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Complainer or Advocate?

What does it take to make a change for the better?

By Joy Jarman-Walsh

Read more: health, advocacy, c section, prom, post birth experience

Photo: Jyn Meyer

This is not my first time on bed rest, I was here last year for 3 weeks at the same hospital with PROM, but this time my condition is much more stable. There is a lot of hope and even enthusiasm from my doctors here.

I guess it may be because I am further along, or probably for a variety of reasons, but the staff here seem to be asking more of me this time -- they are giving me responsibility, making me a part of the process. I have become a kind of resident foreign patient and have been asked to join the head nurse when she greets new "gaijin" patients to help her explain procedure. I am happy to help out -- it gives me something to do and gets me on the good side of the head nurse.

Last week, I was shocked to walk around the corner and see a close friend being wheeled into the emergency examination room. I knew she was pregnant and due any day, but she wasn’t supposed to be here, this is where people are sent in an emergency! I tried to put on a brave face for her and tell her that everything was going to be fine (she really is in the best place I thought), but I could see that she was in too much pain to register what was going on.

I tried to talk to her weeks ago about making a birth plan and talking with her doctor about what might happen if there were complications. But she was having an uncomplicated first pregnancy and didn’t want to hear about the possibility of having to have a c-section or having her baby treated in the NICU. Now it was happening. I tried to talk with her doctors and plead on her behalf for a horizontal cut, instead of a vertical, as they are more apt to do here. They argued that a vertical cut was better to get the baby out sooner, but then it turns out she had never done a bikini cut before. So, for Karen, it was simply an unlucky draw of a doctor that day. Luckily for her, however, she was beyond caring. I remember that mid-labor feeling, “just do whatever you need to… just make the pain stop!”

Surgery was a success and her baby was a healthy 3300 grams, but they wanted to keep him in the NICU overnight for observation due to water in his lungs. I saw Karen the next morning and she said she hadn’t slept all night and when she did, she fantasized about going and seeing her baby whom she hadn’t been allowed to hold yet. I was appalled and called the nurse and asked her to bring the baby to Karen. The nurse and a doctor came and explained that she wasn’t allowed to see the baby until midday, but fortunately I persuaded them to make an exception and wheel her over to see him soon after.
 
Later she told me she was only allowed a few minutes and was not allowed to hold him skin to skin or try to breastfeed -- instead the staff were giving him formula. Later in the day when she made her first effort to walk, she asked to see the baby again, but was turned away at the NICU door and only allowed to look at him through the window, “because he is sleeping”.

Hearing this broke my heart as I remember the wonderful bonding experience I had with our son, being able to cuddle, feed and watch him in awe as I kept him with me from the moment I woke up after my c-section, until we left the hospital 10 days later. I also remember the pain of not being able to hold our twin boys after they were stillborn last year until a week later when we had to prepare them for cremation. My friends are so accepting of the injustice of the situation, luckily for them they don’t know any better. But even when their child is moved to the normal nursery the next day, it is no less cruel as the father is then only allowed to hold his child once a day during visiting hours and the mother is only allowed to come every 2 hours to breastfeed.

When I complain about how unfair it all is, Steve, Karen’s partner, tells me it is okay. “We are British,” he says, “we are not the complaining type. There are people that don’t heed signs like ‘don’t walk on the grass’ and there are others that obey the rules." But I argue that this situation is like someone coming into your own private garden and putting a sign up saying, “don’t walk on the grass.” We both laugh, but I get their point -- they don’t want to make waves no matter how unfair it is. I have to respect that.
 
On my way back to my room, I meet another couple, a Japanese wife and her Scottish husband, who just had a beautiful boy. The husband has to leave in a few days and laments that he will not have the opportunity to hold his child for another two months since they have forbade him to enter the nursery. Why? Since he can’t breastfeed, does he have nothing to offer?

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This adds to my frustration and I write on my blog about the whole situation. A comment on the blog the next day breaks my heart. It is from a mother who says it reminds her of her own horrible hospital post-birth experience. After she had a natural delivery and her baby was fine, she was still denied access to her baby for two days. She remembers looking longingly at her beautiful boy from outside the nursery glass as her heart was breaking with longing to hold him. A nurse soon came by to tell her not to do it again, and to go back to her room.

This comment made me realize how unfair many childbirth and aftercare situations must be here in Japan, but I had such a wonderful first experience at a different hospital, so I knew it could be better. I knew I had to do something, so I wrote a letter to the hospital administration. I explained the injustice of denying access to your own newborn soon after birth and called for recognition of both mothers and fathers in their rights to hold and bond with their babies. I further argued for kangaroo care to be considered as soon as possible after birth as well as the rights of a mother to breastfeed as early as she desires to be considered. Finally, infants should never be given formula without their parents' consent.

I felt good about the letter. I tried to convey the need for a reassessment of policy to make it more family friendly, while trying to express my sincere gratitude for the high quality of care we were all receiving- it was a difficult balance.

The very next day, to my surprise, the head nurse came into my room to talk about what I had written. This is not a very confrontational society; I had expected a polite form letter type of response someday down the road, but the response came so quickly. I was very impressed with her tone, it was not at all defensive and we had a great discussion about the points I had made. She was also very accepting of my conclusion to request a transfer once I reached viability to a family-friendly hospital that would allow me to room-in with our baby. It would simply break my heart, I added, to be separated from our baby for a moment longer than necessary after giving up my life to be on bed rest these past months. She said she would help me do whatever was necessary to secure the transfer and added a promise that she would discuss my recommendations and cited research (I am a teacher after all) with the rest of the management.

The outcome of my letter exceeded my expectations and gave me a renewed faith in the open-mindedness of Japanese management. My friends had pleaded with me not to make waves. “At least wait until we leave,” they said. Was I a bad friend? Was it selfish? I felt I had to give my convictions a voice and now the ideas are out there creating a discussion among management -- what they do with it is up to them, but at least it is there.



Joy Jarman-Walsh has been living and working in Japan for many years, now in Hiroshima where she and her husband started a community website in 1999 which made living there so much more interesting that they have stayed much longer than expected. Joy is a full-time university English assistant professor when she is not on bedrest or maternity leave.

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