Here is a summary of the labours I supported in January of this year – 3 were at Ikuryo Clinic, 2 were at Aiiku, and 1 was at Seijo Kinoshita.
Labour 1 – baby born on Jan 7th
This was a 2nd time labour for my client. Her first baby was born mid-pandemic in 2021 in Aiiku hospital after a long labour with Dr Sen as her doctor. This time around, without Dr Sen being available as an OB anymore, and wanting a bit more flexibility with the labour & birth (not least wanting the option of her first child being able to be there in case of no childcare in the moment) she chose Ikuryo.
I supported her during some of her check ups, helped prepare her for her labour again, and was really happy to be there on the day.
Some pre-labour contractions began on January 6th but nothing significant (although noticeable, it wasn’t “hard”). At a check up on the morning of the 7th, she was 1cm dilated and her cervix was apparently 40% effaced (thinned out). She went back home as it wasn’t officially labour yet.
A few hours later at 3pm in the afternoon, things had got stronger and a lot closer. They headed to Ikuryo (older child as well as it was a Sunday and there was no childcare). She was 5cm on arrival which was great. I got there at 4pm and it was clear the contractions were nice and strong coming every 3 minutes.
As I was now there, it was decided that my client’s husband would go out with their older child (she was only 2) to help out and I’d stay with my client. At 4:20pm, she was moved to the delivery room and was 9cm at this point and bottom pressure was starting to build.
My client’s husband and child returned to the clinic (they’d been hanging around locally) and were in the waiting area as my client didn’t want her daughter in the delivery room at that point. She was trying all 4s and side-lying positions. By 5:15pm she was fully dilated. I was updating her husband and we were coordinating the time when I’d call him back to the room.
Baby was born at 5:45pm and her husband got back just as baby was crowning. At that point, I was just behind the curtain in the room with their older child who was trying to peek round – she was completely unperturbed which was good.
My client was able to have her skin to skin contact immediately – something she wasn’t able to have with her first birth until quite a number of hours after the birth. This was very special that she had a quicker and smoother 2nd birth.
Labour 2 – baby born Jan 12th
My client was admitted on Jan 11th in Seijo Kinoshita Hospital for the start of an induction. She was already 10 days past her due date. A prostaglandin was used to start preparing the cervix.
By the evening, contractions had slowly started to kick in and at 11:30pm, she was 4cm dilated. 2 hours later at 1:30am on the 12th, things had got a lot stronger and more frequent (every 3 minutes) and she was now 7cm.
I headed over and by the time I arrived at 2:30am, my client was 8cm. She was trying really hard to stay active and was using the active chair to manage during and between contractions.
She got onto the bed at 3am and was now 9cm dilated. The midwife could feel baby getting lower with the contractions, which was great. At this point, my client felt the need to vocalise during the contractions.
The water broke at 3:30am and 15 minutes later she was fully dilated. The urge to push was strong and she was now able to go with it. As can be the case for women at this stage, the feeling of not being able to do it came…but of course I was encouraging and motiviating her that all was fine and she was able to do it (we all get to a point where we think we can’t do it anymore).
My client was given a bit of extra oxygen to help and moved on to her side for pushing. The midwife suggested some oxytocin as the gaps were getting longer between contractions and the length of each contraction was also a little shorter. The oxytocin was started at 4:30am.
Baby was born just before 5:30am. The last 20 minutes were a bit of a challenge as baby’s heartrate dropped and wasn’t recovering as they want to see, so the doctor had to do an assisted delivery (vacuum followed by forceps). Baby needed a bit of special observation afterwards and so a transfer was arranged to Seiiku hospital (the NCCHD). While my client’s husband went with baby, I stayed with her. This part was understandably stressful for my client, but thankfully baby’s condition improved quickly. While these situations are uncommon (they don’t happen in most births), hospital and clinic staff have good protocols in place to deal with them.
Labour 3 – baby born Jan 17th
My client had a long pre/early labour. Contractions started slowly on January 13th. Over the next couple of days, my client went to Aiiku (her hospital) a couple of times to check to see how things were going and got sent back home with things being too early still. Her contractions were enough that she could feel them clearly and resting wasn’t easy, but not getting super powerful yet.
On January 16th, she felt that she really couldn’t stay at home any longer (already feeling so tired from 3 days of pre-labour) and went to Aiiku in the early morning. She was 2cm. She decided to get an epidural and an induction was started (oxytocin was given) to keep labour going and hopefully speed it up. I arrived mid-afternoon.
By 5pm she was 7cm and by 6:30pm she was 9cm. By 8pm she was fully dilated.
At 9pm, she was having lots of back pain. The doctor came and checked and all was fine – baby was getting lower. The anaesthesiologist came and did a top up of the epidural.
Baby was still too high for pushing so my client tried to move around on the bed as much as the epidural would allow. The contractions were also on the weak side despite the induction being at the maximum level, so the movement was important for helping to try and make things stronger. They also said no more epidural top up.
At midnight (now Jan 17th), the midwife said a vacuum delivery was looking possible as contractions weren’t strong enough for pushing and they were also a bit too far apart as well (a common occurrence with the epidural plus a long labour in general). It had also been a number of hours since my client had been fully dilated. The doctor then came in shortly after and confirmed that they would be doing a vacuum delivery as contractions weren’t becoming effective for pushing. The doctor also said that there was a chance of c-section if the vacuum didn’t work.
Thankfully, the vacuum did work and baby was born just after 12:30am. My client did have a post-partum complication with a lot of bleeding (post-partum hemorrhage) but it was managed smoothly with meds and a special balloon inflated in the uterus to help stem things and increase the effectiveness of the post-partum contractions.
Baby was taken to the nursery 15 minutes after birth (in part because of vacuum delivery) but my client could get a couple of photos with baby with her husband before. Whilst it was a tough labour, my client recovered her strength well after some post-partum care.
Labour 4 – baby born January 22nd
This was a 2nd baby for my client and the birth was at Ikuryo. My client had had a traumatic first labour a few years before in another country and reached out to me because she wanted support for a more positive experience and also to try this labour naturally (unmedicated)…as her previous labour was in-part impacted by the epidural.
With this baby, my client’s due date came and went…she was worried that she’d need an induction but the clinic was agreeable in letting her wait to 41+5 before doing one. Literally, the day before the induction date her contractions began!
She contacted me in the morning to say that contractions in the morning but they weren’t strong. As she was due for a prenatal check up at 10am, she waited at home till then.
I already happened to be in the clinic when she arrived for her check and whilst she was having contractions, they weren’t powerful yet. But it was certainly looking hopeful that active labour would kick in soon. When she got checked, she was 3cm and was also leaking amniotic fluid, so she was admitted. It was now waiting for baby time.
I headed off to my doula cafe while things were still in the early stages. But then 30 minutes later at just after 12:15pm, her husband called me to say she was now 6cm and things had really got strong, so I went back and got there at 12:40pm.
My client was very quiet during her contractions. just focusing on very slow, deep breathing. She was alternating between side-lying, using the active chair, and all 4s.
She went to the toilet at 3pm and that’s when things changed – more powerful still and she started saying she didn’t think she could do it. As much as I could, I tried to motivate and I also helped her switch to “balloon breathing” – a technique I sometimes use in transition that can help bring baby down and not panic by pretending you’re trying to blow up a balloon. She was good at following along and got herself mentally back on track very well.
The midwife checked at 3:15pm due to the clear change in how she was and my client was now 8cm and baby still a bit high. The doctor then came in to check a few minutes later and she was now fully dilated with a baby very close to crowing! The only 2 pushes later with her “balloon breathing” baby was born (at 3:25pm). Often when it’s a 2nd (or more) labour, transition and birth can come a lot more suddenly than with the 1st baby. She also got skin to skin straight away – something that she couldn’t have the first time (as baby was taken for checks) which upset her a lot, but this time she got to experience the wonderful feeling of having that immediately.
My client was so happy to have a smoother birth experience without the need for interventions this time, and I’m so pleased to have helped give her some confidence with it all! Especially well done to her as her baby was a few grams short of 4kg!
Labour 5 – baby born also on Jan 22nd
As the above labour was happening, another client was being induced as she was also past her due date and due to various personal reasons, including child care, she didn’t want to keep waiting any longer (she was 40+3). This was also her 2nd baby, with her older child having been born in the US 2 years previously.
She went in to Ikuryo in the morning to start the induction. As she was already 3cm, it meant that she didn’t need the cervix dilation part (balloon, sticks or prostaglandin) and went straight on to oxytocin.
Things went gradually and she was 4-5cm at 4pm when I rejoined them after the above labour. The staff turned the oxytocin off at 5pm as that often happens when there have been no significant changes on the first day of an induction. The contractions eased off a little but were still there. She decided to get an epidural (this was her plan anyway to get one at some point) so she could try and sleep before the induction was restarted in the morning. She got the epidural at 7pm and she was still 4-5cm at 8pm when the midwife checked again.
I went home as the expectation would be that it would be round 2 of the oxytocin in the morning. However, at 10am I got a call from her husband asking me to come back – her water had suddenly broke, she was now 6cm, and baby was going through some noticeable and apparently concerning heart rate decelerations.
I got back to the clinic and the staff were preparing for a c-section “just in case” they needed to switch to one suddenly. One of the senior midwives on duty thought that even though she wasn’t fully dilated yet, her cervix was very favourable (felt very soft and was thinned out) and that pushing may work, especially as it was 2nd baby. So just before 11pm, they got her to really try and actively push (she still had some feeling with the epidural which was very helpful for this). It went well and within a few pushes baby was born vaginally at 11:10pm – and no extra interventions were needed (no cutting, vacuum etc which can be the case when baby seems to be in distress).
Although they needed to check baby first, all the checks were done in the birth room and baby was doing well quite quickly. So a short time later, my client was able to get skin to skin and baby stayed with her that way for a long time (until it was time to move back to her room).
My client did a great job remaining calm when there were concerns for baby’s health and the preparation for a c-section – she trusted that staff would do what was in baby’s best interests and wasn’t worried. But ultimately I’m glad she could have a vaginal delivery and that that part went very quickly and smoothly (and that the senior midwife made a good judgement call about the “early” pushing).
As another fun note – this was also a big baby at 4kg on the dot.
Labour 6 – baby born January 26th
This was a first baby for my client and an Aiiku hospital birth.
On January 23rd, I had a meeting with my client & her husband, along with her parents who were visiting Japan for a few days. Her due date was the end of January and her parents were already going to be back in their home country then. At this point, there were no signs of labour.
On the 24th in the middle of the night she had a little spotting, and then she had a check up because she was a bit concerned (some degree of bleeding/spotting is very normal but of course it can make people worried). The cervix was closed and still thick. She thought she was feeling some irregular braxton hicks though.
Then around midnight going into the 26th, contractions started to become a bit more noticeable and frequent. By 7am, they were strong and she was having more bloody discharge (the bloody show). My client wanted to stay at home more as she was doing a good job managing things – also, the contractions were still not so regular yet, coming between every 4-7minutes, so there was still time.
By 9am, there was some bottom pressure as well and the frequency was every 3-4 minutes. They prepared to go to Aiiku and got checked at 11am. She was now 7cm which was great to hear. I was already near Aiiku, so I headed straight over and was there within about 10-15minutes.
At 11:30am, she needed some extra oxygen to help as baby was having some heart rate decelerations. A check just after showed she was already at 9cm! It seemed that the cord was around baby’s neck possibly causing some of the decelerations (the doctor checked with an ultrasound), but things stabilised with the extra oxygen.
My client was already getting a lot more extreme pressure in her bottom and by 12:10pm she was 10cm. The midwives started setting everything up for delivery. Overall, my client was very gentle in her way of dealing with contractions – a gentle voice and very controlled breathing.
My client was actually amazing with the pushing stage – following guidance well and staying calm and controlled, and by 12:48pm baby was born. At 1:35pm, she was then able to get 5 mins of skin to skin before baby was taken up to the nursery (as per policy). In Aiiku, skin to skin is only possible after everything has been sorted out with the mum (with stitching and cleaning up) and only if baby is in great condition, so it can take time before there’s skin to skin. Thankfully my client was able to get at least a little bit.
Here is a collage of some photos from those births!
Tokyo Doula Support 