Today we caught the train to Kamakura and from there we took a cab to the Yamamoto Josanin (free-standing birth center). We met Yamamoto-sensei, the founder and director of the birth center. She explained to us a little bit about why she started the birth center and what it was like to run it. We learned that their selection criteria for women giving birth at the birth center was more strict than at St. Luke’s birth center, but that the transfer rate was much lower (3%!). She showed us their birth log and some other statistics and guidelines and then they took us on a tour of the birth center. The rooms we saw were decorated in the Victorian style and at some point K and one of the other midwives simulated different positions that they might use during the second stage. It really wasn’t any different from anything we’d been taught, but I was surprised at how comfortable and practiced they all seemed to be while demonstrating. I think that if we had been asked to do they same thing in America, there would have been some hesitancy or embarrassment, which K and the other midwife seemed to be lacking. I wonder if it had something to do with the fact that Japanese midwifery students do a lot more simulation practice than we do, where they are really encouraged to embody the role of a laboring woman. During the tour, Yamamoto-sensei also pointed out various classrooms and exam/treatment rooms. She told us that they had all sorts of classes, including fitness, baby massage, childbirth prep and parenting classes. She explained that they really encouraged women to participate in these classes even if they risked out at some point or after their births, which helped to foster a feeling of community and belonging for the women. She also told us that sometimes women received various treatments at the center, and that occasionally chiropractors would visit the birth center to provide chiropractic treatments to postpartum women. We were also introduced to a strange device, made in Korea, that was supposed to help with hip and back pain. I got volunteered to test it out and as I sat down in the device, it began to squeeze my hips together, which actually did feel quite good. Then it started to vibrate, which was a bit weird and when I communicated what was going on to Lisa and Allison, Lisa very delicately asked me, “So, is it vibrating on the sides?” To which I replied that no, it was not vibrating on the sides, but underneath. This resulted in some embarrassed giggling on everyone’s part.
After the tour, we took a break for lunch, which was an example of what they would serve women during their pregnancy or during the postpartum period. All the food was easy to digest and they even made their own special blend of tea to help with constipation. After lunch, we watched a few slideshows of women who had given birth at the birth center and had a fascinating conversation about second stage management. We had learned previously that Japanese midwives are not allowed to suture and so there is a lot of care taken to protect the perineum. During the tour, Yamamoto-sensei had shown us a small clip that midwives sometimes use to hold the perineum together in the case of small tears and as we watched the slideshows she explained her “hands off” approach. We saw from the photos that her method was not truly “hands off” – she maintained flexion on the baby’s head and used that hand to help guide and control the birth of the head. However, she kept her other hand off the perineum and encouraged mothers to control their breathing and pushing during this stage. She also made sure that women’s legs were not spread wide during this stage, as this stretched the skin of the perineum taught and increased the likelihood that a woman would tear. She said that she never “coached” anyone through pushing (i.e. the whole hold your breath, count to 10 and bear down thing). It made me want to re-evaluate the way we manage second stage and I’m eager to be alone with a woman while she’s pushing and take my time with her and see what works best to help her birth over an intact perineum.
We spent a bit longer in conversation and asked a few final questions and then we took a cab down to a different area of Kamakura for a bit of sightseeing. We went to one temple where we enjoyed a miniature traditional tea ceremony, and then we walked around a beautiful bamboo forest. Finally, we made a quick visit to the Daibutsu (Giant Buddha), where I noted that someone had made an offering of a carton of milk and K pointed out the Buddha’s long ear lobes, signifying wealth and prosperity (she also suggested that I take ear lobes into consideration when deciding on a life partner). On the train ride home, K and I spent a long time conversing in Japanese, which was a bit more difficult than I had hoped, but good practice for me all the same. The time passed quickly enough and neither of us realized that we had reached our destination until Allison and Lisa stood up. K dropped us back off at our hotel and then we had some dinner and packed up our bags in preparation for the journey south.