I strategically forget what grade in elementary school I was in when I was called on to read aloud in class. I came across, "Virginia," in the passage, and boldly voiced, "Vagina." My friend Jeannie, sitting next to me at the time, erupted with a case of the giggles that never really subsided. Even though I successfully blocked out what grade that was, I didn't exactly recovered. In an evil twist of fate, that loyal friend moved to Northern Virginia in 8th grade, and we remain in close touch. The only change in our friendship representative of the geographical distance, is that I refer to her residence as "VA" in writing, and "NoVa" in conversation. That verbal typo from the 70s would come to be some spooky foreshadowing on "baby grand" scale (Jeannie is a professional pianist after all, but this would be a different kind of baby). Perhaps it was a sour-note signal that I just might be better off one day going through my "real life" education of anatomic and gynecological terminology in another language, culture and country.
Fast forward however many years it was between my elementary school gaffe to 2004. We lived in a flat accommodating enough, in American terms, for one more tiny person, say in the 7-9 pound range. Our place was conveniently situated within a 10 minute walking distance from Narita Ladies Clinic in Hasuda City, a quaint off-spring of urban sprawl north of Tokyo. Approaching the entrance to the clinic, I was greeted by several tastefully ostentatious statues in the lot, and upon entering the foyer, I was overcome with the fragrant waft from the fresh floral ikebana display. Soothing music piped throughout the building, impressionistic art draped the walls and a formidable ceramic statue leaped out of the fountain through the bay windows as viewed from the plush waiting room sofas. Based on my medical education concerning what to look for in a hospital, outside of location, location, location, I concluded that this could be a place to wait and see for the 9 (although they count 10 here) months of my pregnancy.
"It takes a village to raise a child," so goes the African proverb. If that's the case, than it takes a country to see a woman through childbirth. This soon became everybody's business. I had a team throughout the first trimester, seeing me through my "education." Really, not much news in the twice weekly required ultrasounds, but it was my duty to bring a child into the local community in the Japanese way. Suddenly voicing "vagina" in a room full of curious elementary school kids was a much less public (I just read that three times to ensure I didn't write pubic) memory. After the first trimester, I was required to register my pregnancy with the City hall. This would be one of the first of many requirements that came with the elective course of childbirth in Japan. I registered at the Hasuda City Hall, was issued the required text, the Boshi Techo, or, Mother and Child Health Handbook. This bible of pregnancy, child birth and child rearing, chronicles my blood work, bi-weekly urine test results, daily weight fluctuations, "breast feeding" potential and performance, the child's development and immunization records until she enters elementary school, where I hope that she will become a stronger reader than her mother.
For 6 years, this booklet is as valuable as a passport and is actually more public and revealing than you'd suspect. Nobody likes their passport photos, but hanging on to it throughout its expiration date is the sacrifice we make for international travel. What I considered culturally confidentially details of my insides is inked, stamped or stickered into the Bochi Techo for the world to see. And by world I mean the 77 intuitions and counting that for their own reasons require I hand it over for their review on demand (incidentally, never on my call). Come to think of it, I should consider Googling my record on the internet from time to time just to see if it's posted out there for the cyberworld to see as well (if you are toggling away from this page now to find out, kindly update me the results of your search in the comment column).
My parents visited me in Japan for the first time in 1995. They disembarked at Tokyo's Narita Airport and followed the flow in jet-lagged sheep mode with the masses toward customs and baggage claim. The billboard sized sign hanging above the escalators leading down to immigration read, Welcome to Japan. Obey the Rules. We laughed about it at the time, especially in their jet-lagged fortified punchy state. Japan has since polished its politesse in that department and at least in writing has cropped the second sentence from that larger than life poster. Nevertheless, I have been living the mantra every day since. Off to the city hall was I, obeying the order to fetch the handbook assigned to be the official record of my pregnancy progress reports, the child's development, immunization records, and everything else that you would only email the grandparents. No. You don't question it. You set off to the city hall, Obeying the Rule to get your handbook.
Along with the coveted booklet, the city hall representative handed over my warm welcome kit of necessities: laundry soap, a set of bars of body soap, a 5 kilogram bag of rice, a box of tissues, a towel, a set of "I'm With Child" stickers to wear on the train in order to alert others of my condition so that they obey the rule to give me a priority seat. And finally, my favorite, a "Maternity on Board" tag for the rear windshield of the car. It's interesting that I walk out of registering with the public municipality that I am pregnant, and they in turn load me up with multiple heavy items to carry, but I'm going to take the high road and focus on my gratitude for all the near accidents that would have happened if drivers weren't alerted that they should not plow into my "With Child" compact car.
Now that I was officially registered a la national rules, I could legally make a reservation to give birth at the clinic. Party of one coming in, hoping for party of two by the end. That's right, you make a reservation, with a non refundable deposit of roughly $1,000 to hold a room for the mandatory full week stay. I was given a basic schedule of how my visits would play out until check in: Bi-weekly during the the first half of the second trimester and 3 times a week in the latter part. By the third semester, it was 3-4 times a week third trimester, that bumps up (and out) to four times a week from 36 weeks and finally daily from the week before the due date. I wondered if there was an easier way, like wearing one of those monitoring anklets that convicts on house arrest wear, but equipped with ultra sound technology to alert the midwives of any fluctuation on my progress. The city hall probably installed an echo powered camera in the soaps anyway.
Alas, there were no short-cuts: Attendance was mandatory and there were 5 required classes along the way. Classes. The class record actually got its own chapter in the handbook you're chained to for 6 years. Not one report card or transcript followed me for more than four years in my life up until this point. So much for the auto-instinctive American exit strategy: "how do I get out of this?" There was no playing hooky, and not even my own mother could write me out of class. There were spaces for instructor signatures as well as stickers upon completion. Indeed, if I did well, I would get a sticker. Short term reward: smiley face. Long term reward: wailing face.
I remember the first class. I signed in at the door, collected the handout materials, which included a juice box sized Oolong iced tea (so much for the reduced caffeine rule I'm familiar with in the States). I entered the room and slipped into the back row of too small for pregnant women chairs. Growing up as a Z in the alphabetical seating chart world, I was programmed to warm the back corner seat, so this scene was putting me back into an 8th grade school zone mindset. Obey the rules: Be polite to the teacher. Don't talk out of turn, and respond when called on.
I had a pen. Those around me brought notebooks. I covered that botch by putting my handouts on top of my handbook to "write on." The doctor entered the room, everybody stood, bowed to him with respect, and he began his power point presentation of the process of childbirth. This was the first such lecture I was a part of that didn't require me to submit a permission slip from my parents to hear. I don't think I noted any major changes since the sex education lessons during elementary school in the 70s, but power point was a techno step up from waiting for the film strip to "bleep" for the next graphic.
The Dos and Don'ts
In another culture and language, I was at an advantage since I tuned more into cultural differences then I did to the fact that the actual process they were illustrating was going on inside me. That part, including potential complications or assured pain and discomfort didn't bother me. Instead, I really never got past the fact that my classmates were down to the sucking sounds at the bottom of their tea packs by the second of three hours of the session while I was still stuck on, "we can really have caffeine?" That was the first of many cultural myths I was to throw out the window.
It took me a few months to stop cross referencing all the dos and don'ts I got from Japan with those in America. One friend passed on a reference from the UK, which also had some different game rules. I found the way to Obey the Rules was to just pick one from each country whose language you can read and ignore remaining don'ts in order to find peace. World Peace. That was my justification. If only someone would buy what I was doing was any more than rationalization I would have one whopping sticker in the milestone handbook for striving that mark.
Realistically, my temporary solution for information overload was to run any questions directly by the doctors and nurses that were actually seeing me, what, three times a week by now? That should be enough live consulting to justify not having to read all available print media in my native or host tongue. I was soon scheduled to return to the States for a few weeks and do some traveling for my In-law's 50th wedding anniversary. "Are there any precautions I should be aware of?" I really don't know what I was looking for, but it was just the Japanese nuanced way of leading into the fact that I needed an excused absence from my weekly attendance chart for a family occasion. But he was reassuring:
"Don't worry about anything. Stress is that last thing you want. Why not pour some green tea, and relax in a hot bath?" There they go again with the caffeinated green(tea) light. And a hot bath? Another fundamental NO from the US websites. "Oh, but one thing," he continued. "Fulfill your yen for sushi pre-departure. I wouldn't trust the freshness in the States." Now I got a kick out of that one (or maybe it was the baby). Nonetheless, I stuck to my true red, white and blue when it came to breaking "sweet" rules. They eliminate sweets completely during pregnancy, which includes limiting fruits and juices, as not to exceed the Japan standard ideal of an 8 kilogram weight gain. In the end, I opted to pull the information I needed based on which country's reference told me exactly what I wanted to hear. I gave myself the big sticker and an A plus in Cross Cultural Referencing, and bonus points in Cop Out Research.
The final test (you think it would be delivery) was to prepare your hospital bag six weeks in advance, to insure that there was ample time to fail the test and have a retake. The list of things to bring was size and quantity specific, including hand drawn pictorials for clarification. Some things I had never heard of and still don't understand, but like any school supply list in the States where you can just show your print-out from the teacher to a Kmart attendant and be pointed the way to the jumbo crayons, I was guided by the hand holding, soft-spoken maternity store clerk. Leg warmers for my tummy, Velcro waist bands to "snap my shape back," and other gizmos straight out of pink and blue laced mythology filled that bag to the decaffeinated rim.
It only took two bag check appointments to pass the test, so we just kept it in the entrance way in order to avoid the temptation to over-edit, crossing "t"s or dotting "i"s, or worse, reduce the hand luggage by half the way we do just before international flights. When it is time to pop that bag in the car to go to the hospital for labor and delivery, they require that the mother calls. They claim that they need to hear the mother's voice directly, so no cheating by having the father call to say, "we're on the way." Part of that rule is to force the mother into her endurance test, by putting her into her first situation of being the only one who could possibly be qualified to troubleshoot a situation.
After all, the fathers didn't have any stickers to show for their responsibility at this point. The other part of that policy is a mystery to me, and I didn't dare cut corners on this one since I had already once been accused of cheating. Far enough in when it should have been obvious to the doctor on the other side of the thrice weekly ultrasound screen, we inquired if we were expecting a girl or a boy. Dr. Narita was ready for me, the picture of an impatient American with a bulge. He had pre-pared a photocopy from a Japanese medical journal on why it is wrong to flirt with fate by knowing in advance the sex of your child. This was god's path, and I am not worthy to interrupt, which includes intercepting knowledge of, its course. Feeling small, even at 6 months pregnant, I nodded along and accepted my handout.
A few visits later, I had a different doctor at the clinic. I gently hinted in a round about Japanese way that I would be open to be given a pink or blue clue. That doctor looked at the screen, nodded in a way that revealed he was in on Dr. Narita's god's path for me, proceeded to page through my 3 inch thick file. He noticed that I had been seen last by Dr. Narita, the man on the marquee of the hospital, and likely, the name at the bottom of his paycheck. He nonchalantly confirmed, "you saw Dr. Narita last?" which turned out to be his "round about Japanese way" of saying, "stock up on pastel yellows and greens."
I accepted my twice rejected fate and did what any impatient, hormone-fortified American would do. I turned to the world wide web for self-diagnosis. I took an on-line quiz consisting of 10 Yes or No questions which would lead me to score 9 out of 10 that pointed directly to pink booties. (One of those questions had to do with craving citrus, which I really shouldn't have known since I should have been off the oranges, but allow me to confess...) In sum, I would eventually confirm that the 90% test result handed down by the not-worried-about-fate-internet-gods was correct. Obviously, there was no page for a sticker for that research project in my Mother and Child Handbook, but I kept it under wraps anyway to protect myself from being docked a box of tissues or a city issued gift towel for cheating.
Even though I wore badges on my lapel on the trains, there was a sign on my car letting the world know I was pregnant, and by now more people had seen my Mother and Child Handbook detailing ultrasound photos than had seen my high school senior yearbook picture, as the only Americans in our area and an ocean away from family, we felt somewhat alone in the process. When it came time to wonder if it was time to go to the hospital, I called a good Irish friend, and a young mother of a baby boy who lived in Tokyo, for wisdom. The conversation was deep, and loaded with medical jargon:
Me: Hi Nicola. How did you know when it was time?
Nicola: Now. If you're calling me, it's time for someone else to take care of you. Just go check in the hospital.
Never ignoring the sage Irish, I was at the hospital within minutes, maneuvering around what I thought at one time to be a soothing floral arrangement as if it was an orange construction cone creating a road block on my path. I reached the midwife station and before they glanced in my direction, they nabbed the coveted bag from my husband, confirming the contents were properly assembled. It was like the passport check at immigration. I guess some things just come first. Rules again, and I wasn't in a position to care. We checked in and were escorted to a corner suite on the second floor of the 3 story building. I put my bag down and changed into the gown on my bed. Floral gowns were declared en vogue uniform for the pregnant ladies, and upon delivery, "the mothers" are changed into a solid pink gown for their new lead roles.
I donned the slippers issued for the hallway and dining room and headed to last minute examination room, situated adjacent to the delivery room. Purgatory examination might have been out of a scene from the 70s cult classic, Xanadu. Before I was asked to stretch out on the neon bed, I was given an AV lesson on operating the technology, ironically designed for my relaxation. I was free to choose the color of strobe lights and the angles and shapes of lasers that zipped around the room. Alternatively, I could select a rotating rainbow on the ceiling with a virtual rain forest on the walls, accented by a waterfall image trickling down the door. There was a dial by the bed to operate the accompanying soundtrack. Again, surfing those channels brought me from Xanadu to Lucy in the Sky with Diamonds: Olivia Newton John, the Beatles, followed by Karen Carpenter. I stopped short of ABBA when I realized I'd prefer silence to having "Dancing Queen" running through my head for the rest of this process.
I made it back to my room, but not before gingerly exiting the roller derby purgatory room, since I still felt like I would be caught in some kind of infamous Who concert crowd traffic. I'd like to think that my delusional state was due in part to the meds, but that was not on the full course dinner menu that was served in my room when I returned. With a tap tap on the door, and the server entered in a white tuxedo shirt, bow tie, black skirt, pantyhose and hospital administered slippers with 2 trays carrying my dinner, which I gauged to be about double my baby weight. My husband started flipping through the channels, encouraging me, "not to ignore these shish kabobs, they're delicious!" The chicken kabobs, calamari, Chinese dumplings, rice, miso soup, marinated tofu, seaweed salad, pickled plums, melon wedge and green tea did not appeal to me at the time, a time that my sister would later tell me was "transition." Well during this culinary "transition," I gummed some tofu and one sip of miso before turning my attention to the TV show my husband landed on during his surf session. It was some sort of cryptic puppet Star-Wars-eque type animation on a NHK (Japan's answer to PBS), so bizarre it may just one day be modernized and remade into a 3D film starring Johnny Depp.
The server tapped back in to clear the meal, leaving coffee and cake on a sliver platter in its place. Either the absurdity of the extravagant caffeinated meal service or the inane entertainment selection sped up my progress and we were soon to set off down the hall to the delivery room. I "buzzed" first, as protocol (read: rules) dictated and let them know we (all three of us) were "ready." I thought they would wheel me down or at least send an escort, but apparently wheeled carts were reserved for shish kabobs. Women delivering babies in floral gowns were expected to gut it out down the corridor, which I was picturing to be similar to the slow motion sobering impact of the lead up to the climax scene straight out of Dead Man Walking. In retrospect, I suppose I shouldn't be surprised that I had to hoof it myself. After all, I ignored at least 3 calls to take walks around the halls and up and down the stairs of the clinic during my "wait." Somehow, the puppeteer cartoon was the better option, which shouldn't surprise you that media won the coin toss, given all of the above Hollywood references.
We approached the entrance to the delivery room, and Bob was immediately sent back to the room for "the bag." Three months of preparing that step and we dropped the baton. Meanwhile, I was on my own in the agony of being told to change my slippers. I had to remove my "hallway" slippers and change into "delivery room" slippers. Regretting that I had a sip of miso soup in me at all, I awkwardly crouched down to change the footwear. I put my other slippers on the appointed shelf, stepped up from the entrance into the foyer, and took 6 steps to the delivery table where I, in turn, removed the delivery room slippers. That was the most painful memory of the next 18 minutes. Perhaps that was their strategy. Put me through the culture shock torture of changing slippers to cover 2 meters of ground in my weakest moment in order to erase what was to come. Instead, what followed was comic relief. Bob entered the room wearing a white doctor's coat that was at least 3 inches short up from the wrists. "Do you like my jacket? They said I could keep it." I was focused on how he wasn't issued scrubs, a mask, or hairnet/cap, and how he really had an uncanny Mr. Bean gone wrong on Halloween look about him. Suddenly, my required floral print gown felt Milan runway ready to me.
The clinic rooms were like the Waldorf suites, but next to me in the delivery room, a humble linen/poly blend pleated curtain divided me from the woman at the next table. She was saying, "I can't do it." The midwife scolded her, "if you say you can't do it, you can't. Is that how you want to start motherhood?" Whoa. I thought we were naughty for lapsing on the delivery room bag. She won't get the labor sticker in her handbook. But I was more relieved that she got to the room first, and that seniority dictated her rule-enforcing midwife. It turns out the the midwife assigned to was famous in her circle, as I would hear for the 3 months to follow at the various city administered health checkups how lucky I was since she makes "the best bellybuttons." Up until this point in my life, I thought I brushed fame by frequently hearing that my Mother in Law makes "the best spaghetti marzetti." Nevertheless, she works quickly and silently. There is a Fuji film commercial that spoofs a Japanese birth. The couple deliver the baby in seconds, without a peep, and the baby comes out with a camera and takes their photo. That scenario seems more believable than the Laser Show Examination Room, I realize, but it does ring somewhat true. It was quiet. I was instructed to hold my breath three times. After three intervals of breathing cycles and 18 minutes, we had our daughter. She didn't have a state of the art camera loaded with Fuji film, but she had a world renown bellybutton.
As one midwife was changing me into my titled pink "mother gown," another resumed my education. She approached me with a silver platter, of no less quality than the room service tray, this time serving a different purpose. The deep dish housed the placenta. She was holding the tray with one hand, and kneading it like dough with the other as she spoke. My reaction at the time was probably what you are experiencing just reading that line, screaming a mental, "WHAT?" My assignment was to touch it myself to say "goodbye" to the assist. Its job on the inside was over, and now the life of this child is in my hands, on the outside. This responsibility will outlive me, take it to heart, obey the rules. I didn't give it the same gentle massage as the preaching midwife, but I followed through by caressing it, the way you would approach a snake at a petting zoo, and incidentally have been off baking home made bread dough making ever since.
I returned to my room, where it was my job to recover for the first of the 7 night stay. In-service Mother School would resume the following morning. There was a midnight "snack" delivery, in full formal, "after 5" clad staff, but other than that, it was to be my "uninterrupted time." The babies were cozy in bassinets behind an elegant ceiling to floor glass wall in the midwife station. There were 18 newborns at the time, 5 born on "my day." Those 5 mothers would become my mother degree cohort. We spent the next week in classes, monitored feedings, and meals together. Ashley Hana was the only baby with a name, and I was the only one using it.
In Japan, there is a 2 week rule to naming your baby after birth. That's the deadline to register the baby's birth, including its name at the city hall. Until then, they tend to keep it a secret, or they really haven't decided. There's an unwritten cultural rule that the baby's parents have to seek the approval of the grand parents, great grandparents, and extended family before the name goes public. Next comes the bigger job of making sure the amount of strokes to represent the first and last name in kanji characters does not add up to an omen number, which could doom the child, family and future generations. Also, part of me thinks that since the mother and child's lives will become national record for the via the handbook until the child's 6th birthday, they are simply living dangerously by enjoying the 2 week window of having the freedom to guard anything, if only a name, in seclusion.
In the meantime, the babies are labeled with black permanent marker. The mother's name is inked down its arm and leg. As if the only American baby ever born in the clinic wasn't obviously mine on her looks alone, the phonetic Japanese lettering to write my foreign name totals 15 characters to the average 4 in kanji for the Japanese. The only baby with a real name, was a poor little graffiti child for her week in the display case. The least we could provide was longer than local average limbs to lessen the only cluttered look at the ornamental clinic.
Breakfast call was a classical Mozart selection piped through the room speakers. Mothers took their places in the dining room, where a full breakfast was served on our pink linen and multi colored floral patterned Noritake table settings before the classes kicked off that would take us up to lunch to a different composer. We had a week schedule which eased us in with basics like feeding, burping and bathing newborns then graduated us to detailed challenges like mastering the perfect sushi roll fold of a baby in a blanket. The only one without a secondary education in the art of origami paper folding, I had to retake that test several times a day during my stay. On the bright side, I was better prepared for my post natal education compared to my prenatal lessons, adorned with a full set of shiny, labeled school supplies thanks to the rigidly monitored checklist of the conspicuous hospital stay bag.
Babies moved in with the mothers mid-week, since we needed to learn that 3 PM children are different from 3 AM children. That may be, however, no matter what time of day it was or how many times I had cleared the bath test, this kid still had my name branded across her twentysome inches in bold black pigment. The ink in my pen, in contrast, was the only thing to my name that was fading. I followed the lead of my cohort and filled an entire notebook throughout our daily lectures. For the most part, I doodled during the "birth control" chapter since I thought the deep dish silver platter visual post delivery was more effective and economical than considering purchasing any alternative forms of prevention.
On the final night, our usual full course dinner service was upgraded to a feast worthy of three Michelin stars, including a champagne toast, several elegant Chinese appetizers, lobster as the fish course and Kobe beef as the main dish, followed by mochi ice cream and a dessert tray of tarts and cakes that appeared cuter and even more delicate than the newborn Kodak moments. We took photos and exchanged contact information, even though the hospital would be keeping us together on a twelve month follow-up agenda that led to our final graduation from child rearing education, a celebration on the babies' first birthday a year later.
The next morning was check-out. I saluted my one week stay goodbye as the front desk collected the remainder of the balance in cash-only fashion. In return, I was to pick out a souvenir gift for the child from the "girls'" clothing rack. Every baby also received a package including a hooded towel robe for the fresh out of the bath baby, which is appropriate for February newborns in a country lacking central heat, along with a "sandbox suit," which is appropriate in a country that actually keeps their kids neat and pressed whether it's 3 PM or 3 AM. They didn't forget about the mothers. I was given a parting gift as well. A small cedar box, containing a dose of cultural shock. The Japanese keep a part of their baby's umbilical cord, which I accepted with grace. After all, if she got the midwife that "makes the best bellybuttons," I should have a keepsake to commemorate the craft.
With my hospital stay bag now full of study materials, parting gifts and perfectly folded baby blankets, we loaded the car with a car seat, waved goodbye to the staff, and the cultural experience and headed home as a family of three. I headed inside, plopped my goodie bags down with cautious relief. I glanced around and thought it felt like I was away longer than just one week. Out of the corner of my eye, I caught a glimpse of the empty pizza boxes stacked in the kitchen and instead of a feeling of dread the housework ahead of me, the feeling of solace got the better of me. After an intensive 10 month education session Japanese style, ordained a "mother," and set off on my way, I should have enough confidence to read "Virgina" in a public forum with pride. But yet I don't think I'll have the chance to visit that buddy Jeannie in NoVa anytime soon. At one time bedazzled by the overwhelming scent of the clinic's floral arrangement, my senses grounded and I found myself overcome by the welcome bouquet of leftover pizza. Suddenly, instead of wishing I still had 3 AM and 3 PM access to the Narita Ladies Clinic Iron Chef, I thought, "Ahhh...a taste of the American way. Home and on our own. Without a rule book...at last."