Staying healthy in Japan

Features Health - June 9th, 1989

by Elyse M. Rogers

HIDEKI SAKAMOTO, M.D.
Specialist/Consultant in Obstetrics & Gynecology, Tokyo Medical Surgical Clinic

Many young foreign women come to Tokyo during their childbearing years. Pregnancy is a happy time, or should be, but in years past the concern about care during pregnancy and delivery has cast a shadow over that happiness. Japan has fine obstetric facilities, of course, but naturally they are targeted to Japanese women who understand the language and have grown up with a different cultural attitude to­wards pregnancy and child birth.

Perhaps the major difference between foreign and Japanese women can be seen most clear­ly in Dr. Hideki Sakamoto’s comment, “Foreign women ask lots of questions, which I’m happy to answer, but the ques­tions are far more numerous and more complicated than those of most Japanese wom­en.”

Dr. Sakamoto should know, as he serves both the foreign and Japanese community in his specialty of obstetrics and gynecology.

BACKGROUND ON DR. SAKAMOTO

Dr. Sakamoto began as a consultant to the Tokyo Medi­cal Surgical Clinic in 1987. His arrival was fortuitous, not only because we have many preg­nant foreign women who are seeking English-speaking doc­tors for their pregnancy, but because such women hope to have their babies under the same Western medical system with which they were familiar.

In Japan, most hospital physicians take care of preg­nant patients and delivery is accomplished by the staff physician on duty at the time of delivery. In other words there is not the continuity of care that American women have come to appreciate and expect.

But it is not only in the area of obstetrics that Dr. Sakamoto is making a contribution, but in the area of gynecology as well.

More about that later, but first let’s talk about the doctor’s qualifications. Hideki Sakamoto was graduated from Nihon University Medical School and interned at the U.S. Regional Naval Hospital in Yokosuka. After that he served his residency at Nihon University (Itabashi Hospital), then went on to a postdoctoral fellowship in reproductive neu­roendocrinology at Yale Uni­versity School of Medicine. From 1985 to 1987 he served as an instructor in Endocrin­ology and Obstetrics and Gynecology at Yale, then re­turned to Japan in 1987.

Currently the doctor is an assistant professor of obstetrics and gynecology at Nihon Uni­versity School of Medicine and comes once a week (on Wed­nesday afternoons) to see patients at the Tokyo Medical Surgical Clinic.

PROCEDURES DURING PREGNANCY

In a more simple era, the time prior to a baby’s birth was a time ignored by most, except the mother-to-be. Now. however, we are cognizant that this fetal-formation time is a very important one. Pregnant women are carefully followed during pregnancy, to make sure the pregnancy is progress­ing normally, that they are taking proper care of them­selves (and of the growing fetus), and that they under­stand the whole process of pregnancy, labor and delivery.

A woman who understands the process well can cooperate with the attending physician to make sure both mother and baby are hale and hearty not only during pregnancy and birth, but that they remain so in the future.

Good, ongoing care demands routine visits during pregnancy and Dr. Sakamoto’s schedule reflects his concern with on­going monitoring. Usually, visits are scheduled once a month until 28 weeks and then once every three weeks, two weeks and one week as the pregnancy progresses. At these visits, the patient is weighed, uterine height is measured, a urine sample is tested and the patient can report any prob­lems or ask questions.

With the advent of ultra­sound (internal soft-tissue ex­amination techniques that use sound waves instead of X-rays), much more information on the fetus is available during pregnancy. Although there has been some recent discussion that there may be unknown risk from these tests. Dr. Sakamoto feels the risks are very minimal and says the information gained is extreme­ly valuable and, he feels, outweighs any possible risks. (Remember, this procedure has been considered non-invasive or safe in the past and the data still seems to indicate this.)

Ultrasound tests are con­ducted at the initial visit, then repeated at 20 and 36 weeks of preg­nancy. If the fetus’ heart­beat is not confirmed dur­ing the first ultrasound, it will be repeat­ed two weeks later. (It’s inter­esting to note that only 5 per­cent of patients miscarriage if the fetal heartbeat is heard at this early stage.)

These tests not only warn of a possible miscarriage, but they help the doctor calculate the correct age of the fetus and, perhaps most importantly, can tell if the fetus has a serious defect. If a serious de­fect is detected, the doctor must tell the patient and the patient and her spouse must decide what course of action they wish to pursue.

The ultrasound may also indicate possible problems and suggest other tests, such as blood tests and/or amniocen­tesis. Blood tests can help diagnose fetal defects such as spina bifida (a spinal-cord defect) or encephalitis.

Another test is alpha pro­tein, done routinely at 15 weeks. An abnormally low level can indicate Down’s syn­drome, or an abnormally high level can indicate spina bifida or other neurological problems. In that case, amniocentesis will be recommended.

Amniocentesis (testing the amniotic fluid in the uterus in which the fetus is suspended), can give very important, precise information. Such test­ing is done if other testing reveals possible problems, but it is also routinely recom­mended for women over 35 who arc pregnant for the first time. Older first-pregnancy women risk a higher rate of some types of fetal abnormali­ties, such as Down’s syndrome.

NORMAL PREGNANCY

Since most pregnant women sail through pregnancy without major problems and have normal babies, let’s look at the bulk of the patients who pass through Dr. Sakamoto’s office.

He is very concerned with good health habits during pregnancy and says the foreign women here are good patients because they are well-educated and cooperative. Weight pain remains of major concern dur­ing pregnancy (too large or quick a weight gain can bring on significant problems for the pregnant woman and/or the baby), and Dr. Sakamoto sug­gests a limit of from 12-15 extra kilograms (26-33 pounds) gained during the nine-month pregnancy.

He also suggests routine exercise and a moderate diet and prescribes supplemental vitamins and minerals, par­ticularly vitamin B-12, folic acid and calcium; however, in his practice he says that “undernourished women are seldom a problem.”

HOSPITAL AFFILIATION

One of the nicest aspects of Dr. Sakamoto’s practice is that he has privileges at Seibo Byoin (Catholic International Hospital), and therefore can deliver babies and attend to his patients in their postpartum period. Since Seibo is such a friendly place and has people like Mother Mary who not only speak English but are delighted to serve foreigners, it’s a nice place to have a baby. It’s well to remember that foreigners are still a minority, even at international hospitals such as Seibo.

For example, Seibo has ap­proximately 200 deliveries per month, and maybe two or three are foreign.

It’s also important to re­member that no woman is limited to one specific hospital. She can go to another hospital if she prefers: however, she must be prepared to use the attending nurses, midwives and doctors on that staff. (For example, many foreign women use Aiiku Byoin, Sanno Clinic or Nisseki.)

GYNECOLOGICAL SERVICES

A physician who specializes in OB/GYN wears “two hats” in many ways, since the two specialties (although related) can be quite different.

Dr. Sakamoto, for example takes care of women with severe gynecological problems including cancer. At the Tokyo Medical Surgical Clinic he does routine pap smear exami­nations and includes a kind of “mini physical” as I call it. Once a year is the usual tim­ing for such mini-physicals and they include, in addition to the important pap smear, a pelvic examination, a breast examination, urinalysis, blood pressure testing, etc.

In regard to mammograms (breast examinations by spe­cial X-ray technique) Dr. Sakamoto feels they are indi­cated only in older women (yearly after age 50) or with women who have some special problems or a history of breast cancer in the family. Happily mammograms arc scheduled at nearby Mitsu Kinen Byoin which has up-to-date (low exposure) X-ray equipment.

Hormone Replacement Ther­apy (HRT). used for women after the menopause, has been gaining in acceptance in the United States, particularly be­cause it not only mitigates the uncomfortable menopausal problems of “hot flashes,” but because it helps prevent osteoporosis (bone loss) in aging females.

Many Japanese physicians are reticent to prescribe such therapy or take care of women who are on maintenance doses of post-menopausal hormones. So. it’s nice to know that Dr. Sakamoto is familiar with this program and is happy to work with women who are involved in such programs or are con­templating starting them,

BIRTH CONTROL

For those who need birth control advice or wish a pre­scription for a specific type of device, the doctor includes this type of consultation in his practice. Birth control pills cannot as yet be prescribed in Japan (except for gynecological problems rather than for birth control), but the doctor is hopeful their use will be ap­proved by the government in the near future. (For women who use birth control pills, it’s wise to bring enough medica­tion  “from  home.”

OFFICE LOCATION, HOURS, FEES

The Tokyo Medical Surgical Clinic is well known to many and is conveniently located right across from Tokyo Tow­er. Dr. Sakamoto comes to the clinic weekly, on Wednesday afternoon, scheduling appoint­ments from 1 to 5 p.m. Although he is only at the clinic weekly, he gives his obstetrical patients his home phone number so he can easily be reached at all times. (His wife is a foreigner herself, from South America, so she understands Western medicine and the important doctor/patient  relationship.)

Hideki Sakamoto. M.D., To­kyo Medical Surgical Clinic, Mori Building 32, 3-4-30 Shiba Koen, Minato-ku, Tokyo 105.