Hi

I am in the 5th month of my pregnancy and I am 27 years old. I have surfed the net for vaginal tearing during birth. It looks like it is part and parcel of a normal delivery.

I would love to know if there is a way to avoid severe tears. I am visiting Dr. Sakamoto and he recommends Seibu Byoin for me.

Has anyone ever been to the same hospital and doctor?

I don't have personal experience with the hospital you are looking at, but it is my opinion and experience that tearing doesn't necessarily have to happen... But this is a world-wide thing, not just in japan ;)

Three things that can help prevent tears:
1. Perineal massage.
2. Perineal hot compresses.
3. Having an experienced midwife apply counter pressure as baby is coming out.

That's not to say that even if you do these things you won't tear.

Here's one very non-academic blub about ways to reduce the risk of tearing... there's plenty more out there on the web but this is the best thing I could find this second.
http://www.suite101.com/article.cfm/pregnancy_childbirth/50805

I believe midwifery.com (a US website) also has quite a bit of information about ways to prevent or reduce tearing. Maybe you can check it out.

I totally agree with Rebecca's message.

This is a subject which has come up often in AFWJ (foreign wives of Jpnese) quite a lot. It would appear that episiotomies are THE norm in Japan. When I asked my doctor if I could at least try without, he answered: No way.

I continued seeing doctors for some regular checks, but I decided to have both my babies with a midwife. I did NOT tear at all. However, we did follow all precautions as listed by Rebecca.

In Canada, it is NOT advised anymore (except only if necessary) to have episitomies, as it was 20 years ago. They have found that flesh will rip even more once the cut has been started. (Sorry if that causes a chill, but so it is.)

Having a baby (especially not in your home country) is a learning process. I found that I had to take charge of my pregnancy and learn about options, resources, information sources, etc.

Good luck. I hope that the birth will be a wonderful experience for you!

Kirsten

My doctor (small private clinic) with my first child did not say "absolutely NOT" when I asked him to try without episiotomy, but his response was so no-commital I really thought that he would automatically do it. He did not though. He was getting ready to - even said, okay now it's time for the episiotomy. then he said, okay, no episiotomy. the head is coming out now. I was very relieved.

For my second delivery, I chose a different clinic that had more of a natural philosophy. We talked about episiotomies when I first met with the midwives and their attitude was encouraging. I felt fortunate I had already been in japan for long enough that I could get friends to help me ask questions and make a more educated decision on my hospital choice.

(First delivery I was only in japan 2 months before my due date - not really much time to pick and chose doctors.)

Definitely ask a lot of questions when you meet your doctors/midwives. Ask what their statistics on episiotomies and tears are. Ask them what they do to prevent tearing during the birth. Do a lot of reading and figure out for yourself what kind of birth experience you are hoping for (knowing full well it might not be that experience in the end), and look for a place that fits your needs best. yeah, sometimes it is hard to get a straight answer... but you can at least try

I am pregnant again and have again chosen a completely different type of place than I had for my first 2 births. It's still a learning experience.

Busy doctors like episiotomies because it gets the baby out faster for them. They don't have to spend time waiting for the skin to stretch gradually, and they don't have to work so hard to prevent tearing. Sometimes it is done so they can fit the forceps in to pull the baby out.

I would be very hesitant to go with a doctor who routinely does "necessary" episiotomies. Women should be able to move round in labor, have midwives or doulas to support them and who work to prevent perineal trauma.

Being cut, being stitched up, being cut again for another baby, being stitched up again...do doctors think this is normal for women? Do they not lose sight of the fact this part of a women's body is also a very intimate place, and their actions can impact her sexual life for the rest of her life?

Having a baby is a wonderful natural experience, and if you go with someone who really believes and trusts in a women's body's ability to birth, you may never need to be cut in that way.

Don't choose their convenience over your future comfort. (I have had 3 children myself and experienced three different kinds of births).

Hi Rimpi,

I had Dr Sakamoto for the first 7 months - I gave birth in Australia but I know five people and six babies that went with him at Aiku and they were all very happy. He is US trained so even if episiotomies are routine in Japan, don't assume he does them routinely. I think you should discuss with him your concerns and see what his personal opinion is.

By the way, my midwife in Australia tried really hard to not do an episiotomy, AND I did the prenatal perineal massage, but I still had to get one. I found out later that a study showed the massage probably only prevents 6% of less severe tears (doesn't prevent the severe ones) and works much better for mothers over 30 years. More info is at this website http://www.btinternet.com/~wellmother/projects/sharoncallcott.htm

You're under 30, like me, so if you are finding the massage particularly uncomfy, as I did, I say don't bother.

Good luck with the pregnancy and birth!

Hi Rimpi,

I had Dr Sakamoto for the first 7 months - I gave birth in Australia but I know five people and six babies that went with him at Aiku and they were all very happy. He is US trained so even if episiotomies are routine in Japan, don't assume he does them routinely. I think you should discuss with him your concerns and see what his personal opinion is.

By the way, my midwife in Australia tried really hard to not do an episiotomy, AND I did the prenatal perineal massage, but I still had to get one. I found out later that a study showed the massage probably only prevents 6% of less severe tears (doesn't prevent the severe ones) and works much better for mothers over 30 years. More info is at this website http://www.btinternet.com/~wellmother/projects/sharoncallcott.htm

You're under 30, so if you are finding the massage particularly uncomfy, as I did, I say don't bother.

Good luck with the pregnancy and birth!

Definitely do perineal stretching. Have your hubby do it with his thumbs manipulating the sides as if a head was coming out. Keep increasing the pressure daily until it no longer hurts. It's worth it! Also make sure you have a great diet full of vitamins to encourage skin elasticity.

You could always try 'epi-no', I suppose. I don't know if it works, but it's worth a gamble:

http://www.epino.de/birth.htm

Hello, I agree that doing the perineal massage and diet is key. Also using visualization during massage and in general is helpful. And most of all try to release your fears about tearing or any other apprehensions you may have about giving birth. If you tear, you tear, women have had babies this way naturally since the beginning of time. We are strong. Natural tears usually heal better than being cut anyway. You will be so overjoyed at the moment of the birth of your child that anything else won't matter. Ahead of time picture the moment that your baby passes through your vagina as being easy and joyful. And I agree that open discussion and clarity with your doctor about your preferences and concerns is important. I went the midwife and homebirth route in the US with my child. I tore a bit despite all the preparations, but like I said, it was ok. Trust and let go. You will be fine and your baby will be fine. I have faith that you will have the birth that you want. Best wishes!

Thank you so much for all your advice! It really made things much clearer for me. I am going to discuss the issue with Dr.Sakamoto and have an appointment coming up.

Having a baby away from home is a new experience and I was a bit apprehensive initially but with so much good advice, I feel much stronger...Thanks once again!

Hi everyone, Im due on the 10th of May and im getting nervous about the labour and delivery. Apparently my baby hasnt drop yet and he is pretty huge..8 pounds or 3600 grams. The doctor told me that my cervix is soft and i am 1 cm dilated but it may take up to 2 weeks and if he wont come out, they may have to induce me or worst C section.
I am hoping for a natural birth as they dont give any pain reliefs or epidurals in this hospital and im scared that they dont. I also gathered that when they perform episiotomy, that they dont give an anaesthesia and you can feel all the cut and stitches and that is very painful. They said the most painful part is when they would remove the stitches. Isnt this like torturing not to give any pain reliefs ??? I hope i could hear some stories from women who have had experiences in giving birth here in Japan. thanks in advance.

Dear Newmum,
First of all, keep in mind that a woman's body is designed to give birth. Don't be scared. Fear is your worst enemy.

I started dialation of cervix on a Tuesday night at about 23:00. Because I was determined to have a natural birth, I stayed at home... and stayed and stayed. Amazingly I was able to get used to the pains. I knew why I was having them, I understood where they were coming from, and I was not afraid. I rested between pains, watched movies, took a shower, got up and walked around. I found it helpful with the more intense pains to grip the edge of the kitchen sink and lean forward with all my strength. What I'm saying is that pain that is understood, can be managed. No, it is not like torture.

Finally Thursday night the pains reached the every 2-5 minutes frequency. About 2 hours later the mid-wife clinic told me that I had to go to the clinic, because there were already two other mothers there, giving birth, and they couldn't send someone to my house. So Friday morning at about 1:00am I got a taxi to the mid-wife clinic (in Iidabashi).

Here's the deal with an epidural. They give it to you before you go into labor. "going into labor" is apparently about when your cervix is still a couple centimeters short of fully dialated. Fully dialated is about 10cm. But because putting the needle in your back is slightly tricky, the doctor prefers to give it before you have any pains at all, before you even start dialating. If you were to move suddenly during the procedure to insert the epidural, a very serious accident could happen. The needle could go into the wrong place, and you could end up with a spinal cord injury with permanent remifications. So an epidural is really a very serious moment, and more dangerous than the actual act of giving birth naturally.

Epidural is serious skilled medicine.

Episiotomy, in comparison, is a surface wound more or less, though it can be done badly, and some women can have pain from the healing for quite a while after (for me it was still sensitive 6 months after, but I was able to have intercourse at about 4 months). Perineal massage is very effective, but not always, and should be started a few weeks in advance of the birth. But even a couple days before could help. In my case the midwife attempted to do perineal massage during the delivery, which drove me absolutely nuts. And I told her to stop it.

So I ended up with an episiotomy. It is absolutely necessary to have a local anaesthetic with an episiotomy. Get this bit of communication translated properly! It's the same drug (or very similar) that is used when filling a deep hole in your tooth. Under no circumstances do you want to go to an OB/GYN that would not do this simple shot. It's a muscle anaesthetic, and poses zero danger to the baby who at that point is only moments away from entering the outside world anyway.

My perineum was not terrible elastic... ;-) It didn't even look like it was going to conveniently tear when it was supposed to (much easier healing than an administered cut). It was just the luck of the draw.

And for someone who wanted a natural birth, I also ended up with a forceps delivery, quickly and elegently performed, but nevertheless, not natural.

I've talked to many, many mothers, and those who were more athletic and fit, definitely on average had an easier time giving birth. Oddly, some of them would not describe themselves as fit, but in retrospect due to lots of sports before marriage, they were in quite good shape.

Bad births do happen. Nowadays they can estimate the likelihood in advance better, with the use of sonograms and early detection of certain dangerous conditions. But even so something can go undetected and therefore lead to a bad birth.

These situations are best laid at the door of God, so to speak. It is not going to be productive to worry about something that can't be known in advance. I personally find the attitude in Japan, particularly at the mid-wife clinics very refreshing in comparison to the highly interventionist approach in the USA. I was not rushed, and encouraged to take my time and find my rhythm. The midwives made reports by telephone to my doctor (who was in reserve in case anything should go wrong).

By the way, due to the personal nature of your question, you may receive a lot more replies, if you did not hide your email address. People might be willing to share with you directly things they would not want seen on this public board.

It is very normal for a baby (especially a first baby) not to "drop" until very soon before delivery. It is also just as normal for women to deliver at 38 weeks as it is to deliver at 42 weeks. Your _estimated_ due date is just that. You should not get concerned that your baby hasn't dropped yet. Your baby might not be ready to come until 42 weeks.

I also want to point out that there is HUGE room for error in estimating baby's weight through ultrasound. My first baby measured quite large and my doctor was getting concerned and talked about induction 1 day after my EDD even though before he had said he would let me go to 42 weeks. I was quite annoyed by this. I pursuaded him to continue monitoring me every 2nd day to make sure my amniotic fluid level was still good. In the end I went into labor on my own, one day short of 42 weeks. And my baby weighed 3400g even though the doctor SWORE she was nearly 4000g at the 38 week scan (he stopped estimating after that because I asked him to).

Besides, a 4000g baby is also a completely normal size in the western world. The female body is designed to give birth to babies this big and bigger.

I would also suggest maybe you want to ask your doctor to *not* do internal exams to check for dialation. Many women can be several cm dialated for several weeks. Other women can go from 0 to 10 in a matter of hours. In my (humble) experience, internal exams just gave me a false sense that something would happen soon. I refused internal exams for my 2nd baby and am refusing them for my 3rd baby (due end of may). When the body/baby is ready, it will happen.

If your doctor insists on internals, maybe you can ask him not to tell you.

In regards to avoiding tears and episiotomy, I posted earlier in this thread about that so I won't repeat myself ;) You should talk to your doctor about this and make sure he knows you do not want an episiotomy. An attentive midwive applying counter pressure as the baby crowns is your most effective means of preventing tearing.

Hi ! thankyou so much to everyone who made a response. Unfortunately I couldnt ask the head doctor not to check me internally because that is their procedure in their hospital. He made a point that I have to go 3x a week now so they could insert ( Myris or Mailis ) a certain medicine.This is also one of their procedure in this maternity hospital and they are famous for it. Yest. i had my appointment and the head/owner of the hospital was the one who did the internal exam and i got so pissed because he checked me painfully.Its like hes opening a rusty window and i feel like im gonna ripped on the way he did it. I just hate this internal vaginal checkups !!! Then he inserted the Mailis again and tom. i have to suffer again because they told me to come again tom. and they would insert this certain drug. I just hate the way he checks me up.its so painful. I really have a low tolerance to pain.
Anyhow, pls. pray for me and hope that there will some progress as soon as possible. I dont want to end up having a C section. I have no family here except for my husband and our dog. LOL !
thanks again.

I have many fears about having a child in Japan as well. I am from America and my husband is Japanese. I was going to Aiiku, but they are horribly expensive and since we are not expats, we don't have that kind of money. A couple months ago we switched to a japanese hospital and I asked so many questions that I thought they were getting uncomfortable. The thing is, the rules they have seem so strict to me and I don't think childbirth should be that way. I really like my doctor, but I am loath to give birth there. I have talked to many people here and I am looking into having a homebirth when the time comes since both my previous births were completely normal and this pregnancy is the same. I am afraid of all the things most of you are afraid of. But I think that if I take control of the situation and find something that fits me, the rest of my fears will be smaller in comparison. I have found that most japanese hospitals are the same.

Yes, they do eposiotomies without anesthesia, they stitch you up and remove the stitches all without the anesthesia. Most hospital won't allow your children to your room or to see the new baby except through a glass window. And from what I have heard, when it is time for you to push they literally strap your legs into the stirrups and that's how you have to deliver. (they say it's to keep you from kicking when they do the episiotomy)

I am very uncomfortable about all of this. So, I am currently looking for a natural birth house or a midwife so I can have a homebirth. From what I hear, they support your decisions whole-heartedly and are very good with laboring mothers.

I am planning on going completely natural, and I will absolutely not have an episiotomy this time. I have 2 previous ones and sex after 2 months of healing was sooooo painful, and my vaginal opening swelled up so badly that I couldn't walk for a week...both times. So be very careful on what you choose. It is your body and you should be able to do what you want and not have anyone direct you on how to do it. And from what I hear, homebirths are the cheapest births in Japan.

That's just my take on everything, but every hospital is different. So good luck searching.

Melissa

I am 31 weeks pregnant. Regarding episiotomy, i have a question for "qurz". Is the muscle anasthesia to be done before the procedure painful, where is the shot given exactly?
Also as you mentioned you refused the Perineal massage during the delivery, were they also uncomfortable or painful. I am trying to gather info to prepare myself.. as sometimes I am becomming worried about giving birth in japan too, as my doctor is unfriendly and doesnot encourage much questions. THankyou for the support.

I would not let a doctor do an episiotomy without the local anaesthetic. That would be unecessary pain. And since a lot of Japanese doctors have the attitude that the baby is more important than the mother, they seem to be sloppy in how they treat the mother. That's why I prefer midwives, and also why I did my selection of OB/GYN very carefully.

The local anaesthetic is administered by hypodermic needle and is not noticeable (like a mosquito bite) during the pushing part of giving birth. And actually I did hear a report of no local anaesthetic given for the episiotomy at the National Women's Hospital at Shin Otsuka station (on the Marunouchi subway line) which of course was a way for me to scratch that hospital off my list, though it was the closest one to my home.

There are far fewer babies being born now in Japan. This means that the "buyer", the mother, has a lot of leverage these days. USE IT! Do not worry about being "Noisy" (Udusai). It's your body, and your baby. Stand up for yourself. Same with C-sections. If you need one, then insist on bikini cut (easier recovery). Don't let them browbeat you just because your hormones are zinging and zanging all over the place. If a doctor said to me, "this is how we do it here" or "this is our policy" I would just get up and say "bye, I'll look for another doctor".

And it is true, that I have yet to find a gyn here that I like. They are all "rough" with the normal annual exams, like we are cattle. Well, one was not so rough, but she was absolutely uncommunicative afterwards, which is the reason I'm not going back to her, and she is famous with the expat ladies.

Take a look at the section here on "birth options" if you need ideas. And no, it's not too late to change your plans.

On the other side, Japanese culture is not very "friendly" compared to some other cultures, so just because a doctor doesn't seem too friendly, doesn't make that doctor incompetent. It's really hard to make the right interpretation. My mantra is to go with my gut instinct. It's all I've got.