We share this story with very heavy hearts. This guest blog post, told and photographed so beautifully, comes to us from an American family in Japan.
At 39 weeks pregnant, with her husband 7,500 miles away on military business, Sarah Nannen did something very unusual (make sure you read all the way to the end) in order to have her baby at a place where she felt safe.
Her sweet baby was born six weeks ago in Okinawa, with her husband Reid participating by FaceTime from Key West, Florida. Sarah sent us her birth story, but before we were able to publish it, she received news that Reid had been involved in a plane crash in Nevada. He did not survive.
We share the story of her fourth baby's birth in tribute to this strong, courageous woman, a former Naval Officer herself and the man who loved her so very much. We can't imagine what she and her family are going through right now. Sarah, you are a rock and we are holding you in our hearts.
The Improving Birth family appreciates the dedication and sacrifice all military families give. Captain Nannen and his family paid the ultimate sacrifice. A trust fund has been set up for Sarah and Reid's children. Please consider a contribution.
I was aware all night somewhere in my wakeful sleep of a cramping feeling in my tummy and woke in the morning knowing my little one would be choosing her birth-day soon. My doula friend and I enjoyed a fabulous morning together including a delicious breakfast and shopping. I was grateful for her company despite the fact that I was a bit spacey and increasingly aware of a pattern of gentle surges coming often enough to be noticed. I didn't time them and did my best to ignore their presence, but they continued to come and little by little grew their energy.
Near lunchtime, I began needing to take pause and be still during the surges; although they were not painful, their energy required my concentration as they swelled to their peak and washed away again. We met another doula friend for a delicious sushi lunch and discussed birth and babies and moving and travel plans, and the surges continued to swell and wash away, still without pain but certainly growing in intensity. I didn't mention it, but I knew my lovely doula lunchmates were both aware of what was going on. Finally around 3 pm I met my two doula friends and my translator at the Japanese birth center for an appointment with my OB and midwife. I was 39 weeks, 5 days pregnant and meeting these women for only the second time in my pregnancy (I'll explain later) so I received a gentle sonogram and non-stress test (NST) to give my care providers the peace of mind that all was well with my pregnancy. We discussed my birth plan during my NST while I lounged comfortably in a reclined chair with my OB and midwife by my side. Ten minutes into it, the OB glanced at the printout and asked if I was having any pain with my contractions. I answered I was having a bit of discomfort and they were requiring me to close my eyes and breath as they surged in and washed away. She suggested I not go far as my surges were coming seven minutes apart; that was the first moment I actually realized I was likely in labor.
In Japan, it is customary for women to come to their place of birth early in labor, but I assured her that I was not close to birth yet and wanted to go shopping to grab a few last minute baby supplies I had forgotten to pack. A little wide-eyed, she agreed, but asked me to hurry and come back soon. The shopping trip was brief but the intensity of my surges increased dramatically and my ability to concentrate and make decisions on what kind of baby bits we were buying was limited. I basically handed over my credit card to my friends and hunkered down in the toilet while they shopped for me. By the time we were checking out, I agreed we probably should head back to the birth center to stay - I finally admitted this was actually labor and was so filled with joy to know I'd be meeting my fourth little babe soon.
When we arrived back at the birth center a little before 6 pm, we were quietly shown to my room. The beautiful cedar building was dimly lit and quiet with a small staff standing by in the nurses station. They invited me to change into comfortable clothing and delivered me a gorgeous traditional Japanese dinner as my surges continued to swell in and wash away. They were more and more powerful yet I was very present and conscious and connected between contractions and felt a bit self-aware.
You see, I had a room full of incredible women (two doulas and a fabulous translator) ready to support me in any way that I needed. But at this point in labor, I really wanted to be in my own undisturbed space. I retreated again to the toilet, brushed my teeth, and eventually emerged to walk the halls and up and down the stairs to encourage baby to labor down. My husband was on the opposite side of the world in Key West on military orders so we phoned him to let him know labor was definitely in full swing and decided to call him back in a few hours so he could sleep before his flights the next day.
The gentle care I received was what every woman deserves. There was no triage upon arrival, no forms, no vaginal exams, no nurse telling me I probably wasn't in labor - I arrived and was greeted with knowing smiles and ushered to my sacred space and allowed to labor in my own time and way. They came silently, wordlessly, every twenty to thirty minutes to listen to the baby's heart tones and then silently, wordlessly, left my sacred space again. As a doula, I appreciate how much you can tell about a woman's labor simply by watching and listening to her work and these amazing Japanese midwives did just that. It was completely non-invasive and perfectly gentle; it honored the work I was doing as a laboring woman and never asked me to compromise my body's work for what they needed to accomplish.
After my walk around the birth center, I felt a bit chilled from the drafty halls and retreated back to my cozy private room. I shifted between swaying in the middle of the room and squatting on the very tiny western style toilet - for this fourth birth there was something very comforting about being closed up in my own private space. The bathroom provided just that, with an amazing team of support just on the other side of the door. I soon realized that the chills had transformed into full-body trembles with a side of nausea, a sign that I was full-on in transition and nearing second stage of labor. I was both overjoyed and also overcome by the intensity of my surges as baby worked her way down and I began a deep, throaty moan that had surprised me so much in my first birth, but by now was a welcome sign of good progress in my fourth labor.
Around this time, I noticed an ache at the back of my hips and my doula immediately provided counter-pressure with a double hip-squeeze that provided a complete shift in the intensity of my surges. I was hooked and for the rest of my labor, she squeezed my hips with all her might through every. single. contraction. The power of my contractions was intense by now and I asked my friends to call my husband back after my first few attempts to ring through to him went unanswered. I was worried he would miss the birth and just said "keep trying to call." This was around 8:30 pm.
I retreated once again to the toilet and my vocalizing began to get louder, just a throaty moaning that channeled some of that excess energy roiling around my belly and out of me - it was primitive and subconscious and happened without thought or effort. Knowing it's so important to allow yourself to sink into your "monkey brain" (as Ina May Gaskin calls it) and allow your body to move and make noise in whatever way feels right, it almost seemed as though I was listening to my body labor from somewhere else in the room. Every movement and motion and noise I created was instinctive with no conscious thought applied - it felt natural and I knew the women witnessing and supporting my birth knew it was important work to be done in its own way. The midwife, who I am sure had been listening to my increasingly loud vocalizations, appeared in the doorway and in a quiet voice said "Sarah-san, I think it is a good idea for you to move to the birth room now." I knew she was right, I knew the baby was coming soon and I wanted to hear my husband's voice on the other end of that phone line. My friend continued to dial his number as I slowly walked down the hallway to the birth room. About halfway there I finally heard his voice! He was with us via FaceTime and I immediately felt a rush of relief and release run through me - I new this baby was coming very soon now that he was "here." Almost immediately, I had a very strong contraction at the top of the stairs just before entering the birth room.
Once in the simple Japanese tatami style birth room, the midwife asked me to lay down on the futon mat on the floor as is apparently customary for birthing women in Japan. I had been upright my entire labor and the idea of laying down now seemed impossible and counter-productive, so instead, I headed toward the private toilet off the birth room for more solitude and to empty my system before second stage began, a choice they supported without a word. I only made it as far as that bathroom doorway and held on tight as a massive contraction surged through me. I knew she was close and I was suddenly so hot and removed my fleece wrap and shirt, standing there in a sports bra and stretchy long skirt. I thought to remove the skirt but the next contraction came so quick and intensely that I didn't have a chance. I felt so powerful, so at peace and so intensely filled with energy as these surges labored baby down. There was still a sense of watching my labor from somewhere in the room outside myself, my body was so totally and completely in control of the work that was being done; I was just along for the ride and trying to stay out of the way. My doula continued to apply the absolutely vital hip-squeeze counter pressure with every contraction and it made all the difference as I stood there holding on to that doorway as my body labored.
A couple of surges there in that doorway seemed to peak immediately, there was no gradual swell of energy and I felt myself opening as baby moved down. I still had not had a cervical check, just as desired in my birth plan, but there was no doubt that my body was close to bringing this baby down and out. And then I heard the lioness roar that accompanies my pushing sensations - again, this just came and overtook me without any conscious thought. It is amazing how such an unrecognizable sound can come from your own throat, but it came loud and strong. There was no direction to push nor any need for it, my body in one roar of energy pushed and the forewaters ruptured at my feet hidden inside my long skirt. The ladies immediately began cleaning the floor so I wouldn't slip but I said with great urgency, "Take off my skirt!!!" as I could feel more and more opening. One of the midwives was attempting to put the EFM belts around my belly as all this was going on (it was clinic policy to have these EFM belts on during second stage), but it was the most distracting and agonizing feeling to have her touching my belly and said "no" as the next surge was building and she thankfully agreed. (My doula later informed me that there were some sideways glances around the room since I was breaking protocol with this move along with the fact that I wasn't lying down, but they all just tuned in to my body and my work and honored the way I needed it to be done...it helped that second stage happened so quickly!)
Just as they got the skirt off, another lioness roar came as my knees bent slightly into a squat, my body pushed, and I instinctively reached down to catch my daughter's head at 10:10 pm. I can remember vividly the feel of her soft hair and perfectly round head in the palm of my right hand as time stood still in that instant that is forever engrained on my mother-heart.
In just another moment, in that same long powerful contraction, again my knees bent slightly and I roared through another push that brought my baby's body and the rest of her amniotic fluid down and out. I scooped her body up with my left hand and pulled her to my abdomen and then to my chest as I was flooded with joy and relief. The enormity of that moment, that feeling of birthing my baby standing in the doorway of a Japanese birth center with my husband watching via FaceTime, hit me at the same time as the wave of oxytocin did and I was riding the most incredible birth high of my existence. She was here in my arms and my labor and birth had been honored and protected and gentle in the way nature intended. I felt powerful. I felt safe and supported. I was grateful.
The care I received during third stage was just as gentle and honoring as the labor and birth support. We enjoyed two hours of skin-to-skin together without any mention of interruption. The room was filled with women caring for us, celebrating us, supporting us, and recounting what we had just experienced together. A room full of almost strangers who treated us like family from start to finish. I was grateful.
My baby's umbilical cord was not clamped until it had completely ceased pulsing and the placenta was birthed gently by me when it was ready and not a moment before. My doula cut her cord once the placenta was born and we continued to snuggle as I inspected the placenta which was soon after picked up by a fabulous placenta specialist to encapsulate it, all the while chatting to my husband and staring at our incredible, perfect daughter. She was later weighed (7lbs 9 oz) and was measured the next day. We were tucked in later to our cozy private room in a double bed to co-sleep and nurse the night away with angel-nurses quietly and gently checking in on us every few hours and silently disappearing again. It was the most gentle care in the most gentle space one could image for birth to take place. I'm so thankful for the kindness of the welcome they provided me. This birth center was truly a safe haven for me and my daughter and I am forever grateful for its existence and my experience there.
This fourth beautiful birth story of mine begins long before labor did. When we discovered we'd been blessed with bringing a fourth sweet soul into our family, I immediately began exploring birthing options in our tiny hometown in rural Japan. As a birth educator, doula, and birth advocate who had previously birthed three babes in a San Diego birth center, I knew in the depths of my soul exactly the birth environment and type of care I desired.
As an American military family living on a small base in beautiful Japan, there are only two birthing options readily available, covered by insurance and approved for use. Women can stay in our small town to receive prenatal care and birth support from an elderly and very traditional (perhaps old-school is a better term) Japanese obstetrician -OR they can travel eight hours by high-speed train to a larger military base with a U.S. Naval hospital when they are around 35 weeks of gestation without their spouse to stay in a hotel and await labor. (Spouses are generally granted permission by their command to join their partners around 38-40 weeks gestation.) Often these women travel alone with their children; many times it's their first time leaving the area, and there is little support awaiting them upon arrival. It's up to them to meet people and secure new friendships to support them in their last weeks of pregnancy, and, hopefully, to care for their children while they are laboring, as well as during their recovery stay in the hospital. (This is especially important if birth occurs before the spouse arrives, which has happened many a time).
This second option seemed impossible to me; it was just too exhausting and hard to imagine toting my three littles-under-five along to a tiny hotel room in winter, without a car or any local support for an unknown period of time and likely without my spouse to give birth with a doctor I'd only meet during my birth. I opted to birth locally with the Japanese OB, surrounded by the support of family and friends and without the hassle of travel and unknowns of a care provider at the time of birth I'd never meet ahead of time.
I had attended a handful of births in our local Japanese hospital. Each of those births I was blessed to witness and support as a birth doula was precious, beautiful and full of lessons learned for me and the parents regarding the need to discuss the birth plan in great depth; there were certainly a few cultural differences regarding how birth was "done" here. It was refreshing to learn that although it is deeply engrained in Japanese culture to wholeheartedly adhere to the wisdom of a Japanese doctor ("sensei") without question, this particular sensei had worked with American birthing women long enough to be used to our ever-questioning the process and he was open to honoring most requests in their birth plans. Often the requests were honored with a chuckle or a curious eyebrow shift, but honored, nonetheless. Their stories were all beautiful and I felt it could be the same for me, despite the fact that it was a hospital setting and that I would likely have to advocate heavily for myself and my birth choices along the way. I immediately contacted my friend and fabulous doula sister, Lynn of Assisted Journey Doula Service and asked her to please support our family on this journey.
Halfway through my pregnancy, we learned my husband had been given an incredible career opportunity. This opportunity sent him stateside for a few months just three weeks before my estimated due date. I would again be giving birth without him by my side (he had been deployed to Afghanistan when our third baby was born). My heart ached for the magic he would miss and grieved for the support that only your soul mate can provide that I would be missing.
I was still longing for a birth center or homebirth option, knowing the midwifery model of maternity care was what allowed me to birth in a way that honored my body and the process three times previously. I asked my local Japanese friends if they knew of any midwife options in our area and only came up with a very small list - all that required I travel at least an hour away from my home, and many that would not accept American clients for varying reasons. I heard the words of Ina May Gaskin echoing in my head - just two years earlier she spoke at Bini Birth in LA about the drastic shift in Japanese birth culture. She spent quite a bit of time learning from her friend Dr. Tadashi Yoshimura, one of the only champions of natural birth remaining in Japan. In just a few decades, Japan has shifted almost entirely from local mother houses in every town where midwifery care was the standard to almost entirely medicalized hospital care for birthing women.
I finally learned about an incredible birthing option from a doula friend of mine located on Okinawa. Although it would require airplane travel, it seemed too good not to explore and I booked a plane ticket and made an appointment to be seen by the staff at Yui Clinic around 23 weeks of pregnancy. It felt so good to have at least found one option, and I decided to work out the logistics after my visit. When I got there....it was as though I had landed in a heavenly birthing paradise. My appointment was over two hours long, an hour each with a midwife and obstetrician who spent time discussing my previous three birth experiences as well as my current pregnancy in great detail. I was heard, I was honored, my baby was acknowledged and gently examined. They told me they would welcome me to birth there but requested I travel to Okinawa no later than my 35th week.
While I continued to search for more options locally, I found none and in the end decided to stay in my hometown and birth at the local hospital as I couldn't fathom leaving my kids behind for five to eights weeks waiting for baby to choose her birth-day. I ached in my soul to go to that beautiful place to give birth, but my mother's heart ached more deeply to stay close to my children, especially knowing that their dad would also be away during that same period of time.
Fast-forward to 37 weeks of pregnancy, when for the first time my Japanese OB began to request that we perform weekly 30-minute NST's, cervical checks, and ultrasounds. I knew that none of these tests and checks were medically necessary and none had been shown to improve outcomes for a healthy mother with a healthy pregnancy. I declined them with little response from him. The following week, I brought my birth plan in both English and Japanese to discuss with him. Initially, he took it from me and put it in my chart, presumably to look over when it came time for me to give birth. I asked him to please review it with me during the appointment so we could discuss it and I could answer any questions he had. I knew from previous experience as a doula that it was vital to have that conversation with your OB well in advance of your birth-day to ensure you had their full support and blessing with the plan. Obviously, if a complication developed they were there to manage it, but if your OB rejects your birth plan from the start, it's a good idea to find a new provider who sees birth the same way you do.
I was frustrated and disappointed throughout the birth plan discussion, knowing I was asking to have a fourth birth just as my other three had been - gentle and intervention-free. Although he did not immediately decline to honor my birth plan, there was enough hesitation and confusion on his part that I left that appointment feeling apprehensive. The following day, our local military base medical clinic asked me to come in to discuss and sign two risk consent forms; one from the Japanese OB and the other from the base doctor who was not providing me prenatal care. Both were full of scare tactics and verbiage designed to make me doubt my decisions. They suggested, in essence, that if I proceeded with my birth plan, I was ultimately risking death to my baby. But what they were asking me to sign was neither factual nor based on medical evidence for best outcomes for mother and baby in a healthy pregnancy. I signed those forms to "make it go away," but left feeling frustrated for other mothers who would come through this same medical system and get this same treatment regarding their decisions. My due date was just days away and I felt like I had no choices. My voice was not being heard and my desires for my birth were being rejected.
That night I was lamenting my frustration to a dear friend and in tears heard myself saying over and over that I just wanted to protect the sanctity of birth, I wanted my voice to be heard in my labor and the process to be honored. I wanted a safe, intervention-free birth. Ultimately, I finally allowed myself to say it out loud as tears poured down my face: "I just want to magic myself to that amazing Okinawa birth center and have my baby in a place where I feel safe and supported and where I don't have to fight for what I believe to be so crucial to the birth process." My dear friend just looked at me and said: "So go." That's all I needed to hear. My tears stopped and I immediately began exploring the logistics to make it possible. Less than 24 hours later, I was standing on the flight line of Kadena Air Base in Okinawa, thanks only to the support of my amazing in-laws who happily agreed to stay with the kids, my dear friend who held my hand and worked through the logistics with me, some incredible luck snatching a seat on a military flight, and the help of some amazing doula friends living in Okinawa.* The moment that plane landed, I felt such relief knowing I had made it to a place where I could birth without fear surrounded by people who believe in the birth process and a woman's ability to give birth.
My baby was born 27 hours after that plane landed.
A million thanks to Reid, Johanna, Dale & Mary Ann, Tammy, Anna, Izumi, Ania, Amy and the incredible staff of Yui Clinic in Okinawa for supporting my birth journey. It is my hope that every woman will feel so honored, supported and loved when she brings new life earthside.
Please consider a contribution to the Nannen Children. The goal is $50,000 per child for college. Thank you.
If you are living in Japan and looking for mother-and-baby friendly maternity and birth support, please visit www.japanbirthresourcenetwork.com. Thank you to Okinawa maternity, birth and newborn photographer Ania of www.simplyania.com for allowing me to include her stunning photographs of my journey with this birth story. These images are forever cherished by my family and make complete the celebration of our story.
* My OB at Yui Clinic in Okinawa requested I be clear that my situation was unique and air travel at such late gestation is not advisable; for anyone who would like to explore birthing at their amazing facility in Okinawa, please know that they will expect you to be present in Okinawa no later than 35-36 weeks gestation for your safety.