weight chart for a woman my height before pregnancy, and while I gained quickly in the 1st trimester that's to be expected as I was eating as a self-defense to minimize the nausea and because at the end of the 1st trimester I was sometimes ravenous. This has all changed in the last several weeks and the weight gain has slowed, but now I'm more than a little paranoid.

The shock this woman expressed has been engraved on my brain. I'm sure my own doctor would have talked to me about weight gain and target weights, but I'm sure that she would have been far more sensitive about the whole thing. Not only does my own doctor know that I only gained about 25 pounds during my 1st pregnancy, but she also knows that was not overweight prior to pregnancy. I was stunned and hurt by the doula's reaction. It felt as though she was suggesting that I'm an overweight and out of control crazy American (not an unusual experience for a foreigner here in Japan). I'm sure many of my readers are familiar with this situation, and I actually expected it, but it was startling all the same.

The good news is that I've been able to explain to my husband how much this concerned me and we've made time in our family schedule for me to get back to my maternity exercise routine -something that had fallen by the wayside what with jet lag and settling back in here. Also, Gboy was able to explain what happened to his mother and I'm hoping that now when I say, "No thank you I'm done" when she offers me more food at dinner, she'll believe me. I appreciate her attempts to feed me, but portion control is out of the question when she just keeps dishing up equal portions to everyone at the table regardless of their hunger level.

By the way, does anyone have any speculation about why the hospital would want an EKG? I don't have any history of heart problems or anything else that I can think of which would even make that test relevant for maternity services.

Also, anything else I should be prepared for in my coming visits with the doctor? I've got an ultrasound scheduled for about 3 weeks from now.


  1. oh, medical care in japan...
    now, i can't promise that this will happen to you, but i had an ultrasound when i lived in japan because of some bleeding issues i was having (not preg related at all, mind you). they had this CHAIR... i don't know how to explain it, but it was kind of like a toilet chair in that there wasn't a whole seat. i had to sit in this chair and the whole thing was tilted back and they gave me a transvaginal ultrasound. it was SO WEIRD. yours should be transabdominal though, no?

    hearing about the ekg brought me right back to "physical day" at the school i worked in. i think everyone got an ekg. they let me bow out because i was crazy gaijin. oh, memories.

    good luck with your care there. i know the care is good, it's just seems a bit wacky at times. i'm sure the very same is true to japanese in n. america!

    good luck!

  2. Oh the crazy weight nazis in Japan. I was 74kg when I got pregnant and didn`t gain anything until I was out of my first trimester but I was already "big" to begin with. I am the same height as you though and 54kg is nothing- you are TINY! Don`t let them stress you out.

    I just nod and smile like I do with a lot of things in this country. I used to get pissed off but now I know the easiest thing is to ignore and let go.

    I didn`t have an ekg though- not sure why they did that. Maybe it is a hospital policy. Did your husband have any idea why?

    Good to hear bub is healthy though!

  3. Seriously, don't worry about the weight. Asian countries have an entirely different BMI scale.

    When I was in Japan I didn't bother going shopping since I was sure that even their biggest sizes wouldn't fit me -- that I couldn't even get my arms through the sleeves, nevermind finding anything that would fit my chest. I'm below the average American size (or was pre-babies, anyway) but the way that Japanese women are built it's like we're different species.

    My husband couldn't shop for a different reason: more than a head taller than anyone we encountered in Tokyo, except for other gaijin.

  4. I never had an ECG during pregnancy although I have had them here for health checkups. A variety of other tests though. I had several internal ultrasounds in my first trimester and then again - just internal checks - near the end. I had normal untrasounds and 4D scans at every other check up. The dopler only came out when I was 38 weeks - to check more for contractions and not the heartbeat. I wish I had been able to hear the hearbeat sooner. If I have another baby (god forbid) I will request to hear it sooner.

    Good luck with all the appointments. Compared to NZ, prenatal care in Japan is very very thorough.

  5. That weight gain sounds perfect to me??? I really wouldn't worry about it. You are a tiny-waisted person and you need some padding for that baby to grow!! Eat away, my friend.

  6. I agree with everyone else - your weight gain sounds perfect to me. And the EKG thing is no doubt one of those weird prophylactic Japanese health things - my school physical demanded a yearly chest x-ray, and none of the higher-ups could understand why all the gaijin were refusing to submit to them.

    Glad you're doing well!

  7. I had to have an EKG with my first. I think they wanted it to see if you have any heart defects or problems that would worsen with the stress of labor.

    What sucked is the doctor had me lie down on my back and he spent forever hooking up these antique wires all over my body. My son was resting right on whatever major artery goes along your spine cutting off circulation and I was hyperventilating ready to pass out.
    I can't imagine how awful the results were (high bpm) but it was good enough to pass whatever they were looking for.

  8. It would be so stressful to do all this in a foreign country and language! Glad you had someone to help you.