Jul 27, 2011

2nd Trimester - Personal Account

Here is a personal account of my 2nd trimester of pregnancy in Tokyo at a Japanese public hospital, continuing on from my previous post about 1st trimester. Depending on which hospital you go to in Japan, there may not be alot of English available, and also this may be your first pregnancy, so I have tried to explain my experience in as much detail as possible.

You may be wondering by this stage in your pregnancy what the purpose of the “boshi techo” is?! Well, the hospital finally starts to enter information into it from 2nd trimester. Each monthly checkup from 20 wks pregnancy will involve the following tests and measurements:
- Urine test
- Blood pressure
- Body weight
- Measurement of waist and size of uterus
- Heart beat of baby with a Doppler
- Check for any signs of swelling in ankles and feet
- General questions such as how are you feeling and has the baby been moving, etc

When it was my first time for these tests at 20 wks, it was a bit confusing as I didn’t know what to do and there wasn't any English explanation available. Most hospitals will have their own little routine, and you are basically required to do the routine checkup list above with the nurses before your appointment with the doctor. I stood at the door of the checkup room for a few minutes waiting for the nurses to explain what I had to do, but they didn’t seem to realise and just left me standing there! Luckily my husband was with me and he explained to them it was my first time and then it finally dawned on them and they explained each step to us and that this will happen with every appointment from now on.

The routine at my hospital is:
- When I arrive at the hospital, I put in my hospital card at the ATM-looking machine and it prints out my appointment for the day. I then go straight to take a urine sample (on a different floor of the hospital), and hand it over to the laboratory.
- Then I go to the maternity ward and measure my blood pressure and body weight. I give these results to the nurse (who writes it in my boshi techo) and wait my turn. Then I am called in and the nurse takes me into a separate room closed with a curtain where she asks me how I'm feeling, I hop on the bed and she checks my baby's heartbeat with the doppler, then measures waist and uterus size. She then checks my ankles and feet for any swelling. She writes all this information into my boshi techo, and then I go out to the waiting room to wait for my appointment with the doctor.
- After my doctors appointment, I go down to the hospital front desk to pay my bill and then all finished.

Each hospital will be a bit different, so it is good to ask the nurses about the routine and what you are required to do for each appointment. Once you get to know the routine it is much easier!

At 27 wks I had the test for gestational diabetes. This was another little experience of misunderstanding! The doctor explained the test for gestational diabetes to me at my previous checkup - we were talking in Japanese and I thought he said to drink some softdrink 1 hour before coming to the hospital. So, on the morning of my appointment at 27 wks I drank a can of 7up on the way. This was pretty embarrassing in itself, as I was holding the can of 7up on the bus at 8 o'clock in the morning on the way to the hospital and I was thinking people must think this pregnant lady is not looking after her health!! Anyway, when I got to the hospital, there was a bit of confusion among the nurses when I explained to them that I had done my preparation and drunk softdrink before I came.... after a few minutes it became clear that I had made a mistake! What the doctor had said was that when I come to the hospital, they will get me to drink a glucose drink (which tastes like a softdrink), and then I wait for one hour before they take a blood sample to test for gestational diabetes. I was pretty embarrassed, but I'm sure these types of experiences happen to everyone in Japan!

In terms of weight gain, by the end of 2nd trimester I had put on a total of 10 kg. My baby was estimated to weigh about 1.2 kg, so the other 8.8 kg was extra weight. The nurse seemed to be surprised by my fast weight gain (she actually measured my belly twice just to make sure!) and recommended me to take care and try not to eat too much, particularly fatty foods. I was a bit shocked by her reaction, as I eat relatively healthily and my intake hasn't changed greatly since before I became pregnant. Also, I checked the guideline for weight-gain during pregnancy in Australia, and it seems it is normal to gain 11-16 kg during pregnancy (1-1.5 kg per month in the first trimester, and 1.5-2 kg per month for the rest of the pregnancy). The nurse at my hospital said I should be only gaining 0.5 kg per month, so it seems the Japanese standard is much lower than overseas. Personally I think as long as you eat healthily and feel good, then that is the most important thing for both you and the baby!!

Costs for Pregnancy Check-ups in 2nd Trimester
The following are an example of the costs for maternity check-ups at a Japanese public hospital as of 2011. I have Japanese national health insurance and used the yellow discount tickets from the ward office (Kuyakusho) that were received with my boshi techo.
Note - these costs are only provided as a guide. Actual costs may vary depending on which clinic/hospital you go to.
Also note that ultrasound scan costs approx. 5,000 yen each time, as it is not covered by insurance. This 5,000yen is included in the costs below, unless one of the free scans provided from the Kuyakusho was used.

15 wks: 8,000 yen
- scan and chlamydia test

20 wks: 0 yen 
– checkup and scan (I used one of the free scans, so no cost)

23 wks: 2,000 yen 
- I had this early checkup just 3 wks after my previous appointment as I was going overseas (usually you have an appointment once a month in 2nd trimester). They did the regular checkup and consultation with doctor. I didn’t have a scan (so didn’t have to pay the 5000 yen), but the doctor did check my cervix by vaginal ultrasound to confirm no problems or signs of labour before I went overseas (apparently the cervix shortens and becomes soft if labour is imminent)

27 wks: 10,000 yen
– checkup, scan, and test for gestational diabetes (this test is not covered by insurance, so had to pay)

See you in another 3 months with my personal account of the 3rd and final trimester! Hopefully all goes well!

Click here for information on all 3 trimesters.