Aiiku Labour – Now I’m back in person again!

Some of you reading this may remember that I was recently given permission to start attending births again at Aiiku hospital (as they had strict restrictions in place with the pandemic). Even though I was able to support many births virtually at Aiiku, I’m really glad to be back there in person. It feels a bit like going home, being a hospital I was at so many times before the pandemic started.

Anyway, last night (into the early hours of this morning) I was able to go to a labour there. It was the 3rd baby for my client and her first in Japan. Her and her family had only recently come to Tokyo at 36 weeks pregnant. They were originally in South Korea with the military there and had a choice to make of whether to stay in Korea for the birth and travel and set up in Japan with a newborn, or come to Japan first and give birth here. They chose that option. But coming at 36 weeks is not for the faint of heart – as they had a lot to do in a very short window of time. Get accommodation, get a hospital, and sort out all other day-to-day stuff. ]

My client contacted me just as they arrived in Tokyo asking if I had space to support them. I know how overwhelming a move like this must have been – quite a quick decision on their part – and of course I said I’d support as far as possible. The first step was helping my client get set up with a hospital. This was made a little more complicated by the fact that she wanted somewhere that supported VBAC (vaginal birth after c-section). Her first baby was born by c-section, her 2nd was a successful VBAC, and she wanted that same vaginal experience this time, too. That meant her hospital options were really limited here. She also wanted somewhere that allowed partner and doula support. We discussed 3 places – Ikuryo Clinic, Aiiku Hospital with Dr Sakamoto as the only Doctor that does VBAC, and Tsuchiya Clinic. Tsuchiya was just a bit too far out realistically for her being new to Japan (excellent place, though). Ikuryo Clinic was a top choice but it would have been tricky to get a spot for VBAC there so late. So we settled on Aiiku using Dr Sakamoto. The timing was great because it was just before his retirement from births.

My client was able to get an initial appointment with Dr Sakamoto a few days after arriving at the Aiiku Clinic, and then had a hospital appointment the following week at 38 weeks. They asked for me to attend that appointment with her in case the midwife on duty going through the birth plan didn’t speak much English. After that, and one more appointment with Dr Sakamoto, it was a waiting game. A c-section date had been set as well for 4 days after her due date in case baby didn’t come because in Japan inductions aren’t done for VBACSs.

My client’s due date came and went. She had said she was feeling low and emotional at the thought of baby not coming naturally and needing a c-section again. But then on the evening of March 20th, her contractions began. She contacted me at 11:30pm to say she was heading to hospital as the contractions were roughly every 3 minutes. I went to meet her and her partner there. She was doing great and breathing through everything, mostly standing up and leaning forwards and also trying to sit from time to time. She was 3cm dilated and feeling a bit of pressure in her bottom. Dr Sakamoto was already at the hospital and checked in a couple of times. The midwife on duty spoke some English but also asked me for help with translating from time to time. Dr Sakamoto broke my client’s water at 1:45am (this is something he does quite frequently). 15 minutes later she was 6cm. My client was given some extra oxygen as baby was having a few heart rate dips according to the monitor.

The pressure in bottom continued to be there and get even stronger. I assured her that she was feeling baby pressing down and that’s a really good sign. She was starting to find breathing tough and I was in front of her breathing with her, coaching her through while her partner was behind her doing hip squeezes. She commented that she didn’t like the process of labour one little bit.

At 3:15am, the pressure was really strong and the midwife did another check. She was the same at 6cm. I said to her that with the pressure she was feeling and that it was her 2nd vaginal birth, the last part of dilation would probably suddenly happen and she’d be 10cm and baby would be born really soon. The pressure was just unrelenting and she decided that she really wanted the epidural. Dr Sakamot can to do it at 3:30am and the epidural with finished about 20 minutes later. She was still feeling the bottom pressure a lot and could barely stay still during the epidural. Just as I predicted though, when the epidural was finished and she was given another cervical check shortly after, she was fully dilated and baby’s head was right there. Everything was set up for delivery and within one push baby was born at 4:19am.

She said afterwards, that I had called it with how I thought things would go. I often see, especially with 2nd (or more) births that when the woman gets to the point where she just feels like she can’t continue any longer, baby is so close to being born.

Ultimately, she felt really happy with her birth – it went relatively quickly (9 hours from the start of contractions, and about 4 hours of active labour), and she felt well-supported. She was really brave in making the decision to come to Japan right at the end of her pregnancy and I’m really glad she could get the birth she was hoping for. And, on a personal note, I’m so glad to have another labour in Aiiku. I just really hope they relax the visiting restrictions more!

Here are some photos!

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

My Doula Support is back in Aiiku Hospital!

After an almost 3 year hiatus (due to the coronavirus pandemic restrictions) I have finally been given permission to attend births in Aiiku Hospital again! This will be to support international couples having their babies there to bridge the gap with communication & culture (as well as everything else that goes into doula support), especially now that the International Unit doctors – Dr Sakamoto and Dr Sen – will no longer be doing labours. While some Aiiku staff do speak some English, it’ll be quite different without Dr Sakamoto or Dr Sen at births…and so I will be able to explain what’s going on, provide language support when needed (English/Japanese), and hopefully make it a smoother experience all round for international patients and staff. Having that familiar, continuous support of me as a doula can (as I always hope) make a big difference.

I had a meeting at the hospital today with Kato san who heads up the midwife team in the LDR & OR unit and also Ishikawa san who is the hospital’s Director of Nursing (thanks to Dr Sakamoto who provided the introduction). They were both very positive about starting up my doula support again and Dr Momoeda, the hospital director, is happy if his head nurses are happy. They have known that I’ve been very frequently at facilities such as Ikuryo Clinic (which have had practically no restrictions) and so know of how I work, and they also remembered me from pre-pandemic times. This is such excellent news for me and future clients going forward and something I’ve been hoping for since the pandemic started and the all restrictions began.

Of course, there are still some restrictions in place – the visiting ones being the biggest (as it has only recently been increased to an hour a day between 1-5pm for partners). So that isn’t ideal. It’s hard to say whether Aiiku will increase visiting more at some point after May once the government downgrades Covid – that would be good (let’s see). So, Ikuryo still has the edge on that with their visiting policies and overnight stays for partners. But all this is a step in the right direction for Aiiku!

So, for anyone who is considering or even booked in to have a baby at Aiiku and would like my doula support, please get in touch for an introductory call. I am almost fully booked for April, May and June. 2 Spaces left in July. I will, unfortunately, be unavailable for most of August due to the summer holidays, but again I have more availability from September.

Recent (Virtual) Birth Support at Aiiku

For those of you planning to have a baby in Aiiku, you may know that *currently* as of October 11th husband/partner can attend birth there again and 1 hour of visitation is allowed between 1-5pm (husband/partner only). This is better than the situation back in Feb-end of March and then mid-July-October (and at other points in the pandemic) where women weren’t allowed to have any birth support or visitation. Skin-to-skin is still limited, though, to 5 mins (maybe 10 if you’re really lucky) before they take baby. The unpredictability of restrictions has definitely been a source of stress for women and, as many of you know, has led to a lot of people switching to other places (such as Ikuryo Clinic or Tsuchiya Women’s Clinic). But some people have of course chosen to stay with Aiiku for various reasons, and for these birth I’m still supporting virtually (compared to pre-pandemic where I’d be there in person almost each week).

Here is an account of a recent birth I supported in Aiiku last week!

My client was pregnant with her second child and reached out to me at the start of her 3rd trimester for support. During her pregnancy, we had our regular meetings to prepare together for labour and go through what to expect. It’s always great getting to know couples during this time and ease their minds about things (mental preparation is just as important as physical). And, having that go-to person to ask questions to without being bothersome can be emotionally reassuring too. Having a Doula is a very different relationship dynamic to any other birth support person – husband/partner, doctor or midwife.

Anyway, Aiiku initially wanted to induce my client at 40+3…claiming a big baby (weighing in at 3.3kg at 40 weeks…not big at all by European/American etc standards). Right before the induction date, my client fell ill…fearing the worst of Covid (it’s a c-section if you test positive for Covid in Aiiku and many other hospitals). The hospital cancelled the induction and my client had to do a PCR test. Thankfully, it wasn’t Covid and, as a silver lining, it meant that my client was able to wait till exactly 41 weeks for the next induction date (so she had time to recover).

On the first day of her induction, as can be normal in Aiiku and other hospitals, she was admitted in the afternoon initially to see if her cervix needed any initial “prep”. Basically, if her cervix was closed or only 1-2cm or still long and not yet soft, they would use a balloon catheter inside the cervix to start the process of thinning it out and opening it up 3-4cm. The method can be slightly different depending on each hospital but the purpose is the same. For my client, this wasn’t needed as she was already 3cm dilated and it was also her 2nd baby (her body had done this before). So she was just able to rest.

The next morning, the induction medicine (synthetic oxytocin) was started through an IV drip at a low dose. Over time, this was gradually increased. By midday, she was having frequent strong contractions and was able to get the epidural that she had wanted. In her case, the epidural had more effect on the left side (her right side was still feeling things), so they tried a few things to reposition her to help.

By 3pm, she was at 4cm with a 50% effaced cervix, and then by just before 5pm she was at 6cm. My breathing techniques and support were helping a lot as she was still having some degree of feeling even with the epidural. Then by 5:30pm she was at 8pm. The anesthesiologist also came by around then and repositioned the epidural which helped with a more even spread of relief.

At 6:45pm, she was fully dilated and it was a case of waiting for baby to get low enough in the pelvis now. Not time for pushing yet. At the same time, a temperature check revealed a 38.5 degree fever. My client wasn’t feeling unwell, though, so it seemed like it was a classic “epidural fever” which is a known side-effect of the epidural. The hospital did say that they’d have to test her for Covid again after birth if her temperature doesn’t come down (as it’s protocol for fevers regardless…a bit frustrating).

Finally, baby was born a little after 8pm. Unfortunately, my client wasn’t able to get any skin-to-skin (not even the 5 minutes) with baby because of the fever issue and the fear of it being Covid. Baby was taken to the nursery pretty much straight away. Eventually, my client’s fever did go down and it was clear it wasn’t Covid (as I mentioned, this is a pretty common reaction to the epidural), so it was a shame she missed out on that initial few mins with her baby. But I’m glad it wasn’t Covid as the policy of separating mums and babies is strong here still (if mum is positive at birth and baby isn’t). It took a number of hours until baby was actually able to be brought to her as she stayed in the LDR for some extra time (due to heavier blood loss) and it wasn’t until the early hours of the morning that she could have baby with her. From that point on the rest of the stay went smoothly and breastfeeding got off to a good start (after some initial sleepiness from baby).

Throughout the process in hospital, I was in contact virtually with client and her partner (phone calls, video calls, and messaging) supporting them, giving info, and advice.

As I write this post, my client and her baby are now back at home and adjusting to life as a new family unit of 4 (mum, dad, big sister and baby).

If anyone would like a consult about their hospital and what to expect, other options, the birth plan, or want a birth preparation session, please get in touch. I only have very limited availability between now and the end of the year due to my work with clients. If anyone is curious about Doula Support, please send me an email here for a introductory Zoom call! I have available for new client who have due dates from Feb 2023!

For more info about Aiiku, please see here.

Dr Sen at the Aiiku International Unit Clinic News

Some of you may already have heard this news, but Dr Sen has announced that she’ll be leaving the IU end of March 2023! This means that she’ll no longer be accepting patients for birth who have due dates after the end of February 2023, but she’ll continue providing prenatal support to anyone who needs it until then.

This is something she has been considering for some time and has finally decided the time is right for her to resign. Dr Sakamoto will continue his work with the IU by himself (most likely, gradually, cutting down the number of births he attends although there is no news about when he himself will retire yet…it is just a matter of when).

For those who are wondering, Dr Sen won’t be going to work at another hospital for the time being and will be taking a break from clinical work, but is still undecided about her own next steps.

As a doula, I have always got along really well with her – professionally and personally. She’ll be missed in the international community as an OBGYN.

Aiiku Birth Skills Special Zoom Preparation Session – Preparing for Labour without your Partner!

Edit as of Feb 5th 2022: Since February 1st, Aiiku hospital have completely stopped husband support in labour, and as of Feb 3rd they have also stopped skin to skin after birth – mothers need to wait a certain number of hours before they can hold and have skin to skin time with their babies!

As of Monday, January 24th, Aiiku hospital are no longer allowing partner/husband support “in principle” due to the increased numbers of covid thanks to Omicron. According to the doctors of the International Unit and hospital midwives, the reality is that partners/husbands have either not been allowed in at all or only been allowed in for a very limited amount of time (last hour or so) and that nobody has been able to stay the whole length of labour at the hospital.

This, undoubtedly, has made many couples feel very anxious – especially as these restrictions were reimposed so suddenly after a long period of support being allowed at Aiiku again during the pandemic. For me, it reminds me of April-June 2020 when partners/husbands were not allowed in, in Aiiku – the stress then was a lot.

So, with all this being said – with this being the current, frustrating reality right now – I’ve been in touch with the International Unit doctors who would like me to provide a special Aiiku Birth Skills preparation session on Zoom for this: for how to prepare for going through labour in Aiiku without as much or any support from your partner/husband. This will incorporate many of my usual Birth Skills/Birthing with Confidence class elements with a specific focus on labouring both at home with a partner and alone in Aiiku – it would aim to alleviate anxieties as far as possible as well as foster a more positive mindset with useful labour coping techniques (my famous Breathing for Birth, positions, how to stay home as long as possible and more). Over the past 2 years I’ve had extensive experience in supporting other couples in Tokyo and other areas of Japan with this, so will bring this together for this special preparation session.

Here are the details:

When: Sunday, February 6th, 9:30am-12pm

Where: On Zoom – Virtual, so those who are due very soon can feel safe at home

Class content:

• Understanding the labour process

• How to stay home for as long as possible with comfort measures, breathing and other useful tools

• Positions and massage for partner at home

• What to look out for and when to go to hospital

• Labouring in Aiiku with virtual support from your partner – how to set that up

• What to expect in Aiiku from staff, and what you can use when you’re there

• Mental and emotional preparation for labouring alone

• The early post-partum period at the hospital and how you can have a more positive experience with that

Cost: 10,000 per couple – spaces are limited, so please rsvp to me here asap!

As I know Aiiku hospital very well (through hundreds of clients over the years), questions are very welcome and I’ll try my best to answer them. I really want everyone to feel supported and as informed as possible!

If you are unable to attend this session but want to take the class, I may possibly offer another Zoom date later in February. Private sessions can also be arranged (please enquire).

For more info about Aiiku, here’s a more recent write-up I did recently here.

Also, here’s a post from 2020 that may also be helpful about tips for giving birth alone here.

All About Aiiku

Edit as of March 2023: I AM NOW ALLOWED BACK AS A DOULA IN AIIKU!

Edit as of February 16th: Visitation has been upped to 1 hour for husbands/partner (between 1-5pm). Partners are also able to attend appointments. No changes on skin to skin yet (still 5ish mins).

Edit as of November 28th: Visitation has been reduced to just 15 mins for husbands/partner. No partners allowed at hospital appointments.

Edit as of October 11th: Birth support from husband/partners is allowed again (finally).

Edit as of September 26th: 1 hour of visitation is allowed for husbands/partner only between 1-5pm. No birth support yet.

Edit as of July 25th 2022: Birth support from husbands/partners has been suspended again. No one is allowed in during labour, or in c-section operations, and no visitation afterwards. Skin to skin contact has also, again, been restricted to 5 mins (with no first breastfeeding during this time in principle).

Edit as of July 15th 2022: Since July 13th, partner visitation has unfortunately been stopped again. No visitation is allowed during the hospital stay.

Edit as of May 30th 2022: 1 hour of visitation is allowed between 1-5pm (husband/partner only)

Edit as of May 16th 2022: 1 partner is allowed to attend prenatal appointments at the Aiiku Clinic (the hospital also allows 1 partner to attend).

Edit as of March 22nd 2022: With the end of the quasi State of Emergency, husbands are allowed to attend labours again (no visitation afterwards, though). Skin to skin is 5 minutes only – masks are to be kept on and no breastfeeding at this time (but after baby returns to mum a few hours later, it’s fine). Scheduled c-section support is allowed, and emergency c-section on a case-by-case basis.

Edit as of Feb 5th 2022: Due to the coronavirus pandemic (thanks Omicron), Aiiku have stopped all husband support at labours, and also there is no more visitation. Skin to skin contact at birth has also been removed. If anyone feels anxious about this, please get in touch! I’ll update if things change.

Aiiku is perhaps the most well-known hospital for birth amongst English-speakers living in Tokyo, primarily for the open system Aiiku International Unit. As a doula, I have had extensive experience in Aiiku over the past 8 years (including the old Aiiku hospital, which is now the Aiiku clinic, back in 2014) in countless births (somewhere approaching 200 just with Aiiku), supporting couples both through the International Unit as well as the general unit. In this post, I’ll talk a little bit about about Aiiku, the differences between the IU and the general unit, and general hospital policies (both pre and during pandemic times).

Aiiku hospital was originally opened in the late 1930’s and soon after established the Obstetrics unit for which they have become very well-known for. It has a “royal reputation” due to some members of the Japanese royal family having given birth there and this has made it a popular choice for Japanese families in Tokyo. Aiiku hospital used to be in Hiroo – the building that currently operates as the Aiiku Clinic is. In 2015, the hospital moved to the location it is now in (Shibaura), a short walk from Tamachi and Mita stations.

Aiiku hospital is exclusively for pregnancy, childbirth, gynecological issues and pediatrics. It has both a NICU (neonatal Intensive Care Unit) and MFICU (Maternal and Fetal Intensive Care Unit) and can, therefore, manage certain high-risk patients and pregnancies as well as very straightforward and uncomplicated ones.

There are 2 pathways to having a baby at Aiiku:

1. Through the regular/general unit (i.e directly as a hospital patient).
2. Through the International Unit (an independently-run clinic, whose doctors have privileges -permission – to deliver babies out of Aiiku as part of the Open System). *Please note that this unit is sadly ending births in April 2023 as the doctors retire from deliveries*

1. For those who choose the regular/general unit and go through the hospital directly (either at the hospital or at the Aiiku Clinic general unit), you may see the same doctor for all your prenatal appointments. Some of the doctors have very good English while others a little less so, but generally it doesn’t seem to be a huge issue with prenatal appointments. When it comes to labour, the doctor who’ll be overseeing the care at that point will be whichever doctor is on-call at the time. This is very typical in most hospitals in Japan with labour.
2. For those who choose the Aiiku Clinic International Unit, it is a separately run clinic within the Aiiku Clinic building in Hiroo. This particular clinic is exclusively English-speaking – all the doctors, clinic midwives, and admin support speak English, and Spanish & Chinese can also be supported there language-wise. Dr Sakamoto heads up the International Unit along with Dr Sen (his female partner doctor) and there is also Dr Yuzawa. With the International Unit, you can choose either the open system or semi-open system. If you use the open-system, it means you can choose to use either Dr Sakamoto or Dr Sen (not Dr Yuzawa as she doesn’t do births) as your delivery doctor as well as for prenatal appointments. Essentially, you are hiring them privately and they have permission from the hospital to deliver babies there. So you end up with that continuity of care of having a doctor you become very familiar with for both pregnancy and delivery. If you use the semi-open system, you can choose to see Dr Sakamoto, Dr Sen or Dr Yuzawa for most of your prenatal appointments but then switch over to the general Aiiku hospital unit in the last few weeks of pregnancy and for the delivery (in other words, you’d have an Aiiku hospital doctor for the last few weeks of pregancy and on-call doctor during labour).

The International Unit is popular among English, Spanish and Chinese speakers as Doctor Sakamoto speaks fluent English and Spanish, and Dr Sen speaks fluent English, Chinese & Taiwanese. They have extensive experience of women of so many different nationalities and therefore have more cultural understanding around different expectations and preferences. However, using Dr Sakamoto or Dr Sen as a private doctor for labour & delivery comes with a cost. Not only do you pay for the usual hospital fees for labour & delivery but also their private doctor fees. Depending on other choices you make (type of room you stay in after birth, whether you have an epidural etc), this can also add to the total costs. For those with international insurance, it may not be an issue if your provider covers most or all of these costs. But for those with Japanese health insurance, this is all out-of-pocket and is considered the most expensive option in Japan for having a baby. You can get a breakdown of costs in advance from them at one of your initial appointments to give you a rough idea of what to expect, and then you can decide whether it’s something that both works for you and suits what you’re looking for in terms of a care provider. For those who are with the general Aiiku unit, there are no additional costs other than hospital costs (including room fees & epidural fee for those who opt for that).

Whether you choose the general unit or International Unit, all births take place in Aiiku Hospital in Shibaura (not the Aiiku Clinic in Hiroo). And the hospital staff are the same for everyone. It’s important to note that while Aiiku Hospital is familiar with non-Japanese patients, it’s still a Japanese hospital and not all staff have fluent or good levels of English. Some do, some don’t and it just depends on who is on duty (with midwives, nurses, or doctors). Obviously, those who use Dr Sakamoto or Dr Sen for delivery will know that at least there will be no language issues with them. But for all other members of staff, each patient will have a very different experience language-wise. If any staff don’t speak English or other language much at all, then they do try to use translation support apps or devices (although these can also be a bit strange). I always feel this is important to be reminded of as for those in the international unit, the English in the hospital will be different to what they’ve been experiencing in the clinic.

All the labour rooms (9 in total) in Aiiku are on the 3rd floor and they are all LDRs, which means Labour, Delivery, Recovery. So you go through labour, birth and 2 hours of “recovery” time in the LDR before being moved up to other rooms for the rest of your stay. Women are free to move around in labour and can make use of exercise balls, active chairs, and the bathtub. Waterbirth isn’t possible but women can use a bath for relaxation assuming their waters haven’t broken. Walking around the hallways is fine, although currently with the coronavirus you have to wear a mask. Monitoring isn’t continuous unless you have an epidural or an induction, or some risk factor, although there will be times where you’ll be attached to the monitor for some length of time. Midwives may prefer you to be on the bed for monitoring but you can say that you’d prefer to move around or be upright if it’s more comfortable – it’s ok to advocate for these kinds of preferences. The monitors can also be detached from their units and become portable, so you can still move very freely (although it can end up being rather annoying when you are walking and a midwife is often readjusting the monitor as it slips around).

If all is going smoothly in your labour and taking a bit of time, you will see the midwives intermittently as well. Generally they will come in and out of your room to check how things are going, do monitoring, do any other clinical checks, and vaginal checks as and when needed. They may be a bit more present if things are going much more quickly and birth is soon. In Aiiku, midwives typically don’t spend hours with patients in labour doing massage or coaching with breathing, positions etc, but from time to time they may do a bit of a back rub or make some useful suggestions. If you’re with the International Unit, the midwives will be updating Dr Sakamoto or Dr Sen about how things are going and if everything is straightforward and uncomplicated, you won’t see them much at all until the delivery. It’s similar with the general unit, too, that a doctor would only come if necessary and at delivery.

Epidural is possible in Aiiku 24 hours. For those who are with the International Unit, Dr Sakamoto will come and do the epidural for his and Dr Sen’s patients. Depending on the time of day what he’s currently doing, and where he’s coming from, patients may need to wait before they can get the epidural. For those who are with the general unit, one of the hospital’s anesthesiologists will come to do the epidural as soon as they are able to. Again there may be a little wait. While I won’t go into details about the epidural in this post, if anyone does have questions about it: when to get it/best timing, pros and cons, etc, from an evidence-based standpoint, please let me know.

Here are some other aspects of birth relating to Aiiku:

There is a pre-labour room that is sometimes used. This room has a few beds and women may be placed in here if their water has broken (for example) but labour hasn’t started yet, or if they are starting an induction and have had a cervical dilator (balloon catheter) placed inside – they will stay in the pre-labour room overnight and then get moved to an LDR room in the morning for the start of pitocin (husbands/partners cannot be in this room).

Pushing is generally on the back with legs spread open (lithotomy position) – this is the hospital’s go-to birthing position and the delivery bed actually spreads apart into this. If you think you’d prefer a different position for birthing, please discuss this. It’s sometimes possible, both with the general unit and International Unit doctors, but it’s often something you have to say directly.

Episiotomy rates are not *too* bad in Aiiku. That being said, it’s still important to discuss this in advance, too, to write on your birth plan form, and mention (or have your support person mention) in the moment if it’s brought up. If you need any help in learning the right questions to ask or helpful ways to advocate for your preferences about episiotomies or other delivery interventions, please get in touch. I offer such preparation.

Skin to skin – known as Kangaroo Care in Japan – is possible but only after initial check-ups are done on the baby. In some instances, it is a very short separation of just a few minutes, while in other cases it could be a longer separation. Initial check-ups are done in your LDR on the warming cot next to your bed. There is a pink form to submit in advance for it (where you sign that you understand the “risks”). Also, you may notice on the form that it says skin to skin is for 15 minutes after which they check the baby again. There will be a few instances like this where baby is taken off the mother to be checked. During initial skin to skin time in the LDR, it’s a good time to try and initiate breastfeeding for those who want to. *Edited to add (as mentioned at the top of this post) that skin to skin was completely removed in January and has been reinstated since end of March for a short period of 5, sometimes 10 minutes, and then reinstated back to 15 minutes in May which was the pre-pandemic time – baby is taken to the nursery 1 hour after birth for a couple of hours or so. As of July25th, Skin to skin has been restricted to 5 mins again as mentioned at the top with baby going to the nursery for a period of time after this and not later*

Once 1 hour has passed after baby has been born, baby is taken up to the nursery for approximately 1-2 hours of observation time. This is non-negotiable, unfortunately. Pre-corona, the dads/other parent used to be able to go up to the nursery, too, but currently that’s no longer allowed (hopefully at some point in the future it will change).

The mum gets taken up to another room for the rest of the stay after around 2 hours in total in the LDR. If all is fine, baby is usually brought to the mother’s room soon after. Rooming-in is allowed and encouraged but there’s also flexibility – if you’d like the midwives to have baby in the nursery for a bit of time here and there, that’s fine. For breastfeeding parents in particular, rooming-in is, of course, recommended and it is the biological norm to want to have your baby close. But preferences do differ in this regard, and the option is there of having baby in the nursery.

There are 4 different types of rooms you can stay in after baby is born. You cannot pre-book any room but you can state a preference. If your preferred room is available, that’s great. If not, they will ask you for a second or sometimes third choice. This will happen after baby is born when they know which rooms are currently open. Again, these rooms are all the same whether you are with the general unit or international unit:

1. Shared room of up to 4 people per room (no additional costs)
2. Private room without toilet & shower (20,000 yen per night)
3. Private room with toilet & shower (35,000 yen per night)
4. Special private room – suite style (70,000 yen per night)

If the room of your choice is unavailable, you may be able to move into it the following day when other patients are discharged (they usually don’t allow you to move down a tier, but up a tier is fine).

During your stay, they will give you a schedule of what to expect on each day. As with every other hospital in Japan, they won’t allow you to take a shower until the day after you’ve given birth (the day of birth is counted as day 0). There will be various check-ups for mum and baby and some instruction on topics like bathing. They typically don’t give you a class on baby care but staff are on hand to show you how to do things and point a few important things out, and if you are in any doubt you can always push the “nurse call” button in your room to get some extra help. Breastfeeding help is not too bad at Aiiku but everyone will have different experiences there (and not all breastfeeding support is necessarily evidence-based…it really depends). So if anyone does need more breastfeeding support or is unsure if what they are being advised in hospital is actually evidence-based support, please get in touch with me as I’ll be glad to help (breastfeeding support forms a big part of the support I offer post-partum).

With the general unit, you stay approximately 5 days for a vaginal delivery or 7 days for a c-section. With the International Unit, Dr Sakamoto or Dr Sen can discharge you a couple of days early (day 3 or day 4) if all is well. If you are discharged early via the International Unit, certain tests may not have been done for baby yet at the hospital in which case one of the international clinic midwives would arrange to visit you to do these tests.

For those who have a scheduled c-section at Aiiku, you are often asked to check in the day before your surgery. They also request that you buy a special “belly wrap” that will be put on you post-surgery. With Aiiku c-sections, photos and skin to skin are not allowed in the operation room. This is not unusual in Japan and similar policies would be in place in most hosptials. Pre-corona, husbands used to be able to be in the c-section operations but since corona this is no longer allowed (there was a short 2 month period from November 2021 to mid-January 2022 where they allowed the other parents in c-sections again, but this stopped again from January 11th 2022). They allow the other parent to visit the mum-to-be for 15 minutes before she gets taken down to surgery, and there is a waiting area to wait in to be updated. The other parent can briefly see baby after the operation as baby is taken up to the nursery (literally 1-2 minutes in front of the elevator while the baby is in the cot), and the same for the mum (a very, very brief meet). If midwives tell the other parent to leave before they’ve had a chance to see baby or mum, then tell them you won’t go until you’ve seen them – that is fine to do. If anyone wants more info about c-sections: how to prepare, what to expect, and recovery, please join my special workshop for that held every 1-2 months. *Edited to add (as at the top of this post) that partner support during c-sections has been reinstated since end of March for scehduled operations and in some unplanned/emergency ones depending on the urgency*

Visitation is, understandably, a very important thing for couples after birth. Sadly, because of corona, Aiiku is not allowing this. There was a short window of visitation being allowed between June-August 2020 and December 2021 -mid-January 2022, but at the time of writing this post that has been removed. However, the other parent is currently allowed to attend the birth (there was a period of time in 2020 where this was also not allowed) and the other parent is allowed to stay in the LDR for approximately 2 hours after birth, too. They also allow the other parent to drop off any needed items during the day at a specially-designated time and place (3-4:50pm Mon-Sat). Pre-corona, visitation used to be from 1-8pm every day, and having the other parent stay overnight in certain private rooms also used to be allowed. When this will be allowed again is anybody’s guess.

The hospital does have a convenience store and restaurant on the 9th floor. Patients are able to go up there to get snacks or other items that they may need. The opening hours are a bit short, though. The shop is open 9am-6pm on weekdays and 10am-3pm on weekends, but is closed on national holidays. The restaurant is open 11am-3pm on weekdays but closed on weekends and national holidays.

For anyone who would like a better look inside the hospital, you should take the Aiiku Hospital Virtual Tour. It’s only being offered to patients of the International Unit as the video was made by them for their patients. You’ll see me in the video as I lead the tour. As it was filmed pre-corona, some of the info will be different but it still gives you a good glimpse into the hospital, LDR rooms, other rooms and so on.

Also, for any couples who want to be fully-prepared for having a baby at Aiiku hospital, please take my Aiiku Birth Skills class – we go through labour, more details about the hospital, breathing, positions & massage, interventions, the hospital stay and more. I hold these classes every month as a small group class for 2-4 couples, so please ask me about dates. Private options are also available.

You can see the main Aiiku Hopsital website here. The banner at the top outlines the current corona policies/restrictions:

https://www.aiiku.net/

English-language info on restrictions can be found here:

https://www.aiiku.net//outpatient/covidindex.php

You are also welcome to contact me anytime to see if anything has changed, too, as it can sometimes be unclear as to what rules are currently in place in any hospital.

I hope this information is helpful to anyone who is considering having a baby at Aiiku either with the general unit or International Unit!

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

Aiiku Hospital Virtual Tours

Since 2015, I’ve been running tours of Aiiku hospital for patients of the International Unit. Originally these tours were in person at the hospital directly, but the hospital bosses decided to stop them in early 2019. After that, Dr Sakamoto and Dr Sen decided it would be a good idea to continue the tours virtually so we made a video and have been using it to hold virtual tours ever since.

With the virtual tour on Zoom, you are led (by me in the video) through the hospital, looking at the LDR rooms, the room options to stay in after baby has been born, other amenities available, and we also go through procedures and hospital policies so that everyone can be well prepared and informed (especially important now with the various changes and restrictions in place due to the coronavirus).

It’s a great opportunity to have an inside look at the hospital in advance, ask questions and hopefully come away feeling positive.

It’s also a great opportunity to involve grandparents overseas who may otherwise be feeling somewhat removed from the preparations and excitement. So if you’d like your family from overseas to join, that can be arranged. The fee for each tour is 1,000 yen only per Zoom screen and we run 1-2 of these tours a month (depending on the month).

If you’d like to sign up for one, let me know. Unfortunately as these tours are organised on behalf of the Aiiku clinic International unit, they are limited to only patients of Dr Sakamoto or Dr Sen.

September so far!

Since I’ve been back from my summer holidays, I’ve been to 3 births – all at Aiiku hospital.  2 with Dr Sakamoto and 1 with Dr Sen.  In all 3 cases, everything went very smoothly.  For anyone looking for some perspective and information about what to expect in Aiiku with either Dr Sakamoto and Dr Sen, please get in touch (you are in good hands, though).

Towards the end of this month, or possibly early October depending on when baby decides to come, I’ll also be acting as a distance doula for a client who isn’t able to have a doula for her birth in person.  I’m excited to see how that will go and hope that it will be a positive experience for my client and her partner.  If anyone is in a different part of Japan or has a very strict (less progressive) hospital that flat-out refuses doula support, please get in touch if you’d like to consider distance support instead!

I’m also now working on setting up a Facebook page for Tokyo Doula Support.  As I often post relevant articles, advice and so on on different Facebook groups, I though it was about time (after 5 years of running Tokyo Doula Support) that I have my own page for it all.  Watch this space!!

January Births Done!

January ended up being one of my busiest months birth-wise!  I was at 5 births overall – which I think is the most I’ve done in one month before!  All of the babies were delivered at Aiiku hospital with either Dr Sakamoto or Dr Sen, and, as expected each labour was very different.

Dr Sen continues to impress me with each labour I’m at with her.  She is definitely natural-labour-minded, allowing the woman to labour at her own pace and it seems to me that less women who have her as a doctor end up with an epidural – partly because she has to call Dr Sakamoto or another back up to administer it if a patient wants one, which puts a barrier in front of getting an epidural in the first place, but mostly because of her encouragement and approach to labour in general.  While she can’t spend all labour with her patients (that’s my job as doula when I’m there), she is hands on when she can be.  She often gives massages, stimulates pressure points and so on during labours which is a really nice thing and comforting thing for an OB to do.   She is also great at making sure women don’t have episiotomies.  I think I’ve only seen her do one once in the various labours I’ve been in with her.

My next labour so far will be a home birth, all being well.  My client will be using So san from Matsugaoka Birth House as her home-birth midwife.   I met her today and she’s lovely.  She can speak English well-enough and is very reassuring.  With Matsugaoka Birth House, you can choose to give birth there (with a midwife), at Nisseki in Hiroo with So san, or in your own home with So san.  Of course, conditions apply and they can’t take on women with any complications, but for those who are looking for a very natural labour, this is a great choice – an experienced English-speaking midwife with the back up if needed of an extremely well-respected hospital.  I’m looking forward to this labour very much!

 

Recent Birth at Aiiku

Last week I was at a birth in Aiiku, with Dr Sen as the OB.  It was a really wonderful experience and I quickly wanted to share some general details about it.

My client went into labour during the night and went into hospital that night where she was still very comfortable.  It wasn’t till around 5am when her contractions got intense and very regular.  The LDR unit was actually completely empty – she was the only patient for the whole day.  This meant that we got a lot of extra hands-on support from the midwives which was great.  My client was free to labour however she wanted – so we did a lot of walking, stair-climbing, she used the bath, used the balance ball, and also the active chair.  It was really great at how open she was to trying different things to help her labour along.  It all progressed really smoothly, although the last few centimeters of dilation did take quite a while.  Finding the motivation to keep going naturally not knowing how long there is still left to go and knowing an epidural is an option is a hard thing sometimes, but she really did wonderfully.  She was managing so well that I personally felt she could keep going without an epidural, and I think (I hope) having me there to reassure her that things were going well really helped 🙂

Dr Sen herself is a very laid-back and relaxed doctor when it comes to labour,  letting each woman do what works for them and not over-managing anything (unless the need arises).  She was hands-on during the times she was present doing some massage of foot acupressure points which was nice.  All the times I’ve been in labours with her, I’ve found her to be a really gentle and positive voice.

During the actual delivery, my client was able to have baby immediately placed on her chest and have the heart-rate check and oxygen check of the baby done while on the mother.  In Japan, even if doctors say a mum can have “Kangaroo care” (the term used here for immediate skin to skin contact), it’s not usually as immediate as we expect – usually the baby is quickly taken to the warmer, have the heart-rate check and oxygen checks done, wrapped in a towel and then given back to the mother for the skin to skin time.  So, with Dr Sen, you really can get that immediate contact with your baby which is great!

I’ve got a couple more births coming up with Dr Sen over the next 3 weeks, so I’m looking forward to them, too.