Japan: HUG Your Baby Comes to Japan

I would like to start my Takamatsu, Japan, blog at the end of our stay there.

Natsuno is a nursing student at Kagawa University, learning under the watchful eye of Professor Kimie Tanimoto, a nursing professor who has lived with Jim and me several times over the past three years while she attended workshops at Duke and UNC.  After meeting us for dinner one evening in Takamatsu, Natsuno asked if she could honor us with a tea ceremony (cha-no-yu), the ages-old Japanese tradition she has been studying for three years. We met at the University’s tatami room with Kimie and several other students. Natsuno, dressed in the pale purple, embroidered kimono she wears only once a year, is serene and beautiful as she moves through the specifically orchestrated steps to tea making. Her movements are intentional, exact, and graceful. She snaps her napkin with practiced precision and turns the bamboo ladle each time in what appears to be a predetermined sequence. She whisks our green tea in unique bowls she has chosen specifically for each of us.

When the bowl is placed between Kimie (sitting to my left) and me, I bow and am encouraged to say to her, “Sorry, I will drink first.” With Kimie’s help, I am then shown how to admire the bowl’s decoration (mine has ancient Japanese houses) before turning the front of the bowl to face the center of the room. I sip the tea and bow again before placing my cup back over the important black fabric strip that separates my tatami mat from the young tea master's.

The image and feelings triggered by this tea ceremony were echoed in my experiences yesterday.

Kimie and I found ourselves returning to Takamatsu’s Bokko Birth Center to show The HUG DVD to a pregnant staff member and a group of mothers gathering for a “mother’s morning” with their toddlers. Though I personally found the toddlers more stimulating than my DVD, these women were gracious in their appreciation of an American piece of work. As Kimie and I prepared to leave for the day we were unexpectedly invited to attend a pending birth.

With contractions 10 minutes apart, this second-time mother had arrived just an hour before. Two midwives squatted beside the mother, who was lying on a futon in a lovely tatami room. The father, calm and tender, held his wife gently between his legs. Their four-year-old daughter, comfortable and mildly curious, brought a porcelain cup of water to her mother when asked. At the peak of her contractions, the mother made minimal sounds. The midwives gently reminded her, “No pushing” and joined the family in the rhythmic chant to “breathe . . . breathe . . . breathe . . .” As one midwife continuously massaged the expanding vaginal opening, I wondered how a mother half my size could deliver without a vaginal tear.
Click HERE to hear midwives philosophy and practice.
But, during this second hour, a head popped out of an intact vaginal introitus, and within a very short time a new baby girl entered our world--and found her way promptly to her mother’s breast. Father and sister cut the cord. Minutes later a new double futon was laid out (onto which the mother rolled), the birthing futon and small bucket of birthing equipment and Doppler were removed, and a peaceful mother, father, sister and baby posed for their first family photo. Kimie and I bowed and excused ourselves.

Mothers stay at the birth center for 5-6 days, care covered by the Japanese health insurance system. They are fed delicious fish, root vegetables, and miso soup.

A tea master, poised, calm, measured; a midwife (who has delivered 3,000 babies) sure, grounded, confident (in a woman’s ability to give birth)—these experiences reflect the importance, in Japanese culture, of maintaining calm attention to matters at hand, of building (and sometimes depending) on one's historical experiences, and of respecting the mystery and power of life.

On Day One of our trip to Takamatsu, Kimie took us to meet her colleagues at Kagawa University Hospital, Dr. Kusaka (a neonatologist) and Dr. Kato (a pediatrician and lactation physician). Dr. Kusaka is an exuberant man, eager to share his medical home (and the city where he was born and raised) with interested Americans. We toured the NICU, the L&D suite, and the OB and pediatric clinics. Babies were placed in my arms, and I was shown the transderm bilirubin tester, actually invented in Kagawa!

During our wanderings we learned amazing facts about this hospital. They have the lowest c-section rate in Japan; they do not use epidurals, and anesthesia is only used for c-sections; labor starts on its own, and mothers eat and drink during labor. Circumcision is non-existent. All mothers provide breast milk for their premature babies, and if a mother does not have enough, another mother provides what is needed. Dr. Kusaka talks with great passion about the “care of the whole family, not just the baby.”

His hospital, like most, struggles with the ethics of today’s high-powered medicine. He is caring for a recently-delivered twin born at 32 weeks with both Down Syndrome and leukemia. The brother is a healthy premie. How does one decide what, if any, treatment to initiate? The parents’ passion to “do everything” is understandable. The country’s payment of all these NICU bills is eventually limited, though.

Dr. Kato is a physician any mother would seek out. She is cheerful, highly trained, and practical in her approach to helping young families. She attended the class I offered to Kimie’s nursing students and was captivated by The HUG and by Dr. Brazelton’s NBAS (Neonatal Behavioral Assessment Scale). She appreciates both how understanding a child’s developmental events (as described in Brazelton’s Touchpoints) and how sharing newborn behavior enhance her care of the families she serves.

Dr. Kato liked the concept of The HUG’s Roadmap to Breastfeeding Success, which I presented to the class she attended; however, she questioned some items not relevant to a culture whose mothers routinely take a year of paid maternity leave after the birth of their child. I joined Dr. Kato for a four-week well child visit. The vigorous, thriving youngster drew the attention of a half dozen professionals when he demonstrated his remarkable ability to follow a toy, to watch my moving face, and to turn to his mother’s voice.

Our hospital visit was followed by an evening presentation to the Kagawa School of Nursing faculty. Hoping for a show of 15 and happy to chat with 10, imagine my surprise when Director of Nursing, Dr. Shimizu, welcomed me and 82 others! Since faculty from all areas of nursing were invited to my presentation, Kimie had suggested a broader (than just newborns) topic for discussion. Kimie also willingly served as IT expert, logistics director and translator as I, phrase by translated phrase, began “The Nurse as Innovator: HUG Your Baby as One Example of What Nurses Can Do.”

While discussing the expected steps to reaching a dream (set goals [and write them down], research, take action, share goals and collaborate, evaluate and redesign), I discussed some of the more tender and challenging moments for me in the birth of HUG Your Baby: recognizing and addressing my internal insecurities and resistance, choosing carefully those to share my dream with initially, dealing with failure, committing to small steps even when the goal seems quite unattainable, and being open to discovering new passions and skills in myself. (Who knew I would LOVE to tell stories?!) 

The obvious language barrier, and a cultural hesitancy to share feedback openly in a group setting, made it difficult for me to access how well (or not) this topic and my style were received. But, the joy of meeting colleagues internationally has inspired me to push myself beyond my comfort zone and to see what the world has to teach me!

The following day I felt a bit more "in my element" standing before 40 nursing students and a handful of faculty and hospital nurses. The class began with me “Giving The HUG” to a Kagawa physician who had graciously brought her four-week-old to meet the class. (Click HERE to see a one-minute video of students discovering The HUG). Consistent with what Dr. Brazelton discovered in his visits to Japan in the mid 1980s, this baby exhibited a remarkable ability to calm her body, attend to me and my toy, and persist in what The HUG calls the “Ready Zone.” The Japanese students bubbled with delight and had to be gently “shussed” so as not to over-stimulate this charming, and capable, newborn.

Though interactive teaching is not traditionally practiced here, Kimie gave me the nod when I carefully requested that students reflect on and write down their thoughts about what I was discussing. (Click HERE to see a one-minute video of "interactive teaching" in progress in Japan.) After further information was presented, students were then asked to "share their experiences with a neighbor." Exhilarated by their active participation, I then divided the group into thirds and guided discussion of various forms of mother-child attachment ("secure," "anxious," and "insecure"). 

Their speech was animated, their role-playing was fun, and they were relaxed and engaged as this American nurse and teacher sought to communicate a few new ideas with the same passion we share, wherever in the world we are, to care deeply about the patients we serve.